Knee Pain , Meniscus tear - Everything You Need To Know - Dr. Nabil Ebraheim
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- Опубліковано 10 лис 2016
- Dr. Ebraheim’s educational animated video describes knee pain examination of the meniscus.
There is two types of cartilage between the femur and tibia:
• Articular cartilage
• Meniscus cartilage
And there is a meniscus in between.
The meniscus is a fibrocartilage structure that carries type I collagen, it is triangular shaped in cross section.
There are two menisci:
• Lateral meniscus:more mobile that the medial meniscus
- Circular
- Covers about 70% of the lateral tibial plateau
• Medial meniscus: its tears occur about three times more than that of the lateral meniscus
- C-shaped
- Covers about 50% of the medial tibial plateau
Function:
• Shock absorption
• Load sharing
• Joint stability
Meniscal tear causes:
• Twisting, jumping, or changing directions during sports activities such as skiing or football.
• Degenerative tears of the medial meniscus may occur in older patients.
• Degenerative tears may occur in association with arthritis.
Symptoms of the meniscal tear:
- Pain on the medial or lateral side of the knee
Mechanical symptoms:
- Locking
- Clicking
- Swelling
Examination:
Joint line tenderness is the most sensitive exam; posterior knee pain may also be present when the knee is bent.
Look for the knee joint effusion, effusion may be difficult to find and occur several hours to appear after the injury.
With ACL tears, the hemorrhage and swelling is greater and develops rapidly.
Mcmurray’s test is used to diagnose meniscal tear, a painful pop or click is obtained as the knee is brought from flexion to extension with either internal or external rotation of the knee.
To test the medial meniscus, flex the knee and place the hand on the medial aspect of the knee.
The knee is then extended in order to test the medial meniscus.
Feel a pop or click with knee extension, the patient will experience pain.
A positive test is indicated by pain, clicking, or popping within the joint and may signal a tear of the medial meniscus.
To diagnose the lateral meniscus tear, do the Mcmurray’s test with internal rotation of the knee.
Sometimes the knee is locked with lack of full extension due to a bucket handle tear of the meniscus.
Differential diagnosis:
• The clinical diagnosis accuracy of meniscal tear is about 70%.
• MRI is usually done to confirm the diagnosis or identify other problems in the knee.
• The differential diagnosis can be intra-articular problems or extra-articular problems.
• Intra-articular problems:
- Medial synovial plica irritation.
- Osteochondritis lesions (OCD).
- Patellofemoral pain
- Loose bodies
• Extra-articular problems:
- Collateral ligament injury, especially the medial collateral ligament
- Pes anserine bursitis
- Lumbar disc herniation
- Stress fracture
- Iliotibial band syndrome
- Slipped capital femoral epiphysis (SCFE).
Blood supply:
The meniscus receives blood supply from the genicular vessels and its capsular attachment.
The peripheral 1/3 area is the most vascularized area and tears within this area usually heal.
Where is the tear located?
Treatment of meniscal tears:
• Nonoperative:
- Especially for small nondisplaced tears and degenerative tears.
- Physiotherapy
- NSAIDS
- With persistence of symptoms, cortisone injection may be given.
- When the conservative treatment fails, then do surgery.
• Surgery:
- Excision of the tear (partial meniscectomy): you do excision if the tear is complex, degenerative, or if it is a radial tear that cannot be repaired.
- Repair of the meniscal tear: usually done for a peripheral tear which is vascular and will heal.
It is better to have the combination of repair of the meniscus at the same time you do ACL reconstruction (controversial).
- Meniscal transplant: done in younger patients who had total meniscectomy (especially lateral meniscus).
It takes about one year for the graft to heal.
Re-tear of the transplanted meniscus is also common.
If you do total meniscectomy, this will probably lead to future arthritis of the knee.
Special situations:
• In general, medial meniscal tears occur more often than tear of the lateral meniscus.
- In older patients, the posterior horn of the medial meniscus is usually more often affected.
• With ACL tears that are acute, then there will be more incidences of lateral meniscal tears.
• With ACL tears that are chronic, then there will be more incidences of medial meniscal tears.
• With tibial eminence fractures in children, the medial meniscus can become trapped in this injury.
• Tibial plateau fractures:
- If the injury is medial then it can affect the medial meniscus.
- If the injury is lateral then it can affect the lateral meniscus.
• If you have depression or displacement separation more than 5 mm, you can have meniscal injury.
Discoid meniscus: the meniscus is usually larger than normal and occurs more in the lateral meniscus, the treatment is usually saucerization plus or minus repair of the lateral meniscus if symptomatic.
Great material - one of the best I've seen on the meniscus. Thank's a lot.
This video has been more helpful then the scamming "dr." I went to today, thank you for actually caring about what you doo!!!! 🙏🏽🙏🏽🙏🏽
I’m going in for an knee MRI and this is the most informative video I’ve seen since researching my problem. Thanks!
How us goes for know you are mri
I'm also gonna do an mri how are u now?
Thank you for taking the time to do this.
Thank you Dr Nabil for explaining this in lay man's terms!
Good afternoon Dr, Nabil, I'm Igor Bertola, I'm a physiotherapist. I wanted to thank you for all these teachings.
Embrace of a Brazilian.
Thanks Dr. Nabil Ebrahim. That was the best video explaining Meniscus Tear, very simple and understandable.🙏🏼👏🏼
Dr. Nabil, you explained it in very simple methodology that anyone can understand easily, wonderful slides.
Thanks again...
An excellent and complete lecture! Thank you
Great video Dr. Nabril Ebraheim. Very detail and descriptive in a way a layman like my self could understand my injury.
Thank you for your time to do this video!
Thank you very much for the information. Love to hear from professional like you
Outstanding summary of the pertinent facts. Thank you !
Wow, what an incredible video.. I've learnt so much, thank you Doctor!!
That was very informative. Thank you!
Thank you very much Sir for all valuable teaching you post on the UA-cam!!
I just love your videos , orthopedic was one of my difficult subject in undergraduate years, but in just a week , through your videos , now its one of my fav subject. Thank you a lot Dr Ebrahim.
look up dr. kerlan and jobe doctors
@@onlythewise1
The Best Orthopedic in Cali for sure
@@ZENSIBLE yep they did me
What an amazing video anyone who is concerned about the knee pain must watch it you can learn a lot about it thank you Dr.
Sir is the pain feel behind the knee or Infront of the knee
Thanks so much for this video. Learned a lot about meniscus tear that I am diagnosed.
An absolutely detailed thorough informative video. Excellent presentation.
Excellent video Doctor!
Much appreciation and thanks to you sir
Best video I’ve seen! I’m convinced that I have messed up my meniscus. Gonna make an appointment Monday morning!
Excellent and informative video. Thank you!
Excellent video! Thank-you very much for education. Very helpful.
This video is amazing!! You are my doc on knee problems now?? Thank you!!
thanks nabil for your detailed explanation. thanks a lot.
Thank you doctor, this is the best explanation of this type of injure. I got to diagnose myself due to the quarantine. I think I got a left knee lateral tear. I have been doing some exercises I found on the web, and I have improve my mobility a lot, the only remaining symptom is a click, no pain most of the time, but still bother a lot.
How is your condition? Improvement ? Diagnosed the hospital? . I got diagnosed for Transverse linear high SI seen at posterior horn of lateral meniscus. I have limited mobility with pain and it is so annoying
So precise and complete information. I'm grateful for your videos.
An exellent presentetion ,An absolutely detailed ,thorough,informative video thanks Dr Ebraheim"s for this Lovely explanation
Thanks for all the information. They are life changing
Great video. Thank you Dr Nabil.
An absolutely detailed,thorough,informative video. Excellent presentation. The pain is almost bearable knowing what it could be.
Wow what an incredible video! Thanks so much.
Thank you for this detailed explanation, very well explained
Lovely explanation. I thought I had a medial meniscus problem after a knee bump but on MRI it turned out to be bone edema, although some minor meniscus wear was apparent (cyclist 51 years, 6 year vegan). Complete recovery after 2 months.
vegforce 👏
What does being vegan have to do with anything
@@tjadventures9163 Actually alot, since I turned vegan I recover much faster from illness and injury, so I guess this is universal
@@tjadventures9163 A lack of B12 which is needed to maintain bone strength.
Very good illustrations with clear explanation. Thank you.
Thank you so much for this informative video.
I have been waiting for an MRI for a month a half. This has been the most informative video I have seen so far. I now know what questions to ask during my next doctors visit. Hoping for an MRI soon.
This is a very good discussion of meniscal tears.
I really enjoyed this video. The doctor really broke it down and made it clear to me.
Great information
Really helpful and much appreciated. Thankyou
Having had the procedure at age 17, and now at 79 an other tear has occurred on the same knee. I found your explanation to be very good!
Old man I'm 14
Yeah that’s why they don’t suggest these days operations even in older people) unless necessary because it may happen again years
Did you develop arthritis?
Excellent and informative video. thanks!
Thanks. Very informative. I'm going through meniscus surgery deliberation.
Thank you so much. All that information makes me a better patient.
Thank you for your education...... Awesome and amazing Doctor. I hope to meet and shake your hand one day.
Very informative. Wish I had this information 11 years ago before my surgery. Now my knee is worse than ever and it looks as though I have a meniscus tear again.
Is yr surgery sucess?
Thank you very muvh for your great information on the Meniscus.
I understand much better after viewing this video ..thank you
Thank you very much , very useful .God bless you sir .
Fantastic breakdown of this issue 👌
You are the one!
that was so helpful thank you doctor nabiil
An absolutely detailed thorough informative video. Excellent presentation.. Wow, what an incredible video.. I've learnt so much, thank you Doctor!!.
The knee sure is a complex body part. Thank you for your flawlessly detailed video, Dr!
thank you
Sir, I've been having symptoms of semi-sharp pain located under the highest point of my patella in the center only when I straighten my knee all the way (and sometimes from squatting to sitdown). From what I've been reading, seems like an Articular Cartilage injury. What would you say about my issue, Doc.?
Im getting ready for knee surgery. Thank you this was very informative!!!
THANK YOU
excellent video sir. step by step therapeutic teaching. am from Chennai, India. well explained the differential diagnosis of knee pain. thanking you sir.
Beautifully expained 🥇 superb animation 🌴 tks 🙏
Thankyou for explaining meniscus tear
What a great video! Thank you! 👏
Absolutely very much informative n perfect way of explanation 👍👍👍👍👌👌
Excellent video. Thank you.
The best one so far
Very clear and short and sweet information.
Lots of great info! Thanks
Excellent! Thank you.
Very informative and detailed in layman terms as well. Thank-you for this Video. Hope to see more educational videos from you.
Agree.
Excellent breakdown👍🏽
I wish you were my Dr. Washington state could sure use some good Dr.'s. You have such a pleasant speaking voice and did such a good job explaining.I currently have tears in each meniscus Rt.& Lt. but I also have arthritis so I havnt a clue what this new orthodox Dr.is going to do and I'm very uneasy about it. thanks for sharing Dr.
Very Clear Information. Thank You Very Much!
So good brief description
Thank you for sharing this information !
Sir please upload some stretching or strengthen exercises for the problem thank you
Excellent videi, thank you.
Thank you very much,sir...so grateful
this video cleared all confusion thank u very much dr.nabil sahab
lot of visibility thank you so much
Thank you. Very informative.
Thank you so much
You r the best
just super, thank you ...
What a Vid!! Thank you so much Doc
AMAZING!!!
I miss making Medical Vlogs. My exams are starting from 25th March. This is freakin... 😬🥺
Thank you for this information
Thanks for that 💯
Thank you it was very helpful
Great info, thank you
thank you so much.
This is a great video with great detail I injured my left knee at work I twisted it and rip the meniscus I can’t bend knee with out pain and walking lots of pain clicking sound also I can’t put the leg straight with out pain I can’t walk more then 2-3 minutes with sever pain
Like this vdo very much ,,,,most informative vdo ,,,,well explained so that non medico person also get proper idea of what exact is happened in our knee,,,
I am non medico ,,,and have meniscus tear and suggested arthroscopic surgery so surfing for vdos to get an idea of the surgery ,,, resection or repair which is better for meniscus tear
this is awesome...
Thank you doctor,🙏
Useful video
Very good thank you.
Thank you so much
Thank you for sharing
Thank you Dr
Great one
I got good news today after months of pain and taking care of myself... the tear is small enough and near the area where blood is circulating that my ortho believes I will heal very well. Therefore be able to go back to roller skating and all the things I love to do physically! Yessss !! That was very scary
MaMurray test is no longer recommended in the NICE guidelines due to concerns that it may exacerbate the injury and due to its low diagnostic accuracy. Is it true? thanks