Fact Sheet for Meniscus Injury, Essay Example

Introduction

A meniscus is a rubbery c-shaped disc found in the knee that cushions it (Beaufils, 2010). A meniscus injury is therefore a knee injury. Every knee contains 2 menisci. Each is located at the outer edge of the knee, and one at the inner edge. Indeed, the menisci help in distributing the weight of the body across the knee joint

Etiology/pathophysiology/incidence/prevalence

A meniscus injury is common among people engaged in sports and athletes. It is usually caused by twisting or turning of the knee quickly. According to Beaufils (2010), the injury usually arises when the foot is planted while the knee is in a bent position. The injury usually occurs when an individual lifts something heavy or when engaging in sports. The meniscus usually gets weaker and worn when someone gets older and therefore they are more vulnerable to injury at an old age. The most common causes of meniscus tear or injury are therefore due to traumatic injury which occurs with athletes and degenerative processes which is seen in older people. The larger semi lunar medical meniscus is firmly attached as compared to the circular lateral meniscus which is loosely attached.

The menisci have both the anterior and posterior horns which are attached to the tibial plateaus. The anterior horn helps the transverse ligament to connect the two menisci while the posterior horn helps the meniscofemoral ligament to stabilize the horn of the lateral meniscus. Injuries to the meniscus particularly those related to sports usually involve a rotational force. A common mechanism of injury is a valgus force that is applied to a flexed knee. Hertling (2006) says that when the foot is planted and the femur is rotated, a valgus force applied to a flexed knee may cause a tear of the meniscus. The incidences of the meniscus injury are very high especially to athletes and sports people. They engage in a lot of flexing and therefore the knee is always flexed hence any force applied to the knee may cause a meniscus injury. The prevalence of the injury occurs mostly to anyone involved in sports, athletics and the old people

Differential diagnosis

Meniscus injury has similar symptoms with other knee injuries and therefore to determine that the injury is a meniscus injury, differential diagnosis has to be carried out so as to determine the symptoms that are exclusive only to the meniscus injury. There are several injuries on the knee that can be mistaken for meniscus injuries because they have the same symptoms and they affect the same place. According to Beaufils (2010), the differential diagnoses that have been found of meniscus injury are injuries such as the contusions, the knee oesteochondritis, ligament injuries, lumbosacral radiculopathy, osteoarthritis, tendon inflammation, pastellofemoral joint dysfunction and rheumatoid arthritis. These diagnoses have almost the same symptoms as the meniscus injury and the effects are also almost the same even though they are different in nature and they affect different ligaments, tendons or cartilages in the knee

Evaluation

A medical officer has to carry out an evaluation of the patient and of the injury so as to determine the cause of the injury and how to treat it. The evaluation process will involve taking a complete history and performing a physical examination.

History

The history of the patient and that of the injury has to be determined by an evaluator. When the evaluator is carrying out an evaluation on the history of the patient, he will determine what the patient does on a daily basis and whether he is involved in any physical activity. The evaluator will also determine the history of the injury by checking whether the patient has had a similar injury before or has ever had any pains in the knee that could be related to a meniscus injury (Board of Nursing, n.d). The history is also the chance for the patient to mention any complains or concerns about the injury. The medical officer also finds out behaviors of the patient that has an injury

Physical examination

After a comprehensive evaluation, physical examination has to be carried out before the laboratory tests and finally the treatment. The physical examination will involve checking for physical evidence and symptoms that the injury is a of meniscus nature. The physical examination will involve manipulation of the knee in various ways. The doctor will check for pains, pops and clicks in the knee. These will suggest a meniscus tear. The doctor may also look for knee lock or any swellings on the knee

Diagnosis studies

Immediately after a physical examination, a patient has to go through a laboratory examination and an imaging process to ensure that the injury is really a meniscus injury and where the injury has occurred and which cartilages have been affected

Laboratory evaluation

According to McMahon (2007), during the laboratory examination an arthrocentesis should be performed by the laboratory expert. After this examination, the fluid from the examination should be sent for analysis. Through a hemarthrosis associated with a serious injury often is released so that the patient can be comfortable. The doctor will therefore send non bloody fluid to the laboratory for cell count and determination of glucose and protein levels. Hertling (2006) suggests that the gram stain, bacterial culture and other special tests that are recommended by the evaluator will be carried out. A post traumatic aspiration of bloody fluid that is determined in the laboratory suggests a ligament tear that is very crucial. It can also suggest an injury to the peripheral vascular part of the meniscus. The bloody fluid should however not be confused with that of a fracture because that ok a fracture is associated with fat globules

Imaging

This process will help in determining the exact place that the meniscus is torn and show the extent to which it is torn. The imaging will be done through x-rays or radiographies which will take an image of the meniscus and how it is torn. Radiographic evaluation of the knee will include several views which include the standing anteroposterior, the lateral view, the tunnel view and the skyline view. The MRI is the imaging process that is most preferred because it is more accurate. According to McMahon (2007), this procedure of imaging will help in confirming the diagnosis of the doctor and providing additional information concerning the status of the ligaments and the articular cartilage. The imaging process is usually not a requirement in the diagnosis process and it is not very necessary in the diagnosis process of a meniscus injury. It is however important and recommended by many doctors because it will show the accuracy of the diagnosis and determine whether the injury is truly a meniscus injury and not the differential diagnoses of meniscus injury for example ligament injuries. The following diagrams or images will show the result of an imaging process which shows the knee before and after a meniscus injury.

Treatment

The treatment for meniscus injury is usually physical therapy. According to Swiontkowski (2005) the protocols of treatment of a meniscal injury will be based on the considerations of the biomechanical principles and the results of the physical examination. The treatment program is usually affected by different factors such as the extent and location of the lesion or the injury, the amount of articular cartilage that has degenerated, the duration of the injury and the stability of the joint (Board of Nursing, n.d). The treatment will depend on the progress of the patient and therefore every treatment process should be adjusted to fit every individual patient’s status and goals

Expected outcomes/follow up needs

With the prescribed treatment procedure, the patient should start having a relief from any pains or swellings in the knee and should be able to start walking normally after sometime. The meniscus tear should be repaired by the physical therapy and other prescribed treatments for each specific individual. Swiontkowski (2005) says the medication should be able to reduce morbidity and prevent any complications that may arise from the injury or from the physical therapy. Follow ups should be done on the patients with meniscal injuries. These patients are recommended to receive outpatient physical therapy to keep the treatment process effective

Patient education

Patients need to be advised on the nature of the injury they are having and how they are supposed to maintain that injury. This information is important to the patient because it will determine how the patient will carry on with the treatment and the follow ups. This will be important in determining how quick the patient will recover from the injury

References

Beaufils, P. (2010). The Meniscus. Boston: Springer Board of Nursing. (n.d). Pain Management Nursing Role/Core Competency A Guide for Nurses. Berlin: Prentice Hall.

Hertling, D. (2006). Management of common musculoskeletal disorders: physical therapy principles and methods. New York: Lippincott Williams and Wilkins

McMahon, P. (2007). Current diagnosis and treatment in sports medicine. New York: McGraw Hill Professional

Swiontkowski, M. (2005). Manual of orthopaedics. New York: Lippincott Williams & Wilkins.