Symptoms of a tear in the meniscus
Introduction & causes
In the knee joint there are two cartilage disks (one on the inside and one on the outside), which are known as menisci and which serve to absorb loads that the knee has to withstand. When one or both of them tear, it is called a meniscal tear.
The symptoms of a meniscus tear differ depending on whether the tear is caused by a
- Injury (trauma) occurred suddenly or in the context of
- degenerative changes (signs of wear and tear) of the knee slowly came about and on the other hand depending on
- how severe the injury is.
In the case of an injury-related meniscus tear, which is particularly frequent Sports injuries, especially at Footballers or Skiers, finds, those affected complain of severe pain. However, this pain does not come from the meniscus itself, as it does not come with it annoy that can transmit a pain signal.
As it is Accompanying phenomenon in the case of a meniscal tear, however, often to one
- irritation or even
- inflammation the joint capsule and / or a
- effusion comes in the joint,
will eventually Pain felt that emanate from the surrounding structures. Classical for such a clinical picture is pain in the area of the
- Hollow of the knee and on
- lateral knee, which sometimes go into
- Shin can radiate.
In addition, a meniscus tear sometimes also leads to limited mobility of the knee joint. The is usually particularly affected here Elongation of the lower leg. Typically, the symptoms are more pronounced when moving. If, on the other hand, the meniscus tear is the result of long-term degenerative changes in the jointlike she did with one Osteoarthritis of the knee can occur, it often does not cause a patient any symptoms and therefore often remains undetected for a long time.
Especially when the meniscus is torn due to an injury, there is often incidental damage to other structures in or on Knee joint, for example the Tapes, in front. These can then worsen the pain caused by the meniscus tear.
How and whether symptoms are perceived always depends on how (sporty) is actively a victim. If only in everyday life few movements are performed in the knee joint, complaints can often be tolerated much longer and better (simply because they are not so often and extremely noticeable) than with Athletesthat rely on the joint to function properly.
Symptoms of a ruptured meniscus
People with a torn meniscus typically have stabbing Pain as well as one swelling in the knee joint. In addition, there is limited resilience and mobility combined with taking a relieving posture.
Depending on the cause of the meniscus tear, the pain has a different character. In the event of an acute meniscus tear as a result of an accident or direct application of force, the affected person feels immediately after the event sharp pain in the knee joint.
These join both more active (the affected person moves the leg himself) as well as more passive (the leg is moved by the examiner) Extension and rotation (=rotation) of the knee.
The condition in which the leg cannot be stretched is known as Stretch inhibition or Stretch deficit. This stretching deficit means that those affected adopt the typical gentle posture mentioned above in a slightly bent position. The inhibition of mobility arises either reflexively through the nerve endings in the joint space or mechanically due to the entrapment of torn meniscus parts in the joint space.
A chronic meniscus tear remains inconspicuous for a long time and is often difficult to determine even by an experienced examiner. The pain is not so acute and sudden, it is often load-dependent.
The continuous load (e.g. kneeling activity of a tiler) leads to the creeping emergence of the Meniscus damage. The pain becomes apparent with increasingly smaller activities and movements that are associated with strain on the knee joint (Walking, climbing stairs, kneeling down).
The permanent ones small tears and Injuries in the Cartilage tissue lead to decreasing resilience of the menisci.
You are then no longer able to cope with everyday stress and the stress-dependency of the pain increases until at some point, in the worst case, when you walk lightly.
If the damage exceeds a certain level, an inconspicuous movement can at some point lead to the final tearing or tearing of individual cartilage parts and suddenly lead to the above-described entrapment in the knee joint gap. A typical example of the emergence of a tear-off is when the person concerned gets up from a crouch.
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The knee joint is one of the joints with the greatest stress.
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Localization of the symptoms
Which of the two menisci is injured can be seen from the Place of pain often recognize in the knee joint. Symptoms of damage to the medial meniscus are pain on the inside of the knee, pain on the outside suggests damage in the External meniscus.
The pain can also be triggered by placing your finger on the Joint space presses, because that is where the menisci are located. To do this, with the knee bent, press into the furrow on the right and left on the lower edge of the Kneecap can feel.
The pain can also be passed through rotation Trigger (= rotation) of the leg in the flexed position. To do this, rotate the bent leg inwards or outwards while lying down. Symptoms of medial meniscus damage here are pain on the inside of the knee during external rotation. Pain on the outside during counter-rotation inwards suggests a meniscus tear in the outer meniscus.
Furthermore, a wandering of the pain and the sensitivity to pressure can often be found symptomatically with increasing flexion of the knee. Pain in the knee joint in the usual yoga seat can also occur if the medial meniscus is injured.
With these and other tests, in which the pain is triggered by targeted movements, a trained examiner can pinpoint the location of the meniscus tear more precisely. However, this usually requires some practice and the exact diagnosis should be left to a specialist.
In addition to the pain, there is another Swelling in the knee joint.
The meniscus tear represents for the Mucous membrane the joint capsule is an enormous stimulus, which is why it reflexively produces more synovial fluid. The consequence of this is an excess of this.
This condition with excessive synovial fluid in the joint is called Joint effusion. Since the joint capsule only offers limited space, the entire capsule swells, which leads to visible symptoms in the form of a visible thickening and restriction of movement in the knee joint. Outwardly, the knee appears thick and swollen. The pressure in the capsule irritates the Nerve endings in the joint capsule and those affected feel one Tension pain in the entire knee joint area.
With larger effusions you can use the sign of "dancing patella (kneecap) " observe. With the knee extended, the kneecap can be pressed down like a cushion of fluid.
If the affected person naturally has thick knees or is insecure, the affected person's healthy knee is always suitable comparison on.
In the case of longer complaints, a doctor should be consulted in any case and, if necessary, treatment should be initiated to avoid negative long-term effects such as a Osteoarthritis of the knee (= Knee joint wear) to prevent.
Symptoms of an internal meniscal tear
When the meniscus is torn off on the inside of the knee, the pain is typically also primarily localized there.
The pain can be triggered by applying pressure to the inner joint space of the knee. Often, even a slight pressure at this point is enough to create strong Pain in the knee to evoke.
Especially if, as is often the case with injuries to the medial meniscus, that too Inner ligament of the knee was injured. In addition, they are particularly painful Turning movements and the Bending the knee.
Rotating the foot outwards while flexing the knee joint in particular leads to severe pain on the inside of the knee. Therefore, this type of pain triggering is also used as a diagnostic test. Pain can also often be triggered if the extended leg is pushed out slightly at knee level. Of course, one also notices when standing that putting pressure on the knee is painful if it is tilted slightly inward. However, with every type of meniscus tear usually a knee joint effusion occurs, which leads to the entire knee joint being painful after a short time, so that a side assignment is sometimes difficult.
Symptoms of an external meniscal tear
At the Meniscus tear on the outside of the knee the outer joint space of the knee is very painful when pressed.
You can trigger pressure pain from above as well as from the side. A shift in weight that puts strain on the outside of the knee can also cause pain.
As with the medial meniscus, it is usually difficult to assign the pain to the side without special tests. The outer meniscus is particularly painful when the foot is turned inward with the knee bent. This movement is also the typical test for damage to the external meniscus.
Often, outward pressure on the extended leg can also trigger pain. Since the outer meniscus is damaged less often by accidents and more slowly, a joint effusion has often already occurred here, so that the whole knee is usually painful.
Movement restrictions can also occur if the external meniscus is torn.
The cracking or snapping described above can also occur. Some patients generally experience a feeling of instability in the knee when the meniscus tears.
Pain when the meniscus tears
The typical sharp pain at a Meniscal tear are very strong, which sometimes even leads to that normal walking is no longer possible due to pain is.
Often the pain is too diffusely localized and cannot be limited to a specific point. The painful thing about the meniscus tear is not the tear as such, since the meniscus is not over annoy that could cause pain and pass it on.
The pain comes through that Irritation of the surrounding tissue comes about by either torn off the meniscus pieces Irritate joint capsule or by the meniscus itself, which is no longer stable due to the tear Knee joint is anchored, is shifted by small movements so that it pressure on the joint capsule, which then results in the typical sharp pain.
At the same time, this model of the origin of pain also explains why the pain is predominantly movement-dependent is because the pain-sensitive structures in the knee are only irritated when moving.
The cracking knee as a symptom
A cracking noise in the knee joint is an indication of a severe form of knee damage.
This is particularly typical for a difficult one Meniscal tear with complete demolition of parts of the meniscus.
But if the noise occurs e.g. directly related to a fall on the knee, bone damage can also be the cause.
In the case of a meniscus tear, the sound can also be less cracking but rather snapping. It arises from the fact that parts of the meniscus have separated from the rest and are now floating freely around the joint.
This not only leads to the formation of noises, but also leads to an inflammatory reaction. It is possible that the free meniscus parts are pinched in the joint, or that the still fixed parts behave atypically when moving.
Both can cause the noises.
In addition to the cracking of certain movements, there is also a restriction of movement in a certain direction of movement, since the free meniscus parts block the joint function here. In the event of such a severe meniscus tear, treatment in the form of arthroscopy should definitely be carried out to remove the meniscus parts and prevent further damage. (please refer: Operation of the meniscal tear)
Anatomy of the knee joint
The Knee joint (Articulatio genus) represents that largest joint in the human body represent.
There are actually two different joints in the knee. One is the connection between the Thigh bone (Femur) and the Bones of Lower leg (Tibia), which consequently Articulatio femorotibialis is called.
The second joint of the knee is between the thigh bone and the Kneecap (patella) and is therefore called Articulatio femoropatellaris. As is characteristic of a real joint, the bones involved are on the surface where they touch (joint surface) of one Cartilage layer overdrawn. This has the task of a painless and smooth movement of the bone to ensure against each other.
Same task and an additional one Nutritional function for the cartilage fulfills that joint surrounding Synovial fluid (Synovia). This is enclosed and thus delimited from the neighboring muscle tissue Knee joint by a Joint capsule.
The knee joint secures it Tape apparatus. That means there are ligaments on knee that stabilize the joint and thereby the Limit the range of motion. This serves to protect the offending Musculature from overstretching or even tearing, which could otherwise occur with excessive movement of the joint.
The Tapes (Ligaments), the the Knee joint On the one hand, they are secure Sidebands (inner and outer collateral ligament) that too Collateral ligaments to be named (Ligamentum collaterale mediale and lateral).
On the other hand, play with the knees Cruciate ligaments (Cruciate ligament) other important ligament structures also play a role. In the knee there are so-called Menisci, namely one Interior and one Outer. These are crescent-shaped cartilages that play an important role in transmitting power within the knee joint.
Due to their shape and their position between the upper and lower leg bones, they enlarge their contact area and thus also the joint surface. On the one hand, this results in a greater stability of the joint, because the menisci improve the contact between the two bones. On the other hand, it also plays a big role in that even distribution of that pressure, which acts on the joint and would be transferred punctiform between the bones without the menisci and thanks to them is now passed on evenly and flat.
Without an intact menisci, the cartilage at the rubbing contact point of the bones would wear out very quickly, resulting in osteoarthritis (joint wear). Finally, the back of the knee joint, the popliteal fossa, is also important on the knee, as large blood vessels and nerves run through it.
diagnosis
A Meniscal tear is diagnosed by a doctor who is im Anamnesis interview first questions about the present Symptoms and the the accident which usually provides information about the location of the damage.
He then pays attention to the following examination of Knee joint for the presence of symptoms suggestive of a meniscus tear, such as a Tension pain over the joint space, a Knee joint effusion or pain with typical movement patterns.
This pain can help with special meniscus tests provoked by the Passively turned knee and is moved. Fall the tests to which for example Steinmann I and II, of the Payr test or Apley grinding belong, positive, you can narrow down which of the two Menisci, of the Inside- or the External meniscus, is injured.
The investigation is followed by a imaging diagnostics at which usually one first X-ray image to the exclusion of accompanying bony injury is made.
Meniscus tears can also be very good in the MRI (Magnetic resonance imaging, magnetic resonance imaging) can be made visible. Another diagnostic method is that Jointoscopy (Arthroscopy). This is where operational and in general anesthetic A small camera is inserted into the knee joint and you can examine any meniscus injuries directly. A great advantage of this examination is that in the same session also intervened therapeutically and thus a meniscus tear can be treated directly during diagnosis.
