Bilateral Quadriceps Tendon Rupture & Repair Everything You Need To Kn...

The Radial Nerve - Everything You Need To Know - Dr. Nabil Ebraheim

Meniscal Tears—Examination and Tests

Meniscal Tears

The meniscus is an important cushion which lies between the femoral condyles and the tibial plateau. When the meniscus is injured, there is usually a history of a twisting injury, and the patient will have pain on either the medial or lateral side of the knee. The patient may be experiencing some swelling of the knee as well as mechanical symptoms such as clicking, locking, and catching.

During the exam there may be some effusion. However, the most important finding will be the presence of tenderness along the medial or lateral joint line, which the doctor should suspect is occurring due to a meniscal tear. Pain at the knee may possibly come from other sources such as arthritis, bursitis, or a ligament injury. The most important test is the presence of tenderness at the joint line. The range of motion is usually normal.

Provocative Tests

The provocative tests all have the same idea. One of the tests is done with the patient standing, another with the patient lying in the prone position, and the last test is done with the patient lying in the supine position.

The goal of the test is to trap the meniscus between the tibia and the femur with rotation and twisting. These tests allow medical professionals to evaluate the lateral and medial menisci. When performing these provocative tests, if there is a presence of “clicking” or “popping” with pain when doing these maneuvers, then this is suggestive of a meniscal tear.

The most popular test is the McMurray’s Test. During this exam, a painful click may be obtained as the knee is brought from flexion to extension in either internal or external rotation.

Another type of testing is known as the Apley Compression Test. When performing this exam, the patient should be lying in the prone position with the knee bent to 90°. This will allow the weight of the tibia and foot to press down onto the joint. The physician will place the fingers over the joint line and rotate the tibia with compression force. If during this procedure the patient experiences pain with either a click or pop, then the test is positive for a meniscal tear.

If you rotate the tibia with distractive force which causes the patient pain, then this means that there is a ligament injury and not a meniscal tear.

During the Thessaly Test, the patient will stand on the affected limb and bend the knee about 20°.

The patient should then twist their body with the knee in either internal or external rotation aboue three times. A positive test result is determined with the patient experiences either a click or pop sensation with pain in the knee.

These tests are not specific for meniscal pathology. An MRI is the procedure of choice to confirm a meniscal tear. If you have a bucket handle tear that will block full extension of the knee, then you will probably need to get an MRI early.

What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome video, all you need to know.
If you are experiencing frequent burning, tingling or itching numbness in the palm of your hand and fingers, you may be one of the 8 million Americans suffering from carpal tunnel syndrome. With more than 260,000 carpal tunnel release operations performed annually, carpal tunnel syndrome remains a grave concern for the aging population.

Figure 1
(Median Nerve in Yellow)

To understand carpal tunnel syndrome, it is helpful to know a bit about its anatomy (Figure 1) The median nerve is the most essential component of carpal tunnel syndrome anatomy.

Beginning as part of the brachial plexus, the median nerve travels

down the inside of the forearm into the wrist and hand and ends at the thumb, index and middle finger. This important nerve is responsible for controlling sensation to the palm side of the thumb and fingers, as well as impulses to some small muscles in the hand that allow the fingers and thumb to move. 

Figure 2

The wrist is the second major part of carpal tunnel anatomy (Figure 2), The several small carpal bones form the carpal tunnel, which houses the median nerve, tendons and blood vessels.

So what is carpal tunnel syndrome? The condition occurs from pressure placed on the median nerve at the wrist. In other words, carpal tunnel syndrome arises when space in the carpal tunnel becomes limited, causing an atypical pressure on the median nerve and surrounding tendons. This atypical pressure causes the nerve to become irritated.

As mentioned earlier, typical symptoms of carpal tunnel syndrome include burning, tingling or itching numbness in the palm of the hand and fingers. In addition, people suffering from carpal tunnel syndrome may find it difficult to grasp small objects or form a fist due to decreased grip strength. Because many people sleep with flexed wrists, symptoms are often first noticed at night.

There are several causes of carpal tunnel syndrome. First, carpal tunnel syndrome may be due to a congenital disposition.

Some individuals have a smaller-than-normal carpal tunnel. This is likely the reason that women are three times more likely than men to develop carpal tunnel syndrome. In addition, carpal tunnel syndrome has also been linked to sprain and fractures; hypothyroidism; mechanical problems in the wrist joint; rheumatoid arthritis; and over activity of the pituitary gland.

Some evidence suggests that repetitive motion causes carpal tunnel syndrome. According to a study done by the National Institute for Occupational Safety and Health, job tasks involving highly repetitive manual acts or necessitating wrist bending or other stressful wrist postures were connected with incidents of carpal tunnel syndrome. Moreover, the National Center for Health Statistics approximated 260,000 carpal tunnel release operations performed each year, with 47 percent of the cases considered to be work related.

Figure 3

Figure 4

 To diagnose carpal tunnel syndrome, doctors use a variety of tests including the Tinel Test and Phalen Test. Using the Tinel Test (Figure 3), the doctor will tap on or press the median nerve in the patient’s wrist. If the test is positive, a patient will report a shock or tingling in the fingers. During a Phalen Test (Figure 4), patients hold their forearms upright by pointing their fingers down and pressing the backs of their hands together. If numbness or tingling arises, the test is considered positive.

 Doctors may also use nerve conduction studies. By measuring the nerve’s response to electric shock, doctors are able to determine if the nerve is responding normally. Electromyography may also be used to diagnose carpal tunnel syndrome. Here, a needle is inserted into the muscle which transmits electrical activity on a screen.

Figure 6

Figure 5

Figure 7

Treatments for carpal tunnel syndrome can be conservative or surgical. Conservative treatments include medication; (Figure 5-6) exercise including stretching and strengthening; physiotherapy; and immobilization. If conservative treatment fails and pain persists, doctors will perform a carpal tunnel release (Figure 7). This surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. 

Johnny Widmer Marine Artist

Compartment Syndrome Animation - Everything You Need to Know - Dr. Nabil...

Compartment Syndrome Animation - Everything You Need to Know - Dr. Nabil...