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Meniscal Tears: Current Understanding, Diagnosis, And Management Discussion Response

Meniscal Tears: Current Understanding, Diagnosis, And Management Discussion Response

A health professional would rule out the meniscus tear because it occurs after twisting one’s knee, and the pain ranges from mild to severe depending on the extent of injury, unlike the intermittent dull pain experienced by the patient. Further, the patient’s knees are stable without possibly giving way (Bhan, 2020). They would also rule out osteochondritis dissecans because the condition develops gradually, and symptoms begin to show after several months of activity, after which the patient becomes unable to move the knees through the full ROM, unlike the patient in this case (Chau et al., 2021). Similarly, experts would rule out Anterior Cruciate Ligament Knee Injuries (ACL) because the patient can move their knees through the full ROM. Although the patient risks developing patellar tendonitis from jumping while playing basketball, he does not currently have the condition because he does not experience constant pain (Challoumas et al., 2021). Moreover, the health professional does not observe tenderness upon physical examination as is required for a positive diagnosis of the condition Meniscal Tears: Current Understanding, Diagnosis, And Management Discussion Response.

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A health professional would most likely diagnose the condition as chondromalacia of the patella because the symptom description coincides with the patient’s experience. The pain occurs in both knees after physical activity such as climbing stairs and subsides during rest. For example, the patient denied feeling pain during the appointment because he had not engaged in rigorous physical activity involving the knees before the appointment. During the physical examination, the patient experienced pain in both knees upon full extension even though he moved them to the full range of motion (ROM). Further, the imaging tests support the chondromalacia of the patella diagnosis as X-ray has low sensitivity and specificity for the condition, especially in the early stages, as is the case with this patient (Zheng et al., 2021). Further, OCD lesions were observed under MRI imaging as expected. Finally, the patient’s age supports the diagnosis as runner’s knee is most common among teenagers.

References

Bhan K. (2020). Meniscal Tears: Current Understanding, Diagnosis, and Management. Cureus, 12(6), e8590. https://doi.org/10.7759/cureus.8590

Challoumas, D., Pedret, C., Biddle, M., Ng, N., Kirwan, P., Cooper, B., Nicholas, P., Wilson, S., Clifford, C., & Millar, N. L. (2021). Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies. BMJ open sport & exercise medicine, 7(4), e001110. https://doi.org/10.1136/bmjsem-2021-001110

Chau, M. M., Klimstra, M. A., Wise, K. L., Ellermann, J. M., Tóth, F., Carlson, C. S., Nelson, B. J., & Tompkins, M. A. (2021). Osteochondritis Dissecans: Current Understanding of Epidemiology, Etiology, Management, and Outcomes. The Journal of bone and joint surgery. American volume, 103(12), 1132–1151. https://doi.org/10.2106/JBJS.20.01399

Zheng, W., Li, H., Hu, K., Li, L., & Bei, M. (2021). Chondromalacia patellae: current options and emerging cell therapies. Stem Cell Research & Therapy, 12(1), 412. https://doi.org/10.1186/s13287-021-02478-4

Respond to at least two of your colleagues on 2 different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition and justify your reasoning.

Patient Initials: J.S.              Age:  15                                 Gender: M

 SUBJECTIVE DATA:

 Chief Complaint (CC): Dull pain in both knees

 History of Present Illness (HPI):

15-year-old healthy Caucasian male with a complaint of dull pain in bilateral knees. Both knees click when running. Catching sensation under patella with activity. The pain started 1 week ago. Has pain when running, squatting, jumping, or climbing stairs. Denies pain at the time of assessment. Pain 10/10 at worst and last approximately 10-15 minutes after stopping activity. Pain is relieved with rest. Has taken Tylenol alternating with Ibuprofen to help with the discomfort. The patient is an active track runner in school and plays on the basketball team Meniscal Tears: Current Understanding, Diagnosis, And Management Discussion Response.

 

Medications:

  1. Tylenol 650mg by mouth every 4 to 6 hours as needed for pain
  2. Ibuprofen 400mg every by mouth every six hours as needed for pain
  3. Children’s Multivitamin by mouth Daily
  4. Singulair 10mg by mouth daily
  5. Albuterol 2 puffs every 4-6 hours as needed

 

 

Allergies:

 

  1. NKDA

 

Past Medical History (PMH):

 

  1. Asthma

 

Past Surgical History (PSH):

 

  1. No past surgical history

 

Sexual/Reproductive History:

 

The patient is a virgin. He denies current or past sexual intercourse. Denies current or past sexually transmitted diseases.

 

 

 

 

Personal/Social History:

 

J.S. is a middle school student who has a passion for sports. He is active on the Track and Basketball team. He lives with his parents and his sister and brother. His bedroom is on the first floor of the family home. Denies use of any alcohol, tobacco, or illicit drugs. Has two dogs, one cat, and one Bearded dragon.  Doesn’t currently work but stated he has chores around the house.

 

 

Health Maintenance:

 

The last physical was 1 year ago. Last Dental exam was 6 months ago. Gets teeth cleaned every 6 months. Last eye exam was 1 year ago. Has appointment in 1 week. No recent hearing exam.

 

 

Immunization History:

  1. Hepatitis B – Given at birth, 1 month, 2 months, 18 months
  2. Rotavirus- Given at 2 months, 4 months
  3. DTaP – Given at 2 months, 4 months, 6 months, 18 months, 6 years
  4. Hib- Given at 2 months, 4 months, 12 months
  5. PCV13 – Given at 2 months, 4 months, 6 months, 12 months
  6. IPV- Given at 2 months, 4 months, 6 months, 6 years
  7. MMR- Given at 12 months, 6 years
  8. VAR- Given at 12 months, 6 years
  9. Hep A- Given at 12 months, 18 months
  10. Influenza- This season
  11. Tdap- 10 years of age
  12. HPV – 10 years of age
  13. Meningococcal- 12 Years of age

 

Significant Family History:

 

Mother

  1. High Blood pressure
  2. Breast Cancer at age 38 years old
  3. Diabetes Type 2

Father

  1. High Blood pressure
  2. Hyperlipidemia

Maternal Grandmother

  1. COPD
  2. High Blood pressure
  3. Diabetes Type 2

Maternal Grandfather

  1. Stroke at age 54
  2. Heart attack at age 67

Paternal Grandmother

  1. Lung Cancer at age 62
  2. Lyme Disease

Paternal Grandfather

  1. Colon Cancer at age 58
  2. Aortic Stenosis

Sister

  1. Healthy- Age 17

Brother

  1. Healthy – Age 13

 

Review of Systems:

 

General:

 

No weight loss, fever, chills, weakness, or fatigue.

 

Respiratory:

 

Denies cough, shortness of breath, or difficulty breathing Meniscal Tears: Current Understanding, Diagnosis, And Management Discussion Response

 

Cardiovascular/Peripheral Vascular:

 

Denies history of angina, edema, circulation problems, blood clots, rheumatic fever, heart murmur, easy bleeding, easy bruising, and blue skin

 

 

Musculoskeletal:

 

States joint stiffness and swelling in bilateral knees. States limited range of motion after a long run or a long basketball game.  Denies arthritis, gout, trauma, and back pain

 Neurological:

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Denies syncope, seizures, numbness, tingling, gait disturbances, coordination problems, coordination problems, altered sensation, alternation in memory, difficulty concentration, headaches, head trauma, or brain injury

Psychiatric:

 

Denies mood changes, anxiety, depression, sleep disturbances, hallucinations, delusions, illusions, affective or personality disorders, nervousness or irritability, and suicidal ideations

 

OBJECTIVE DATA:

 

Physical Exam:

 

Vital signs: Blood Pressure 100/60. Heart rate 88. Respirations – 16. Temperature 36.5. 99% on Room Air. Height 6’0. Weight 140 pounds. BMI 19.

 

General:

 

A 15-year-old Caucasian healthy male in otherwise good health.  Alert, oriented, pleasant mood. Sitting upright on the exam table. Steady gait. Well-groomed and appears freshly showered. Good historian. Appears to be in no distress. Looks like his stated age.

 

Chest/Lungs:

Breath sounds throughout. No crackles/rhonchi/wheezes. Good air movement throughout.

Heart/Peripheral Vascular:

 

Regular heart rhythm.  Prominent heart sounds, S1 and S2 normal, no gallop or murmur. Pulses 2+ equal on both sides.

 

Musculoskeletal:

 

Right and Left knee mild swelling, crepitus, and small effusion. No erythema. Not tender to palpation but painful upon full extension of bilateral knees.  Full ROM of knees bilaterally

 

Lymphatics:

 

No cervical or inguinal lymphadenopathy

 

Psychiatric:

 

Alert and oriented to person, place, and time

 

Diagnostic results:

 

  1. Xray- Normal
  2. CT Scan of bilateral knees – Normal
  3. MRI- OCD lesions in the subchondral bone with intraosseous subchondral osteopenia. Thickening of articular cartilage and low signal changes.Areas of hypointensity in cartilage

 

 

 

ASSESSMENT:

 

Diagnoses:

 

  1. Chondromalacia of the patella – Chondromalacia (sick cartilage) is an affliction of the hyaline cartilage coating of the articular surfaces of the bone (Habusta, Coffey, Ponnarasu, & Griffin, 2022). Patients typically complain of Anterior knee pain.  This pain is usually made worse with activities that increase the stress on the patellofemoral joint, for example, stair climbing, squatting, and running. Our patient is an active runner and basketball player. He complains of dull pain in bilateral knees. Both knees click when running. Catching sensation under patella with activity. Has Right and Left knee mild swelling, crepitus, and small effusion. Complains of pain when running, squatting, jumping, or climbing stairs Meniscal Tears: Current Understanding, Diagnosis, And Management Discussion Response.

 

  1. Meniscus tear – Though initially described as a functionless remain of a leg muscle, extensive scientific investigations in recent decades have described the meniscus as a vital part of the knee joint with anatomical, biomechanical, and functional importance (Bhan, 2020). Meniscal tears can cause a range of symptoms, including pain localizing to the joint line, swelling, clicking, catching, locking, and the classic “giving away” of the knee. This patient experienced all of these symptoms except giving away at the knee.

 

  1. Osteochondritis dissecans of the Patellofemoral joint – Osteochondritis dissecans (OCD) is a common cause of knee disorder among skeletally immature and adult patients and it occurs when a small piece of subchondral bone begins to separate from its surrounding area due to a disturbance of the local blood supply (Bruns, Werner, & Habermann, 2018). Patients typically have pain and stiffness, swelling, catching, and effusions. This patient presented with all of the above symptoms.
  2. Anterior Cruciate Ligament Knee Injuries (ACL) – ACL sprain or tear is one of the most common knee injuries.  Typically, injury occurs during activity/sports play that includes sudden changes in the direction of movement, rapid stopping, jumping and landing abnormally, a direct blow to the lateral aspect of the knee, or slowing down while running (Evans & Nielson, 2022). Our patient is active in track and basketball. Symptoms include tenderness along the joint line, pain, and swelling, decreased or loss of range of motion, and difficulty ambulating.

 

  1. Patellar tendonitis – Patellar tendon pain is a significant problem in athletes who participate in jumping and running sports and can interfere with athletic participation (Reinking, 2016). Often referred to as jumpers’ knees. Patients typically present with constant tendon pain Meniscal Tears: Current Understanding, Diagnosis, And Management Discussion Response.