Possible Meniscus Tear Possible Meniscus Tear

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Thread: Possible Meniscus Tear

  1. #1
    Join Date
    Jan 2014
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    Default Possible Meniscus Tear

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    I'm a 49 year old male, 5'8" and about 190 lbs. I've been lifting fairly regularly for several years, but more for general health than to achieve big numbers. I think I'm probably near the bottom end of the intermediate range, with fairly recent e1RMs around 320 (SQ) and 360 (DL).

    Starting a couple of months or so ago, I noticed the occasional, sometimes sharp knee pain, not just during exercise, but also after sitting for a while, during longish walks, stairs etc. I'm not aware of any specific acute trauma that might have caused the pain. Both the presentation of the pain and its location seemed quite different from the occasional tendonitis-type pain I've experienced before. The pain is located on the medial side, near the joint line, and it's worst near maximum flexion and near full extension (when I flex my quad), as well as during loaded rotations. I do not have mechanical locking symptoms, but I do have crepitus (in both knees, actually).

    I have seen a doctor specializing in sports medicine about this, whose tentative diagnosis was that I probably have a meniscus tear. He recommended getting an MRI just to make sure, but also thought surgery was extremely unlikely to be indicated, and that physio of some kind would be the way to rehab this.

    Given my situation, I was hoping to get your thoughts on the following:

    • Would you agree that a meniscus tear is the most likely diagnosis for my symptoms?
    • It seems like surgery is not a great idea even with mechanical symptoms, so pretty much ruled out for a case like mine. Given that, would you recommend getting an MRI at all, or is the rehab protocol independent of anything the MRI is likely to show, so there is no real point in getting one?
    • What is a sensible rehab protocol for a (likely) meniscus tear like this?
    • More fundamentally, I'm a bit confused about what is causing the actual pain here -- is it basically "just" inflammation of the meniscus and/or tissue surrounding it? I.e. is the goal to reduce this inflammation in the hope that the tear will then become asymptomatic? Are anti-inflammtories (e.g. topical diclofenac or ibuprofen+levomenthol) a good idea or a bad idea?
    Thanks in advance for any information or advice you might be able to provide!

  2. #2
    Join Date
    Aug 2010
    Location
    South Korea
    Posts
    2,301

    Default

    Quote Originally Posted by lazygun37 View Post
    I'm a 49 year old male, 5'8" and about 190 lbs. I've been lifting fairly regularly for several years, but more for general health than to achieve big numbers. I think I'm probably near the bottom end of the intermediate range, with fairly recent e1RMs around 320 (SQ) and 360 (DL).

    Starting a couple of months or so ago, I noticed the occasional, sometimes sharp knee pain, not just during exercise, but also after sitting for a while, during longish walks, stairs etc. I'm not aware of any specific acute trauma that might have caused the pain. Both the presentation of the pain and its location seemed quite different from the occasional tendonitis-type pain I've experienced before. The pain is located on the medial side, near the joint line, and it's worst near maximum flexion and near full extension (when I flex my quad), as well as during loaded rotations. I do not have mechanical locking symptoms, but I do have crepitus (in both knees, actually).

    I have seen a doctor specializing in sports medicine about this, whose tentative diagnosis was that I probably have a meniscus tear. He recommended getting an MRI just to make sure, but also thought surgery was extremely unlikely to be indicated, and that physio of some kind would be the way to rehab this.

    Given my situation, I was hoping to get your thoughts on the following:

    • Would you agree that a meniscus tear is the most likely diagnosis for my symptoms?Since you are 49 years old, it is almost implausible to think you don't have a meniscus tear. Whether or not that is what is causing your symptoms is difficult to say. It is at least a good working hypothesis. You still have to consider Knee OA, patellofemoral joint OA, among a few other issues.
    • It seems like surgery is not a great idea even with mechanical symptoms, so pretty much ruled out for a case like mine. Given that, would you recommend getting an MRI at all, or is the rehab protocol independent of anything the MRI is likely to show, so there is no real point in getting one?If you aren't a surgical candidate, I don't see what the value in an MRI would be.
    • What is a sensible rehab protocol for a (likely) meniscus tear like this?For this, you will need to hire the services of a coach who is skilled in training clients in an injured state / rehabbing injuries. I enjoy answering questions, providing feedback, giving education, but I don't practice my profession for free.
    • More fundamentally, I'm a bit confused about what is causing the actual pain here -- is it basically "just" inflammation of the meniscus and/or tissue surrounding it? I.e. is the goal to reduce this inflammation in the hope that the tear will then become asymptomatic? Are anti-inflammtories (e.g. topical diclofenac or ibuprofen+levomenthol) a good idea or a bad idea? Combination of multiple things. If it was a meniscus tear, there is typically a reactive effusion in the joint. Depending on the nature of the meniscus tear, there can be increased stress on the tissue at the knee, especially the joint line which can lead to subchondral edema / bone marrow edema. Finally, a meniscus tear can create cartilage fragments that get into the joint fluid and kickstarts the complement-mediated membrane attack complex which is a major player in the development of osteoarthritis.
    Thanks in advance for any information or advice you might be able to provide!
    See above.

  3. #3
    Join Date
    Jan 2014
    Posts
    95

    Default

    Thank you -- this is incredibly helpful.

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