Now let’s get into the signs and symptoms of a meniscus tear.
This is the third article on the topic of meniscus tears. If you missed the last two, you can check them out at the end of this article.
Signs and Symptoms of a Meniscus Tear
Similar to other knee injuries, a meniscus injury is manifested by acute or abrupt pain in the joint-line of the involved knee. All signs of inflammation, which include redness, warmth, pain, swelling, and function loss, may be observed and noted by the physician during physical examination.
A client with a meniscal tear may experience and report the following signs and symptoms:
- Pain – After an acute injury, pain in the joint line of the affected knee is usually reported. Acute trauma is not a prerequisite to develop meniscal tears. Some patients may not even recall or describe the injury event. For non-traumatic cases, the pain may be intermittent and limited to the affected knee.
- Tenderness on The Joint Line – This symptom is found in 77 to 86% of patients diagnosed with meniscal tears, classifying it as an accurate clinical sign of meniscal injuries (Baker, 2011).
- Joint Swelling – Some patients may experience swelling in the involved joint line, occurring as a delayed symptom. Others may not display this symptom all. Research revealed that 50% of patients with meniscus tears presented with knee joint swelling (Baker, 2011).
Swelling that occurs minutes after an acute injury is highly indicative of a meniscus tear resulting from a tear associated with hemarthrosis, a condition where bleeding occurs in the joint space.
Immediate swelling with bleeding typically occurs in the outer one-third of the meniscus. In the 1993 study by Stanitski and colleagues, it was found that 47% of adult patients with hemarthrosis had a tear in the ACL (Bhagia, 2012). The same study also revealed that 47% of the affected patients had meniscal tears (Bhagia, 2012).
- Locking of the Knee – Locking is a frequent symptom of meniscal tears. The knee of a client with a meniscus injury may freeze or get stuck in one position as it being bent or straightened, causing inability to straighten out the knee. Locking is more likely to occur with a displaced tear, where the torn fragment is trapped within the knee joint. Swelling may mimic the sign of locking. The physician may observe for clicks or snaps after unlocking the joint to distinguish locking from joint swelling.
- Giving Away Sensation in the Knee – This symptom occurs when the detached fragment is temporarily lodged in the joint. A patient may report feeling wobbly without warning. Giving away sensation in the knee may occur immediately or 2 to 3 days after the inciting injury.
- Abnormal Range of Motion of the Knee – Meniscal injuries may cause difficulty with straightening of the knee. When the knee is fully bent, as in squatting, pain may be reported. The pain may be so severe that the client is unable to perform or complete the movement. Deviations and compensatory patterns during walking are also observed.
Diagnosing Meniscal Injuries
A meniscal injury can be accurately diagnosed through a detailed subjective history, physical examination, performance of certain maneuvers, and diagnostic tests.
Taking the History of Your Meniscus Injury
Your physician will first obtain a detailed history, focusing on the mechanism of the injury, which includes timing of the injury. Trauma is not necessary to cause meniscal tears. There are cases where you may not recall or be able to describe the symptom leading event.
Physical Meniscus Injury Examination
A complete physical examination is conducted by your physician. During evaluation, the lower spine, hip and thigh of the affected leg, and the patellofemoral joint will be examined. Joint line tenderness, swelling, and range of motion of the affected knee will be checked.
A part of a complete physical examination is the performance of certain provocative maneuvers. These maneuvers elicit the signs and symptoms of a meniscus injury by causing impingement of the torn meniscus.
Your physician may perform the following provocative maneuvers:
- McMurray Test – In the presence of a tear, this maneuver elicits knee pain or reproduces a click.
- Steinmann Test – Pain is elicited when the shin bone is rotated with the patient sitting and the knee bent to 90-degrees. A medial meniscus is possibly torn if the client complains of pain as the shin bone as it is rotated going away from the center of the body. A torn lateral meniscus is suspected if pain is reported as the shin bone is being rotated toward the center of the body.
- Apley Test – A client has a positive test when pain is elicited at the medial or lateral side of the knee joint as force is applied through the heel with the leg in internal or external rotation.
Diagnostic tests for a Meniscus Tear
If a meniscus injury is suspected, the physician may first order plain radiography to rule out arthritis and fractures.
To confirm the diagnosis, a magnetic resonance imaging (MRI) test is ordered. This diagnostic test is widely recognized as the standard imaging study for suspected meniscus pathologies (Baker, 2011). MRI is more reliable in capturing sharp and clear images of the soft tissues in the knee joint.
Arthroscopy may also be a reliable tool for meniscal tear diagnosis if it is performed by a skilled arthroscopist (Baker, 2011). Research showed that arthroscopy is nearly 100% specific and sensitive in diagnosing meniscal tears (Baker, 2011).
Types of Meniscus Tears
Meniscus tears are not all the same. Identifying the type of meniscal tear through MRI scanning is important during the diagnosis. Your treatment plan is also based on the type of tear you have sustained. Some tears may be treated conservatively. Other tears may be resolved through surgery.
There are Seven Types of Meniscus Tears:
- Frayed Tear – A meniscus with frayed and jagged fronds on its sharp edges may be a sign of degeneration. If the inner meniscal rim is involved, the risk for further injuries and complications is not likely. If the whole meniscus demonstrates frayed fronds, the meniscus may collapse in ragged motion. A meniscus with severe degeneration is impaired to carry out its shock-absorber function. Arthritis of the knee is a likely consequence.
- Radial Tear – In a radial tear, tearing occurs across the lateral rim of the meniscus. Tearing occurs from the edge of the meniscus, going inwards. In this type, the inner part of the meniscus may not completely heal due to inadequate supply of blood.
- Parrot-Beak Tear – If an oblique radial tear is left untreated, it can lead to a parrot-beak tear. As an oblique radial heals, the tear may assume a rounded beak-shaped appearance.
- Circumferential Tear – In this type, the tear may run along the length of the cartilage.
- Bucket-Handle Tear – A tear running across the length of the meniscus may cause detachment of one of its sections from the shin bone, leading to the formation of a flap that resembles a bucket handle. A bucket-handle tear is more likely to cause complete straightening of the knee, locking, and pain. This type of tear is more susceptible to sustaining more damage.
- Horizontal Cleavage Tear – Classified as a rare type of tear, a horizontal cleavage tear is manifested by a horizontal split found in the body of the meniscus. This tear is usually first sustained after a minor injury and then followed by degeneration.
- Flap Tear – This type of tear is manifested by a horizontal split in the middle of the meniscus. The formed flap may flip over occasionally, leading to the symptoms associated with meniscal injuries.
Rick Kaselj, MS
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