Meniscus tears are one of the most common knee injuries. That’s because an athlete, an older person and anyone in between can tear a meniscus.
They can be torn in different ways. Tears are described by how they look as well as where the tear occurs. Common tears include bucket handle, flap and radial. Sports related tears often include more than just the meniscus (such as an anterior cruciate ligament tear).
A meniscus tear is diagnosed by obtaining a medical history, discussing symptoms, and examination of the knee. One of the main tests for meniscus tears is the McMurray test. The doctor bends the knee, straightens it and then rotates it. This puts tension on a torn meniscus and will cause a clicking sound. Imaging tests, such as x-ray or MRI may be ordered as well.
Treatment depends on the type of tear, size and location. The outside one-third of the meniscus has a rich blood supply which may allow it to heal on its own. The inner two-thirds of the meniscus lacks a blood supply which does not allow it to heal. These are complex tears which often occur in thin, worn cartilage. These types of tears usually require surgery.
Without treatment a piece of meniscus may come loose and drift into the joint. This can cause the knee to slip, pop or lock.
Since meniscus tears are extremely common knee injuries, proper diagnosis, treatment and rehabilitation often returns patients to their pre-injury abilities.
Plantar fasciitis is one of the most common causes of heel pain. It occurs when the thick band of tissue that runs across the bottom of the foot and connects the heel bone to the toes gets inflamed. Symptoms include a stabbing pain at the bottom of the foot near the heel. It generally occurs when you haven’t walked for a while, such as first thing in the morning. As more movement of the foot occurs through walking the pain normally decreases but could return after long periods of standing or upon rising from a seated position.
Plantar fasciitis is common in persons between the ages of 40-60 but can be brought about at any age with certain types of exercise, such as running, jumping, ballet dancing, aerobic dance. Plantar fasciitis can also be the result of anatomic deviations from normal, such as being flat footed, a high arch, or an abnormal walking pattern. Obesity is also known to put extra stress on the plantar fascia. Occupations which involve mostly standing can also damage the plantar fascia leading to plantar fasciitis.
Plantar Fasciitis is tough to treat. Often times treatment takes several months. Rest, ice, and Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce inflammation and pain. If pain isn’t responding to NSAIDs, a steroid injection can ease pain for about a month and will keep inflammation down for even longer. Physical therapy might be recommended if none of the other modes of treatment worked. From this point forward, treatment gets more aggressive.
Shock-wave therapy, where sound waves literally “shock” the plantar fascia to stimulate blood flow and help tissue to heal; pain is stopped from the stunning affect it has on the nerves.
Tenex procedure, like an “arthroscopy” of the foot there is a small incision and an ultrasound is used to target and remove scar tissue. Life gets back to normal in as little as 10 days.
The last resort is surgery, where the plantar fascia is removed from the heal bone. Although this can be done as an outpatient, healing takes longer with the use of a splint or boot and no weight bearing, then limited weight bearing and things will hopefully progress to unrestricted weight bearing.
Plantar fasciitis is a common condition that is difficult to treat and can have a long healing period. Time away from work can easily cost employers thousands in lost time and treatment bills for just one employee. Encouraging healthy habits can lessen the incidence of plantar fasciitis in the workplace, which in turn can lower the cost of lost time and treatment. Examples of healthy practices include:
Proactive involvement in prevention can cost little as compared to what it saves.
The meniscus is often described as the knee’s “shock absorbers.” That’s because they are a piece of cartilage providing a cushion between the thigh bone (femur) and shin bone (tibia). Each knee joint has two menisci. Their purpose is to help equally distribute the body’s weight, protecting and extending the life surrounding cartilage.
A meniscus can be torn or damaged during any activity that puts pressure on or rotates the knee joint. Younger people are likely to experience sports related traumatic tears. However, as a person ages, the cartilage in the knee becomes weaker and thinner, and is more prone to tears from simple activities of daily living.
Generally, when a meniscus tear occurs, a popping sound is heard around the knee joint. Afterwards, many people experience pain (especially when the area is touched), swelling, difficulty moving the knee or inability to fully move it, a feeling of the knee locking or catching, and a feeling the knee is giving way or unable to support you.
Meniscus tears are actually quite common. In fact, about 700,000 Americans undergo a meniscectomy (meniscus surgery) annually. Many others have the condition and choose not to move forward with surgery. Decades ago the entire meniscus was removed on the belief that it would grow back, and when it didn’t a total replacement was undertaken.
Today, the standard approach is to remove only the torn section of the meniscus through a partial meniscectomy and leave the healthy tissue. The arthroscopic surgery is performed through two small incisions on the knee.
There have been many advances in technology which have progressed to a less invasive surgery resulting in quicker recovery time. However, even with today’s advances, the symptoms go away and the patient has 5-10 years of relief, but the loss of even part of the meniscus can accelerate the onset of arthritis.
A new development of a tissue-engineered meniscus replacement has been announced. It consists of a biodegradable polymer that has been submerged in collagen and hyaluronic acid and weaved into the shape of a meniscus. The sponge-like device is inserted into the knee where it fully dissolves and stimulates the body to rebuild new meniscal tissue naturally.
The dissolvable polymer is strong enough to bear the pressure between the two bones while stimulating the body to grow a new meniscus in its place. The new meniscus is not comprised of scar tissue – rather it is neo-meniscal tissue. For many people with meniscal injuries this would eliminate the need for a future knee replacement.
This technology, which will be marketed under the name “MeniscoFix” is not yet available to the general public. It is scheduled for clinical trials in the next two years and will be commercially available within 5-7 years. This new technology will allow doctors to tailor treatment to the patient’s specific type of tear and employ the least invasive method for the best outcome.
In order to resolve claims quickly and cost-effectively, it is necessary to recognize red flags, pre-existing conditions such as health concerns and degenerative issues at the onset. This allows you to determine what tools are necessary to move the claim to closure.
The single most important key factor in keeping claims moving forward is communication, with the claimant, insured, treating doctor(s), and if appropriate your defense attorney.
