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Injury Care

There are two approaches to injury care. They are active and passive treatment. While both can help get patients on the road toward recovery, only active treatment has long-term impact and keeps patients moving.

We focus on treating injuries sustained in auto accidents, personal injuries, work injuries and sports injuries and provide complete interventional pain management services and therapeutic programs. Everything from bumps and bruises to torn ligaments and back pain.

Passive Injury Care

Passive injury care usually given by a doctor or a physical therapist. It includes:

  • Acupuncture
  • Applying heat/ice to sore muscles
  • Pain medication

It’s a good starting point to help reduce pain, but passive injury care isn’t the most effective treatment. While it helps an injured person feel better in the moment, the relief doesn’t last. A patient won’t fully recover from injury unless they actively work to return to their normal life.

Active Injury Care

Active treatment also provided by a physician or physical therapist, relies on commitment from the injured person in order to work. When a patient takes ownership of their health, the active injury care process becomes more meaningful and productive. A modified activity plan will not only help an injured person transition to full function but also improves their overall physical, and emotional wellness.

  • Spine, neck and back
  • Headaches
  • Knees, shoulders and wrists
  • Torn ligaments
  • Soft tissue injuries (muscle strains and sprains)

What does active injury care involve?

An active treatment plan keeps the body as strong and flexible as possible through a personalized work/transitional plan, which limits long-term impact and helps injured patients work toward a faster recovery. Injury Medical & Chiropractic clinic’s injury care, a clinician will work with the patient to understand the cause of injury, then create a rehabilitation plan that keeps the patient active and brings them to back to proper health in no time. For Answers to any questions you may have please call Dr. Jimenez at 915-850-0900


How Can Physical Therapy Help Me El Paso, Texas

How Can Physical Therapy Help Me El Paso, Texas

Physical therapists (PTs) are healthcare professionals that treat patients of all ages with various ailments/conditions. A spine surgeon, physiatrist, orthopedist, primary care physician, neurosurgeon, and a chiropractor may refer patients to a physical therapist as part of a non-operative treatment plan.

An organized physical therapy plan may be an integral part of after-care following surgery. Therapists practice in a variety of settings, like hospitals, outpatient clinics, rehabilitation centers, and nursing homes. Physical therapists provide:

  • Treatments
  • Exercises
  • Mechanics

The primary goals of physical therapy include:

  • Maintain practical skills
  • Improvement
  • Building endurance and strength
  • Increasing flexibility
  • Reducing pain
  • Preventing impairment

Physical therapists also instruct patients on the best way to exercise to enhance overall physical fitness, move about safely (biomechanics and ergonomics), and injury prevention. Physical therapists also help patients with long-term physical incapacity (eg, spinal cord injury).

 

11860 Vista Del Sol, Ste. 128 How Can Physical Therapy Help Me El Paso, Texas

 

Aquatic Therapy

Patients with osteoarthritis have found water exercise to be beneficial. With a gravity-free environment, patients can perform simple exercises without stressing the tender joints. Movement increases circulation to the affected joints and can relieve stiffness. Swimming is also a great exercise for anyone for loosening up stiff joints and strengthening muscles.

 

Electrical Stimulation

This type of therapy forces a muscle or muscle group to contract and relax. Therapists place surface patches containing electrodes on the skin over the area to be treated. The therapist programs the equipment to deliver the correct amount of stimulation for a set time.

The electrical current flows through nerve and muscle cells. The treatment is not painful. The patient feels gentle pulsating or an on/off sensation. This treatment stimulates circulation and supplies the area with oxygen and nourishment for healing. Electrical stimulation enhances healing and alleviates swelling and pain.

 

11860 Vista Del Sol, Ste. 128 How Can Physical Therapy Help Me El Paso, Texas

Electrical stimulation in physical therapy. Therapist positioning electrodes onto a patient’s knee

 

Heat and Ice

Heat increases circulation, decreases stiffness, pain and muscle spasms.

Patients with early arthritis symptoms find relief by taking a warm bath or hot shower.

It is best when done in the morning to help loosen up and alleviate stiffness.

Physical therapists use moist hot packs wrapped in a towel that is laid or wrapped around the affected area.

A moist hot pack transfers moist heat that penetrates deeply into soft tissues and stimulates local circulation more than heat alone.

 

 

Ice decreases pain by slowing the nerve impulses.

Inflammation subsides with forms of cold therapy:

  • Cold packs
  • Ice massage
  • Iced towels

They are usually the first aid following trauma.

When treating an overworked body part ice treatment should be supervised by a physical therapist.

Hydrotherapy

This is like a whirlpool bath. The water temperature and agitation loosen up joints, stimulate muscles and are controlled for maximum benefit.

 

Myofascial Release

This therapy improves circulation, decreases muscular tension and increases range of motion.

It is a type of massage that stimulates the muscles. The muscle tissue is manipulated by hand to stretch the tissue. Tight tissues become loosened using a cross friction motion with this therapy.

 

 

Movement & Conditioning

A physical therapist teaches patients how to move properly while being able to work through the pain. Therapists want patients to work as pain-free as possible. This does not mean that the exercises will be easy. More than likely they are going to be tough, but that is what you want to get back into top physical form.

 

11860 Vista Del Sol, Ste. 128 How Can Physical Therapy Help Me El Paso, Texas

Physical therapist assisting woman on an exercise ball at the clinic

 

Warming-Up can be accomplished by riding a stationary bike and some light stretching. The type of warm-up that goes with the therapy is determined by the individual treatment plan.

There will be muscle soreness for 24 to 48 hours following exercise therapy. This is completely normal and should be expected. As the exercises become a normal part of the day the discomfort will gradually go away. Stretching will increase flexibility. And as the treatment goes on resistive and strength exercises could be added.

 

Couple warming up

Home Exercise

With any treatment plan, there is usually a custom home exercise program. Exercises pretty much follow clinic exercises with variations and added stretches to keep the body from stiffening staying limber. Changes can be discussed with a physician.

 

Body Mechanics & Posture

Proper body mechanics helps to prevent further injury/s from occurring. Patients willing to maintain

  • Physical fitness
  • Reduce stress
  • Apply proper body mechanics

This reduces the risk of injury.

Proper posture is defined as keeping the natural curve of the spine. Proper posture minimizes stress to the spine. This is the first lesson a physical therapist teaches a patient.

Poor posture and poor body mechanics are leading contributors to neck and back pain.

 

11860 Vista Del Sol, Ste. 128 How Can Physical Therapy Help Me El Paso, Texas

Proper Work Habits

  • Do not lean over a desk for long periods.
  • Try not to sit without back support.
  • Adjust chair height so the knees are bent at a 90-degrees.
  • Bend the elbows at a 90-degree angle or they can rest on the work surface.
  • Don’t cradle the phone against the ear and shoulder as this can cause neck and shoulder issues.

 

movement in the work place el paso tx.

 

Lifting and Carrying Objects

  1. First, look at the object to be moved. If it looks too heavy find help.
  2. Remove obstacles from the pathway where the object will be going through.
  3. Visualize maintaining proper posture.
  4. Get as close to the object as you can.
  5. Place feet slightly apart and flat on the floor.
  6. Bend at the knees to provide stable support.
  7. Tighten the stomach muscles.
  8. Breathe deeply.
  9. Smoothly lift the object using arms and legs and not the back.
  10. Hold the object at the sides and bottom.
  11. Keep the object close to the body.
  12. Keep back straight and carry the object with elbows slightly bent.

With shopping bags or luggage split the load in two, and try to carry the same amount of weight in each hand.

 

 

Pushing versus Pulling

Pushing is the more efficient and safer method of moving objects. Keep the back straight and use the knees to push. Keep close to the object and reposition the body every so often.

Reaching for Objects

  1. Check the size, weight, and location of the object.
  2. Use a proper stool or step-ladder to get the object. Stand with both feet flat.
  3. One hand can be used for additional support.
  4. Try not to look over too much as this can cause neck strain.
  5. Think about storing regularly used items within easy reach.

Physical therapists may work directly for or with a physician, therapist, chiropractor and other healthcare providers to organize aspects of physical treatment plans. For example, a doctor may send physical therapist information of graphs, medications, analysis, and imaging results.


 

Massage Rehabilitation El Paso, Texas

 


 

NCBI Resources

During the first consultation, a physical therapist will talk about symptoms, analysis, and medical history.  Severity the location, type, and variables that decrease or increase pain are significant, and the PT will ask many questions regarding pain.

Physical therapists are healthcare professionals and members of your medical team. While physical therapy may be challenging or demanding at first, there are many benefits. It’s an opportunity to take charge of back or neck pain while building a stronger more resilient body.

 

Poor Biomechanics, Overuse Injury, Runner’s Knee and Chiropractic

Poor Biomechanics, Overuse Injury, Runner’s Knee and Chiropractic

One of the most recognized running injuries is runner’s knee. However, runner’s knee is not an injury but a result of different injuries. Running can hurt when improper mechanics, inadequate shoes, and cheap over the counter insoles are being used. It can lead to:

  • Plantar fasciitis
  • Achilles tendonitis
  • Medial tibial stress syndrome
  • Metatarsalgia
  • Runner’s knee

11860 Vista Del Sol, Ste. 128 Poor Biomechanics, Overuse Injury, Runner's Knee and Chiropractic El Paso, TX.

 

Runner’s knee is not an actual injury in of itself

It’s a broad description of knee pain caused by other knee injuries, which include:

  • Iliotibial band syndrome
  • Patellofemoral pain syndrome (PFPS)
  • Chondromalacia patella

This can keep runners sidelined, annually.

Runner’s knee is caused by usually one of two things: poor biomechanics and overuse.

Feet are the foundation of the body and if not taken care of, pain

Feet are 99% normal at birth.

Then life takes over and issues begin to arise.

8% develop foot conditions, then by age 5 that number jumps to 41% and 80%  at twenty.

By forty pretty much everyone has a foot condition or some type of foot pain from work and activity.

These foot issues then begin to set up problems for the rest of the body, especially the generalized condition of back pain or leg/knee/hip problems.

Being able to foresee and realize a potential problem with the feet can PREVENT other injuries from beginning to present themselves and dodge any issues that can affect health and lifestyle.

Runners who are able to avoid injury are those that land the lightest, much like a cat and sustain the lowest level of impact.

Runners think about landing softly and adjust their stride so they land closer to the midfoot.

However, it’s easier said than done.

Most runners tend to be heel-strikers

  1. Runners with excessive pronation that try to change to a forefoot strike pattern are more prone to inner foot and ankle injuries,
  2. And runners with high arches that try to change to a forefoot strike pattern end up with sprained ankles and metatarsal fractures.
  3. Runners try to treat the pain with stretches or exercises that target the area, but the source of the pain is actually elsewhere and they don’t realize it and are treating the wrong area.
  4. A lot of the time the source of the imbalance comes from the feet.
  5. An overlooked option for reducing knee injury and pain is the use of custom orthotics.

Custom orthotics align and support the foot/ankle in a more normal physiologic position for weight-bearing, which prevents dysfunction and improves the function of the body as a whole.

What they do is:

  • Make a symmetrical foundation that blocks pronation and supports supination
  • Give the heels shock absorption
  • Stops serial stress throughout the body
  • Enhances re-educating muscle-memory

Custom-made orthotics help reduce the impact of heel strikes when running or walking.

Shock absorption is a must when there is

  • Instability
  • Chronic degeneration
  • Inflammatory arthritis

Orthotics that are designed specifically to cushion the impact load from running can reduce pain triggers throughout the body.

 

Avoiding knee injuries

When orthotic care is indicated, custom-made functional orthotics can help reduce pain.

Look for orthotics that support the running gait and

  • Absorb shock at heel-strike
  • Support mid-stance
  • Provide propulsion at toe-off

 

Excessive Foot Pronation can Affect *FOOT POSTURE & MOBILITY* | El Paso, TX (2019)

 

 

The following video discusses how excessive foot pronation can ultimately have an effect on foot posture and mobility. Several things can impact foot posture and mobility, such as excessive foot pronation. Excessive foot pronation is most widespread among the overall populace, therefore, it’s regarded as one of the most frequent factors for abnormal foot posture and mobility, which can lead to a variety of health issues like overuse injuries. Excessive foot pronation and supination can ultimately impact general health and wellness.


 

What’s Afoot

Misalignment can be caused by many common runners’ experiences including running on the same type of surface every day, running on a slanted surface such as a beach or replacing running shoes too infrequently. As a runner, you can work to vary your running surfaces and keep a better watch on your shoes, but your chiropractor will let you know if your body is in need of more balance.

 

VasyliMedical Pronation

 

NCBI Resources

If you are an active amateur or a competitive runner, using the services of a chiropractor can make a vast change in your overall health, reduce your pain from injuries and improve your alignment for a more effective run. Runners may not even realize that the tension they feel is the beginning of pain caused by being out of balance until it is adjusted. Chiropractic adjustments are often part and parcel of a runner’s training program to strengthen and improve performance. They can also help recover from pregnancy and postpartum bodily changes.

 

 

Find Relief From Achilles Tendonitis Using Chiropractic El Paso, TX.

Find Relief From Achilles Tendonitis Using Chiropractic El Paso, TX.

If you are suffering from Achilles tendonitis, you are definitely not alone. Plantar fasciitis and Achilles tendonitis are the two most common causes of pain in the heel. Athletes and active individuals, in particular, find themselves developing pain in the heel from Achilles tendonitis, but it is possible to develop the condition even if you are not an athlete.

Fortunately, chiropractic and associated therapies can do a lot to relieve your heel pain. With a combination of chiropractic care and Active Release therapy, you can get back on your feet and back to doing what you love as soon as possible.

Heel Pain Connected to the Achilles Tendon

Most people know how to point out the Achilles tendon. It is the large, thick tendon that travels up from the base of the heel and into the calf muscle. In fact, it connects the calf muscle and heel. It allows your body to transfer power from the calf muscle to the feet so that you can walk, run and jump. The Achilles tendon is strong and durable, but it is possible to overwork it and cause enough repetitive strain to develop tendonitis in the tendon.

 

11860 Vista Del Sol, Ste. 128 Find Relief From Achilles Tendonitis Using Chiropractic El Paso, TX.

 

Pain Causes in the Achilles Tendon

There are several stages to the process of developing pain in the Achilles tendon. These include:

Micro-tears

Heavy use of the tendon can lead to small tears. The micro-tears that develop in the Achilles tendon are known as tendinosis. They may not be noticeable at first and you may not feel much pain or any pain at all. However, over time and with increased tearing, the condition can become chronic.

Tendonitis

When you start to feel pain in your Achilles tendon that keeps occurring or lasts for a few days, you are likely experiencing tendonitis. The pain and inflammation of tendonitis need to be treated to avoid developing a chronic condition.

Tendinosis

If the pain becomes chronic—meaning it never or rarely goes away—then you have developed tendinosis. Instead of being inflamed, tendinosis is characterized by a lack of inflammation and the development of scar tissue. The scar tissue makes the tendon stiff and is usually quite painful. The stiffness of the tendon makes it more prone to tearing.

Rupture

If the tendinosis is not treated properly the tendon can eventually tear. A torn tendon is referred to as a rupture and usually requires surgery.

 

Symptoms

  • Pain and stiffness around the lower leg, right above the back of the heel
  • Begins as a mild ache and worsens throughout the day
  • Jumping,  running, stair climbing, and sprinting can spark intense pain
  • Tenderness or stiffness especially in the morning, but improves with movement/activity

Achilles Tendonitis Treatment

When you start to feel constant pain in your Achilles tendon it is time to go see your chiropractor. It is important to start treatment as soon as possible to avoid developing more advanced issues like tendinosis or even a ruptured tendon.

Your chiropractor will recommend several different types of treatment, including:

Active Release Therapy (ART)

ART is extremely effective for breaking up scar tissue and improving issues with soft tissues. Treatment can do a lot to improve the health of your tendon and the surrounding tissues to avoid further complications. It will also do a lot to help relieve the pain you are experiencing.

Chiropractic

Many times, the issues with your Achilles tendon are the result of misalignment in other parts of your body. When your joints are misaligned it tends to put extra stress on your feet and Achilles tendons. To minimize the stress on your joints, your chiropractor will adjust your spine and other joints to ensure proper alignment.

Get Help for Your Achilles Tendonitis

If you are experiencing heel pain, please get in touch with our chiropractic team. We can help to alleviate your pain and help you avoid experiencing further problems with your Achilles tendon.


 

Reduce *PLANTAR FASCIITIS PAIN* with Custom Foot Orthotics | El Paso, TX (2019)

 

 

Foot pronation is the natural movement which occurs during foot landing while walking or running. Foot pronation also occurs while standing, and in this instance, it is the amount in which the foot rolls inward toward the arch. Foot pronation is normal, however, excessive foot pronation can cause a variety of health issues, including bad posture. The following video describes the 5 red flags of excessive foot pronation, which can ultimately affect a person’s overall health and wellness. Dr. Alex Jimenez can help diagnose and treat excessive foot pronation. Patients recommend Dr. Alex Jimenez and his staff as the non-surgical choice for excessive foot pronation health issues.


 

Orthotics

If you are considering custom orthotics, a health care professional such as Doctor Jimenez and Injury Medical Chiropractic Clinic can perform a foot scan to show you what imbalances in the feet can lead to. The foot scan will show how the orthotics can help. Following the foot scan, a report will provide the caregiver a Pronation/Stability Index, Foot Assessment, and Body Assessment.

 

Take2_PB_Alps

 

What’s Afoot

Foot pain can commonly occur from various injuries. In the United States alone, about 2 million acute ankle sprains occur every year, one of the most prevalent causes of ankle pain. Chiropractic care is a popular alternative treatment option which can help treat a variety of health issues, including foot and ankle pain.

 

VasyliMedical Biomechanical foot function

 

NCBI Resources

Tendonitis often recurs in many people. This is due, at least in part to improper or incomplete healing. Many people will resume normal activities as soon as the pain subsides when they should continue caring for the injury so that it can heal completely. This leads to inflammation of the area again as the original injury is aggravated, but it can also lead to re-injury in that same area. Chiropractic care can help tendonitis heal completely and help prevent re-injury to the area.

 

 

Chiropractic Relief for Golfer’s Elbow El Paso, Texas

Chiropractic Relief for Golfer’s Elbow El Paso, Texas

Golfer’s elbow is a condition that affects far more than those that golf regularly. According to Dynamic Chiropractic, golfer’s elbow can affect violinists, construction workers, tennis players, bikers and more. It’s more an expression similar to tennis elbow.

Anyone who overuses the elbow can find themselves with pain inside the forearm and elbow, pain that is unlikely to go away without treatment.

While medication and surgery can be options for treatment, chiropractic provides a non-invasive, effective way to relieve golfer’s elbow without the side-effects that come with surgery and medications.

What is it?

The joint and muscles on the inside of your elbow are activated during so many activities—pretty much every time you squeeze, grip or throw something, you use them. Even when you are doing less athletic activities like texting or typing at a keyboard, you are activating the muscles, tendons, and ligaments surrounding your elbow. It is not surprising that they can be overused, especially during work activities or leisure activities that you love so much you play all the time.

Golfer’s elbow is considered an overuse injury—an injury caused by using one or more parts of the body so much that they cannot recover quickly enough. Inflammation becomes constant, scar tissue can develop and pain becomes a regular problem.

11860 Vista Del Sol, Ste. 128 Chiropractic Relief for Golfer's Elbow El Paso, Texas

How Chiropractic Helps Golfer’s Elbow

Chiropractic care is ideal for the treatment of golfer’s elbow. For some sufferers, coming to the chiropractor is the first and obvious choice. For others, going to the doctor is the first place they start.

Once they find that prescription medications are not alleviating the problem, they may be presented with the idea of surgery. Most people are hesitant to go through surgery if they do not have to, which is understandable. They reach out to a chiropractor because they are looking for an alternative that will help them heal without the pain and uncertainty that surgery brings.

At the chiropractor, you will find non-invasive, drug-free treatments that work to return your range of motion, reduce inflammation and break up the scar tissue in the soft tissues surrounding your elbow joint.

Chiropractic Treatment

Once you visit a chiropractor you will be given a careful, thorough physical examination to determine the nature of your problem and its cause. With golfer’s elbow, the problem is fairly obvious, so your chiropractor will focus on understanding exactly what your golfer’s elbow consists of—including your level of pain, your range of motion and the effects it is having on your day-to-day movement.

Some of the ways chiropractic can treat golfer’s elbow include:

Break Scar Tissue Up

Scar tissue keeps your muscles from operating correctly and causes pain. Chiropractors have methods for breaking up scar tissue to return normal muscle function, including active release.

Returns Mobility

Joint manipulation from your chiropractor is designed to make your joints move properly. The chiropractor will gently move your elbow back and forth to realign it and to ensure that it goes as far as it should go, and no further.

Reduces Inflammation

Inflammation is what causes much of the pain you are experiencing in your elbow. Joint adjustments and breaking up scar tissue are excellent ways to reduce inflammation. As the inflammation reduces the body can heal more easily and the pain will lessen.

We Can Get You the Help You Need

As you know, golfer’s elbow can be painful and make it difficult to do the things you need to do. Let us help you get some relief. Please contact our office today to schedule an appointment with our chiropractic team.

11860 Vista Del Sol, Ste. 128 Chiropractic Relief for Golfer's Elbow El Paso, Texas


Fibromyalgia and Functional Medicine

Fibromyalgia.Magazine.TruePDF-November.2018

 


El Paso Back Clinic


Additional Research

Ankle Sprain Injury Degree & How Chiropractic Can Help

Ankle Sprain Injury Degree & How Chiropractic Can Help

An ankle sprain is always inconvenient, and often painful. But not all ankle sprains are equal in their severity. When diagnosing an ankle sprain, your doctor or chiropractor will classify the injury in one of three ways—first degree, second degree, and third degree. Knowing what each classification means can help you understand the nature of your injury and how careful you need to be with it. For you and your chiropractor, the classification of the ankle sprain degrees will help to direct the best treatment options.

Ankle Sprain Degrees and What They Mean

A sprain is an injury involving the stretching and/or tearing of your ligaments. With the ankle, it is possible to suffer an injury to either side of the joint, the interior or the exterior. You may have an inversion sprain or an eversion sprain. Whichever type you suffer from, it will fall into one of three categories:

11860 Vista Del Sol, Ste. 128 Ankle Sprain Injury Degree & How Chiropractic Can Help

Grades of ankle sprains

First Degree

A first-degree sprain is one where the ligaments have not torn, only stretched further than normal. Symptoms of a first-degree sprain include discomfort when jumping, jogging or sometimes walking. Pain is usually mild and swelling is minimal. The joint may be a little stiff and slightly less stable than normal.

Second Degree

A second-degree sprain is the most common type of sprain people seek medical care for. The ligament is partially torn, which can lead to several uncomfortable symptoms. The sprain will make walking difficult, be moderately painful and make it hard to use the ankle. The injury will result in noticeable swelling and often bruising.

Third Degree

A third-degree sprain is the most severe and involves a full tear of the ligament. Pain is often severe and swelling is significant. The torn ligament makes the joint unstable, so it is not only painful but also very hard to use.

How Chiropractic Can Help

Whether you are walking, running, jumping or just standing, the ankle plays a vital role in how you move and use your body. That is why it can be so frustrating when you find yourself with an ankle injury. Fortunately, ankle sprains do heal with enough rest and the right treatment.

Your chiropractor can help you recover from an ankle injury, both reducing pain and speeding up recovery time. There is research to support the use of chiropractic for ankle sprains. One study showed that patients with ankle sprains experienced less pain when chiropractic was added to their treatment program. Chiropractic also focuses on improving mobility and range of motion, which can be quite beneficial when trying to recover from a sprain and get back to your normal life.

Some of the most common chiropractic treatments for ankle sprains include:

Adjustments

Adjustments can be made to more than just the spine. The bones, ligaments, and tendons in the ankle are designed to work in a certain way. A sprain can knock the ankle out of alignment, something that most traditional doctors and rehabs do not consider. An ankle adjustment will work to put things back into their proper places.

Strengthen Exercises

There are a variety of useful exercises that your chiropractor can take you through to improve strength and mobility in the ankle. Things like a wobble board, where you stabilize yourself on a wobbly platform and drawing on a board with a market held in your toes can be surprisingly effective at strengthening your ankle.

Call Us Today

Please contact us today to schedule an appointment with a chiropractor for your sprained ankle. Let us help you get stronger and heal faster!

11860 Vista Del Sol, Ste. 128 Ankle Sprain Injury Degree & How Chiropractic Can Help

El Paso Back Clinic

Best Chiropractic Care for Injuries | El Paso, Tx

Best Chiropractic Care for Injuries | El Paso, Tx

As a business owner at El Paso, Texas, Louie Martinez depends upon his general health to have the ability to execute his daily physical activities. And thanks to Dr. Alex Jimenez, a chiropractor in El Paso, Texas, Louie has found pain relief for a variety of wellness issues.

Chiropractic care is a safe and effective treatment option which focuses on the diagnosis, therapy, and prevention of many different accidents and/or conditions related to the musculoskeletal and nervous systems.

Louie describes how Dr. Jimenez has revived his wellness. Louie Martinez is thankful for the chiropractic care Dr. Jimenez has provided for him, and he highly recommends him as the non-surgical choice for many different health issues, including back pain and sports injuries.

El Paso Back Clinic

best chiropractic care for injuries el paso back clinic el paso tx.

We are blessed to present to you El Paso’s Premier Wellness & Injury Care Clinic.

Our services are specialized and focused on injuries and the complete recovery process. Our areas of practice include Wellness & Nutrition, Chronic Pain, Personal InjuryAuto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Treatment, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Stress Management, and Complex Injuries.

As El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we passionately are focused on treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.

We want you to live a life filled with more energy, positive attitude, better sleep, less pain, proper body weight and educated on how to maintain this way of life.

I assure you, I will only accept the best for you…

If you have enjoyed this video and we have helped you in any way, please feel free to subscribe and recommend us.

Recommend: Dr. Alex Jimenez – RN, DC, MSACP, CCST

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Information: Dr. Alex Jimenez – Chiropractor

Clinical Site: https://www.dralexjimenez.com

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Sports Injury Site: https://chiropracticscientist.com

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Sprains Or Strains, What Is The Difference? El Paso, Texas

Sprains Or Strains, What Is The Difference? El Paso, Texas

Hiking with the family and you twist your ankle. It hurts, but you make it back without much problem. You notice you have some swelling and soreness, so you head home for some R.I.C.E. (rest, ice, compression, elevation).

You pass it off, saying, “Oh, it’s just a sprain.” But when your doctor checks you out the next day, he tells you that it is “strained.” Sprain vs. strain, what’s the difference?

While many people use the two terms interchangeably, they are not the same. There are some distinct differences although many of the symptoms are almost identical. In short, when a ligament is injured, it is called a sprain. When a muscle or tendon is injured, it is called a strain.

What Exactly are Sprains & Strains?

Ligaments are tough bands of tissue that connect two bones as they sit in a joint. For example, the tibia and fibula come together to fit in the ankle joint. Tendons join those two bones together to keep the ankle stable. A joint sprain occurs when these ligaments are torn or overstretched. The ankle is the most commonly sprained joint.

Tendons are cords of tissue made up of a dense network of fibers. They connect the muscle to the bone. A joint strain occurs when the tendons or muscles tear or overstretch. The lower back and hamstrings are the most common areas for muscle strain.

Both injuries are very similar, so it stands to reason that the symptoms of the injuries are also almost identical. This is why they are so commonly confused.

sprain and strain treatment - injury medical and chiropractic clinic el paso, tx.

Symptoms of Sprains & Strains

The symptoms for each condition is very similar, but there are some differences.

Symptoms of Sprains include:

  • Pain around the area that is affected
  • Bruising in the affected area
  • Swelling in the immediate area but can expand to encompass more area
  • Limited range of motion
  • Decreased flexibility

Symptoms of Strains include:

  • Pain at the site of the joint that is affected
  • Muscle spasm
  • Swelling in the immediate area but can expand to encompass more area
  • Limited range of motion
  • Decreased flexibility

As you can see, the symptoms of sprains and strains are very close. The primary differences though are that bruising may occur with a sprain while a strain may elicit muscle spasms in the muscle that is affected.

sprain and strain treatment - injury medical and chiropractic clinic el paso, tx.

What Causes Sprains and Strains?

Experiencing a sprain or strain every once in a while is not out of the ordinary. We put our bodies through a lot in a day. However, certain activities can make you more susceptible to movements that can lead to these injuries. They include:

  • Exercise or athletic activities, especially those that are high impact
  • Walking
  • Repetitive motion for a long period of time
  • Overexertion
  • Jogging or running
  • Slipping or falling
  • Standing or sitting in an unnatural or awkward position
  • Walking or running on unstable surfaces, like rocks or ice
  • Lifting objects that are too heavy

The most common areas for these injuries include:

  • Back
  • Ankle
  • Wrist
  • Knee
  • Thumb

How to Avoid Sprains and Strains

Sometimes injuries just happen and there’s nothing you can do about it. However, in most cases, you can take proactive steps to minimize your risks. These are some of the most common risk factors:

  • Being in poor physical condition
  • Using proper form when exercising
  • Failing to warm up before activities like exercising
  • Not using the right equipment for your workout or sporting activity.
  • Maintaining a hazardous environment at home, such as clutter on the floor or things you can trip over or slip on.
  • Fatigue or overly tired
  • Failure to avoid hazardous areas like floors that are wet and slippery or sidewalks that are iced over and slick.

If you have a sprain or strain and notice that the swelling has not subsided or if you still have pain after a week or so, you need to follow up with your doctor to make sure you don’t have a more severe injury.

*Sciatica Pain* Treatment Relief | El Paso, TX (2019)

The Way Chiropractic Relives Acromioclavicular Pain

The Way Chiropractic Relives Acromioclavicular Pain

When a patient comes in with complaints of pain in the shoulder and restricted motion in the joint, one possible diagnosis may be acromicioclavicular (AC) joint injury. While it is often an injury that is common among athletes, it can happen to anyone. Fortunately, chiropractic is a very effective treatment. While most people think of chiropractors, the first thing that comes to mind is back pain. Yes, chiropractors do specialize in back/spine issues, but chiropractic care is used to treat a variety of conditions from joint pain to migraines, fitness, and diet.

What is an acromioclavicular joint injury?

There are two bones, the clavicle, and acromion, that make up the AC joint. Four ligaments hold the joint together. When those ligaments are strained to stress, it results in an AC joint injury, often causing at least some joint separation. AC injuries fall into one of two categories: overuse and traumatic.

Overuse injury occurs over a period of time and is caused by excessive stress on the joint that is repeated or consistent. This causes damage to the cartilage and can lead to AC joint arthritis.

Traumatic injury occurs when the damaged ligaments disrupt the joint called a shoulder separation. This is different from a shoulder dislocation which involves the actual ball and socket shoulder joint.

What causes acromioclavicular joint injury?

The cause of an AC joint injury depends on the type of injury.

Overuse AC joint injuries are caused by overuse and are commonly seen in people who perform tasks that involve lifting heavy weight (including military or bench presses) or that perform physical labor that involves often stretching their arms over their heads.

A fall often causes traumatic AC joint injuries. The person may fall and land on their shoulder or fall on their hand then they put it out to brace their fall. It is often seen in cyclists who are involved in crashes, football players when they are tackles or a laborer who falls from a high place, such as a ladder. These injuries are graded from mild to severe, depending on how much the separation there is in the joint.

chiropractic care for acromioclavicular pain, el paso, tx.

What are the symptoms of acromioclavicular joint pain?

A patient with AC joint pain may experience the following symptoms:

  • A bump that sits above the shoulder and is easily visible
  • A catching sensation or popping sound when the shoulder moves
  • Pain and swelling in the shoulder
  • Loss of range of motion of the shoulder
  • Loss or decrease in shoulder strength
  • Tenderness and swelling over the AC joint
  • Pain when lying on the affected side
  • Discomfort and pain in the shoulder when performing activities that place stress on the AC joint, including:
    • Carrying heavy objects at the side
    • Reaching across the body
    • Lifting objects overhead

What are the treatments for acromioclavicular joint pain?

Mild cases of traumatic AC joint injuries are often treated with physical therapy and chiropractic. Ice, rest, and immobilization can also be used to manage the pain.

Overuse AC joint injuries can also be treated with immobilization and ice as well as physical therapy and chiropractic. More severe cases may require surgery. Doctors may prescribe muscle relaxants, pain medication, or NSAIDs to help manage the pain.

Is chiropractic for acromioclavicular joint pain effective?

Chiropractic has been proven to be very effective for AC joint pain. The chiropractor performs what is called an AC adjustment which involves manipulation of the shoulder.

While it can be a little uncomfortable for the patient, it is one of the best ways to quickly decrease the pain. After the procedure, the chiropractor may recommend icing the area to minimize or prevent swelling and pain. Regular chiropractic care can ensure continued mobility and continued decrease in pain.

*CHRONIC* pain Chiropractic Relief | El Paso, Tx

Best Knee Injury Rehabilitation Therapy | Video | El Paso, Tx (2019)

Best Knee Injury Rehabilitation Therapy | Video | El Paso, Tx (2019)

The knee is the largest, complicated joint in the human body. The knee joint is exposed to many different wellness issues. Knee injuries related to sports are a common issue that can affect playing time. Dr. Jimenez helps many athletes recover from knee injuries along with a variety of other sports-related injuries. Individuals share their experience of knee injury rehabilitation and treatment Dr. Jimenez has provided them. As an added benefit it has enhanced their sports performance. Chiropractic rehabilitation is an alternative treatment option focusing on spinal adjustments and manual manipulations to deal with many different accidents and/or conditions related to the musculoskeletal and nervous system. Patients say Dr. Jimenez is the non-surgical, chiropractic choice.

Non-Surgical Injury Rehabilitation

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We are blessed to present to you El Paso’s Premier Wellness & Injury Care Clinic.

Our services are specialized and focused on injuries and the complete recovery process. Our areas of practice include Wellness & Nutrition, Chronic Pain, Personal InjuryAuto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Treatment, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Stress Management, and Complex Injuries.

As El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we passionately are focused on treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.

We want you to live a life filled with more energy, positive attitude, better sleep, less pain, proper body weight and educated on how to maintain this way of life.

I assure you, I will only accept the best for you…

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Why Chiropractors Use X-Rays As A Diagnostic Tool For Treatment

Why Chiropractors Use X-Rays As A Diagnostic Tool For Treatment

Most healthcare providers use x-rays as a diagnostic tool to treat a variety of patient complaints, including chiropractors. They can help doctors identify the source of a problem or if there is something more going on. X-rays can also help chiropractors determine the best course of action for treatment. To understand more, let’s take a closer look at what they are and how they’re used in most chiropractic offices.

What are x-rays?

An x-ray is a very vigorous form of electromagnetic radiation that is similar to radio waves, ultraviolet radiation, microwaves, or visible light that is used to view the internal composition of a person or thing. A beam is focused on a specific part of a person’s body, such as the back, it produces a digital image of the skeletal structure.

The beam passes easily through skin and other soft tissues but is unable to pass through bone and teeth. Soft tissue that is denser, such as organs, ligaments, and muscles, will be visible but will be captured in shades of gray. Areas like the bowel or lungs appear on the film as black.

The use of chiropractic x-rays

Chiropractic x-rays provide vital information that can affect how the chiropractor chooses to treat a patient. In some cases, chiropractic care or spinal manipulation may not be an appropriate course of action at that time, and the patient may be started on a different, gentler therapy.

Other times, it can show the chiropractor how to best proceed in treating the patient. In short, patients can receive better, more well-rounded care which can better facilitate their healing and pain management.

Some of the benefits of chiropractic x-rays include:

  • Identify a condition or symptom, such as a spinal tumor or lesion that would provide a medical reason that a specific course of care should not be done.
  • Obtain important biomechanical information that can aid in guiding treatment.
  • To stay apprised and maintain a record of a patient’s degenerative process.
  • Aid in identifying anomalies in the spine and joints that can affect treatment.
  • Allows patients to understand their condition and treatment plan better, allowing them to take ownership of the process and be more involved in their therapy and healing.
x-rays as a diagnostic tool el paso tx.

What does a chiropractor look for on an x-ray film?

When a chiropractor takes an x-ray of a patient, they are looking for things in several particular areas. The first thing they check is to make sure that there are no dislocations, fractures, cancer, infections, tumors, or other potentially dangerous conditions.

They then look for disk height and other signs of disk degeneration, bone density, bone spurs, joint spaces, and alignment. This allows them to identify conditions like scoliosis and other conditions that may require specific forms of treatment.

Many chiropractors prefer that the patient is in a weight-bearing position when taking spinal x-rays. This differs from the majority of medical facilities which have the patient lie down.

The advantage of weight-bearing x-rays as a diagnostic tool is that it allows for measuring, i.e., leg length deficiency, scoliosis, and the narrowing of joint space. It can also show that certain bones, such as the tibia and fibula, are separating which can be an indication of a torn tendon or problem with the joint. A non-weight bearing x-ray cannot provide the same perspective, and vital clues to a patient’s condition may be missed.

Shoulder Pain Treatment

The Basic Science of Human Knee Menisci Structure, Composition, and Function

The Basic Science of Human Knee Menisci Structure, Composition, and Function

The knee is one of the most complex joints in the human body, consisting of the thigh bone, or femur, the shin bone, or tibia, and the kneecap, or patella, among other soft tissues. Tendons connect the bones to the muscles while ligaments connect the bones of the knee joint. Two wedge-shaped pieces of cartilage, known as the meniscus, provide stability to the knee joint. The purpose of the article below is to demonstrate as well as discuss the anatomy of the knee joint and its surrounding soft tissues.

 

Abstract

 

  • Context: Information regarding the structure, composition, and function of the knee menisci has been scattered across multiple sources and fields. This review contains a concise, detailed description of the knee menisci—including anatomy, etymology, phylogeny, ultrastructure and biochemistry, vascular anatomy and neuroanatomy, biomechanical function, maturation and aging, and imaging modalities.
  • Evidence Acquisition: A literature search was performed by a review of PubMed and OVID articles published from 1858 to 2011.
  • Results: This study highlights the structural, compositional, and functional characteristics of the menisci, which may be relevant to clinical presentations, diagnosis, and surgical repairs.
  • Conclusions: An understanding of the normal anatomy and biomechanics of the menisci is a necessary prerequisite to understanding the pathogenesis of disorders involving the knee.
  • Keywords: knee, meniscus, anatomy, function

 

Introduction

 

Once described as a functionless embryonic remnant,162 the menisci are now known to be vital for the normal function and long-term health of the knee joint.§ The menisci increase stability for femorotibial articulation, distribute axial load, absorb shock, and provide lubrication and nutrition to the knee joint.4,91,152,153

 

Injuries to the menisci are recognized as a cause of significant musculoskeletal morbidity. The unique and complex structure of menisci makes treatment and repair challenging for the patient, surgeon, and physical therapist. Furthermore, long-term damage may lead to degenerative joint changes such as osteophyte formation, articular cartilage degeneration, joint space narrowing, and symptomatic osteoarthritis.36,45,92 Preservation of the menisci depends on maintaining their distinctive composition and organization.

 

Anatomy of Menisci

 

Meniscal Etymology

 

The word meniscus comes from the Greek word mēniskos, meaning “crescent,” diminutive of mēnē, meaning “moon.”

 

Meniscal Phylogeny and Comparative Anatomy

 

Hominids exhibit similar anatomic and functional characteristics, including a bicondylar distal femur, intra-articular cruciate ligaments, menisci, and asymmetrical collateral.40,66 These similar morphologic characteristics reflect a shared genetic lineage that can be traced back more than 300 million years.40,66,119

 

In the primate lineage leading to humans, hominids evolved to bipedal stance approximately 3 to 4 million years ago, and by 1.3 million years ago, the modern patellofemoral joint was established (with a longer lateral patellar facet and matching lateral femoral trochlea).164 Tardieu investigated the transition from occasional bipedalism to permanent bipedalism and observed that primates contain a medial and lateral fibrocartilaginous meniscus, with the medial meniscus being morphologically similar in all primates (crescent shaped with 2 tibial insertions).163 By contrast, the lateral meniscus was observed to be more variable in shape. Unique in Homo sapiens is the presence of 2 tibial insertions—1 anterior and 1 posterior—indicating a habitual practice of full extension movements of the knee joint during the stance and swing phases of bipedal walking.20,134,142,163,168

 

Embryology and Development

 

The characteristic shape of the lateral and medial menisci is attained between the 8th and 10th week of gestation.53,60 They arise from a condensation of the intermediate layer of mesenchymal tissue to form attachments to the surrounding joint capsule.31,87,110 The developing menisci are highly cellular and vascular, with the blood supply entering from the periphery and extending through the entire width of the menisci.31 As the fetus continues to develop, there is a gradual decrease in the cellularity of the menisci with a concomitant increase in the collagen content in a circumferential arrangement.30,31 Joint motion and the postnatal stress of weightbearing are important factors in determining the orientation of collagen fibers. By adulthood, only the peripheral 10% to 30% have a blood supply.12,31

 

Despite these histologic changes, the proportion of tibial plateau covered by the corresponding meniscus is relatively constant throughout fetal development, with the medial and lateral menisci covering approximately 60% and 80% of the surface areas, respectively.31

 

Gross Anatomy

 

Gross examination of the knee menisci reveals a smooth, lubricated tissue (Figure 1). They are crescent-shaped wedges of fibrocartilage located on the medial and lateral aspects of the knee joint (Figure 2A). The peripheral, vascular border (also known as the red zone) of each meniscus is thick, convex, and attached to the joint capsule. The innermost border (also known as the white zone) tapers to a thin free edge. The superior surfaces of menisci are concave, enabling effective articulation with their respective convex femoral condyles. The inferior surfaces are flat to accommodate the tibial plateau (Figure 1).28,175

 

image-7.png

 

 

Medial meniscus. The semicircular medial meniscus measures approximately 35 mm in diameter (anterior to posterior) and is significantly broader posteriorly than it is anteriorly.175 The anterior horn is attached to the tibia plateau near the intercondylar fossa anterior to the anterior cruciate ligament (ACL). There is significant variability in the attachment location of the anterior horn of the medial meniscus. The posterior horn is attached to the posterior intercondylar fossa of the tibia between the lateral meniscus and the posterior cruciate ligament (PCL; Figures 1 and and2B).2B). Johnson et al reexamined the tibial insertion sites of the menisci and their topographic relationships to surrounding anatomic landmarks of the knee.82 They found that the anterior and posterior horn insertion sites of the medial meniscus were larger than those of the lateral meniscus. The area of the anterior horn insertion site of the medial meniscus was the largest overall, measuring 61.4 mm2, whereas the posterior horn of the lateral meniscus was the smallest, at 28.5 mm2.82

 

The tibial portion of the capsular attachment is the coronary ligament. At its midpoint, the medial meniscus is more firmly attached to the femur through a condensation in the joint capsule known as the deep medial collateral ligament.175 The transverse, or “intermeniscal,” ligament is a fibrous band of tissue that connects the anterior horn of the medial meniscus to the anterior horn of the lateral meniscus (Figures 1 and and2A2A).

 

Lateral meniscus. The lateral meniscus is almost circular, with an approximately uniform width from anterior to posterior (Figures 1 and and2A).2A). It occupies a larger portion (~80%) of the articular surface than the medial meniscus (~60%) and is more mobile.10,31,165 Both horns of the lateral meniscus are attached to the tibia. The insertion of the anterior horn of the lateral meniscus lies anterior to the intercondylar eminence and adjacent to the broad attachment site of the ACL (Figure 2B).9,83 The posterior horn of the lateral meniscus inserts posterior to the lateral tibial spine and just anterior to the insertion of the posterior horn of the medial meniscus (Figure 2B).83 The lateral meniscus is loosely attached to the capsular ligament; however, these fibers do not attach to the lateral collateral ligament. The posterior horn of the lateral meniscus attaches to the inner aspect of the medial femoral condyle via the anterior and posterior meniscofemoral ligaments of Humphrey and Wrisberg, respectively, which originate near the origin of the PCL (Figures 1 and and22).75

 

Meniscofemoral ligaments. The literature reports significant inconsistencies in the presence and size of meniscofemoral ligaments of the lateral meniscus. There may be none, 1, 2, or 4.‖ When present, these accessory ligaments transverse from the posterior horn of the lateral meniscus to the lateral aspect of the medial femoral condyle. They insert immediately adjacent to the femoral attachment of the PCL (Figures 1 and and22).

 

In a series of studies, Harner et al measured the cross-sectional area of the ligaments and found that the meniscofemoral ligament averaged 20% of the size of the PCL (range, 7%-35%).69,70 However, the size of the insertional area alone without knowledge of the insertional angle or collagen density does not indicate their relative strength.115 The function of these ligaments remains unknown; they may pull the posterior horn of the lateral meniscus in an anterior direction to increase the congruity of the meniscotibial fossa and the lateral femoral condyle.75

 

Ultrastructure and Biochemistry

 

Extracellular Matrix

 

The meniscus is a dense extracellular matrix (ECM) composed primarily of water (72%) and collagen (22%), interposed with cells.9,55,56,77 Proteoglycans, noncollagenous proteins, and glycoproteins account for the remaining dry weight.¶ Meniscal cells synthesize and maintain the ECM, which determines the material properties of the tissue.

 

The cells of the menisci are referred to as fibrochondrocytes because they appear to be a mixture of fibroblasts and chondrocytes.111,177 The cells in the more superficial layer of the menisci are fusiform or spindle shaped (more fibroblastic), whereas the cells located deeper in the meniscus are ovoid or polygonal (more chondrocytic).55,56,178 Cell morphology does not differ between the peripheral and central locations in the menisci.56

 

Both cell types contain abundant endoplasmic reticulum and Golgi complex. Mitochondria are only occasionally visualized, suggesting that the major pathway for energy production of fibrochondrocytes in their avascular milieu is probably anaerobic glycolysis.112

 

Water

 

In normal, healthy menisci, tissue fluid represents 65% to 70% of the total weight. Most of the water is retained within the tissue in the solvent domains of proteoglycans. The water content of meniscal tissue is higher in the posterior areas than in the central or anterior areas; tissue samples from surface and deeper layers had similar contents.135

 

Large hydraulic pressures are required to overcome the drag of frictional resistance of forcing fluid flow through meniscal tissue. Thus, interactions between water and the matrix macromolecular framework significantly influence the viscoelastic properties of the tissue.

 

Collagens

 

Collagens are primarily responsible for the tensile strength of menisci; they contribute up to 75% of the dry weight of the ECM.77 The ECM is composed primarily of type I collagen (90% dry weight) with variable amounts of types II, III, V, and VI.43,44,80,112,181 The predominance of type I collagen distinguishes the fibrocartilage of menisci from articular (hyaline) cartilage. The collagens are heavily cross-linked by hydroxylpyridinium aldehydes.44

 

The collagen fiber arrangement is ideal for transferring a vertical compressive load into circumferential “hoop” stresses (Figure 3).57 Type I collagen fibers are oriented circumferentially in the deeper layers of the meniscus, parallel to the peripheral border. These fibers blend the ligamentous connections of the meniscal horns to the tibial articular surface (Figure 3).10,27,49,156 In the most superficial region of the menisci, the type I fibers are oriented in a more radial direction. Radially oriented “tie” fibers are also present in the deep zone and are interspersed or woven between the circumferential fibers to provide structural integrity (Figure 3).# There is lipid debris and calcified bodies in the ECM of human menisci.54 The calcified bodies contain long, slender crystals of phosphorous, calcium, and magnesium on electron-probe roentgenographic analysis.54 The function of these crystals in not completely understood, but it is believed that they may play a role in acute joint inflammation and destructive arthropathies.

 

 

Noncollagenous matrix proteins, such as fibronectin, contribute 8% to 13% of the organic dry weight. Fibronectin is involved in many cellular processes, including tissue repair, embryogenesis, blood clotting, and cell migration/adhesion. Elastin forms less than 0.6% of the meniscus dry weight; its ultrastructural localization is not clear. It likely interacts directly with collagen to provide resiliency to the tissue.**

 

Proteoglycans

 

Located within a fine meshwork of collagen fibrils, proteoglycans are large, negatively charged hydrophilic molecules, contributing 1% to 2% of dry weight.58 They are formed by a core protein with 1 or more covalently attached glycosaminoglycan chains (Figure 4).122 The size of these molecules is further increased by specific interaction with hyaluronic acid.67,72 The amount of proteoglycans in the meniscus is one-eighth that of articular cartilage,2,3 and there may be considerable variation depending on the site of the sample and the age of the patient.49

 

 

By virtue of their specialized structure, high fixed-charge density, and charge-charge repulsion forces, proteoglycans in the ECM are responsible for hydration and provide the tissue with a high capacity to resist compressive loads.‡ The glycosaminoglycan profile of the normal adult human meniscus consists of chondroitin-6-sulfate (40%), chondroitin-4-sulfate (10% to 20%), dermatan sulfate (20% to 30%), and keratin sulfate (15%; Figure 4).65,77,99,159 The highest glycosaminoglycan concentrations are found in the meniscal horns and the inner half of the menisci in the primary weightbearing areas.58,77

 

Aggrecan is the major proteoglycan found in the human menisci and is largely responsible for their viscoelastic compressive properties (Figure 5). Smaller proteoglycans, such as decorin, biglycan, and fibromodulin, are found in smaller amounts.124,151 Hexosamine contributes 1% to the dry weight of ECM.57,74 The precise functions of each of these small proteoglycans on the meniscus have yet to be fully elucidated.

 

 

Matrix Glycoproteins

 

Meniscal cartilage contains a range of matrix glycoproteins, the identities and functions of which have yet to be determined. Electrophoresis and subsequent staining of the polyacrylamide gels reveals bands with molecular weights varying from a few kilodaltons to more than 200 kDa.112 These matrix molecules include the link proteins that stabilize proteoglycan–hyaluronic acid aggregates and a 116-kDa protein of unknown function.46 This protein resides in the matrix in the form of disulfide-bonded complex of high molecular weight.46 Immunolocalization studies suggest that it is predominantly located around the collagen bundles in the interterritorial matrix.47

 

The adhesive glycoproteins constitute a subgroup of the matrix glycoproteins. These macromolecules are partly responsible for binding with other matrix molecules and/or cells. Such intermolecular adhesion molecules are therefore important components in the supramolecular organization of the extracellular molecules of the meniscus.150 Three molecules have been identified within the meniscus: type VI collagen, fibronectin, and thrombospondin.112,118,181

 

Vascular Anatomy

 

The meniscus is a relatively avascular structure with a limited peripheral blood supply. The medial, lateral, and middle geniculate arteries (which branch off the popliteal artery) provide the major vascularization to the inferior and superior aspects of each meniscus (Figure 5).9,12,33-35,148 The middle geniculate artery is a small posterior branch that perforates the oblique popliteal ligament at the posteromedial corner of the tibiofemoral joint. A premeniscal capillary network arising from the branches of these arteries originates within the synovial and capsular tissues of the knee along the periphery of the menisci. The peripheral 10% to 30% of the medial meniscus border and 10% to 25% of the lateral meniscus are relatively well vascularized, which has important implications for meniscus healing (Figure 6).12,33,68 Endoligamentous vessels from the anterior and posterior horns travel a short distance into the substance of the menisci and form terminal loops, providing a direct route for nourishment.33 The remaining portion of each meniscus (65% to 75%) receives nourishment from synovial fluid via diffusion or mechanical pumping (ie, joint motion).116,120

 

 

Bird and Sweet examined the menisci of animals and humans using scanning electron and light microscopy.23,24 They observed canal-like structures opening deep into the surface of the menisci. These canals may play a role in the transport of fluid within the meniscus and may carry nutrients from the synovial fluid and blood vessels to the avascular sections of the meniscus.23,24 However, further study is needed to elucidate the exact mechanism by which mechanical motion supplies nutrition to the avascular portion of the menisci.

 

Neuroanatomy

 

The knee joint is innervated by the posterior articular branch of the posterior tibial nerve and the terminal branches of the obturator and femoral nerves. The lateral portion of the capsule is innervated by the recurrent peroneal branch of the common peroneal nerve. These nerve fibers penetrate the capsule and follow the vascular supply to the peripheral portion of the menisci and the anterior and posterior horns, where most of the nerve fibers are concentrated.52,90 The outer third of the body of the meniscus is more densely innervated than the middle third.183,184 During extremes of flexion and extension of the knee, the meniscal horns are stressed, and the afferent input is likely greatest at these extreme positions.183,184

 

The mechanoreceptors within the menisci function as transducers, converting the physical stimulus of tension and compression into a specific electrical nerve impulse. Studies of human menisci have identified 3 morphologically distinct mechanoreceptors: Ruffini endings, Pacinian corpuscles, and Golgi tendon organs.‡‡ Type I (Ruffini) mechanoreceptors are low threshold and slowly adapting to the changes in joint deformation and pressure. Type II (Pacinian) mechanoreceptors are low threshold and fast adapting to tension changes.§§ Type III (Golgi) are high-threshold mechanoreceptors, which signal when the knee joint approaches the terminal range of motion and are associated with neuromuscular inhibition. These neural elements were found in greater concentration in the meniscal horns, particularly the posterior horn.

 

The asymmetrical components of the knee act in concert as a type of biological transmission that accepts, transfers, and dissipates loads along the femur, tibia, patella, and femur.41 Ligaments act as an adaptive linkage, with the menisci representing mobile bearings. Several studies have reported that various intra-articular components of the knee are sensate, capable of generating neurosensory signals that reach spinal, cerebellar, and higher central nervous system levels.‖‖ It is believed that these neurosensory signals result in conscious perception and are important for normal knee joint function and maintenance of tissue homeostasis.42

Dr Jimenez White Coat

The meniscus is cartilage which provides structural and functional integrity to the knee. The menisci are two pads of fibrocartilaginous tissue which spread out friction in the knee joint when it undergoes tension and torsion between the shin bone, or tibia, and the thigh bone, or femur. The understanding of the anatomy and biomechanics of the knee joint is essential towards the understanding of knee injuries and/or conditions. Dr. Alex Jimenez D.C., C.C.S.T. Insight

 

Biomechanical Function

 

The biomechanical function of the meniscus is a reflection of the gross and ultrastructural anatomy and of its relationship to the surrounding intra-articular and extra-articular structures. The menisci serve many important biomechanical functions. They contribute to load transmission,¶¶ shock absorption,10,49,94,96,170 stability,51,100,101,109,155 nutrition,23,24,84,141 joint lubrication,102-104,141 and proprioception.5,15,81,88,115,147 They also serve to decrease contact stresses and increase contact area and congruity of the knee.91,172

 

Meniscal Kinematics

 

In a study on ligamentous function, Brantigan and Voshell reported the medial meniscus to move an average 2 mm, while the lateral meniscus was markedly more mobile with approximately 10 mm of anterior-posterior displacement during flexion.25 Similarly, DePalma reported that the medial meniscus undergoes 3 mm of anterior-posterior displacement, while the lateral meniscus moves 9 mm during flexion.37 In a study using 5 cadaveric knees, Thompson et al reported the mean medial excursion to be 5.1 mm (average of anterior and posterior horns) and the mean lateral excursion, 11.2 mm, along the tibial articular surface (Figure 7).165 The findings from these studies confirm a significant difference in segmental motion between the medial and lateral menisci. The anterior and posterior horn lateral meniscus ratio is smaller and indicates that the meniscus moves more as a single unit.165 Alternatively, the medial meniscus (as a whole) moves less than the lateral meniscus, displaying a greater anterior to posterior horn differential excursion. Thompson et al found that the area of least meniscal motion is the posterior medial corner, where the meniscus is constrained by its attachment to the tibial plateau by the meniscotibial portion of the posterior oblique ligament, which has been reported to be more prone to injury.143,165 A reduction in the motion of the posterior horn of the medial meniscus is a potential mechanism for meniscal tears, with a resultant “trapping” of the fibrocartilage between the femoral condyle and the tibial plateau during full flexion. The greater differential between anterior and posterior horn excursion may place the medial meniscus at a greater risk of injury.165

 

 

The differential of anterior horn to posterior horn motion allows the menisci to assume a decreasing radius with flexion, which correlates to the decreased radius of curvature of the posterior femoral condyles.165 This change of radius allows the meniscus to maintain contact with the articulating surface of both the femur and the tibia throughout flexion.

 

Load Transmission

 

The function of the menisci has been clinically inferred by the degenerative changes that accompany its removal. Fairbank described the increased incidence and predictable degenerative changes of the articular surfaces in completely meniscectomized knees.45 Since this early work, numerous studies have confirmed these findings and have further established the important role of the meniscus as a protective, load-bearing structure.

 

Weightbearing produces axial forces across the knee, which compress the menisci, resulting in “hoop” (circumferential) stresses.170 Hoop stresses are generated as axial forces and converted to tensile stresses along the circumferential collagen fibers of the meniscus (Figure 8). Firm attachments by the anterior and posterior insertional ligaments prevent the meniscus from extruding peripherally during load bearing.94 Studies by Seedhom and Hargreaves reported that 70% of the load in the lateral compartment and 50% of the load in the medial compartment is transmitted through the menisci.153 The menisci transmit 50% of compressive load through the posterior horns in extension, with 85% transmission at 90° flexion.172 Radin et al demonstrated that these loads are well distributed when the menisci are intact.137 However, removal of the medial meniscus results in a 50% to 70% reduction in femoral condyle contact area and a 100% increase in contact stress.4,50,91 Total lateral meniscectomy results in a 40% to 50% decrease in contact area and increases contact stress in the lateral component to 200% to 300% of normal.18,50,76,91 This significantly increases the load per unit area and may contribute to accelerated articular cartilage damage and degeneration.45,85

 

 

Shock Absorption

 

The menisci play a vital role in attenuating the intermittent shock waves generated by impulse loading of the knee with normal gait.94,96,153 Voloshin and Wosk showed that the normal knee has a shock-absorbing capacity about 20% higher than knees that have undergone meniscectomy.170 As the inability of a joint system to absorb shock has been implicated in the development of osteoarthritis, the meniscus would appear to play an important role in maintaining the health of the knee joint.138

 

Joint Stability

 

The geometric structure of the menisci provides an important role in maintaining joint congruity and stability.## The superior surface of each meniscus is concave, enabling effective articulation between the convex femoral condyles and flat tibial plateau. When the meniscus is intact, axial loading of the knee has a multidirectional stabilizing function, limiting excess motion in all directions.9

 

Markolf and colleagues have addressed the effect of meniscectomy on anterior-posterior and rotational knee laxity. Medial meniscectomy in the ACL-intact knee has little effect on anterior-posterior motion, but in the ACL-deficient knee, it results in an increase in anterior-posterior tibial translation of up to 58% at 90o of flexion.109 Shoemaker and Markolf demonstrated that the posterior horn of the medial meniscus is the most important structure resisting an anterior tibial force in the ACL-deficient knee.155 Allen et al showed that the resultant force in the medial meniscus of the ACL-deficient knee increased by 52% in full extension and by 197% at 60° of flexion under a 134-N anterior tibial load.7 The large changes in kinematics due to medial meniscectomy in the ACL-deficient knee confirm the important role of the medial meniscus in knee stability. Recently, Musahl et al reported that the lateral meniscus plays a role in anterior tibial translation during the pivot-shift maneuver.123

 

Joint Nutrition and Lubrication

 

The menisci may also play a role in the nutrition and lubrication of the knee joint. The mechanics of this lubrication remains unknown; the menisci may compress synovial fluid into the articular cartilage, which reduces frictional forces during weightbearing.13

 

There is a system of microcanals within the meniscus located close to the blood vessels, which communicates with the synovial cavity; these may provide fluid transport for nutrition and joint lubrication.23,24

 

Proprioception

 

The perception of joint motion and position (proprioception) is mediated by mechanoreceptors that transduce mechanical deformation into electric neural signals. Mechanoreceptors have been identified in the anterior and posterior horns of the menisci.*** Quick-adapting mechanoreceptors, such as Pacinian corpuscles, are thought to mediate the sensation of joint motion, and slow-adapting receptors, such as Ruffini endings and Golgi tendon organs, are believed to mediate the sensation of joint position.140 The identification of these neural elements (located mostly in the middle and outer third of the meniscus) indicates that the menisci are capable of detecting proprioceptive information in the knee joint, thus playing an important afferent role in the sensory feedback mechanism of the knee.61,88,90,158,169

 

Maturation and Aging of The Meniscus

 

The microanatomy of the meniscus is complex and certainly demonstrates senescent changes. With advancing age, the meniscus becomes stiffer, loses elasticity, and becomes yellow.78,95 Microscopically, there is a gradual loss of cellular elements with empty spaces and an increase in fibrous tissue in comparison with elastic tissue.74 These cystic areas can initiate a tear, and with a torsional force by the femoral condyle, the superficial layers of the meniscus may shear off from the deep layer at the interface of the cystic degenerative change, producing a horizontal cleavage tear. Shear between these layers may cause pain. The torn meniscus may directly injure the overlying articular cartilage.74,95

 

Ghosh and Taylor found that collagen concentration increased from birth to 30 years and remained constant until 80 years of age, after which a decline occurred.58 The noncollagenous matrix proteins showed the most profound changes, decreasing from 21.9% ± 1.0% (dry weight) in neonates to 8.1% ± 0.8% between the ages of 30 to 70 years.80 After 70 years of age, the noncollagenous matrix protein levels increased to 11.6% ± 1.3%. Peters and Smillie observed an increase in hexosamine and uronic acid with age.131

 

McNicol and Roughley studied the variation of meniscal proteoglycans in aging113; small differences in extractability and hydrodynamic size were observed. The proportions of keratin sulfate relative to chondroitin-6-sulfate increased with aging.146

 

Petersen and Tillmann immunohistochemically investigated human menisci (ranging from 22 weeks of gestation to 80 years), observing the differentiation of blood vessels and lymphatics in 20 human cadavers. At the time of birth, nearly the entire meniscus was vascularized. In the second year of life, an avascular area developed in the inner circumference. In the second decade, blood vessels were present in the peripheral third. After 50 years of age, only the peripheral quarter of the meniscal base was vascularized. The dense connective tissue of the insertion was vascularized but not the fibrocartilage of the insertion. Blood vessels were accompanied by lymphatics in all areas.†††

 

Arnoczky suggested that body weight and knee joint motion may eliminate blood vessels in the inner and middle aspects of the menisci.9 Nutrition of meniscal tissue occurs via perfusion from blood vessels and via diffusion from synovial fluid. A requirement for nutrition via diffusion is the intermittent loading and release on the articular surfaces, stressed by body weight and muscle forces.130 The mechanism is comparable with the nutrition of articular cartilage.22

 

Magnetic Resonance Imaging of The Meniscus

 

Magnetic resonance imaging (MRI) is a noninvasive diagnostic tool used in the evaluation, diagnosis, and monitoring of the menisci. MRI is widely accepted as the optimal imaging modality because of superior soft tissue contrast.

 

On cross-sectional MRI, the normal meniscus appears as a uniform low-signal (dark) triangular structure (Figure 9). A meniscal tear is identified by the presence of an increased intrameniscal signal that extends to the surface of this structure.

 

 

Several studies have evaluated the clinical utility of MRI for meniscal tears. In general, MRI is highly sensitive and specific for tears of the meniscus. The sensitivity of MRI in detecting meniscal tears ranges from 70% to 98%, and the specificity, from 74% to 98%.48,62,105,107,117 The MRI of 1014 patients before an arthroscopic examination had an accuracy of 89% for pathology of the medial meniscus and 88% for the lateral meniscus.48 A meta-analysis of 2000 patients with an MRI and arthroscopic examination found 88% sensitivity and 94% accuracy for meniscal tears.105,107

 

There have been discrepancies between MRI diagnoses and the pathology identified during arthroscopic examination.‡‡‡ Justice and Quinn reported discrepancies in the diagnosis of 66 of the 561 patients (12%).86 In a study of 92 patients, discrepancies between the MRI and arthroscopic diagnoses were noted in 22 of the 349 (6%) cases.106 Miller conducted a single-blind prospective study comparing clinical examinations and MRI in 57 knee examinations.117 He found no significant difference in sensitivity between the clinical examination and MRI (80.7% and 73.7%, respectively). Shepard et al assessed the accuracy of MRI in detecting clinically significant lesions of the anterior horn of the meniscus in 947 consecutive knee MRI154 and found a 74% false-positive rate. Increased signal intensity in the anterior horn does not necessarily indicate a clinically significant lesion.154

 

Conclusions

 

The menisci of the knee joint are crescent-shaped wedges of fibrocartilage that provide increased stability to the femorotibial articulation, distribute axial load, absorb shock, and provide lubrication to the knee joint. Injuries to the menisci are recognized as a cause of significant musculoskeletal morbidity. Preservation of the menisci is highly dependent on maintaining its distinctive composition and organization.

 

Acknowledgements

 

Ncbi.nlm.nih.gov/pmc/articles/PMC3435920/

 

Footnotes

 

Ncbi.nlm.nih.gov/pmc/articles/PMC3435920/

 

In conclusion, the knee is the largest and most complex joint in the human body. However, because the knee can commonly become damaged as a result of an injury and/or condition, it’s essential to understand the anatomy of the knee joint in order for patients to receive proper treatment.  The scope of our information is limited to chiropractic and spinal health issues. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

 

Curated by Dr. Alex Jimenez

 

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Additional Topic Discussion: Relieving Knee Pain without Surgery

 

Knee pain is a well-known symptom which can occur due to a variety of knee injuries and/or conditions, including sports injuries. The knee is one of the most complex joints in the human body as it is made-up of the intersection of four bones, four ligaments, various tendons, two menisci, and cartilage. According to the American Academy of Family Physicians, the most common causes of knee pain include patellar subluxation, patellar tendinitis or jumper’s knee, and Osgood-Schlatter disease. Although knee pain is most likely to occur in people over 60 years old, knee pain can also occur in children and adolescents. Knee pain can be treated at home following the RICE methods, however, severe knee injuries may require immediate medical attention, including chiropractic care.

 

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EXTRA EXTRA | IMPORTANT TOPIC: El Paso, TX Chiropractor Recommended

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References
1. Adams ME, Hukins DWL. The extracellular matrix of the meniscus. In: Mow VC, Arnoczky SP, Jackson DW, editors. eds. Knee Meniscus: Basic and Clinical Foundations. New York, NY: Raven Press; 1992:15-282016
2. Adams ME, McDevitt CA, Ho A, Muir H. Isolation and characterization of high-buoyant-density proteoglycans from semilunar menisciJ Bone Joint Surg Am. 1986;68:55-64 [PubMed]
3. Adams ME, Muir H. The glycosaminoglycans of canine menisciBiochem J. 1981;197:385-389 [PMC free article] [PubMed]
4. Ahmed AM, Burke DL. In-vitro measurement of static pressure distribution in synovial joints: part I. Tibial surface of the kneeJ Biomech Eng. 1983;185:290-294 [PubMed]
5. Akgun U, Kogaoglu B, Orhan EK, Baslo MB, Karahan M. Possible reflex pathway between medial meniscus and semi-membranous muscle: an experimental study in rabbitsKnee Surg Sports Traumatol Arthrosc. 2008;16(9):809-814 [PubMed]
6. Alberts B, Johnson A, Lewis J, Raff M, Roberts K, Walter P. Molecular Biology of the Cell. 4th ed. Bethesda, MD: National Center for Biotechnology Information; 2002
7. Allen CR, Wong EK, Livesay GA, Sakane M, Fu FH, Woo SL. Importance of the medial meniscus in the anterior cruciate ligament-deficient kneeJ Orthop Res. 2000;18(1):109-115 [PubMed]
8. Arnoczky SP. Building a meniscus: biologic considerationsClin Orthop Relat Res. 1999;367S:244-253[PubMed]
9. Arnoczky SP. Gross and vascular anatomy of the meniscus and its role in meniscal healing, regeneration and remodeling. In: Mow VC, Arnoczky SP, Jackson DW, editors. , eds. Knee Meniscus: Basic and Clinical Foundations. New York, NY: Raven Press; 1992:1-14
10. Arnoczky SP, Adams ME, DeHaven KE, Eyre DR, Mow VC. The meniscus. In: Woo SL-Y, Buckwalter J, editors. , eds. Injury and Repair of Musculoskeletal Soft Tissues. Park Ridge, IL: American Academy of Orthopaedic Surgeons; 1987:487-537
11. Arnoczky SP, Warren RF. Anatomy of the cruciate ligaments. In: Feagin JA, editor. , ed. The Crucial Ligaments. New York, NY: Churchill Livingstone; 1988:179-195
12. Arnoczky SP, Warren RF. Microvasculature of the human meniscusAm J Sports Med. 1982;10:90-95[PubMed]
13. Arnoczky SP, Warren RF, Spivak JM. Meniscal repair using exogenous fibrin clot: an experimental study in dogsJ Bone Joint Surg Am. 1988;70:1209-1217 [PubMed]
14. Aspden RM, Yarker YE, Hukins DWL. Collagen orientations in the meniscus of the knee jointJ Anat. 1985;140:371. [PMC free article] [PubMed]
15. Assimakopoulos AP, Katonis PG, Agapitos MV, Exarchou EI. The innervations of the human meniscusClin Orthop Relat Res. 1992;275:232-236 [PubMed]
16. Atencia LJ, McDevitt CA, Nile WB, Sokoloff L. Cartilage content of an immature dogConnect Tissue Res. 1989;18:235-242 [PubMed]
17. Athanasiou KA, Sanchez-Adams J. Engineering the Knee Meniscus. San Rafael, CA: Morgan & Claypool Publishers; 2009
18. Baratz ME, Fu FH, Mengato R. Meniscal tears: the effect of meniscectomy and of repair on the intraarticular contact areas and stress in the human knee. A preliminary reportAm J Sports Med. 1986;14:270-275 [PubMed]
19. Barrack RL, Skinner HB, Buckley SL. Proprioception in the anterior cruciate deficient kneeAm J Sports Med. 1989;17:1-6 [PubMed]
20. Beaufils P, Verdonk R, editors. , eds. The Meniscus. Heidelberg, Germany: Springer-Verlag; 2010
21. Beaupre A, Choukroun R, Guidouin R, Carneau R, Gerardin H. Knee menisci: correlation between microstructure and biomechanicsClin Orthop Relat Res. 1986;208:72-75 [PubMed]
22. Benninghoff A. Form und Bau der Gelenkknorpel in ihren Beziehungen zur Funktion. Erste Mitteilung: Die modellierenden und formerhaltenden Faktoren des KnorpelreliefsZ Anat Entwickl Gesch. 1925;76:4263
23. Bird MDT, Sweet MBE. Canals of the semilunar meniscus: brief reportJ Bone Joint Surg Br. 1988;70:839. [PubMed]
24. Bird MDT, Sweet MBE. A system of canals in semilunar menisciAnn Rheum Dis. 1987;46:670-673 [PMC free article] [PubMed]
25. Brantigan OC, Voshell AF. The mechanics of the ligaments and menisci of the knee jointJ Bone Joint Surg Am. 1941;23:44-66
26. Brindle T, Nyland J, Johnson DL. The meniscus: review of basic principles with application to surgery and rehabilitationJ Athl Train. 2001;32(2):160-169 [PMC free article] [PubMed]
27. Bullough PG, Munuera L, Murphy J, et al. The strength of the menisci of the knee as it relates to their fine structureJ Bone Joint Surg Br. 1979;52:564-570 [PubMed]
28. Bullough PG, Vosburgh F, Arnoczky SP, et al. The menisci of the knee. In: Insall JN, editor. , ed. Surgery of the Knee. New York, NY: Churchill Livingstone; 1984:135-149
29. Burr DB, Radin EL. Meniscal function and the importance of meniscal regeneration in preventing late medial compartment osteoarthrosisClin Orthop Relat Res. 1982;171:121-126 [PubMed]
30. Carney SL, Muir H. The structure and function of cartilage proteoglycansPhysiol Rev. 1988;68:858-910 [PubMed]
31. Clark CR, Ogden JA. Development of the menisci of the human knee jointJ Bone Joint Surg Am. 1983;65:530 [PubMed]
32. Clark FJ, Horsh KW, Bach SM, Larson GF. Contributions of cutaneous and joint receptors to static knee-position sense in manJ Neurophysiol. 1979;42:877-888 [PubMed]
33. Danzig L, Resnik D, Gonsalves M, Akeson WH. Blood supply to the normal and abnormal meniscus of the human kneeClin Orthop Relat Res. 1983;172:271-276 [PubMed]
34. Davies D, Edwards D. The vascular and nerve supply of the human meniscusAm R Coll Surg Engl. 1948;2:142-156
35. Day B, Mackenzie WG, Shim SS, Leung G. The vascular and nerve supply of the human meniscusArthroscopy. 1985;1:58-62 [PubMed]
36. DeHaven KE. Meniscectomy versus repair: clinical experience. In: Mow VC, Arnoczky SP, Jackson DW, editors. , eds. Knee Meniscus: Basic and Clinical Foundations. New York, NY: Raven Press; 1992:131-139
37. DePalma AF. Diseases of the Knee. Philadelphia, PA: JB Lippincott Co; 1954
38. De Smet AA, Graf BK. Meniscal tears missed on MR imaging: relationship to meniscal tear patterns and anterior cruciate ligament tearsAJR Am J Roentgenol. 1994;162:905-911 [PubMed]
39. De Smet AA, Norris MA, Yandow DR, et al. MR diagnosis of meniscal tears of the knee: importance of high signal in the meniscus that extends to the surfaceAJR Am J Roentgenol. 1993;161:101-107[PubMed]
40. Dye SF. Functional morphologic features of the human knee: an evolutionary perspectiveClin Orthop Relat Res. 2003;410:19-24 [PubMed]
41. Dye SF. The knee as a biologic transmission with an envelope of function: a theoryClin Orthop Relat Res. 1996;325:10-18 [PubMed]
42. Dye SF, Vaupel GL, Dye CC. Conscious neurosensory mapping of the internal structures of the human knee without intraarticular anesthesiaAm J Sports Med. 1998;26(6):773-777 [PubMed]
43. Eyre DR, Koob TJ, Chun LE. Biochemistry of the meniscus: unique profile of collagen types and site dependent variations in compositionOrthop Trans. 1983;8:56
44. Eyre DR, Wu JJ. Collagen of fibrocartilage: a distinctive molecular phenotype in bovine meniscusFEBS Lett. 1983;158:265. [PubMed]
45. Fairbank TJ. Knee joint changes after meniscectomyJ Bone Joint Surg Br. 1948;30:664-670[PubMed]
46. Fife RS. Identification of the link proteins and a 116,000-dalton matrix protein in canine meniscusArch Biochem Biophys. 1985;240:682. [PubMed]
47. Fife RS, Hook GL, Brandt KD. Topographic localization of a 116,000 dalton protein in cartilageJ Histochem Cytochem. 1985;33:127. [PubMed]
48. Fischer SP, Fox JM, Del Pizzo W, et al. Accuracy of diagnoses from magnetic resonance imaging of the knee: a multi-center analysis of one thousand and fourteen patientsJ Bone Joint Surg Am. 1991;73:2-10[PubMed]
49. Fithian DC, Kelly MA, Mow VC. Material properties and structure-function relationships in the menisciClin Orthop Relat Res. 1990;252:19-31 [PubMed]
50. Fukubayashi T, Kurosawa H. The contact area and pressure distribution pattern of the knee: a study of normal and osteoarthritic knee jointsActa Orthop Scand. 1980;51:871-879 [PubMed]
51. Fukubayashi T, Torzilli PA, Sherman MF, Warren RF. An in vivo biomechanical analysis of anterior-posterior motion of the knee, tibial displacement rotation and torqueJ Bone Joint Surg Am. 1982;64:258-264 [PubMed]
52. Gardner E. The innervations of the knee jointAnat Rec. 1948;101:109-130 [PubMed]
53. Gardner E, O’Rahilly R. The early development of the knee joint in staged human embryosJ Anat. 1968;102:289-299 [PMC free article] [PubMed]
54. Ghadially FN, LaLonde JMA. Intramatrical lipidic debris and calcified bodes in human semilunar cartilagesJ Anat. 1981;132:481. [PMC free article] [PubMed]
55. Ghadially FN, LaLonde JMA, Wedge JH. Ultrastructure of normal and torn menisci of the human knee jointJ Anat. 1983;136:773-791 [PMC free article] [PubMed]
56. Ghadially FN, Thomas I, Yong N, LaLonde JMA. Ultrastructure of rabbit semilunar cartilageJ Anat. 1978;125:499. [PMC free article] [PubMed]
57. Ghosh P, Ingman AM, Taylor TK. Variations in collagen, non-collagenous proteins, and hexosamine in menisci derived from osteoarthritic and rheumatoid arthritic knee jointsJ Rheumatol. 1975;2:100-107[PubMed]
58. Ghosh P, Taylor TKF. The knee joint meniscus: a fibrocartilage of some distinctionClin Orthop Relat Res. 1987;224:52-63 [PubMed]
59. Ghosh P, Taylor TKF, Pettit GD, Horsburgh BA, Bellenger CR. Effect of postoperative immobilization on the regrowth of knee joint semilunar cartilage: an experimental studyJ Orthop Res. 1983;1:153.[PubMed]
60. Gray DJ, Gardner E. Pre-natal development of the human knee and superior tibial fibula jointsAm J Anat. 1950;86:235-288 [PubMed]
61. Gray JC. Neural and vascular anatomy of the menisci of the human kneeJ Orthop Sports Phys Ther. 1999;29(1):23-30 [PubMed]
62. Gray SD, Kaplan PA, Dussault RG. Imaging of the knee: current statusOrthop Clin North Am. 1997;28:643-658 [PubMed]
63. Greis PE, Bardana DD, Holmstrom MC, Burks RT. Meniscal injury: I. Basic science and evaluationJ Am Acad Orthop Surg. 2002;10:168-176 [PubMed]
64. Gronblad M, Korkala O, Liesi P, Karaharju E. Innervation of synovial membrane and meniscusActa Orthop Scand. 1985;56:484-486 [PubMed]
65. Habuchi H, Yamagata T, Iwata H, Suzuki S. The occurrence of a wide variety of dermatan sulfate-chondroitin sulfate copolymers in fibrous cartilageJ Biol Chem. 1973;248:6019-6028 [PubMed]
66. Haines RW. The tetrapod knee jointJ Anat. 1942;76:270-301 [PMC free article] [PubMed]
67. Hardingham TE, Muir H. Binding of oligosaccharides of hyaluronic acid to proteoglycansBiochem J. 1973;135 (4):905-908 [PMC free article] [PubMed]
68. Harner CD, Janaushek MA, Kanamori A, Yagi AKM, Vogrin TM, Woo SL. Biomechanical analysis of a double-bundle posterior cruciate ligament reconstructionAm J Sports Med. 2000;28:144-151 [PubMed]
69. Harner CD, Kusayama T, Carlin G, et al. Structural and mechanical properties of the human posterior cruciate ligament and meniscofemoral ligaments. In: Transactions of the 40th Annual Meeting of the Orthopaedic Research Society; 1992
70. Harner CD, Livesgay GA, Choi NY, et al. Evaluation of the sizes and shapes of the human anterior and posterior cruciate ligaments: a comparative studyTrans Orthop Res Soc. 1992;17:123
71. Hascall VC. Interaction of cartilage proteoglycans with hyaluronic acidJ Supramol Struct. 1977;7:101-120 [PubMed]
72. Hascall VC, Heinegård D. Aggregation of cartilage proteoglycans: I. The role of hyaluronic acidJ Biol Chem. 1974;249(13):4205-4256 [PubMed]
73. Heinegard D, Oldberg A. Structure and biology of cartilage and bone matrix noncollagenous macromoleculesFASEB J. 1989;3:2042-2051 [PubMed]
74. Helfet AJ. Osteoarthritis of the knee and its early arrestInstr Course Lect. 1971;20:219-230
75. Heller L, Langman J. The meniscofemoral ligaments of the human kneeJ Bone Joing Surg Br. 1964;46:307-313 [PubMed]
76. Henning CE, Lynch MA, Clark JR. Vascularity for healing of meniscal repairsArthroscopy. 1987;3:13-18 [PubMed]
77. Herwig J, Egner E, Buddecke E. Chemical changes of human knee joint menisci in various stages of degenerationAnn Rheum Dis. 1984;43:635-640 [PMC free article] [PubMed]
78. Höpker WW, Angres G, Klingel K, Komitowksi D, Schuchardt E. Changes of the elastin compartment in the human meniscusVirchows Arch A Pathol Anat Histopathol. 1986;408:575-592 [PubMed]
79. Humphry GM. A Treatise on the Human Skeleton Including the Joints. Cambridge, UK: Macmillan; 1858:545-546
80. Ingman AM, Ghosh P, Taylor TKF. Variation of collagenous and non-collagenous proteins of human knee joint menisci with age and degenerationGerontologia. 1974;20:212-233 [PubMed]
81. Jerosch J, Prymka M, Castro WH. Proprioception of the knee joints with a lesion of the medial meniscusActa Orthop Belg. 1996;62(1):41-45 [PubMed]
82. Johnson DL, Swenson TD, Harner CD. Arthroscopic meniscal transplantation: anatomic and technical considerations. Presented at: Nineteenth Annual Meeting of the American Orthopaedic Society for Sports Medicine; July 12-14, 1993; Sun Valley, ID
83. Johnson DL, Swenson TM, Livesay GA, Aizawa H, Fu FH, Harner CD. Insertion-site anatomy of the human menisci: gross, arthroscopic, and topographical anatomy as a basis for meniscal transplantationArthroscopy. 1995;11:386-394 [PubMed]
84. Johnson RJ, Pope MH. Functional anatomy of the meniscus. In: Symposium on Reconstruction of the Knee of the American Academy of Orthopaedic Surgeons. St Louis, MO: Mosby; 1978:3
85. Jones RE, Smith EC, Reisch JS. Effects of medial meniscectomy in patients older than forty yearsJ Bone Joint Surg Am. 1978;60:783-786 [PubMed]
86. Justice WW, Quinn SF. Error patterns in the MR imaging evaluation of the menisci of the kneeRadiology. 1995;196:617-621 [PubMed]
87. Kaplan EB. The embryology of the menisci of the knee jointBull Hosp Joint Dis. 1955;6:111-124[PubMed]
88. Karahan M, Kocaoglu B, Cabukoglu C, Akgun U, Nuran R. Effect of partial medial meniscectomy on the proprioceptive function of the kneeArch Orthop Trauma Surg. 2010;130:427-431 [PubMed]
89. Kempson GE, Tuke MA, Dingle JT, Barrett AJ, Horsfield PH. The effects of proteolytic enzymes on the mechanical properties of adult human articular cartilageBiochim Biophys Acta. 1976;428(3):741-760[PubMed]
90. Kennedy JC, Alexander IJ, Hayes KC. Nerve supply of the human knee and its functional importanceAm J Sports Med. 1982;10:329-335 [PubMed]
91. Kettelkamp DB, Jacobs AW. Tibiofemoral contact area: determination and implicationsJ Bone Joint Surg Am. 1972;54:349-356 [PubMed]
92. King D. The function of the semilunar cartilagesJ Bone Joint Surg Br. 1936;18:1069-1076
93. Kohn D, Moreno B. Meniscus insertion anatomy as a basis for meniscus replacement: a morphological cadaveric studyArthroscopy. 1995;11:96-103 [PubMed]
94. Krause WR, Pope MH, Johnson RJ, Wilder DG. Mechanical changes in the knee after meniscectomyJ Bone Joint Surg Am. 1976;58:599-604 [PubMed]
95. Kulkarni VV, Chand K. Pathological anatomy of the aging meniscusActa Orthop Scand. 1975;46:135-140 [PubMed]
96. Kurosawa H, Fukubayashi T, Nakajima H. Load-bearing mode of the knee joint: physical behavior of the knee joint with or without menisciClin Orthop Relat Res. 1980;149:283-290 [PubMed]
97. LaPrade RF, Burnett QM, II, Veenstra MA, et al. The prevalence of abnormal magnetic resonance imaging findings in asymptomatic knees: with correlation of magnetic resonance imaging to arthroscopic finding in symptomatic kneesAm J Sports Med. 1994;22:739-745 [PubMed]
98. Last RJ. Some anatomical details of the knee jointJ Bone Joint Surg Br. 1948;30:368-688 [PubMed]
99. Lehtonen A, Viljanto J, Kärkkäinen J. The mucopolysaccharides of herniated human intervertebral discs and semilunar cartilagesActa Chir Scand. 1967;133(4):303-306 [PubMed]
100. Levy IM, Torzilli PA, Warren RF. The effect of lateral meniscectomy on motion of the kneeJ Bone Joint Surg Am. 1989;71:401-406 [PubMed]
101. Levy IM, Torzilli PA, Warren RF. The effect of medial meniscectomy on anterior-posterior motion of the kneeJ Bone Joint Surg Am. 1982;64:883-888 [PubMed]
102. MacConaill MA. The function of intra-articular fibrocartilages with special reference to the knee and inferior radio-ulnar jointsJ Anat. 1932;6:210-227 [PMC free article] [PubMed]
103. MacConaill MA. The movements of bones and joints: III. The synovial fluid and its assistantsJ Bone Joint Surg Br. 1950;32:244. [PubMed]
104. MacConaill MA. Studies in the mechanics of synovial joints: II. Displacements on articular surfaces and the significance of saddle jointsIr J Med Sci. 1946;6:223-235 [PubMed]
105. Mackenzie R, Dixon AK, Keene GS, et al. Magnetic resonance imaging of the knee: assessment of effectivenessClin Radiol. 1996;41:245-250 [PubMed]
106. Mackenzie R, Keene GS, Lomas DJ, Dixon AK. Errors at knee magnetic resonance imaging: true or false? Br J Radiol. 1995;68:1045-1051 [PubMed]
107. Mackenzie R, Palmer CR, Lomas DJ, et al. Magnetic resonance imaging of the knee: diagnostic performance studiesClin Radiol. 1996;51:251-257 [PubMed]
108. Markolf KL, Bargar WL, Shoemaker SC, Amstutz HC. The role of joint load in knee instabilityJ Bone Joint Surg Am. 1981;63:570-585 [PubMed]
109. Markolf KL, Mensch JS, Amstutz HC. Stiffness and laxity of the knee: the contributions of the supporting structuresJ Bone Joint Surg Am. 1976;58:583-597 [PubMed]
110. McDermott LJ. Development of the human knee jointArch Surg. 1943;46:705-719
111. McDevitt CA, Miller RR, Sprindler KP. The cells and cell matrix interaction of the meniscus. In: Mow VC, Arnoczky SP, Jackson DW, editors. , eds. Knee Meniscus: Basic and Clinical Foundations. New York, NY: Raven Press; 1992:29-36
112. McDevitt CA, Webber RJ. Ultrastructure and biochemistry of meniscal cartilageClin Orthop Relat Res. 1990;252:8-18 [PubMed]
113. McNicol D, Roughley PJ. Extraction and characterization of proteoglycan from human meniscusBiochem J. 1980;185:705. [PMC free article] [PubMed]
114. Merkel KHH. The surface of human menisci and its aging alterations during age: a combined scanning and transmission electron microscopic examination (SEM, TEM)Arch Orthop Trauma Surg. 1980;97:185-191 [PubMed]
115. Messner K, Gao J. The menisci of the knee joint: anatomical and functional characteristics, and a rationale for clinical treatmentJ Anat. 1998;193:161-178 [PMC free article] [PubMed]
116. Meyers E, Zhu W, Mow V. Viscoelastic properties of articular cartilage and meniscus. In: Nimni M, editor. , ed. Collagen: Chemistry, Biology and Biotechnology. Boca Raton, FL: CRC; 1988
117. Miller GK. A prospective study comparing the accuracy of the clinical diagnosis of meniscal tear with magnetic resonance imaging and its effect on clinical outcomeArthroscopy. 1996;12:406-413 [PubMed]
118. Miller GK, McDevitt CA. The presence of thrombospondin in ligament, meniscus and intervertebral discGlycoconjugate J. 1988;5:312
119. Mossman DJ, Sargeant WAS. The footprints of extinct animalsSci Am. 1983;250:78-79
120. Mow V, Fithian D, Kelly M. Fundamentals of articular cartilage and meniscus biomechanics. In: Ewing JW, editor. , ed. Articular Cartilage and Knee Joint Function: Basic Science and Arthroscopy. New York, NY: Raven Press; 1989:1-18
121. Mow VC, Holmes MH, Lai WM. Fluid transport and mechanical properties or articular cartilage: a reviewJ Biomech. 1984;17:377. [PubMed]
122. Muir H. The structure and metabolism of mucopolysaccharides (glycosaminoglycans) and the problem of the mucopolysaccharidosesAm J Med. 1969;47 (5):673-690 [PubMed]
123. Musahl V, Citak M, O’Loughlin PF, Choi D, Bedi A, Pearle AD. The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient kneeAm J Sports Med. 2010;38(8):1591-1597 [PubMed]
124. Nakano T, Dodd CM, Scott PG. Glycosaminoglycans and proteoglycans from different zones of the porcine knee meniscusJ Orthop Res. 1997;15:213-222 [PubMed]
125. Newton RA. Joint receptor contributions to reflective and kinaesthetic responsesPhys Ther. 1982;62:22-29 [PubMed]
126. O’Connor BL. The histological structure of the dog knee menisci with comments on its possible significanceAm J Anat. 1976;147:407-417 [PubMed]
127. O’Connor BL, McConnaughey JS. The structure and innervation of cat knee menisci, and their relation to a “sensory hypothesis” of meniscal functionAm J Anat. 1978;153:431-442 [PubMed]
128. Oretorp N, Gillquist J, Liljedahl S-O. Long term results of surgery for non-acute anteromedial rotatory instability of the kneeActa Orthop Scand. 1979;50:329-336 [PubMed]
129. Pagnani MJ, Warren RF, Arnoczky SP, Wickiewicz TL. Anatomy of the knee. In: Nicholas JA, Hershman EB, editors. , eds. The Lower Extremity and Spine in Sports Medicine. 2nd ed. St Louis, MO: Mosby; 1995:581-614
130. Pauwels F. [Developmental effects of the functional adaptation of bone]Anat Anz. 1976;139:213-220[PubMed]
131. Peters TJ, Smillie IS. Studies on the chemical composition of the menisci of the knee joint with special reference to the horizontal cleavage lesionClin Orthop Relat Res. 1972;86:245-252 [PubMed]
132. Petersen W, Tillmann B. Collagenous fibril texture of the human knee joint menisciAnat Embryol (Berl). 1998;197:317-324 [PubMed]
133. Poynton AR, Javadpour SM, Finegan PJ, O’Brien M. The meniscofemoral ligaments of the kneeJ Bone Joint Surg Br. 1997;79:327-330 [PubMed]
134. Preuschoft H, Tardieu C. Biomechanical reasons for divergent morphology of the knee joint and the distal epiphyseal suture in hominoidsFolia Primatol (Basel). 1996;66:82-92 [PubMed]
135. Proctor CS, Schmidt MB, Whipple RR, Kelly MA, Mow VC. Material properties of the normal medial bovine meniscusJ Orthop Res. 1989;7:771-782 [PubMed]
136. Proske U, Schaible H, Schmidt RF. Joint receptors and kinanesthesiaExp Brain Res. 1988;72:219-224 [PubMed]
137. Radin EL, de Lamotte F, Maquet P. Role of the menisci in the distribution of stress in the kneeClin Orthop Relat Res. 1984;185:290-294 [PubMed]
138. Radin EL, Rose RM. Role of subchondral bone in the initiation and progression of cartilage damageClin Orthop Relat Res. 1986;213:34-40 [PubMed]
139. Raszeja F. Untersuchungen Bber Entstehung und feinen Bau des KniegelenkmeniskusBruns Beitr klin Chir. 1938;167:371-387
140. Reider B, Arcand MA, Diehl LH, et al. Proprioception of the knee before and after anterior cruciate ligament reconstructionArthroscopy. 2003;19(1):2-12 [PubMed]
141. Renstrom P, Johnson RJ. Anatomy and biomechanics of the menisciClin Sports Med. 1990;9:523-538 [PubMed]
142. Retterer E. De la forme et des connexions que presentment les fibro-cartilages du genou chez quelques singes d’AfriqueCr Soc Biol. 1907;63:20-25
143. Ricklin P, Ruttimann A, Del Bouno MS. Diagnosis, Differential Diagnosis and Therapy. 2nd ed. Stuttgart, Germany: Verlag Georg Thieme; 1983
144. Rodkey WG. Basic biology of the meniscus and response to injury. In: Price CT, editor. , ed. Instructional Course Lectures 2000. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2000:189-193 [PubMed]
145. Rosenberg LC, Buckwalter JA, Coutts R, Hunziker E, Mow VC. Articular cartilage. In: Woo SLY, Buckwalter JA, editors. , eds. Injury and Repair of the Musculoskeletal Soft Tissues. Park Ridge, IL: American Academy of Orthopaedic Surgeon; 1988:401
146. Roughley PJ. Changes in cartilage proteoglycan structure during aging: origin and effects: a reviewAgents Actions. 1986;518:19 [PubMed]
147. Saygi B, Yildirim Y, Berker N, Ofluoglu D, Karadag-Saygi E, Karahan M. Evaluation of neurosensory function of the medial meniscus in humansArthroscopy. 2005;21(12):1468-1472 [PubMed]
148. Scapinelli R. Studies on the vasculature of the human knee jointActa Anat. 1968;70:305-331[PubMed]
149. Schutte MJ, Dabezius EJ, Zimny ML, Happe LT. Neural anatomy of the human anterior cruciate ligamentJ Bone Joint Surg Am. 1987;69:243-247 [PubMed]
150. Scott JE. Supramolecular organization of extracellular matrix glycosaminoglycans, in vitro and in the tissuesFASEB J. 1992;6:2639-2645 [PubMed]
151. Scott PG, Nakano T, Dodd CM. Isolation and characterization of small proteoglycans from different zones of the porcine knee meniscusBiochim Biophys Acta. 1997;1336:254-262 [PubMed]
152. Seedhom BB. Loadbearing function of the menisciPhysiotherapy. 1976;62(7):223. [PubMed]
153. Seedhom BB, Hargreaves DJ. Transmission of the load in the knee joint with special reference to the role in the menisci: part II. Experimental results, discussion and conclusionEng Med. 1979;8:220-228
154. Shepard MF, Hunter DM, Davies MR, Shapiro MS, Seeger LL. The clinical significance of anterior horn meniscal tears diagnosed on magnetic resonance imagesAm J Sports Med. 2002;30(2):189-192[PubMed]
155. Shoemaker SC, Markolf KL. The role of the meniscus in the anterior-posterior stability of the loaded anterior cruciate-deficient knee: effects of partial versus total excisionJ Bone Joint Surg Am. 1986;68(1):71-79 [PubMed]
156. Skaags DL, Mow VC. Function of the radial tie fibers in the meniscusTrans Orthop Res Soc. 1990;15:248
157. Skinner HB, Barrack RL. Joint position sense in the normal and pathologic knee jointJ Electromyogr Kinesiol. 1991;1(3):180-190 [PubMed]
158. Skinner HB, Barrack RL, Cook SD. Age-related decline in proprioceptionClin Orthop Relat Res. 1984;184:208-211 [PubMed]
159. Solheim K. Glycosaminoglycans, hydroxyproline, calcium, and phosphorus in healing fracturesActa Univ Lund. 1965;28:1-22
160. Spilker RL, Donzelli PS. A biphasic finite element model of the meniscus for stress-strain analysis. In: Mow VC, Arnoczky SP, Jackson DW, editors. , eds. Knee Meniscus: Basic and Clinical Foundations. New York, NY: Raven Press; 1992:91-106
161. Spilker RL, Donzelli PS, Mow VC. A transversely isotropic biphasic finite element model of the meniscusJ Biomechanics. 1992;25:1027-1045 [PubMed]
162. Sutton JB. Ligaments: Their Nature and Morphology. 2nd ed. London: HK Lewis; 1897
163. Tardieu C. Ontogeny and phylogeny of femoral-tibial characters in humans and hominid fossils: functional influence and genetic determinismAm J Phys Anthropol. 1999;110:365-377 [PubMed]
164. Tardieu C, Dupont JY. The origin of femoral trochlear dysplasia: comparative anatomy, evolution, and growth of the patellofemoral jointRev Chir Orthop Reparatrice Appar Mot. 2001;87:373-383 [PubMed]
165. Thompson WO, Thaete FL, Fu FH, Dye SF. Tibial meniscal dynamics using three-dimensional reconstruction of magnetic resonance imagingAm J Sports Med. 1991;19:210-216 [PubMed]
166. Tissakht M, Ahmed AM. Tensile stress-strain characteristics of the human meniscal materialJ Biomech. 1995;28:411-422 [PubMed]
167. Tobler T. Zur normalen und pathologischen Histologie des KniegelenkmeniscusArch Klin Chir. 1933;177:483-495
168. Vallois H. Etude anatomique de l’articulation du genou chez les primates. Montpelier, France: L’Abeille; 1914
169. Verdonk R, Aagaard H. Function of the normal meniscus and consequences of the meniscal resectionScand J Med Sci Sports. 1999;9(3):134-140 [PubMed]
170. Voloshin AS, Wosk J. Shock absorption of meniscectomized and painful knees: a comparative in vivo studyJ Biomed Eng. 1983;5:157-161 [PubMed]
171. Wagner H-J. Die kollagenfaserarchitecktur der menisken des menschlichen kniegelenkesZ Mikrosk Anat Forsch. 1976;90:302. [PubMed]
172. Walker PS, Erkman MJ. The role of the meniscus in force transmission across the kneeClin Orthop Relat Res. 1975;109:184-192 [PubMed]
173. Wan ACT, Felle P. The menisco-femoral ligamentsClin Anat. 1995;8:323-326 [PubMed]
174. Warren PJ, Olanlokun TK, Cobb AG, Bentley G. Proprioception after knee arthroplasty: the influence of prosthetic designClin Orthop Relat Res. 1993;297:182-187 [PubMed]
175. Warren RF, Arnoczky SP, Wickiewiez TL. Anatomy of the knee. In: Nicholas JA, Hershman EB, editors. , eds. The Lower Extremity and Spine in Sports Medicine. St Louis: Mosby; 1986:657-694
176. Watanabe AT, Carter BC, Teitelbaum GP, et al. Common pitfalls in magnetic resonance imaging of the kneeJ Bone Joint Surg Am. 1989;71:857-862 [PubMed]
177. Webber RJ, Norby DP, Malemud CJ, Goldberg VM, Moskowitz RW. Characterization of newly synthesized proteoglycans from rabbit menisci in organ cultureBiochem J. 1984;221(3):875-884 [PMC free article] [PubMed]
178. Webber RJ, York JL, Vanderschildren JL, Hough AJ. An organ culture model for assaying wound repair of the fibrocartilaginous knee joint meniscusAm J Sports Med. 1989;17:393-400 [PubMed]
179. Wilson AS, Legg PG, McNeu JC. Studies on the innervations of the medial meniscus in the human knee jointAnat Rec. 1969;165:485-492 [PubMed]
180. Wirth CJ. The meniscus: structure, morphology and functionKnee. 1996;3:57-58
181. Wu JJ, Eyre DR, Slayter HS. Type VI collagen of the intervertebral disc: biochemical and electron microscopic characterization of the native proteinBiochem J. 1987;248:373. [PMC free article] [PubMed]
182. Yasui K. Three dimensional architecture of normal human menisciJ Jpn Ortho Assoc. 1978;52:391
183. Zimny ML. Mechanoreceptors in articular tissuesAm J Anat. 1988;64:883-888
184. Zimny ML, Albright DJ, Dabezies E. Mechanoreceptors in the human medial meniscusActa Anat. 1988;133:35-40 [PubMed]
185. Zivanovic S. Menisco-meniscal ligaments of the human knee jointAnat Anz. 1974;145:35-42[PubMed]
Close Accordion

Evaluation of Patients Presenting with Knee Pain: Part II. Differential Diagnosis

Evaluation of Patients Presenting with Knee Pain: Part II. Differential Diagnosis

The knee is the largest joint in the human body, where the complex structures of the lower and upper legs come together. Consisting of three bones, the femur, the tibia, and the patella which are surrounded by a variety of soft tissues, including cartilage, tendons and ligaments, the knee functions as a hinge, allowing you to walk, jump, squat or sit. As a result, however, the knee is considered to be one of the joints that are most prone to suffer injury. A knee injury is the prevalent cause of knee pain.

A knee injury can occur as a result of a direct impact from a slip-and-fall accident or automobile accident, overuse injury from sports injuries, or even due to underlying conditions, such as arthritis. Knee pain is a common symptom which affects people of all ages. It may also start suddenly or develop gradually over time, beginning as a mild or moderate discomfort then slowly worsening as time progresses. Moreover, being overweight can increase the risk of knee problems. The purpose of the following article is to discuss the evaluation of patients presenting with knee pain and demonstrate their differential diagnosis.

Abstract

Knee pain is a common presenting complaint with many possible causes. An awareness of certain patterns can help the family physician identify the underlying cause more efficiently. Teenage girls and young women are more likely to have patellar tracking problems such as patellar subluxation and patellofemoral pain syndrome, whereas teenage boys and young men are more likely to have knee extensor mechanism problems such as tibial apophysitis (Osgood-Schlatter lesion) and patellar tendonitis. Referred pain resulting from hip joint pathology, such as slipped capital femoral epiphysis, also may cause knee pain. Active patients are more likely to have acute ligamentous sprains and overuse injuries such as pes anserine bursitis and medial plica syndrome. Trauma may result in acute ligamentous rupture or fracture, leading to acute knee joint swelling and hemarthrosis. Septic arthritis may develop in patients of any age, but crystal-induced inflammatory arthropathy is more likely in adults. Osteoarthritis of the knee joint is common in older adults. (Am Fam Physician 2003;68:917-22. Copyright© 2003 American Academy of Family Physicians.)

Introduction

Determining the underlying cause of knee pain can be difficult, in part because of the extensive differential diagnosis. As discussed in part I of this two-part article,1 the family physician should be familiar with knee anatomy and common mechanisms of injury, and a detailed history and focused physical examination can narrow possible causes. The patient’s age and the anatomic site of the pain are two factors that can be important in achieving an accurate diagnosis (Tables 1 and 2).  

 

Table 1 Common Causes of Knee Pain

 

Children and Adolescents

Children and adolescents who present with knee pain are likely to have one of three common conditions: patellar subluxation, tibial apophysitis, or patellar tendonitis. Additional diagnoses to consider in children include slipped capital femoral epiphysis and septic arthritis.

Patellar Subluxation

Patellar subluxation is the most likely diagnosis in a teenage girl who presents with giving-way episodes of the knee.2 This injury occurs more often in girls and young women because of an increased quadriceps angle (Q angle), usually greater than 15 degrees.

Patellar apprehension is elicited by subluxing the patella laterally, and a mild effusion is usually present. Moderate to severe knee swelling may indicate hemarthrosis, which suggests patellar dislocation with osteochondral fracture and bleeding.

Tibial Apophysitis

A teenage boy who presents with anterior knee pain localized to the tibial tuberosity is likely to have tibial apophysitis or Osgood- Schlatter lesion3,4 (Figure 1).5 The typical patient is a 13- or 14-year-old boy (or a 10- or 11-year-old girl) who has recently gone through a growth spurt.

The patient with tibial apophysitis generally reports waxing and waning of knee pain for a period of months. The pain worsens with squatting, walking up or down stairs, or forceful contractions of the quadriceps muscle. This overuse apophysitis is exacerbated by jumping and hurdling because repetitive hard landings place excessive stress on the insertion of the patellar tendon.

On physical examination, the tibial tuberosity is tender and swollen and may feel warm. The knee pain is reproduced with the resisted active extension or passive hyperflexion of the knee. No effusion is present. Radiographs are usually negative; rarely, they show avulsion of the apophysis at the tibial tuberosity. However, the physician must not mistake the normal appearance of the tibial apophysis for an avulsion fracture.  

 

Table 2 Differential Diagnosis of Knee Pain

 

Figure 1 Anterior View of the Structures of the Knee

 

Patellar Tendonitis

Jumper’s knee (irritation and inflammation of the patellar tendon) most commonly occurs in teenage boys, particularly during a growth spurt2 (Figure 1).5 The patient reports vague anterior knee pain that has persisted for months and worsens after activities such as walking down stairs or running.

On physical examination, the patellar tendon is tender, and the pain is reproduced by resisted knee extension. There is usually no effusion. Radiographs are not indicated.

Slipped Capital Femoral Epiphysis

A number of pathologic conditions result in referral of pain to the knee. For example, the possibility of slipped capital femoral epiphysis must be considered in children and teenagers who present with knee pain.6 The patient with this condition usually reports poorly localized knee pain and no history of knee trauma.

The typical patient with slipped capital femoral epiphysis is overweight and sits on the examination table with the affected hip slightly flexed and externally rotated. The knee examination is normal, but hip pain is elicited with passive internal rotation or extension of the affected hip.

Radiographs typically show displacement of the epiphysis of the femoral head. However, negative radiographs do not rule out the diagnosis in patients with typical clinical findings. Computed tomographic (CT) scanning is indicated in these patients.

Osteochondritis Dissecans

Osteochondritis dissecans is an intra-articular osteochondrosis of unknown etiology that is characterized by degeneration and recalcification of articular cartilage and underlying bone. In the knee, the medial femoral condyle is most commonly affected.7

The patient reports vague, poorly localized knee pain, as well as morning stiffness or recurrent effusion. If a loose body is present, mechanical symptoms of locking or catching of the knee joint also may be reported. On physical examination, the patient may demonstrate quadriceps atrophy or tenderness along the involved chondral surface. A mild joint effusion may be present.7

Plain-film radiographs may demonstrate the osteochondral lesion or a loose body in the knee joint. If osteochondritis dissecans is suspected, recommended radiographs include anteroposterior, posteroanterior tunnel, lateral, and Merchant’s views. Osteochondral lesions at the lateral aspect of the medial femoral condyle may be visible only on the posteroanterior tunnel view. Magnetic resonance imaging (MRI) is highly sensitive in detecting these abnormalities and is indicated in patients with a suspected osteochondral lesion.7  

 

Dr Jimenez White Coat

A knee injury caused by sports injuries, automobile accidents, or an underlying condition, among other causes, can affect the cartilage, tendons and ligaments which form the knee joint itself. The location of the knee pain can differ according to the structure involved, also, the symptoms can vary. The entire knee may become painful and swollen as a result of inflammation or infection, whereas a torn meniscus or fracture may cause symptoms in the affected region. Dr. Alex Jimenez D.C., C.C.S.T. Insight

Adults

Overuse Syndromes

Anterior Knee Pain. Patients with patellofemoral pain syndrome (chondromalacia patellae) typically present with a vague history of mild to moderate anterior knee pain that usually occurs after prolonged periods of sitting (the so-called “theater sign”).8 Patellofemoral pain syndrome is a common cause of anterior knee pain in women.

On physical examination, a slight effusion may be present, along with patellar crepitus on the range of motion. The patient’s pain may be reproduced by applying direct pressure to the anterior aspect of the patella. Patellar tenderness may be elicited by subluxing the patella medially or laterally and palpating the superior and inferior facets of the patella. Radiographs usually are not indicated.

Medial Knee Pain. One frequently overlooked diagnosis is medial plica syndrome. The plica, a redundancy of the joint synovium medially, can become inflamed with repetitive overuse.4,9 The patient presents with acute onset of medial knee pain after a marked increase in usual activities. On physical examination, a tender, mobile nodularity is present at the medial aspect of the knee, just anterior to the joint line. There is no joint effusion, and the remainder of the knee examination is normal. Radiographs are not indicated.

Pes anserine bursitis is another possible cause of medial knee pain. The tendinous insertion of the sartorius, gracilis, and semitendinosus muscles at the anteromedial aspect of the proximal tibia forms the pes anserine bursa.9 The bursa can become inflamed as a result of overuse or a direct contusion. Pes anserine bursitis can be confused easily with a medial collateral ligament sprain or, less commonly, osteoarthritis of the medial compartment of the knee.  

 

 

The patient with pes anserine bursitis reports pain at the medial aspect of the knee. This pain may be worsened by repetitive flexion and extension. On physical examination, tenderness is present at the medial aspect of the knee, just posterior and distal to the medial joint line. No knee joint effusion is present, but there may be slight swelling at the insertion of the medial hamstring muscles. Valgus stress testing in the supine position or resisted knee flexion in the prone position may reproduce the pain. Radiographs are usually not indicated.

Lateral Knee Pain. Excessive friction between the iliotibial band and the lateral femoral condyle can lead to iliotibial band tendonitis.9 This overuse syndrome commonly occurs in runners and cyclists, although it may develop in any person subsequent to activity involving repetitive knee flexion. The tightness of the iliotibial band, excessive foot pronation, genu varum, and tibial torsion are predisposing factors.

The patient with iliotibial band tendonitis reports pain at the lateral aspect of the knee joint. The pain is aggravated by activity, particularly running downhill and climbing stairs. On physical examination, tenderness is present at the lateral epicondyle of the femur, approximately 3 cm proximal to the joint line. Soft tissue swelling and crepitus also may be present, but there is no joint effusion. Radiographs are not indicated.

Noble’s test is used to reproduce the pain in iliotibial band tendonitis. With the patient in a supine position, the physician places a thumb over the lateral femoral epicondyle as the patient repeatedly flexes and extends the knee. Pain symptoms are usually most prominent with the knee at 30 degrees of flexion.

Popliteus tendonitis is another possible cause of lateral knee pain. However, this condition is fairly rare.10

Trauma

Anterior Cruciate Ligament Sprain. Injury to the anterior cruciate ligament usually occurs because of noncontact deceleration forces, as when a runner plants one foot and sharply turns in the opposite direction. Resultant valgus stress on the knee leads to anterior displacement of the tibia and sprain or rupture of the ligament.11 The patient usually reports hearing or feeling a “pop” at the time of the injury and must cease activity or competition immediately. Swelling of the knee within two hours after the injury indicates rupture of the ligament and consequent hemarthrosis.

On physical examination, the patient has a moderate to severe joint effusion that limits the range of motion. The anterior drawer test may be positive, but can be negative because of hemarthrosis and guarding by the hamstring muscles. The Lachman test should be positive and is more reliable than the anterior drawer test (see text and Figure 3 in part I of the article1).

Radiographs are indicated to detect possible tibial spine avulsion fracture. MRI of the knee is indicated as part of a presurgical evaluation.

Medial Collateral Ligament Sprain. Injury to the medial collateral ligament is fairly common and is usually the result of acute trauma. The patient reports a misstep or collision that places valgus stress on the knee, followed by the immediate onset of pain and swelling at the medial aspect of the knee.11

On physical examination, the patient with medial collateral ligament injury has point tenderness at the medial joint line. Valgus stress testing of the knee flexed to 30 degrees reproduces the pain (see text and Figure 4 in part I of this article1). A clearly defined endpoint on valgus stress testing indicates a grade 1 or grade 2 sprain, whereas complete medial instability indicates full rupture of the ligament (grade 3 sprain).

Lateral Collateral Ligament Sprain. Injury of the lateral collateral ligament is much less common than the injury of the medial collateral ligament. Lateral collateral ligament sprain usually results from varus stress to the knee, as occurs when a runner plants one foot and then turns toward the ipsilateral knee.2 The patient reports acute onset of lateral knee pain that requires prompt cessation of activity.

On physical examination, point tenderness is present at the lateral joint line. Instability or pain occurs with varus stress testing of the knee flexed to 30 degrees (see text and Figure 4 in part I of this article1). Radiographs are not usually indicated.

Meniscal Tear. The meniscus can be torn acutely with a sudden twisting injury of the knee, such as may occur when a runner suddenly changes direction.11,12 Meniscal tear also may occur in association with a prolonged degenerative process, particularly in a patient with an anterior cruciate ligament-deficient knee. The patient usually reports recurrent knee pain and episodes of catching or locking of the knee joint, especially with squatting or twisting of the knee.

On physical examination, a mild effusion is usually present, and there is tenderness at the medial or lateral joint line. Atrophy of the vastus medialis obliquus portion of the quadriceps muscle also may be noticeable. The McMurray test may be positive (see Figure 5 in part I of this article1), but a negative test does not eliminate the possibility of a meniscal tear.

Plain-film radiographs usually are negative and seldom are indicated. MRI is the radiologic test of choice because it demonstrates most significant meniscal tears.

Infection

Infection of the knee joint may occur in patients of any age but is more common in those whose immune system has been weakened by cancer, diabetes mellitus, alcoholism, acquired immunodeficiency syndrome, or corticosteroid therapy. The patient with septic arthritis reports abrupt onset of pain and swelling of the knee with no antecedent trauma.13

On physical examination, the knee is warm, swollen, and exquisitely tender. Even slight motion of the knee joint causes intense pain.

Arthrocentesis reveals turbid synovial fluid. Analysis of the fluid yields a white blood cell count (WBC) higher than 50,000 per mm3 (50 􏰀 109 per L), with more than 75 percent (0.75) polymorphonuclear cells, an elevated protein content (greater than 3 g per dL [30 g per L]), and a low glucose concentration (more than 50 percent lower than the serum glucose concentration).14 Gram stain of the fluid may demonstrate the causative organism. Common pathogens include Staphylococcus aureus, Streptococcus species, Haemophilus influenza, and Neisseria gonorrhoeae.

Hematologic studies show an elevated WBC, an increased number of immature polymorphonuclear cells (i.e., a left shift), and an elevated erythrocyte sedimentation rate (usually greater than 50 mm per hour).

Older Adults

Osteoarthritis

Osteoarthritis of the knee joint is a common problem after 60 years of age. The patient presents with knee pain that is aggravated by weight-bearing activities and relieved by rest.15 The patient has no systemic symptoms but usually awakens with morning stiffness that dissipates somewhat with activity. In addition to chronic joint stiffness and pain, the patient may report episodes of acute synovitis.

Findings on physical examination include decreased range of motion, crepitus, a mild joint effusion, and palpable osteophytic changes at the knee joint.

When osteoarthritis is suspected, recommended radiographs include weight-bearing anteroposterior and posteroanterior tunnel views, as well as non-weight-bearing Merchants and lateral views. Radiographs show joint-space narrowing, subchondral bony sclerosis, cystic changes, and hypertrophic osteophyte formation.

Crystal-Induced Inflammatory Arthropathy

Acute inflammation, pain, and swelling in the absence of trauma suggest the possibility of a crystal-induced inflammatory arthropathy such as gout or pseudogout.16,17 Gout commonly affects the knee. In this arthropathy, sodium urate crystals precipitate in the knee joint and cause an intense inflammatory response. In pseudogout, calcium pyrophosphate crystals are the causative agents.

On physical examination, the knee joint is erythematous, warm, tender, and swollen. Even minimal range of motion is exquisitely painful.

Arthrocentesis reveals clear or slightly cloudy synovial fluid. Analysis of the fluid yields a WBC count of 2,000 to 75,000 per mm3 (2 to 75 􏰀 109 per L), a high protein content (greater than 32 g per dL [320 g per L]), and a glucose concentration that is approximately 75 percent of the serum glucose con- centration.14 Polarized-light microscopy of the synovial fluid displays negatively birefringent rods in the patient with gout and positively birefringent rhomboids in the patient with pseudogout.

Popliteal Cyst

The popliteal cyst (Baker’s cyst) is the most common synovial cyst of the knee. It originates from the posteromedial aspect of the knee joint at the level of the gastrocnemio-semimembranous bursa. The patient reports insidious onset of mild to moderate pain in the popliteal area of the knee.

On physical examination, palpable fullness is present at the medial aspect of the popliteal area, at or near the origin of the medial head of the gastrocnemius muscle. The McMurray test may be positive if the medial meniscus is injured. Definitive diagnosis of a popliteal cyst may be made with arthrography, ultrasonography, CT scanning, or, less commonly, MRI.

The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported.

In conclusion, although the knee is the largest joint in the human body where the structures of the lower extremities meet, including the femur, the tibia, the patella, and many other soft tissues, the knee can easily suffer damage or injury and result in knee pain. Knee pain is one of the most common complaints among the general population, however, it commonly occurs in athletes. Sports injuries, slip-and-fall accidents, and automobile accidents, among other causes, can lead to knee pain.

As described in the article above, diagnosis is essential towards determining the best treatment approach for each type of knee injury, according to their underlying cause. While the location and the severity of the knee injury may vary depending on the cause of the health issue, knee pain is the most common symptom. Treatment options, such as chiropractic care and physical therapy, can help treat knee pain. The scope of our information is limited to chiropractic and spinal health issues. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

Curated by Dr. Alex Jimenez  

 

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Additional Topic Discussion: Relieving Knee Pain without Surgery

 

Knee pain is a well-known symptom which can occur due to a variety of knee injuries and/or conditions, including sports injuries. The knee is one of the most complex joints in the human body as it is made-up of the intersection of four bones, four ligaments, various tendons, two menisci, and cartilage. According to the American Academy of Family Physicians, the most common causes of knee pain include patellar subluxation, patellar tendinitis or jumper’s knee, and Osgood-Schlatter disease. Although knee pain is most likely to occur in people over 60 years old, knee pain can also occur in children and adolescents. Knee pain can be treated at home following the RICE methods, however, severe knee injuries may require immediate medical attention, including chiropractic care.

 

 

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References
1. Calmbach WL, Hutchens M. Evaluation of patients presenting with knee pain: part I. History, physical examination, radiographs, and laboratory tests. Am Fam Physician 2003;68:907-12.
2. Walsh WM. Knee injuries. In: Mellion MB, Walsh WM, Shelton GL, eds. The team physician’s hand- book. 2d ed. St. Louis: Mosby, 1990:554-78.
3. Dunn JF. Osgood-Schlatter disease. Am Fam Physi- cian 1990;41:173-6.
4. Stanitski CL. Anterior knee pain syndromes in the adolescent. Instr Course Lect 1994;43:211-20.
5. Tandeter HB, Shvartzman P, Stevens MA. Acute knee injuries: use of decision rules for selective radiograph ordering. Am Fam Physician 1999;60: 2599-608.
6. Waters PM, Millis MB. Hip and pelvic injuries in the young athlete. In: DeLee J, Drez D, Stanitski CL, eds. Orthopaedic sports medicine: principles and practice. Vol. III. Pediatric and adolescent sports medicine. Philadelphia: Saunders, 1994:279-93.
7. Schenck RC Jr, Goodnight JM. Osteochondritis dis- secans. J Bone Joint Surg [Am] 1996;78:439-56.
8. Ruffin MT 5th, Kiningham RB. Anterior knee pain: the challenge of patellofemoral syndrome. Am Fam Physician 1993;47:185-94.
9. Cox JS, Blanda JB. Peripatellar pathologies. In: DeLee J, Drez D, Stanitski CL, eds. Orthopaedic sports medicine: principles and practice. Vol. III. Pediatric and adolescent sports medicine. Philadel- phia: Saunders, 1994:1249-60.
10. Petsche TS, Selesnick FH. Popliteus tendinitis: tips for diagnosis and management. Phys Sportsmed 2002;30(8):27-31.
11. Micheli LJ, Foster TE. Acute knee injuries in the immature athlete. Instr Course Lect 1993;42:473- 80.
12. Smith BW, Green GA. Acute knee injuries: part II. Diagnosis and management. Am Fam Physician 1995;51:799-806.
13. McCune WJ, Golbus J. Monarticular arthritis. In: Kelley WN, ed. Textbook of rheumatology. 5th ed. Philadelphia: Saunders, 1997:371-80.
14. Franks AG Jr. Rheumatologic aspects of knee dis- orders. In: Scott WN, ed. The knee. St. Louis: Mosby, 1994:315-29.
15. Brandt KD. Management of osteoarthritis. In: Kel- ley WN, ed. Textbook of rheumatology. 5th ed. Philadelphia: Saunders, 1997:1394-403.
16. Kelley WN, Wortmann RL. Crystal-associated syn- ovitis. In: Kelley WN, ed. Textbook of rheumatol- ogy. 5th ed. Philadelphia: Saunders, 1997:1313- 51. 1
7. Reginato AJ, Reginato AM. Diseases associated with deposition of calcium pyrophosphate or hy- droxyapatite. In: Kelley WN, ed. Textbook of rheumatology. 5th ed. Philadelphia: Saunders, 1997:1352-67.
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Heel Spurs Treatment | Video

Heel Spurs Treatment | Video

Blanca suffered from heel spurs as a result of her occupation as a registered nurse. Her painful symptoms made it challenging for her to accomplish her daily tasks, both in the workplace and in her everyday life. Due to her unbearable heel spurs, Blanca considered finding a new job until she found Dr. Alex Jimenez, doctor of chiropractic. Blanca highly recommends Dr. Alex Jimenez as the non-surgical choice for heel spurs, among other sports injuries and health issues.

Heel Spurs Treatment

A heel spur is a health issue which occurs when a bony-like expansion, known as a calcium deposit, develops between the heel arch and bone of the foot. Heel spurs frequently start in front of the heels and finally affect different elements of the foot. Indicators of heel spurs can include pain, soreness, swelling, and inflammation in the front of the foot. The affected area may also feel hot to the touch. The indicators can also spread to the back of the foot. Finally, a tiny bony protrusion could be observable if left untreated.

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Evaluation of Patients Presenting with Knee Pain: Part I. History, Physical Examination, Radiographs, and Laboratory Tests

Evaluation of Patients Presenting with Knee Pain: Part I. History, Physical Examination, Radiographs, and Laboratory Tests

Knee pain is a common health issue among athletes and the general population alike. Although symptoms of knee pain can be debilitating and frustrating, knee pain is often a very treatable health issue. The knee is a complex structure made up of three bones: the lower section of the thighbone, the upper region of the shinbone, and the kneecap.

Powerful soft tissues, such as the tendons and ligaments of the knee as well as the cartilage beneath the kneecap and between the bones, hold these structures together in order to stabilize and support the knee. However, a variety of injuries and/or conditions can ultimately lead to knee pain. The purpose of the article below is to evaluate patients with knee pain.

Abstract

Family physicians frequently encounter patients with knee pain. Accurate diagnosis requires a knowledge of knee anatomy, common pain patterns in knee injuries, and features of frequently encountered causes of knee pain, as well as specific physical examination skills. The history should include characteristics of the patient’s pain, mechanical symptoms (locking, popping, giving way), joint effusion (timing, amount, recurrence), and mechanism of injury. The physical examination should include careful inspection of the knee, palpation for point tenderness, assessment of joint effusion, range-of-motion testing, evaluation of ligaments for injury or laxity, and assessment of the menisci. Radiographs should be obtained in patients with isolated patellar tenderness or tenderness at the head of the fibula, inability to bear weight or flex the knee to 90 degrees, or age greater than 55 years. (Am Fam Physician 2003; 68:907-12. Copyright© 2003 American Academy of Family Physicians.)

Introduction

Knee pain accounts for approximately one-third of musculoskeletal problems seen in primary care settings. This complaint is most prevalent in physically active patients, with as many as 54 percent of athletes having some degree of knee pain each year.1 Knee pain can be a source of significant disability, restricting the ability to work or perform activities of daily living.

The knee is a complex structure (Figure 1),2 and its evaluation can present a challenge to the family physician. The differential diagnosis of knee pain is extensive but can be narrowed with a detailed history, a focused physical examination and, when indicated, the selective use of appropriate imaging and laboratory studies. Part I of this two-part article provides a systematic approach to evaluating the knee, and part II3 discusses the differential diagnosis of knee pain.

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History

Pain Characteristics

The patient’s description of knee pain is helpful in focusing the differential diagnosis.4 It is important to clarify the characteristics of the pain, including its onset (rapid or insidious), location (anterior, medial, lateral, or posterior knee), duration, severity, and quality (e.g., dull, sharp, achy). Aggravating and alleviating factors also need to be identified. If knee pain is caused by an acute injury, the physician needs to know whether the patient was able to continue activity or bear weight after the injury or was forced to cease activities immediately.

 

Mechanical Symptoms

The patient should be asked about mechan- ical symptoms, such as locking, popping, or giving way of the knee. A history of locking episodes suggests a meniscal tear. A sensation of popping at the time of injury suggests liga- mentous injury, probably complete rupture of a ligament (third-degree tear). Episodes of giving way are consistent with some degree of knee instability and may indicate patellar sub- luxation or ligamentous rupture.

Effusion

The timing and amount of joint effusion are important clues to the diagnosis. Rapid onset (within two hours) of a large, tense effusion suggests rupture of the anterior cru- ciate ligament or fracture of the tibial plateau with resultant hemarthrosis, whereas slower onset (24 to 36 hours) of a mild to moderate effusion is consistent with meniscal injury or ligamentous sprain. Recurrent knee effusion after activity is consistent with meniscal injury.

Mechanism of Injury

The patient should be questioned about specific details of the injury. It is important to know if the patient sustained a direct blow to the knee, if the foot was planted at the time of injury, if the patient was decelerating or stopping suddenly, if the patient was landing from a jump, if there was a twisting component to the injury, and if hyperextension occurred.

A direct blow to the knee can cause serious injury. The anterior force applied to the proximal tibia with the knee in flexion (e.g., when the knee hits the dashboard in an automobile accident) can cause injury to the posterior cruciate ligament. The medial collateral ligament is most commonly injured as a result of direct lateral force to the knee (e.g., clipping in football); this force creates a val- gus load on the knee joint and can result in rupture of the medial collateral ligament. Conversely, a medial blow that creates a varus load can injure the lateral collateral ligament.

Noncontact forces also are an important cause of knee injury. Quick stops and sharp cuts or turns create significant deceleration forces that can sprain or rupture the anterior cruciate ligament. Hyperextension can result in injury to the anterior cruciate ligament or posterior cruciate ligament. Sudden twisting or pivoting motions create shear forces that can injure the meniscus. A combination of forces can occur simultaneously, causing injury to multiple structures.

 

Medical History

A history of knee injury or surgery is important. The patient should be asked about previous attempts to treat knee pain, including the use of medications, supporting devices, and physical therapy. The physician also should ask if the patient has a history of gout, pseudogout, rheumatoid arthritis, or other degenerative joint diseases.

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Knee pain is a common health issue which can be caused by sports injuries, automobile accident injuries, or by an underlying health issue, such as arthritis. The most common symptoms of knee injury include pain and discomfort, swelling, inflammation and stiffness. Because treatment for knee pain varies according to the cause, it’s essential for the individual to receive proper diagnosis for their symptoms. Chiropractic care is a safe and effective, alternative treatment approach which can help treat knee pain, among other health issues.

Dr. Alex Jimenez D.C., C.C.S.T. Insight

Physical Examination

Inspection and Palpation

The physician begins by comparing the painful knee with the asymptomatic knee and inspecting the injured knee for erythema, swelling, bruising, and discoloration. The mus- culature should be symmetric bilaterally. In particular, the vastus medialis obliquus of the quadriceps should be evaluated to determine if it appears normal or shows signs of atrophy.

The knee is then palpated and checked for pain, warmth, and effusion. Point tenderness should be sought, particularly at the patella, tibial tubercle, patellar tendon, quadriceps tendon, anterolateral and anteromedial joint line, medial joint line, and lateral joint line. Moving the patient’s knee through a short arc of motion helps identify the joint lines. Range of motion should be assessed by extending and flexing the knee as far as possible (normal range of motion: extension, zero degrees; flex- ion, 135 degrees).5

Patellofemoral Assessment

An evaluation for effusion should be conducted with the patient supine and the injured knee in extension. The suprapatellar pouch should be milked to determine whether an effusion is present.

Patellofemoral tracking is assessed by observing the patella for smooth motion while the patient contracts the quadriceps muscle. The presence of crepitus should be noted during palpation of the patella.

The quadriceps angle (Q angle) is determined by drawing one line from the anterior superior iliac spine through the center of the patella and a second line from the center of the patella through the tibial tuberosity (Figure 2).6 A Q angle greater than 15 degrees is a predisposing factor for patellar subluxation (i.e., if the Q angle is increased, forceful contraction of the quadriceps muscle can cause the patella to sublux laterally).

A patellar apprehension test is then performed. With fingers placed at the medial aspect of the patella, the physician attempts to sublux the patella laterally. If this maneuver reproduces the patient’s pain or a giving-way sensation, patellar subluxation is the likely cause of the patient’s symptoms.7 Both the superior and inferior patellar facets should be palpated, with the patella subluxed first medially and then laterally.

 

Cruciate Ligaments

Anterior Cruciate Ligament. For the anterior drawer test, the patient assumes a supine position with the injured knee flexed to 90 degrees. The physician fixes the patient’s foot in slight external rotation (by sitting on the foot) and then places thumbs at the tibial tubercle and fingers at the posterior calf. With the patient’s hamstring muscles relaxed, the physician pulls anteriorly and assesses anterior displacement of the tibia (anterior drawer sign).

The Lachman test is another means of assessing the integrity of the anterior cruciate ligament (Figure 3).7 The test is performed with the patient in a supine position and the injured knee flexed to 30 degrees. The physician stabilizes the distal femur with one hand, grasps the proximal tibia in the other hand, and then attempts to sublux the tibia anteriorly. Lack of a clear end point indicates a positive Lachman test.

Posterior Cruciate Ligament. For the posterior drawer test, the patient assumes a supine position with knees flexed to 90 degrees. While standing at the side of the examination table, the physician looks for posterior displacement of the tibia (posterior sag sign).7,8 Next, the physician fixes the patient’s foot in neutral rotation (by sitting on the foot), positions thumbs at the tibial tubercle, and places fingers at the posterior calf. The physician then pushes posteriorly and assesses for posterior displacement of the tibia.

 

Collateral Ligaments

Medial Collateral Ligament. The valgus stress test is performed with the patient’s leg slightly abducted. The physician places one hand at the lateral aspect of the knee joint and the other hand at the medial aspect of the distal tibia. Next, valgus stress is applied to the knee at both zero degrees (full extension) and 30 degrees of flexion (Figure 4)7. With the knee at zero degrees (i.e., in full extension), the posterior cruciate ligament and the articulation of the femoral condyles with the tibial plateau should stabilize the knee; with the knee at 30 degrees of flexion, application of valgus stress assesses the laxity or integrity of the medial collateral ligament.

Lateral Collateral Ligament. To perform the varus stress test, the physician places one hand at the medial aspect of the patient’s knee and the other hand at the lateral aspect of the distal fibula. Next, varus stress is applied to the knee, first at full extension (i.e., zero degrees), then with the knee flexed to 30 degrees (Figure 4).7 A firm end point indicates that the collateral ligament is intact, whereas a soft or absent end point indicates complete rupture (third-degree tear) of the ligament.

Menisci

Patients with injury to the menisci usually demonstrate tenderness at the joint line. The McMurray test is performed with the patient lying supine9 (Figure 5). The test has been described variously in the literature, but the author suggests the following technique.

The physician grasps the patient’s heel with one hand and the knee with the other hand. The physician’s thumb is at the lateral joint line, and fingers are at the medial joint line. The physician then flexes the patient’s knee maximally. To test the lateral meniscus, the tibia is rotated internally, and the knee is extended from maximal flexion to about 90 degrees; added compression to the lateral meniscus can be produced by applying valgus stress across the knee joint while the knee is being extended. To test the medial meniscus, the tibia is rotated externally, and the knee is extended from maximal flexion to about 90 degrees; added compression to the medial meniscus can be produced by placing varus stress across the knee joint while the knee is degrees of flexion. A positive test produces a thud or a click, or causes pain in a reproducible portion of the range of motion.

Because most patients with knee pain have soft tissue injuries, plain-film radiographs generally are not indicated. The Ottawa knee rules are a useful guide for ordering radiographs of the knee10,11.

If radiographs are required, three views are usually sufficient: anteroposterior view, lateral view, and Merchant’s view (for the patellofemoral joint).7,12 Teenage patients who report chronic knee pain and recurrent knee effusion require a notch or tunnel view (posteroanterior view with the knee flexed to 40 to 50 degrees). This view is necessary to detect radiolucencies of the femoral condyles (most commonly the medial femoral condyle), which indicate the presence of osteochondritis dissecans.13

Radiographs should be closely inspected for signs of fracture, particularly involving the patella, tibial plateau, tibial spines, proximal fibula, and femoral condyles. If osteoarthritis is suspected, standing weight-bearing radiographs should be obtained.

 

Laboratory Studies

The presence of warmth, exquisite tenderness, painful effusion, and marked pain with even slight range of motion of the knee joint is consistent with septic arthritis or acute inflammatory arthropathy. In addition to obtaining a complete blood count with differential and an erythrocyte sedimentation rate (ESR), arthro- centesis should be performed. The joint fluid should be sent to a laboratory for a cell count with differential, glucose and protein measure- ments, bacterial culture and sensitivity, and polarized light microscopy for crystals.

Because a tense, painful, swollen knee may present an unclear clinical picture, arthrocentesis may be required to differentiate simple effusion from hemarthrosis or occult osteochondral fracture.4 A simple joint effusion produces clear, straw-colored transudative fluid, as in a knee sprain or chronic meniscal injury. Hemarthrosis is caused by a tear of the anterior cruciate ligament, a fracture or, less commonly, an acute tear of the outer portion of the meniscus. An osteochondral fracture causes hemarthrosis, with fat globules noted in the aspirate.

Rheumatoid arthritis may involve the knee joint. Hence, serum ESR and rheumatoid factor testing are indicated in selected patients.

The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported.

In conclusion, knee pain is a common health issue which occurs due to a variety of injuries and/or conditions, such as sports injuries, automobile accidents, and arthritis, among other problems. Treatment of knee pain depends largely on the source of the symptoms. Therefore, it is essential for the individual to seek immediate medical attention to receive a diagnosis.

Chiropractic care is an alternative treatment option which focuses on the treatment of a variety of injuries and/or conditions associated with the musculoskeletal and nervous system. The scope of our information is limited to chiropractic and spinal health issues. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

Curated by Dr. Alex Jimenez

Green Call Now Button H .png

 

Additional Topic Discussion: Relieving Knee Pain without Surgery

Knee pain is a well-known symptom which can occur due to a variety of knee injuries and/or conditions, including sports injuries. The knee is one of the most complex joints in the human body as it is made-up of the intersection of four bones, four ligaments, various tendons, two menisci, and cartilage. According to the American Academy of Family Physicians, the most common causes of knee pain include patellar subluxation, patellar tendinitis or jumper’s knee, and Osgood-Schlatter disease. Although knee pain is most likely to occur in people over 60 years old, knee pain can also occur in children and adolescents. Knee pain can be treated at home following the RICE methods, however, severe knee injuries may require immediate medical attention, including chiropractic care.

 

blog picture of cartoon paper boy

EXTRA EXTRA | IMPORTANT TOPIC: El Paso, TX Chiropractor Recommended

 

 

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References

1. Rosenblatt RA, Cherkin DC, Schneeweiss R, Hart LG. The content of ambulatory medical care in the United States. An interspecialty comparison. N Engl J Med 1983;309:892-7.

2. Tandeter HB, Shvartzman P, Stevens MA. Acute knee injuries: use of decision rules for selective radiograph ordering. Am Fam Physician 1999;60: 2599-608.

3. Calmbach WL, Hutchens M. Evaluation of patients presenting with knee pain: part II. Differential diag- nosis. Am Fam Physician 2003;68:917-22

4. Bergfeld J, Ireland ML, Wojtys EM, Glaser V. Pin- pointing the cause of acute knee pain. Patient Care 1997;31(18):100-7.

5. Magee DJ. Knee. In: Orthopedic physical assessment. 4th ed. Philadelphia: Saunders, 2002:661-763.

6. Juhn MS. Patellofemoral pain syndrome: a review and guidelines for treatment. Am Fam Physician 1999;60:2012-22.

7. Smith BW, Green GA. Acute knee injuries: part I. History and physical examination. Am Fam Physi- cian 1995;51:615-21.

8. Walsh WM. Knee injuries. In: Mellion MB, Walsh WM, Shelton GL, eds. The team physician’s hand- book. 2d ed. St. Louis: Mosby, 1997:554-78.

9. McMurray TP. The semilunar cartilage. Br J Surg 1942;29:407-14.

10. Stiell IG, Wells GA, Hoag RH, Sivilotti ML, Cacciotti TF, Verbeek PR, et al. Implementation of the Ottawa knee rule for the use of radiography in acute knee injuries. JAMA 1997;278:2075-9.

11. Stiell IG, Greenberg GH, Wells GA, McKnight RD, Cwinn AA, Caciotti T, et al. Derivation of a decision rule for the use of radiography in acute knee injuries. Ann Emerg Med 1995;26:405-13.

12. Sartoris DJ, Resnick D. Plain film radiography: rou- tine and specialized techniques and projections. In: Resnick D, ed. Diagnosis of bone and joint disor- ders. 3d ed. Philadelphia: Saunders:1-40.

13. Schenck RC Jr, Goodnight JM. Osteochondritis dis- secans. J Bone Joint Surg [Am] 1996;78:439-56.

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What is a Quadriceps Tendon Rupture?

What is a Quadriceps Tendon Rupture?

The tendons are powerful soft tissues which connect the muscles to the bones. One of these tendons, the quadriceps tendon, works together with the muscles found at the front of the thigh in order to straighten the leg. A quadriceps tendon rupture can affect an individual’s quality of life.

A quadriceps tendon rupture can be a debilitating injury and it usually requires rehabilitation and surgical interventions to restore knee function. These type of injuries are rare. Quadriceps tendon ruptures commonly occur among athletes who perform jumping or running sports.

Quadriceps Tendon Rupture Description

The four quadriceps muscles come together above the kneecap, or patella, to form the quadriceps tendon. The quadriceps tendon joins the quadriceps muscles into the patella. The patella is connected to the shinbone, or tibia, by the patellar tendon. Working collectively, the quadriceps muscles, the quadriceps tendon, and the patellar tendon, straighten the knee.

A quadriceps tendon rupture can be partial or complete. Many partial tears don’t completely disrupt the soft tissues. However, a full tear will divide the soft tissues into two parts. If the quadriceps tendon ruptures entirely, the muscle is no longer attached to the kneecap or patella. As a result, the knee is unable to straighten out when the quadriceps muscles contract.

Quadriceps Tendon Rupture Causes

A quadriceps tendon rupture frequently occurs due to an increased load on the leg where the foot is planted and the knee is somewhat flexed. By way of instance, when landing from an awkward jump, the power is too much for the soft tissues to bear, causing a partial or complete tear. Tears may also be due to falls, direct impacts to the knee, and lacerations or cuts.

A weakened quadriceps tendon is also more likely to rupture. Several factors may result in tendon weakness, including quadriceps tendinitis, the inflammation of the quadriceps tendon, called quadriceps tendinitis. Quadriceps tendinitis is one of the most common sports injuries in athletes who participate in sports or physicial activities which involve jumping.

Weakened soft tissues may also be brought on by diseases that interrupt blood flow to the knee or patella. Utilizing corticosteroids and some antibiotics have also been connected to weakness associated with quadriceps tendon ruptures. Immobilization for an extended period of time can also decrease strength in the quadriceps tendons. Finally, quadriceps tendon ruptures can occur due to dislocations and/or surgery.

Quadriceps Tendon Rupture Symptoms

A popping or tearing feeling is one of the most common symptoms associated with a quadriceps tendon rupture. Pain followed by swelling and inflammation of the knee might make the individual unable to straighten out their knee. Other symptoms of a quadriceps tendon rupture include:

  • An indentation at the top of the kneecap or patella of the affected site
  • Bruising
  • Tenderness
  • Cramping
  • Sagging or drooping of the kneecap or patella where the tendon tore
  • Difficulty walking because the knee is buckling or giving away

 

 

Quadriceps Tendon Rupture Evaluation

The healthcare professional will perform an evaluation to diagnose a quadriceps tendon rupture by first discussing the patient’s symptoms and medical history. After talking about the patient’s symptoms and medical history, the doctor will conduct a comprehensive evaluation of the knee.

To ascertain the precise cause of the patient’s symptoms, the healthcare professional will examine how well it is possible to stretch, or straighten, the knee. Although this area of the evaluation can be debilitating, it’s essential to diagnose a quadriceps tendon rupture.

To verify a quadriceps tendon rupture diagnosis, the doctor may order some imaging tests, like an x-ray or magnetic resonance imaging, or MRI, scan. The kneecap moves from place once the quadriceps tendon ruptures. This can be quite evident on a sideways x-ray perspective of the knee.

Complete tears may frequently be identified with x-rays alone. The MRI can reveal the quantity of tendon torn along with the positioning of the tear. From time to time, an MRI will also rule out another injury with similar symptoms. Diagnostic imaging is helpful in the evaluation of sports injuries.

Dr Jimenez White Coat

The quadriceps tendon is the large tendon found just above the kneecap, or patella, which allows us to straighten out our knee. While the quadriceps tendon is a strong, fibrous cord which can withstand tremendous amounts of force, sports injuries or other health issues may lead to a quadriceps tendon rupture. Quadriceps tendon ruptures are debilitating problems which can affect a patient’s quality of life.

Dr. Alex Jimenez D.C., C.C.S.T. Insight

Quadriceps Tendon Rupture Treatment

Non-Surgical Treatment

A majority of partial tears react well to non-surgical treatment approaches. The doctor may advise the patient to utilize a knee immobilizer or brace to allow the quadriceps tendon to heal. Crutches will help avoid placing weight onto the leg. A knee immobilizer or brace is used for 3 to 6 months.

Once the initial pain, swelling, and inflammation have decreased, alternative treatment options, such as chiropractic care and physical therapy, can be utilized. A doctor of chiropractic, or chiropractor, utilizes spinal adjustments and manual manipulations to carefully correct any spinal misalignments, or subluxations, which may be causing problems.

Furthermore, chiropractic care and physical therapy can provide lifestyle modifications, including physical activity and exercise programs to help speed up the recovery process. The patient may be recommended a variety of stretches and exercises to improve strength, flexibility and mobility. The healthcare professional will determine when it’s safe to return-to-play.

Surgical Treatment

Many individuals with complete tears require surgery to repair a quadriceps tendon rupture. Surgical interventions depend on the patient’s age, actions, and prior level of function. Surgery for quadriceps tendon ruptures involves re-attaching the tendon to the kneecap or patella. Surgery is carried out with regional spinal anesthetic or general anesthetic.

To reattach the tendon, sutures are put in the tendon and then threaded through drill holes at the kneecap. The stitches are attached in the base of the kneecap. The physician will tie the sutures to find the ideal tension in the kneecap or patella. This will also make sure that the place of the kneecap closely matches that of the uninjured patella or kneecap.

A knee immobilizer, brace or a long leg cast may be utilized following the surgery. The patient may be allowed to set weight on their leg by means of crutches. Stretches and exercises are added into a rehabilitation program by a chiropractor or physical therapist after a surgical intervention.

The precise timeline for chiropractic care and physical therapy following a surgery for those patients that require it will be individualized personally. The patient’s rehabilitation program will be contingent upon the kind of tear, their surgery, medical condition, along with other requirements.

Conclusion

The majority of patients can return to their original routines after recovering from a quadriceps tendon rupture. The individual’s return will be addressed very carefully by the healthcare professional. The scope of our information is limited to chiropractic and spinal health issues. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .

Curated by Dr. Alex Jimenez

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Additional Topic Discussion: Relieving Knee Pain without Surgery

Knee pain is a well-known symptom which can occur due to a variety of knee injuries and/or conditions, including sports injuries. The knee is one of the most complex joints in the human body as it is made-up of the intersection of four bones, four ligaments, various tendons, two menisci, and cartilage. According to the American Academy of Family Physicians, the most common causes of knee pain include patellar subluxation, patellar tendinitis or jumper’s knee, and Osgood-Schlatter disease. Although knee pain is most likely to occur in people over 60 years old, knee pain can also occur in children and adolescents. Knee pain can be treated at home following the RICE methods, however, severe knee injuries may require immediate medical attention, including chiropractic care.

 

 

 

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