Knee Pain, Meniscal Tear Diagnosis & MRI - Everything You Need To Know - Dr. Nabil Ebraheim
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- เผยแพร่เมื่อ 20 พ.ย. 2016
- Dr. Ebraheim’s educational animated video describes knee pain and its indications.
The patient will come to you with a history of a twisting injury and pain around the knee.
The patient may give you a history of mechanical symptoms, such as: locking, clicking, or some swelling.
You examine the patient and you’ll find there is joint line tenderness, maybe some effusion, and mcmurray’s test may be positive; Painful click is obtained at the knee is brought by flexion to extension with internal or external rotation.
This maneuver also helps you to differentiate if the meniscus tear is on the medial or lateral side.
Treatment:
• NSAIDS
• Physical Therapy
• Injections
• If there is no improvement, get an MRI.
• You get the MRI early if patient has locked knee, means: you don’t have full extension of the knee, or if there is blood in the knee, so when you aspirate the knee because there is an effusion you get blood and you suspect ACL, you get an MRI.
• In this situation you will suspect lateral meniscal tear.
• It is usually a vertical tear of the posterior horn of the lateral meniscus and it is the commonly missed tear on an MRI.
• Get x-ray first before you get an MRI to check if there is a fracture, arthritis, or any other problems in the knee.
Why do you get an MRI?
Because the clinical diagnosis accuracy is about 70%, and because there are other issues on the knee that can give you the same symptoms like the meniscal tear.
These things may be intra articular or extra articular, and the symptoms will mimic meniscal tear, so we get the MRI, and it is the most sensitive test.
You need to know these facts:
• The lateral meniscus has twice the excursion of the medial meniscus, that’s why the medial meniscal tear is three times more often to occur than the lateral meniscus, so look for a tear of the medial meniscus because it is more common than the lateral meniscus.
• Also the lateral meniscus will have most of the meniscal cyst.
• On an MRI, how do you know which is the lateral meniscus?
Check the position of the fibula, the lateral meniscus is on the same side as the fibula, also note that the fibula is posterior.
• MRI is the best study to diagnose or to confirm meniscal pathology.
• What do you see on the MRI?
A normal meniscus will be dark; in the video we can see how we make these cuts in the MRI of the meniscus.
The globular intrasubstance signal:
• This increased signal intensity is within the meniscus, but it doesn’t extend to the surface of the meniscus in the grade I tear.
• In grade II tear: you will have a linear area increased signal intensity, its inside the meniscus, and it does not go to the surface of the meniscus.
• In grade III tear: you can see that the tear extends to the articular surface.
What are the MRI signs of the meniscal tear?
• Grade III signal, extend to the surface of the meniscus, among other things., example: may be horizontal, vertical, radial, oblique, complex, could be degenerative, displaced or missing a fragment, it can be in different forms and types, but there are a few important things in the MRI worth mentioning, this material frequently comes in the examinations, and they are:
1- The double PCL sign, the bucket handle tear of the medial meniscus, it is seen on the sagittal MRI, when a torn meniscal fragment is flipped and displaced into the notch, it’s a 100% specific for a flip bucket handle medial meniscal tear.
2- On the other hand bucket handle tear of the lateral meniscus where the posterior horn of the lateral meniscus flips anteriorly you will see the double anterior horn sign.
What are the false positives in the MRI?
1- There’s a ligament called the transverse meniscal ligament, which attaches to the anterior horn of the lateral meniscus, and this one mimics the meniscal tear.
2- There is also a meniscofemoral ligament, attaches to the superior horn of the lateral meniscus, and this one also mimics meniscal tear.
It is the humphrey or the wrisberg ligament.
3- Also if you have fluid tracking onto the sheath of the popliteal tendon, it will mimic posterior horn lateral meniscal tear.
4- Discoid meniscus: it is common in the lateral meniscus, patient will have a history of clicking or locking, or history of lack of full knee extension, patient will have more than 2 bowties, and the meniscus will extend beyond the half-way point of the condyle.
5- Parameniscal cysts: if you see it, you could have meniscal tear, especially with lateral meniscus horizontal tear, for this condition you will do partial meniscectomy and decompression of the cyst, the differential diagnosis will be: ganglion cyst and bursitis.
6- Baker’s cyst: you could have a combination of meniscal tear and baker’s cyst, it does not mean you have a meniscal tear,
Awesome video. Thank you
Thanks
An absolutely detailed thorough, informative video. Excellent presentation.
I’ve spent months researching my knee problem, when all I had to do was watch this one video
Thank you so much for the video. Highly educational.
thanks for tous vert benefic video Dr. Nabil.
Best explanation of meniscal tear out there!
Very informative. Thank you.
great video , very helpful, thank you very much
Very informative, thank you so much...
Superb! Thank you!
It's simple explanation even a common man can easily understand.great. thumps up.
Thank you
You were helpful to me! thank you very much!!!
Ty! Excellent video
Excellent presentation.
very well explained👍
Thank you , yes I felt pop prior to breast cancer surgery- finally got mri 4 months later confirmed complete lateral tear and bakers cyst with drainage- you are on point! Now I wait to see what they will do
great information
Dr. Ebrahhiem- Thanks so much for your channel sharing invaluable user-friendly content for
Thank you.
Thank you.. So medically detail
Thanks doctor all most all points clear for patient,
Very helpful indeed
thanks very much
Very good thanks
thank you
Indeed your video is much helpful in understanding the ligaments in clear enough ✌️
Good video.
Thank you 👌
Outstanding
thanks for u alot
Thank you very good information
I'm a layman--with a knee problem. You're the first to explain the myriad of problems I could have. My doctors didn't explain this to me the way you just did in 10 minutes. I did NOT get an MRI..just standard x-ray. So thanks. Now I'm armed with questions!
You r such an expert of your field. Like your tone of voice. Confident voice
JAZAKALLAH
THANK YOU SIR
Nice and informative video..thank u Sir doctor
Thank you very much from the videos and knowledge
👌
🌹1:50 外半月板後角的垂直縱向裂常伴隨於前十字韌帶損傷
🌹2:49
🌹 MRI 3:42 3:53
4:14
半月板在MRI 上樣貌:
🌹正常 4:42
🌹MRI Gr I裂 4:47: Intrasubstance globular 圓點白裂訊, 但未及於半月板的關節面。
🌹MRI Gr 2裂 5:03 已呈線條的白裂訊，但未及於半月板的關節面。
🌹MRI Gr 3裂 5:17 白裂訊延伸到半月板關節面。
數種MRI Gr3的白裂訊5:44 如 水平、垂直裂
🌹Double PCL sign 6:14 內半月板後角水桶提把裂 6:18 6:25
🌹Double Ant Horn Sign 外半月板後角的水桶提把裂 6:55
Thank you Dr. It was an excellent presentation. Few weeks back I was diagnosed with horizontal tear involving the body of medial meniscus reaching up to the articular surface, ACL and buckling of PCL. I am doing physiotherapy and exercises. Can I prolong like this without surgery. I am not a sports person.
Hello! Thank you so much for this video! Very informative because I recently got news of a meniscus tear. It says I have oblique posterior horn tear of the medial meniscus. How do I know if It’s in the red or white zone in terms of healing on its own without surgery? The reporter of the MRI also didn’t put the dimensions of the tear that I can see on my report. I’m an athlete I play basketball, how long will take to heal?
Hello where are you practicing?
Very important video! Sir pls give answer of my one question, can only meniscus swelling causes pain the knee? 🙏
Hi sir , Do grade 2 signal can cure without treatment ? It that possible to heal on it own
I have a complex peripheral medial meniscus tear. I'm 43. How do you trim the periphery?
Thank you!
the lateral meniscus shows a suspicious discoid morphology with a large horizontal tear through the anterior horn, body and posterior horn with extension to the superior and inferior articular surfaces as well as the capsular surface. A lobulated para meniscal cyst is seen along the lateral aspect of the lateral meniscus measuring about 13×8×8mm.
2) there is superficial chondral fibrillation along the trochlear facets.
that is my report
what can treatmemt i can have pls suggest .. there is no grade in my MRI report
Hello! I hope you are doing well. I recently got my MRI results, and it mentioned a grade 3 tear at the posterior horn of the medial meniscus. The report also states that the ACL is not adequately seen. There's no joint effusion. I'm quite worried and hesitant about surgery. Can this be fixed through physiotherapy and a knee immobilizer? I really want to explore alternatives to surgery. Your insights would mean a lot to me during this challenging time. Thanks in advance for your help.
Grade 2 horizontal meniscus and complex tear in anterior lateral meniscus need surgery? i have no pain or swelling or bending problems
Sir I have grade 3 horizontal tear involving the posterior horn of medical meniscus what should I do...my age is 35 ??
Hello Dr. Nabil! I truly appreciate your videos of extension about the damage structures of the knee. I would like your opinion on what you suggest or think I should do of my knee damages of viewing of Diagnosis in MRI; A mild mucinous degeneration of the ACL, A mild to moderate scarring of proximal MCL, A mild fraying of the medial meniscus and lateral meniscus without tear, mild scattered chondral softening and surface fibrilation in the medial & lateral compartment and of the patellofemoral joint, A small effusion with a mold synovitis, small Baker's cyst, MCL Bursitis, An undersurface vertical tear of the posterior horn segment of the medial meniscus centered at the root attachment, A focal high grade chondral thinning and fissuring at the intermediate femoral throchlea with mild underlying subchondral cystic change, and A Lobular and Septated fluid collection along the medial aspects of proximal tibial metaphysis of which is part around the MCL.
im in pain constantly causes my Left hip to hurt too and had numerous Cortisone Injections and Physical Therapy..etc.(5/19/17) **Desperately Seeking Answer*
How are you today? What is your age? You should get plenty of rest and try to eat healthy and lose weight.
Very short reply has been given!
Hi how are you now, 5 years after you posted this?
Thanks, May grad -1, but very pain?
AS doctor, pls advice, I have a horizontal maniscus tear, only a little discomfort, no locking or giving way. Is it worth surgery? If I dont have surgery what are negatives? If I have surgery will the pain go away and will I be able to return to my outdoor activities, I do a lot of walking and hiking.
But, u didn't explain about (Anterior horn lateral meniscus vertical tear) plz explain it sir 🙏
Dr. Nabil
what do you think about PRP and own body stem cells for meniscus tear?
Abdulaziz Adil unfortunately there is no one fact study about that .
I have OA of R knee. ....multiple medial meniscus tears last Feb. Had stem cell injection n PRP at Steadman Clinic in Vail September 5. Doing well. Just got home from ski trip. Knee did well w brace.
@@carolynanders2677 how many PRP sessions did you have?
@@spezia8066 I only had 1 PRP at same time as my stem cell injection.
@@carolynanders2677 thank you. Gosh even after one PRP session, I hadn't realized that stem cell and PRP are two different treatments. Nearly 2 weeks after the PRP, I've had a marked improvement. I've delayed my 2nd appointment, to try to stretch the gap in the hope that the first jab might be sufficient pain relief. Thanks for the clarification.
Is this curable in Kerala treatment
I have manicus grade 11 shold i opration my knee? ???
Thank you for the info. My MRI was diagnosed with fracture of meniscus tear on the inner part of medial meniscus. (Horizontal, grade3) Having refrained from extreme activities, I don't have daily symptom now after a year since injury but is surgery "ultimately" necessary for fractured meniscus to get back to heavy sports and prevent potential arthritis?
So you are saying you had a third grade tear and you don't go for surgery??
@@mohiman5242 Correct, I didn't have surgery because I didn't have pain on normal days. However I use kinesiology taping before heavy sports(tennis) and icing pack afterwards. Good luck
@@stanstead_korea Good luck indeed that you been able to continue doing sports despite of having a grade 3 medial meniscus tear, a younger person truly has difference to older folk like me if that's in your case, but Osteoarthritis may visit you if you will not reduce your athletic activity cause you've an untreated meniscus injury, in my point of view I don't think so that surgery will prevent the Osteoarthritis to develop hence these are wear & tear illness and Arthritis is a disease.. Me at age 50's medium built I've a complex medial meniscus tear injury & severe Osteoarthritis, Doctors advice me to change lifestyle continue physiotherapy exercise stretching and diet all these just to slowing down the progress of which was become now a lifetime illness, Orthopedic Surgeon explained that a surgery to the Complex meniscus tears doesn't do me good due to the severity of the Osteoarthritis...
@@jasmines3490 Thank you for sharing and I'm aware of future development. I guess cases are different for everyone but I'm still managing my symptoms with rehab exercises (leg extension, knee strengthening workouts etc) Hopefully you will get better too!
@@mohiman5242 midial miniscues grade 2 horizontal tear what treatment brother
Plz suggest me the solution..this is my MRI report
20 years old male with left parameniscal cyst lateral side mri left knee shows:
1) Horizontal tear in the peripheral part of body of lateral meniscus extending in to the
anterior as well as posterior horn, small parameniscal cyst seen adjacent to the posterior part
of body.
2) Hyperintense signal is seen deep to LCL-traumatic synovial thickening
3) Mild fluid within the suprapatellar bursa and tibiofemoral joint space
Grade 2 do i have to do a surgery
ihave mri image that show's ihave posterior horn of the medial meniscus tear grade 2 and im having pain and weakness in my leg cant do sport or carry heavy weight idont know if ishould do surgrey or physical terapy please answer me and god bless you thank you for the video doc
I have same problem posterior horn of the medial meniscus tear grade 1 and 2, how did you manage and how is your pain now
hi
Sir recently I was skid from scooty when I stand my self my leg bend and I fell down.the bend happened MCL ligment area I consult doctor and he given rest for 20 days by keeping straight.now the bandage was taken and suggested to do exercises to bend down and upwards.so can u please suggest what's my injury Condition.howmuch time it will take to recover from this injury.wat is the exact injury.when I am trying to bend my knee it's coming only up to 30° later it's giving pain
Akka ippudela vundi
Physiotherapy and high protein diet
Exercise daily , everything will fine
@@jassasingh5871 paji nber deo apna
Punjab toh a
My left leg now grade III doctor abvice only excercice but no improve my request any suggestions.
Did you do surgery brother?? N how is your leg now
Hello Dr, I am having grade 3 posterior horn of medial meniscus tear on my MRI, will it be fixed without surgery?
Haw are you now
How are you now
@@deepakyadav7502 no pain except locking issue while bending knee fully
@@Bkbond no pain except locking issue while bending knee fully
Dr. I have been worried and not knowing what to do I was told I needed surgery I have a oblique tear in my posterior horn of the medial meniscus and it does extend to the inferior articulations surface. They want to do surgery . Is it considered grade 3 tear? Has anyone had this ?? I’m scared and worried and I have been driving myself crazy. Please help.
U had surgery sister??
I have the same tear in my lateral meniscus I’m curious on how your recovery is two years later
my medial meniscus came to me at 17/08/2017 when i was playing a football match, since that time i stopped playing for one and half month approximately and the pain went during this period.
i tried to play after that period but the pain came back again and immediately i stopped playing and did the MR and they told me it is torn grade 3.
I do not have pain while walking now, i can bend my knee as well, just going down (while i am standing) depending on my right leg ONLY is the thing i can NOT do.
may you kindly give me your opinion (like what to do now, physical therapy or surgery, and what will be the type of the surgery, can i walk normal now, i mean to exercise for 30 minutes in a day).
NOTE: I am 25 years old now and when i stopped playing my weight has increased 5 kilos .
really thank you so much for your valuable time, i really appreciate that.
Heyy.. I have also the same
Brother how are you
How are you now
How's it now?
Both knees have arthritis and meniscus tear and baker cyst. what can i do , lease help. been to surgeon .
Did u do surgery sis?
I also have a medial meniscus tear and a leaking Baker's Cyst and a bone bruise. DR says my knee is a MESS. And it's all from pressing a sm garden flag into the ground. I'm in for a long haul.
Is a grade III BAD?
Sr in my mri points are given.
Strain anterior cruciate ligament
Grade2 horizontal tear of posterior horn of medical meniscus
Grade2 horizontal tear of posterior horn of lateral meniscus
Mild joint effusion.
What to do is operation is good or not plz tel me
How are u brother?
It sounds like you were skiing or racing dirt bikes. I have an oblique mildly complex tear of posterior horn of lateral meniscus in my right knee from racing I brace it now but I’m getting calls to schedule surgery and I’m not sure what’s the best thing to do
Plz Dr grade 1 cleavage tear is possible to heal by it self
Kofi Achampong i am also grade 1 tear wt ws ur condition now
@@aneefasharaf4622 , what is your condition now ?
i have Grade 3 Horizontal Tear. may b in one week i will be surgery
Are u do surgery?
How are you now
If i'm diagnosed with medial meniscal tear grade 3 and tendonosis, knee joint effusion and edema, should i do arthroscopy ?? Please let me know i was told it can't heal with physio alone.
How is the recovery? I had a similar injury. Oblique mildly complex tear of the posterior horn of the lateral meniscus with some bone bruising as well from motocross racing. Did it on the second day of the new year, as long as I’m not overusing it it won’t act up on me, curious on how your recovery is going
@@donalddonaldson7211 how are u
@@deepakyadav7502 I am well, I raced yesterday and brought home a fourth place! I have full range of motion back and can do a deep squat but I don’t lift weights just body weight and I ride my bicycle often. My knee will click and pop but it is not painful. Sometimes when walking it will want to go backward if I’m not standing correctly. But there is no lack of strength. I am very fortunate to be able to still be pain free but time will tell. I hope you are well too
@@deepakyadav7502 I had to give it more time. The body is amazing in what it can accomplish
@@donalddonaldson7211 my mri riport acl 50% tear miniscues grade 2 what I do big brother physio or surgury i try for police force
Mujhe 3 month pehle bike se knee me chot lagi thi , Dr ne ligament fatt gya btaaya or treatment diya , almost 1 month treatment leker mujhe aaraam laga or mujhe running walking me koi problem nhi hui but after 1 month swelling fir se bhadne lagi or ab permanent swelling and pain bhi rehne laga or jab Dr ne mri k liye bola toh ,, report me complex grade 3rd posterior horn of medial meniscus aaya ,,,ab surgery k liye advice di h and ( I'm 21 years old now 😔).
Surgery k liye MCH ortho dr suggest kiya h but I'm scared about surgery results...
It's a common surgery.dnt get scared. You will be okay n normal in 3-4 weeks
@@bharathraj4007 does this surgery works brother?
Hello Doctor,
About two weeks ago,I had gone to do an MRI of my left knee.The result was that i have a chronic but mild injury on the acl and mild knee effusion on the inttaarticular and retropatellar.I took the results to the doc and he said (after doing some tests)it that Acl is intact .I went for a second opinion,and the next doc told me a i have a problem with my meniscus(after some tests too).He added ,nevetheless my knee is stable..He told me he didnt believe in the imaging reports.But he did read the MRI after the report and concluded that it is a meniscus tear.My question is :aren't MRI suspose to be accurate,did the radiologist read it wrong?I am confused.
Guess doc doesn't respond to comments. Ever get answer elsewhere?
@@ericwes7351 nope.btw,it is not gone.just don't do excessive jumping or hiit workout of those sorts
@@myvideochannel6404 Thankyou. Yep, just easy walks for me, until the pain subsides. Not going to take chances.
Doctor abvice no surgery
Sir please help me.
I did the MRI but the report is normal still I'm suffering from knee pain, i was thinking that it's a acl tear but shockingly everything on the report was normal. Still there's swelling and i feel pain in the near area's to the knee and sometimes in the calf muscle and sometimes there's a cracking sound . I visited the doctor he advised me a knee brace and it's more than a month from the date of injury . I started few excercise ,advised by the doctor but still I'm getting pain and swelling . Please help me
Sports person ?
No I'm not a sports person. It's more than 9 months but still i feel the pain and the popping sound is very high.
How is your pain now
@@parshan7687 now how are you sir
Popping is still there( 24z7),very less pain. I don't feel any other problem, i have prepared myself with this - " Nothing will change, so just go with the flow "
Visited 5 doctors, 2 specialist of sports medicine but nothing happened. Tried gym, excercise probably this was bit helpful.
grade 1 signal in the posterior horn of medial meniscus . Sir a mera MRI report hain jab injury hua maine itna dhyn nhi dia bus x ray karke chordi, but pain ho rahatha MRI karaya tho a report aya ,ab tho 2 month ho gaya main kaya karu sir please help me sir🙏🙏🙏🙏🙏
How are you now?
Brother how are you now i have same problem, dis you recovered
mark
B
fyy
Thank you