Radiological Assessment of Medial Meniscus Tear of the Knee - Research Paper Example

?Radiological Assessment of Medial Meniscus Tear of the Knee Meniscus refers to a fibro-cartilaginous, crescent-shaped structure partly dividing a joint cavity. These structures are present in the knee, sternoclavicular, temporomandibular and acromioclavicular joints within the human body. The cartilage of the knee comprises of lateral and medial menisci, both serving the purpose of providing structural integrity during instances of tension (Jette & Jette, 1996). Sometimes these menisci are referred to semi-lunar cartilages; a name attributed to their shapes. Within the knee, these structures provide strength to the joint enabling the knees to perform various functions like movement. Because of the functions performed by these structures, they remain highly prone to injuries among other problems (Jette & Jette, 1996). In layman’s terms, medical practitioners and patients commonly refer the meniscus tear of the knee as “torn cartilage”. Individuals participating in active sporting activities suffer most from meniscus tear resulting from traumatic forces encountered during these activities. These traumatic forces result from quick, twisting movements of the knee. Meniscus tear can also occur while indulging in innocuous actions like squatting (Rath & Richmond, 2000). In numerous cases involving aged individuals, damages could result from prolonged ‘tear and wear’, commonly called degenerative tear (Anz et al., 2013). Individuals older than 45 years remain highly susceptible to degenerative tears. These effects, however, remain subject to the nature of activities, which the individual engages in during his lifetime. Injuries into the other vital ligaments of human knee could also contribute towards meniscus tear (Anz et al., 2013). Patients experiencing meniscus tear complain of swelling and excruciating knee pains. These symptoms could be worsened if the individual continues performing activities that increase the knee stress (Teitz, 2009). Joint locking might also be experienced, making it impossible for the patient to stretch the leg, which could be accompanied by a clicking feeling in some patients (Winslow & Bach, 2001). Meniscus tear could occur slowly following involvement in strenuous activities like running and patients might not remember the injury-causing incident. While resting, a patient might not experience any pains, but slight movements of the knee remain extremely painful following meniscus tear. The presence of these symptoms in patients prompts doctors to perform clinical tests aimed at ascertaining cause. Tenderness at a specified knee could prove the presence of meniscus tear (Winslow & Bach, 2001). Meniscus tear causes immense pain with a twisting motion because the meniscus fragments get pinched and stretched during the process. Meniscus tear normally limits the joint movement ranges. Doctors use McMurray test in establishing the presence of medial meniscus tears. The affected leg is stretched and turned, and pain or click indicates the presence of the medial meniscus tear. Sources put McMurray’s test sensitivity at 53% and specificity at 97% (Solomon et al., 2001). Bending the knee and squatting become extremely painful maneuvers when the meniscus becomes torn. Excruciating pains present within the knee areas could indicate torn meniscus, although other knee ligaments could present similar painful experiences once injured. Injury to any of the four knee ligaments could produce similar feelings to the patient, and McMurray’s test, therefore, becomes essential in ascertaining the presence of the medial meniscus tear (Solomon, et al., 2001). The importance of the meniscus in the knee remains distributing body weight across the knee joint for easy locomotive activities. This even distribution of body weight prevents early damages from occurring through giving stability to the joint. There are two principal causes of meniscus tears in human knees, namely traumatic injuries and degenerative process (Teitz, 2009). Traumatic tears commonly occur in active individuals and are mostly radial in nature (Bellabarba, Bush-Joseph, & Bach,1997). These tears moveable fragment s within knees, requiring surgical treatments for correction and resumption to normal physical ligament state. The main complaint of patient with meniscus tears include swelling, excruciating pain and joint locking. Inability to straighten joints perfectly is associated with torn ligaments, which prevent knee joint from functioning properly (Winslow & Bach, 2001). Degenerative tears mainly occur in individuals over 45 years though smokers are also likely to suffer from degeneration of menisci, associated with tobacco consumption. Meniscus tears prevent pain-free knee movements, hence causing individuals intense pain when walking or performing other basic tasks requiring knee movements (Anz, et al., 2013). Meniscus tears result from activities individuals engage in, and can be prevented through following several precautions. While degenerative tears cannot be prevented, safety precautions can be employed in preventing tears associated with sporting activities. Proper footwear in individuals engaging in sports remains essential safety precaution for preventing medial meniscus tears. Shoes enable proper foot balance as misstep could cause meniscus tear. During training, individuals should ensure proper and sufficient stretching of key leg muscles. Stretching ensures these muscles become strong enough to support the body weight and prevent potential meniscus tears. Individuals engaging in sporting activities should be equipped with essential techniques for preventing such injuries (Bellabarba, Bush-Joseph, & Bach,1997; Anz, et al., 2013). Radiological assessment methods X-rays The diagnosis for this impairment is carried out through numerous examinations aimed at ascertaining the presence of the medial meniscus tear. X-rays, within the context of pathology for the impairment, are normally utilized in eliminating the probability of other ligament damages. Osteoarthritis is a common condition, which displays similar symptoms to this impairment and can be ascertained through x-rays. Though x-rays cannot identify the presence of meniscus tear, they are utilized to establish the presence of other related impairments with similar symptoms. X-rays are commonly utilized in establishing the presence of fractures and injuries within bones and not soft tissues. Physical examination of this condition only checks the presence of symptoms related to meniscus tear, but never ascertains presence of the impairment. The first diagnostic process of the impairment remains physical examination and observation (Christiansen, 2005). Figure 1 shows an x-ray image showing a knee with osteoarthritis. The utilization of x-ray based diagnosis critically enables doctors to eliminate similar diseases. This could be attributed to the inability for x-rays to accurately diagnose the presence of meniscus tears. The sensitivity of x-rays when analyzing meniscus tear is 16% and specificity 96% (Sprawls, 2008). This elimination process allows doctors to narrow their diagnosis aimed at reducing cases of misdiagnosis. Since x-rays are straightforward procedures, compared to specialized imaging methods used for establishing the presence of meniscus tear, they remain indispensable for purposes of elimination. Doctors opt to utilize x-rays upon physical examination since there are many conditions that exhibit similar observable symptoms (Christiansen, 2005). Following recognition of the symptoms of swelling, excruciating pain and locking joints, an elimination process should be initiated for the numerous impairments with these symptoms. X-rays alone cannot ascertain the presence of the medial meniscus tears although they remain a fundamental part of the diagnostic process. Most of the other processes utilized also relay on x-ray images, in addition to other technologies. Doctors perform x-rays as initial processes for diagnosing meniscus related impairments that could occur (Sprawls, 2008). Arthrogram Arthrogram technique of using x-ray images can be utilized in attempting to ascertain the presence of the medial meniscus tear impairment. This process involves injection of specified contrast medium under local anesthetic into the area being examined (Christiansen, 2005). This process utilizes fluoroscopy where real-time X-ray images are obtained by the radiologist and utilized in checking the internal structures of ligaments. Numerous images are taken continuously and quickly enabling a real-time analysis of knee ligaments. The fluoroscope can be connected to CCD video camera that allows viewing and recording of images on a computer. This connection enhances the capability for storing and analyzing images taken during the process. Patients are placed between a fluorescent screen and an x-ray source enabling the radiologist to create images that could assist in analyzing and identifying the presence of meniscus tear. Figure 2 is an arthrogram image of the knee joint (Temmerman, et al., 2005). Arthrogram technique assists the doctors in checking the tissues as x-rays only check bone related injuries. The accuracy level becomes increased with specificity at 47% and sensitivity at 55% (Temmerman, et al., 2005). The utilization of contrast medium and introduction of fluorescent screen into the process enables the creation of real-time images of body tissues that can review injuries in ligaments like the meniscus. Following the elimination of related impairments through x-ray, this method can effectively identify medial meniscus tears within knee ligaments. Doctors continue to utilize this method because of the increased accuracy enhanced by the addition of cameras and fluorescent screens. These fiber-optic cameras increase the number of images taken during the procedure. These enhancements profoundly increase the efficiency of the testing process as it produces reliable evidence based results. This method could also include the use of ultrasound technology, which similarly increases the reliability of results displayed by testing. Arthroscopy Arthroscopy enables doctors to perform straightforward procedures on patients with this impairment. Arthroscopy is utilized in both identification and treatment of damaged interior joints and ligaments like the meniscus. Arthroscopic procedures could be performed when evaluating and treating numerous orthopedic conditions like torn and damaged cartilages. This technique continues to be utilized in areas where quick recovery is essential, like in cases of footballers (Kirkley et al., 2008). The technique involves small incisions that immensely enable quick recovery compared to open surgery. This could be mainly attributed to the fact that the process creates minimal trauma on connective tissues. Patients also do not have to encounter with long processes of nursing wounds caused by open surgery. The absence of open wounds significantly reduces the healing duration, helping patients with tight schedules save crucial time. This method is commonly utilized in cases where patients require quick analysis and healing, as well. The accuracy of this method is presented by sensitivity of 71% and specific of 84% for knee injuries (Temmerman, et al., 2005). Doctors commonly utilize this method when administering treatment and check-ups to athletes and sportsmen. This category of patients commonly suffers from meniscus related impairments and requires quick recovery period because of work-related issues. Doctors would consider this method first option when treating such patients. This method saves time through conducting assessment and treatment concurrently within the same procedural setting and utilizing similar equipment. This method can be able to examine almost all human joints prone to ligament injuries. The utilization of this process, therefore, remains dependent on the patient’s occupations and the intensity of the injury. Large medial meniscus tears could necessitate open surgery if there are tissues being replaced. Figure 3 shows an arthroscopic image of the knee. Computed tomography Computed tomography is another method utilized in medical imaging that can be utilized in testing of medial meniscus tears in humans. The process utilizes x-rays in creating tomographic images of specified body parts, essential in making diagnostic and therapeutic medical decisions. The x-ray images taken are fed into computers, which generate three-dimensional images of the desired section. The data produces information that can be manipulated for purposes of examining bodily abilities to block x-rays (Tubiana, 2008). This capability enables the technology to be utilized in imaging fractures around different joints as it can reconstruct multiple planes of the significant area under observation. Computers in this process significantly improve the overall efficacy of the process while utilizing images created from normal x-rays. Computers assist medical practitioners in analyzing the results revealed by the x-rays through reconstruction of different parts from the pictures taken. This method utilizes ionizing radiation in generating x-ray images used in making decisions regarding the presence of impairment. This ionizing radiation presents an imminent danger in the utilization of the process when testing for medial meniscus impairment. The radiations released in the process are strong enough to damage human DNA, either directly or indirectly. Though rare, these damages cause different types of cancers, estimated at about 2% (Brenner & Hall, 2007). The risk of developing cancer, resulting from these radiations, reduces with advancement in age. In reducing this risk, controlling of the radiation becomes essential when dealing with young patients. Other testing methods could also be applied when dealing with these patients. Doctors ought to consider the patient’s age in determining the cancer risk available at the patient’s age group, before engaging in this procedure. This remains a crucial setback to the utilization of computed tomography in testing medial menisci damages (Hall & Brenner, 2008). Figure 4 illustrates a typical computed tomographic image of the knee. Being a three dimensional technology, computed tomography eliminates superimposition of images from structures, not within the required area. For purposes of studying small areas, where and x-ray could include nearby features, this technology remains highly useful. In diagnosing medial meniscus of the knee, this technology could be utilized because the area under study forms a small fraction of x-ray images. This produces sensitivity of 67% with specificity of 50% (Sprawls, 2008). The technology can enable doctors to take numerous pictures during examination, and narrow their focus to specified locations when reporting. The technology can also differentiate images of tissues whose density differs, therefore, increasing the accuracy of diagnosis. The technology does not involve insertion of objects into patients’ bodies when checking internal structures. In using computed tomography, therapists take numerous x-ray images of the knee from different angles. These images are fed to a computer for analysis, and using special computer software 3D images are generated. The computer software generates 3 dimensional images from the information gathered from the x-ray images. Three-dimensional images recreated using computers provide clear views of the knee structures. These images assist therapists in identifying the presence of meniscus tears (Sprawls, 2008). Magnetic Resonance Imaging (MRI) Magnetic resonance imaging, MRI is a commonly employed method of imaging and scanning internal body structures, which is utilized in imaging of the meniscus, to establish the presence of impairments. This process provides clear images, essential for accurate diagnosis of the impairment. The images created during the process are extremely clear on the soft tissues compared to X-ray related imaging processes (Rosen & Lenkinski, 2007). X-rays have limited capabilities when dealing with soft tissues, as they require injection of fluids to enable clear viewing of tissues. According to Temmerman, et al. (2005), this process is also capable of delivering real-time images of specified areas being diagnosed. During the process, images can also be taken for particular analysis at later stages and for storage. The capability to store images can enable patients to seek treatment from specialized medical practitioners once proper diagnosis is completed (Temmerman, et al., 2005). Figure 5 shows an image of posterior ligament tear taken using the MRI technology. While this method continues to replace other methods because of its accuracy medical association provide guidelines concerning its utilization. The technology creates a significantly strong magnetic field that could have adverse effects of patients with medical implants. Reduction of these dangers continues to be undertaken through the development of non-magnetic implant materials (Archibold, 2001). The radio waves generated during the process lead to production of high temperatures that could be catastrophic should the patient contact them. In claustrophobic patients, the utilization of this technology might cause immense discomfort. The equipment performing the procedure must have the part being scanned fully. Doctors, therefore, ought to consider emotional state of the patient before performing magnetic resonance imaging. Magnetic resonance imaging surpasses arthroscopy in terms of checking efficiency, and recent times have almost replaced it in checking. This method does not utilize ionizing radiation and therefore, evades the risks associated with radiation (Hasebroock & Serkova, 2009). Testing using this method presents sensitivity of 81% and specificity of 67% at 95% confidence interval (Temmerman, et al., 2005). This method can provide 3D images from any orientation minimizing the efforts of turning the patient during examination. This reduces the amount of time taken in performing an analysis of a patient, as the patient does not turn during evaluation. The magnetic field created by the system enables doctors to view different angle elevations perfectly without moving patients. This imaging process does not include inserting objects into patients’ bodies as some individuals might not desired being injected, it can be termed as pain-free. This might make patients prefer the technology to other existing testing methods. Medical decisions regarding physical therapy Physical observation of patients with knee impairments remains fundamentals in making decisions regarding the treatment method to be applied. Physical therapy mostly occurs following reporting of certain symptoms suggesting the presence of impairments. Medial meniscus impairments normally constitute various symptoms accompanied by excruciating pains (Teitz, 2009). While under some circumstances, doctors might fail to conduct desired physical therapy; the accompanying pains of knee impairments could immensely contribute to inevitable physical therapy. Patients might insist on physical therapy being performed to establish the exact cause of pains. Though the presence of pains cannot guarantee impairment, it could necessitate physical therapy to demystify causative agents of pain. Establishment of pain causes could enable therapists to administer the relevant remedies to notable impairments (Teitz, 2009). Administration of medical attention cannot be undertaken without establishing the essential facts regarding the impairments. The injured ligaments must be correctly assessed before embarking on the process of offering medical assistance. Treatment of injuries can be performed using various methods, including operations, and physical observation becomes essential when deciding on the remedial procedure to be performed. Majority of impairments are treated using operations and these procedures require serious consideration before undertaking. There arises need, therefore, to conduct a physical examination aimed at ascertaining the necessity of an operation. Cases of knee impairments require assessment of medical history of patients and occupation in establishing the possible causes of these impairments (Teitz, 2009). The patients’ occupations and medical history could also be a fundamental element for therapists in deciding the kind of testing necessary. The physical state of patients greatly affects the decision being made by therapists. For example, patients using birth control implants cannot be exposed to magnetic resonance imaging (MRI) when testing for medial meniscus impairment. This remains essential because the process might produce magnetic waves that could present potential risks when exposed to these implants. Doctors therefore must consider any medical equipment inserted into the patient’s body. Accompanying this information would be medical history of patients, which could assist doctors in establishing any medical reactions that might occur. When using MRI testing medical information remains fundamental in establishing suitability of performing the test on a patient (Teitz, 2009). Knee impairments could cause surmountable negative effects to normal functioning of the entire body system. Therapists must therefore perform necessary tests aimed at establishing the possible effects of the identified impairment on the body. Therapists therefore require huge amounts of information in establishing the methods of treatment applicable to different patients. This could be attributed to the fact that knee impairments can be treated differently with similar results. The differences arise from the magnitude of impairment, physical state of patients, and patients’ medical history. These three elements must be carefully considered when providing medical care to individuals diagnosed with knee ligament impairments (Sohn & Toth, 2008). Consideration of the factors aimed at assisting in decision-making can only occur following availability of the essential information. While some information can be obtained from questioning the patient, majority of the information requires physical examination of the patient. Within the process of treating knee ligament impairment, testing could be identified as an information gathering process aimed at providing true information. This information helps doctors in establishing the magnitude of the impairment therefore, assisting in deciding the essential treatment process. Embarking on treatment always remains a product of the diagnosis. The information gathering process assists doctors in establishing informed and accurate diagnosis of different situation (Jette & Jette, 1996). Lack of enough information regarding a situation could potentially lead to misdiagnosis and failed treatment process. When diagnosing presence of medial meniscus tears, for example, x-rays are utilized in eliminating the possibility of other closely related conditions, which exhibit similar symptoms. This elimination significantly increases the accuracy of diagnosis delivered by doctors. Failure to conduct enough, physical examination poses the imminent danger of misdiagnosis, consequently leading to wrong treatment. Medial meniscus tears could easily be confused with Osteoarthritis as they have similar symptoms but different treatment methods (Jette & Jette, 1996). Professionally, most therapists consider this information in their decisions and performing on medical treatments. Though cases of misdiagnosis continue to be reported, majority of these instances result from patients failing to offer information voluntarily leading to doctors having error in their diagnosis. Some patients fail to understand why doctors require medical history, which patients might be ashamed to inform the doctors about. All cases of misdiagnosis, however, cannot be attributed to lack of information. Sometimes, machines performing testing procedures fail, resulting in misdiagnosis following acquisition of inaccurate information. Medical ethics and standard operating procedures followed by doctors remain fixed. These ethics ensure doctors maintain required standards, eliminating instances of negligence (Teitz, 2009). Doctors could be denied operating licenses, by medical association, following serious medical errors. Medical associations ensure operating standards throughout the medical profession. Instances of doctors failing to incorporate medical information remain rare as references could be made and doctors questioned on their decisions when errors occur. The responsibility of ensuring professional services therefore supersedes personal interests within the medical profession (Jette & Jette, 1996). Conclusion Radiological assessment of medial meniscus tear of the knee remains a fundamental element of establishing proper medical care offered under various situations. The assessment could be identified as the beginning point of treating the condition as well as other associated conditions (Rath & Richmond, 2000). In performing the assessment, medical staffs need to establish various facts occurring before the condition. These include patient’s occupation, medical history and physical states of different patients. This information enables therapists to make informed decisions regarding the method to be utilized in performing the assessment. While doctors might have capacity and freedom to perform any test, consideration must always be made regarding the best techniques for testing different patients. Various testing techniques and procedures in existence can be utilized in testing and achieving accurate results. The testing processes possess different challenges and potential risks as well. Majority of assessment procedures include the utilization of ionizing radiations, identified as carcinogenic. The responsibility of minimizing the dangers caused by these methods lies purely on the doctors. Doctors performing such assessment therefore need to maintain professionalism and observe medical ethics when making these crucial decisions. Doctors must understand the patients in order to offer the best, available medical attention under these circumstances (Sohn & Toth, 2008). The decisions regarding treatment, comes from physical observations performed by doctors on patients. Although patients might have personal preferences and choices, doctors must always assess patient’s situations before agreeing with patient’s preferences. Misdiagnosis of medial meniscus tear of the knee could result in wrong treatment. While these impairments remain treatable slight mistakes could create catastrophic results. Doctors as indicated by Sohn & Toth (2008), therefore, need to incorporate information gathered during assessment when administering treatment. Though they are not obliged to incorporate this information, what could happen if a doctor fails to incorporate such information? 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