meniscus pain

Synonyms in the broader sense

Cartilage disc, anterior horn, pars intermedia, posterior horn, inner meniscus, outer meniscus,

English: meniscus

Sports injury or degeneration

Pain of a meniscus can have different triggers. Most commonly, these are either due to long-term wear ( degeneration ) or injury, typically during exercise.

A sports injury results in a wrong, jerky movement, often combined with a twist in the knee joint (often when stopping or changing direction, for example when playing soccer or skiing) or direct violence (for example, a fall or the kick of a teammate) to a sudden onset of violent pain in the area of ​​the knee joint. Often, this pain is due to damage to the outer meniscus, or more often the inner meniscus, usually in the form of a meniscal tear.

In the case of degenerative changes in the knee joint (usually caused by osteoarthritis caused by the wear and tear of the cartilaginous tissue of which the menisci are present), the pain develops over a longer period of time and does not occur as acutely. Often they are initially barely noticed, so that an exact onset of the complaints can not be determined afterwards. In the course of these, however, they continue to increase and severely restrict those affected at some point. This form of pain occurs mainly in older patients.

symptoms

In addition to pain, the damaged meniscus sometimes causes further symptoms. These have their origin also where the pain develops, at the knee. Other symptoms include swelling of the knee joint (knee joint effusion) and limitations in mobility. The effusion is due to the tear in the meniscus, which initiates inflammatory processes and leads to overproduction where the synovial fluid is formed. The joint and the surrounding tissue swell significantly. When it comes to the Baker's cyst, tingling or numb discomfort can sometimes occur when nerves have become trapped. These occur where the nerve has its innervation area, ie on the lower leg in front or in the calf. The limitations of movement, which may appear as additional symptoms where a meniscus is ruptured, come about through a combination of pain, swelling and eventual nerve damage.

Significant symptoms occur when parts of the meniscus completely tear off and float freely in the joint. These parts can hinder processes in the joint. An example is the Streckhemmung, in which an extension of the leg is no longer possible. In addition, one sometimes hears a clacking or snapping in the joint, where torn parts lead to blockages. However, pain is usually the predominant symptom in the lesion of a meniscus.

Localization of meniscus pain- popliteal fossa

Where a meniscus causes pain is different.
A meniscus is painful if, for example, it has been injured by a tear or stretching. The pain can also occur in the popliteal fossa. Where the pain occurs depends on the location of the injury. Most meniscus pain occurs laterally, in the popliteal fossa, they are mainly perceived when the posterior horn of the meniscus has been injured.

Walking or running, even getting up or stretching the knee often causes pain in the popliteal fossa. There is also a special phenomenon that manifests itself in the popliteal fossa, the so-called Baker's cyst. This also occurs in some cases with damage to the meniscus.

The knee joint, in which the menisci are located, is surrounded by a joint skin. When a meniscus is damaged, the inflammation increases the pressure in the joint, to which the surrounding structures must yield to a certain degree. Through the place where there is the least resistance, then, between two muscles in the popliteal fossa an outward bulge forms, a Baker cyst arises. There is a noticeable swelling in the popliteal fossa, which can cause pain. Although other diseases of the joint can cause this cyst, a lesion on the meniscus is a typical risk factor.

The Baker's cyst is usually diagnosed by MRI of the popliteal fossa, which is made after persistent pain and swelling in the popliteal fossa.
The therapy is to treat the causes in the joint. The meniscus must be rehabilitated and the inflammation controlled to normalize the pressure where the cyst has formed. Only in an emergency, if in addition to the pain also a numbness or circulatory problems occur, the cyst should be punctured or surgically removed. However, this does not eliminate the cause, so recurrence is relatively likely. However, not all pain that occurs in the popliteal fossa is due to a Baker's cyst, and damage to the meniscus alone radiates into that region as often.

Figure meniscus

Figure right knee joint from the front (A) and view of the menisci from above (B)
  1. Inner meniscus -
    Meniscus medialis
  2. Inner joint knobby
    (Slide) -
    Medial condyle
  3. Transverse ligament of the knee joint -
    Lig. Transversum genus
  4. Patella Ribbon -
    Ligamentum patellae
  5. Bursa - Bursa
  6. Outer meniscus -
    Lateral meniscus
  7. Outer hinge pin
    (Slide) -
    Condylus lateralis
  8. Anterior cruciate ligament -
    Lig. Cruciatum anterius
  9. Posterior cruciate ligament -
    Ligamentum cruciatum posterius
  10. Thighbone - femur
  11. Shin - Tibia
  12. Patella - patella

pain signals

In both cases, however, the pain is not caused by the meniscus itself. The menisci consist of cartilage, a tissue that is not supplied with blood vessels and nerve fibers. Therefore, the menisci themselves can not transmit a pain signal to the brain. However, cracks or splintered pieces of cartilage can irritate or damage the surrounding tissue, causing a pain signal. It often comes in addition to an inflammatory reaction or joint effusion, both of which can lead to swelling or overheating and redness of the affected knee.

Meniscal pain - especially at night?

Chronic meniscal pain is often dependent on the situation in advanced stages and is especially noticeable at night when lying down or at rest.

Acute meniscal pain is usually sudden and in the form of shooting, stinging or pulling pain. Chronic pain is similar, but usually develops continuously and increases in intensity over time.
In the advanced stage, however, pain in the meniscus is often dependent on the situation and is noticeable when lying down at night or appears calmly.
Even if the meniscus is torn unnoticed, the pain is often noticed after a long period of rest, for example, the next morning, when the knee is loaded. Often, these pains are then felt below the kneecap, the knee may be swollen and mobility may be limited.
Night-time meniscal pain, for example, caused by meniscal tears, through which the meniscal tissue can move through prolonged lying and can press against the joint capsule. The knee joint capsule is criss-crossed with many nerves, irritation leads to severe pain.

For meniscal pain that occurs at night, a thorough diagnostic evaluation by a physician is recommended. Nocturnal meniscal pain is associated with so-called morning pain in the knee, which may be a sign of knee osteoarthritis, a chronic wear and tear of the cartilage. Frequently, the knee is stiff and hurts in the morning, which improves with exercise during the day. A medical examination is recommended.

Meniscal pain during sports

Meniscal pain during sports

Some sports are at high risk for knee problems and meniscal pain. So it is often jumping sports such as volleyball or sports with abrupt stops and rapid spins such as tennis or squash, which cause pain in the area of ​​the meniscus.
Particularly at risk are recreational athletes who challenge by improper footwear, inadequate training or overweight improper overloading of the menisci.
It is very important for the meniscus and the prevention of pain to be physically active. Because the meniscus is not well supplied with blood and is only nourished by the synovial fluid during movements in the knee joint. By warming up sufficiently before exercise, the meniscus can better cushion shocks.
In addition, the correct dosage of knee-straining sports such as jogging is advisable, especially beginners should start slowly and gradually increase. Strengthened leg muscles are needed for any kind of physical activity, as it can reduce knee strain by up to 30 percent and reduce the risk of injury. Matching footwear for athletic activities can also effectively prevent meniscal pain as the knee load can be reduced.

Meniscus pain after jogging

Many runners, especially hobby runners or beginners, more or less often report pain after jogging. Not infrequently the knee is affected. Overloading in the knee joint can occur after jogging, especially if it is in a rather untrained condition. Most of the pain goes away a day or two after jogging, but in some cases the meniscus may be behind it. Whether the meniscus is responsible for the pain, you notice where the pain occurs.

At the side of the knee is the characteristic place where the meniscus causes pain. However, it is rare for a meniscus to be acutely injured while jogging as it requires a violent force. This can happen, for example, when bent over. If the meniscus is responsible for pain after jogging, it is likely to be a degenerative decrease in cartilage where the meniscus is heavily loaded, especially for the elderly. Even after previous surgery, a meniscus can make complaints after jogging, so that the burden should be reduced here.

Meniscus pain after surgery

If damage to the meniscus has been treated surgically, pain may continue after surgery. As after each operation, the surgical wound must first heal and the meniscus, if not removed, grow together and regenerate. This can cause pain.

In the first few weeks after surgery, care should be taken not to unnecessarily burden the meniscus. But even in the long term, it may be that after surgery is not completely without pain. Especially in sports that are demanding for the meniscus, such as football or skiing, pain may occur again after a long period of work on the knee where the operation took place. These disappear after the sport but mostly again. This need not be a sign of a renewed injury to the meniscus, but usually stems from the fact that a meniscus after surgery is often no longer as resilient as a healthy, non-operated meniscus. Therefore, you should reduce the intensity of athletic exercise in pain. Nonetheless, there are many people who no longer complain of pain after surgery.

Relieve meniscal pain

There are some therapy methods that can be used for conservative (non-operative) treatment of meniscal pain. If the meniscus pain occurs acutely, you should strain the leg as little as possible. Leaning, protection and cooling counteract swelling and alleviate the acute symptoms.
A sports ointment with pain-relieving effect and an elastic bandage or sports bandage can counteract the meniscal pain.

Through acupuncture or special injection procedures in the joint can also be achieved a relief of pain. With medicines that have an analgesic and anti-inflammatory effect (eg anti-inflammatory drugs such as Diclofenac, Voltaren®) the pain can be alleviated effectively.
It is advisable to reduce obesity, because the higher the body weight of the person concerned, the greater the risk that the knee joint will be damaged.
In some cases, the regulation of orthopedic shoes or insoles may compensate for any malpositions resulting in painful malaise of the meniscus.
Other ways to relieve meniscal pain are water and bath therapy procedures, electrotherapy, ultrasound therapy or physical therapy procedures. Basically, it is recommended to do an in-depth muscle training in order to strengthen and build up the muscles surrounding the knee. This can often improve pain symptoms.

If a direct accident event is responsible for the meniscal pain and the symptoms persist for more than one to two days, a doctor should be consulted for proper therapy to be initiated.

Diagnosis of meniscal damage

If you feel pain in the knee joint, you should either choose an orthopedist or his family doctor directly, who will issue a referral to an orthopedic doctor after a survey of the medical history and a basic diagnosis in the continuing suspected pain from the meniscus.
The orthopedist will eventually perform some clinical tests, called meniscus tests, to see if the pain actually comes from the meniscus.
Read more about: Meniscus test

In many cases, the preparation of an X-ray image and, in most cases, the performance of a magnetic resonance tomography (MRI) are also useful.
Neither the meniscus tests nor an X-ray can show any meniscal damage. Only by an MRI the cause of the pain can be represented by an imaging.
Read more under the following topic: MRI for meniscal damage

Treatment / What to do?

The menisci compensate for incongruities (inequalities) between the articular surfaces of the bones involved in the knee joint. They are virtually as a small crescent-shaped uneven slices between the femur (femur) and the tibial plateau of the tibia (tibia). Pain caused by damage to the menisci is manifested as knee pain and is not always distinguishable from other causes such as torn ligament. Often athletes are affected by meniscal injuries or workers, such as tilers, which strain their knees.
There are different types of injuries or causes of meniscal pain, the most important of which are the canine squeezing, the meniscal tear, or a degenerative change, that is, osteoarthritis. Often meniscus injuries, a meniscal tear, for example, are symptom-free and do not hurt so much. Characteristic, however, if discomfort is present, a stretch and flexion deficit, more or less severe pain in the popliteal fossa and on the sides over the injured meniscus. This pain pulls into the tibia.
If you feel pain in your knee, for example immediately after a sports injury, it is advisable not to strain the knee and cool it. You can wrap cold and damp cloths around the affected knee. Cooling elements should never be placed directly on the affected area. Furthermore, elastic bandages or knee joint bandages can initially relieve the discomfort. Such bandages are usually obtained in pharmacies. There you can also ask for a painkiller or a pain and inflammation-relieving ointment, which improve the symptoms. However, if the pain is very severe, the knee swollen or red, and the mobility is severely limited hours or a day later, it is advisable to see a doctor who closely examines the knee joint.
Whether and how the knee is treated depends on the severity and type of injury as well as the level of exercise of the patient. In mild degenerative changes or injuries and a good level of training of the patient physiotherapeutic exercises may be sufficient to make the pain disappear. However, if the meniscus is torn or severely damaged, surgery may be necessary in which the ruptured meniscal component is partially resected by knee arthroscopy. As a basic therapy, however, a physiotherapy is usually first prescribed. Before an operation is performed, it must be confirmed by MRI that this is really necessary. In case of a very severe injury and a very advanced degenerative change, an artificial meniscus can also be transplanted.

homeopathy

You can also try to control the pain of an injured meniscus with homeopathy. A number of homeopathic remedies have been used for some time in joint complaints to relieve pain and suppress inflammatory processes. It must be clearly stated that homeopathy alone can not cure rupture or similar damage to the meniscus, but homeopathic or herbal remedies can be used to support symptom relief in addition to conventional medical treatment.

In the acute phase, the pain relief by homeopathy will probably be too weak. After an operation or as part of a conservative therapy, these funds make more sense. On the other hand, the treatment of pain on the meniscus always involves an orthopedist who can objectively assess the damage and initiate appropriate therapy.

The use of homeopathy should also be accompanied by a trained specialist. For pain in homeopathy substances such as Aconitum napellus be used, against inflammation, for example, Acidum nitricum help. Also against the swelling, which can cause pain, there are preparations such as Apisinum. In the best case, remedies of homeopathy are combined with conventional medicine, self-medication should be avoided because of possible interactions of the funds among themselves.


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