Friday, October 21, 2011

Meniscus Tear

In sports and orthopedics, a tear of a meniscus is a rupturing of one or more of the fibrocartilage strips in the knee called menisci. When doctors and patients refer to "torn cartilage" in the knee, they actually may be referring to an injury to a meniscus at the top of one of the tibiae. Menisci can be torn during innocuous activities such as walking or squatting. They can also be torn by traumatic force encountered in sports or other forms of physical exertion. The traumatic action is most often a twisting movement at the knee while the leg is bent. In older adults, the meniscus can be damaged following prolonged 'wear and tear' called a degenerative tear.

Tears can lead to pain and/or swelling of the knee joint. Especially acute injuries (typically in younger, more active patients) can lead to displaced tears which can cause mechanical symptoms such as clicking, catching, or locking during motion of the knee joint.[1] The joint will be in pain when in use, but when there is no load, the pain goes away.

A tear of the medial meniscus can occur as part of the unhappy triad, together with a tear of the anterior cruciate ligament and medial collateral ligament.


The menisci are C-shaped wedges of fibrocartilage located between the tibial plateau and femoral condyles. The menisci contain 70% type I collagen.[2] The larger semilunar medial meniscus is attached more firmly than the loosely fixed, more circular lateral meniscus. The anterior and posterior horns of both menisci are secured to the tibial plateaus. Anteriorly, the transverse ligament connects the 2 menisci; posteriorly, the meniscofemoral ligament helps stabilize the posterior horn of the lateral meniscus to the femoral condyle. The coronary ligaments connect the peripheral meniscal rim loosely to the tibia. Although the lateral collateral ligament (LCL) passes in close proximity, the lateral meniscus has no attachment to this structure.[2]

The joint capsule attaches to the entire periphery of each meniscus but adheres more firmly to the medial meniscus. An interruption in the attachment of the joint capsule to the lateral meniscus, forming the popliteal hiatus, allows the popliteus tendon to pass through to its femoral attachment site. Contraction by the popliteus during knee flexion pulls the lateral meniscus posteriorly, avoiding entrapment within the joint space. The medial meniscus does not have a direct muscular connection. The medial meniscus may shift a few millimeters, while the less stable lateral meniscus may move at least 1 cm.

In 1978, Shrive et al. reported that the collagen fibers of the menisci are oriented in a circumferential pattern.[2] When a compressive force is applied in the knee joint, a tensile force is transmitted to the menisci. The femur attempts to spread the menisci anteroposteriorly in extension and mediolaterally in flexion. Shrive et al. further studied the effects of a radial cut in the peripheral rim of the menisci during loading. In joints with intact menisci, the force was applied through the menisci and articular cartilage; however, a lesion in the peripheral rim disrupted the normal mechanics of the menisci and allowed it to spread when a load was applied. The load now was distributed directly to the articular cartilage. In light of these findings, it is essential to preserve the peripheral rim during partial meniscectomy to avoid irreversible disruption of the structure's hoop tension capability.


The patient's chief complaints are usually knee pain and swelling. These are worse when the knee bears more weight (for example, when running). Another typical complaint is joint locking, when the patient is unable to fully straighten the leg. This can be accompanied by a clicking feeling. Sometimes, a meniscal tear also causes a sensation that the knee gives way.

The patient can sometimes remember a specific activity during which the injury was sustained. A tear of the meniscus commonly follows a trauma which involves rotation of the knee while it was slightly bent. These maneuvers also excite the pain after the injury; for example, getting out of a car is often reported as painful.

After noting symptoms, a physician can perform clinical tests to determine if the pain is caused by compression and impingement of a torn meniscus. The knee is examined for swelling. In meniscal tears, pressing on the joint line on the affected side typically produces tenderness. The McMurray test involves pressing on the joint line while stressing the meniscus (using flexion-extension movements and varus or valgus stress). Similar tests are the Steinmann test (with the patient sitting) and the Appley test (a grinding maneuver while the patient lies prone and the knee is bent 90°). Bending the knee (into hyperflexion if tolerable), and especially squatting, is typically a painful maneuver if the meniscus is torn. The range of motion of the joint is often restricted.

The Cooper's sign is present in over 92% of tears. It is a subjective symptom of pain in the affected knee when turning over in bed at night. Osteoarthritic pain is present with weightbearing, but the meniscal tear causes pain with a twisting motion of the knee as the meniscal fragment gets pinched, and the capsular attachment gets stretched causing the complaint of pain.

Also see: bounce home test, Thessally's test, Wilson test (internal/external rotation), and Bohler's test.

There are two menisci in your knee. They sit between the thigh bone femur and shin bone tibia. While the ends of the thigh bone and shin bone have a thin covering of soft hyaline cartilage, the menisci are made of fibrocartilage tough cartilage and conform to the surfaces of the bones upon which they rest. One meniscus rests on the medial tibial plateau; this is the medial meniscus. The other meniscus rests on the lateral tibial plateau; this is the lateral meniscus.[4]

These menisci act to distribute body weight across the knee joint. Without the menisci, the weight of the body would be unevenly applied to the bones in the legs (the femur and tibia). This uneven weight distribution would cause the development of abnormal excessive forces leading to early damage of the knee joint. The menisci also contribute to the stability of the joint.

The menisci are nourished by small blood vessels, but the menisci also have a large area in the center of that has no direct blood supply (avascular). This presents a problem when there is an injury to the meniscus as the avascular areas tend not to heal. Without the essential nutrients supplied by blood vessels, healing cannot take place.[4]

The two most common causes of a meniscus tear are traumatic injury (often seen in athletes) and degenerative processes (seen in elderly patients who have more brittle cartilage).[4] Meniscus tears can occur in all age groups. Traumatic tears are most common in active people from age 10-45.[4] Traumatic meniscal tears are usually radial or vertical in the meniscus and are more likely to produce a moveable fragment that can catch in the knee and therefore require surgical treatment.

The most common mechanism of a traumatic meniscus tear occurs when the knee joint is bent and the knee is then twisted. It is not uncommon for the meniscus tear to occur along with injuries to the anterior cruciate ligament ACL and the medial collateral ligament MCL — these three problems occurring together are known as the "unhappy triad," which is seen in sports such as football when the player is hit on the outside of the knee. Individuals who experience a meniscus tear usually experience pain and swelling as their primary symptoms. Another common complaint is joint locking, or the inability to completely straighten the joint. This is due to a piece of the torn cartilage preventing the normal functioning of the knee joint.

Degenerative tears are most common in people from age 40 upward. Degenerative meniscal tears are thought to occur as part of the aging process when the collagen fibers within the meniscus start to break down and lend less support to the structure of the menicus. Degenerative tears are usually horizontal in the meniscus, producing both an upper and lower segment of meniscus. These segments usually don't move out of place and therefore are less likely to produce mechanical symptoms of catching or locking.[4]

Degenerative meniscal tears are also more common in smokers.

A torn meniscus can prevent normal pain-free motion of the knee and therefore can interfere with the patient's ability to climb stairs or get in and out of chairs and cars.

The medial and lateral menisci are shock absorbers and force distributors located between the femur and the tibia. Consequently, menisci can tear due to traumatic injury or degenerative wear (e.g., in knee joint arthritis), and can compromise force distribution across the knee joint, increasing force concentration on the cartilage and other joint structures.

Damage to the meniscus is due to rotational forces directed to a flexed knee (as may occur with twisting sports) is the usual underlying mechanism of injury. A valgus force applied to a flexed knee with the foot planted and the femur rotated externally can result in a lateral meniscus tear. A varus force applied to the flexed knee when the foot is planted and the femur rotated internally can result in a tear of the medial meniscus.

Tears produce rough surfaces inside the knee, which cause catching, locking, buckling, pain, or a combination of these symptoms. Abnormal loading patterns and rough surfaces inside the knee, especially when coupled with return to sports, significantly increase the risk of developing arthritis if not already present.

X-RAY images (normally during weightbearing) can be obtained to rule out other conditions or to see if the patient also has osteoarthritis. The menisci themselves cannot be visualised with plain radiographs. If the diagnosis is not clear from the history and examination, the menisci can be imaged with magnetic resonance imaging (an MRI scan). This technique has replaced previous arthrography, which involved injecting contrast medium into the joint space. In straightforward cases, knee arthroscopy allows quick diagnosis and simultaneous treatment. Recent clinical data shows that MRI and clinical testing are comparable in sensitivity and specificity when looking for a meniscal tear.

Sumber: Wikipedia

Sunday, October 16, 2011


Terasa ingin menyatakan sesuatu..juga ingin menasihati diri sendiri..tetapi melihat kepada poster-poster kecil yang cantik dan cute..hati tercuit. (^^).
Betapa ia terkesan dihati.
Untuk perkongsian sahabat semua.
(saya kutip gambar comel2 ni dari seorg kawan..jika ada yang tidak suka saya paparkan disini kerana mungkin copy right reserved habaq ya..nanti saya remove)..jzkk
(mengingatkan bahawa Rasa keabdian (kehambaan) dalam diri merupakan anugerah pemahaman terbesar sebagai seorang muslim. kerana tanpa merasa diri kerdil dan hina, tidak mungkin hati kan tunduk dan patuh padaNya,apatahlagi berusaha mencari cintaNya)

(Remind me about them..may Allah bless them always <3)

( Bahawa Hadith Rasul; ingat 5 perkara sebelum 5 perkara mengandungi hikmah yang sangat besar..kerana setiap manusia kan melalui saat itu..dan bersiap-siaplah untukmenghadapi saat-saat yang dimana hanya iman yang mampu berbicara)

(Ujian itu satu keniscayaan...satu sunnatullah. Yang datang sama ada dalam bentuk susah mahupun senang..Ketika ini juga, hanya iman sebagai peneman setia. Hati yang hidup dengan cintaNya, sukar dilalaikan dengan ujian. Pun begitu bukankah ujian juga kan mendekatkan hati itu kepadaNya..)

(Sebagai motivasi saat diberi ujian ALLAH.. Cukuplah Allah sebagai pelindung "Hasbunallahu wani'kmal wakiiill")
Dan kekuatan itu hanya milik Allah, Rasul-rasul dan orang-orang mukmin..

Semoga ujian dan nikmat setiap saat yang Allah berikan mampu mengekalkan rasa kehambaan dalam diri.

Wednesday, October 12, 2011

Copy paste: meraih kekuatan dan ketaatan

"Kesalahan paling fatal adalah bila engkau berusaha mengatur dan menata kehidupan sekitarmu, tapi engkau membiarkan kekacauan di hatimu.” (Mustafa Shadiq ar Rifa’i dalam Wahyul Qalam)

Ibnu Qayyim al Jauziah, dalam bukunya Madaarij as Saalikiin berkata, “Sesungguhnya dalam hati terdapat sebuah robekan yang tidak mungkin dapat dijahit kecuali dengan menghadap penuh kepada Allah. Di dalamnya terdapat juga yang tidak mampu diobati kecuali dengan menyendiri bersama Allah. Di dalam hati juga ada sebuah kesedihan yang tidak akan mampu diseka kecuali dengan kebahagiaan yang tumbuh karena mengenal Allah dan ketulusan berinteraksi dengan Nya. Di dalam hati juga terdapat sebuah kegelisahan yang tidak mampu ditenangkan kecuali dengan berhimpun karena Allah dan pergi meninggalkan kegelisahan itu menuju Allah. Di dalam hati juga terdapat gejolak api yang tidak dapat dipadamkan kecuali oleh keridhaan akan perintah, larangan, dan keputusan Allah, yang diiringi dengan ketabahan dan kesabaran sampai tiba saat perjumpaan dengan Nya.”

Bersyukurlah, karena Allah telah anugerahkan pada kita sebuah ‘alat’ motivasi terbaik dunia. Percayalah, hati yang dekat pada Allah adalah sumber motivasi dan semangat pergerakan kita. Maka raihlah kekuatan dengan mengokohkan ketaatan. Dan hindarilah kelemahan dengan menjauhi kemaksiatan.

Multiplier Effect dari Kebaikan dan Keburukan

“Akibat ternikmat dalam kebaikan adalah menghadirkan kebaikan pula,” kata Syaikhul Islam Ibnu Taimiyah. Begitu pula kemaksiatan akan mengundang kemaksiatan-kemaksiatan yang lain. Nothing personal, karena semua tindakan kita akan berakibat pada tindakan-tindakan kita yang lain. Bahkan pengaruhnya bisa sangat besar. Fudhail ibnu Iyadh berkata, “Aku bermaksiat kepada Allah, kemudian aku lihat dampaknya pada istriku bahkan hewan-hewan peliharaanku”.

Akhirnya, hal mendasar yang paling perlu kita perbaiki ketika kelemahan hadir adalah ketaatan kita kepada Allah SWT. Dan Semoga Allah kokohkan kita dalam ketaatan kepadaNya. Aamiin.


Thursday, October 6, 2011

Nak jadi yang jenis mana?

Hidup ini adalah pilihan..keputusan di atas sesuatu pilihan akan mempengaruhi perjalanan,kita semua sebenarnya selalu berdepan dengan pelbagai pilihan..salah satu pilihan yang ingin saya nyatakan disini adalah pilihan yang mungkin dihadapi sebahagian orang..

Situasi satu:
“malas la nak jaga patient Dr tu..tak suka dia..”
“kenapa tak suka Dr tu?”
“ Dia kan ada title..nurse Call dia, dia tak angkat. Dia tak suka nurse call dia..Hanya Dr sahaja yang boleh call dia..”

Situasi dua:
“ Suka la Dr tu..tak menyusahkan..senang saja dengan dia..”
“Ketika buat round sangat independent..tak bergantung dengan nurse..Dr lain, nak touch light pun nurse kena ambik....lepas tu.susah tengok dia marag-marah..”

Situasi tiga:
“Saya tak nak ketika saya buat round nursing students disini..” bentak seorang specialist.
“I don’t like crowded..”

Situasi empat:
“awak junior staff nurse ke? Si junior stafnurse angguk sambil mengiyakan.
“bagi phone ni pada senior..saya nak cakap dengan senior”

Situasi lima:
“ Dr tu..kalau dengan patient bukan main lagi manis nyer.. tapi kalo dengan nurse, nak mesra pun susah..”
“ok la tu kira baik dengan patient..ada Dr yang dengan patient pun tak baik..tu lagi teruk! Kalau dengan nurse ni..biasanya most Dr susah nak pandang atau buat baik dengan nurse..kalau apa-apa jadi mesti nak salahkan nurse..dia lambat tahu pasal patient pun, dia salahkan nurse..pendek kata jarang la Dr memandang nurse ni sebagai “ seseorang..” hanya “angel Dr” je yang hargai nurse…”

Situasi enam:
“semasa saya buat Round, saya tak mahu students tak Tanya..saya nak awak semua Tanya-tanya…kalau awak tak Tanya saya tak tahu nak ajar apa. OK! Kita semua mesti proactive..!!” pesan cardiologist kepada nursing students.

Setiap dari kita punyai pilihan ingin dikenali sebagai apa..kerana kehidupan kita di dunia ini hanya lah sementara. Rasa lebih baik, rasa lebih superior dari yang lain hanya virus yang akan membunuh rasa kehambaan dalam diri..Title, pangkat, gelaran hanyalah “mainan” di dunia yang tidak kekal. Pun begitu yang pastinya kita semua adalah manusia..yang tidak akan terlepas dari segala kelemahan dan kesilapan. Maka, terimalah kelemahan dan kesilapan orang disekeliling kita dengan penuh lapang dada… kerana kita menyedari bahawa kita juga akan membuat kesilapan dan kesalahan keranaa kita juga adalah manusia biasa. Cuma yang bezanya adalah mereka yang mahu membaiki kesilapan mereka atau masih tetap sama mengulanginya kerana tidak merasakan mereka membuat kesilapan…

Moral of the story… dari sudut lain, for all nurses, juga bakal-bakal nurse especially, work professionally, sometimes they behave like that because nurses does not perform their task, prove you can do the best!