Chris Henry: Injury Analysis

Chris Henry

Born: 17 October, 1984 (age 28)
Height: 6 ft 3 in (1.91 m)
Weight: 16 st 11 lb (107 kg)
Plays for: Ireland, Ulster
Position Back row

Injury update

February 15th,2012:

“Following an MRI scan today, it was confirmed to the Ireland medical team that back row Chris Henry suffered a cartilage tear to his right knee while playing last Friday,” read a statement from the Irish Rugby Football Union (IRFU).

“The injury will require surgery and will rule Henry out of playing for approximately four weeks.”

What is a meniscal tear?

Knee anatomy: Meniscal Tear

Within the knee are two semi circular  ‘pads’ of cartilage that help absorbed shock in the knee.  These are commonly injured in high impact sports particularly if the mechanism of injury involves a twisting motion or if the knee is flexed and loaded (ie weight bearing). You have medial menisci (towards the inside) or lateral (situated on the outside).

Want to learn more on the anatomy? Check out physio-pedia!! 

 

This picture is displayed with the kind

permission of SportInjuryClinic.net

 What are the symptoms of a medial/lateral meniscal tear?

  • Pain on the medial/lateral (depending on position of tear) aspect of the knee and joint line.
  • Can be swelling but not always.
  • Squatting and kneeling aggravate symptoms.
  • Pain with increased impact or when the knee is loaded and twisted.
  • 3 key questions physio’s ask every patient in the subjective assessment of a knee are..
  1. Does it give way? Psuedo giving way can occur in meniscal tears due to pain inhibition.
  2. Does it lock? If it get locks this can indicate a bucket handle tear which is getting caught when the patient moves the knee.
  3. Does it click? Crepitis can be a sign of a meniscal tear.

How do you assess a meniscal tear?

  • Check out a full knee assessment here
  • A quick pitchside assessment would incude –
  • History and mechanism of injury – what structures is is likely to be? Then rule out what its not. Is there immediate swelling/bruising? If a twisting injury has occurred ligaments should be tested for integrity and a McMurrays could be performed. Meniscal testing is not always specific or sensitive particularly in the acute phase therefore reassessment at a later date may be more useful. As a pitchside physio your job is to assess whether the player needs to come off or stay on.
  • A clinical assessment by a doctor or a physio is enough to form a ‘working diagnosis’
  • An MRI is only required if conservative management fails or if the consultant would like to rule out any other involvement ie ligament damage.
  • MRI’s are also good in the elite athlete to give a more specific prognosis.
  • Most meniscal injury (if in a region with adequate blood supply) will settle with conservative management within 4-6 weeks (with appropriate advice and exercises).
  • Immediate referral to a consultant should occur if the patient is suspected of any ligament damage or has any mechanical problems (ie locking).

Physiotherapy management

NOT all tears will require surgery. This depends on the location and severity of the tear. Some areas of the menisci are avascular (ie no blood supply). Regeneration and repair in these areas are poor. A course of physiotherapy to maintain muscle strength and control, acupuncture for pain relief and soft tissue mobilisation to prevent secondary problems is usually provided. If surgery is necessary physiotherapists will review the patient and progress the patient through their rehabilitation which will involve strengthening, balance, co-ordination, change of direction and proprioception exercises to get the patient to a level where they are fit to return (usually 4-6 weeks).

Meniscus surgery

In the case of a torn meniscus (cartilage), arthroscopic surgery can be used  either repair or remove the torn part of the cartilage. The decision on whether to repair or remove depends on the site of the tear and also the extent of the tear.

Menisectomy

If Chris is expected to return after four weeks he will not be having a repair because this has a much longer rehabilitationperiod. Instead, he is likely to be having a menisectomy. This involves removing part of the cartilage as shown in the video above. This is day surgery and usually performed arthroscopically (key hole). Patients will normally be up and feeling ‘with it’ approximately 3-4 hours after surgery. Most private hospitals have a protocol that they will not discharge people until 4 hours after being on the ward. The patient will be taught basic ROM exercises to help reduce stiffness and static quads to get the muscle firing. If there is good practice they should be provided with an information sheet with these exercises written down. RICE guidelines are advised (R=Relative rest, I=Ice, C=Compression, E=Elevation). The patient will generally mobilise independently with the advice to ‘weight bear as tolerated’ and will not require elbow crutches (However if increased pain or more extensive surgery these may be required). Always read the notes to confirm weight bearing status.

WBAT =Weight bear as tolerated, FWB=full weight bearing, PWB=Partial weight bearing, NWB=Non weight bearing.

As a general rule to be discharged a patient needs 4 requirements.

  • That they can safely get up/down stairs (if they have stairs)
  • Their pain is well controlled
  • They can mobilise safely and independently.
  • The rest of the MDT is happy.

“I always warn the patient to take it easy the first day. They often wake and have minimal pain due to the local anaesthetic. I warn them that this may begin to wear off later in the day and that they should take regular pain relief as prescribe to by their doctor.If they follow this advice usually they do well”

Physiotherapist

References

Arnoczky SP, Warren RF. Microvasculature of the human meniscus. Am J Sports Med. 1982;10:90-95.
Robert S. P. Fan, Richard K. N. Ryu, (2000) Meniscal Lesions: Diagnosis and Treatment. Medscape Orthopaedics & Sports Medicine 4(2)

Meserve BB, Cleland JA, Boucher TR. (2008) A meta-analysis examining clinical test utilities for assessing meniscal injury. Clinical Rehabilitation, 22(2), 143-61.
photo credit: darkmatter via photopin cc

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