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A 24-year-old female injured her right knee 2 days ago during a city-league basketball game. She was unable to continue playing after the injury and required "a little" assistance from a teammate to get to her car. She was evaluated by her primary care provider (PCP) the next day. The PCP recommended the use of over-the-counter nonsteroidal anti-inflammatory medication, and referred the patient to physical therapy. Five days postinjury, the patient reports to the physical therapist that the injury occurred when she planted her right leg and rotated to the right to evade a defender. She denies hearing a pop; however, she reports that the immediate pain was severe (8 out of 10 on a visual analog scale). Her current pain level is 5 out of 10. The patient's pain and mechanism of injury are consistent with a meniscus injury.

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What examination signs may be associated with this suspected diagnosis?

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What are the most appropriate examination tests?

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SENSITIVITY: Ability of a diagnostic test to correctly identify individuals who have the target disease or health condition in a patient population (Table 29-1)

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SPECIFICITY: Ability of a diagnostic test to correctly identify individuals who do not have the target disease or health condition (Table 29-1)

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SnNout: Mnemonic for a highly sensitive test (high sensitivity, negative, rules out)1

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SpPin: Mnemonic for a highly specific test (high specificity, positive, rules in)1

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Table Graphic Jump Location
Table 29-1 2 × 2 Table for Diagnostic Tests
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  1. Describe the anatomy and function of the menisci.

  2. Describe the pathomechanics associated with a meniscal injury.

  3. Recognize symptoms associated with a meniscal injury.

  4. Describe appropriate clinical examination tests that may help rule in a diagnosis of a meniscus sprain.

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PT considerations during management of the individual with a suspected meniscus sprain:

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  • General physical therapy plan of care/goals: Rule out other knee injuries; decrease pain; increase muscular flexibility; increase or prevent loss of knee range of motion; increase lower quadrant strength; prevent or minimize loss of aerobic fitness capacity
  • Physical therapy interventions: Modalities to reduce pain; interventions to restore range of motion deficits; therapeutic exercises to restore muscular strength and aerobic fitness
  • Precautions during physical therapy: Monitor vital signs; avoid exercises that place a rotatory force on the knee during acute and subacute phases of healing
  • Complications interfering with physical therapy: Damage to additional knee structures such as anterior cruciate or medial collateral ligaments; articular cartilage pathology; osteochondritis dissecans, fracture, tumor,2 cysts3

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