Sections

Meniscal Injury

Sections Meniscal Injury
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Follow-up
Questions & Answers
Media Gallery
References

Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort and have sedating properties, which are beneficial for patients who have sustained injuries.

Acetaminophen (Tylenol, Feverall, Tempra, Aspirin-Free Anacin)

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DOC for pain in patients with documented hypersensitivity to aspirin or NSAIDs, with upper GI disease, or who are taking oral anticoagulants.

Class Summary

Have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclooxygenase (COX) activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.

Ibuprofen (Motrin, Ibuprin)

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DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

Naproxen (Naprelan, Anaprox, Naprosyn)

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For relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing activity of COX, which results in a decrease of prostaglandin synthesis.

Diclofenac (Voltaren, Cataflam)

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Designated chemically as 2-[(2,6-dichlorophenyl)amino] benzeneacetic acid, monosodium salt, with an empirical formula of C₁₄ H₁₀ Cl₂ NO₂ NA. One of a series of phenylacetic acids that has demonstrated anti-inflammatory and analgesic properties in pharmacological studies. Believed to inhibit COX, which is essential in biosynthesis of prostaglandins. Can cause hepatotoxicity; hence, monitor liver enzyme levels in first 8 wk of treatment.

Rapidly absorbed; metabolism occurs in liver by demethylation, deacetylation, and glucuronide conjugation. Delayed-release, enteric-coated form is diclofenac sodium, and immediate release form is diclofenac potassium. Has relatively low risk for bleeding GI ulcers.

Celecoxib (Celebrex)

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Primarily inhibits COX-2. COX-2 is considered an inducible isoenzyme, induced during pain and by inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited, thus GI toxicity may be decreased. Seek lowest dose of celecoxib for each patient.

Class Summary

Narcotic analgesics should be used sparingly in the conservative treatment period. The use of these agents is warranted only in special cases in which intolerable pain is present that cannot be controlled by first-line medications. However, these drugs are commonly used in the postoperative period when surgical treatment is necessary. Many options are available, and narcotic analgesics are commonly combined with drugs from the above categories. Common examples are listed.

Hydrocodone and acetaminophen (Vicodin, Lortab, Lorcet)

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Drug combination for moderate to severe pain.

Oxycodone (OxyIR, OxyContin, Roxicodone)

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Indicated for moderate to severe pain.

Follow-up

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Media Gallery

Magnetic resonance imaging scan showing a normal meniscus.
Magnetic resonance imaging scan showing a torn medial meniscus.
Arthroscopic probing of a posterior horn complex meniscal tear with multiple flaps.
Arthroscopic view of medial meniscus after excision of flap tear.

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Author

Sarjoo M Bhagia, MD † Consulting Staff, OrthoCarolina; Voluntary Teaching Faculty, Carolinas Rehabilitation

Sarjoo M Bhagia, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, North American Spine Society, Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

Coauthor(s)

Selina Yingqi Xing, MD, MS Staff Physician, Department of Physical Medicine and Rehabilitation, Temple University

Selina Yingqi Xing, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Physiatric Association of Spine, Sports and Occupational Rehabilitation, American Medical Association

Disclosure: Nothing to disclose.

Michael Weinik, DO Associate Chairman, Associate Professor, Physical Medicine and Rehabilitation, Temple University Hospital

Michael Weinik, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Bradley S Baker, MD Orthopedic Surgeon, American Board of Orthopaedic Surgery Certified in Orthopaedic Surgery and Orthopaedic Sports Medicine; Partner, Nevada Orthopedic and Spine Center

Bradley S Baker, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael T Andary, MD, MS Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Chief Editor

Ryan O Stephenson, DO Associate Professor of Clinical Practice, Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine; Medical Director of Polytrauma and Brain Injury (Polytrauma Network Site), Department of Physical Medicine and Rehabilitation, Eastern Colorado Veterans Affairs Medical Center

Ryan O Stephenson, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Additional Contributors

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, Texas Medical Association

Disclosure: Nothing to disclose.

James H Lubowitz, MD Director, Taos Orthopaedic Institute, Taos Orthopaedic Institute Research Foundation (TOIRF), and Taos Orthopaedic Institute Sports Medicine Fellowship Training Program; Clinical Professor, Department of Orthopaedic Surgery, University of New Mexico School of Medicine

James H Lubowitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America

Disclosure: Received consulting fee from Arthrex for consulting; Received salary from AANA for employment; Received royalty from Arthrex for other.

Bryce T Wolf, MD Sports Medicine Fellow, Taos Orthopedic Institute

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors wish to thank Kavita Gupta, DO, MEng, Department of Orthopedics, Center of Physical Medicine and Rehabilitation, University of Dentistry and Medicine of New Jersey, for her previous contributions to this article.

Sections Meniscal Injury
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Follow-up
Questions & Answers
Media Gallery
References

Meniscal Injury Medication

Medication Summary

Analgesics

Class Summary

Acetaminophen (Tylenol, Feverall, Tempra, Aspirin-Free Anacin)

Acetaminophen (Tylenol, Feverall, Tempra, Aspirin-Free Anacin)

Nonsteroidal anti-inflammatory drugs