By Carl Green 

 

This post is the fifth in my musculoskeletal condition series, so if you are interested in other types of conditions, please take a look at my other posts, if you have not already. 

 

I am going to present information in a similar way to my last post on dislocations, and will be separating cartilage tears into two different categories, traumatic cartilage tears and non-traumatic cartilage tears. 

 

Now, before we go any further I should first explain what cartilage is, and where in the body you will find it. All cartilage is made of connective tissue, and there are 3 main types which I’ve put below in order of most to least mobile/flexible: 

 

· Flexible cartilage is used to reinforce other soft tissues providing increased structure, for example in the ear. This is the least relevant in regard to musculoskeletal injuries and conditions. 

 

· Hyaline or articular cartilage lines the ends of our bones at the joint surfaces, where one bone moves on another. This is the most common type of cartilage in the body, and it is usually the cartilage at weight bearing joints that we have problems with, such as the knees, hips, spine and ankles. However, we may see problems in other areas, for example the hand, shoulder, wrist or elbow, particularly if there has been a trauma or overload to the joint. 

 

· Fibrous cartilage is stronger as the name implies, and is used often as a shock absorber and to fill spaces in joints to provide increased structure and stability. The most common fibrous cartilage structures we see affected in our physiotherapy clinic are the meniscus of the knee, labrum of the hip socket (aka acetabulum) or shoulder socket (aka glenoid), or the triangular fibrocartilage complex on the little finger side of the wrist. 

As the name implies, a traumatic cartilage tear has been caused directly from a specific injury. The articular or fibrous cartilage are usually torn when a joint has been twisted or forced in any direction whilst weight-bearing or under compression. Sometimes people describe a pop or click at the time, a catching or locking on joint movement, instability or a feeling of giving way and weakness. Usually the joint will swell within an hour or so, and it is often difficult to weight-bear for at least the first few days. However, these symptoms can be also present with other types of injury such as ligament sprains, muscle strains, tendon tears, and even fractures. 

 

Also as mentioned in previous posts it is not uncommon to injure multiple structures from the same injury, as such forceful events also often place lots of stress through our bones and soft tissues, and not just the cartilage in isolation. For example, if you had a weight-bearing twisting injury of the knee, this could injure the meniscus (fibrous cartilage in the knee joint) but also the medial collateral ligament (MCL), or anterior cruciate ligament (ACL). Also, if there was a large muscle contraction involved, you could potentially have strained your quadricep, hamstring, glute or calf muscle. 

 

This is why it is important to be assessed by an adequately qualified and experienced health professional soon after any traumatic injury (such as a traumatic cartilage tear). A registered physiotherapist, GP, or clinicians within A&E should then consider what structures may have been involved, and if any further assessments, additional treatments or precautions are required. 

in this scenario the non-traumatic cartilage tears have not been a result of an obvious injury, but are instead related to degenerative and deconditioning processes within the cartilage tissue. So, first I had better explain what I mean by all these terms. In brief, these processes affect the structure of the tissue making it less resilient to mechanical stress and causing it to be slower in recovery. However, I would encourage you to not think of these processes as a disease but instead as a normal response to an ageing body and/or adaptations of the tissue caused by reduced activity and fitness. 

 

It is also important to say that how a tissue or joint looks, or the degree of degenerative processes seen on a scan, does not always match up with how a person feels or functions. Therefore, some people can have very significant changes seen on a scan, but are actually managing really well, or could have very mild or no changes on a scan but be finding things very difficult. Sometimes the tissues can become sensitive and sore rather than damaged, but the pain is still very real, even if the scan is relatively “normal”, and there are lots of things we can do to help you in either scenario. 

 

In non-traumatic cartilage tears, it is important to interpret and use scans cautiously, as the level of degeneration seen does not form the sole basis for decision making in most cases. Experienced and up to date clinicians like myself, my colleagues, and many other health professionals and consultants will take this into account. We will request or use scans effectively and only if appropriate, and make decisions based on all the information, but especially on how our patients are coping, their goals, demands, abilities and difficulties, amongst many other things. 

Another reason that I have divided cartilage tears into traumatic cartilage tears and non-traumatic cartilage tears, is because these tend to be treated differently. Unfortunately, cartilage does not have a very good blood supply and therefore it does not heal as well as many other tissues, such as bones and muscles. 

 

Traumatic cartilage tears have a significant effect on function (such as giving way and locking) often require timely assessment by an experienced musculoskeletal physiotherapist, or relevant doctor or consultant who can consider if surgery may be appropriate. Sometimes symptoms are able to settle in time with physiotherapy and ample recovery time, usually over 3-6 months. However, if the affected joint has been giving way or locking since the injury, it would be relevant to seek a surgical opinion. If an operation is recommended then physiotherapy treatment is used for prehabilitation leading up to surgery, or rehabilitation afterwards, and aims to facilitate better outcomes. 

 

However, when it comes to degenerative or non-traumatic cartilage tears, often surgery is less successful and relevant, and the main method of treatment is physiotherapy to facilitate better physical health, and learn to manage the pain and any modifications needed to reduce irritation in the future. If pain or function does not improve to an adequate level within around 6-12 months, surgical options may be considered. Often these are limited to joint replacement (where possible), although some consultants may offer short-term pain relieving treatments to help manage flare ups. 

If you are having joint aching/pain and would like professional support, then please get in touch with us at Colchester Physiotherapy and Sports Injuries Clinic, and myself (Carl Green) or my physiotherapist colleagues Craig Fowlie or Jane Marr will do all we can to help you. 

 

The next topic I will be covering in my “musculoskeletal conditions” series is going to be fractures and bone health. As always please check this blog page on our website, or follow us on social media, to see when it is published. 

If you are having issues with any of the different types of musculoskeletal conditions we would advise you to speak to a professional. Our team are experts in treatment and rehabilitation of musculoskeletal injuries or problems, and can offer you practical and effective advice on how to avoid or deal with a wide range of musculoskeletal conditions. If you require any more information about our services, reach out today or give us a call on 01206 579631.