Arthiritis and lower limb conditions Flashcards
What is arthiritis?
Inflammation and stiffness in a joint
what is oesteoarthiritis?
Wearing away of cartilage due to old age, resulting in bone on bone grinding
What are the xray features of osteoarthiritis?
Joint space narrowing
Osteophytes (boney spurs)
Subchondral sclerosis (thin layer of increased bone density beneath the articular cartilage (appears more white)
Subchrondral cysts (fluid filled legions in bone- appear darker)
LOSS
What is rheumatoid arthiritis?
An auto immune condition where antibodies attack the synovial membranes leading to joint erosion and deformity
How are symptoms and signs of rheumatoid arthiritis different to osteoarthiritis?
RA: rheumatic nodules, age 40-50 (osteo generally 50+), also comes with systemic effects in eyes, skin, lungs, heart, kidneys ect)
What are the x ray features of Rheumatoid arthirits?
- Less joint space
- Erosion in non cartilage protected bone
- Periarticular osteopnea (loss of bone substances near joints)
- Gross deformity and sublaxation
What movement is difficult with a patella fracture?
extension of the knee
Where does the patella normally lie?
patellofemoral groove
Which muscle normally helps stabilise the patella and how?
vastus medius
attaches to pattella on its medial side pulling it inwards
In what group of people are patella dislocations more common due to the way that the muscles develop?
young girls
What is common mechanism of patella dislocations and which direction does it normally go in??
Pivoting femur internally on planted foot while knee is bent
direct blows or falls onto knee
normally dislocates laterally
What are signs and symptoms of patella dislocations?
pain feeling a shift & hearing popping sound knee buckling swelling and deformity fear of changing direction when running
Which menisci is more commonly injured and why?
medial
it is more firmly adhered to the medial collateral ligament and joint capsule
What is sign of medial and lateral menisci tears?
lateral- pain on lateral rotation of tibia
medial- pain on internal rotation of tibia
Why do peripheral menisci tears often repair on their own?
They have a good enough blood supply
Which collateral ligament of the knee will be injured for varus and valgus stress’?
varus- extended and locked knee pushed laterally as ankle fixed will injure lateral collateral ligament
Valgus- extended and locked knee pushed medially can cause medial collateral ligament
What movements can tear an ACL?
- Lateral blows to a extended leg with fixed foot (causes unhappy triad)
- Excessive lateral twisting of a flexed knee with fixed foot (also unhappy tirad)
- Hyperextension and severe force to front of femur with knee semi flexed
What is an unhappy tirad?
- medial collateral ligament tear
- Medial menisci tear
- ACL tear
When can a PCL tear occur?
- When femur moves forward over tibia
- falling onto tibial tuberosity with flexed knees
- Tibia hitting dashboard in car crash
what is supraplatella bursitis and how does it occur?
Swelling and inflammation of the bursa infront of the knee cap
Housemaids knee
Due to one off direct injury or repeatative friction from working on knees
What is a superficial/ subcutaneous infrapatella bursitis how does it occur
clergymans knee
occurs due to friction between skin and tibial tuberosity causing oedema over proximal end of the tibia
What is a locked knee?
When the leg is stuck in one position and it is unable to bend or straighten
Usually caused by a mechanical block where something is stuck inside the joint, such as a meniscal tear or loose body
Why does the knee normally lock out on full knee extention- standing
Gives stability and means quads not needed to flex to stand up
What happens when the knee locks on full extension? What muscle unlocks the knee?
biceps femoris flexs and tibia rotates laterally and femur rotates medially
popiteal muscle unlocks it
What causes an antalgic gait?
a painful leg
- also called a limb
Describe an antalgic gait
- short stance phase in affected leg
- lack bodyweight shift onto affected leg
- short swing phase in unaffected leg
- uneven gait cycle lengths on each leg
On what side should someone place the walking stick?
On the opposite side to the painful leg
When does a hempiplagic gait occur?
- after brain injury affecting one side of the body (stroke, cerebral palsy, trauma ect)
describe a hemiplagic gait
- flexed arm with wrist hanging down on affected side
- exteneded lower limb on affected leg
- circumduction of affected leg- joint flexion on this side is hard so foot wont clear floor otherwise
When does a diplegic gait occur?
in neuromuscular disorders affecting both sides
describe a diplegic gait
- scissoring of legs (knees in front of the other)
- adductors and calf muscles tight
- ankle is always planterflexed so hard to clear foot off ground and place it
What is a high steppage gait?
- the foot drops due to inability to dorsiflex the foot
- toe hanging down meaning the often fall over their own feet
- need excessive hip flexion on affected side to compensate
What can cause a high steppage gait?
- sciatica
- common peroneal nerve palsy or neuromuscular disorders
What is a parkinsonian gait?
- the shuffling/ short step gait where they lean forwards with no arm swinging
- often must lean forward and start to fall in order to start walking and have difficulty stopping (fenistant)
- seen in parkinsons
What is a trendlenburg gait?
- dropping of pelvis when lifting leg opposite to the one affected
- caused by weakness of abductor muscles, which can be due to legions of the superior gluteal nerve
