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MSK > Clinical anatomy of the knee, foot and ankle > Flashcards

Clinical anatomy of the knee, foot and ankle Flashcards

1
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4
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What kinds of forces do a) the lateral and b) medial collateral ligaments resist?

A

a) varus force
b) valgus force

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5
Q

What forces are resisted by:

a) anterior cruciate ligament
b) posterior cruciate ligament

A

a) anterior translation and external rotationof the tibia
b) posterior translation of the tibia

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6
Q

What is the common insertion of the knee extensor muscles?

A

Tibial tuberosity via the patellar tendon

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7
Q

What can predispose to knee OA?

A

Previous injury e.g. meniscal tears, ligamentous injury

Misalignment (e.g. genu valgum, varus)

? Distance running

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8
Q

How is knee OA managed?

A

Conservative management

If conservative is no longer sufficient- knee replacement which may be total (TKR) or partial

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9
Q

Why should steroid injections for tendonitis of the extensor mechanism of the knee be avoided?

A

High risk of tendon rupture

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10
Q

How is the extensor mechanism tested?

A

Straight leg raise

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11
Q

How does the position of the patella on X-ray help locate an extensor mechanism tear?

A

High lying patella- PT rupture

Low-lying patella- quad rupture

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12
Q

How is extensor mechanism rupture treated?

A

Surgical- tendon to tendon repair or reattachment

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13
Q

What is patellofemoral dysfunction?

A

Anterior knee pain caused by the lateral pull of the quadriceps

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14
Q

How does patellofemoral dysfunction present?

A

Anterior knee pain usually worse going downhill, knee locking, stiffening in a flexed position, “grinding” sensation

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15
Q

How is patellofemoral dysfunction treated?

A

Vast majority improve PT aimed at strengthening vastus medialis

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16
Q

What might cause patellar dislocation, and what direction is this almost always in?

A

Direct blow or twisting of the knee

Almost always lateral

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17
Q

How do meniscal injuries classically present?

A

Twisting force on a loaded knee e.g. twising when playing football

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18
Q

What do patients with meniscal tears complain on?

A

Localised pain, feeling as though the knee is about to give way, knee locking or catching, may be unable to fully extend knee

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19
Q

Which meniscus is most commonly turn?

A

Medial

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20
Q

What type of meniscal tear can cause a failure to fully extend the knee?

A

Bucket-handle meniscal tear

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21
Q

What type of meniscal tear is suitable for surgery?

A

Longitudinal tears in the outer third of the meniscus in younger patients (very few are suitable)

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22
Q

How are meniscal tears unsuitable for repair managed?

A

Conservatively- most tears heal themselves

Steroid injections may help

Persistent pain may be an indication for arthroscopic meniscectomy

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23
Q

How do ACL ruptures typically present and what do patients complain of?

A

High rotational force on a planted foot

Deep pain in the knee, feeling of instability, tense swelling (haemarthrosis) within the knee

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24
Q

What injuries can be caused by:

a) valgus force
b) varus force

A

a) MCL rupture and potentially ACL with higher forces (think Roy Keane on Alf-Inge Haaland)
b) LCL rupture

25
Q

What accompanies an ACL rupture in 25% of cases?

A

Meniscal tear

26
Q

What is the main ankle dorsiflexor?

A

Tibialis anterior

27
Q

Which ankle plantar flexor is missing from this diagram? What is the common insertion of these muscles?

A

Plantaris

Calcaneus via the Achilles Tendon

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31
Q

What is hallux valgus?

A

Deformity of the big toe- medial deviation of the first metatarsal and lateral deviation of the big toe itself

32
Q

In what groups of patient is hallux valgus more common?

A

Rheumatoid and other inflammatory arthropathies, neuromuscular disease (e.g. MS, cerebral palsy)

33
Q

How is hallux valgus treated a) conservatively and b) surgically? What is the satisfaction rate of the surgery?

A

a) wider “accomodating” shoes; spacer between first and second toes. b) osteotomy and release/tightening of tight/slack structures.

30% patients are unsatisfied with results.

34
Q

What is hallux rigidus?

A

OA of the first MTPJ.

35
Q

What is the gold standard for surgical treatment of hallux rigidus?

A

Arthrodesis

36
Q

Where do the medial and lateral plantar nerves arise from?

A

The tibial nerve

37
Q

What is Morton’s neuroma and what causes it?

A

Swelling of nerve fibres in the foot due to repeated trauma. The third and second interspace nerves are most commonly affected.

38
Q

What do patient’s with Morton’s neuroma typically complain of?

A

Burning pain and tingling radiating into the affected toes; loss of sensation in the affected web space

39
Q

How does plantar fasciitis present?

A

Pain with walking at the plantar aponeurosis

40
Q

How is plantar fasciitis treated?

A

Rest, analgesia, Achilles/plantar fascia stretching, gel-filled heel pad, steroid injections

41
Q

What causes pes planus/flat feet?

A

Failure of the medial arch to develop properly

42
Q

In which groups of patients are flat feet seen?

A

People with generalised ligamentous laxity e.g. Ehler’s Danlos

Acquired- rheumatoid, charcot arthropathy, tibialis posterior tendon stretch/rupture

43
Q

What is pes cavus?

A

Abnormally high arch of the foot

44
Q

What kinds of condition is pes cavus related to?

A

Neuromuscular e.g. cerebral palsy, polio

45
Q

How do claw toes and hammer toes arise?

A

Acquired imbalance between flexor and extensor tendons

46
Q

What are the two most common mechanism of injury in the ankle?

A

Inversion injury and/or rotational force on a planted foot

47
Q

What are sprains of the lateral ankle ligaments commonly caused by?

A

Inversion injuries

48
Q

What are the criteria used to identify a suspected ankle fracture and give guidance as to whether they require an X-ray?

A

Ottowa criteria

49
Q

How are stable and unstable ankle fractures distinguished?

A

Stable- no medial fracture or rupture of the deltoid ligament

Unstable- medial fracture or deltoid ligament rupture

50
Q

A patient with an injured ankle has medial tenderness and bruising, what might this suggest?

A

Deltoid ligament rupture

51
Q

How are stable and unstable ankle fractures treated?

A

Stable- walking cast or splint for around 6 weeks

Ustable- ORIF with plates and screws

52
Q

Where is the commonest site of metatarsal fracture and what is the typical mechanism of injury?

A

5th metatarsal

Inversion injury, avulsion fracture at site of insertion of peroneus brevis tendon

53
Q

How are 5th metatarsal fractures treated?

A

Cast, supportive bandaging, protective boot for 4-6 weeks

54
Q

What is a Jones fracture?

A

Fracture of the 5th metatarsal in the region of the proximal diaphysis- risk of non-union due to poor blood supply. May undergo screw fixatation in active patients

55
Q

Where is a common site for a metatarsal stress fracture? What is the typical history?

A

The second metatarsal. Typical history- sudden increased intensity of exercise

56
Q

How does Achilles tendonitis typically occur?

A

Repetive strain from sports

Quinolone antibiotics e.g. ciprofloxacin can cause tendintiis

RA, other inflammatory arthropathies, gout

57
Q

Why should a steroid injection never be given for Achilles tendonitis?

A

Risk of tendon rupture

58
Q

How do patients often describe the pain of Achilles tendon rupture?

A

“Like being shot”

“Like being kicked”

59
Q

What clinical signs may be seen in Achilles tendon rupture?

A

Weakness of plantar flexion

Palpable gap in the tendon

Simmonds test positive (lack of plantar flexion when squeezing the calf)

MSK (16 decks)

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