Clinical Lecture : Leg Pain

Question 1

Bursitis

Answer 1

Inflammation of a bursa
Bursa - potential space between 2 epithelial linings
Reduces friction and trauma

Trochanteric, prepatella, anserine, retrocalcaneal

Pre patella bursa more common than septic arthritis

Question 2

Approach to limb pain

Answer 2

History - SOCRATES, mechanism etc.
Examination - how they move, systemically well?, look, feel, move, special tests, numbness and weakness
Investigations - bloods, X-ray, ct, ultrasound…
Management - physio, immobilization, surgery, rice, etc

Question 3

Causes of pain in a leg

Answer 3

Anatomical structures involved:
– Skin
– Bursa
– Tendons
– Muscle
– Ligament
– Blood vessels eg arteries, veins – Nerve
– Bone
– Lymphatic system

Question 4

Causes of pain in a leg

Answer 4

Anatomical structures involved:
– Skin
– Bursa
– Tendons
– Muscle
– Ligament
– Blood vessels eg arteries, veins – Nerve
– Bone
– Lymphatic system

Question 5

Processes that can cause pain Injury

Answer 5

Injury
Infection
Inflammation
Insidious (Tumour)

Question 6

Pain from skin

Answer 6

Cellulitis
◦ Staph or strep
Bruise
Bites
Burns
Haemosiderin
Rashes (yr 2)
Nails
Ulcers

Question 7

Tendon causing pain

Answer 7

Degeneration, overuse, tear
Inflammatory
Tenosynovitis

Tenosynovitis e.g. post tib tendon sheath
Tendinopathies: degenerative
Enthesitis: inflammation of the
entheses, the sites where tendons or ligaments insert into the bone.

Question 8

Muscle pain

Answer 8

Overuse
Viral infections e.g. flu
Cramp
Claudication
Muscle rupture / tear e.g. hamstrings
Chronic pain e.g.fibromyalgia, myofascial pain syndromes
Alcohol and other drugs e.g. statins Endocrine causes – e.g. Hypothyroidism
Inflammatory diseases of muscle eg polymyositis, PMR
Compartment syndrome

Question 9

Ligament pain

Answer 9

Sprains

Medial Collateral Ligament
Lateral Collateral Ligament
Ankle ligaments

Treatment
RICE
analgesia
physio

Ankle sprains:
3 grades
Small tears
Large, but incomplete tear
Complete tear

Question 10

Blood vessel pain

Answer 10

Veins – varicose, superficial thrombophlebitis, DVT
Arteries- aneurysm, peripheral vascular disease (PVD) causes loss of blood to periphery

Question 11

Nerve pain

Answer 11

Referred e.g. sciatica
Peripheral neuropathy- gloves and stockings appearance. Hands and lower limb. Nerves being damaged due to toxins/ lack of vitamin
Entrapment e.g. Meralgia paraesthetica. Trapping of the nerve as it travels under the inguinal ligament

Question 12

Lymph

Answer 12

Lymphoedema - whole limb swollen. More likely to get infected in that limb