Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Common Conditions, Management and Imaging > Common conditions of the lower limb > Flashcards

Common conditions of the lower limb Flashcards

1
Q

What is hip OA?

A

Degenerative condition that involves degeneration of the articular cartilage in the acetabulum and head of the femur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What demographic is hip OA?

A

After 40 years F
After 50 years M

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the non-modifiable risk factors of hip OA?

A

Advanced age
Family history
History of acute joint injury &/or deformity
Labral tears, ligament laxity, fracture, cam deformity, joint dysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the modifiable risk factors of hip OA?

A

Obesity
Biomechanical loading
Hormonal influences on inflammation
Repetitive joint overloading
Certain sports: high intensity, direct joint impact with other individuals
Occupational factors: physical labour
Occupation is non-modifiable for some patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the pathophysiological factors of hip OA?

A

Biomechanical factors
Inflammatory factors
Enzymatic factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the process of hip OA?

A

Cartilage develops small tears that grow larger with more stress > cartilage eventually fragments > chondrocytes attempt to keep up with cartilage loss but eventually cannot > underlying bone becomes exposed > bone rubs on bone resulting in reactive sclerosis and osteophyte formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the clinical features of hip OA?

A

Gradual onset
May be bilateral
Pain is cardinal symptom
Aching and poorly located – groin, buttock, medial thigh, knee
Joint stiffness
Especially in morning (due to articular gelling)
Limited ROM
First movements lost are internal rotation and extension
+/- crepitus, visible deformity, signs of acute or subacute inflammation
+/- weakness, tenderness and spasm/contracture of gluteals, quadriceps; abnormal gait

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the common aetiology of an SIJ dysfunction?

A

Degeneration
Mechanical disorders
Hyper or hypo mobility
Women following childbirth
Structural abnormalities
Post-traumatic
Severe trauma e.g. MVA, horse-riding accidents
Repetitive rotational stresses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the less common aetiology of SIJ dysfunction?

A

Inflammatory disorders e.g. ankylosing spondylitis
Infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the factors that affect SIJ dysfunction?

A

Joint structure
Ligamentous support
Muscular influences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the clinical features of SIJ dysfunction?

A

Dull aching pain in buttock, groin or upper thigh
Can mimic pain from the lumbosacral spine or hip joint
+/- sensation of heaviness – usually no accompanying neuro symptoms
Can be unilateral or bilateral
Positive SIJ provocation tests
Imaging may demonstrate certain pathologies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do hamstring injuries occur?

A

Hamstring injuries occur when they are exposed to large eccentric tensile forces during hip flexion and knee extension
They also play a role in foot and ankle biomechanics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the two classifications of hamstring injuries?

A

Type I: long head of biceps at musculotendinous junction
Type II: Semimembranosus occurring near ischial tuberosity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the risk factors of hamstring strain injuries?

A

Type I;
Sprinters (during eccentric activation in terminal swing phase)
Usually involve long head of biceps – often at musculotendinous junction
Type II;
Large amplitude, stretching movements
Involve the proximal free tendon of semimembranosus and occur close to ischial tuberosity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the risk factors for proximal hamstring tendinopathy?

A

Due to repetitive mechanical overload of tendon (long distance running, jumping, repeated hip flexion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the clinical features of hamstring strains?

A

Type I and II: Sudden onset pain
Moderate to severe depending on grade
Disabling – difficulty walking, unable to run
Pain and weakness on active-resisted muscle testing
Reduced stretch
Marked focal tenderness with palpation
+/- local haematoma, bruising
Important to differentiate referred pain to hamstring region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the clinical features of proximal hamstring tendinopathy?

A

Insidious onset pain: lower gluteal region, posterior thigh
Aggravated through passive stretch, active resisted testing, direct palpation of ischial tuberosity
Lumbar flexion can also aggravate (causes compression of tendon against ischial tuberosity and ischiogluteal bursa)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is greater trochanter pain syndrome?

A

A condition that encompasses the structures surrounding the greater trochanter of the hip: gluteus medius, gluteus minimus tendons, bursae: trochanteric, subgluteal, ITB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the risk factors for greater trochanter pain syndrome?

A

Compressive loading of lateral soft tissue
Repetitive adduction of hip
Unaccustomed or sustained weight-bearing
Menopause
Direct contusion injury to lateral hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the pathophysiology of greater trochanter pain syndrome?

A

Abnormal hip biomechanics a key factor
Increased compressive forces between ITB and greater trochanter
Compression of underlying gluteal tendons and bursae

Tenocytes respond by secreting larger proteoglycans
Increased water content leads to thicker tendon
Appearance of cartilage-like cells change structure of tendon
Associated thickening of ITB and bursae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the clinical features of greater trochanter pain syndrome?

A

Diagnosis of exclusion
Must consider lumbar spine and hip joint pathology
Insidious onset that worsens
Pain and tenderness over greater trochanter
Aggravated by lying on affected side, single leg weight bearing
+/- pain and weakness with active-resisted testing
Trendelenburg: useful as a pain provocation test
FABER: often reproduces familiar pain but ROM is general preserved
Contrast this to hip OA: limited ROM with FABER

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is a labral tear?

A

A tear in the acetabulum of the hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the demographics of a labral hip tear?

A

Any age
F>M 3:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What does the fibrocartilaginous extension of the acetabular rim do?

A

Enhances hip joint stability
Shock absorption and pressure distribution
Assist with joint lubrication and chondral nutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the risk factors of hip labral tears?
Athletic populations
26
What is the aetiology of hip labral tears?
Trauma (usually compression with a degree of rotation; increased shear forces on outer joint margin) FAI (esp cam impingement) Capsular laxity/hypermobility Degeneration Developmental dysplasia of hip
27
What are the types of hip labral tears?
Type 1: detachment of the labrum from cartilage at acetabular rim Type 2: tear within the labrum
28
What are the clinical features of a hip labral tear?
Deep pain (usually groin or anterior hip) Some patients report pain in buttock Can be sharp and catching on movement +/- mechanical symptoms Snapping clicking or locking An unstable feeling in the hip like it is going to give way
29
What is femoroacetabular impingement?
Abnormal contact occurs between the femoral head and the acetabulum caused by deformities in the femoral head and/or acetabulum of the innominate
30
What does FAI predispose?
FAI is not itself a pathology but can predispose intra-articular damage (labral tears, hip OA, chondropathy)
31
What are the classifications of FAI?
CAM PINCER MIXED
32
What is a CAM lesion?
Extra bone at anterolateral femur Leads to non-spherical femoral head Motion (esp IR) forces cam lesion into acetabulum More common in men
33
What is a PINCER lesion?
Abnormality of acetabulum, leading to over-coverage of femoral head More common in women
34
What is a mixed lesion?
Presence of both cam and pincer Most common
35
What is the aetiology of FAI?
Hip loading during adolescence (repetitive, torsional movements) Causes over activity of epiphyseal plate between femoral head anc neck Genetics Slipped capital femoral epiphysis
36
What are the extrinsic factors causing FAI?
Types of sports played and movements involved Volume of sport/activity Footwear Surface
37
What are the intrinsic factors causing FAI?
Reduced hip flexion, internal rotation, hip extension Poor lumbopelvic control Increased subtalar pronation
38
What are the symptoms of FAI?
Motion or position-related pain in hip or groin Pain may also be felt in the back, buttock or thigh +/- clicking, catching, locking, stiffness, restricted ROM or giving way
39
What are the clinical signs of FAI?
Positive FADIR: limited ROM +/- pain
40
What are the imaging processes of FAI?
Anterio-posterior radiographs of pelvis Lateral femoral neck view of hip
41
What is groin pain?
Adductor Iliopsoas Inguinal Pubic Hip related Other: orthopaedic, neurological, rheumatological, urological, gastrointestinal, dermatological, oncological and surgical
42
What sports are common for adductor pathologies?
AFL, soccer, callisthenics, ice hockey
43
What is the aetiology of acute adductor strains?
Sudden onset, usually occur during explosive actions (kicking, reaching with leg, sudden COD, forceful eccentric contraction Usually affects the musculotendinous junction sometimes the tendon itself Overuse-type injuries: gradual onset, pain aggravated by sprinting, cutting changes of direction, kicking Usually accompanied by post-activity pain and stiffness
44
What is the pathophysiology of adductor strains?
Pain medially in groin (esp. adductor longus tendon) Acute strain: bruising, swelling, warmth; antalgic gait Gradual onset: progressive deterioration with continued activity +/- stiffness, tightness or weakness
45
What is the diagnostic criteria of adductor strains?
Adductor tenderness and pain on active resisted adduction
46
What is the second most common injury of the groin?
Iliopsoas
47
What are iliopsoas groin injuries?
Second most common injury of the groin Pain in anterior part of proximal thigh – more laterally than adductor related groin pain Often seen in conjunction with adductor issue or an intra-articular problem (plays large compensatory role) +/- snapping when hip is extended from flexed position
48
What is the diagnostic criteria of iliopsoas strains?
Iliopsoas tenderness Pain on resisted hip flexion &/or pain on passive stretch of the hip flexors
49
What are the clinical features of knee OA?
Gradual onset Joint pain Stiffness Swelling, warmth, redness +/- crepitus; feeling of giving way Decreased ROM – can be due to pain osteophytes, joint mice Bony deformity Crepitus
50
What is the aetiology of ACL injuries?
Sudden change in direction or cutting manoeuvres Internal tibial rotation on fixed knee Single-leg landings
51
What is the pathophyisiology of ACL injuries?
Often disabling (functional impairment) Risk of chronic instability Often occur in combination with other injuries (MCL, meniscus, chondral damage)
52
What are the clinical features of ACL injuries?
Audible pop/crack or sensation of subluxation at onset Knee pain and widespread tenderness Reduced ROM and functional impairment due to pain or tense effusion due to haemoarthrosis +/- joint line tenderness due to associated meniscal injury Lachman test most sensitive
53
What is the aetiology of PCL injuries?
Direct blow to anterior tibia on a flexed knee Hyperextension injury
54
What is the level of disability of a PCL injury?
Minimal
55
What are the clinical features of PCL injuries?
Vague symptoms such as unsteadiness or discomfort (may not recall pop or tear) Mild effusion Pain in the posterior aspect of knee Pain with kneeling Subacute injuries: vague anterior pain, pain with deceleration/running, descending inclines Posterior draw test most sensitive
56
What is the aetiology of MCL injuries?
Excess valgus force at knee – can be direct blow or non-contact Excess external tibial rotation
57
What is the incidence of MCL injuries?
More common than LCL
58
Which cruciate ligament is more commonly associated with MCL injuries?
Grade III MCL associated ACL tears
59
What are the clinical features of MCL injuries?
Grade I: local tenderness; usually no swelling Pain with valgus stress test Grade II: marked tenderness, localised swelling Pain and laxity with valgus stress test, distinct end point Grade III: localised swelling, feeling of instability Gross laxity on valgus testing with no end point Amount of pain is variable due to complete disruption of ligament
60
What is the aetiology of LCL injuries?
Excess varus force at knee – can be direct blow or non-contact Hyperextension injury
61
Which nerve is commonly injured in LCL injuries?
Common peroneal nerve injury has been reported – 1/3 LCL injuries
62
What are the clinical features of LCL injuries?
Pain and perceived side to side instability near extension Difficulty walking on uneven group or stairs Localised bruising and swelling Varus stress test – variable amounts of pain and laxity depending on grade Common peroneal nerve involvement (foot drop or paraesthesia)
63
What is the aetiology of meniscal injuries?
Excessive shear stress to a semi-flexed knee Rotational and compressive forces (twisting injury with anchored foot) Consider degenerative meniscal tears in older patient with a history of knee trauma or known meniscal/cartilage pathology
64
Which meniscus is more affected?
Medial
65
Why is the medial meniscus more susceptible to injury?
Less mobile due to attachments
66
What are the clinical features of meniscal injuries?
Variable amounts of pain and joint line tenderness Aggravated by knee hyperflexion e.g. squatting +/- joint effusion Small tears may have minimal or delayed symptoms Severe tears: pain and reduced ROM +/- intermittent locking due to impingement of torn flap +/- clicking or clunking Meniscal tests: McMurray’s, Thessaly
67
Which knee bursae is most commonly affected?
Pre-patellar
68
Which bursae is most associated with rheumatological conditions?
Pes anserine bursa
69
What are the clinical features of bursitis?
Anterior knee pain and superficial swelling History of knee trauma or repetitive compressive forces Consider knee effusion and patellar tendinopathy
70
What are the extrinsic factors of patellofemoral pain?
PFJ load crated by the ground reaction force Body mass Speed of gait Surfaces Footwear Type and intensity of activity Duration of activity
71
What are the intrinsic factors of patellofemoral pain?
Influence magnitude and distribution of load
72
What are the local factors of patellofemoral pain syndrome?
Patellar position and tracking Quadriceps (esp vastus) dysfunction: weakness, delayed activation, atrophy
73
What are the remote factors of patellofemoral pain syndrome?
Consider weakness, hypo/hypermobility Increased hip IR, increased adduction Increased knee valgus; dynamic foot function Poor trunk and pelvic control
74
What are the clinical features of patellofemoral pain syndrome?
Anterior knee pain: non-specific or vague – can be medial, lateral or infrapatellar Worse with weight-bearing (running, stairs, hills) PFJ taping shoulder relieve Tenderness on palpation of patellofemoral joint line Reduction in, or pain reproduced on, patellofemoral joint ROM +/- swelling in suprapatellar/infrapatellar region +/- wasting of VMO +/- crepitus on knee activation +/- abnormal patellar position (superior sitting patella)
75
What is achilles tendinopathy?
A chronic overuse injury affecting the achilles tendon Achilles has 10x body weight pass through it
76
What is the aetiology of achilles tendinopathy?
Chronic overuse injury Repeated load overwhelms the ability of tendon to withstand and heal microtrauma Recall that: tendon blood supply is poor, esp. distally
77
What are the risk factors of achilles tendinopathy?
Advanced age: poor conditioning Overuse: inadequate recovery Change in training activity or surface Footwear Biomechanical factors (muscle weakness, decreased flexibility)
78
What are the clinical features of achilles tendinopathy?
Posterior heel pain Often first noticed on waking, following a recent increase in training volume/intensity Pain is worse at the start of activity; morning stiffness and pain post-activity is common Palpable tenderness of the tendon +/- palpable thickening of tendon or palpable crepitus – due to fibrinous exudate in the peritendon Achilles rupture will present with obvious swelling and deformity
79
What are the two common types of ankle sprains?
Lateral: anterior talofibular ATFL (most common) Medial: deltoid
80
What are lateral ankle sprains?
Lateral: Anterior talofibular ATFL (most common) Calcaneofibular CFL Posterior talofibular PTFL
81
What are medial ankle sprains?
Medial (deltoid ligament) – due to forced eversion Far less common but more debilitating May occur with fracture e.g. medial malleolus, talar dome
82
What are the risk factors for lateral ankle sprains?
Usually inversion and plantarflexion Weight bearing activity on uneven surface e.g. grass Activities requiring rapid change in direction (football, netball, tennis, basketball) Lack of strength and stability in the ankle due to previous injury Congenital ligamentous laxity (connective tissue disorder associated with hypermobility) Acquired ligamentous laxity (pregnancy)
83
What is a grade I ankle sprain?
Grade I: MILD Slight stretching and microscopic tearing of ligament fibres Mild tenderness and swelling around the ankle
84
What is a grade II ankle sprain?
Grade II: MODERATE Partial tearing of the ligament Moderate tenderness and swelling around the ankle Hypermobility on testing but a firm end point
85
What is a grade III ankle sprain?
Grade III: SEVERE Complete tear of the ligament Significant tenderness and swelling around the ankle Gross laxity on testing without a discernible end point
86
What are the clinical features of ankles sprains?
Pain on weight bearing in lateral ankle Associated inversion injury incident +/- audible snap, crack or tear Feeling of instability Swelling, bruising and level of disability can be variable Manual stress testing is most reliable and valid when performed 5-7 days post injury Anterior draw test Pain with passive stretch: plantarflexion, inversion Tenderness on palpation of ligaments (grade III tears are least painful) +/- injury to peroneal muscles
87
What is morton's neuroma?
A swelling of nerve and scar tissue arising from mechanical compression of the interdigital nerve Usually between 3rd and 4th metatarsal heads
88
How common are morton's neuroma?
Fairly common and occurs at any age
89
What are the risk factors for morton's neuroma?
Excessive pronation or compression of the foot leads to metatarsal hypermobility and nerve impingement e.g. high-heeled shoes, narrow fitting footwear
90
What are the clinical features of morton's neuroma?
Gradual onset pain on plantar surface of forefoot which might radiate into toes Moves from an ache to a sharp burning pain Paraesthesia and numbness are common Feels like ‘walking on marble’ Aggravated with compression/weight bearing of forefoot Relieved by rest, massage, removal of compression Localised tenderness in the web space A clicking sensation can develop due to chronic proliferation – may be detectable on palpation +/- deficit in toe tip sensation
91
What is the aetiology of shin splints?
Running
92
What is the aetiology of anterior stress shin splints?
Overuse of TA, EHL, EDL Pain anterolateral aspect leg Aggrvated by heel strike, down hill running, over striding
93
What is the aetiology of medial tibial stress shin splints?
Involvement of TP, FHL, FDL +/- soleus Pain with toe off
94
What are the risk factors for shin splints?
Athletic populations More common in women Poor technique or training errors Poor footwear of hard surfaces History of previous stress fractures
95
What are the range of biomechanical contributors to shin splints?
Muscle weakness and decreased flexibility Higher BMIL increased calf girth Excessive pronation, tibial torsions, hip ER/IR, leg length discrepancy, increased Q angle Metabolic issues - ? Lower bone density
96
What is the pathophysiology of shin splints?
Repetitive traction during physical activity Progressive micro-trauma of fascia and muscles attaching to tibia
97
What are the clinical features of shin splints?
Gradual onset anterior shin pain – usually dull and achy Worse with activity, relieved by rest or stretching Tenderness on palpation of tibial borders and on passive stretch Few visible signs: ankle Rom usually normal No neuro or vascular features No special tests except to exclude other conditions
98
Which aspect of the tibia is most commonly affected by stress fractures?
90% is posteromedial tibia
99
What are the risk factors of tibial stress fractures?
Athletes involved in impact, running and jumping sports – esp with rigid surfaces
100
What are the intrinsic factors of tibial stress fractures?
Lower limb biomechanics Limb length discrepancy
101
What are the clinical features of tibial stress fractures?
Gradual onset leg pain – aggravated by exercise +/- recent increase in training intensity/duration Pain can occur with walking, at rest of even at night Localised tenderness over medial border of tibia Biomechanical issues common in lower limb
102
What is plantar fasciopathy?
An overuse condition of the plantar fascia at its calcaneal attachment Most common cause of plantar heel pain Originally termed plantar fasciitis – now known that degenerative processes are involved
103
What are the risk factors of plantar fasciopathy?
Weight and BMI (increased mechanical load) Prolonged standing work (especially hard surfaces) Physically active populations (high-volume, repetitive training e.g. running) Foot biomechanics Flexibility and strength Decreased flexibility of ankle joint Myofascial tightness of calf; hamstrings; gluteal region Decreased torque of plantarflexion; toe flexion
104
What is the pathophysiology of plantar fasciopathy?
Deterioration of collagen fibres Increased secretion of ground substance proteins increase vascularity
105
What are the clinical features of plantar fasciopathy?
Gradual onset pain Inferior medial aspect of heel Initially, worse in morning (first step pain) Decreases with activity but returns post-activity Severe cases: pain with standing, non-weight bearing, night pain Palpable tenderness along medial tuberosity of calcaneus and down the medial/central aspects of plantar fascia Reproduction of pain with passive stretch

Common Conditions, Management and Imaging (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions