Common MSK problems _ lower limb

Question 1

Cause of trochanteric bursitis

Answer 1

• due to repeated movement of the fibroelastic iliotibial band
• most common in women aged 50-70 years

Question 2

Another name for trochanteric bursitis

Answer 2

Greater Trochanteric pain syndrome

Question 3

Symptoms of trochanteric bursitis

Answer 3

• pain in the lateral hip region on walking
• tenderness over the upper part of the femur, which may result in the inability to lie in comfort on the affected side

Question 4

Investigations/diagnosis of trochanteric bursitis

Answer 4

• diagnosis usually clinical
• X-rays, ultrasound and magnetic resonance imaging may reveal tears or swelling; most often these imaging tests are normal

Question 5

Management of trochanteric bursitis

Answer 5

• rest → avoiding actions which result in aggravation of the pain
• Icing the joint
• NSAIDs
• steroid injection into the inflamed area
• Physical therapy to strengthen the hip muscles and stretch the iliotibial band
• If the pain does not improve with the above management → bursectomy (removal of the inflamed bursa)

Question 6

Characteristics of the pain in plantar fascitis

Answer 6

• worse around the medial calcaneal tuberosity
• most severe with the first steps of the day or following a period of rest
• pain is also frequently brought on by bending the foot and toes up towards the shin

Question 7

Management of plantar fascitis

Answer 7

Most cases of plantar fasciitis resolve with time and conservative methods of treatment

For the first few weeks: rest, change their activities, take pain medications, and stretch.

2nd line: physiotherapy, orthotics, splinting, or steroid injections may be options

3rd line: extracorporeal shockwave therapy or surgery

Question 8

Risk factors for plantar fascitis

Answer 8

Cause is unclear but risk factors:

• overuse, such as from long periods of standing, an increase in exercise,
• obesity
• associated with inward rolling of the foot
• tight Achilles tendon
• sedentary lifestyle

Question 9

What happens in plantar fascitis?

Answer 9

• It is unclear if heel spurs have a role in causing plantar fasciitis even though they are commonly present in people who have the condition
• a disorder of the insertion site of the ligament on the bone characterized by micro tears, breakdown of collagen, and scarring

​* Since inflammation plays either a lesser or no role, a review proposed it be renamed plantar fasciosis