Hip and knee Flashcards
What is meralgia paraesthetica?
Sensory sx of the outer thigh due to compression of the lateral femoral cutaneous nerve
How does meralgia paraesthetica present?
Numbness/ pain/ tingling on the upper outer part of the thigh
Worse upon extension
What is trochanteric bursitis? Where else can bursitis happen?
Bursa (filled synovial fluid) inflammed. Also happen in the shoulders, knees and elbow.
What would you find on examination for trochanteric bursitis?
Pain over greater trochanter upon palpation
Pain upon resisted abduction, external and internal rotation
How do you mx trochanteric bursitis
ice, rest, steroid injections, analgesia.
If infective cause then address.
How does a meniscal tear present?
Popping Locking Acute swelling Pain / restricted movement upon McMurays test Gives way
What are the Ottawa rules?
Rules on whether to XR knee or not, one of:
1) >55 years
2) Can’t walk more than 4 steps
3) Pain over the fibular head
4) Pain over the patella
5) Can’t flex to 90 degrees
What Ix should you do for a meniscal tear/ ligament injury?
MRI first line
Gold standard is arthroscopy
What is the mx of mensical tears and ligament injury?
RICE (rest, ice, compression, elevation) NSAIDs PT Surgery potentially Refer to ED/ # clinic
What are the key sx of a meniscal tear/ ligament injury and what should you do if they present in primary care?
Pop
Swelling rapidly
Instability
locking
Send for urgent assessment - A+E/ # clinic
What is the most common ligament injury in a sports person?
ACL!
What journey does the ACL go on?
Starts on the posterior, lateral aspect of the femur intracondyal notch and inserts on the anterior, medial aspect of the tibia (PCL is opposite)
What special test is used for ACL?
Anterior drawer test or Lachmans
What is the presentation of osgood-schlatters disease?
Young, teenage, male usually
They have a initially soft inflammed lump and then a hard lump on the tibial tuberosity.
Pain on the anterior part of the knee.
Pain on moving knee.
How is osgood-schlatters disease managed? What should you monitor for?
RICE
Monitor for a avulsion fracture
What causes a Baker’s cyst?
Inflammatory changes (can be meniscal tear, OA, knee injury) in the joint which lead to synovial fluid (from bursa) leaking into the popliteral fossa area
How would a Baker’s cyst present?
Unburst:
Pain potentially, swelling which is more apparent on standing and disappear when flexing knee (fouchers sign), if big enough limited ROM
Burst:
red, swollen, painful
Differentials for Baker’s cyst
DVT popliteal anuerysm abscess varicose vein gaglion cyst lipoma
What Ix can you do rule out a DVT in a popliteal cyst?
U/s to rule out
How do you mx a baker’s cyst?
Modified activity to avoid exacerbating symptoms Analgesia (e.g., NSAIDs) Physiotherapy Ultrasound-guided aspiration Steroid injections Potentially surgery - arthoscopy
