Hip and knee

Question 1

What is meralgia paraesthetica?

Answer 1

Sensory sx of the outer thigh due to compression of the lateral femoral cutaneous nerve

Question 2

How does meralgia paraesthetica present?

Answer 2

Numbness/ pain/ tingling on the upper outer part of the thigh
Worse upon extension

Question 3

What is trochanteric bursitis? Where else can bursitis happen?

Answer 3

Bursa (filled synovial fluid) inflammed. Also happen in the shoulders, knees and elbow.

Question 4

What would you find on examination for trochanteric bursitis?

Answer 4

Pain over greater trochanter upon palpation

Pain upon resisted abduction, external and internal rotation

Question 5

How do you mx trochanteric bursitis

Answer 5

ice, rest, steroid injections, analgesia.

If infective cause then address.

Question 6

How does a meniscal tear present?

Answer 6

Popping
Locking 
Acute swelling
Pain / restricted movement upon McMurays test 
Gives way

Question 7

What are the Ottawa rules?

Answer 7

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

Question 8

What Ix should you do for a meniscal tear/ ligament injury?

Answer 8

MRI first line

Gold standard is arthroscopy

Question 9

What is the mx of mensical tears and ligament injury?

Answer 9

RICE (rest, ice, compression, elevation)
NSAIDs
PT
Surgery potentially
Refer to ED/ # clinic

Question 10

What are the key sx of a meniscal tear/ ligament injury and what should you do if they present in primary care?

Answer 10

Pop
Swelling rapidly
Instability
locking

Send for urgent assessment - A+E/ # clinic

Question 11

What is the most common ligament injury in a sports person?

Answer 11

ACL!

Question 12

What journey does the ACL go on?

Answer 12

Starts on the posterior, lateral aspect of the femur intracondyal notch and inserts on the anterior, medial aspect of the tibia (PCL is opposite)

Question 13

What special test is used for ACL?

Answer 13

Anterior drawer test or Lachmans

Question 14

What is the presentation of osgood-schlatters disease?

Answer 14

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.

Question 15

How is osgood-schlatters disease managed? What should you monitor for?

Answer 15

RICE

Monitor for a avulsion fracture

Question 16

What causes a Baker’s cyst?

Answer 16

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

Question 17

How would a Baker’s cyst present?

Answer 17

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

Question 18

Differentials for Baker’s cyst

Answer 18

DVT
popliteal anuerysm
abscess
varicose vein
gaglion cyst
lipoma

Question 19

What Ix can you do rule out a DVT in a popliteal cyst?

Answer 19

U/s to rule out

Question 20

How do you mx a baker’s cyst?

Answer 20

Modified activity to avoid exacerbating symptoms
Analgesia (e.g., NSAIDs)
Physiotherapy
Ultrasound-guided aspiration 
Steroid injections
Potentially surgery - arthoscopy