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Ortho and Rheum > Hip and Knee > Flashcards

Hip and Knee Flashcards

1
Q

Presentation of child with hip disease

A

Not necessarily hx of pain or trauma but normally with unexplained limp
Also unexplained thigh or knee pain should raise suspicion because of referred pain

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2
Q

6 important causes of childhood hip pain

A 
Congenital dislocation of the hip
Perthe's disease
Slipped upper femoral epiphysis 
Septic arthritis
Transient synovitis or "irritable hip"
Other arthrtides
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3
Q

Presentation of congenital dislocation of the hip

A

Physical exam or US should pick it up

Usually present before age 5 with delay in walking, limp or discrepancy in leg length

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4
Q

What can missed cases of congenital dislocation of the hip lead to?

A

Non-congruent joint and early OA degeneration in adulthood

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5
Q

What is Perthe’s disease?

A

Disintegration of femoral head with subsequent healing and deformity of the hip

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6
Q

Who does Perthes disease usually occur in?

A

Boys age 5-10 years

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7
Q

Most likely cause of Perthe’s disease

A

Segmental avascular necrosis of femoral head probably responsible

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8
Q

Symptoms of Perthe’s disease?

A

Limp, hip pain or knee pain

Examination shows limitation of all movements of hip

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9
Q

Treatment aims with Perthe’s disease

A

To contain the femoral head in the acetabulum to reduce risk of future OA (40 years post diagnosis and 40% have hip replacement)

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10
Q

Who does slipped upper femoral epiphysis normally occur in?

A

Overweight, hypogonadal boys (can occur in girls)

Aged 10-16 years

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11
Q

How does SUFE often present?

A

With knee pain - referred pain

Also limping and pain in groin and anterior thigh

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12
Q

Management of SUFE?

A

Surgical stabilisation is needed urgently to prevent further slippage of the disc
Also be wary as risk of it occurring in contralateral hip too

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13
Q

Child who is ill, toxic and unable to walk and can’t move hip joint from pain

A

Suspect septic arthritis - it is rare but dangerous

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14
Q

What is “irritable hip”

A

Chief cause of hip pain in children
Transient synovitis which can occur due to reactive effusion in association with systemic viral illness
Usually self-limiting and responds to NSAIDs

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15
Q

Where is hip pain in adults felt?

A

Usually in groin or lateral/anterior thigh

Can also be referred to knee

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16
Q

What is one of the most common causes of hip pain in adults?

A

OA

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17
Q

Management of hip OA

A

Rest, analgesia, ROM and strengthening exercises and a walking stick
These relieve the pain

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18
Q

What can develop in patients with hip OA

A

Trendelenburg gait due to weakened hip abductors

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19
Q

Common cause of hip pain in elderly women

A

Hip fracture - inability to bear weight and short ex.rotated leg

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20
Q

What is trochanteric bursitis?

A

Self-limiting inflammation of bursa between greater trochanter and fascia lata
frequently accompanies other MSK problems such as spinal stenosis that alter gait and attendant muscle forces across greater trochanter

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21
Q

What is iliopsoas bursitis?

A

Bursa deep to psoas muscle and anterior to hip joint - pain in groin and across thigh
Occasionally infectious aetiology

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22
Q

What is snapping iliopsoas tendon?

A

Painful clunk when hip goes from extension to flexion - hip is otherwise normal
Surgical release may be needed

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23
Q

What is ischial bursitis?

A

Inflammation of bursa separating glut.max from ischial tuberosity - comes from prolonged sitting or trauma to bursa

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24
Q

What is meralgia paraesthesia?

A

Local compression of lat.cut.femoral nerve at inguinal ligament
Numbness and burning pain in anterior thigh
Arises from direct compression eg. obesity, pregnancy, tight clothes

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25
Q

What is anterior knee pain syndrome?

A

Pain in anterior knee, either directly behind the patella or in the medial/lateral retinaculum

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26
Q

Who does anterior knee pain syndrome typically occur in? X3

A

People who engage in repetitive athletic activity, those with abnormalities in extensor mechanical alignment or overweight patient

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27
Q

When do patients with anterior knee pain syndrome complain of accentuated pain?

A

Accentuated by climbing and descending stairs. Squatting, kneeling and sitting for long periods of time

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28
Q

Treatment of anterior knee pain syndrome? x4

A

Activity modification, weight control if necessary, physio to strengthen the quadriceps muscles and core musculature
Pain meds

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29
Q

What is pes anserine bursitis?

A

Inflammation of bursa overlying insertion of semitendinosus, gracilis and sartorius on anterio medial aspect of proximal tibia

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30
Q

Where is pain in pes anserine bursitis?

A

Medial aspect of the knee, distal to the medial joint line

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31
Q

Management of pes anserine bursitis

A

Activity modification, strengthening exercises and anti inflammatories - it chronic may respond to corticosteroid injections

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32
Q

Where is pain with iliotibial band friction syndrome?

A

It’s inflammation of iliotibial band which is the distal portion of tensor fascia lata which inserts on anterolateral aspect of proximal tibia

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33
Q

Who normally gets iliotibial band friction syndrome?

A

Runners or cyclists who complain of activity-related knee pain

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34
Q

Management of iliotibial band friction syndrome

A

Activity modification, stretching and strengthening

Ice and anti inflammatories

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35
Q

Relation of clinical symptoms with knee OA and radiological findings?

A

Often not correlated, can have lots of pain with nothing on X-ray and vice versa

36
Q

What is arthritis of the knee commonly associated with?

A

Peri articular soft tissue problems which can often be a major source of knee pain eg. Pes anserine bursitis

37
Q

Non pharmacological management of knee OA x6

A

Weight loss, aerobic exercise, knee strengthening exercises, patellar taping, acupuncture and knee bracing

38
Q

Pharmacological management of knee OA

A 
Paracetamol 
NSAIDs not indicated
Nutraceuticals use is still debated 
NSAID gels short term use 
Injections of steroids and hyaluronans can be very effective (hyaluronans longer lasting effect but more expensive)
39
Q

When do you use surgical management of knee OA

A

Arthroscopic treatment is reserved for mechanical symptoms such as catching, locking or instability due to loose bodies or a meniscal tear

40
Q

When is knee replacement done in knee OA? What sort

A

Poorly controlled symptoms - can be total or can do unicompartmental - eg. Just medial compartment

41
Q

What causes most knee injuries in sport

A

Indirect trauma such as twisting motion

42
Q

What is most commonly injured in indirect trauma to the knee causing twisting motion?

A

Menisci, collateral ligaments and cruciate ligaments

43
Q

What is o’donoghues triad?

A

Injury of medial meniscus, medial collateral and anterior cruciate

44
Q

What does direct trauma to the knee usually cause?

A

Bone contusions, fracture or dislocations - can affect either tibiofemoral joint or patellofemoral joint

45
Q

What is usually required for dislocation of the tibiofemoral joint? And what usually occurs

A

High energy trauma - neurovascular damage usually occurs as well

46
Q

When do the majority of meniscus tears occur in young people?

A

Mild to moderate twisting injuries - usually occur alone or with collateral
Ligament strain

47
Q

What does high energy twisting motion usually cause In the knee?

A

Anterior cruciate injury with acute haemarthroses and inability to bear weight

48
Q

What are symptoms of meniscus tear?

A

Focal tenderness over joint line
May have catching and locking
Joint effusion and pain

49
Q

When can you do arthroscopic repair in meniscus injury?

A

If it is acute tear (can also get chronic condition) in well-vascularised peripheral portion of the meniscus

50
Q

What is done to manage chronic meniscus tears?

A

They are typically vascular and degenerative therefore will not heal if repair
Only do arthroscopic resection on torn parts because total resection leads to early onset OA

51
Q

What causes articular cartilage injury in the knee?

A

Often result of traumatic injury that involves impact injury to cartilage surface

52
Q

Symptoms of articular cartilage injury?

A

Focal pain, joint effusion and mechanical catching symptoms

53
Q

Treatment of articular cartilage injury in knee?

A

Graduated physiotherapy or arthroscopic repair if there’s displaced osteochondral fragments

54
Q

What is osteochondritis dissecans?

A

Occult episodes of trauma to the knee which result in separation of cartilage from the subchondral bone due to subchondral bone becoming avascular - fragments of bone break away to form loose bodies - causes poorly localised pain and pain after exercise with intermittent knee swelling

55
Q

What does haemarthrosis development imply?

A

Significant articular injury such as anterior cruciate ligament tear, osteochondral fracture or patellar dislocation - develops immediately

56
Q

What does delayed knee effusion after injury imply?

A

Meniscus tear or posterior cruciate ligament injury - developing over hours

57
Q

What is patella tendonopathy?

A

Overuse syndrome - especially in explosive athletes such as jumping

58
Q

Symptoms of patellar tendonopathy

A

Pain and soft tissue swelling around patellar tendon usually at proximal attachment to patella

59
Q

Treatment of patella tendonopathy?

A

Ice, pain medication, activity modification and strengthening exercises focusing on eccentric loading of the tendon

60
Q

What is the most commonly affected large joint in RA?

A

the knee

61
Q

How are knees usually affected in RA?

A

Usually bilateral - symptom onset usually occurs early in course of the disease

62
Q

Other chronic inflammatory arthritides which affect the knee? x2

A

Psoriatic arthritis and ankylosing spondilitis

63
Q

Treatment of knee pain in inflammatory arthritides

A

Treated with the management of the systemic disease - lifestyle modification, physiotherapy, disease-modifying agents, NSAIDs etc

64
Q

What is the most commonly affected joint?

A

The knee

65
Q

How does knee joint infection present?

A

Red, swollen, hot knee with difficulty in weight bearing and a limitation in passive ROM

66
Q

What is the common infecting organism in septic arthritis

A

Staphylococcus aureus

67
Q

Management of septic arthritis - in knee

A

Joint aspiration for microbiological culture and looking for crystals
Systemic antibiotics
Serial joint aspiration or arthroscopic assisted washout

68
Q

What is Reiters disease?

A

Reactive arthritis with conjunctivitis and urethritis

69
Q

Tumours in knee

A

Knee is one of the most commonly affected sites for benign tumours - including osteoid osteoma, enchondroma and chondroblastoma
Also malignant tuours which as osteosarcoma and chondrosarcoma

70
Q

Red flags indicating possible bone tumour as cause of knee pain

A

Unexplained pain, worse at night, unexplained swelling, systemic symptoms

71
Q

What is Galeazzi test

A

Test for DDH
Child lies supine on examination table, hips flexed and feet flat on table with ankles touching buttocks -+ve test if knees are at different heights
If both legs are dislocated test will be -ve

72
Q

Other signs of DDH

A

Unequal leg length
Asymmetrical groin creases
Widened perineum and buttock flattening on affected side
If >3 months, limited abduction of hip whilst in flexion may be the most sensitive test

73
Q

Sign of bilateral DDH

A

Increased lumbar lordosis

74
Q

What is bipartite patella?

A

Congenital fragmentation of the patella - usually incidental radiographic finding but may give pain if superolateral fragment is mobile with tenderness over the junction
If pain - extra fragment excision may relieve it

75
Q

What is recurrent patella subluxation

A

A tight lateral retinaculum causes the patella to sublux laterally - giving medial pain
Knee may give way
Commoner in girls and with those with valgus knees

76
Q

What is housemaids knee?

A

Prepatella bursitis - swelling anterior to the patella - typically following trauma or overuse

77
Q

What is clergymans knee?

A

Infrapatellar bursitis - swelling inferior to patella

78
Q

Treatment of knee bursitis

A

Friction bursitis can aspirate

If suppurative bursitis then needs drainage and antibiotics

79
Q

Immediate knee haemarthrosis

A

ACL ligament damage because ACL is very vascular

80
Q

Investigation of ACL injury

A

Xray to exclude evulsion

MRI

81
Q

Knee locking

A

Meniscus tear

82
Q

Swelling after medial meniscus tear

A

After hours

83
Q

Treatment of medial meniscus tear

A

Analgesia, arthroscopy for locking or persisting symptoms

84
Q

Swelling with unhappy triad

A

Immediate

85
Q

Partial ACL tear swelling

A

Still immediate even if partial

86
Q

DDH investigation

A

Ultrasound

Ortho and Rheum (13 decks)

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