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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
What is anterior knee pain syndrome?
Pain in anterior knee, either directly behind the patella or in the medial/lateral retinaculum
26
Who does anterior knee pain syndrome typically occur in? X3
People who engage in repetitive athletic activity, those with abnormalities in extensor mechanical alignment or overweight patient
27
When do patients with anterior knee pain syndrome complain of accentuated pain?
Accentuated by climbing and descending stairs. Squatting, kneeling and sitting for long periods of time
28
Treatment of anterior knee pain syndrome? x4
Activity modification, weight control if necessary, physio to strengthen the quadriceps muscles and core musculature Pain meds
29
What is pes anserine bursitis?
Inflammation of bursa overlying insertion of semitendinosus, gracilis and sartorius on anterio medial aspect of proximal tibia
30
Where is pain in pes anserine bursitis?
Medial aspect of the knee, distal to the medial joint line
31
Management of pes anserine bursitis
Activity modification, strengthening exercises and anti inflammatories - it chronic may respond to corticosteroid injections
32
Where is pain with iliotibial band friction syndrome?
It's inflammation of iliotibial band which is the distal portion of tensor fascia lata which inserts on anterolateral aspect of proximal tibia
33
Who normally gets iliotibial band friction syndrome?
Runners or cyclists who complain of activity-related knee pain
34
Management of iliotibial band friction syndrome
Activity modification, stretching and strengthening | Ice and anti inflammatories
35
Relation of clinical symptoms with knee OA and radiological findings?
Often not correlated, can have lots of pain with nothing on X-ray and vice versa
36
What is arthritis of the knee commonly associated with?
Peri articular soft tissue problems which can often be a major source of knee pain eg. Pes anserine bursitis
37
Non pharmacological management of knee OA x6
Weight loss, aerobic exercise, knee strengthening exercises, patellar taping, acupuncture and knee bracing
38
Pharmacological management of knee OA
``` 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
When do you use surgical management of knee OA
Arthroscopic treatment is reserved for mechanical symptoms such as catching, locking or instability due to loose bodies or a meniscal tear
40
When is knee replacement done in knee OA? What sort
Poorly controlled symptoms - can be total or can do unicompartmental - eg. Just medial compartment
41
What causes most knee injuries in sport
Indirect trauma such as twisting motion
42
What is most commonly injured in indirect trauma to the knee causing twisting motion?
Menisci, collateral ligaments and cruciate ligaments
43
What is o'donoghues triad?
Injury of medial meniscus, medial collateral and anterior cruciate
44
What does direct trauma to the knee usually cause?
Bone contusions, fracture or dislocations - can affect either tibiofemoral joint or patellofemoral joint
45
What is usually required for dislocation of the tibiofemoral joint? And what usually occurs
High energy trauma - neurovascular damage usually occurs as well
46
When do the majority of meniscus tears occur in young people?
Mild to moderate twisting injuries - usually occur alone or with collateral Ligament strain
47
What does high energy twisting motion usually cause In the knee?
Anterior cruciate injury with acute haemarthroses and inability to bear weight
48
What are symptoms of meniscus tear?
Focal tenderness over joint line May have catching and locking Joint effusion and pain
49
When can you do arthroscopic repair in meniscus injury?
If it is acute tear (can also get chronic condition) in well-vascularised peripheral portion of the meniscus
50
What is done to manage chronic meniscus tears?
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
What causes articular cartilage injury in the knee?
Often result of traumatic injury that involves impact injury to cartilage surface
52
Symptoms of articular cartilage injury?
Focal pain, joint effusion and mechanical catching symptoms
53
Treatment of articular cartilage injury in knee?
Graduated physiotherapy or arthroscopic repair if there's displaced osteochondral fragments
54
What is osteochondritis dissecans?
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
What does haemarthrosis development imply?
Significant articular injury such as anterior cruciate ligament tear, osteochondral fracture or patellar dislocation - develops immediately
56
What does delayed knee effusion after injury imply?
Meniscus tear or posterior cruciate ligament injury - developing over hours
57
What is patella tendonopathy?
Overuse syndrome - especially in explosive athletes such as jumping
58
Symptoms of patellar tendonopathy
Pain and soft tissue swelling around patellar tendon usually at proximal attachment to patella
59
Treatment of patella tendonopathy?
Ice, pain medication, activity modification and strengthening exercises focusing on eccentric loading of the tendon
60
What is the most commonly affected large joint in RA?
the knee
61
How are knees usually affected in RA?
Usually bilateral - symptom onset usually occurs early in course of the disease
62
Other chronic inflammatory arthritides which affect the knee? x2
Psoriatic arthritis and ankylosing spondilitis
63
Treatment of knee pain in inflammatory arthritides
Treated with the management of the systemic disease - lifestyle modification, physiotherapy, disease-modifying agents, NSAIDs etc
64
What is the most commonly affected joint?
The knee
65
How does knee joint infection present?
Red, swollen, hot knee with difficulty in weight bearing and a limitation in passive ROM
66
What is the common infecting organism in septic arthritis
Staphylococcus aureus
67
Management of septic arthritis - in knee
Joint aspiration for microbiological culture and looking for crystals Systemic antibiotics Serial joint aspiration or arthroscopic assisted washout
68
What is Reiters disease?
Reactive arthritis with conjunctivitis and urethritis
69
Tumours in knee
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
Red flags indicating possible bone tumour as cause of knee pain
Unexplained pain, worse at night, unexplained swelling, systemic symptoms
71
What is Galeazzi test
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
Other signs of DDH
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
Sign of bilateral DDH
Increased lumbar lordosis
74
What is bipartite patella?
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
What is recurrent patella subluxation
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
What is housemaids knee?
Prepatella bursitis - swelling anterior to the patella - typically following trauma or overuse
77
What is clergymans knee?
Infrapatellar bursitis - swelling inferior to patella
78
Treatment of knee bursitis
Friction bursitis can aspirate | If suppurative bursitis then needs drainage and antibiotics
79
Immediate knee haemarthrosis
ACL ligament damage because ACL is very vascular
80
Investigation of ACL injury
Xray to exclude evulsion | MRI
81
Knee locking
Meniscus tear
82
Swelling after medial meniscus tear
After hours
83
Treatment of medial meniscus tear
Analgesia, arthroscopy for locking or persisting symptoms
84
Swelling with unhappy triad
Immediate
85
Partial ACL tear swelling
Still immediate even if partial
86
DDH investigation
Ultrasound

Ortho and Rheum (13 decks)

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