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MSK > Hip and Knee Pain > Flashcards

Hip and Knee Pain Flashcards

1
Q

How do people often present with hip problems

A 
Pain and discomfort 
Referred pain 
Night pain - insomnia 
Stiffness 
Pain when exercising
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2
Q

Where does true hip joint pain present

A

Mid groin

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3
Q

Pain on the outside of the hip is more likely to be?

A

Trochanteric bursitis

Referred pain from back

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4
Q

What would you look for in a patient presenting with hip pain

A

Deformity
Asymmetry
Scars - previous trauma or surgery

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5
Q

What would you feel for in a patient presenting with hip pain

A

Swelling - may be over trochanter in bursitis
Bony landmarks
Tenderness
Heat

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6
Q

What investigations may be done for hip pain

A

X-ray - though finding may be incidental so must compare to symptoms
ESR/viscosity if suspect inflammatory
FBC is infection suspected

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7
Q

What are the x-ray signs of osteoarthritis

A

Loss of joint space
Osteophytes
Sclerosis
Subarticular cysts

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8
Q

How do you manage hip pain

A 
education 
weight reduction 
walking stick 
analgesia or NSAIDs 
Physio 
Mobility aid - car badge, home adaption etc
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9
Q

List some common causes of hip pain

A 
OA 
RA and other arthritides 
Fracture 
Referred pain from back 
malignancy
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10
Q

List some rarer causes of hip pain

A

Soft tissue issues - bursitis
Paget’s
Infection
Avascular necrosis

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11
Q

Why are knee and hip problems increasing in the population

A

Age - more wear and tear etc

Obesity - more weight being put through joints

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12
Q

What are some common presentations of knee problems

A 
Pain - often localised 
Stiffness 
Swelling or lump 
Giving way - unstable 
Deformity 
Loss of sleep 
Loss of function - can't kneel or trouble walking
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13
Q

What would you look for in a patient presenting with knee pain

A

Deformity
Gait
Swelling
Scars

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14
Q

What would you feel for in a patient presenting with knee pain

A

Bony landmarks
Tenderness
Effusion
Stability

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15
Q

What investigations may be done for knee pain

A

Usually none
X-ray
MRI
Urate - suspect gout?

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16
Q

How do you manage knee pain

A 
Explanation 
Keep leg mobile 
Leg supports if knee unstable 
NSAID - short term 
Analgesia 
Physio 
Referral if severe
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17
Q

What are some common problems that affect the knee

A

Ligament strain - MC
Bursitis - common if on knees a lot
Osteoarthritis
Osgood-Schlatter’s - inflammation of tibial tuberosity and cartilage

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18
Q

What are some rarer problems that affect the knee

A 
Chondromalacia patellae 
Meniscus injury 
Cruciate damage 
Gout 
RA 
Dislocation
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19
Q

What makes the hip an effective joint

A

Ball and socket
Wide range of movement
Stable - can take a lot of weight

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20
Q

List the layers of bone

A

Hyaline (articular) cartilage
Subchondral bone
Cancellous bone

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21
Q

What is FAI

A

Femoroacetabular impingement syndrome
Morphology of the femoral neck and/or acetabulum is altered
Causes issues with flexion, adduction and internal rotation

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22
Q

Name two types of impingement caused by FAI

A

CAM type

Pincer type

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23
Q

Describe a CAM type deformity

A

Caused by deformity in the femur - asymmetrical head
Usually occurs in young athletic men
Can be related to previous SUFE

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24
Q

Describe a pincer type deformity

A

Caused by deformity in the acetabulum
Acetabulum overhangs
Usually seen in females

25
Q

Why are young athletic men likely to get FAI

A

May be due to increased weight bearing and stress in adolescent years

26
Q

What damage does FAI do to the joint

A

Damages the labrum and causes tears
Damages cartilage
Leads to OA in later life

27
Q

How do patients present with FAI

A

Groin pain relating to activity - particularly when flexing and rotating
Difficulty sitting
C-sign positive
FADIR provocation test positive

28
Q

What is the FADIR provocation test

A

Tests flexion, adduction and internal rotation of the hip

29
Q

How do you diagnose FAI

A

Imaging
Radiograph, CT and/or MRI
MRI best for looking at damage to labrum and oedema

30
Q

How do you manage FAI

A

Just observe in asymptomatic patients
Arthroscopic/open surgery to remove CAM or debride tears
Osteotomy and debride labral tears for pincer impingement
Replacement in people with secondary OA

31
Q

What is avascular necrosis

A

Failure of blood supply to the femoral head

32
Q

What are the causes of AVN

A

Can be idiopathic or associated with trauma (e.g. damages to the blood supply)

33
Q

How does idiopathic AVN develop

A

Coagulation of the microcirculation in the bone
Leads to venous thrombosis which causes retrograde arterial occlusion
Leads to hypertension in the bone
Decreases blood flow to the femoral head, leading to necrosis

34
Q

Who is affected by AVN

A

Men
Typically age 35-50
Usually bilateral

35
Q

What are the risk factors for AVN

A 
Irradiation
Trauma
Hematologic diseases - leukaemia 
Decompression sickness - divers 
Alcoholism 
Steroid use
36
Q

How do patient’s present with AVN

A

Insidious onset of groin
Exacerbated by stairs or impact
Examination usually normal

37
Q

How do you diagnose AVN

A

Radiographs - normal unless late disease

MRI scan - most sensitive/specific

38
Q

AVN is irreversible - true or false

A

BOTH

There are reversible and irreversible stages

39
Q

How do you treat AVN

A 
Bisphosphonates 
Core decompression 
Curettage & bone grafts 
Vascularised bone graft 
Rotational osteotomy 
Total hip replacement
40
Q

What is ITOH

A

Idiopathic Transient Osteonecrosis of the Hip

Local hyperaemia and impaired venous return with marrow oedema and increased intramedullary pressure

41
Q

How do patients present with Idiopathic Transient Osteoporosis of the Hip

A

Progressive groin pain
Difficulty weight bearing
Usually unilateral

42
Q

Who is affected by Idiopathic Transient Osteoporosis of the Hip

A

Men more than women
Middle aged
Does affect pregnant women in 3rd trimester

43
Q

How do you diagnose Idiopathic Transient Osteoporosis of the Hip

A

ESR - will be elevated
Radiographs
MRI - gold standard
Bone scan

44
Q

What are the radiograph signs of Idiopathic Transient Osteoporosis of the Hip

A

Osteopenia of head and neck of femur
Thinning of cortices
Preserved joint space

45
Q

How do you manage Idiopathic Transient Osteoporosis of the Hip

A

Self-limiting and should resolve in 6-9 months
Treat symptoms with analgesia
Protective weight bearing to avoid fracture - bone is weaker

46
Q

What is trochanteric bursitis

A

Inflammation of the trochanteric bursa

Common condition caused by IT band tracking across the bursa and causing repetitive trauma

47
Q

Who commonly gets trochanteric bursitis

A

Females - wider pelvis rubs on IT band more
Young, active patients
Older people

48
Q

How does trochanteric bursitis present

A

Pain on lateral aspect of hip

Pain on palpation of greater trochanter

49
Q

How do you diagnose trochanteric bursitis

A

Clinical diagnosis usually
X-ray usually normal
Visible on MRI but not normally needed

50
Q

How do you treat trochanteric bursitis

A

Analgesia
NSAIDs
Physio
Steroid injection

51
Q

Do you ever operate on trochanteric bursitis

A

No

No proven benefit

52
Q

What is the common presentation for simple backache

A

20-55
Systemically well
Back, buttock and/or thigh pain
Pain changes with movement

53
Q

What is the common presentation for nerve root pain

A 
unilateral leg pain 
Parathesia in the same distribution 
Abnormal neurology
Weakness 
Reflex and sensory changes 
Nerve stretch pain
54
Q

Which risk factors suggest a more serious spinal pathology

A 
Past history of Cancer, TB, HIV, IVDA
Unexplained weight loss
Constant unremitting pain
Unable to lie supine or to sleep
Age under 20 or over 55
Recent trauma
55
Q

What are some key signs of cauda equina syndrome

A

Saddle Anaesthesia
Altered Bladder Control
Bowel Incontinence
Gait disturbance

56
Q

What is the prognosis and treatment for simple backache

A

Prognosis good
90% better in 6 weeks
Advice and simple painkillers

57
Q

What is the prognosis and treatment for nerve root pain

A

Good prognosis
50% better in 8 weeks
Give advice and pain management as per NICE guidelines
If not better after 2 months with 4 weeks of physio then refer for imaging

58
Q

What is the next step if you suspect serious spinal pathology

A

Consider cancer, infection, fracture or inflammatory disease
Needs further investigations so refer urgently

59
Q

What is the next step if you suspect cauda equina syndrome

A

Emergency surgical referral

MSK (21 decks)

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