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othopaedics > hip and knee pathologies > Flashcards

hip and knee pathologies Flashcards

1
Q

3 main differential of hip pain in the young

A

impingment
laberal tears
paediatric hip issues

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2
Q

middle age differentials 3 main of hip pain

A

trochanteric bursitis
OA
AVN-alcohol/steroids

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3
Q

2 main differentials of hip pain in old

A

OA

rare pathological lesion

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4
Q

grade o for oa of the hip

A

no radiographic features of OA

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5
Q

grade 1 for OA of the hip

A

possible joint space narrowing and subtle osteophytes

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6
Q

grade 2 for OA of the hip

A

definitie joint space narrowing, defined osteophytes and some sclerosis, especially in acetabular region

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7
Q

grade 3 for OA of the hip

A

marked joint space narrowing, defined ostepohytes, some sclerosis and cust formation and deformity of the femoral head and acetabulum

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8
Q

grade 4 for OA of the hip

A

gross loss of joint space with above features plus large osteophytes and increased deformity of the femoral head and acetabulum

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9
Q

4 cardinal signs of OA on an x-ray

A

joint space narrowing
subchondral sclerosis
subchondral cysts
osteophytes

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10
Q

what is OA

A

progressive loss of articular cartilage and as a result subchondral bone remodelling

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11
Q

key pathophysiology of OA

A 
increased water content
chondrocytes die
aggrecan keeps up production but then can't 
fibrillation 
subchondral bone sclerosis
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12
Q

why is cartilage prone to injury

A

it is avascular and nourished via synovial fluid

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13
Q

what makes up cartilage

A

chondrocytes in an extracellular matrix of proteoglycans, 65-85% water, type 2 collagen

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14
Q

superficial and deep function/ content of hyaline cartilage

A 
superficial= decreases friction- smooth surface, parallel collagen fibres, few chondrocytes
DEEP= load bearing, perpendicular fibres and greater cell numbers
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15
Q

changes in OA to collagen, proteoglycan, water content, elasticity of cartilage

A

collagen-decreased
proteoglycan- increases
water content-increases
elasticity- decreases

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16
Q

primary and secondary causes of OA

A 
primary= idiopathic, risk factors
secondary= trauma, infection, developmental, inflammatory, gout crustal
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17
Q

ragiographic features and why they form (OA)

A

sclerosis and cyst formation= weight bearing

osteophytes= attempt to spread weight

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18
Q

what feature of OA is assoc. to progression

A

cyst formation

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19
Q

what muscles are affected in the tredelengburg test

A

gluteus medius and minimus

abductors

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20
Q

presentation of hip OA

A 
central cartilage loss
mostly women
bilateral at presentation
medial assoc. to generalised nodular
better prognosis
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21
Q

examination features of OA hip

A

fixed flexion deformity- Thomas leg raise
Reduced ROM
gait- tredelenburg
difficulty hip flexion and internal rotation
referred pain down
leg length shortening

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22
Q

what 3 features need to be present to make a working diagnosis of OA without an x-ray

A

> 45 years
chronic joint pain (>3 months), worse on use
morning stiffness <30 min

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23
Q

what is Hilton’s law

A

pain from hip refers down to knee

24
Q

management conservative OA

A 
walking aids
orthotics
analgesia
physio
education
25
surgical options for OA
arthroplasty osteotomy arthrodesis uni-compartmental
26
x-rays for a knee OA views
``` AP lateral patellar skyline weight bearing with valgus stress test ```
27
presentation knee OA
``` varus deformity worse pain on movement limited walking antalgic gait fixed flexion deformity swelling weak/waste quads ```
28
2 main types of knee OA
medial compartment | patellar femoral
29
what causes posterior knee pain in knee OA
baker cyst
30
when is patellar femoral knee pain worse
climbing stairs
31
knee OA grade 0
no radiographic features
32
knee OA grade 1
doubtful JSN, possible osteophytes
33
2 knee oa grade
definite osteophyte formation, possible JSN
34
3 knee OA grade
multiple osteophytes, definitie JSN, sclerosis, possible bony deformity
35
4 knee OA grade
large osteophytes marked JSN severe sclerosis definite bony deformity
36
what is trochanteric bursitis
point of tenderness over GT | inflammation of bursa
37
causes of trochanteric bursitis
``` injury overuse incorrect posture disease previous surgery calcium depositis ```
38
what age is trochanteric bursitis more common
middle aged
39
complication of trochanteric bursitis
abductor tear as inserts onto greater tubercle
40
management of trochanteric bursitis
analgesia | steroids injection
41
collateral ligament injury presentation
``` valgus/ varus force to the knee slower swelling can keep playing painful to palpate valgus/ varus force may open joint- instability no haemarthrosis instability with extension ```
42
mechanism of a medial and lateral collateral ligament injury
direct blow vagus for medial varus for lateral
43
management for collateral ligament injury
conservatively with -physio for medial -for lateral may need to operate for reconstruction -posteerolateral corner crutches -operate in multi-ligament
44
3 parts of the unhappy triad and force mechanism
medial meniscus ACL medial collateral ligament twisting round foot and varus force
45
history of an ACL ligament injury
twisting around fixed foot eg sport netball immediate haemarthrosis (<5 minutes) unable to play anymore may here a pop
46
exam for an ACL injury
anterior drawer test with no posterior sag- positive if translation of the tibia
47
management of ACL injury
rehab for 3 months | extensive ACL reconstruction
48
indication for extensive ACL reconstruction
young physically active ongoing instability multi-liagment damage
49
meniscal injury history
twisting injury often occur with/after ligamentous injury | may present late due to severe symptoms
50
exam of a meniscal injury
- mechanical symptoms: lock, click - inability to fully straighten knee - joint tenderness and effusion
51
test for meniscal injury
provocative test- McMurray's test
52
management for meniscal injury
- MRI gold standard for DX - conservative in degenerate tears if OA present - arthroscopic debridement
53
posterior cruciate ligament injury history
- direct blow to proximal/ anterior tibia with flexed knee - hyperextension or hyperflexion with plantar flexed foot - immediate haemarthrosis - rare injury
54
exam for posterior cruciate ligament
false postive anterior drawer test- ie positive sag
55
management PCL
conservative physio rehab | -operate in multiligament or chronic instability
56
3 type of extensor mechanism injury and what age do they commonly occur
quads tendon rupture >40 patellar fracture-any age patellar tendon rupture -<40

othopaedics (21 decks)

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