hip and knee pathologies Flashcards
3 main differential of hip pain in the young
impingment
laberal tears
paediatric hip issues
middle age differentials 3 main of hip pain
trochanteric bursitis
OA
AVN-alcohol/steroids
2 main differentials of hip pain in old
OA
rare pathological lesion
grade o for oa of the hip
no radiographic features of OA
grade 1 for OA of the hip
possible joint space narrowing and subtle osteophytes
grade 2 for OA of the hip
definitie joint space narrowing, defined osteophytes and some sclerosis, especially in acetabular region
grade 3 for OA of the hip
marked joint space narrowing, defined ostepohytes, some sclerosis and cust formation and deformity of the femoral head and acetabulum
grade 4 for OA of the hip
gross loss of joint space with above features plus large osteophytes and increased deformity of the femoral head and acetabulum
4 cardinal signs of OA on an x-ray
joint space narrowing
subchondral sclerosis
subchondral cysts
osteophytes
what is OA
progressive loss of articular cartilage and as a result subchondral bone remodelling
key pathophysiology of OA
increased water content chondrocytes die aggrecan keeps up production but then can't fibrillation subchondral bone sclerosis
why is cartilage prone to injury
it is avascular and nourished via synovial fluid
what makes up cartilage
chondrocytes in an extracellular matrix of proteoglycans, 65-85% water, type 2 collagen
superficial and deep function/ content of hyaline cartilage
superficial= decreases friction- smooth surface, parallel collagen fibres, few chondrocytes DEEP= load bearing, perpendicular fibres and greater cell numbers
changes in OA to collagen, proteoglycan, water content, elasticity of cartilage
collagen-decreased
proteoglycan- increases
water content-increases
elasticity- decreases
primary and secondary causes of OA
primary= idiopathic, risk factors secondary= trauma, infection, developmental, inflammatory, gout crustal
ragiographic features and why they form (OA)
sclerosis and cyst formation= weight bearing
osteophytes= attempt to spread weight
what feature of OA is assoc. to progression
cyst formation
what muscles are affected in the tredelengburg test
gluteus medius and minimus
abductors
presentation of hip OA
central cartilage loss mostly women bilateral at presentation medial assoc. to generalised nodular better prognosis
examination features of OA hip
fixed flexion deformity- Thomas leg raise
Reduced ROM
gait- tredelenburg
difficulty hip flexion and internal rotation
referred pain down
leg length shortening
what 3 features need to be present to make a working diagnosis of OA without an x-ray
> 45 years
chronic joint pain (>3 months), worse on use
morning stiffness <30 min
what is Hilton’s law
pain from hip refers down to knee
management conservative OA
walking aids orthotics analgesia physio education
surgical options for OA
arthroplasty
osteotomy
arthrodesis
uni-compartmental
x-rays for a knee OA views
AP lateral patellar skyline weight bearing with valgus stress test
presentation knee OA
varus deformity worse pain on movement limited walking antalgic gait fixed flexion deformity swelling weak/waste quads
2 main types of knee OA
medial compartment
patellar femoral
what causes posterior knee pain in knee OA
baker cyst
when is patellar femoral knee pain worse
climbing stairs
knee OA grade 0
no radiographic features
knee OA grade 1
doubtful JSN, possible osteophytes
2 knee oa grade
definite osteophyte formation, possible JSN
3 knee OA grade
multiple osteophytes, definitie JSN, sclerosis, possible bony deformity
4 knee OA grade
large osteophytes
marked JSN
severe sclerosis
definite bony deformity
what is trochanteric bursitis
point of tenderness over GT
inflammation of bursa
causes of trochanteric bursitis
injury overuse incorrect posture disease previous surgery calcium depositis
what age is trochanteric bursitis more common
middle aged
complication of trochanteric bursitis
abductor tear as inserts onto greater tubercle
management of trochanteric bursitis
analgesia
steroids injection
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
mechanism of a medial and lateral collateral ligament injury
direct blow
vagus for medial
varus for lateral
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
3 parts of the unhappy triad and force mechanism
medial meniscus
ACL
medial collateral ligament
twisting round foot and varus force
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
exam for an ACL injury
anterior drawer test with no posterior sag- positive if translation of the tibia
management of ACL injury
rehab for 3 months
extensive ACL reconstruction
indication for extensive ACL reconstruction
young
physically active
ongoing instability
multi-liagment damage
meniscal injury history
twisting injury often occur with/after ligamentous injury
may present late due to severe symptoms
exam of a meniscal injury
- mechanical symptoms: lock, click
- inability to fully straighten knee
- joint tenderness and effusion
test for meniscal injury
provocative test- McMurray’s test
management for meniscal injury
- MRI gold standard for DX
- conservative in degenerate tears if OA present
- arthroscopic debridement
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
exam for posterior cruciate ligament
false postive anterior drawer test- ie positive sag
management PCL
conservative physio rehab
-operate in multiligament or chronic instability
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
