Hip, Knee, Ankle and Foot problems Flashcards
What mechanism most often causes an ACL rupture?
Forward momentum, leg fixed plus/minus rotation
Foot rigid on the ground with knee flexed (e.g. landing after a jump)
How is an ACL tear diagnosed?
Clinical: history of trauma, effusion and pain
Decreased range of movement
Positive anterior draw test
MRI or arthroscopy
Describe the management options for cruciate ligament tears
Rest
Physiotherapy
Immobilisation if needed
May need to be surgically repaired, particularly if the patient is an athlete
What are the potential complications of cruciate ligament tears?
Chronic instability
Osteoarthritis of the knee
What mechanism most often causes PCL tears?
Knee flexed, tibia forced posteriorly; common after road traffic collisions
How is a PCL tear diagnosed?
History of trauma
Inability to weight bear; knee gives way
Positive posterior draw test
MRI or arthroscopy
Name five problems that can develop in the hindfoot
Achilles tendonitis/tendinosis Plantar fasciitis Ankle osteoarthritis Tibialis posterior dysfunction Cavovarus foot
Name six problems that can develop in the forefoot
Hallux valgus Hallux rigidus Lesser toe deformities Morton’s neuroma Metatarsalgia Rheumatoid Forefoot
Name three problems that can develop in the midfoot
Ganglia
Osteoarthritis
Plantar fibromatosis
Which organism is most commonly responsible for septic arthritis?
Staphylococcus aureus (especially MRSA)
How does septic arthritis present?
Swollen, painful joint (usually unilateral)
Fever, rigors
Bacteraemia causes vomiting and hypotension etc
Describe the approach to treating septic arthritis
1) empirical IV antibiotics e.g. flucloxacillin (should cover staph and strep)
2) move on to specific antibiotics (still IV) once the culture/sensitivity results are available
How is trochanteric bursitis treated?
Steroid injections
What type of knee deformity is usually seen in OA of the knee?
Varus deformity (due to OA of the medial compartment)
Describe the aetiology of septic arthritis (of the knee)
Penetrating injuries
Spread from osteomyelitis of the adjacent bone
Systemic infection (bacteraemia, commonly gonorrhoea)
Iatrogenic
What is the function of the menisci of the knee?
To convert downward force to lateral force on the knee
This reduces force on the articular cartilage
Describe the presentation of meniscal tears
May be acute pain (“painful squelch”) but often the inital trauma goes unnoticed
Inability to fully extend the knee
May be effusion (slow onset swelling)
Pain on weight bearing
Describe the management options for meniscal tears
Arthroscopy:
- excision of fragment
- meniscal repair
- meniscal transplantation/graft
What is a bunion?
Development and subsequent inflammation/swelling of a bursa on the first metatarsal head (due to lateral subluxation of the first MTP joint)
Describe the operative and non-operative management options for hallux valgus
Non-operative - footwear modification - orthotics - analgesia Operative - 1st metatarsal osteotomy - soft tissue realignment - bunion excision
Describe the clinical features associated with hallux valgus
Deformity (including bunions)
Metatarsalgia
OA of the first MTP joint
Symptoms from footwear
What is hallux rigidus?
Osteoarthritis of the big toe, usually the first MTP joint
What is Morton’s neuroma?
A.k.a interdigit neuralgia
Irritation and thickening of the interdigital nerve, in the 3rd or 2nd web space
What causes Morton’s neuroma?
Chronic, repetitive trauma to the ball of the foot, e.g. wearing high heels
How is Morton’s neuroma diagnosed?
Clinical features: pain/discomfort (+ paraesthesia) in the ball of the foot
Mulder’s click on examination
What are the treatment options for Morton’s neuroma?
Modification of footwear
Steroid Injections
Surgical excision
Describe the presenting features of plantar fasciitis
Heel pain; tenderness over the insertion of the plantar fascia on the calcaneus
- worse in the morning
- worse on weight-bearing after rest
What are the treatment options for plantar fasciitis?
Rest, change training schedule Analgesia (NSAIDs) and ice Orthotics (heel pads) Physiotherapy Weight loss Night splinting/immobilisation Local corticosteroid injections Local analgesia injections
What degenerative changes occur in plantar fasciitis?
Changes in the plantar fascia:
- fibroblast hypertrophy
- absence of inflammatory cells
- disorganised/dysfunctional collagen
- avascularity
