hip, knee, foot, ankle- CORTEX Flashcards
where does hip pathology cause pain?
pain in groin and often radiates to knee
what causes buttock pain?
- hip pathology
- lumbar spine pathology
- SI joint pathology
where does SUFE tend to present pain?
knee pain
how long do THA (total hip arthroplasty) normally last?
15 years
pathophysiology behind THA (total hip arthroplasty) loosening?
- wear and tear
- particles from the surface of the THA cause an inflammatory response at the implant-bone interface. Macrophages ingest microscopic wear particles and release inflammatory mediators resulting in osteoclastic bone reabsorption
(osteoclasts are cell that break down bone tissue)
what are some early local complications of hip replacement?
- infection
- dislocation
- nerve injury (sciatic nerve)
- leg length discrepancy
what are some late local complications of hip replacement surgery?
- early loosening
- late infection
- late dislocation
where does avascular necrosis more commonly occur?
hip
ho does trochanteric bursitis present?
- pain and tenderness over greater trochanter
- pain on resisted abduction
what is treatment for trochanteric bursitis?
- no surgical treatment has been proven to benefit
- analgesics, anti inflammatory, physio and steroid injection
what are the 4 main ligaments of the knee?
- anterior cruciate ligament (ACL)
- posterior cruciate ligament (PCL)
- medial collateral ligament (MCL)
- lateral collateral ligament (LCL)
what is the role of the ACL?
-to prevent abnormal internal rotation of the tibia
what is the role of the PCL?
-prevents hyperextension and anterior translation of the femur
what may predispose early OA in the knee?
- previous meniscal tears
- ligament injuries
- malalignment (varus/valgus)
how are meniscal injuries usually caused?
-occur with a twisting force on a loaded knee (eg turning at football, squatting)
how do meniscal injuries present?
- patient fels localised pain to the medial (majority) or lateral joint line
- positive sign on steinmens test
- effusion develops the next day
- patient can feel a ‘locking’ of knee or have a catching sensation
what is ‘locking’ of the knee?
a mechanical block to full extension
what normally causes ACL rupture?
-occur with a higher rotational force, turning the upper body laterally on a planted foot (leading to internal rotation force on the tibia)
how do ACL injuries normally present?
- A ‘pop’ is heard or felt
- patient usually develops haemarthrosis (an effusion due to bleeding in joint)
- deep pain in knee
- choronically the patient may complain of rotatory instability with knee giving away on a planted foot
how do ACL injuries normally present?
- A ‘pop’ is heard or felt
- patient usually develops haemarthrosis (an effusion due to bleeding in joint)
- deep pain in knee
- choronically the patient may complain of rotatory instability with knee giving away on a planted foot
what do valgus stress injuries (eg rugby tackle from the side) usually tear?
Medial collateral ligament
what does a direct blow to the anterior tibia usually injure when the knee is flexed (eg motorcycle crash)?
PCL
what may a varus stress injury damage?
LCL
what may happen to the knee during a bucket handle meniscal tear?
the knee may fully lock and is unable to extend fully
Acute ACL injuries have no correlation with meniscal tears
True or False
False- around 25% of acute ACL injuries also have a meniscal tear
what injury may occur as the meniscus weakens with age?
degenerative meniscal tear
what type of meniscal injuries should be considered for repair?
fresh longitudinal tears involving outer 1/3 of the meniscus
what is the principle complaint of ACL rupture?
-rotatory instability with giving way on turning
PCL rupture in isolation is common
True or False
False- PCL rupture in isolation is uncommon
what are the extensor mechanisms of the knee?
- tibial tuberosity
- patellar tendon
- patellar
- quadriceps tendon
- quadriceps muscles
what type of antibiotics can cause tendonitis and risk tendon rupture?
quinolones
steroid injections should be used to treat pain of tendonitis of the extensor mechanism of the knee
True or False
False- steroid injections for tendonitis of the extensor mechanism of the knee should be avoided due to high risk of tendon rupture
what is the assessment to check if extensor mechanisms of the knee are still in tact?
Straight leg raise
what is patellofemoral dysfunction?
disorders of the patellofemoral articulation resulting in anterior knee pain
which direction do the quadriceps tend to pull the patella?
in a slight lateral direction
who is patellofemoral dysfunction more common in?
females (particularly during adolescence)- due to wider hips resulting in a more lateral pull of the quadriceps, adolescence tend to have a greater degree of ligament laxicity
- hypermobility
- genu valgum (knock knees)
- femoral neck anteversion
how do patients with patellofemoral dysfunction tend to present?
- anterior knee pain
- worse going downhill
- grinding or clicking sensation on front of knee
- stiffness after prolonged sitting causing ‘pseudolocking’ where the knee acutely stiffens in a flexed position
treatment for patellofemoral dysfunction?
- 90% improve with physio
- taping can alleviate symptoms
- surgery is last resort (70% success rate)
when can patellar dislocation occur?
-with a direct blow or sudden twist of knee
which direction does the patella usually dislocate in?
virtually always laterally
what tearls when the patella dislocates?
the medial patellofemoral ligament tears
what treatment may be given to a patient with recurrent patellar dislocation?
-tibial tubercle transfer or medial patellofemoral ligament reconstruction with tendon autograft
what are some causes of ankle OA?
- idiopathic
- consequence of previous injury
what is hallux valgus?
-a deformity in the great toe due to medial deviation of the 1st metatarsal and lateral deviation of the toe itself
who is hallux valgus more common in?
- females
- incidence increases with age but can occur in adolescence
- more common in patients with RA
- more common in neuromuscular disease
what is treatment for hallux valgus?
conservative:
-wearing of wider and deeper ‘accomodating’ shoes
Surgery
what is hallux rigidus?
OA of the 1st MTP joint
what is the treatment for hallux rigidus?
conservative treatment:
- wearing of stiff soled shoe to limit motion of MTPJ
- metal bar may also be inserted into sole of shoe
Surgery:
GOLD STANDARD IS ARTHRODESIS
what is a mortons neuroma?
plantar interdigital nerves overlying the intermetatarsal ligaments can be subjected to repeated trauma, causing the nerves to become irritated and become inflamed and swollen forming a neuroma
how do motor neuroma present?
-patients complain of a burning pain and tingling radiating into the affected toes
Wearing heels increases chances of developing a morton’s neuroma
True or false?
-true
what can be used to diagnose Morton’s neuroma?
USS
what is the management for Morton’s neuroma?
conservative management:
- use of metatarsal pad or offloading insole
- steroid and local anaesthetic injection may relieve symptoms and aid diagnoses
It can also be excised!
where do metatarsal stress fractures commonly occur?
in the 2nd metatarsal followed by the third
who commonly gets metatarsal stress fractures?
- runners
- soldiers
- dancers
- hikers/walkers
what is the treatment for metatarsal stress fractures?
-prolonged rest for 6 to 12 weeks
