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MRCS B Examinations and practical skills > Knee and hip examinations > Flashcards

Knee and hip examinations Flashcards

1
Q

Hip exam-introduction

A

Wash hands
Chaperone

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2
Q

Hip exam: look

A

General inspection
Anterior, lateral and posterior inspection of hips (get pt to turn)
Gait
Inspect while pt on bed

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3
Q

Hip exam: Feel

A

Temperature
Hip joint palpation (greater trochanter)-painful in trochanteric bursitis
Leg length assessment

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4
Q

Hip exam: Move

A

Active movement:
–> Hip flexion (normal ROM 120 degrees)
–> Hip extension (normal ROM 180 degrees: flat on bed)
Passive movement
–> Flexion (120)
–> Internal rotation (flex to 90, then laterally rotate foot)
–> External rotation (flex to 90, then medially rotate foot)
–> Abduction: stabilise contralateral iliac crest and abduct until pelvis begins to tilt
–> Adduction: stabilise contralateral iliac crest, adduct until pelvis begins to tilt
–> Extension: prone position, place hand on ipsilateral pelvis

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5
Q

Hip exam: Special tests

A

Thomas’s test
Trendelenburg’s test

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6
Q

Thomas’s test

A

-Assess for fixed flexion deformity (inability to fully extend leg)

  1. Put hand under lumbar sign to prevent compensation by increasing lumbar lordosis
  2. Passively flex unaffected hip
  3. Repeat on other side

Abnormal if affected hip rises off bed
Shouldn’t be performed with hip replacement due to risk of dislocation

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7
Q

Trendelenberg’s test

A

-Ask pt to put their hands on your hands
-Lift same leg off floor
-Observe for pelvic tilt

If pelvis tilts on side of raised leg, this suggests contralateral abductor weakness

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8
Q

HIp: To complete examination:

A

Neurovascular examination of both lower limbs.
Examination of the joints above and below (lumbar spine and knee joint).
Further imaging if indicated (e.g. X-ray and MRI).

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9
Q

Hip exam general inspection findings

A

Body habitus (osteoarthritis)
Scars
Wasting (disuse atrophy secondary to joint pathology/LMN lesion)
Walking aids

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10
Q

Hip exam: Leg length assessment

A

-To distinguish between true leg length discrepancy and apparent (e.g. due to pelvic tilt)
-Apparent leg length: Measure from umbilicus to tip of medial malleolus each side
-True leg length: Asis to tip of medial malleolus

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11
Q

Hip exam closer inspection of hip findings

A

Swelling, bruising, scars, quadriceps wasting
Leg length discrepancy (congenital/aquired-fracture, surgery, joint disease)
Pelvic tilt (hip abductor weakness)

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12
Q

Hip: Gait

A

ROM (reduced in joint disease)
Trendelenberg (gluteal nerve weakness)
Wadding gait (muscular dystrophy)

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13
Q

HIp: Trendelenberg gait

A

As the pelvis sags towards the unaffected side, the trunk lurches towards the opposite side in an effort to maintain balance.

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14
Q

OA vs RA symptoms

A

The symptom of joint stiffness can be used to differentiate non-inflammatory arthropathies such as osteoarthritis from inflammatory arthropathies such as rheumatoid arthritis.

In inflammatory arthropathies, joint stiffness improves with activity and stiffness typically lasts longer than 30 minutes in the morning

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15
Q

XR findings OA

A

Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts

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16
Q

Osteoarthritis on XR

A

Osteophytes
Joint space narrowing
Subchondral sclerosis
Subchondral cysts

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17
Q

Mx OA

A

Conservative
-Weight loss
-Physiotherapy
-Hydrotherapy

Medical
-WHO pain ladder

Surgical
-Discuss options re: THR
-Comorbidities, shx, send for preassessment

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18
Q

Knee: Look

A

General inspection
Anterior inspection
Lateral inspection
Posterior inspection
Gait
Inspection with pt on bed

19
Q

Knee: Feel

A

Temperature

Measurement of muscle bulk

Palpation of extended knee: Patellar, medial and lateral joint lines

Assess for effusion: patellar tap, sweep

Palpation of flexed knee (popliteal fossa and joint line easier to feel): Patellar, medial and lateral joint lines, tibial tubersoity, fibular head, popliteal fossa

20
Q

Knee: Move

A

Straight leg raise
Active movement: flexion, extension
Passive movement: Flexion, extension

21
Q

Special tests knee

A

-Posterior sag sign
-Anterior and Posterior drawer test
-Medial and lateral collateral ligament assessment

Offer:
-Lachman’s test
-Mcmurray’s test
-patellar apprehension test

22
Q

Patellar apprehension test

A

-Patellar always dislocates laterall
-Push patellar laterally: if anxious/in pain, positive

23
Q

Knee: general inspection findings

A

Same as hip: Body habitus, walking aids, scars, prescriptions, wasting

24
Q

Knee: anterior inspection findings

A

Patellar position (dislocation/subluxation)
Psoriasis plaques (psoriatic arthritis)
Valgus deformity: tibia turned outwards in relation to femur, knees ‘knocking’ together
Varus deformity: tibia turned inwards, bowlegged appearance
Quadriceps wasting

25
Q

Knee: lateral inspection findings

A

Extension abnormalities: knee hyperextension-cruciate ligament injury.
Flexion abnormalities: fixed flexion deformity

26
Q

Knee: posterior inspection findings

A

Popliteal swelling

27
Q

Knee: palpation of patellar

A

Patellar
1. Palpate medial and lateral border of patellar, stabilising one side and palpating with fingertips
–> tenderness: patellofemoral arthritis
–> tensing of muscles on mobilising patellar may suggest recent dislocation
2. Palpate patellar tendon for signs of tendonitis/rupture

28
Q

Knee: measurement of quadriceps bulk

A

20cm above tibial tuberosity

29
Q

Mcmurray’s

A

Check meniscal tear. Positive sign is pain

Medial: -Flex and externally rotate knee, slowly extend
Lateral: -Flex and internally rotate knee, before slowly extending

30
Q

Knee: further tests/investigations

A

Further assessments and investigations to suggest may include:

Neurovascular examination of both lower limbs
Examination of the joints above and below (e.g. ankle and hip)
Bloods: FBC, U + E, CRP, Urate
Further imaging if indicated (e.g. X-ray AP and lateral and MRI)

31
Q

Clinical features of a varus deformity

A

Can be physiological (up to 2 years old) or pathological

Bony deformity: the tibia is turned inward in relation to the femur

Abnormal gait: limp with in-toeing (feet are pointed towards the midline)

Lower limb pain: due to abnormal stress placed on the ligaments, joints, and muscles

32
Q

Clinical features osgood schlatter’s disease and age affected

A

Typically affects males aged 10 to 15

Tender bony elevation of the tibial tuberosity

Pain exacerbated by activity and relieved by rest

33
Q

Clinical features patellar dislocation

A

Intense pain

Swelling over the knee joint

May be associated with a “pop” or the knee “giving way” at time of dislocation

Haemarthrosis (bleeding into the knee joint cavity)

34
Q

Describe the posterior sag sign and its clinical relevance

A

The posterior cruciate ligament (PCL) is responsible for preventing backward displacement of the tibia or forward sliding of the femur.

As a result, if the PCL is ruptured the tibia can sag posteriorly in relation to the femur and this is what is known as the posterior sag sign.

35
Q

Significance of posterior drawer test

A

Significant movement may suggest posterior cruciate ligament laxity or rupture.

36
Q

Describe the role of the medial collateral ligament (MCL) and a common mechanism of injury

A

The primary function of the MCL is to stabilise the knee by resisting valgus forces that would push the knee medially.

Injury of the MCL typically occurs secondary to excessive valgus force when the knee is partially flexed (e.g. a direct blow to the lateral aspect of the knee joint).

37
Q

Describe the role of the lateral collateral ligament (LCL) of the knee and a common mechanism of injury

A

The primary function of the LCL is to stabilise the knee by resisting varus forces that would push the knee medially.

Injury of the LCL typically occurs secondary to excessive varus force (e.g. a direct blow to the medial aspect of the knee joint).

38
Q

Name three causes of leg-length discrepancy in children

A

Congenital causes include:

-Congenital femoral deficiency
-Fibular hemimelia (shortened or missing fibula)
-Tibia hemimelia

Acquired causes are often secondary to joint pathologies, such as:
-Perthes
-Developmental dysplasia of the hip
-Slipped capital femoral epiphysis

39
Q

Describe the anatomy and role of the posterior cruciate ligament (PCL)

A

LAMP: lateral acl, medial pcl

The PCL originates from the lateral edge of the medial femoral condyle and attaches in the posterior region of the intercondylar area.

Its primary purpose is to stabilise the knee joint by preventing posterior tibial subluxation (i.e. prevent posterior displacement of the tibia relative to the femur).

40
Q

Describe the anatomy and role of the anterior cruciate ligament (ACL)

A

LAMP: lateral ACL, medial PCL

The ACL originates from medial wall lateral femoral condyle and inserts in the anterior region of the intercondylar area of the tibia.

Its primary purpose is to stabilise the knee joint by preventing anterior tibial subluxation (i.e. prevent anterior displacement of the tibia relative to the femur).

41
Q

Describe the typical clinical features of a meniscal tear

A

Typical clinical features of a meniscal tear include:

Acute knee pain immediately following knee trauma
Popping, catching, locking of the knee
Knee joint swelling/effusion

42
Q

List five causes of knee joint effusion

A

Ligament rupture: cruciate ligament, collateral ligaments
Septic arthritis
Inflammatory arthritis: rheumatoid arthritis, reactive arthritis
Gout
Osteoarthritis
Meniscal injury

43
Q

Knee: soft tissue injury differentials

A

Primary differential plus:
-Or other soft tissue injury such as meniscus, pcl/acl and collaterals

44
Q

What is RICE

A

Rest
Ice
Compression-e.g. knee brace
Elevation

MRCS B Examinations and practical skills (13 decks)

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