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Musculoskeletal > Lower Limb > Flashcards

Lower Limb Flashcards

1
Q

Hip pathology typically produces pain in the …. which may radiate to the ….

Fill in the blanks?

A

Hip pathology typically produces pain in the groin which may radiate to the knee

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2
Q

What is total hip arthroplasty?

A

A broad term for hip surgeries - includes replacements and resurfacing

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3
Q

Total Hip Athroplasty will eventually fail due to..?

How long should it last in an elderly, low demand patient?

A

Joint Loosening (Caused by wear particles setting up an inflammatory response)

Should last up to 15 years in an elderly, lower demand patient

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4
Q

Before THA is considered, conservative therapy must be used. Describe this?

A
  • Analgesia
  • Physiotherapy
  • Stick use
  • Weight Loss
  • Activity Modification

-

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5
Q

Early complications of THA?

A

Infection

Dislocation

Nerve injury (Sciatic Nerve)

Leg Length Discrepancy

Hypovolaemia

PE

MI
DVT

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6
Q

Describe some late complications of THA?

A

Early Loosening

Late Infection

Late Dislocation

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7
Q

Describe hip replacement revision surgerys?

A

Once a hip replacement fails, a revision can be done

However, this has a poorer prognosis and higher risk of complications

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8
Q

Describe THR in young patients?

A

There are some implications:

  • Early loosening (more demand)
  • Will need revision

Surgery should be delayed for as long as possible however if there is severe pain and disability then hip replacement may be justified

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9
Q

What are the common sites of avascular necrosis?

A

Femoral Head (Hip)

Talus

Scaphoid

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10
Q

Describe avascular necrosis of the hip?

A

Can be primary (Eg: Caused by hip fracture) or secondary to alcohol abuse, steroid abuse, thrombophilia or hyperlipidaemia

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11
Q

What is seen on imaging of avascular necrosis?

A

Early changes may only show MRI changes

Late changes

  • Patchy Sclerosis
  • Hanging Rope Sign on X-ray
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12
Q

Describe the treatment of avascular necrosis based on early or late detection?

A

Early = Drill holes to decompress, promote healing and prevent collapse

Late = Femoral head has collapsed, only treatment is THR

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13
Q

Describe trochanteric bursitis/gluteal cuff syndrome?

A

Inflammation of the trochanteric bursa

Inflammation of abductor muscle insertion

Causes pain, tenderness in the region of the greater trochancter and pain on abudction

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14
Q

Treatment of trochanteric bursitis/gluteal cuff syndrome?

A

Treatment:

Analgesia

Physiotherapy

Steroid Injection

NO SURGERY

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15
Q

Name the two joints of the knee?

A

Patellofemoral

Tibiofemoral

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16
Q

Name the ligaments of the knee?

A

Anterior Cruciate

Posterior Cruciate

Medial Collateral

Lateral Collateral

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17
Q

What can predipose the knee to early osteoarthritis?

A

Meniscal Tears

Ligament Injury (Eg: ACL)

Malalignment

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18
Q

Describe the role of each knee ligament?

A

ACL - Prevents internal rotation of tibia

PCL - Prevents hyperextension, prevents anterior translation of the femur

MCL - Resists valgus

LCL - Resists varus

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19
Q

When would you consider knee replacement?

A

If there is susbstantial pain or disability and conservative treatment has failed

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20
Q

What are the types of knee replacement?

A

Total

Partial

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21
Q

What treatment would you offer to a young patient/manual worker with isolated medical compartment OA, especially with varus knees?

A

Osteotomy of proximal tibia

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22
Q

Describe a meniscal tear?

A

Very common knee injury

Often sports related

Classic twisting on a loaded knee

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23
Q

Who gets meniscal tears?

A

Young

Athletes

Those who have ACL rupture (25% also have meniscal tear)

Elderly (Degenerative)

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24
Q

Signs and symptoms of meniscal tear?

A

Pain

  • Medial (10x more common)
  • Lateral

Effusion has developed by the next day

Tender joint line

Catching/locking sensation

Unable to fully extend knee

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25
Q

Describe bucket handle meniscal tear?

A

A fragment of the meniscus flaps out of place

Prevents full extension of the knee (knee has locked)

Uneven heel heights

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26
Q

Describe Degenerative meniscal tear?

A

Age related

Spontaneous or due to mild injury

Steinman’s test is negative

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27
Q

Investigation of meniscal tear?

A

Examination

  • Steinmans test

(Pain is worse when knee is externally rotated/internally rotated AWAY from affected side, better when rotated TOWARDS)

  • Heel Heights

Uneven suggests bucket handle meniscal tear

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28
Q

Treatment of meniscal tear?

A

90% aren’t suitable for repair

  • Analgesia
  • NSAIDs
  • Steroid injection

Athroscopic repair if young

Menisectomy if symptoms persist (not in elderly)

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29
Q

Describe an ACL rupture?

A

Often seen in young patients

Complain about rotation instability (gives away on turning)

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30
Q

Describe who/how an ACL rupture occurs?

A

Young

Females

Sports Players

Twisting injury on planted foot

Rapid deceleration

Rapid change of direction

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31
Q

Signs and symptoms of ACL rupture?

A

Twisting on planted foot

Popping sound

Rapid effusion (1 hr)

Pain

Unable to continue

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32
Q

Investigation of ACL rupture?

A

Examination shows:
- Effusion

  • Positive Lachmans Test
  • Positive anterior drawer test
33
Q

Treatment of ACL rupture?

A

RICE (First Aid)

Physiotherapy

Primary Repair (40% fail)

Reconstruction

  • Tendon graft
  • Need intensive rehab
34
Q

Describe MCL damage?

A

Quite common

Caused by valgus force

Tenderness of insertion of MCL

Heals very well and instability is uncommon

35
Q

Treatment of MCL, acute and chronic?

A

Acute = Hinged Knee Brace

Chronic = MCL Tightening

Reconstruction (Tendon Graft)

36
Q

Describe PCL damage?

A

Often doesn’t occur as an isolated injury

Reconstruction is normally performed during multi-ligament reconstruction

Isolated PCL rupture is seen as chronic hyperextension and instability when coming down stairs. Treatment is reconstruction

37
Q

Describe LCL ruptures?

A

Patients have marked instability on rotational movement

38
Q

Describe extensor mechanism rupture?

Cause?

A

Caused by rupture of quadriceps tendon or patella tendon

Can rupture with rapid contractile force - eg: Weight lifting, fall or spontaneously in a degenerative tendon

39
Q

Name some factors than can predispose to extensor mechanism rupture?

A
  • Tendonitis
  • Chronic steroid use/abuse
  • Diabetes
  • Rheumatoid Arthritis
  • Chronic Renal Failure
  • Quinolone Antibotics (Ciprofloxacin)
40
Q

Should steroid injections be used for extensor mechanism tendonitis?

A

No

This leads to a risk of extensor mechanism rupture

41
Q

Signs and symptoms of extensor mechanism rupture?

A

Popping/tearing

Immediate swelling

Unable to extend

Unable to straight leg raise

42
Q

Describe investigations for extensor mechanism rupture?

A

Examination

  • Unable to straight leg raise
  • Effusion

X-Ray

  • High patella = PT rupture
  • Low Patella = QT rupture
43
Q

Treatment for extensor mechanism rupture?

A

Tendon Repair

Reattach tendon to patella

44
Q

Describe patellofemoral dysfunction?

Symptoms?

A

Disorder of the patellofemoral articulation that lead to anterior knee pain

Symptoms:
- Anterior knee pain

  • Worse on sitting
  • Worse going downhill
  • Clicking sensation
  • Pseudolocking (after sitting in a flexed position)
45
Q

Treatment of patellofemoral dysfunction?

A

90% resolve with physiotherapy

Surgery is a last resort

46
Q

Describe patellar instability?

Who is this seen in?

A

Can be caused by patellar dislocation (Eg: A direct blow to the knee)

Can cause unstable patella which regularly dislocates LATERALLY

Risk of instability decreases with age

47
Q

Treatment of patellar instability?

A

Physiotherapy

Tendon Transfer (if recurrent dislocations and frequent)

48
Q

Describe ankle osteoarthritis?

Causes?

A

This is common osteoarthritis as the ankle is weight bearing

Can be primary or secondary

Primary = Elderly Degenerative

Secondary = Due to injury

Due to sports (eg; footballers)

49
Q

Signs and symptoms of ankle osteoarthritis?

A
  • Tenderness
  • Stiffness
  • Some swelling
  • Reduced ability to walk and weight bear
  • Pain on dorsiflexion (due to osteophyte impingement)
50
Q

Investigations of ankle osteoarthritis?

A

History

Examination

X-Ray

  • Loss of joint space
  • Osteophytes
  • Subchondral Sclerosis
  • Subchondral Cysts
51
Q

Treatment of ankle osteoarthritis?

A
  • Arthrodesis

(Fusion of bones, can cause loss of some movement but lower chance of failure)

  • Replacement
  • Reserved for elderly patients

High rate of early loosening

52
Q

Describe Hallux Valgus?

Who is it seen in?

A

Medial deviation of metacarpals

Lateral deviation of the toe itself

More common in females, possible genetic link

Seen in those with rheumatoid, inflammatory arthropathies and neuromuscular disease

53
Q

Signs and symptoms of hallux valgus?

Treatment?

A

Pain (Inflamed Bursa)

Deviated toe

Treatment:

Conservative - Wider, deeper shoes

Use spacer between 1st and 2nd toe to prevent rubbing

Surgery does not have good prognosis and people are often unhappy with the results

54
Q

What is Hallux Rigidis?

Treatment?

A

Osteoarthritis of the big toe

Conservative:

  • Stiff soled shoes
  • Removed osteophytes (Cheilectomy)

Surgery: Arthrodesis

55
Q

What is a Morton’s Neuroma?

A

Inflammation and swelling of the plantar interdigital nerves to form a neuroma

This causes burning, tingling pain

Commonly affects the 3rd or 2nd interspace

56
Q

Who does Morton’s Neuroma commonly affect?

What is seen on examination?

A

Women - high heel wearers

Examination - Loss of sensation in interspace. Medio-lateral metatarsal compression causes a click and causes symptoms

57
Q

Treatment of Morton’s Neuroma?

A

Metatarsal Pad/Insole

Steroid/Local Anaesthetic Injection

Surgical Excision

58
Q

Describe a metatarsal stress fracture?

Where is it commonly seen?

Who is it commonly seen in?

A

Fracture of the metatarsal, often seen in dancers, walkers, soldiers on long parades

Commonly seen in 2nd metatarsal, followed by 3rd metatarsal

59
Q

Investigation of metatarsal stress fracture?

Treatment?

A

X-Ray shows fracture for 3 weeks

Bone scan may be useful

Rest for 6-12 weeks

Rigid soled boot

60
Q

What is Achille’s tendonitis?

A

Inflammation of the achilles tendon

Often due to sports playing

61
Q

Who gets Achille’s tendonitis?

Cause?

A

Repetivie Strain (from sport)

Quinolone Antibiotics (Eg: Ciprofloxacin)

Rheumatoid Arthritis

Gout

62
Q

Symptoms of achille’s tendonitis?

A

Pain - worse on movement

Stiffness

Weakness

Swelling

63
Q

Treatment of Achilles tendonitis?

A

Rest

Physiotherapy

Heel Raised

Splint/Boot

NO STEROID INJECTION

64
Q

Describe achilles tendon rupture?

Cause?

Symptoms?

A

Occurs in middle aged or elderly

Caused by achille’s tendonitis or degenerative

Cause is sudden deceleration

Symptoms:

  • Feels like being kicked in the back of the leg
  • Difficulty weight bearing
  • Weakness of plantarflexion
  • No plantarflexion when squeezing the calf (Simmonds Test)
65
Q

Treatment of Achilles Tendon Rupture?

A

Non -operative:

  • Series of casts over 8 weeks

Surgery

  • Suture repair
  • Followed by casts for 8 weeks
66
Q

What is plantar fasciits?

A

Thickening of the plantar fascia - due to repetivie stress or degenerative injury

Causes pain when walking which is localised to the heel

67
Q

Causes of plantar fasciitis?

A
  • Diabetes
  • Obesity
  • Frequent walking on hard floors (bare foot)
  • Poor supportive footwear
  • AGE (Degenerative)
68
Q

Symptoms of plantar fasciitis?

A

Pain

  • Localised to the heel
  • Worse on walking
  • Worse in the morning (first step)
69
Q

Treatment of plantar fasciitis?

A

Rest

Stretching Exercise (for achilles and plantar fascia)

Gel filled heel pad

Corticosteroid injection

Not surgery

70
Q

What is pes planus?

Common or rare?

A

Flat foot - caused by a failure of the medial arch

Affects about 20% of the population so very common

71
Q

Who is pes planus seen in?

A

Those with generalised ligament laxity

Familial Tendency

Congenital

Rheumatoid Arthritis

Charcot Foot

Tibialis posterior tendonitis

72
Q

Treatment of pes planus?

A

Doesn’t require any specific treatment

73
Q

Describe tibialis posterior tendonitis?

A

Tendon is under constant stress

Can develop tendonitis from stress or due to degenerative causes

74
Q

Treatment of posterior tibialis tendon:

  • Tendonitis?
  • Rupture?
  • Rupture with OA?
  • To prevent tendon rupture?
A

Tendonitis = Splint

Rupture = Tendon Transfer

Rupture + OA = Arthrodesis

To prevent rupture = Tenosynovectomy, surgical decompression

75
Q

What is pes cavus?

A

Abnormally high arch of the foot

Often related to neuromuscular conditions

Often accompanied by claw toe

76
Q

Treatment of pes cavus:

  • Supple?
  • Rigid?
  • Severe?
A

Supple = Soft tissue release, tendon transfer

Rigid = Calcaneal Osteotomy

Severe = Arthrodesis

77
Q

Describe claw and hammer toes?

Symptoms?

Treatment?

A

Claw toes and hammer toes occur due to an imbalance between the flexor and extensor tendons

Symptoms include deformed toes, pain and rubbing

Treatment invovles tenotomy, tendon transfer, arthrodesis or toe amputation

78
Q

Name these toe deformities?

A

A = Hammer Toe

B = Mallet Toe

C = Claw Toe

79
Q
A

Musculoskeletal (23 decks)

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