Lower limb

Question 1

List the Ix for a suspected knee ligament injury (3)

Answer 1

XR (AP/Lat/Sky) – exclude fracture/OA
MRI (picks up 90%)
Arthroscopy (if MRI –ve but hx suggestive)

Question 2

Outline the management for a knee ligament injury

Answer 2

Conservative:
Sprain/partial – self-heals w. physio/brace
Low func elderly – educate on limitations / long physio

Surgical:
ACL – tendon graft repair (donor tendon + screws)
PCL – early screw fixation
MCL/LCL – early surgical

Question 3

What are the features of a Baker’s cyst?

Answer 3

Due to RA/OA

Unruptured:
Popliteal fossa swelling
Reduced joint flexibility

Ruptured:
Mimicks DVT swelling
Crescent sign (lat. malleolus bruising)

Question 4

What are the features of plantar fasciitis?

What is the main DDx? + differentiating feature

Answer 4

Localised heel pain on walking
Worse on wt bearing
Worse in morning (flexed at night)
Local tenderness

DDx: subcalcaneal bursitis
Compression heel pad is more painful

Question 5

What are the features of posterior tibialis rupture?

Answer 5

Sudden pain on medial aspect foot
Planovalgus deformity (forefoot abduction / loss of arch)
Medial malleolus swelling/tenderness

Question 6

Where are the diff types of knee bursitis?

Answer 6

Pre-patellar (housemaids)
Infra-patellar (clergyman’s)
Anserine (obese/breast stroke)

Question 7

What are the main types of malignant bone primary cancers? (2)

Answer 7

Osteosarcoma (malig osteoblast)
Children / Knee **
Poor prognosis / advanced

Chondrosarcoma
Adults / Pelvis **
Slow growing / better prog

Question 8

What are some non-neoplastic DDx to primary bone cancers (2)

Answer 8

Osteomyelitis

Stress fractures