Lower Limb Conditions Flashcards
what is avascular necrosis
loss of blood supply, most commonly to the femoral head
how is avascular necrosis of the hip managed
pre-collapse of femoral relieve pressure by air holes
once collapsed the only option is THR
what is trochanteric bursitis
inflammation of the bursa surrounding the greater trochanter as the tendons around the abductor muscles are under great stress
pain around the greater trochanter and pain on resisted abduction is suggestive of what
trochanteric bursitis
describe the management of trochanteric bursitis
analgesics
steroid injection
physiotherapy
list some pre-disposing factors to knee arthritis
previous meniscal or ligamentous injury
malalignment eg valgus or varus
what is the function of the menisci
to act as shock absorbers and distribute load from fmeoral condyles to flat tibial articular surfaces
the medial meniscus is fixed/mobile and under lots/little stress
fixed and under a lots of stress
describe the mechanism of injury that occurs with meniscal tears
occurs with twisting force on a loaded knee - playing sport
describe the presentation of a meniscal tear
pain localised to medial/lateral joint line
sense of knee locking
cannot fully extend the knee 15 degree block
steinmanns test positive
describe the blood supply to the meniscus
only peripheral third of the meniscus has blood supply therefore tears dont always heal well
what investigation is carried out for suspected meniscal tear
MRI - showing the location and degree of the tear
describe a bucket handle tear
large longitudinal tear causing fragment to come out of normal position and displacing anteriorly
what is the treatment for a meniscal tear
vascular ones can be treated by suturing the meniscus to the bed
if no blood supply the tears must be removed altogether predisposing to OA
describe a grade 1, 2 and 3 ligament injury
1 - sprain with some torn fibres but macroscopically intact
2 - partial tear with fascicles disrupted
3 - complete tear
describe the presentation of ACL rupture
occurs on rotating body laterally with foot planted, internal rotation on the tibia
hear a pop when injury occurs
development of haemarthrosis
long term feeling of instability
what is a haemarthrosis
effusion due to bleeding within the joint
what is the management for ACL rupture
rest and physio best option in elderly etc
if young and active attempt reconstruction of ligament with tendon graft from patella
what mechanism causes an MCL rupture
valgus stress - usually contact sports
what is the management for MCL rupture
rarely surgery - usually knee brace if no other ligament injuries
what causes a PCL rupture
direct blow to anterior tibia eg motor cycle crash
the PCL is more or less common to rupture than the ACL and why
less common as is a thicket ligament
list the structures in the extensor mechanism from proximal to distal
quadriceps quadriceps tendon patella patella tendon tibial tuberosity
list some of the risk factors for developing extensor mechanism ruptures
chronic steroid use diabetes chronic renal disease previous tendonitis quinolone antibiotics - increases tendonitis risk
patella rupture commonly occurs in which age group
<40s
quadriceps rupture commonly occurs in which age group
> 40s
straight leg raise is positive in which condition
extensor mechanism rupture - cannot lift leg on extension
describe the management of extensor mechanism rupture
surgical tendon to tendon repair or reattach tendon to patella
what is hallux valgus
lateral deviation of the great toe with medial deviation of the first metatarsal head
list the risk factors for developing hallux valgus
female > male
wearing shoes
familial history
inflammatory arthritis and MS
describe the presentation of hallux valgus
pain around first MTP
development of bunion - shoes rubbing to cause inflamed bursa
rubbing of great toe against second toe causing skin break and ulceration
describe the management of hallux valgus
conservative - wear accomodating shoes, use of spacer between first and second toe
surgical - osteotomies to realign bones and soft tissue procedures to release tight tissues
what is hallux rigidus
osteoarthritis of the first MTP
describe both the conservative and surgical management for hallux rigidus
conservative - wearing of stiff soled shoes to prevent movement
surgical - arthrodesis to prevent motion and alleviate pain or MTP ceramic joint replacement
which nerves are affected in mortons neuroma
plantar interdigital nerves overlying the intermetatarsal ligaments
how does mortons neuroma present
burning pain and tingling commonly in the third toe
loss of sensation of webbed space
positive mulders test
describe mulders test
click heard when compressing MTPs medio-laterally means mortons neuroma
what is used to diagnose mortons neuroma
ultrasound showing swollen nerve
what is the treatment for mortons neuroma
conservative - steroid or local anaesthetic in injections to relieve pain
surgical - excision of neuroma but high rates of recurrence
where are metatarsal stress fractures most likely to occur
second and third MTPs
how is a stress fracture diagnosed
x-ray may not show fracture until 3 weeks after injury when calluses are formed - must re-do then
what is the management of metatarsal stress fracture
prolonged rest for 6-12 weeks in a rigid soled boot
what increases risk of developing achilles tendonitis
quinolone antibiotics
RA and gout
repetitive strains from sports
tendonitis can be treated with steroid injection true/false
false as increases risk of ruptures
describe simmonds test when assessing for achilles tendon rupture
loss of plantarflexion when squeezing the calf
plantar fasciitis is a self-limiting condition true/false
true - caused by repetitive stress and overload on the foot
what are the risk factors for developing plantar fasciitis
obesity
excessive walking
diabetes
how does plantar fasciitis present
pain felt walking on the instep of the foot
localised tenderness on palpation
pain is worst in the morning taking first steps
how is plantar fasciitis managed
rest and achilles stretching, corticosteroids can also improve pain
what is pes cavus
abnormally high arched feet
how is pes cavus managed
soft tissue releases and tendon transfers if supple
osteotomies if more rigid
describe claw toes appearance
hyperextension at MTP
hyperflexion at PIP and DIP
describe hammer toes appearance
hyperextension at MTP
hyperflexion at PIP
hyperextension at DIP
describe mallet toes appearance
fixed flexion deformity of the DIP, manage with flexor tenotomy and joint arthrodesis at DIP
