Lower Limb Coretext Flashcards
Where does hip pathology typically produce pain?
Groin
buttock
Knee
What range of motion is usually reduced first in hip pathology?
Internal Rotation
What does a positive trandellenburg test suggest?
Abductor weakness
What muscles are tested in the Trendellenburg test?
Gluteus Medius and Gluteus minimus
Abductors of the hip
How long do total hip replacements usually last?
15 - 20 years
What is Avascular Necrosis?
Poor blod suplly leading to cell death , common in the hip joint
How do people with Avascular Necrosis of the hip present ?
Groin pain
What happens if Avascuar Necrosis is left unoticed?
Patchy sclerosis of femoral head
Lytic sones resulting in “hanging rope sign” on xray
Femoral head collapse
What does sclerosis mean?
Abnormal hardening
What are the treatment options for Avascular Necrosis of the hip?
Pre collapse- drill holes can be made in an attempt to releive pressure and promote healing
Post collapse- total hip replacement
What is Trochanteric bursitis?
inflamation of the trochanteric bursa
What do people with trochanteric bursitis present with?
Pain and tenderness in the region of the greater trochanter with pain on resisted abduction
How do you treat Trochanteric Bursitis?
Analgesic
NSAIDs
Physiotherapy
Steroid injections
No surgical treatment has proven benefit
What are the four main ligaments in the knee joint?
ACL - anterior crustiate ligament
PCL - posterior crusiate ligament
MCL- Medial collateral ligament
LCL - lateral collateral ligament
What is the principle role of the ACL?
To prevent abnormal internal rotation of the tibia
What is the main function of the PCL?
Prevents hyperextension and anterior translation of the femur.
How do Meniscal Injuries usually occur?
twisting force on a loaded knee
Where will people with meniscal injuries feel the pain?
Medial or lateral joint line
Usually medial
What are common mechanical symptoms of meniscal tears?
Catching sensation
or
“Locking”
What is true knee locking ?
Mechanical block to full extension causes by a torn meniscus flipping over and being stuck in the joint line
What will the patient feel if they rupture their ACL?
Immediatly
Rotational force
they will hear a “POP”
Haemarthrosis
Chronically
Rotatory instability
What parts of the meniscur are supllied by blood?
Outer 1/3
What is more common, medial or lateral meniscal tears?
Medial
Which special physical examination test can be preformed to diagnose ACL rupture?
Anterior draw test
and
Lachmans test
What is the 1/3 rule for ACL ruptures?
1/3 have no problems
1/3 manage by avoiding certain movements
1/3 will do poorly with frequent giving away
What percentage of patients with a torn ACL will end up having reconstruction
4
How are acute MCL tears usually treated?
Hinged knee brace
How can chronic MCL instability be treated?
MCL tightening or with reconstruction with a tendon graft
What is the usual treatment for LCL ruptures?
surgical
Early repair or late reconstruction with tendon graft
What must you be aware of during reperfusion of a leg?
compartment syndrome
what are osteochondral and chondral injuries?
Occour due to impaction or shearing of articular surfaces due to a direct blow
What are the characterisitc symptoms of osteochondral and chondral injuries?
Ongoing pain and effusion after a knee injury
What investigations would you consider in osteochonfral injuries?
MRI
Arthroscopy
X ray
What structures are invloved in the extensor mechanisim of the knee?
quadriceps muscle
quadriceps tendon
patella
patellar tendon
tibial tuberosity
How do you treat a extensor mechanism rupture?
Surgical repair
what physcial examination is most useful in extensor mechanism ruptures?
Straight leg raise
What is Patellofemoral dysfunction?
Disorders of the patellofemoral articulation resulting in anterior knee pain
Which way does the patella usually dislocate?
Laterally
What are the two surgical options for patients with advanced ankle osteoarthritis?
Arthrodesis
Ankle replacement
What is hallux valgus also known as ?
Bunion
What is a cheilectomy?
Removal of oesteophytes in the foot
What is the gold standard surgical treatment for hallux rigidus?
Arthrodesis
What is Morton’s Neuroma?
Neuroma forming from plantar interdigital nerves
What is this?
Morton’s neuroma
What would a patient with morton’s neuroma experiance?
tingiling and burning pain in affected toes
What investigation is used to diagnose Mortons neuroma?
ultrasound looking for the swollen nerve
What are the management options for morton’s neuroma?
Conservative
insoles
Steroids and anaesthetic
Surgical
Neurom can be excsied - patients may continue to feel pain
What are the most common metatarsals to stress fracture?
2nd metatarsal followed by the 3rd metatarsal
What is the treatment for metatarsal stressfractures?
prolonged rest for 6-12 weeks while wearing a rigid solid boot
Why should steriod injection around the achillies tendon in achillies tendonitis be avoided?
Risk of tendon rupture
what is simmonds test?
Plantar flexsion upon squeezing of the calf muscles
What is plantar fasciitis?
Self-limiting repetative strain injury chracterised by pin with walking felt on the instep of the foot.
What is pes planus ?
Flat feet
Where does the tibialis posterior tendon attatch on to ?
Medial navicular
How should Tibialis posterior tendonitis be treated?
a splint with a media arch support to avoid rupture
What happens if the tibialis posterior tendon ruptures?
loss of the medial arch of the foot
What is Pes cavus?
Abdnormally high arch of the foot
