lower limb pathologies 1 Flashcards
Avulsion injuries
most common in adolescence who are involved in sport as the tendons are stronger than apophyses (where tendon attach), bones are not ossified. occur when tendon/ ligament is pulled of the bone and a fragment of cortical bone with it
where are avulsion injuries common
glut med/ min- GT, iliopsoas- LT, ASIS- sartorius, ischial tuberosity- hamstrings, AIIS- rec fem
what can delayed treatment to an avulsion injury lead to
sub optimal outcome- not always possible to repair tendon if left too long
what is a stress fracture of femoral neck
They are a consequence of exceeding repetitive submaximal loads, which creates an imbalance between bone resorption and bone formation, early recognition is necessary to prevent development, can become displaced, losing blood supply to head of femur
how are stress fracture of femoral neck diagnosed
they appear white on MRI (high signal zone)= early aspect of stress fractures, the MRI is a test looking for bone marrow oedema
1% occur at femoral neck
risk factors stress fracture of femoral neck
common in runners, less in general population,
REDs- relative injury deviancy syndrome- look for female athletes in teens/20’s and exercising a lot- they do not have correct calorie intake for amount burned, reducing bone density
what is avascular necrosis
this is a condition where there is a loss of blood supply to the bone. bone is a living tissue, hence loss of blood supply, means bone death. Can lead to bone collapse and arthritis
symptoms of avascular necrosis
stiffness of hip, night pain, limp, pain in groin, buttocks, front of the thigh
femoral neck avascular necrosis
the femoral head receives its blood supply through the neck of femur. fractures across this zone may cause a loss of this supply leading to tissue death
what is hip dysplasia
where the hip socket doesn’t cover the ball portion of thigh bone, it may lead to hip joint being dislocated, the joint doesn’t form around the ball leading to excessive movement
hip dysplasia- centre edge angle
normal centre edge between 25-40°, <25-30 borderline dysplasia, 20° dysplasia, <16° will develop arthritis
labrum tears
this involves rim of collagen called labrum, also associated with condole injuries- injury to articular cartilage. end range of motion position of hyper-abduction, hyperextension, hyper-flexion and ER contributes to tears
risk factors labrum tears
football, ice hockey, soccer, the majority are not caused by specific event, standard MRI only has 35% sensitivity and accuracy in detecting labrum pathology, accuracy can be improved by up to 90% using contrast
2 mechanisms of impingement
CAM type- FAI- femoral side of join, pincer type FAI- acetabulum side of joint, pathological hip condition characterised by abnormal contact of femoral head/ neck junction with acetabulum, can occur in normal ROM as a result of bony abnormality
what does FAI stand for
femoral acetabular impingement
hip impingement CAM FAI
this is caused extra bony growth/ tuberance on the proximal femoral neck of head junction. can become symptomatic in physical young males- growth plates
how are hip impingement CAM FAI diagnosed
radiography- alpha angle- X ray hip at 90° flexion and 20° abduction
Hip impingement pincer
result of excess acetabular coverage of femoral head-pressing on labrum, can be global (coxa profunda)- deep hip socket, or focal anteriorly (acetabular retroversion)- altered orientation rim pressing upon labrum
how can Hip impingement pincer be located
, can be located on radiographic imaging by looking at lateral centre head angle- line from head of femur, second line going to rim of acetabulum- <40°=positive
does hip impingement lead to
it can lead to osteoarthritis but not always- increased risk of impingement in athletes competing in sport in early adult year, less risk compared to general population,
how can Hip impingement pincer occur
can occur in extreme ROM such as ballie and gymnastics, bone deformity from birth, may be caused by repetitive abutments of articular cartilage
greater trochanteric pain syndrome
GT[S common cause of lateral hip pain, attribute to tendinopathy of glut max/min, or bursal pathology, compressive forces cause impingement of these structures onto the GT by the ITB- puts pressure on tendons and structures on bursa and glut med/min tendons
risk factors greater trochanteric pain syndrome
females 40-60, post-menopausal, lower femoral neck shaft angle, increase BMI
snapping hip syndrome/ coxa saltans
characterised by audible snapping of hip joint during movement, can be charcterised into internal and external
internal snapping hip syndrome
caused by iliopsoas over iliopectineal eminence, paralabral cysts
external snapping hip syndrome
cause by ITB snapping over GT, or proximal hamstring tendon rolling over ischial tuberosity, or TFL or glut max over GT
what does a chondral refer to
a chondral defect refers to a focal area of damage to the articular cartilage
osteo- bones, chondral- cartilage
what is an osteochondral defect
refers to a focal area of damage that involves both the cartilage and piece of underlying bone, can occur acutely or develop as a result of several chronic condition
what is osteochondral defect caused by- osteochondral fragment
can be due to seperation of the osteochondral fragment caused by an acute traumatic injury or as the end result of an unstable fragment in oesochondritis dissecans- where a small segment of bone separates due to a lack of blood support
what is osteochondral defect caused by- osteochondral ion
could occur due to acute osteochondral impact ion of bone with resultant contour deformity
what is osteochondral defect caused by- collapsed subchondral bone
could occur due to a collapse of the subchrondral bone in a subchondral insufficiency fracture (where underlying bone loses bone density leading to insufficiency fracture) or avascular necrosis or a bone collapse uncovering a large subchondral cyst
subchondral cyst- synovial fluid interfusion theory
which proposes that articular surface defects and increase intra-articular pressure allow intrusion of synovial fluid into the bone, leading to formation at cavities
subchondral cyst- bone contusion theory
according to which non- communication cysts arise from subchondral foci of bone. necrosis that are the result of opposing articular surface coming in contact with each other
groin injury
3 points of the traiangl- ASIS, pubic tubercle, 3G (groin, gluteal, greater trochaner)
osteitis pubis-
overuse injury causing localised tenderness over pubic symphysis, pubic symphysis instability caused by microtrauma due to repetitive muscle strains, thought to be from abd and add muscles as they attach to pubic bones and act antagonistically, reduced IR= risk factor
osteitis pubis- symptoms
pain exacerbated by running, pivoting on 1 leg, kicking, or pushing off to change direction, pain=walking, climbing stairs, coughing or sneezing
clicking/popping- DTS, turning i nbed or walking
weakness and difficulty ambulating
fever, chills orrigors along with pubic pain
hip bursitis- subcutaneous trochanteric bursitis
pain in buttock and lateral aspect thigh, onset gradual, walking uncomfortable, full pass hipflex/ER/ADD= painful, resisted MR/ER/EXT/ABD= pain
hip bursitis- trochanteric bursitis
can sometimes be inflammation of the insertion of glut med, pain proximal and lateral thigh, patient will have tender ITB, myofascial pain from secondary muscles
hip bursitis- iliopsoas bursitis
uncommon, no specefic agg, +ve passive and active add (90°), =ve LR, -ve all resisted movements
myositis ossification-
formation of bone within a muscle, caused by returning to activity too quickly post dead leg
myositis ossification- cause
when muscle injured or bruised, bony tissue can be deposited into the bruise during healing process
not taking measure to reduced inflammation, calcification occurs 2-4 weeks after initial injury
myositis ossification- symptoms
unsually slow recovery, pain and ROM often improve- pain and muscle stiffness worsen as bone matures, hard bumps
pre patella bursitis-
can occur from infectious nature (30%) or a non-infectious nature (70%)
pre patella bursitis- causes
a direct fall on the patella, an acute trauma, repeated blows or friction on the knee, infectious or low grade inflammatory condition, prolonged knee flexion
pre patella bursitis- symptoms
pain, swelling, differential warmth around the knee, painful and limited ROM at the knee, if bursitis’s caused by an infection, pain is associated with fever and chills
foot compartment syndrome
compartment syndrome is a condition where bleeding or oedema develops in area of the body which is surrounded by non-expandable structures of bone and fascia, increasing local pressure, 4 compartments= interosseous, medial, lateral, central)
foot compartment syndrome- causes
crush injuroes, burns, tightly fitting bandages, fractures, steriods
foot compartment syndrome- symptoms
pain- sever and spontaneous or occurring during exercises, pain with passive stretch, pain during DF, increased soreness caused by moving toes, pain on palpation, swelling or tightness, pale skin, sensory deficits, firmness, muscle weakness, 5 p’s(pain, pallor, paresthesia, paralysis, paralysis, pulselessness
