lower limb pathologies 1

Question 1

Avulsion injuries

Answer 1

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

Question 2

where are avulsion injuries common

Answer 2

glut med/ min- GT, iliopsoas- LT, ASIS- sartorius, ischial tuberosity- hamstrings, AIIS- rec fem

Question 3

what can delayed treatment to an avulsion injury lead to

Answer 3

sub optimal outcome- not always possible to repair tendon if left too long

Question 4

what is a stress fracture of femoral neck

Answer 4

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

Question 5

how are stress fracture of femoral neck diagnosed

Answer 5

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

Question 6

risk factors stress fracture of femoral neck

Answer 6

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

Question 7

what is avascular necrosis

Answer 7

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

Question 8

symptoms of avascular necrosis

Answer 8

stiffness of hip, night pain, limp, pain in groin, buttocks, front of the thigh

Question 9

femoral neck avascular necrosis

Answer 9

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

Question 10

what is hip dysplasia

Answer 10

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

Question 11

hip dysplasia- centre edge angle

Answer 11

normal centre edge between 25-40°, <25-30 borderline dysplasia, 20° dysplasia, <16° will develop arthritis

Question 12

labrum tears

Answer 12

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

Question 13

risk factors labrum tears

Answer 13

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

Question 14

2 mechanisms of impingement

Answer 14

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

Question 15

what does FAI stand for

Answer 15

femoral acetabular impingement

Question 16

hip impingement CAM FAI

Answer 16

this is caused extra bony growth/ tuberance on the proximal femoral neck of head junction. can become symptomatic in physical young males- growth plates

Question 17

how are hip impingement CAM FAI diagnosed

Answer 17

radiography- alpha angle- X ray hip at 90° flexion and 20° abduction

Question 18

Hip impingement pincer

Answer 18

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

Question 19

how can Hip impingement pincer be located

Answer 19

, 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

Question 20

does hip impingement lead to

Answer 20

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,

Question 21

how can Hip impingement pincer occur

Answer 21

can occur in extreme ROM such as ballie and gymnastics, bone deformity from birth, may be caused by repetitive abutments of articular cartilage

Question 22

greater trochanteric pain syndrome

Answer 22

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

Question 23

risk factors greater trochanteric pain syndrome

Answer 23

females 40-60, post-menopausal, lower femoral neck shaft angle, increase BMI

Question 24

snapping hip syndrome/ coxa saltans

Answer 24

characterised by audible snapping of hip joint during movement, can be charcterised into internal and external

Question 25

internal snapping hip syndrome

Answer 25

caused by iliopsoas over iliopectineal eminence, paralabral cysts

Question 26

external snapping hip syndrome

Answer 26

cause by ITB snapping over GT, or proximal hamstring tendon rolling over ischial tuberosity, or TFL or glut max over GT

Question 27

what does a chondral refer to

Answer 27

a chondral defect refers to a focal area of damage to the articular cartilage
osteo- bones, chondral- cartilage

Question 28

what is an osteochondral defect

Answer 28

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

Question 29

what is osteochondral defect caused by- osteochondral fragment

Answer 29

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

Question 30

what is osteochondral defect caused by- osteochondral ion

Answer 30

could occur due to acute osteochondral impact ion of bone with resultant contour deformity

Question 31

what is osteochondral defect caused by- collapsed subchondral bone

Answer 31

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

Question 32

subchondral cyst- synovial fluid interfusion theory

Answer 32

which proposes that articular surface defects and increase intra-articular pressure allow intrusion of synovial fluid into the bone, leading to formation at cavities

Question 33

subchondral cyst- bone contusion theory

Answer 33

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

Question 34

groin injury

Answer 34

3 points of the traiangl- ASIS, pubic tubercle, 3G (groin, gluteal, greater trochaner)

Question 35

osteitis pubis-

Answer 35

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

Question 36

osteitis pubis- symptoms

Answer 36

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

Question 37

hip bursitis- subcutaneous trochanteric bursitis

Answer 37

pain in buttock and lateral aspect thigh, onset gradual, walking uncomfortable, full pass hipflex/ER/ADD= painful, resisted MR/ER/EXT/ABD= pain

Question 38

hip bursitis- trochanteric bursitis

Answer 38

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

Question 39

hip bursitis- iliopsoas bursitis

Answer 39

uncommon, no specefic agg, +ve passive and active add (90°), =ve LR, -ve all resisted movements

Question 40

myositis ossification-

Answer 40

formation of bone within a muscle, caused by returning to activity too quickly post dead leg

Question 41

myositis ossification- cause

Answer 41

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

Question 42

myositis ossification- symptoms

Answer 42

unsually slow recovery, pain and ROM often improve- pain and muscle stiffness worsen as bone matures, hard bumps

Question 43

pre patella bursitis-

Answer 43

can occur from infectious nature (30%) or a non-infectious nature (70%)

Question 44

pre patella bursitis- causes

Answer 44

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

Question 45

pre patella bursitis- symptoms

Answer 45

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

Question 46

foot compartment syndrome

Answer 46

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)

Question 47

foot compartment syndrome- causes

Answer 47

crush injuroes, burns, tightly fitting bandages, fractures, steriods

Question 48

foot compartment syndrome- symptoms

Answer 48

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