Lower Limb Pathologies

Question 1

What are some of the likely complications from hip arthroplasty?

Answer 1

Infection, dislocation, nerve injury , leg length discrepancy, splitting of the femur, inflammatory reaction from cement, can get PE, MI, Chest infections

Question 2

Man of 40 years presents with insidious onset of groin pain on his right side, he cannot weight bear of the right side without extreme pain. You do an MRI which shows sclerosis of the femoral head with a lytic zone underneath. What is the likely diagnosis?

Answer 2

Avascular necrosis where the microcirculation of the femoral head compromised so get necrosis

Question 3

What is the treatment for avascular necrosis?

Answer 3

If head collapsed then total hip replacement

If head still intact then decompression, biphosphonates (decreased bone resorption), and maybe bone grafting

Question 4

Young female hockey player presents with pain and tenderness on her lateral proximal thigh. She has pain on resisted abduction. Likely diagnosis?

Answer 4

Trochanteric bursitis

Due to active young patient, morelikely in females due to anatomy, bursa underneath greater trochanter becomes inflamed

Question 5

Treatment for trochanteric bursitis?

Answer 5

Analgesia, NSAIDs, physiotherapy, steroid injections

Question 6

What type of femoroacetabular impingement syndrome is common in males with previous SUFE? What movment impinged?

Answer 6

CAM type, with shape of femoral head becoming ovular so impinges on acetabulum during flexion

Question 7

What type of femoroacetabular impingement syndrome is common in females?

Answer 7

Pincer type where the acetabulum overhangs onto the femoral head causing pain on abduction

Question 8

Active male rugby player presents with c-sign positive pain around his hip, it is worse when sitting. Likely diagnosis?

Answer 8

Femoroacetabular impingement syndrome CAM type (flexion worse)

Question 9

What is the treatment for femoroaetabular impingement syndrome??

Answer 9

Arthroscopic surgery to remove lesion

Question 10

Name the ligaments in the knee

Answer 10

Lateral/ medial collateral
Meniscal
Anterior/ posterior cruciates

Question 11

Man of 45 years presents with localised medial joint line pain in the left knee with difficulty straightening his knee. He was doing football then suddenly turned his leg and then felt pain. On examination his knee is swollen with a positive gutter sweep test and steinmenns test. What is the likely diganosis?

Answer 11

Medial meniscal tear

Question 12

Young rugby player presents with a deep pain in his knee, it is hot, swollen and describes his knee as giving way while he tries to walk. He was playing rugby then twisted his knee and felt a ‘pop’ soon after getting really swollen. On examination there is positive lachmans test. Likely diagnosis? Treatment?

Answer 12

Anterior cruciate ligament tear. Surgical reconstruction using patellar tendon or gracilis

Question 13

What is the treatment for collateral ligament tears? (Get pain with valgus/varus stress and tenderness)

Answer 13

Hinged knee brace

Reconstruction

Question 14

60 year old diabetic man presents with difficulty walking and bruising superior to his patella. On examination he is unable to do a straight leg raise. Diagnosis and treatment

Answer 14

Quadriceps tendon rupture

Surgical repair

Question 15

What epidemiological group is likely to have extensor mechanism rupture

Answer 15

Tendonitis history, chronic steroid abuse, diabetes, rheumatoid arthritis, renal failure, ciprofloxacin use, OA of patellar tendon

Question 16

What was do patella usually dislocate? Medial or lateral?

Answer 16

Lateral due to shallower cup

Question 17

What are the tendons that run posterior to the medial malleolus

Answer 17

Tibialis posterior
Flexor digitorum longus
Flexor hallus longus

Question 18

What is a hallux valgus deformity?

Answer 18

Where there is deformity of the great toe causing medial deviation of the 1st metatarsal and lateral deviation of the toe itself

Question 19

What is the treatment for hallux valgus deformity?

Answer 19

Wearing wider/ deeper shoes

Spacer in first web

Question 20

Women of 50 years presents with sharp burning tingling pain in her right foot radiating to her 3 and 4th digits. On examination she has lost sensation in the 3/4th web space,and compression of the metatarsal heads producing mudlers click. On ultrasound there is a swollen nerve in this area. Diagnosis? Treatment?

Answer 20

Mortons neuroma

Metatarsal pad/ offloading insole, steroid and local anaesthesia injections or excision as last resort

Question 21

Male athlete presents with extremely painful calf that occured when he was running. It felt like someone shot him in the back of the leg. He has recently been on ciprofloxacin. On examination simmonds test was positive. Treatments?

Answer 21

Achilles tendon rupture

So rest, can be surgical or use casts

Simmonds test where heels off bed supine and you squeeze the calf to see if there is plantar flexion if not then positive sign

Question 22

What is pes planus?

Answer 22

Flat foot

Question 23

Obese female aged 50 presents with pain and swelling posterior to the medial malleolus of her left foot. She says she feels like its been getting flatter. From behind you compare her feet and they are assymetrical with more toes seen on the left foot. Likely diagnosis? Treatment?

Answer 23

Tibialis posterior tendon dysfunction

Phsyiotherapy and insoles

Question 24

You suspect osteoporosis in a patient. What do you advise them to do/ prescribe?

Answer 24

Increase dietary calcium intake to 700mg a day
Weight bearing exercises
Avoid excess alcohol 
Avoid smoking
Falls prevention

Calcium and vit D supplements, bisphosphonates