Lower Limb Pathologies

Question 1

What are the 3 most common types of LL disorders?

Answer 1

Bone, tendon/muscle, and joint

Question 2

What is the most common LL tendonopathy ?

Answer 2

Gluteal tendonopathy

Question 3

What is the most common tendonopathy sort osteoarthritis?

Answer 3

Tendonopathy

Question 4

Does a tendonopathy involve degenerative and inflammatory factors?

Answer 4

Yes it’s a mixture of both it’s degeneration of the tissue but involves inflammatory cells called immuno-active cells that try to lay down new tissue.

Question 5

How does a tendonopathy involve inflammatory and degenerative factors?

Answer 5

Over stimulating tissue cells with stress will prime the cell making it change shape, this prime cell can then release pro-inflammatory macrophages and chemicals, these chemicals cause the resident tenocytes to become overly active and therefor it remains in the altered shape causing chronic inflammation.

Question 6

What structural changes occur in a tendonopathy?

Answer 6

1.Alterations to tendon cell population
(increased tenocytes, hyperactive tenocytes[they therefore produce wrong chemicals due to that], increased cell death/apoptosis, more immunoactive cells)

2. Therefore we get disorganisation of collagen
   (Decrease in type 1 collagen and higher concentrations of imamature collagen bundles and increased type 3)

3.ground substances change
(Increased proteoglycens and glucoseaminoglycens and therefor increased water contents into the tendon between collagen fibres which therefore makes the tendon much weaker)

4.Neovascularization
(Increase in blood vessels and nerve fibres)

Question 7

What happens to some cell areas of a tendon if consistent wear And compression occurs?

Answer 7

Some of the cells turn into more of a condracyte (cartilage cell) or osteocytes (bone cell) laying bone down into the tendon.

Question 8

When will pain be felt in a gluteal tendonopathy and who is a typical patient?

Answer 8

When the leg is adducted and on the trochanter.

A typical patient would be females who are post menopausal and often with an incread BMI

Question 9

What is a paratenonitis disorder?

Answer 9

Inflammation of the sheath not the tendon

Question 10

What is a inflammatory arthritic condition?

Answer 10

An autoimmune disorder where your white blood cells attack your own body tissue targeting the synovial fluid causing an inflamed response which can leads to osteoarthritis.

Question 11

When does osteoarthritis occur?

Answer 11

When there is an imbalance between the wear and repair process of cells leading to cartilage matrix degradation. Leading to subcondryl cyst formation, cartilage fragmentation and fibrillation.

Question 12

What does #NOF mean?

Answer 12

Fractured (#) Neck of Femur

Question 13

What does OCD’s stand for?

Answer 13

Osteochondral defects

Question 14

What are the different types of fractures that can occur in the lower limb?

Answer 14

OCD’s 
Stress,
NOF,
Long bone,
Acetabulum,
Tibial plateau,
Weber’s,

Question 15

Who normally suffered from a NOF #?

Answer 15

Normally females suffering trauma, this can lead to death due to compromise of the blood supply to the neck of the femur a vascular narcosis, and then due to fatty embolisms becoming free in the blood stream.

Question 16

What is snapping hip syndrome?

Answer 16

It’s when the ITB or illiopsoas tendon flicks over a bony prominence,

Question 17

What treatments are used for hamstring strains?

Answer 17

Electro therapy,
PRICE,
Exercise,
Mobilisation

Question 18

Facts about Collateral ligament injuries?

Answer 18

Usually Varus or valgus force to the knee.
MCL is more common than LCL damage.
Caused due to instability of the MCL or LCL.

Question 19

What are the signs and symptoms of a Medial Collateral ligament and lateral collateral ligament injuries?

Answer 19

Early adulthood,
Localised swelling develops,
MCL= Pain on valgus at 30 degrees,
LCL= pain on varus stress test
No locking or clicking

Question 20

When does ACL injury occur And what are the signs and symptoms?

Answer 20

When there is excessive rotation of the tibia on femur.
Knee buckles,
Audible pop,
Immediate swelling within 2 hours (haemarthrosis)
Instability visible,
Positive Lachlan’s test

Question 21

How does a posterior cruciate ligament injury occur and what are the signs and symptoms?

Answer 21

Occurs when you fall into a flexed knee or a force applied a AP.
Mild swelling,
Positive posterior drawer test

Question 22

What is a postero-lateral complex injury?

Answer 22

An injury caused by hyper extension or a varus force which damages any of the structures supporting the posterior lateral aspect of the leg. Eg ITB, LCL, politeus, arcuate ligament, posterior lateral horn of meniscus, lateral coronary ligament,
Bicep femur is tendon.

Question 23

How does a meniscal injury occur and what are the signs and symptoms?

Answer 23

Due to compressions forces being applied during flexion and rotation.
Locking,
Block to extension,
Positive results for Mcmurrays, Apleys,and joint line tenderness.

Question 24

What are some patella femoral disorders?

Answer 24

Mal-tracking (moving),
Dislocation,
Bursitis around patella,
Patella tendinosis,
Chondromalacia patella ( softening of cartilage under patella),
Patella femoral lain syndrome.

Question 25

What is the difference between patella dislocation and patellar subluxation?
What’s are the signs and symptoms?

Answer 25

Dislocation is where the Petalas is slipped out and has to be manually relocated,
Subluxation is where the patella slipped out and spontaneously relocates.

Localised tenderness around medial extensor retinaculum ams lateral knee pain,
Haemothrosis

Question 26

What is plantar fasciitis and how does it occur and what are the signs and symptoms?

Answer 26

Inflammation of the plantar aponeurosis,
Mostly 50 yr+ and obese people,
Pain when walking after prolonged rest,

Question 27

What tendonopathy do we most commonly see in the lower limb?

Answer 27

Gluteal tendonopathy,
Patella,
Achilles,
Tibialis posterior,
Tibialis anterior,
Peroneius longus and brevis.