lower limb pathology Flashcards
neck of femur fracture presentation
• commonly due to falls
• stabbing pain, worse on palpation
• localized pain
• loss of movement
• complication: avascular necrosis of femoral head
osteomyelitis of lower limb bones presentation
• gradually worsening pain
• constitutional infective symptoms
• infectious history / risk factors
• confirm diagnosis with x-ray (haziness) and FBC (increased WBC count)
osteoarthritis of the lower limb presentation
• on and off pain with no specific timing
• risk factors: increased activity causing microtrauma
• increased pain on motion (suggestive of mechanical/articular cause)
sciatica presentation
• radiating pain, tingling, numbness due to compression of spinal nerve
• longer onset
• poor posture is a risk factor
• differential: artherosclerosis
meniscus tear presentation
• due to activity or trauma
• initial inflammation and swelling with unresolving pain
• unhappy triad: also includes ACL tear and MCL tear (not included, but bursitis is also common)
septic joint arthritis presentation
• risk factor: DM
• short onset (a few days)
• constitutional symptoms
• hallmarks of inflammation present
• pussy, thick and white joint aspirate
ligament sprain presentation
• commonly due to trauma
• initially no symptoms (different from fracture - immediate pain)
• gradual onset of pain, inflammation
• common ligament sprains: calcaneofibular ligament, anterior talofibular ligament
diabetic foot ulcer presentation
• ulcer on the foot (obviously)
• risk factors: diabetes (obviously), wet foot dressing
• minimal foot pain
• chronic
• can lead to osteomyelitis, treat immediately
gout presentation
• painful joint (v pain), most often 1st metatarsalphalangeal joint
• swelling
• abrupt onset
• remission in 2 weeks
• erythema
• podagra
• tophi
• urate crystals (strongly negatively birefringent needle shaped crystals under polarized microscopy)
pseudogout presentation
• acute attack
• joint pain
• stiffness at affected joint
• swelling and inflammation at joint
• calcium pyrophosphate crystals (rhomboid-shaped, positively birefringent crystals under polarized microscopy)
septic arthritis/gonococcal septic arthritis presentation
• risk factors: joint surgery, unprotected sexual activity
• migratory joint pain
• tenosynovitis
• pustules
• high WBC count in joint aspirate with positive gram stain / culture
osteoarthritis presentation
• risk factors: >50yo
• joint pain worsening with activity
• morning stiffness <30min
• crepitus with joint movement
• bony enlargement of affected joints (BUT no palpable warmth, bc not usually inflamed)
• x-ray: joint space narrowing, osteophyte formation, subchondral sclerosis
meralgia paresthetica presentation
• numbness and burning sensation on lateral thigh (especially after standing for long periods or wearing tight clothes)
• due to compression of lateral cutaneous nerve
referred pain from hip osteoarthritis presentation
• unilateral chronic pain in knee, worsening with activity
• limited hip range of motion, especially in internal rotation
L5 radiculopathy presentation
• lower back pain and numbness radiating to unilateral lateral thigh + anterior shin + dorsal foot
• poor foot dorsiflexion and big toe extension
• positive straight leg test
• inability to extort/abduct hip
S1 radiculopathy presentation
• lower back pain and numbness radiating to unilateral posterior leg, sole and lateral edge of foot
• poor plantar flexion of foot and diminished Achilles tendon reflex
• positive straight leg test
common peroneal (fibular) nerve palsy presentation
• foot drop, weakness in foot eversion
• sensory deficits in dorsum of foot and lateral shin
• STILL CAN extort and abduct hip (unlike L5 radiculopathy)
• caused by prolonged squatting and pressure on lateral aspect of knee
poliomyelitis presentation
• risk factors: no polio vaccine, childhood onset
• asymmetric flaccid paralysis with no sensory loss
• constitutional symptoms
• no deep tendon reflexes
myasthenia gravis presentation
• fatiguable muscle weakness
• bilateral ptosis
• diplopia
• difficulty speaking
• no sensory deficits, normal reflexes
• test with acetylcholine receptor antibody test (pyridostigmine)
peripheral neuropathy presentation
• symmetric sensory loss in glove and stocking distribution
• diminished ankle reflex
• risk factor: diabetes mellitus
vitamin B12 deficiency presentation
• peripheral neuropathy with decreased deep tendon reflexes
• preserved muscle strength
• oral ulcers
• risk factors: total gastrectomy, tapeworms, malnutrition
femoral artery pseudoaneurysm presentation
• pain and swelling in groin area with a pulsatile mass (can hear a bruit)
• diminished foot pulse on swelling side
• usually due to cardiac catheterization causing blood to leak out of puncture site and form a sac
trochanteric bursitis presentation
• lateral hip pain over greater trochanter with gradual onset
• pain worsens when lying on affected side, rising from seated position, crossing legs
• risk factor: middle age
• diagnose with positive Trendelenburg test
hallux valgus presentation
• bony prominence and pain at 1st MTPJ
• lateral deviation of toe
• exacerbated pain and swelling by tight footwear
Duchenne Muscular Dystrophy presentation
• onset in early childhood
• risk factors: male (X-linked recessive genetic disease), family history
• progressive muscle weakness (Gower’s sign, waddling gait, calf muscle pseudohypertrophy, Trendelenburg positive on both sides of hip)
• due to nonsense/frameshift mutation causing a lack of dystrophin protein
myotonic dystrophy presentation
• progressive muscle weakness bilaterally (especially in face)
• myotonia (fine motor difficulties)
• systemic symptoms (sleep disturbances, frontal balding, cataracts, bilateral ptosis)
• risk factor: family history (genetic mutations in C19 DMPK gene and/or C3 CNBP gene) - diagnostic
