Lower limb soft tissue injury Flashcards
What are Achilles tendon disorders?
Achilles tendon disorders are the most common cause of posterior heel pain. Possible presentations include tendinopathy (tendinitis), partial tear, and complete rupture of the Achilles tendon.
What are the risk factors for Achilles tendon disorders?
Risk factors include quinolone use (e.g. ciprofloxacin) and hypercholesterolaemia, which predisposes to tendon xanthomata.
What are the features of Achilles tendinopathy (tendinitis)?
Features include gradual onset of posterior heel pain that worsens following activity, and common morning pain and stiffness.
What is the management for Achilles tendinopathy?
Management is typically supportive, including simple analgesia, reduction in precipitating activities, and calf muscle eccentric exercises.
What symptoms suggest an Achilles tendon rupture?
Symptoms include an audible ‘pop’ in the ankle, sudden onset significant pain in the calf or ankle, and inability to walk or continue the sport.
What is Simmond’s triad used for?
Simmond’s triad is used to help exclude Achilles tendon rupture by examining the angle of declination, feeling for a gap in the tendon, and assessing calf muscle response.
What is the initial imaging modality of choice for suspected Achilles tendon rupture?
Ultrasound is the initial imaging modality of choice for suspected Achilles tendon rupture.
What should be done following a suspected Achilles tendon rupture?
An acute referral should be made to an orthopaedic specialist following a suspected rupture.
What are the bony components of the ankle joint?
The bony components include the distal tibia, fibula, and the superior aspect of the talus.
What is the configuration of the ankle joint?
The configuration forms a mortise, with the body of the talus acting as the tenon.
What ligaments secure the distal tibia and fibula together?
The syndesmosis binds them together, composed of the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament (PITFL), interosseous ligament (IOL), and the interosseous membrane.
What ligaments secure the distal fibula to the talus and calcaneus?
The anterior and posterior talofibular ligaments (ATFL and PTFL) secure the distal fibula to the talus, and the calcaneofibular ligament secures it to the calcaneus.
What ligament secures the distal tibia to the talus?
The deltoid ligament secures the distal tibia to the talus.
What is a sprain?
A sprain is a stretching, partial, or complete tear of a ligament.
What are the two types of ankle sprains?
High ankle sprains involving the syndesmosis and low ankle sprains involving the lateral collateral ligaments.
What is the most common type of ankle sprain?
Low ankle sprains are the most common, accounting for over 90% of cases.
What is the most common mechanism of low ankle sprains?
The most common mechanism is an inversion injury.
What are the classifications of low ankle sprains?
They are classified into Grade I (mild), Grade II (moderate), and Grade III (severe).
What is the treatment protocol for low ankle sprains?
The treatment includes rest, ice, compression, and elevation (RICE protocol).
What should be done if symptoms of a low ankle sprain fail to settle?
An MRI and surgical intervention may be contemplated if symptoms fail to settle or there is significant joint instability.
What is the presentation of high ankle sprains?
High ankle sprains are rare (about 0.5%) and often involve severe pain when weight-bearing.
What is the mechanism of injury for high ankle sprains?
The mechanism is usually external rotation of the foot, causing the talus to push the fibula laterally.
What test is used to assess high ankle sprains?
The Hopkin’s squeeze test assesses pain when the tibia and fibula are squeezed together at the mid-calf.
What should be done if there is diastasis in a high ankle sprain?
Operative fixation is usually warranted if diastasis or failed non-operative management occurs.
What is a Maisonneuve fracture?
A Maisonneuve fracture is a fracture of the proximal fibula that can be associated with isolated injuries to the deltoid ligament.
What is iliotibial band syndrome?
Iliotibial band syndrome is a common cause of lateral knee pain in runners, occurring in around 1 in 10 people who run regularly.
What is a key feature of iliotibial band syndrome?
Tenderness 2-3cm above the lateral joint line.
What is the management for iliotibial band syndrome?
Activity modification and iliotibial band stretches.
What should be done if iliotibial band syndrome is not improving?
Physiotherapy referral.
What is the most commonly injured knee ligament?
The anterior cruciate ligament (ACL).
What are common mechanisms of ACL injury?
Common mechanisms include a lateral blow to the knee and skiing, although non-contact injuries are the most common overall (e.g. sudden twisting or awkward landing).
What are the features of an ACL injury?
Features include sudden ‘popping’ sound, knee swelling, and instability, feeling that the knee will give way.
What is the anterior draw test?
The patient lies supine with the knee at 90 degrees. The examiner places one hand behind the tibia and the other grasping the patient’s thigh, with the thumb on the tibial tuberosity. The tibia is pulled forward to assess anterior motion.
What does an intact ACL do during the anterior draw test?
An intact ACL should prevent forward translational movement.
What is Lachman’s test?
A variant of the anterior draw test, performed with the knee at 20-30 degrees to evaluate anterior translation of the tibia in relation to the femur.
How does Lachman’s test compare to the anterior draw test?
Lachman’s test is considered more reliable than the anterior draw test.
What typically causes a tear?
Typically result from twisting injuries.
What is a feature of a knee tear?
Pain worse on straightening the knee.
What may happen to the knee in case of a tear?
The knee may ‘give way’.
What can displaced meniscal tears cause?
Displaced meniscal tears may cause knee locking.
Where is tenderness felt in a knee tear?
Tenderness along the joint line.
What is Thessaly’s test?
Weight bearing at 20 degrees of knee flexion, patient supported by doctor, positive if pain on twisting knee.
What is Chondromalacia patellae?
Softening of the cartilage of the patella.
Common in teenage girls; characteristically causes anterior knee pain on walking up and down stairs and rising from prolonged sitting; usually responds to physiotherapy.
What is Osgood-Schlatter disease?
Also known as tibial apophysitis, it is seen in sporty teenagers.
Characterized by pain, tenderness, and swelling over the tibial tubercle.
What are the symptoms of Osteochondritis dissecans?
Pain after exercise, intermittent swelling, and locking.
What is Patellar subluxation?
Medial knee pain due to lateral subluxation of the patella.
The knee may give way.
What is Patellar tendonitis?
More common in athletic teenage boys, it causes chronic anterior knee pain that worsens after running.
Tenderness is noted below the patella on examination.
What is referred pain in relation to knee problems?
Referred pain may come from hip problems such as slipped upper femoral epiphysis.
What is plantar fasciitis?
Plantar fasciitis is the most common cause of heel pain seen in adults.
Where is the pain usually worse in plantar fasciitis?
The pain is usually worse around the medial calcaneal tuberosity.
What is one management strategy for plantar fasciitis?
Rest the feet where possible.
What type of shoes should be worn for plantar fasciitis?
Wear shoes with good arch support and cushioned heels.
What aids may be helpful for plantar fasciitis?
Insoles and heel pads may be helpful.
