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Year 2 - MSK (Cortext notes) > Pathology in the Hip, Knee and Foot > Flashcards

Pathology in the Hip, Knee and Foot Flashcards

1
Q

Where does pain in the hip present? Where might it radiate to and why?

A

Presents with pain in the groin

This may radiate to the knee as the obturator nerve supplies both areas

May also present in buttock

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2
Q

What range of motion is usually first to be lost in hip pathology?

A

Internal rotation

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3
Q

Conditions that may require total hip replacement/hip arthroplasty

A

Primary OA

RA

Seronegative inflammatory arthropathies

Perthes

AVN

Dysplasia

SUFE

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4
Q

What is the Gold Standard form of hip replacement?

A

Cemented metal head/polyethylene cup

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5
Q

How long can a replacement hip be expected to last?

What may rarely happen to a replacement hip?

A

In low demand patients, replacements should last 15-20 years

In less than 5% of patients, loosening of the implant may develop, predominantly due to particles from the metal bearing being released and causing an inflammatory response

Macrophages ingest the particles, release inflammatory cytokines and recruit osteoclasts

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6
Q

What conditon is classically characterised by a “hanging rope” sign on Xray?

A

late sign of Avascular Necrosis - patchy sclerosis in the weight bearing area of the femoral head, lytic zone underneath formed by granulation tissue from attempted repair

(reminder, this can be caused by numerous conditons and so this Xray presentation may be seen in multiple conditions e.g. Perthes diseas)

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7
Q

Causes of AVN

A

Primary e.g. Perthes

Idiopathic

Secondary to alcohol/steroid abuse, hyperlipidaemia, thrombophilia

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8
Q

AVN - treatment

A

If caught pre-collapse, can drill holes in femoral neck and head to extravasate the area with blood and improve supply

Post-collapse - only treatment is THR

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9
Q

How is Trochanteric bursitis/Gluteal Cuff Syndrome caused?

A

Abductor muscles have a broad tendinous insertion on the greater trochanter that is constantly under a lot of strain, resulting in inflammation and tearing

Trochanteric bursa can also become inflamed in a manner similar to rotator cuff impingement

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10
Q

Where has the thickest hyaline cartilage in the body?

A

The retropatellar surface

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11
Q

What is the purpose of the fibrocartilagenous menisci in the tibiofemoral joint?

A

Ensure good communication between the concave condyles of the femur and the relatively flat tibial plateua

Essentially, they act as shock absorbers

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12
Q

What are the functions of the following 4 ligaments

  • Anterior cruciate
  • Posterior cruciate
  • Medial collateral
  • Lateral collateral
A

ACL - prevents abnormal internal rotation of the tibia

PCL - prevents hyperextension and anterior translocation of the tibia

MCL - resists valgus force

LCL - resists varus force and abnormal external rotation of the tibia

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13
Q

How does failure rate of total knee replacement compare to that of partial knee replacement?

A

Partial knee replacements have a worse outcome in the longer term, as unsurfaced joints can still show progression of OA etc.

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14
Q

What type of movement classically causes meniscal tears?

A

Twisting force on a loaded knee

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15
Q

Which is longer - the medial or lateral collateral ligament?

How does this affect injury rates?

A

The medial collateral ligament is longer and is also fixed, making it more prone to injury

The lateral collateral ligament is shorter and more mobile, so it is more resistant to injury

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16
Q

Which meniscus is more commonly damaged?

When does effusion in the knee develop?

A

The medial meniscus is more commonly damaged, and effusion develops the following day

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17
Q

How will a patient with a meniscal tear present?

What types of meniscal tear are there and which is the most important to watch out for?

A

Pain

Mechanical symptoms e.g. locking, clicking, possibly difficulty extending the knee (15 degree springy block - indicates Bucket Handle Tear)

May be unable to weight bear

Types of meniscal tear

  • Longitudinal -> bucket handle
  • Radial -> parrot beak
  • Horizontal -> flap tear
18
Q

What type of movement classically causes an ACL rupture?

A

Higher rotational force on a planted foot as the individual turns laterally

Reminder - the ACL’s function is to prevent abnormal internal rotation of the tibia

19
Q

What will a patient with an ACL rupture describe?

A

Hearing a “pop”

Haemarthrosis within an hour of the injury

Rotator instability, with their knee giving away whenever they turn on the planted foot

20
Q

How is a PCL rupture typically caused?

A

By a direct blow to the anterior surface of the tibia when the knee is fully extended, causing forced hyperextension

21
Q

If a patient has injured their knee, when is it best to examine them?

A

Wait for 2-7 days after the injury and examine the knee after the initial swelling has gone down

22
Q

Types of meniscal tear…

Longitudinal tears may progress to…

Radial tears may progress to…

Horizontal tears may progress to…

A

Longitudinal = Bucket Handle

Radial = Parrot Beak

Horizontal = Flap tear

23
Q

What clinical test can be used to distinguish between acute and degenerate meniscal tears?

A

Steinmann’s test - positive in acute, negative in degenerate

24
Q

Why is the healing potential of the mensici limited?

A

Because only the outer 1/3rd receives a blood supply

25
Q

What is the rule of thirds regarding ACL rupture?

A

ACL ruptures have a highly variable prognosis…

1/3 will be fine and can carry on with their normal lives

1/3 will have to limit certain activities, but can manage

1/3 will have prolonged instability and their knee will give away during everyday tasks

26
Q

How is ACL rupture treated surgically?

A

Primary repair of the tendon is not effective

ACL reconstruction using a tendon graft is the most effective treatment

27
Q

In an ACL tendon graft, where can tendons be harvested from?

A

Semitendonosus/gracillis tendons

Patellar (higher amount of co-morbidity)

28
Q

Patellofemoral dysfunction describes anterior knee pain that is made worse when going (uphill/downhill)

A

Pain is worse going downhill

29
Q

LCL tears/ruptures are caused by hyperextension and excessive varus force.

What nerve may also be injured?

A

The common fibular nerve

30
Q

Damage to the LCL is rare and if it occurs it is usually as a result of multi-ligamentous damage/dislocation

Which artery is also at risk if this is the nature of the injury?

A

The popliteal artery

31
Q

Combined knee ligament injury and dislocations are (common/rare)

What are they associated with?

A

Rare - require at least 3/4 of the ligaments of the knee to be ruptured

High tendency of neurovascular damage (fibular nerve, popliteal artery etc.)

32
Q

What clinical test can be done to assess the extensor function of the knee?

A

Straight Leg Raise

33
Q

Why should steroid injections into the knee be avoided?

A

Risk of tendon rupture

34
Q

What is hallux rigidis?

What is the gold standard of treatment? What’s the downside

A

OA of the first MTP joint

Stiff-soled shoes to prevent MTPJ motio, cheilectomy to remove impinging osteophytes

Gold standard of surgery is arthrodesis - fusion of bones should remove pain with little/no loss of function

Downside of fusion is that patient will no longer be able to wear high heels

35
Q

What is Mulder’s Click test used to diagnose?

A

A Morton’s neuroma

compression of the MTP joints either elicits pain in the foot or gives a characteristic “click”

36
Q

What medication causes inflammation of tendons?

What can this result in?

What should not be done to treat Achilles tendonitis

A

Quinolones e.g. ciprofloxacin can cause tendonitis

Tendonitis can then lead to tendon rupture

DON’T give a steroid injection around the Achilles tendon as this may cause rupture

37
Q

What is Simmond’s test?

What does it test for?

A

Simmond’s test is squeezing of the calf muscle to elicit movement of the foot

If the Achilles tendon has been ruptured, Simmond’s test will be negative

38
Q

How is a ruptured Achilles tendon treated?

A

Surgical repair and cast for 8 weeks

OR

Non-surgical management, still casting the foot for 8 weeks but in an equinus position

39
Q

What is pes planus more commonly known as?

A

Flat foot

40
Q

What tendon inserts predominantly into the medial navicular and supports the medial arch of the foot?

How does pathology arise here?

A

The Tibialis Posterior Tendon

Repeated strain causes inflammation, elongation and potentially rupture

41
Q

What is pes cavus?

A

Abnormally high arched foot

Year 2 - MSK (Cortext notes) (26 decks)

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