Pelvis and LL

Question 1

Hip parthology that can present purely with knee pain

Answer 1

SUFE

Question 2

Loosening of hip prosthesis is due to

Answer 2

Wear particles = inflammatory response = resorption

Question 3

Pseudotumour

Answer 3

Due to metal on metal implant = bone and muscle necrosis

Question 4

Early local complications of THR

Answer 4

Infection
Dislocation
Nerve injury (sciatic)
Leg length discrepancy

Question 5

Early general complications of THR

Answer 5

MI, chest infection, UTI, blood loss

PE, DVT

Question 6

Late local complications of THR

Answer 6

Loosening
Infection
Dislocation

Question 7

MRI findings in AVN

Answer 7

Patchy sclerosis of weight bearing areas

Lytic zones with granulation tissue = hanging rope sign

Question 8

Symptoms/signs of trochanteric bursitis

Treatment

Answer 8

Pain on resisted abduction

Steroids, NSAIDs, physio, analgesia

Question 9

Area with thickest cartilage

Answer 9

Posterior patella

Question 10

ACL prevents:

Answer 10

abnormal internal rotation of tibia

Question 11

PCL prevents:

Answer 11

anterior translation of femur

hyperextension

Question 12

LCL prevents:

Answer 12

Varus

external rotation of tibia

Question 13

MCL prevents:

Answer 13

Valgus

Question 14

When is UKR (unicompartmental) used?

Answer 14

Younger patients

Isolated OA of one compartment

Question 15

Meniscal injuries occur with _______ force

Symptoms

Answer 15

Twisting

Effusion next day, localised pain to joint line (Steinmans), locking (15 degrees), fixed flexion

Question 16

Pseudolocking

Answer 16

Stiffness in arthritis

Question 17

ACL ruptures occur with _________ injury

Symptoms

Answer 17

High rotational force on planted foot
Pop, haemarthrosis within an hour, deep pain, rotatory instability/giving way
Lachmans

Question 18

Which are more common medial or lateral meniscal tear?

Answer 18

Medial (less mobile than lateral meniscus)

Question 19

Blood supply to meniscus

Answer 19

Outer 1/3 = limited healing potential

Question 20

When do you repair a meniscus?

Answer 20

Young
Outer 1/3
Otherwise: steroids, meniscectomy

Question 21

Treatment of ACL tear

Answer 21

Self limiting
Physio
Reconstruction (may take up to 1 year to get back to high impact sports)

Question 22

Treatment of MCL tear

Answer 22

Brace, self limiting
MCL tightening
Reconstruction

Question 23

Treatment of PCL tear

Answer 23

Rare to rupture on its own

Reconstruction if other ligametns damaged

Question 24

LCL tear symptoms

Answer 24

Rotational instability
Hyperextension and varus
Common peroneal nerve injury, popliteal artery injury

Question 25

Risk factors for extensor mechanism rupture

Answer 25

RA, steroids, diabetes, CKD, tendonitis, ciprofloxacin, fall/weight lifting

Question 26

Avoid what in extensor mechanism rupture?

Answer 26

Steroid injection

Question 27

Predisposing factors for patellofemoral dysfunction

Answer 27

Females
Hypermobility
Genu valgum
Femoral neck anteversion

Question 28

Symptoms of patellofemoral dysfunction

Answer 28

Anterior knee pain worse downhill
Grinding/clicking
Stiffness = pseudolocking

Question 29

Treatment of patellofemoral dysfunction

Answer 29

Physio (strength vastus medialis obliquus)
Taping
Surgery

Question 30

Patellar discloation symptoms

Answer 30

Blow to knee
Lateral
Medial patellofemoral ligament tears
Lipohaemarthrosis
Laxity/female/valgum/femoral anteversion

Question 31

Who gets ankle replacement?

Answer 31

Elderly (once it fails need fusion)

Question 32

Hallux valgus

Answer 32

Medial deviation of 1st metatarsal
Lateral deviation of toe
Bunion, pain, ulceration
Females/RA/shoes/age/FH

Question 33

Treatment of hallux valgus

Answer 33

Wider shoes

Osteotomy

Question 34

Hallux rigidus

Answer 34

1st MTP OA

Question 35

Treatment of hallux rigidus

Answer 35

Stiff soled shoes
Remove osteophytes
Arthrodesis (stops wearing high heels)

Question 36

Morton’s neuroma

Answer 36

Plantar interdigital nerves subject to trauma
Inflamed swollen nerve (neuroma)
Burning, tingling, loss of sensation web space
Third interspace nerve most common
High heels cause

Question 37

Treatment of Morton’s neuroma

Answer 37

Mulder’s click test and US
Insole, metatarsal pad
Steroid or LA injection
Excision

Question 38

Metatarsal stress fracture

Answer 38

2nd metatarsal most common

Runners, soldiers, dancers

Question 39

Diagnosis and treatment of metatarsal stress fracture

Answer 39

xrays don’t show for 3 weeks until callus forms
bone scan
Bed rest 6-12 weeks, rigid soled boot

Question 40

Achilles tendonitis

Answer 40

Repetitive strain, microtears
Predisposes to rupture
Pain, difficulty weight bearing, shot in back of leg, palpable gap
Middle aged/older

Question 41

Treatment of achilles tendonitis

Answer 41

Rest, physio
Heel raise, boot
Decompression, resection
NO steroids
Repair, cast

Question 42

Test for achilles rupture

Answer 42

Simmond’s test, squeeze calf

Question 43

Plantar fasciitis

Answer 43

Repetitive stress/degeneration
Pain with walking on instep (origin of plantar aponeurosis), localised tenderness
Diabetes, obesity, walking on hard floors

Question 44

Treatment for plantar fasciiits

Answer 44

Rest, physio
Steroid injection
Gel heel pad
can take up to 2 years

Question 45

Pes planus

Answer 45

Flat foot - medial arch doesn’t develop, FH

Increased risk of tendonitis

Question 46

Insertion and function of TP

Answer 46

Inserts onto medial navicular, supports medial arch

Plantarflexion, inversion

Question 47

TP dysfunction

Answer 47

Repetitive strain = tendonitis, elongation, rupture. Pes planus
Splint, medial arch support
Decompression, tendon transfer

Question 48

Pes cavus

Answer 48

High arch (idiopathic or neuromuscular - spina bifida oculta)
Claw toes
Pain = soft tissue release, tendon transfer

Question 49

Claw and hammer toes

Answer 49

Due to imbalance of flexors and extensors
Claw: hyperextension at MTP, hyperflexion at PIP and DIP
Hammer: hyperextension at MTP and DIP, hyperflexion at PIP
Pain, corns, ulcers = tendon transfer/amputation