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Y2 MSK > Week 4 > Flashcards

Week 4 Flashcards

1
Q

What type of joint does the sacroiliac joint have

A

Fibrous and Synovial: fibrous capsule filled with synovial fluid

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2
Q

What movements can the sacroiliac joint perform

A

Not much movement because it is fibrous

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3
Q

What is the function of pubic symphysis

A
  1. Absorbs some upper body weight before it travels to the lower body
  2. Separates the pelvic bone for vaginal birth
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4
Q

What is the acetabulum

A

Where the head of femur inserts into = socket of the ball and socket joint

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5
Q

What type of joint does the hip joint have

A

ball and socket joint

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6
Q

What types of movements can the hip joint perform

A

Flexion, extension
abduction, adduction
lateral and medial rotation
Circumduction

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7
Q

What is a comminuted fracture

A

The bone is broken into more than 2 pieces

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8
Q

What are the 3 components that stabilize the joints

A

Congruency
Muscle tone
Ligaments

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9
Q

What does congruency of the joint mean

A

How well the bones in a joint fit into each other

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10
Q

What are the ligaments in hip joint

A

iliofemoral
pubofemoral
ischiofemoral (seen at posterior view)

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11
Q

What is a acetabular labrum

A

fibrocartilaginous rim along the acetabulum

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12
Q

What would the leg appearance be if there was a posterior hip dislocation

A

Internally rotated
Adducted
Shortened

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13
Q

What type of hip dislocation is the most common

A

Posterior hip dislocation

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14
Q

Why is posterior hip dislocation most common

A

Because the iliofemoral ligament is the strongest which prevents hyperextension of the hip hence anterior dislocation

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15
Q

What would the leg appearance be if there was an anterior hip dislocation

A

Externally rotated
abducted

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16
Q

Origin of sciatic nerve

A

L4-S3, sacral plexus

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17
Q

Where is the sciatic nerve located at

A

Runs inferiorly to piriformis and posterior to the acetabulum

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18
Q

From which foramen did the sciatic nerve leave from to exit the pelvis

A

Greater sciatic foramen

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19
Q

Which branch of the sciatic nerve is the most commonly damaged and why

A

Common fibular nerve (peroneal nerve) because it runs more laterally than tibial nerve

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20
Q

What is the consequence if the common fibular nerve is damaged

A

Foot drop - inability to lift front of the feet because of muscle paralysis caused by neurological damage

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21
Q

What is Trendelenburg’s gait

A

Dropping of the contralateral hip when standing on one leg

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22
Q

What causes the Trendelenburg’s gait

A

Weakness/paralysis of gluteus medius and or gluteus minimus

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23
Q

In Trendelenburg’s gait, if the hip dips on the right, which side has the affected muscles

A

Left

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24
Q

Which nerve innervates the gluteus medius and minimus muscles

A

Superior gluteal nerve

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25
Q

Origin of the superior gluteal nerve

A

L4 - S1

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26
Q

Location of the superior gluteal nerve

A

runs superiorly to the piriformis and passes between the gluteus medius and minimus muscles

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27
Q

From which foramen in the pelvis did the superior gluteal nerve exit from

A

Greater sciatic foramen

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28
Q

What arteries supply the head of femur

A

Medial and lateral circumflex arteries
Retinacular arteries

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29
Q

The medial and lateral circumflex arteries are branches of

A

Deep femoral artery

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30
Q

Which part of the femur is the weakest

A

Neck

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31
Q

What can muscle contractions do to femoral shaft fractures

A

Dislocate the fractured parts, potentially damaging surrounding arteries and nerves

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32
Q

What are the menisci

A

Cartilage at the knee joint that acts as shock absorbers between the tibia and femur

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33
Q

What are the ligaments at the middle of the knee joint

A

Anterior / Posterior Cruciate ligaments

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34
Q

What are the ligaments at the sides of the knee joint

A

Medial / Lateral collateral ligaments

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35
Q

Describe the load bearing axis in normal knee joints

A

In normal knee joints, there is a load bearing axis down the middle of the leg
Prevents stress on either side of leg

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36
Q

What is a varus knee

A

When the knees don’t touch each other even if feet are together

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37
Q

What causes varus knee

A

The load-bearing axis shifted to the medial side, increasing stress on the medial compartments of the knee and damage cartilage and medial meniscus

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38
Q

What is a valgus knee

A

When the knees are touching each other while feet are apart

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39
Q

What causes valgus knee

A

The load-bearing axis shifted to the lateral side, increasing stress on the lateral compartment of the knee and damage cartilage and lateral meniscus

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40
Q

Valgus and Varus knee can increase the risk of

A

Osteoarthritis

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41
Q

What is the drawer test for

A

To examine the function of anterior and posterior cruciate ligaments

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42
Q

Describe the drawer test

A

Ask the patient to flex their knee
Sit on patient’s feet to stabilize the leg
Grasp the leg and move it anteriorly / posteriorly
Observe any pain/asymmetrical movements/dysfunction

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43
Q

What are the ligaments around the inner ankle

A

Deltoid ligaments
- anterior tibiotalar ligament
- tibionavicular ligament
- tibiocalcaneal ligament
- posterior tibiotalar ligament

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44
Q

What are the ligaments around the outer ankle

A

anterior talofibular ligament
posterior talofibular ligament
calcaneofibular ligament

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45
Q

Which ligament is the most commonly damaged when you sprain your ankle

A

Anterior talofibular ligament

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46
Q

What is a Maisonneuve fracture

A

Fracture of proximal fibula and tear of anterior tibiofibular ligament at distal tibia and fibula
Can be associated with fracture at medial malleolus

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47
Q

Tibiofibular ligament is an example of syndesmosis. What is a syndesmosis

A

Fibrous joint between 2 bones connected by ligaments

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48
Q

What nerves innervate the dorsal surface of the foot

A

Mostly superficial branch of common fibular nerve (superficial peroneal nerve)
Sural nerve
Deep branch of common fibular nerve (deep peroneal nerve)
Saphenous nerve

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49
Q

What nerves innervate the plantar surface of the foot

A

Medial plantar nerve
Lateral plantar nerve
Saphenous nerve
Sural nerve
Calcaneal branch of tibial nerve

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50
Q

What is Simmond’s test used for and what is a positive result

A

To test for achilles tendon rupture; positive = ruptured

Positive result = No foot plantarflexion while calf compression

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51
Q

\what is anterior drawer test for ankle used for

A

To see if there is any damage to anterior talofibular ligament

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52
Q

How do you perform anterior drawer test for the ankle

A
  1. Patient is supine, with their feet hanging off the bed
  2. Foot is flexed, hold the heel
  3. Put pressure on the leg to stabilize it then move the heel upwards
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53
Q

What is the talar tilt test used for

A

To see if there is any damage to calcaneofibular ligament

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54
Q

How do you perform talar tilt

A
  1. Patient is seated with foot and ankle unsupported
  2. Foot is flexed
  3. Hold the leg to stabilize it then use the other hand to invert the foot
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55
Q

\what is the grind test used for

A

To test the metatarsophalangeal joints in the foot (can be used in thumb too)

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56
Q

Which ankle disorder will cause pain in grind test

A

hallux rigidus

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57
Q

What is hallux valgus

A

A progressive foot disorder affecting the 1st MTP, causing the MTP to be deviated and the 1st metatarsal to be abducted

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58
Q

What may form in hallux valgus overtime

A

bunion - a bony prominence on the medial side

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59
Q

What is the main risk factor for hallux valgus

A

Genetic predisposition; 70% of the patients have family history of hallux valgus

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60
Q

What are the risk factors for hallux valgus

A

Wearing high heels
Narrow toe box of shoe
Genetic predisposition
Pes planus
Cerebral palsy 2nd toe amputation

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61
Q

What can happen if hallux valgus is left untreated for a long time

A

Pain / discomfort / abnormal gait / soreness

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62
Q

What can hallux valgus cause if left untreated

A

Osteoarthritis
Tightness of gastrocnemius muscles
Defunctioned 1st ray

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63
Q

What is 1st ray

A

1st metatarsal bone + 1st cuneiform

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64
Q

Management of hallux valgus

A

Wear soft, wide toe box shoes
Analgesia
bunion pads / toe spacers / orthotics
Osteotomies if non-surgical options are not working or tolerated

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65
Q

What is osteotomy

A

Surgery that removes a part of a bone to realign the bones

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66
Q

What are the lesser toe deformities

A

Claw toes
Hammer toes
Mallet toes

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67
Q

What causes the lesser toe deformities and why do they cause lesser toe deformities

A

improper shoe wear
trauma
genetics
inflammatory arthritis
neuromuscular
metabolic diseases

These can cause lesser toe deformities due to imbalance of flexor and extensor muscles, tendons and ligaments that are supposed to hold the joint in place

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68
Q

What is hallux rigidus

A

Osteoarthritis of the 1st metatarsophalengeal in the first metatasal

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69
Q

Most common cause of hallux rigidus

A

Old age - wear and tear; overuse of the joint
Past trauma

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70
Q

Management of hallux rigidus

A

Analgesia
Orthotics
activity modification
Surgical - fusion / replacement

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71
Q

What is rheumatoid foot

A

Rheumatoid arthritis normally affects the joints of hands and toes first, causing inflammation of the synovium
As disease progresses, the ankle joint, midfoot, hindfoot, forefoot can be involved

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72
Q

What can happen if rheumatoid foot is left untreated for a long time

A

Lesser toe deformities
Flat foot
Calluses
Ulcers
Bunions

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73
Q

Difference between rheumatoid arthritis and osteoarthritis in clinical presentation

A

Rheumatoid arthritis - symmetrical , polyarticular
Osteoarthritis - asymmetrical, monoarticular

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74
Q

What is a sign of early ankle involvement in rheumatoid foot

A

difficulty in inclines and stairs

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75
Q

What is a sign of early hindfoot involvement in rheumatoid foot

A

difficulty in walking on uneven grounds such as grass

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76
Q

How does rheumatoid foot cause flat foot

A

As it damages the ligaments that support the medial arch hence the medial arch collapses

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77
Q

Which structures support the medial arch of the foot

A

Posterior tibial tendon
Plantar ligaments - long, short, calcaneonavicular
Plantar apopneurosis

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78
Q

What is pes planus

A

flat foot

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79
Q

What are the causes of pes planus

A

Congenital or acquired

80
Q

What are the acquired causes of pes planus

A

Arthritis
Tibialis posterior dysfunction
Trauma that causes rupture of ligaments / tendon
After a long period of inactivity due to injury / coma -> causes muscle weakness when you resume to walking

81
Q

What type of pes planus is normal during early childhood development and how does it present

A

Flexible pes planus
Flat feet on ground but arched when tip toeing

82
Q

Why does pes planus occur in babies / young children

A

ligamentous laxity
immature neuromuscular control
adipose tissue underneath the arch giving it a flat look

83
Q

What is the most common cause of adult-acquired flat foot

A

Tibialis posterior dysfunction

84
Q

When does tendon degeneration begin in tibialis posterior dysfunction

A

Years before clinical presentations

85
Q

Risk factors for tibialis posterior dysfunction

A

Females
young atheletes
elderly
Trauma
Diabetes
Obesity
Hypertension
Long term use of steroids

86
Q

What causes tibialis posterior dysfunction

A

repetitive microtrauma and tenosynovitis

87
Q

What can tibialis posterior dysfunction cause

A

Collapse of the arch of foot. Collapse of the arch can put more stress on surrounding ligaments and soft tissues

88
Q

Clinical signs of tibialis posterior dysfunction

A

Pain and swelling around medial malleolus
Pain worsened with activity
Unable to tip toe
Difficulty in walking on uneven surfaces/stairs
Abnormal wear of shoes
Pain may move to lateral aspect

89
Q

Why may pain in tibialis posterior dysfunction move from the medial aspect to the lateral aspect

A

In severe deformity, distal fibula becomes in contact with calcaneus

90
Q

What is the difference between stage 2 and 3 tibialis posterior dysfunction

A

Both includes flat foot deformity
But in stage II, the deformity is passively correctable whereas stage III is not

91
Q

What does stage III tibialis posterior dysfunction consist of

A

flat foot
hindfoot deformities
rigid forefoot

92
Q

What is a sign that can be seen in flat foot deformity

A

too many toes sign

93
Q

What is a positive too many toes sign

A

Look at the heel from the back of the patient
More toes can be seen

94
Q

What is a negative too many toes sign

A

when only the fifth and a bit of fourth toe can be seen from behind

95
Q

Examinations for TPD

A

Too many toes
Single and double leg heel raise
Plantarflexion and inversion of the foot against resistance

96
Q

management of TPD

A

Orthotic devices to support the arch / maintain foot shape
Surgery

97
Q

What is pes cavus

A

An abnormally high plantar arch

98
Q

What can pes cavus lead to

A

People putting too much stress and weight on the ball and heel of foot

99
Q

What are the deformities associated with pes cavus

A

Claw toes
hindfoot varus
forefoot adduction

100
Q

What is plantar fasciitis

A

Inflammation of the plantar fascia (aponeurosis)

101
Q

Causes of plantar fasciitis

A

excessive exercise
excessive weight
abnormal foot shape
arthropathies

102
Q

Symptoms of plantar fasciitis

A

Pain with first few steps after rest but subsides
Pain worse after exercise
Tenderness / swelling at plantar aspect of heel

103
Q

Management of plantar fasciitis

A

NSAID
Steroid injections
Rest
Orthotics
Night splints

104
Q

Management of plantar fasciitis

A

NSAID
Steroid injections
Rest
Orthotics
Night splints
Surgery - for acute onset / those that don’t respond to therapy

105
Q

What is Morton’s neuroma

A

Degenerative fibrosis of digital nerve near its bifurcation

106
Q

Symptoms of Morton’s neuroma

A

Pain in forefoot
Burning, tingling sensation in toes
numbness
Sensation of having pebbles/marbles under their forefoot while walking

107
Q

Do you need to remove Morton’s neuroma

A

Only if non-surgical treatments didn’t work or the symptoms recurred

108
Q

What is tendo-achilles tendinosis

A

degenerative process of the achilles tendon due to repetitive microtrauma and failure to repair it

109
Q

Symptoms of achilles tendinosis

A

pain behind the ankle
Pain eases with heat or walking
Morning stiffness

110
Q

Which foot disorders does not allow you to inject steroids

A

Achilles tendinosis
Tibialis posterior dysfunction

111
Q

Which is more common, primary or secondary bone cancer

A

Secondary (metastasised from another cancer

112
Q

Risk factors for bone cancer

A

Previous radiotherapy
Predisposing conditions
Genetics

113
Q

What are the predisposing conditions for bone cancer

A

Paget’s
Multiple Enchondromas
Fibrous dysplasia

114
Q

What is Paget’s disease and why is it a risk factor for bone cancer

A

Disorder that increases the rate of bone renewal.

It is a risk factor because it increases the rate of cell turnover meaning malignant mutations has a higher chance of occurring, causing malignancy

115
Q

What genetics are associated with bone cancer

A

p53 (Li Fraumeni syndrome)
RBI (retinoblastoma)

116
Q

Red flag symptoms that may indicate bone cancer

A

Persistent pain
Pain at night
Swelling over joint
Palpable mass
Pathological fractures

117
Q

What can tumours cause pathological fractures

A

Weakens the bone, causing the bone to fracture even due to a minor trauma

118
Q

What are the imaging tests for bone cancer

A

Xrays
CT
MRI
bone scan

119
Q

Why are xrays not always reliable

A

because it will only show when at least 50% of the bone is gone
so may not detect early stages

120
Q

Which type of bone cancer is the most common

A

Osteosarcoma

121
Q

Which age group is most commonly affected by osteosarcoma

A

Children and young adults

122
Q

Where does the osteosarcoma usually affect

A

Distal femur / proximal tibia (long bones)

123
Q

Which cells are affected by osteosarcoma

A

Mutation in Osteoblasts causing abnormal bone formation

124
Q

Difference between Ewing’s sarcoma and osteosarcoma

A

Malignant cells in Ewing’s sarcoma look different

Ewing’s sarcoma most likely occur in shafts of bones whereas osteosarcoma usually occurs in metaphysis

Ewing’s sarcoma is more likely to respond to radiation therapy

125
Q

What are the 4 most common bone cancers

A

osteosarcoma
Ewing’s sarcoma
chondrosarcoma
Osteoid Osteoma

126
Q

Which bones do ewing’s sarcoma most commonly affect

A

distal femur and proximal tibia

127
Q

What is chondrosarcoma

A

malignancy of chondrocytes; mutations in chondroblasts cause them to abnormally produce cartilage

128
Q

Which age group does chondrosarcoma usually affect

A

Older people; 40-75 years olds

129
Q

Which bones are most commonly affected by chondrosarcoma

A

pelvis
proximal femur
distal femur

130
Q

What is osteoid osteoma

A

a painful benign tumour on the long bones

131
Q

Which age group is most likely to be affected by osteoid osteoma

A

Young people 5-25 years old

132
Q

What does osteoid osteoma look like on xrays

A

o shaped; well demarcated central nodule with sclerotic rim (white on xrays)

133
Q

Symptoms of osteoid osteoma

A

Pain
Pain at night
Swelling
limping

134
Q

Can pain caused by osteoid osteoma be alleviated

A

ye pain can be alleviated the NSAIDs

135
Q

what is osteochondroma

A

Abnormal formation of bones and cartilage

136
Q

can osteochondroma develop into malignancy

A

yes but <1%

137
Q

What are enchondromas

A

Benign intramedullary cartilage lesion (inside the bone)

138
Q

Where do enchondromas usually affect

A

small bones of the hand

139
Q

can enchondroma develop into maligancy

A

rarely

140
Q

Which tumours are most likely to metastasize to bones (BLT with a Kosher Pickle)

A

Breast
Lungs
Thyroid
with a
Kidney
Prostate

141
Q

Sites that are most commonly affected y bone cancer

A

pelvis
ribs
vertebra
femurs
skull

142
Q

What is MIREL’s score for

A

to predict the likelihood of pathological fractures in patients with long bone metastasis

143
Q

What supplies the hyaline cartilage of joints

A

Synovial fluid
Subchondral bone

144
Q

What is the hyaline cartilage made of

A

proteoglycan
water
collagen

145
Q

Risk factors of knee OA

A

Old age
Obesity
Heavy physical workload
Sports
Genetics
ACL injury / meniscal tear / fractures
malalignment of the knee joint

146
Q

Name the 2 articulations of the knee joint

A

Tibiofemoral joints x2
Patellofemoral joint

147
Q

Describe the tibiofemoral articulations of the knee joint

A

Medial and lateral femoral condyles articulating with the medial and lateral tibial condyles, with menisci in between each

148
Q

Which articulation in the knee joint is usually affected first in osteoarthritis

A

Patellofemoral joint

149
Q

Pathology of osteoarthritis

A
  1. imbalance between wear and repair of articular cartilage leading to progressive loss; articular cartilage has poor healing potential
  2. increased pressure and rubbing on the bony surfaces
  3. inflammation
  4. subchondral bone sclerosis and hypertrophy
  5. the bone tries to remodel itself, causing formation of osteophytes
  6. microfractures on the subchondral bone causes synovial fluid to enter the bone and form cysts
  7. eventually, surrounding tissues, nerves and muscles can become inflamed
150
Q

Symptoms of knee osteoarthritis

A

Joint pain
Joint swelling
Joint stiffness in the morning, but resolves within 30 minutes
Joint pain worse with activity
Locked knee - unable to bend or straighten the knee

151
Q

Will every patient with knee OA have the same symptoms

A

No
Some people may have mild symptoms but advanced OA
Patients can have flare ups as well while feeling normal on other days

152
Q

Non surgical management of knee OA

A

NSAID
Weight loss
Low intensity activity
Physiotherapy

153
Q

What is given to treat flare ups of knee OA

A

steroid injections

154
Q

How many steroid injections can be given in a year for flare ups of knee OA and why

A

3 a year
too much can damage the knee and accelerate OA

155
Q

Total knee replacement surgery for OA is reserved for

A

Patients who are
- older
- medically fit
- with end stage OA
- frequent flare ups
- sleep disturbance
- severe pain affecting physical activities such as walking

156
Q

Cons of total knee replacement

A

doesn’t last forever
can get infected
not suitable for young patients
doesn’t improve stiffness
some patients still experience pain

157
Q

Why are knee replacement surgeries not indicated for young patients

A

Because the knee replacements do not last forever and with higher level of activity in young patients, it can loosen up more quickly
this means that a young patient will need revision surgeries in the future
Long term use of knee replacements can damage the patient’s own bones (scratches it)
High risk of complications in revision surgeries

158
Q

Function of the medial collateral ligament in knee joint

A

resists valgus stress

159
Q

Function of the lateral collateral ligament in knee joint

A

resists varus stress

160
Q

Function of the anterior cruciate ligament in knee joint

A

Prevents anterior subluxation of the tibia
Prevents internal rotation of the tibia during extension

161
Q

Function of the posterior cruciate ligament in knee joint

A

Prevents anterior subluxation of the femur
Prevents hyperextension of the knee

162
Q

When can ACL be torn

A

During exercises that require sudden change in directions

163
Q

Result of torn PCL

A

recurrent hyperextension of the knee

164
Q

Result of torn ACL

A

Difficulty in turning on the spot

165
Q

Why can’t the ACL and LCL repair itself when torn

A

Because it does not have a blood supply

166
Q

Why can the MCL and PCL repair itself when torn

A

Because it has a good blood supply

167
Q

Non surgical management of torn ACL

A

Rest
brace to protect the knee from instability
physiotherapy to strengthen surrounding ligaments for greater stability

168
Q

Surgical management of torn ACL

A

autograft
allograft

169
Q

Difference between autograft and allograft

A

Autograft - from patient’s own tissue whereas allograft is from another person

170
Q

What examination test can be done to identify torn ACL

A

Anterior drawer test
Lachman’s test

171
Q

Which knee ligament is the least commonly injured and doesn’t usually occur on its own

A

Lateral collateral ligament

172
Q

What examination can be done to test LCL function

A

Straight leg raise
Varus stress test

173
Q

Which direction does a high energy blow needs to be to damage LCL

A

Anteromedial
E.g. a person needs to tackle another person at their anteromedial part of their knee

174
Q

Which direction does a high energy blow needs to be to damage the PCL

A

Anterior tibia

175
Q

What happens if your PCL is torn

A

Recurrent hyperextension / feeling unstable when going down stairs

176
Q

Which ligament injury is often associated with meniscal tear

A

ACL

177
Q

Which type of meniscal tear is more common

A

medial meniscal tear

178
Q

How can meniscal tears occur

A

Sport injury
Getting up from squatting position
Degenerate tear

179
Q

Why do the menisci only have limited healing potential

A

Only peripheral 1/3 has blood supply

180
Q

What to do if the patient with meniscal tear has locked knee / the tear is irreparable by itself

A

Arthroscopic menisectomy

181
Q

What is a bucket handle tear

A

Full thickness tear of the meniscus, common in medial meniscus
Harder to treat

182
Q

What is a key symptom of a bucket handle tear

A

Locked knee

183
Q

What is degenerative meniscal tear

A

Spontaneous meniscal tear due to meniscus weakening with age

184
Q

What are the complications of knee dislocation

A

Popliteal artery injury
Nerve injury
Compartment syndrome

185
Q

Which nerve may be damaged by a knee dislocation

A

Common fibular nerve

186
Q

How does compartment syndrome occur

A

Swelling or bleeding occurs in a muscle compartment. Because the deep fascia cannot be stretched, it will cause an increase in pressure on the arteries, veins, nerves and muscles in the compartment. This causes damage to blood flow / nerve injury

187
Q

What is patellofemoral pain syndrome

A

Idiopathic adolescent anterior knee pain

188
Q

What causes patellofemoral pain syndrome

A

Muscle imbalance
Tightness of lateral tissues
Bony malalignment
Flat feet

189
Q

What is extensor mechanism rupture

A

Patellar tendon injuries and/or quad tendon injuries

190
Q

What examination can be used to test for extensor mechanism rupture

A

Straight leg raise

191
Q

What is osteochondritis dissecans

A

An area of the surface of the knee loses its blood supply so cartilage and bone can fragment off

192
Q

Which age group does osteochondritis dissecans most commonly affect

A

children / young adults

193
Q

Can fragmented pieces from osteochondritis dissecans heal itself

A

Yes, especially in developing children or young adults

194
Q

What can happen if there are loose bodies in a joint

A

The fragments can grow by getting nutrients from the synovial fluid and cause locking/catching of the joint

Stick to synovium or fat pad

195
Q

What is Baker’s cyst

A

Fluid filled sac located at the posterior of the knee joint

196
Q

What causes Baker’s cyst

A

Synovial fluid escaped through a communication (connection) to a bursa under the medial gastrocnemius or semimembranosis

197
Q

What conditions can cause Baker’s cyst in adults

A

OA
RA
meniscal tear

Y2 MSK (19 decks)

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