Week 4 Flashcards
1
Q
What type of joint does the sacroiliac joint have
A
Fibrous and Synovial: fibrous capsule filled with synovial fluid
2
Q
What movements can the sacroiliac joint perform
A
Not much movement because it is fibrous
3
Q
What is the function of pubic symphysis
A
- Absorbs some upper body weight before it travels to the lower body
- Separates the pelvic bone for vaginal birth
4
Q
What is the acetabulum
A
Where the head of femur inserts into = socket of the ball and socket joint
5
Q
What type of joint does the hip joint have
A
ball and socket joint
6
Q
What types of movements can the hip joint perform
A
Flexion, extension
abduction, adduction
lateral and medial rotation
Circumduction
7
Q
What is a comminuted fracture
A
The bone is broken into more than 2 pieces
8
Q
What are the 3 components that stabilize the joints
A
Congruency
Muscle tone
Ligaments
9
Q
What does congruency of the joint mean
A
How well the bones in a joint fit into each other
10
Q
What are the ligaments in hip joint
A
iliofemoral
pubofemoral
ischiofemoral (seen at posterior view)
11
Q
What is a acetabular labrum
A
fibrocartilaginous rim along the acetabulum
12
Q
What would the leg appearance be if there was a posterior hip dislocation
A
Internally rotated
Adducted
Shortened
13
Q
What type of hip dislocation is the most common
A
Posterior hip dislocation
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
15
Q
What would the leg appearance be if there was an anterior hip dislocation
A
Externally rotated
abducted
16
Q
Origin of sciatic nerve
A
L4-S3, sacral plexus
17
Q
Where is the sciatic nerve located at
A
Runs inferiorly to piriformis and posterior to the acetabulum
18
Q
From which foramen did the sciatic nerve leave from to exit the pelvis
A
Greater sciatic foramen
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
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
21
Q
What is Trendelenburg’s gait
A
Dropping of the contralateral hip when standing on one leg
22
Q
What causes the Trendelenburg’s gait
A
Weakness/paralysis of gluteus medius and or gluteus minimus
23
Q
In Trendelenburg’s gait, if the hip dips on the right, which side has the affected muscles
A
Left
24
Q
Which nerve innervates the gluteus medius and minimus muscles
A
Superior gluteal nerve
25
Origin of the superior gluteal nerve
L4 - S1
26
Location of the superior gluteal nerve
runs superiorly to the piriformis and passes between the gluteus medius and minimus muscles
27
From which foramen in the pelvis did the superior gluteal nerve exit from
Greater sciatic foramen
28
What arteries supply the head of femur
Medial and lateral circumflex arteries
Retinacular arteries
29
The medial and lateral circumflex arteries are branches of
Deep femoral artery
30
Which part of the femur is the weakest
Neck
31
What can muscle contractions do to femoral shaft fractures
Dislocate the fractured parts, potentially damaging surrounding arteries and nerves
32
What are the menisci
Cartilage at the knee joint that acts as shock absorbers between the tibia and femur
33
What are the ligaments at the middle of the knee joint
Anterior / Posterior Cruciate ligaments
34
What are the ligaments at the sides of the knee joint
Medial / Lateral collateral ligaments
35
Describe the load bearing axis in normal knee joints
In normal knee joints, there is a load bearing axis down the middle of the leg
Prevents stress on either side of leg
36
What is a varus knee
When the knees don't touch each other even if feet are together
37
What causes varus knee
The load-bearing axis shifted to the medial side, increasing stress on the medial compartments of the knee and damage cartilage and medial meniscus
38
What is a valgus knee
When the knees are touching each other while feet are apart
39
What causes valgus knee
The load-bearing axis shifted to the lateral side, increasing stress on the lateral compartment of the knee and damage cartilage and lateral meniscus
40
Valgus and Varus knee can increase the risk of
Osteoarthritis
41
What is the drawer test for
To examine the function of anterior and posterior cruciate ligaments
42
Describe the drawer test
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
43
What are the ligaments around the inner ankle
Deltoid ligaments
- anterior tibiotalar ligament
- tibionavicular ligament
- tibiocalcaneal ligament
- posterior tibiotalar ligament
44
What are the ligaments around the outer ankle
anterior talofibular ligament
posterior talofibular ligament
calcaneofibular ligament
45
Which ligament is the most commonly damaged when you sprain your ankle
Anterior talofibular ligament
46
What is a Maisonneuve fracture
Fracture of proximal fibula and tear of anterior tibiofibular ligament at distal tibia and fibula
Can be associated with fracture at medial malleolus
47
Tibiofibular ligament is an example of syndesmosis. What is a syndesmosis
Fibrous joint between 2 bones connected by ligaments
48
What nerves innervate the dorsal surface of the foot
Mostly superficial branch of common fibular nerve (superficial peroneal nerve)
Sural nerve
Deep branch of common fibular nerve (deep peroneal nerve)
Saphenous nerve
49
What nerves innervate the plantar surface of the foot
Medial plantar nerve
Lateral plantar nerve
Saphenous nerve
Sural nerve
Calcaneal branch of tibial nerve
50
What is Simmond's test used for and what is a positive result
To test for achilles tendon rupture; positive = ruptured
Positive result = No foot plantarflexion while calf compression
51
\what is anterior drawer test for ankle used for
To see if there is any damage to anterior talofibular ligament
52
How do you perform anterior drawer test for the ankle
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
53
What is the talar tilt test used for
To see if there is any damage to calcaneofibular ligament
54
How do you perform talar tilt
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
55
\what is the grind test used for
To test the metatarsophalangeal joints in the foot (can be used in thumb too)
56
Which ankle disorder will cause pain in grind test
hallux rigidus
57
What is hallux valgus
A progressive foot disorder affecting the 1st MTP, causing the MTP to be deviated and the 1st metatarsal to be abducted
58
What may form in hallux valgus overtime
bunion - a bony prominence on the medial side
59
What is the main risk factor for hallux valgus
Genetic predisposition; 70% of the patients have family history of hallux valgus
60
What are the risk factors for hallux valgus
Wearing high heels
Narrow toe box of shoe
Genetic predisposition
Pes planus
Cerebral palsy 2nd toe amputation
61
What can happen if hallux valgus is left untreated for a long time
Pain / discomfort / abnormal gait / soreness
62
What can hallux valgus cause if left untreated
Osteoarthritis
Tightness of gastrocnemius muscles
Defunctioned 1st ray
63
What is 1st ray
1st metatarsal bone + 1st cuneiform
64
Management of hallux valgus
Wear soft, wide toe box shoes
Analgesia
bunion pads / toe spacers / orthotics
Osteotomies if non-surgical options are not working or tolerated
65
What is osteotomy
Surgery that removes a part of a bone to realign the bones
66
What are the lesser toe deformities
Claw toes
Hammer toes
Mallet toes
67
What causes the lesser toe deformities and why do they cause lesser toe deformities
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
68
What is hallux rigidus
Osteoarthritis of the 1st metatarsophalengeal in the first metatasal
69
Most common cause of hallux rigidus
Old age - wear and tear; overuse of the joint
Past trauma
70
Management of hallux rigidus
Analgesia
Orthotics
activity modification
Surgical - fusion / replacement
71
What is rheumatoid foot
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
72
What can happen if rheumatoid foot is left untreated for a long time
Lesser toe deformities
Flat foot
Calluses
Ulcers
Bunions
73
Difference between rheumatoid arthritis and osteoarthritis in clinical presentation
Rheumatoid arthritis - symmetrical , polyarticular
Osteoarthritis - asymmetrical, monoarticular
74
What is a sign of early ankle involvement in rheumatoid foot
difficulty in inclines and stairs
75
What is a sign of early hindfoot involvement in rheumatoid foot
difficulty in walking on uneven grounds such as grass
76
How does rheumatoid foot cause flat foot
As it damages the ligaments that support the medial arch hence the medial arch collapses
77
Which structures support the medial arch of the foot
Posterior tibial tendon
Plantar ligaments - long, short, calcaneonavicular
Plantar apopneurosis
78
What is pes planus
flat foot
79
What are the causes of pes planus
Congenital or acquired
80
What are the acquired causes of pes planus
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
What type of pes planus is normal during early childhood development and how does it present
Flexible pes planus
Flat feet on ground but arched when tip toeing
82
Why does pes planus occur in babies / young children
ligamentous laxity
immature neuromuscular control
adipose tissue underneath the arch giving it a flat look
83
What is the most common cause of adult-acquired flat foot
Tibialis posterior dysfunction
84
When does tendon degeneration begin in tibialis posterior dysfunction
Years before clinical presentations
85
Risk factors for tibialis posterior dysfunction
Females
young atheletes
elderly
Trauma
Diabetes
Obesity
Hypertension
Long term use of steroids
86
What causes tibialis posterior dysfunction
repetitive microtrauma and tenosynovitis
87
What can tibialis posterior dysfunction cause
Collapse of the arch of foot. Collapse of the arch can put more stress on surrounding ligaments and soft tissues
88
Clinical signs of tibialis posterior dysfunction
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
Why may pain in tibialis posterior dysfunction move from the medial aspect to the lateral aspect
In severe deformity, distal fibula becomes in contact with calcaneus
90
What is the difference between stage 2 and 3 tibialis posterior dysfunction
Both includes flat foot deformity
But in stage II, the deformity is passively correctable whereas stage III is not
91
What does stage III tibialis posterior dysfunction consist of
flat foot
hindfoot deformities
rigid forefoot
92
What is a sign that can be seen in flat foot deformity
too many toes sign
93
What is a positive too many toes sign
Look at the heel from the back of the patient
More toes can be seen
94
What is a negative too many toes sign
when only the fifth and a bit of fourth toe can be seen from behind
95
Examinations for TPD
Too many toes
Single and double leg heel raise
Plantarflexion and inversion of the foot against resistance
96
management of TPD
Orthotic devices to support the arch / maintain foot shape
Surgery
97
What is pes cavus
An abnormally high plantar arch
98
What can pes cavus lead to
People putting too much stress and weight on the ball and heel of foot
99
What are the deformities associated with pes cavus
Claw toes
hindfoot varus
forefoot adduction
100
What is plantar fasciitis
Inflammation of the plantar fascia (aponeurosis)
101
Causes of plantar fasciitis
excessive exercise
excessive weight
abnormal foot shape
arthropathies
102
Symptoms of plantar fasciitis
Pain with first few steps after rest but subsides
Pain worse after exercise
Tenderness / swelling at plantar aspect of heel
103
Management of plantar fasciitis
NSAID
Steroid injections
Rest
Orthotics
Night splints
104
Management of plantar fasciitis
NSAID
Steroid injections
Rest
Orthotics
Night splints
Surgery - for acute onset / those that don't respond to therapy
105
What is Morton's neuroma
Degenerative fibrosis of digital nerve near its bifurcation
106
Symptoms of Morton's neuroma
Pain in forefoot
Burning, tingling sensation in toes
numbness
Sensation of having pebbles/marbles under their forefoot while walking
107
Do you need to remove Morton's neuroma
Only if non-surgical treatments didn't work or the symptoms recurred
108
What is tendo-achilles tendinosis
degenerative process of the achilles tendon due to repetitive microtrauma and failure to repair it
109
Symptoms of achilles tendinosis
pain behind the ankle
Pain eases with heat or walking
Morning stiffness
110
Which foot disorders does not allow you to inject steroids
Achilles tendinosis
Tibialis posterior dysfunction
111
Which is more common, primary or secondary bone cancer
Secondary (metastasised from another cancer
112
Risk factors for bone cancer
Previous radiotherapy
Predisposing conditions
Genetics
113
What are the predisposing conditions for bone cancer
Paget's
Multiple Enchondromas
Fibrous dysplasia
114
What is Paget's disease and why is it a risk factor for bone cancer
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
What genetics are associated with bone cancer
p53 (Li Fraumeni syndrome)
RBI (retinoblastoma)
116
Red flag symptoms that may indicate bone cancer
Persistent pain
Pain at night
Swelling over joint
Palpable mass
Pathological fractures
117
What can tumours cause pathological fractures
Weakens the bone, causing the bone to fracture even due to a minor trauma
118
What are the imaging tests for bone cancer
Xrays
CT
MRI
bone scan
119
Why are xrays not always reliable
because it will only show when at least 50% of the bone is gone
so may not detect early stages
120
Which type of bone cancer is the most common
Osteosarcoma
121
Which age group is most commonly affected by osteosarcoma
Children and young adults
122
Where does the osteosarcoma usually affect
Distal femur / proximal tibia (long bones)
123
Which cells are affected by osteosarcoma
Mutation in Osteoblasts causing abnormal bone formation
124
Difference between Ewing's sarcoma and osteosarcoma
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
What are the 4 most common bone cancers
osteosarcoma
Ewing's sarcoma
chondrosarcoma
Osteoid Osteoma
126
Which bones do ewing's sarcoma most commonly affect
distal femur and proximal tibia
127
What is chondrosarcoma
malignancy of chondrocytes; mutations in chondroblasts cause them to abnormally produce cartilage
128
Which age group does chondrosarcoma usually affect
Older people; 40-75 years olds
129
Which bones are most commonly affected by chondrosarcoma
pelvis
proximal femur
distal femur
130
What is osteoid osteoma
a painful benign tumour on the long bones
131
Which age group is most likely to be affected by osteoid osteoma
Young people 5-25 years old
132
What does osteoid osteoma look like on xrays
o shaped; well demarcated central nodule with sclerotic rim (white on xrays)
133
Symptoms of osteoid osteoma
Pain
Pain at night
Swelling
limping
134
Can pain caused by osteoid osteoma be alleviated
ye pain can be alleviated the NSAIDs
135
what is osteochondroma
Abnormal formation of bones and cartilage
136
can osteochondroma develop into malignancy
yes but <1%
137
What are enchondromas
Benign intramedullary cartilage lesion (inside the bone)
138
Where do enchondromas usually affect
small bones of the hand
139
can enchondroma develop into maligancy
rarely
140
Which tumours are most likely to metastasize to bones (BLT with a Kosher Pickle)
Breast
Lungs
Thyroid
with a
Kidney
Prostate
141
Sites that are most commonly affected y bone cancer
pelvis
ribs
vertebra
femurs
skull
142
What is MIREL's score for
to predict the likelihood of pathological fractures in patients with long bone metastasis
143
What supplies the hyaline cartilage of joints
Synovial fluid
Subchondral bone
144
What is the hyaline cartilage made of
proteoglycan
water
collagen
145
Risk factors of knee OA
Old age
Obesity
Heavy physical workload
Sports
Genetics
ACL injury / meniscal tear / fractures
malalignment of the knee joint
146
Name the 2 articulations of the knee joint
Tibiofemoral joints x2
Patellofemoral joint
147
Describe the tibiofemoral articulations of the knee joint
Medial and lateral femoral condyles articulating with the medial and lateral tibial condyles, with menisci in between each
148
Which articulation in the knee joint is usually affected first in osteoarthritis
Patellofemoral joint
149
Pathology of osteoarthritis
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
Symptoms of knee osteoarthritis
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
Will every patient with knee OA have the same symptoms
No
Some people may have mild symptoms but advanced OA
Patients can have flare ups as well while feeling normal on other days
152
Non surgical management of knee OA
NSAID
Weight loss
Low intensity activity
Physiotherapy
153
What is given to treat flare ups of knee OA
steroid injections
154
How many steroid injections can be given in a year for flare ups of knee OA and why
3 a year
too much can damage the knee and accelerate OA
155
Total knee replacement surgery for OA is reserved for
Patients who are
- older
- medically fit
- with end stage OA
- frequent flare ups
- sleep disturbance
- severe pain affecting physical activities such as walking
156
Cons of total knee replacement
doesn't last forever
can get infected
not suitable for young patients
doesn't improve stiffness
some patients still experience pain
157
Why are knee replacement surgeries not indicated for young patients
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
Function of the medial collateral ligament in knee joint
resists valgus stress
159
Function of the lateral collateral ligament in knee joint
resists varus stress
160
Function of the anterior cruciate ligament in knee joint
Prevents anterior subluxation of the tibia
Prevents internal rotation of the tibia during extension
161
Function of the posterior cruciate ligament in knee joint
Prevents anterior subluxation of the femur
Prevents hyperextension of the knee
162
When can ACL be torn
During exercises that require sudden change in directions
163
Result of torn PCL
recurrent hyperextension of the knee
164
Result of torn ACL
Difficulty in turning on the spot
165
Why can't the ACL and LCL repair itself when torn
Because it does not have a blood supply
166
Why can the MCL and PCL repair itself when torn
Because it has a good blood supply
167
Non surgical management of torn ACL
Rest
brace to protect the knee from instability
physiotherapy to strengthen surrounding ligaments for greater stability
168
Surgical management of torn ACL
autograft
allograft
169
Difference between autograft and allograft
Autograft - from patient's own tissue whereas allograft is from another person
170
What examination test can be done to identify torn ACL
Anterior drawer test
Lachman's test
171
Which knee ligament is the least commonly injured and doesn't usually occur on its own
Lateral collateral ligament
172
What examination can be done to test LCL function
Straight leg raise
Varus stress test
173
Which direction does a high energy blow needs to be to damage LCL
Anteromedial
E.g. a person needs to tackle another person at their anteromedial part of their knee
174
Which direction does a high energy blow needs to be to damage the PCL
Anterior tibia
175
What happens if your PCL is torn
Recurrent hyperextension / feeling unstable when going down stairs
176
Which ligament injury is often associated with meniscal tear
ACL
177
Which type of meniscal tear is more common
medial meniscal tear
178
How can meniscal tears occur
Sport injury
Getting up from squatting position
Degenerate tear
179
Why do the menisci only have limited healing potential
Only peripheral 1/3 has blood supply
180
What to do if the patient with meniscal tear has locked knee / the tear is irreparable by itself
Arthroscopic menisectomy
181
What is a bucket handle tear
Full thickness tear of the meniscus, common in medial meniscus
Harder to treat
182
What is a key symptom of a bucket handle tear
Locked knee
183
What is degenerative meniscal tear
Spontaneous meniscal tear due to meniscus weakening with age
184
What are the complications of knee dislocation
Popliteal artery injury
Nerve injury
Compartment syndrome
185
Which nerve may be damaged by a knee dislocation
Common fibular nerve
186
How does compartment syndrome occur
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
What is patellofemoral pain syndrome
Idiopathic adolescent anterior knee pain
188
What causes patellofemoral pain syndrome
Muscle imbalance
Tightness of lateral tissues
Bony malalignment
Flat feet
189
What is extensor mechanism rupture
Patellar tendon injuries and/or quad tendon injuries
190
What examination can be used to test for extensor mechanism rupture
Straight leg raise
191
What is osteochondritis dissecans
An area of the surface of the knee loses its blood supply so cartilage and bone can fragment off
192
Which age group does osteochondritis dissecans most commonly affect
children / young adults
193
Can fragmented pieces from osteochondritis dissecans heal itself
Yes, especially in developing children or young adults
194
What can happen if there are loose bodies in a joint
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
What is Baker's cyst
Fluid filled sac located at the posterior of the knee joint
196
What causes Baker's cyst
Synovial fluid escaped through a communication (connection) to a bursa under the medial gastrocnemius or semimembranosis
197
What conditions can cause Baker's cyst in adults
OA
RA
meniscal tear
