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MSK Y2 > WK4 - lower limb orthopaedics > Flashcards

WK4 - lower limb orthopaedics Flashcards

1
Q

how are meniscal tears more likely to happen

A

Sporting injury in younger patients or getting up from a squatting position in younger patients. Can get atraumatic spontaneous degenerative tears in older patients

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2
Q

do ACL ruptures also have meniscal tears

A

50% of ACL ruptures have meniscal tears

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3
Q

what are clinical features of meniscal tears

A

pain and tenderness localised to joint line

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4
Q

is a medial or lateral meniscus tear more common

A

medial tear is 9-10 times more common than lateral meniscal tears

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5
Q

why do meniscal tears have limited healing potential

A
  • only peripheral 1/3 has blood supply

- radial tears won’t heal

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6
Q

how do you treat a meniscal tear in a younger patient

A

consider arthroscopic meniscal repair for acute traumatic peripheral meniscal tear in younger patient

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7
Q

how do you treat an irreparable tear with recurrent pain, effusion and mechanical symptoms which fails to settle

A

arthroscopic meniscectomy

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8
Q

how do you get an acute locked knee

A

displaced handle meniscal tear

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9
Q

what are features of acute locked knee

A
  • 15% springy block to extension
  • urgent surgery required to unlock knee
  • may be repairable if picked up early
  • if knee remains locked then may develop FFD
  • if irreparable needs partial meniscectomy to unlock knee and prevent further damage
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10
Q

what is a degenerate meniscal tear

A

meniscus weakens with age and can tear spontaneously

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11
Q

what ligament resists valgus stress

A

Medial cruciate ligament

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12
Q

which ligament resists varus stress

A

lateral cruciate ligament

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13
Q

what ligament resists anterior sublimation of the tibia and internal rotation of the tibia in extension

A

Anterior cruciate ligament

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14
Q

what ligament resists posterior sublimation of the tibia ie anterior sublimation of the femur and hyperextension of the knee

A

posterior cruciate ligament

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15
Q

what is a grade 1 knee ligament injury

A

tear some fibres but macroscopic structure in tact

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16
Q

what is a grade 2 knee ligament injury

A

partial tear - some fascicles disrupted

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17
Q

what is a grade 3 knee ligament injury

A

complete tear

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18
Q

MCL rupture may lead to

A

valgus instability

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19
Q

ACL rupture may lead to

A

rotatory instability

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20
Q

PCL rupture may lead to

A

recurrent hyperextension or instability descending stairs

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21
Q

how do you heal a MCL injury

A
  • usually heals well even if complete tear
  • use a brace, early motion, physio
  • pain can take a few to several months to settle
  • rarely requires surgery
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22
Q

when does an ACL injury require surgery

A

when rotatory instability is not responding to physio

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23
Q

what is the prognosis of ACL reconstruction

A
  • 3 months to a year rehab
  • some never get back to full sport (20% failure rate)
  • graft donor site morbidity
  • stiffness
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24
Q

how does someone get a PCL rupture

A

direct blow to anterior tibia or hyperextension injury causing popliteal knee pain and bruising

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25
Q

how can a patellar dislocation arise

A

rapid turn or direct blow

10% undergo a recurrent dislocation

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26
Q

what is patellofemoral pain syndrome and what does it cause

A

idiopathic adolescent anterior knee pain, chondromalacia patellae

may be due to muscle imbalance, tightness of lateral tissues, bony malaignment, flat feet

27
Q

how is an extensor mechanism rupture come about

A

fall onto flexed knee with quads contraction leading to rupture quads or patellar tendon

28
Q

what is Osteochondritis dissecans

A

an area of the surface of the knee loses blood supply and cartilage +/- bone can fragment off

29
Q

what are bakers cysts

A

common swelling at the back of the knee

30
Q

what movements are possible at the hip joint

A
  • abduction and adduction
  • flexion and extension
  • medial and lateral rotation
  • circumduction
31
Q

what is the acetabular labrum

A

fibrocartilagenous rim along the margin of the acetabulum

32
Q

what are the 3 mechanisms of stabilising a joint to prevent dislocation

A
  1. muscle tone
  2. ligaments
  3. shape of bones - how they fit together
33
Q

when does posterior hip dislocation typically occur

A

Traumatic event when the hip is in a flexed, adducted and medially rotated position

34
Q

what area does the sciatic nerve supply

A

supplies posterior to the thigh and everything from the knee down

35
Q

where does the sciatic nerve originate

A

L4-S3 anterior rami

36
Q

what can occur due to sciatic nerve injury

A
  • foot drop
  • loss of ankle jerk reflex
  • movement of toes
  • walk on tip toes
  • parasthesia from the knee down apart from the medial aspect of the calf
37
Q

what is Trendelenbergs sign

A

inferior movement (‘drooping’) of the contralateral hip when standing on one leg due to dysfunctional hip abduction caused by muscle weakness or paralysis

38
Q

where does the superior gluteal nerve originate

A

L4-S1 of the anterior rami

It leaves the pelvic cavity via the greater sciatic foramen superior to Piriformis

39
Q

what do the anterior and posterior drawer test test

A

anterior cruciate ligament and the posterior cruciate ligament

40
Q

what is a Maisonneuve fracture

A

separation of the distal tibia and fibula causes rupture of tibiofibular syndesmosis - fracture of proximal fibular

41
Q

what anatomy do X-rays show

A

bone outlines

42
Q

what anatomy does CTs show

A

bone outlines in more detail and some soft tissue structures eg lumbar discs

43
Q

what anatomy does an MRI show

A

bone outlines in less detain but shows bone marrow, discs, ligaments and the spinal chord and nerves

44
Q

what lies inferior to the pedicle

A

neural foramen

45
Q

what are physical features of C1 in the spine

A

C1 has no vertebral body. It comprises anterior and posterior arches, united by two large lateral masses, that articulate with the occipital bone and C2

46
Q

what are physical features of C2 of the spine

A

C2 has an odontoid process which projects superiorly into C1, anterior to the spinal canal, where it forms a joint with the C1 anterior arch

47
Q

what structure is responsible for spinal stability

A

ligaments tether vertebrae together and are responsible for spinal stability

48
Q

can ligaments be seen on an X-ray or CT?

A

No. But seeing normal vertebral alignment on these tests implies intact ligaments and stable spine

49
Q

what do damaged/not damaged ligaments look like on MRI

A 
normal = black 
damaged = light
50
Q

what is bone sclerosis

A

zones of increased bone density

51
Q

what is bone destruction

A

normal structures become invisible

52
Q

what is the function of intervertebral discs in relation to the vertebrae

A

they cushion the vertebrae from stress

53
Q

what happens when the intervertebral discs prelude to disease

A

healthy discs are pliable and contain water as they prelude to disease they dehydrate

54
Q

how may intervertebral discs cause sciatica

A
  • disc material may herniate through the disc lining into the spinal canal
  • herniated disc material may press on spinal nerves
  • nerve pressure produces sciatica
55
Q

what imaging technique shows the spinal chord

A

MRI

56
Q

what can cause spinal chord disease

A
  • trauma
  • tumour
  • demyelination
  • ischaemia
57
Q

what is the role of imaging in arthritis

A

To detect features of disease in order to

  • make a diagnosis
  • monitor disease activity and response to treatment
58
Q

where does osteoarthritis usually affect

A

Weight bearing or active joints

  • spine
  • hip
  • knee
  • thumb base
  • DIP (primary OA) q
59
Q

what events lead to sclerosis of the subchondraln bone in OA

A

increase in subchondral bone vascularity and cellularity drives new bone formation leading to sclerosis of subchondral bone

60
Q

what are radiologic features of OA

A
  • sclerosis of subchondral bone
  • synovial fluid dissects into bone, forming cysts
  • periosteal stimulation leads to marginal osteophyte formation
  • weakened bone may cave in, resulting in gross joint deformity
61
Q

is joint involvement symmetrical or non symmetrical in RA

A

Symmetrical

62
Q

what type of joints does RA affect

A

synovial

common sites:

  • MCP,MTP
  • PIP (not DIP)
  • wrists, hips, knees, shoulders
  • atlantoaxial joints (C1/2)
63
Q

what features can be seen on imaging RA

A
  • synovial proliferation and reactive joint effusion cause soft tissue swelling
  • hyperaemia causes bone demineralisation resulting in periarticular osteoporosis
  • inflamed thickened synovial (pannus) destroys bone, initially at the joint margins
  • marginal erosion is the hallmark of RA
  • joint subluxation and deformity develop
64
Q

what imaging feature characterises seronegative arthritides

A
  • synovitis (inflammation of joint and tendon sheath)

- Enthesitis (inflammation at sites where ligaments and tendons attach to bone)

MSK Y2 (3 decks)

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