Lower limb pathologies Flashcards

1
Q

What hip pathologies do we need to know?

A

Arthritis
AVN
Trochanteric bursitis/gluteal cuff syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What arthritises can affect the hip?

A

OA- primary or secondary to AVN, dysplasia, SUFE, Perthes
RA
Seronegative inflammatory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is conservative treatment for hip arthritis?

A

Simple analgesia, physio, walking aids and weight reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When is surgery indicated for hip arthritis?

A

Hip replacement depending on pain levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How long do hip replacements tend to last?

A

10-20 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What can cause AVN in the hip?

A

Idiopathic
Trauma
Alcohol abuse
Steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you treat AVN in the hip?

A

MRI early on- Release pressure

Late on- damage done therefore replace.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

WHat is trochanteric bursitis/gluteal cuff syndrome?

A

Tendonitis/tendon tears of gluteus medius insertion or trochanter bursa inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does trochanteric bursitis/gluteal cuff syndrome present?

A

Pain and tenderness over greater trochanter and pain on resisted abduction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is trochanteric bursitis/gluteal cuff syndrome treated?

A

Analgesia, anti-inflammatory, physio and steroids

No surgery!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where does hip pain usually localise?

A

Groin but can radiate to knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does hip pain often present?

A

Decreased range of movement and increased pain on rotation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the forms of arthritis found in the knee?

A

Primary OA
OA secondary to: Meniscal tears, ligament injury and malalignment.
Seropositive and negative arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do you treat arthritis in the knee?

A

Conservative- Analgesia and physio

Surgery- Partial or full knee replacement if in substantial pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the complications of a knee replacement?

A

SImilar to hip but decreased chance of dislocation but increased chance of pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the five soft tissue injuries of the knee we need to know?

A
Meniscal tears
ACL rupture
PCL rupture
MCL tear
LCL tear
Combined ligament injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is a meniscal tear?

A

Tear in the meniscus usually due to twisting a loaded knee. Often occurs with ACL rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does a meniscal tear present?

A

Pain on medial (commonly) or lateral joint line
Catching sensation
Locking- can’t fully extend
Effusion
Pain on tibial rotation (+ive Steinmann’s test)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What meniscal tear is most likely to produce locking?

A

Bucket handle tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do you treat a meniscal tear?

A

Limited healing due to poor blood supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is an ACL rupture?

A

Rupture of the ACL due to high rotation force turning body laterally.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does an ACL rupture present?

A

Feel a ‘pop’ and develop haemarthrosis within an hour. Deep pain and knee gives way on walking.
+ive anterior draw test and Lachman test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How do you treat an ACL rupture?

A

Primary repair not effective so manage with physio.

If sports person reconstruct (tendon graft).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is a PCL rupture?

A

Rupture of PCL due to direct blow to anterior tibia with knee flexed or hyperextended.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How to you treat a PCL rupture?

A

Reconstruct but not common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What causes a MCL tear?

A

Valgus stress injury- tackle from side

Get laxity and pain on valgus stressing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How do you treat a MCL tear?

A

Heals by itself but brace while doing so.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What causes a LCL tear?

A

Varus stress injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How do you treat a LCL tear?

A

SUrgical repair or reconstruction but get lots of instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is a combined ligament injury?

A

Damage to 2+ knee ligaments. Often requires surgery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

WHat is the most important combined ligament tear?

A

Complete knee dislocation. This is an emergency due to potential for neurovascular injury!!!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is an emergency knee situation?

A

Complete knee dislocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is an osteochondral injury of the knee?

A

Damage to the articular surface of the knee due to a direct blow.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How does osteochondral damage to the knee present?

A

Ongoing pain and effusion after injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

How do you treat osteochondral injury of the knee?

A

Replace with fibrocartilage

36
Q

What makes up the extensor mechanism?

A

Tibial tuberosity, patellar tendon, patella, quads tendon and quads muscle

37
Q

What is an extensor mechanism rupture?

A

Rupture of the patella or quads tendon due to rapid contraction or spontaneous in degraded tendon

38
Q

What predisposes you to extensor mechanism rupture?

A
Tendonitis
Steroid use
Diabetes
RA
CRF
39
Q

How do you diagnose extensor mechanism rupture?

A

Straight leg raise and obvious gap in extensor mechanism

40
Q

How do you treat an extensor mechanism rupture?

A

Tendon to tendon or tendon to patella repair

41
Q

What is patellofemoral dysfunction?

A

DIsorders of patellofemoral articulation causing anterior knee pain.

42
Q

What things can cause patellofemoral dysfunction?

A

Chondromalacia, lateral patellar compression syndrome and adolescent anterior knee pain

43
Q

How does patellofemoral dysfunction present?

A

ANterior knee pain worse going down hill
Grind or click at front of knee
Stiffness after sitting

44
Q

How do you treat patellofemoral dysfunction?

A

Physio and tape up

45
Q

What is patellar instability?

A

Patella dislocation- nearly always lateral

46
Q

What causes patellar instability?

A

DIrect blow or sudden twist of knee

Lax ligaments

47
Q

What happens when you dislocate your patella laterally?

A

Tear medial patellofemoral ligament making future dislocation likely

48
Q

How do you treat patellar instability?

A

Chance of future dislocation decreases with age and give physio

49
Q

What are the common sites for OA in the foot?

A

Dorsum of foot- Remove osteophytes

Ankle- Arthrodesis or replace

50
Q

What is hallux rigidus?

A

OA of the first MTP joint

Can be primary or secondary

51
Q

How do you treat hallux rigidus?

A

Stiff soled shoes
Remove osteophytes
Arthrodesis

52
Q

What is hallux valgus?

A

Deformation of great toe due to medial deviation of 1st metatarsal and lateral movement of toe

53
Q

What makes hallux valgus more common?

A

Woman, shoes and RA

54
Q

What are some of the complications of hallux valgus?

A

Painful

RUbbing leading to bursitis and ulcers

55
Q

How do you treat hallux valgus?

A

Conservative: Wider shoes and spacer between toes

Surgery to realign but not the best

56
Q

What is morton’s neuroma?

A

Inflammation and swelling of plantar interdigital nerves

57
Q

How does morton’s neuroma present?

A

Burning pain and tingling radiating to toes.
Loss of sensation in webbing
+ive Muller’s click test- mediolateral compression of tarsal heads.

58
Q

How do you treat morton’s neuroma?

A

Conservative: Metatarsal pad or insole. Steroid + analgesia

Neuroma excision

59
Q

Where are metatarsal stress fractures most common?

A

2nd followed by 3rd metatarsal

60
Q

WHat causes metatarsal stress fractures?

A

Exercise

61
Q

What makes metatarsal stress fractures hard to diagnose?

A

Take up to 3 weeks to show on XR

62
Q

How do you treat metatarsal stress fractures?

A

Rest and rigid shoe

63
Q

What causes Achilles tendonitis?

A

RSI or degeneration

64
Q

What can predispose you to Achilles tendonitis?

A

Quinalone AB, RA and gout

65
Q

How do you treat Achilles tendonitis?

A

Rest
Physio
Heel risers
Splint

66
Q

How do you treat a ruptured Achilles tendon?

A

Repair and cast for 8 weeks or non-op in equine boot

67
Q

What is plantar fasciitis?

A

Inflammation of plantar fascia due to RSI or degeneration

68
Q

How does plantar fasciitis present?

A

Pain in instep when walking

69
Q

How do you treat plantar fasciitis?

A
Self-limiting.
Rest
Plantar and Achilles stretches
Gel soles
Steroids
Surgery rare
70
Q

What is pes planus?

A

Flat feet- medial arch does not develop or is lost

71
Q

What causes pes planus?

A

Lax ligaments

Lose arch due to: RA, tendon stretch or diabetes

72
Q

How do you treat pes planus?

A

No problems therefore treatment normally but can predispose to posterior tibial tendonitis

73
Q

What is pes cavus?

A

Abnormally high arch to foot

74
Q

What causes pes cavus?

A

Idiopathic or neuromuscular conditions such as CP

75
Q

What complications can pes cavus cause?

A

Claw toe

Pain

76
Q

How do you treat pes cavus?

A

Soft tissue release
Tendon transfer
Arthrodesis

77
Q

What is tibialis posterior tendon dysfunction?

A

Tendonitis, elongation or rupture of TPT which supports medial arch

78
Q

How do you treat tibialis posterior tendonitis?

A

Splint and decompression

79
Q

How do you treat an elongated/ruptured tibialis posterior tendon?

A

Tendon transfer if no OA

Arthrodesis if got OA

80
Q

What are claw and hammer toes?

A
Claw = Hyperextension of MTP and flexion of PIP = DIP
Hammer = Hyperextension of MTP + DIP and flex of PIP
81
Q

What causes claw and hammer toes?

A

Flexor and extensor tendon imbalance

82
Q

What are some of the complications of claw and hammer toes?

A

Rubbing, pain and ulcers

83
Q

How do you treat claw and hammer toes?

A
Protect skin
Divide tendons
Tendon transfer
Arthrodesis
Amputation
84
Q

What is primus varus?

A

Where the 1st metatarsal points away from the second widening the feet.

85
Q

What can primus varus cause?

A

Pain, shoes to feel tight and rubbing to form bursitis (bunion)

86
Q

How do you treat primus varus?

A

Reposition 1st metatarsal