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MSK > Anatomy clinical correlates Leg and ankle > Flashcards

Anatomy clinical correlates Leg and ankle Flashcards

1
Q

What are knee ligament injuries often the result of?

A

Rotational movement of the knee joint, such as cutting and pivoting movements in sports.

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2
Q

Why might the knee be difficult to examine immediately after an injury?

A

Pain and apprehension may limit examination findings.

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3
Q

When is it helpful to re-examine patients with knee injuries?

A

2-7 days after the initial examination.

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4
Q

In cases of suspected significant knee injuries, what can help delineate the extent of the injury?

A

Early MRI.

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5
Q

How is a Grade 1 knee ligament injury classified?

A

Some fibers torn but macroscopic structure intact (sprain).

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6
Q

What characterizes a Grade 2 knee ligament injury?

A

Some fasicles disrupted (partial tear).

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7
Q

How is a Grade 3 knee ligament injury defined?

A

Complete tear.

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8
Q

What instability may result from an MCL rupture?

A

Valgus instability.

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9
Q

What instability may result from an ACL rupture?

A

Rotatory instability.

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10
Q

What instability may result from a PCL rupture?

A

Recurrent hyperextension or instability descending stairs.

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11
Q

What instability may result from a posterolateral corner rupture?

A

Varus and rotatory instability.

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12
Q

What can multiligament injuries result in?

A

Gross instability.

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13
Q

What is the mechanism of injury for MCL injuries?

A

Valgus stress with possible external rotation (e.g., rugby tackling from the side).

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14
Q

What are the clinical features of an MCL injury?

A

Knee swelling, ecchymosis, pain, deformity, instability, medial joint line tenderness, and pain on valgus stress.

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15
Q

How is an isolated MCL tear diagnosed?

A

Clinical diagnosis, but x-rays and MRI can be used to rule out associated injuries.

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16
Q

How does a Grade 1 MCL injury usually heal?

A

Usually heals well, even if a complete tear.

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17
Q

What is the typical management for acute MCL tears?

A

Hinged knee brace.

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18
Q

How is chronic MCL instability treated?

A

MCL tightening (advancement) or reconstruction with a tendon graft (rare).

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19
Q

Which knee ligament is most commonly injured?

A

ACL (Anterior Cruciate Ligament).

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20
Q

What is the mechanism of injury for ACL injuries?

A

Twisting sports injury, often involving higher rotational force and turning the upper body laterally on a planted foot (e.g., football, rugby, skiing).

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21
Q

What is the main stabilizer of the internal aspect of the tibia?

A

ACL (Anterior Cruciate Ligament).

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22
Q

Who has a higher incidence of ACL injuries?

A

Females.

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23
Q

What are the clinical features of an ACL injury?

A

Audible pop, deep knee pain, swelling (haemarthrosis) within an hour of the injury, pain settles but leaves rotatory instability, and excessive anterior translation of the tibia on tests like the anterior drawer test and Lachman test.

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24
Q

How is an ACL injury diagnosed?

A

Joint aspiration to check for haemarthrosis and confirmation through MRI.

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25
Q

What is the management for ACL injuries that may stabilize with time and physiotherapy?

A

Time and physiotherapy.

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26
Q

In what cases is ACL reconstruction (tendon graft) mainly indicated?

A

Rotatory instability not responding to physiotherapy, part of multi-ligament reconstruction, or in professional athletes.

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27
Q

How long might it take for intensive rehabilitation after ACL reconstruction to return to high-impact sports?

A

Up to a year.

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28
Q

What is the mechanism of injury for LCL injuries?

A

Varus stress and hyperextension.

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29
Q

When is urgent repair needed for a complete LCL rupture?

A

Within 2-3 weeks.

30
Q

What is the clinical presentation of an LCL injury?

A

Knee swelling, ecchymosis, pain, deformity, instability, lateral joint line tenderness, and positive varus stress test indicating lateral joint laxity.

31
Q

How is an isolated LCL tear diagnosed?

A

Clinical diagnosis, but x-rays and MRI can be used to rule out associated injuries.

32
Q

What can happen if an LCL rupture is not promptly repaired?

A

Varus and rotatory instability, high incidence of common fibular nerve palsy, and early osteoarthritis of the knee.

33
Q

What is the typical mechanism of injury for PCL injuries?

A

Tend to occur following a direct blow to the anterior tibia, such as in a dashboard injury or a motorbike accident.

34
Q

Is isolated PCL rupture common or rare?

A

Isolated PCL rupture is rare; it usually occurs with other injuries.

35
Q

What are the clinical features of a PCL injury?

A

Popliteal knee pain and bruising, positive posterior drawer test, and positive sag sign.

36
Q

What investigations are used to assess PCL injuries?

A

X-ray and MRI.

37
Q

Is reconstruction typically required for most isolated PCL cases?

A

Most isolated cases don’t require reconstruction.

38
Q

When is reconstruction considered for a PCL injury?

A

If the patient develops instability, such as recurrent hyperextension or feeling unstable when going down stairs.

39
Q

In the case of multi-ligament knee injuries, what is often required?

A

Surgical reconstruction due to the degree of instability.

40
Q

What can combined knee ligament ruptures result from?

A

Higher degrees of force.

41
Q

What is inflammation of the synovium-lined sacs that protect bony prominences and joints called?

A

Bursitis.

42
Q

Define a bursa.

A

A small fluid-filled sac lined by synovium around a joint that prevents friction between tendons, bones, muscles, and skin.

43
Q

What can cause inflammation of a bursa?

A

Repeated pressure or trauma.

44
Q

What may be the presentation of inflamed bursa?

A

Soft tissue swelling.

45
Q

Give examples of conditions associated with bursitis.

A

Pre-patellar bursitis, olecranon bursitis, and bunions (bursitis over the medial 1st metatarsal head in hallux valgus).

46
Q

What can inflamed bursa become secondarily?

A

Infected, leading to the formation of an abscess, usually due to bacterial infection from a small wound on the limb.

47
Q

What is the typical management for inflammatory bursitis?

A

The fluid component of the swelling usually subsides, but a thickened bursal sac may be left. Recurrence may occur, and excision may be required, but problems can arise with scarring.

48
Q

What are Baker’s cysts?

A

Ganglion cysts found in the popliteal fossa.

49
Q

What does the term “Baker’s cysts” refer to?

A

Inflammation and swelling of the semimembranosus bursa, a fluid-filled sac found in the knee joint.

50
Q

What is often associated with the development of Baker’s cysts?

A

Osteoarthritis (OA) of the knee.

51
Q

How do Baker’s cysts typically present clinically?

A

They can appear as a general fullness of the popliteal fossa and are usually soft and non-tender.

52
Q

What is the suggested management for Baker’s cysts?

A

Management of osteoarthritis (OA).

53
Q

Why are knee dislocations considered medical emergencies?

A

Because they can cause vascular compromise to the popliteal artery, resulting in an ischemic limb.

54
Q

What is Iliotibial band syndrome, and what typically causes it?

A

Pain over the lateral knee, typically caused by overuse and irritation of the iliotibial band over the lateral femoral epicondyle.

55
Q

How do medial collateral ligament injuries typically occur?

A

With a valgus force.

56
Q

What is the clinical diagnosis method for medial collateral ligament injuries?

A

A positive valgus stress test.

57
Q

How can lateral collateral ligament injuries occur?

A

With a varus force.

58
Q

What is the clinical diagnosis method for lateral collateral ligament injuries?

A

A positive varus stress test.

59
Q

What is the typical mechanism of injury for the anterior cruciate ligament (ACL)?

A

A direct anterior blow to the femur or a non-contact twisting injury when the foot is planted.

60
Q

What clinical tests can be used to assess the anterior cruciate ligament?

A

Lachman test and anterior drawer tests.

61
Q

When is the posterior cruciate ligament (PCL) susceptible to injury?

A

After a direct anterior blow to the tibia.

62
Q

What clinical test can be used to assess the posterior cruciate ligament?

A

The posterior drawer test.

63
Q

How do medial and lateral meniscus injuries often result?

A

Twisting injurieswith foot in fixed postion

64
Q

What are the clinical presentations of medial and lateral meniscus injuries?

A

Pain, locking, catching, and “giving out” at the knee.

65
Q

What tests are used clinically to assess medial and lateral meniscus injuries?

A

McMurray test .

66
Q

What is the unhappy triad in the context of knee injuries?

A

A combined tear of the anterior cruciate ligament, medial collateral ligament, and medial meniscus.

67
Q

What is a more common injury pattern than the unhappy triad?

A

Involving the anterior cruciate ligament, medial collateral ligament, and lateral meniscus.

68
Q

What is bursitis in the context of knee injuries?

A

Inflammation of different bursae around the knee.

69
Q

Name five common types of knee bursitis.

A

Prepatellar bursitis, superficial infrapatellar bursitis, deep infrapatellar bursitis, suprapatellar bursitis, and pes anserine bursitis.

70
Q

What causes Baker cysts, or popliteal cysts?

A

Extrusions of synovial fluid from the knee joint into either the gastrocnemius or semimembranosus tendon bursa.

MSK (21 decks)

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