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Musculoskeletal > Hip and Knee Conditions > Flashcards

Hip and Knee Conditions Flashcards

1
Q

What are the risk factors for bursitis?

A 
Occupation that causes mechanical stress on bursa
Rheumatoid arthritis
Gout or pseudogout
Penetrating injury
Osteoarthritis of the hip
Infection in a nearby joint
Lower limb length discrepancy
Iliotibial band contracture
Lumbar spondylosis
Valgus knee deformity
Low-riding shoes
Anatomical or functional impingement within the Coracoacromial arch
Muscle wasting following surgery
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2
Q

What are the symptoms of bursitis?

A

Pain
Tenderness
Limited movement
low-grade temperature (septic bursitis)

swelling

erythema (septic bursitis)

warmth of overlying skin (septic bursitis)

painful arc on shoulder abduction (subacromial)

lateral hip pain (trochanteric)
pain at the extremes of hip rotation, abduction, or adduction (trochanteric)

pain of contraction of the hip abductors against resistance (trochanteric)

pseudoradiculopathy: pain radiating down the lateral aspect of the thigh (trochanteric)

impalpable patella (prepatellar)

palpable bump over heel (retrocalcaneal)

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3
Q

What investigations should be carried out for bursitis?

A 
X ray
MRI
US
Gram stain of fluid aspirate
Crystal analysis
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4
Q

What is the management for bursitis?

A 
NSAIDs
Relative rest / Activity modification
Physiotherapy
Correct posture, abnormal movements
Stretching
Strengthen muscles around joint
Injection
Corticosteroids
Surgery
Bursectomy- rarely done as risks are too high
US guided needle aspiration
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5
Q

What is avascular necrosis?

A

Death of bone due to loss of blood supply

If have end artery supply and have fracture or something blocking it then can get AVN

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6
Q

What are the risk factors for AVN?

A 
Trauma-fracture, dislocation, iatrogenic or irradiation
Idiopathic
Hypercoagulable state
Steroids
Haematological
Alcoholism
Caisson's disease
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7
Q

What are the symptoms of AVN?

A 
Pain that is insidious in groin
Pain on incline
Limp
Stiffness
Reduced motion esp internal rotation
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8
Q

What investigations should be done for AVN and what is seen on imaging?

A 
X ray
MRI
See crescent sign-micro trabecular structures collapse but cartilage is still fine
Then head of femur flatten off
Then see arthritis type patterns
Then head breaks off
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9
Q

What is the management for AVN?

A 
Reduce weight-bearing
NSAIDs
Bisphosphonates
Anticoagulants-improve flow of blood
Physiotherapy
Maintain range of motion
Surgical
-Restore blood supply
-Core decompression
-Core decompression and vascularised graft
-Move the lesion away from the weight-bearing area
-Rotational Osteotomy
-Total Hip Replacement
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10
Q

What is Femoroacetabular Impingement?

A

In younger patients get impingement of femoral neck against anterior neck of acetabulum
Excess bone
Aspherical head

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11
Q

What are the two categories of FAI?

A

Cam lesion-extra bone on femur head

Pincer-acetabulum problems with more bone, more common in females

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12
Q

What are the associated injuries with FAI?

A

Labral tear

Cartilage damage and flap tears (secondary arthritis)

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13
Q

What is the presentation of FAI?

A

Groin pain worse with flexion
Mechanical symptoms-get to a certain point of passive movement and get stuck
Reduced flexion and internal rotation
FADIR test-flexion, adduction and internal rotation

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14
Q

What imaging should be used for FAI?

A

X ray to see bones

MRI to look at surrounding structures

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15
Q

What is the management for FAI?

A

Activity modification
NSAIDs
Physiotherapy
Arthroscopy-shave down bone and deal with labrum and cartilage
Open surgery-resection
Hip Replacement or resurfacing (take away a lot less bone and leave acetabulum)

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16
Q

What is the most common labral tear?

A

anterosuperior tear

17
Q

Are labral tears more common in females or males?

A

Females

18
Q

What are the causes of labral tears?

A 
FAI
Trauma
OA
Dysplasia
Collagen diseases – Ehlers-Danlos
19
Q

What is the presentation of labral tears?

A

Groin or Hip Pain
Snapping sensation
Jamming or locking
Positive FABER test-Flexion, Abduction, External Rotation

20
Q

What investigations should be done for labral tears?

A

X ray
MRI arthrogram-fluid goes up to cleft of tear
Diagnostic injection-local anaesthetic into area and see if pain reduces

21
Q

What is the management of labral tears?

A 
Activity modification
NSAIDs 
Physiotherapy
Injection of Steroids
Arthroscopy
Repair
Resection
22
Q

What are the risk factors for a meniscal tear?

A 
Acute trauma (twisting injury)
Knee joint arthritis
Knee instability
FH of anterior cruciate ligament injury
Malalignment of the knee joint
Rough or uneven playing surface
Poor ground/weather conditions
Construction work and manual labour jobs
Discoid meniscus
23
Q

What is the presentation of a meniscal tear?

A

Intermittent Knee swelling
Sensation of knee instability or buckling/catching
Knee pain
Tenderness at joint line and joint line crepitation
Positive McMurray’s test
Positive Apley’s test
Positive hyperextension test
Popliteal (Baker’s) cyst in chronic cases
Limited range of motion
Positive Thassaly’s (Bend knee at 20 degrees with one leg raised and get them to twist, recreate injury pattern)
Effusion (do patellar tap)
Mechanical block to movement
Cant do deep squat

24
Q

What is the McMurray test?

A

Patient is supine with knee in flexion. Examiner flexes the hip and, with one hand on the joint line, rotates the foot internally and externally. Pain with rotation suggests a meniscal tear. (Click is more suggestive of meniscal tear) This test has low sensitivity and high specificity for diagnosing a meniscal tear.

25
Q

What is the Apley’s test?

A

Patient is prone with knee flexed at 90°. Examiner places axial load on the lower leg while rotating the foot. Patient often feels pain in the affected compartment.

26
Q

What is the management for meniscal tear?

A

Unlikely to heal due to poor blood supply
NSAIDs
Rest
Physiotherapy-quadriceps strengthening so don’t put as much pressure on mensicus
Arthroscopy (can also be diagnostic)

27
Q

What are the risk factors for an anterior cruciate ligament injury?

A 
Acute trauma
Female sex (after puberty)
Poor technique for landings
History of previous ACL injury
Use of cleats or spikes
Rough or uneven playing surface
Ground condition/weather
Fatigue
Adolescence
Athlete with higher skill level
28
Q

What is the presentation of an ACL tear?

A 
Audible pop
Rapid knee swelling from haemarthrosis
Inability to return to activity
Sensation of knee instability or buckling
Pain
Positive Lachman's test
Positive pivot shift manoeuvre
Tenderness at lateral femoral condyle, lateral tibial plateau
Positive anterior drawer test
Had a non contact pivot injury
29
Q

What is Lachman’s test?

A

Lachman’s test involves putting the patient supine and while placing one hand behind the tibia and the other on the patient’s thigh, the knee is at about 20 to 30 degrees in flexion. With the clinician’s thumb on the tibial tuberosity, the tibia is pulled anteriorly. If the ACL is intact, a firm end point is found. If a soft end-point is found, and there is more than 2 mm of anterior movement compared with the uninjured knee, the test is positive, suggesting a torn ACL.

30
Q

What is a pivot shift manoeuvre?

A

The patient is in the lateral decubitus position and the examiner holds the patient’s leg with both hands. The knee is at 20 degrees of flexion and the patient is asked to relax the muscles. The examiner then places the knee in full extension and internally rotates the tibia. Then the knee is pushed from the lateral side and flexed. If a clunk is felt at 30 degrees, the test is positive for ACL rupture.

31
Q

What is the management for ACL injury?

A

Focussed quadricep programme

ACL reconstruction

32
Q

What is the presentation of an MCL tear?

A 
Heard a ‘pop’ or ‘crack’
Pain
Medial side
Unable to continue playing
Bruising medial knee
Localised swelling
Tender medial joint line 
Tender femoral insertion of mcl
 Painful in full extension
Opening on valgus stress
33
Q

What is the management for an MCL tear?

A 
Rest
Physiotherapy
Brace for comfort
NSAIDs
Repair or reconstructions
34
Q

What is osteochondritis dissecans?

A

Osteochondritis dissecans is an acquired, potentially reversible idiopathic lesion of subchondral bone resulting in delamination and sequestration with or without articular cartilage involvement and instability.
AVN of the knee
Can get juvenile and adult

35
Q

What are the risk factors for OD?

A 
Repetitive throwing/valgus stress
Gymnastics/weight-bearing on upper extremity
Ankle sprain/instability
Competitive athletics
Family history
Vascular problems
36
Q

What is the presentation of OD?

A

Pain is exacerbated by activity
Location of pain anteromedial aspect of the knee with the knee flexed to 90 degrees
Location of pain lateral aspect of elbow
Location of pain posteromedial aspect of dorsiflexed ankle or anterolateral aspect of plantar-flexed ankle
Effusion present
Locking of joint
Catching of joint
Decreased range of motion
Antalgic gait in osteochondritis dissecans involving the knee or talus
External rotation gait in osteochondritis dissecans involving the knee
Crepitus
Quadriceps atrophy
Wilson’s test

37
Q

What is Wilson’s test?

A

Pain with tibial internal rotation and extension of the knee from flexion of 90 degrees to 30 degrees may be elicited from impaction of the medial tibial eminence on the lateral aspect of the medial femoral condyle

38
Q

What is the management of OD?

A 
Restricted weight-bearing
Rom brace
Arthroscopy
Subchondral drilling
Fixation of loose fragment
Open fixation

Musculoskeletal (20 decks)

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