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Hip and Knee Pain Flashcards

(59 cards)

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1
Q

How do people often present with hip problems

A 
Pain and discomfort 
Referred pain 
Night pain - insomnia 
Stiffness 
Pain when exercising
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2
Q

Where does true hip joint pain present

A

Mid groin

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3
Q

Pain on the outside of the hip is more likely to be?

A

Trochanteric bursitis

Referred pain from back

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4
Q

What would you look for in a patient presenting with hip pain

A

Deformity
Asymmetry
Scars - previous trauma or surgery

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5
Q

What would you feel for in a patient presenting with hip pain

A

Swelling - may be over trochanter in bursitis
Bony landmarks
Tenderness
Heat

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6
Q

What investigations may be done for hip pain

A

X-ray - though finding may be incidental so must compare to symptoms
ESR/viscosity if suspect inflammatory
FBC is infection suspected

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7
Q

What are the x-ray signs of osteoarthritis

A

Loss of joint space
Osteophytes
Sclerosis
Subarticular cysts

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8
Q

How do you manage hip pain

A 
education 
weight reduction 
walking stick 
analgesia or NSAIDs 
Physio 
Mobility aid - car badge, home adaption etc
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9
Q

List some common causes of hip pain

A 
OA 
RA and other arthritides 
Fracture 
Referred pain from back 
malignancy
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10
Q

List some rarer causes of hip pain

A

Soft tissue issues - bursitis
Paget’s
Infection
Avascular necrosis

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11
Q

Why are knee and hip problems increasing in the population

A

Age - more wear and tear etc

Obesity - more weight being put through joints

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12
Q

What are some common presentations of knee problems

A 
Pain - often localised 
Stiffness 
Swelling or lump 
Giving way - unstable 
Deformity 
Loss of sleep 
Loss of function - can't kneel or trouble walking
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13
Q

What would you look for in a patient presenting with knee pain

A

Deformity
Gait
Swelling
Scars

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14
Q

What would you feel for in a patient presenting with knee pain

A

Bony landmarks
Tenderness
Effusion
Stability

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15
Q

What investigations may be done for knee pain

A

Usually none
X-ray
MRI
Urate - suspect gout?

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16
Q

How do you manage knee pain

A 
Explanation 
Keep leg mobile 
Leg supports if knee unstable 
NSAID - short term 
Analgesia 
Physio 
Referral if severe
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17
Q

What are some common problems that affect the knee

A

Ligament strain - MC
Bursitis - common if on knees a lot
Osteoarthritis
Osgood-Schlatter’s - inflammation of tibial tuberosity and cartilage

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18
Q

What are some rarer problems that affect the knee

A 
Chondromalacia patellae 
Meniscus injury 
Cruciate damage 
Gout 
RA 
Dislocation
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19
Q

What makes the hip an effective joint

A

Ball and socket
Wide range of movement
Stable - can take a lot of weight

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20
Q

List the layers of bone

A

Hyaline (articular) cartilage
Subchondral bone
Cancellous bone

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21
Q

What is FAI

A

Femoroacetabular impingement syndrome
Morphology of the femoral neck and/or acetabulum is altered
Causes issues with flexion, adduction and internal rotation

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22
Q

Name two types of impingement caused by FAI

A

CAM type

Pincer type

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23
Q

Describe a CAM type deformity

A

Caused by deformity in the femur - asymmetrical head
Usually occurs in young athletic men
Can be related to previous SUFE

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24
Q

Describe a pincer type deformity

Study These Flashcards
A

Caused by deformity in the acetabulum
Acetabulum overhangs
Usually seen in females

25
Why are young athletic men likely to get FAI
May be due to increased weight bearing and stress in adolescent years
26
What damage does FAI do to the joint
Damages the labrum and causes tears Damages cartilage Leads to OA in later life
27
How do patients present with FAI
Groin pain relating to activity - particularly when flexing and rotating Difficulty sitting C-sign positive FADIR provocation test positive
28
What is the FADIR provocation test
Tests flexion, adduction and internal rotation of the hip
29
How do you diagnose FAI
Imaging Radiograph, CT and/or MRI MRI best for looking at damage to labrum and oedema
30
How do you manage FAI
Just observe in asymptomatic patients Arthroscopic/open surgery to remove CAM or debride tears Osteotomy and debride labral tears for pincer impingement Replacement in people with secondary OA
31
What is avascular necrosis
Failure of blood supply to the femoral head
32
What are the causes of AVN
Can be idiopathic or associated with trauma (e.g. damages to the blood supply)
33
How does idiopathic AVN develop
Coagulation of the microcirculation in the bone Leads to venous thrombosis which causes retrograde arterial occlusion Leads to hypertension in the bone Decreases blood flow to the femoral head, leading to necrosis
34
Who is affected by AVN
Men Typically age 35-50 Usually bilateral
35
What are the risk factors for AVN
``` Irradiation Trauma Hematologic diseases - leukaemia Decompression sickness - divers Alcoholism Steroid use ```
36
How do patient's present with AVN
Insidious onset of groin Exacerbated by stairs or impact Examination usually normal
37
How do you diagnose AVN
Radiographs - normal unless late disease | MRI scan - most sensitive/specific
38
AVN is irreversible - true or false
BOTH | There are reversible and irreversible stages
39
How do you treat AVN
``` Bisphosphonates Core decompression Curettage & bone grafts Vascularised bone graft Rotational osteotomy Total hip replacement ```
40
What is ITOH
Idiopathic Transient Osteonecrosis of the Hip | Local hyperaemia and impaired venous return with marrow oedema and increased intramedullary pressure
41
How do patients present with Idiopathic Transient Osteoporosis of the Hip
Progressive groin pain Difficulty weight bearing Usually unilateral
42
Who is affected by Idiopathic Transient Osteoporosis of the Hip
Men more than women Middle aged Does affect pregnant women in 3rd trimester
43
How do you diagnose Idiopathic Transient Osteoporosis of the Hip
ESR - will be elevated Radiographs MRI - gold standard Bone scan
44
What are the radiograph signs of Idiopathic Transient Osteoporosis of the Hip
Osteopenia of head and neck of femur Thinning of cortices Preserved joint space
45
How do you manage Idiopathic Transient Osteoporosis of the Hip
Self-limiting and should resolve in 6-9 months Treat symptoms with analgesia Protective weight bearing to avoid fracture - bone is weaker
46
What is trochanteric bursitis
Inflammation of the trochanteric bursa | Common condition caused by IT band tracking across the bursa and causing repetitive trauma
47
Who commonly gets trochanteric bursitis
Females - wider pelvis rubs on IT band more Young, active patients Older people
48
How does trochanteric bursitis present
Pain on lateral aspect of hip | Pain on palpation of greater trochanter
49
How do you diagnose trochanteric bursitis
Clinical diagnosis usually X-ray usually normal Visible on MRI but not normally needed
50
How do you treat trochanteric bursitis
Analgesia NSAIDs Physio Steroid injection
51
Do you ever operate on trochanteric bursitis
No | No proven benefit
52
What is the common presentation for simple backache
20-55 Systemically well Back, buttock and/or thigh pain Pain changes with movement
53
What is the common presentation for nerve root pain
``` unilateral leg pain Parathesia in the same distribution Abnormal neurology Weakness Reflex and sensory changes Nerve stretch pain ```
54
Which risk factors suggest a more serious spinal pathology
``` Past history of Cancer, TB, HIV, IVDA Unexplained weight loss Constant unremitting pain Unable to lie supine or to sleep Age under 20 or over 55 Recent trauma ```
55
What are some key signs of cauda equina syndrome
Saddle Anaesthesia Altered Bladder Control Bowel Incontinence Gait disturbance
56
What is the prognosis and treatment for simple backache
Prognosis good 90% better in 6 weeks Advice and simple painkillers
57
What is the prognosis and treatment for nerve root pain
Good prognosis 50% better in 8 weeks Give advice and pain management as per NICE guidelines If not better after 2 months with 4 weeks of physio then refer for imaging
58
What is the next step if you suspect serious spinal pathology
Consider cancer, infection, fracture or inflammatory disease Needs further investigations so refer urgently
59
What is the next step if you suspect cauda equina syndrome
Emergency surgical referral

MSK (21 decks)

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