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othopaedics > hip and knee pathologies > Flashcards

hip and knee pathologies Flashcards

1
Q

3 main differential of hip pain in the young

A

impingment
laberal tears
paediatric hip issues

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2
Q

middle age differentials 3 main of hip pain

A

trochanteric bursitis
OA
AVN-alcohol/steroids

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3
Q

2 main differentials of hip pain in old

A

OA

rare pathological lesion

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4
Q

grade o for oa of the hip

A

no radiographic features of OA

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5
Q

grade 1 for OA of the hip

A

possible joint space narrowing and subtle osteophytes

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6
Q

grade 2 for OA of the hip

A

definitie joint space narrowing, defined osteophytes and some sclerosis, especially in acetabular region

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7
Q

grade 3 for OA of the hip

A

marked joint space narrowing, defined ostepohytes, some sclerosis and cust formation and deformity of the femoral head and acetabulum

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8
Q

grade 4 for OA of the hip

A

gross loss of joint space with above features plus large osteophytes and increased deformity of the femoral head and acetabulum

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9
Q

4 cardinal signs of OA on an x-ray

A

joint space narrowing
subchondral sclerosis
subchondral cysts
osteophytes

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10
Q

what is OA

A

progressive loss of articular cartilage and as a result subchondral bone remodelling

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11
Q

key pathophysiology of OA

A 
increased water content
chondrocytes die
aggrecan keeps up production but then can't 
fibrillation 
subchondral bone sclerosis
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12
Q

why is cartilage prone to injury

A

it is avascular and nourished via synovial fluid

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13
Q

what makes up cartilage

A

chondrocytes in an extracellular matrix of proteoglycans, 65-85% water, type 2 collagen

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14
Q

superficial and deep function/ content of hyaline cartilage

A 
superficial= decreases friction- smooth surface, parallel collagen fibres, few chondrocytes
DEEP= load bearing, perpendicular fibres and greater cell numbers
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15
Q

changes in OA to collagen, proteoglycan, water content, elasticity of cartilage

A

collagen-decreased
proteoglycan- increases
water content-increases
elasticity- decreases

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16
Q

primary and secondary causes of OA

A 
primary= idiopathic, risk factors
secondary= trauma, infection, developmental, inflammatory, gout crustal
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17
Q

ragiographic features and why they form (OA)

A

sclerosis and cyst formation= weight bearing

osteophytes= attempt to spread weight

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18
Q

what feature of OA is assoc. to progression

A

cyst formation

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19
Q

what muscles are affected in the tredelengburg test

A

gluteus medius and minimus

abductors

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20
Q

presentation of hip OA

A 
central cartilage loss
mostly women
bilateral at presentation
medial assoc. to generalised nodular
better prognosis
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21
Q

examination features of OA hip

A

fixed flexion deformity- Thomas leg raise
Reduced ROM
gait- tredelenburg
difficulty hip flexion and internal rotation
referred pain down
leg length shortening

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22
Q

what 3 features need to be present to make a working diagnosis of OA without an x-ray

A

> 45 years
chronic joint pain (>3 months), worse on use
morning stiffness <30 min

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23
Q

what is Hilton’s law

A

pain from hip refers down to knee

24
Q

management conservative OA

A 
walking aids
orthotics
analgesia
physio
education
25
Q

surgical options for OA

A

arthroplasty
osteotomy
arthrodesis
uni-compartmental

26
Q

x-rays for a knee OA views

A 
AP
lateral
patellar skyline
weight bearing
with valgus stress test
27
Q

presentation knee OA

A 
varus deformity
worse pain on movement
limited walking
antalgic gait
fixed flexion deformity
swelling
weak/waste quads
28
Q

2 main types of knee OA

A

medial compartment

patellar femoral

29
Q

what causes posterior knee pain in knee OA

A

baker cyst

30
Q

when is patellar femoral knee pain worse

A

climbing stairs

31
Q

knee OA grade 0

A

no radiographic features

32
Q

knee OA grade 1

A

doubtful JSN, possible osteophytes

33
Q

2 knee oa grade

A

definite osteophyte formation, possible JSN

34
Q

3 knee OA grade

A

multiple osteophytes, definitie JSN, sclerosis, possible bony deformity

35
Q

4 knee OA grade

A

large osteophytes
marked JSN
severe sclerosis
definite bony deformity

36
Q

what is trochanteric bursitis

A

point of tenderness over GT

inflammation of bursa

37
Q

causes of trochanteric bursitis

A 
injury
overuse
incorrect posture
disease
previous surgery
calcium depositis
38
Q

what age is trochanteric bursitis more common

A

middle aged

39
Q

complication of trochanteric bursitis

A

abductor tear as inserts onto greater tubercle

40
Q

management of trochanteric bursitis

A

analgesia

steroids injection

41
Q

collateral ligament injury presentation

A 
valgus/ varus force to the knee 
slower swelling
can keep playing
painful to palpate
valgus/ varus force may open joint- instability 
no haemarthrosis 
instability with extension
42
Q

mechanism of a medial and lateral collateral ligament injury

A

direct blow
vagus for medial
varus for lateral

43
Q

management for collateral ligament injury

A

conservatively with -physio for medial
-for lateral may need to operate for reconstruction -posteerolateral corner
crutches
-operate in multi-ligament

44
Q

3 parts of the unhappy triad and force mechanism

A

medial meniscus
ACL
medial collateral ligament
twisting round foot and varus force

45
Q

history of an ACL ligament injury

A

twisting around fixed foot eg sport netball
immediate haemarthrosis (<5 minutes)
unable to play anymore
may here a pop

46
Q

exam for an ACL injury

A

anterior drawer test with no posterior sag- positive if translation of the tibia

47
Q

management of ACL injury

A

rehab for 3 months

extensive ACL reconstruction

48
Q

indication for extensive ACL reconstruction

A

young
physically active
ongoing instability
multi-liagment damage

49
Q

meniscal injury history

A

twisting injury often occur with/after ligamentous injury

may present late due to severe symptoms

50
Q

exam of a meniscal injury

A
  • mechanical symptoms: lock, click
  • inability to fully straighten knee
  • joint tenderness and effusion
51
Q

test for meniscal injury

A

provocative test- McMurray’s test

52
Q

management for meniscal injury

A
  • MRI gold standard for DX
  • conservative in degenerate tears if OA present
  • arthroscopic debridement
53
Q

posterior cruciate ligament injury history

A
  • direct blow to proximal/ anterior tibia with flexed knee
  • hyperextension or hyperflexion with plantar flexed foot
  • immediate haemarthrosis
  • rare injury
54
Q

exam for posterior cruciate ligament

A

false postive anterior drawer test- ie positive sag

55
Q

management PCL

A

conservative physio rehab

-operate in multiligament or chronic instability

56
Q

3 type of extensor mechanism injury and what age do they commonly occur

A

quads tendon rupture >40
patellar fracture-any age
patellar tendon rupture -<40

othopaedics (21 decks)

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