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MSK > Hip & Knee > Flashcards

Hip & Knee Flashcards

1
Q

What kind of presentations of the knee are commonly seen?

A
  • Pain (anterior, often well-localised)
  • Stiffness
  • Swelling/lump
  • Giving way
  • Deformity
  • Loss of sleep
  • Loss of function
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2
Q

What are the look, feel, moves relevant to the knee?

A

Look: - Deformity
- How the patient walks
- Swelling
- Scars

Feel: - Bony landmarks
- Any tenderness
- Any effusion
- Knee stability
- Get the patient to show where it is sore
- Patellar apprehension test

MOVE : - Extension
- Flexion
- Quads strength

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3
Q

What are investigations relevant to knee presentations?

A

Usually none

X-Ray

MRI

Viscosity (if inflammation is relevant)

Urate (gout usually affect big toe joint, but can affect knee as well)

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4
Q

What are common causes of knee presentations?

A

Ligament strain often medial collateral

Bursitis

Osgood-Schlatter’s

Osteoarthritis (Patello-femoral>knee)

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5
Q

What are less common, but important causes of knee presentations?

A

Chondromalacia patellae

Meniscus injury (though common in A&E)

Cruciate damage

Gout

Rheumatoid arthritis

Patellar subluxation/dislocation

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6
Q

Where does most part of weight pass through the knee? hence most commonly arthritis

A

The medial side

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7
Q

How is osteoarthritis treated?

A

Non-operative:

Operative:

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8
Q

What are risks of total knee replacement/total hip replacement?

A
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9
Q

Can ACL be repaired in adults?

A

Not really

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10
Q

What is the usual location for hip pain?

A

especially site, pain from hip usually groin radiating to anterior thigh.
If patient indicates buttock pain, that is probably coming from back.

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11
Q

What is the look, feel, move for hip joint?

A

LOOK
-Deformity
- Asymmetry
- Scars

FEEL
- Bony landmarks

      - Tenderness

MOVE
- Range of movement

     - Stiffness especially limited internal rotation

     - Pain on moving, how they walk
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12
Q

What are the investigations for hip joint?

A

X-RAY
- only if it will affect your management

CRP/Viscosity

FBC-?Infection

Calcium, Alkaline Phosphatase
- if you suspect bone damage such as by metastases

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13
Q

What are cardinal signs of osteoarthritis on X-ray?

A

Loss of joint space

Osteophytes

Sclerosis

Subarticular cysts

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14
Q

What are primary care management strategies for knee/hip problems?

A

Education / explanation

Weight reduction

Home adaptations (occupational therapy)

Walking stick

Analgesia

NSAIDs

Physio

Complementary therapies

Mobility Allowance, disability badge for car

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15
Q

What are common causes of hip problems?

A

Ostearthritis

Rheumatoid arthritis

Fracture

Referred from back

Malignancy

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16
Q

What are rare, but important causes of knee presentations?

A

Soft tissue e.g. trochanteric bursitis

Paget’s disease

Infection e.g. septic, TB

Avasular necrosis

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17
Q

What factors affect when to refer from primary care?

A

Pain(Especially night pain)

Loss of function

Physical fitness, co-morbidities

Mental fitness (capacity to understand, consent)

Support at home

Patient expectations

Age of patient, possibly

Uncertainty about diagnosis

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18
Q

What are causes of meniscal tears and how are they usually presented?

A

Medial meniscal tears approx. 9-10 times more common than lateral meniscal tears

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19
Q

What are the different patterns of mechanical meniscal tears?

A

bucket handle meniscal tears cause acute locked knee

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20
Q

What is the sign of acute locked knee and how to manage it?

A
21
Q

How to treat mechanical meniscal tears?

A

Limited healing potential

22
Q

What are causes of degenerate meniscus tears and how to manage them?

A
23
Q

What are the ligaments of the knee?

A

Medial collateral ligament - well innervated so very sore when injured

24
Q

How to grade ligament injuries of the knee?

A
25
Q

What are the (biomechanic) consequences of MCL rupture and how to manage them?

A
  1. MCL rupture - valgus
  2. ACL rupture
26
Q

What are the (biomechanic) consequences of ACL rupture and how to manage them?

A

If ACL is damaged, meniscal repair alone would not be sufficient, ACL reconstruction is required

27
Q

What are the outcomes of ACL reconstruction?

A
28
Q

What are the (biomechanic) consequences of LCL rupture and how to manage them?

A
29
Q

What are the (biomechanic) consequences of PCL rupture and how to manage them?

A

Posterior draw test

30
Q

How does knee dislocation present and what are associated injuries? How to manage it?

A
31
Q

Which groups are more likely to get patellar dislocation and how to manage it?

A
32
Q

What is patellofemoral pain syndrome and what can cause it?

A
33
Q

What is extensor mechanism rupture and which groups are more likely to have it? How does it present?

A
34
Q

How to manage osteochondral injuries? (not very efficient)

A
35
Q

What is osteochondritis dissecans? (a mysterious and controversial condition)

A
36
Q

What is bone marrow oedema/bone bruising and how is it managed?

A
37
Q

What are loose bodies? How to diagnose and how to manage?

A
38
Q

What are baker’s cyst and bursitis?

A
39
Q

What are some classic scenarios with knee soft tissue injuries?

A
40
Q

What is osteoarthritis?

A
41
Q

What are causes of OA (especially knee)?

A
42
Q

How might knee alignment predispose to osteoarthritis?

A
43
Q

How to treat osteoarthritis in the knee?

A
44
Q

How to manage osteoarthritis conservatively?

A

Steroid injection reserved only for flare-ups!

45
Q

When is total knee replacement indicated and what is the impact/limitations of it?

A
46
Q

Which groups of patients are more likely to have bad outcomes of TKR?

A

young, obesity, psychologic distress, chronic pain syndrome, less severe OA, very active lifestyle

47
Q

What is an IDEAL patient for TKR like?

A

Only for older, medically fit, appropriate patient with END STAGE arthritis and SEVERE PAIN refractory to conservative management
*constant severe pain
*sleep disturbance
*pain limiting function
*frequent bad flare-ups

48
Q

What are realistic outcomes of TKR?

A
49
Q

What are alternatives of TKR and what are the benefits/limitations of them?

A

MSK (36 decks)

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