Hip & Knee Flashcards
(49 cards)
What kind of presentations of the knee are commonly seen?
- Pain (anterior, often well-localised)
- Stiffness
- Swelling/lump
- Giving way
- Deformity
- Loss of sleep
- Loss of function
What are the look, feel, moves relevant to the knee?
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
What are investigations relevant to knee presentations?
Usually none
X-Ray
MRI
Viscosity (if inflammation is relevant)
Urate (gout usually affect big toe joint, but can affect knee as well)
What are common causes of knee presentations?
Ligament strain often medial collateral
Bursitis
Osgood-Schlatter’s
Osteoarthritis (Patello-femoral>knee)
What are less common, but important causes of knee presentations?
Chondromalacia patellae
Meniscus injury (though common in A&E)
Cruciate damage
Gout
Rheumatoid arthritis
Patellar subluxation/dislocation
Where does most part of weight pass through the knee? hence most commonly arthritis
The medial side
How is osteoarthritis treated?
Non-operative:
Operative:
What are risks of total knee replacement/total hip replacement?
Can ACL be repaired in adults?
Not really
What is the usual location for hip pain?
especially site, pain from hip usually groin radiating to anterior thigh.
If patient indicates buttock pain, that is probably coming from back.
What is the look, feel, move for hip joint?
LOOK
-Deformity
- Asymmetry
- Scars
FEEL
- Bony landmarks
- Tenderness
MOVE
- Range of movement
- Stiffness especially limited internal rotation
- Pain on moving, how they walk
What are the investigations for hip joint?
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
What are cardinal signs of osteoarthritis on X-ray?
Loss of joint space
Osteophytes
Sclerosis
Subarticular cysts
What are primary care management strategies for knee/hip problems?
Education / explanation
Weight reduction
Home adaptations (occupational therapy)
Walking stick
Analgesia
NSAIDs
Physio
Complementary therapies
Mobility Allowance, disability badge for car
What are common causes of hip problems?
Ostearthritis
Rheumatoid arthritis
Fracture
Referred from back
Malignancy
What are rare, but important causes of knee presentations?
Soft tissue e.g. trochanteric bursitis
Paget’s disease
Infection e.g. septic, TB
Avasular necrosis
What factors affect when to refer from primary care?
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
What are causes of meniscal tears and how are they usually presented?
Medial meniscal tears approx. 9-10 times more common than lateral meniscal tears
What are the different patterns of mechanical meniscal tears?
bucket handle meniscal tears cause acute locked knee
What is the sign of acute locked knee and how to manage it?
How to treat mechanical meniscal tears?
Limited healing potential
What are causes of degenerate meniscus tears and how to manage them?
What are the ligaments of the knee?
Medial collateral ligament - well innervated so very sore when injured
How to grade ligament injuries of the knee?
