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MSK > hip, knee, foot, ankle- CORTEX > Flashcards

hip, knee, foot, ankle- CORTEX Flashcards

1
Q

where does hip pathology cause pain?

A

pain in groin and often radiates to knee

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2
Q

what causes buttock pain?

A
  • hip pathology
  • lumbar spine pathology
  • SI joint pathology
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3
Q

where does SUFE tend to present pain?

A

knee pain

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4
Q

how long do THA (total hip arthroplasty) normally last?

A

15 years

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5
Q

pathophysiology behind THA (total hip arthroplasty) loosening?

A
  • wear and tear
  • particles from the surface of the THA cause an inflammatory response at the implant-bone interface. Macrophages ingest microscopic wear particles and release inflammatory mediators resulting in osteoclastic bone reabsorption

(osteoclasts are cell that break down bone tissue)

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6
Q

what are some early local complications of hip replacement?

A
  • infection
  • dislocation
  • nerve injury (sciatic nerve)
  • leg length discrepancy
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7
Q

what are some late local complications of hip replacement surgery?

A
  • early loosening
  • late infection
  • late dislocation
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8
Q

where does avascular necrosis more commonly occur?

A

hip

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9
Q

ho does trochanteric bursitis present?

A
  • pain and tenderness over greater trochanter

- pain on resisted abduction

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10
Q

what is treatment for trochanteric bursitis?

A
  • no surgical treatment has been proven to benefit

- analgesics, anti inflammatory, physio and steroid injection

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11
Q

what are the 4 main ligaments of the knee?

A
  • anterior cruciate ligament (ACL)
  • posterior cruciate ligament (PCL)
  • medial collateral ligament (MCL)
  • lateral collateral ligament (LCL)
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12
Q

what is the role of the ACL?

A

-to prevent abnormal internal rotation of the tibia

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13
Q

what is the role of the PCL?

A

-prevents hyperextension and anterior translation of the femur

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14
Q

what may predispose early OA in the knee?

A
  • previous meniscal tears
  • ligament injuries
  • malalignment (varus/valgus)
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15
Q

how are meniscal injuries usually caused?

A

-occur with a twisting force on a loaded knee (eg turning at football, squatting)

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16
Q

how do meniscal injuries present?

A
  • patient fels localised pain to the medial (majority) or lateral joint line
  • positive sign on steinmens test
  • effusion develops the next day
  • patient can feel a ‘locking’ of knee or have a catching sensation
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17
Q

what is ‘locking’ of the knee?

A

a mechanical block to full extension

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18
Q

what normally causes ACL rupture?

A

-occur with a higher rotational force, turning the upper body laterally on a planted foot (leading to internal rotation force on the tibia)

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19
Q

how do ACL injuries normally present?

A
  • A ‘pop’ is heard or felt
  • patient usually develops haemarthrosis (an effusion due to bleeding in joint)
  • deep pain in knee
  • choronically the patient may complain of rotatory instability with knee giving away on a planted foot
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20
Q

how do ACL injuries normally present?

A
  • A ‘pop’ is heard or felt
  • patient usually develops haemarthrosis (an effusion due to bleeding in joint)
  • deep pain in knee
  • choronically the patient may complain of rotatory instability with knee giving away on a planted foot
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21
Q

what do valgus stress injuries (eg rugby tackle from the side) usually tear?

A

Medial collateral ligament

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22
Q

what does a direct blow to the anterior tibia usually injure when the knee is flexed (eg motorcycle crash)?

A

PCL

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23
Q

what may a varus stress injury damage?

A

LCL

24
Q

what may happen to the knee during a bucket handle meniscal tear?

A

the knee may fully lock and is unable to extend fully

25
Q

Acute ACL injuries have no correlation with meniscal tears

True or False

A

False- around 25% of acute ACL injuries also have a meniscal tear

26
Q

what injury may occur as the meniscus weakens with age?

A

degenerative meniscal tear

27
Q

what type of meniscal injuries should be considered for repair?

A

fresh longitudinal tears involving outer 1/3 of the meniscus

28
Q

what is the principle complaint of ACL rupture?

A

-rotatory instability with giving way on turning

29
Q

PCL rupture in isolation is common

True or False

A

False- PCL rupture in isolation is uncommon

30
Q

what are the extensor mechanisms of the knee?

A
  • tibial tuberosity
  • patellar tendon
  • patellar
  • quadriceps tendon
  • quadriceps muscles
31
Q

what type of antibiotics can cause tendonitis and risk tendon rupture?

A

quinolones

32
Q

steroid injections should be used to treat pain of tendonitis of the extensor mechanism of the knee

True or False

A

False- steroid injections for tendonitis of the extensor mechanism of the knee should be avoided due to high risk of tendon rupture

33
Q

what is the assessment to check if extensor mechanisms of the knee are still in tact?

A

Straight leg raise

34
Q

what is patellofemoral dysfunction?

A

disorders of the patellofemoral articulation resulting in anterior knee pain

35
Q

which direction do the quadriceps tend to pull the patella?

A

in a slight lateral direction

36
Q

who is patellofemoral dysfunction more common in?

A

females (particularly during adolescence)- due to wider hips resulting in a more lateral pull of the quadriceps, adolescence tend to have a greater degree of ligament laxicity

  • hypermobility
  • genu valgum (knock knees)
  • femoral neck anteversion
37
Q

how do patients with patellofemoral dysfunction tend to present?

A
  • anterior knee pain
  • worse going downhill
  • grinding or clicking sensation on front of knee
  • stiffness after prolonged sitting causing ‘pseudolocking’ where the knee acutely stiffens in a flexed position
38
Q

treatment for patellofemoral dysfunction?

A
  • 90% improve with physio
  • taping can alleviate symptoms
  • surgery is last resort (70% success rate)
39
Q

when can patellar dislocation occur?

A

-with a direct blow or sudden twist of knee

40
Q

which direction does the patella usually dislocate in?

A

virtually always laterally

41
Q

what tearls when the patella dislocates?

A

the medial patellofemoral ligament tears

42
Q

what treatment may be given to a patient with recurrent patellar dislocation?

A

-tibial tubercle transfer or medial patellofemoral ligament reconstruction with tendon autograft

43
Q

what are some causes of ankle OA?

A
  • idiopathic

- consequence of previous injury

44
Q

what is hallux valgus?

A

-a deformity in the great toe due to medial deviation of the 1st metatarsal and lateral deviation of the toe itself

45
Q

who is hallux valgus more common in?

A
  • females
  • incidence increases with age but can occur in adolescence
  • more common in patients with RA
  • more common in neuromuscular disease
46
Q

what is treatment for hallux valgus?

A

conservative:
-wearing of wider and deeper ‘accomodating’ shoes

Surgery

47
Q

what is hallux rigidus?

A

OA of the 1st MTP joint

48
Q

what is the treatment for hallux rigidus?

A

conservative treatment:

  • wearing of stiff soled shoe to limit motion of MTPJ
  • metal bar may also be inserted into sole of shoe

Surgery:
GOLD STANDARD IS ARTHRODESIS

49
Q

what is a mortons neuroma?

A

plantar interdigital nerves overlying the intermetatarsal ligaments can be subjected to repeated trauma, causing the nerves to become irritated and become inflamed and swollen forming a neuroma

50
Q

how do motor neuroma present?

A

-patients complain of a burning pain and tingling radiating into the affected toes

51
Q

Wearing heels increases chances of developing a morton’s neuroma

True or false?

A

-true

52
Q

what can be used to diagnose Morton’s neuroma?

A

USS

53
Q

what is the management for Morton’s neuroma?

A

conservative management:

  • use of metatarsal pad or offloading insole
  • steroid and local anaesthetic injection may relieve symptoms and aid diagnoses

It can also be excised!

54
Q

where do metatarsal stress fractures commonly occur?

A

in the 2nd metatarsal followed by the third

55
Q

who commonly gets metatarsal stress fractures?

A
  • runners
  • soldiers
  • dancers
  • hikers/walkers
56
Q

what is the treatment for metatarsal stress fractures?

A

-prolonged rest for 6 to 12 weeks

MSK (64 decks)

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