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Leg pain Flashcards

1
Q

MC nerve root causing leg pain

A

L5 and S1 nerve roots

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2
Q

Chronic ischaemia due to arterial occlusion can

manifest as :

A

intermittent claudication or rest pain in

the foot due to small vessel disease

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3
Q

varicose veins can certainly cause a dull aching ‘heaviness’ and cramping, and can lead to _____

A

painful ulceration

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4
Q

The most common cause of leg pain in children is _______

A

soreness and muscular strains due to trauma or unaccustomed exercise.

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5
Q

So-called _________, or idiopathic leg pain, is
thought to be responsible for up to 20% of leg pain in
children

A

‘growing pains’

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6
Q

Pain location of growing pains

A

The pains are typically intermittent and
symmetrical and deep in the legs, usually in the
anterior thighs or calves

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7
Q

Main consideartions for leg pain in the elderly

A

The older the patient, the more likely it is that arterial
disease with intermittent claudication and neurogenic
claudication due to spinal canal stenosis will develop

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8
Q

_______ is usually contraindicated for radicular sciatica

A

Conventional spinal manipulation

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9
Q

Referred pain in the leg can arise from disorders

of the _____ or ______

A

SIJs or from spondylogenic disorders

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10
Q

__________ is that which
originates from any of the components of the vertebrae
(spondyles), including joints, the intervertebral disc,
ligaments and muscle attachments

A

Non-radicular or spondylogenic pain

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11
Q

This causes typically a dull ache in the buttock
but it can be referred to the iliac fossa, groin or
posterior aspects of the thighs

A

Sacroiliac dysfunction

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12
Q

This is the commonest lower limb entrapment and
is due to the lateral femoral cutaneous nerve of the
thigh being trapped under the lateral end of the
inguinal ligament, 1 cm medial to the ASIS.

A

Meralgia paraesthetica

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13
Q

DDx for Meralgia paraesthetica

A

• L2 or L3 nerve root pain (L2 causes buttock pain
also)
• Femoral neuropathy (extends medial to midline)

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14
Q

The _________nerve can
be entrapped where it winds around the neck of the
fibula or as it divides and passes through the origin of
the peroneus longus muscle 2.5 cm below the neck of
the fibula.

A

common peroneal (lateral popliteal)

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15
Q

Pain location of peroneal nerve palsy

A

Pain in the lateral shin area and dorsum of the

foot

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16
Q

This is an entrapment neuropathy of the posterior
tibial nerve in the tarsal tunnel beneath the flexor
retinaculum on the medial side of the ankle. The

A

Tarsal tunnel syndrome

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17
Q

SSx of Tarsal tunnel syndrome

A

A burning or tingling pain in the toes and sole of
the foot, occasionally the heel.

Retrograde radiation to calf, perhaps as high as
the buttock

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18
Q

Test for Tarsal tunnel syndrome

A

Tinel test (finger or reflex hammer tap over
nerve below and behind medial malleolus) may
be positive

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19
Q

Mx of Tarsal tunnel syndrome

A
  • Relief of abnormal foot posture with orthotics
  • Corticosteroid injection into tunnel
  • Decompression surgery if other measures fail
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20
Q

The commonest site of acute occlusion is the _____

A

common femoral artery

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21
Q

Ominous sign of acute limb ischemia

A

Paralysis (paresis or weakness) and muscle compartment
pain or tenderness is a most important and
ominous sign

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22
Q

acute limb ischemia

If the foot becomes dusky purple and fails to blanch on pressure, ________ has occurred

A

irreversible necrosis

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23
Q

What artery is being tested?

Palpate deeply just below the inguinal ligament, midway between the ASIS and the symphysis pubis. If absent or diminished, palpate over abdomen for aortic aneurysm

A

Femoral artery.

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24
Q

What artery?

Palpate, with curved fingers,
just behind and below the tip of the medial malleolus
of the ankle.

A

Posterior tibial artery

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25
Q

What artery?

Feel at the proximal end of the first metatarsal space just lateral to the extensor tendon of the big toe.

A

Dorsalis pedis artery.

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26
Q

pitting oedema is tested by ________

A

pressing firmly with your thumb for at least
5 seconds over the dorsum of each foot, behind each
medial malleolus and over the shins.

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27
Q

What test?

Raise both legs to about 60 ° for about 1 minute, when
maximal pallor of the feet will develop. Then get the
patient to sit up on the couch and hang both legs
down.

A

Postural colour changes (Buerger test)

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28
Q

What is a positive Buerger test?

A

A positive Buerger test is pallor on elevation and rubor on dependency and indicates severe chronic ischaemia

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29
Q

What is the golden rule for Tx of ALI

A

Occlusion is usually reversible if treated within 4 hours (i.e. limb salvage). It is often irreversible if treated after 6 hours (i.e. limb amputation).

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30
Q

Mx of ALI

A
  • Intravenous heparin (immediately) 5000 U

* Emergency embolectomy (ideally within 4 hours):

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31
Q

Sx of ALI

A

• Stenting of vessels (a good modern option)—discuss
this with an interventional cardiovascular physician
• Arterial bypass if acute thrombosis in chronically
diseased artery

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32
Q

Mx of irreversible ALI

A

Amputation (early) if irreversible ischaemic changes

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33
Q

ALI prevention

A

Lifetime anticoagulation with warfarin will be

required

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34
Q

_______caused by gradual arterial
occlusion can manifest as intermittent claudication,
rest pain in the foot, or overt tissue loss—ulceration,
gangrene

A

Chronic ischaemia

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35
Q

_______is a pain or tightness
in the muscle on exercise (Latin claudicare, to limp),
relieved by rest

A

Intermittent claudication

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36
Q

________ is a constant severe
burning-type pain or discomfort in the forefoot at
rest, typically occurring at night when the blood flow
slows down.

A

Rest pain

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37
Q

Determine the level of obstruction

• Pain in the buttock, thigh and calf, especially
when walking up hills and stairs
• Persistent fatigue over whole lower limb
• Impotence is possible (Leriche syndrome)

A

Proximal obstruction (e.g. aortoiliac)

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38
Q

Obstruction in the thigh

Determine the level of osbtruction

•____________ (the commonest) causes
pain in the calf (e.g. 200–500 m), depending on
collateral circulation
• ___________ → claudication at about 100 m
•___________ → claudication at 40–50 m

A

Superficial femoral

profunda femoris

multiple segment involvement

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39
Q

affects small arteries, causes rest

pain and cyanosis (claudication uncommon)

A

Buerger disease

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40
Q

The presence of_________implies an immediate threat to limb viability.

A

rest pain

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41
Q

In CLI,

Why do doppler?

A

measure resting ankle systolic BP; determine ankle/brachial index; normal value 0.9–1.1

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42
Q

Gold standard for dx of CLI

A

Angiography: the gold standard, reserved for

proposed intervention

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43
Q

What to do in CLI if need surgery is needed?

A

Arteriography

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44
Q

Drug TX for CLI

A

Drug therapy: aspirin 150 mg daily.

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45
Q

What has no value in CLI Tx

A

Drug therapy: aspirin 150 mg daily.

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46
Q

Prognosis of CLI

A

About one-third progress, while the rest regress

or don’t change. 5

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47
Q

When to refer to a vascular surgeon?

A
  • ‘Unstable’ claudication of recent onset; deteriorating
  • Severe claudication—unable to maintain lifestyle
  • Rest pain
  • ‘Tissue loss’ in feet
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48
Q

What surgical procedure?

__________—for localised iliac stenosis

A

endarterectomy

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49
Q

What procedure?

This angioplasty is performed with a special intra-arterial balloon catheter for localised limited occlusions. An alternative to the balloon is laser angioplasty

A

Percutaneous transluminal dilation

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50
Q

________ are dilated, tortuous and elongated

superficial veins in the lower extremity

A

Varicose veins

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51
Q

Why are varicose veins dilated?

1
2

A

The veins are dilated because of incompetence
of the valves in the superficial veins or in the
communicating or perforating veins between the
deep and superficial systems

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52
Q

Risk factors for varicose veins

A 
Female sex
Family history
Pregnancy
Multiparity
Age
Occupation
Diet (low fibre)
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53
Q

Dilated superficial veins, which can mimic varicose
veins, may be caused by extrinsic compression of
the veins by a_____ or _________

A

pelvic or intra-abdominal tumour

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54
Q

Uncommon causes of superficial veins

A

Uncommonly, but importantly, superficial veins
dilate as they become collaterals following previous
DVT, especially if the ilio-femoral segment is involved.

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55
Q

When do varicose veins become painful?

A

Pain is a feature where there are incompetent perforating
veins running from the posterior tibial vein to the
surface through the soleus muscle

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56
Q

Cx of varicose veins

A 
Superficial thrombophlebitis
Skin ‘eczema’ (10%)
Skin ulceration (20%)
Bleeding
Calcification
Marjolin ulcer (squamous cell carcinoma
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57
Q

This helps determine long saphenous vein incompetence.
A marked dilated long saphenous vein in the fossa ovalis (saphena varix) will confirm incompetence. It disappears when the patient lies down

A

Venous groin cough impulse

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58
Q

A doubly positive __________is
when the veins fill rapidly before the pressure is
released and then with a ‘rush’ when released. This
indicates coexisting incompetent perforators and
long saphenous vein

A

Trendelenburg test

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59
Q

A similar test to the Trendelenburg test is performed with the pressure (tourniquet or finger) being applied over the
short saphenous vein just below the popliteal fossa

A

Short saphenous vein incompetence test.

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60
Q

Where are the sites where it is difficult to identify incompetence

A

medial aspect of the

leg, posterior to the medial border of the tibia

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61
Q

_____________studies will accurately localise sites of incompetence and determine the state of the functionally important deep venous system.

A

Venous duplex ultrasound

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62
Q

How to Tx varicose veins

A

• Keep off legs as much as possible.
• Sit with legs on a footstool.
• Use supportive stockings or tights (apply in
morning before standing out of bed).
• Avoid scratching itching skin over veins.

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63
Q

What Tx regimen?

It is ideal for smaller, isolated veins, particularly
below the knee joint.

A

Compression sclerotherapy

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64
Q

This is the best treatment when a clear
association exists between symptoms and
obvious varicose veins (i.e. long saphenous vein
incompetence

A

Surgical ligation and stripping

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65
Q

T or F

Surgery for varicose veins may relieve
heavy, aching legs

A

F (does not relieve)

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66
Q

• Usually occurs in superficial varicose veins
• Presents as a tender, reddened subcutaneous
cord in leg
• Usually localised oedema

A

Superficial thrombophlebitis

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67
Q

When is there a risk of DVT in superficial thrombophlebitis?

A

there is extension above the level of the

knee when there is a risk of pulmonary embolism

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68
Q

This rare but life-threatening condition is when an
extensive clot obstructs the iliofemoral veins so
completely that subcutaneous oedema and blanching
occurs.

A 
Iliofemoral thrombophlebitis
(phlegmasia dolens)
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69
Q

Initial presentation of Iliofemoral thrombophlebitis

A

This initially causes a painful ‘milky white

leg’, previously termed phlegmasia alba dolens

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70
Q

Cx of Iliofemoral thrombophlebitis

A

may develop ‘shock’,

gangrene and pulmonary embolus.

71
Q

Mc etiologies of Cellulitis and erysipelas

A

Streptococcus pyogenes (commonest) and Staphylococcus aureus.

72
Q

Tx of S. pyogenes

A

If S. pyogenes confirmed:

phenoxymethylpenicillin 500 mg(o) 6 hourly for 10 days

73
Q

Doubtful of Dx of S. pyogenes? How to Tx

A

If organism doubtful:

flu/dicloxacillin 500 mg (o) 6 hourly for 7–10 days

74
Q

Tx of severe, life threatenong S. aureus

A

Severe, may be life-threatening: flucloxacillin/dicloxacillin 2 g IV 6 hourly for 7–10 days

75
Q

T or F

Always X-ray the legs (including hips) of a patient
complaining of unusual deep leg pain, especially
a child.

A

T

76
Q

Pain that does not fluctuate in intensity with

movement, activity or posture has ____ or ______ cause

A

an inflammatory

or neoplastic cause

77
Q

Hip disorders such as _____ and _______can present as pain in the knee
(usually medial aspect).

A

osteoarthritis and slipped

femoral epiphysis

78
Q

Avoidance of amputation with acute lower limb

ischaemia depends on early recognition which is __________

A

(surgery

within 4 hours—too late if over 6 hours).

79
Q

Common presentation of knee problems

A

pain, stiffness, swelling, clicking and

locking

80
Q

Excessive strains across the knee, such as a _________are more likely to cause ligament
injuries, while twisting injuries tend to cause
_________

A

valgus producing force,

meniscal tears

81
Q

It should be suspected with a history of either a valgus strain or a sudden pivoting of the knee, often associated
with a cracking or popping sensation.

It is often associated with the rapid onset of haemarthrosis or inability to walk or weight-bear.

A

A ruptured anterior cruciate ligament (ACL)

82
Q

A rapid onset of painful knee swelling (minutes

to 1–4 hours) after injury indicates________

A

blood in the

joint—haemarthrosis

83
Q

Swelling over 1–2 days after injury indicates

synovial fluid—______

A

traumatic synovitis

84
Q

Any collateral ligament repair should be undertaken
early but, if associated with ACL injuries, early
surgery may result in ________

A

knee stiffness

85
Q

Consider_________ in the
prepubertal child (especially a boy aged 10–14)
presenting with knee

A

Osgood–Schlatter disorder (OSD)

86
Q

The condition known as _______ is the
commonest type of knee pain and accounts for
at least 11% of sports-related musculoskeletal
problems.

A

anterior knee pain

87
Q

Prime cause of anterior knee pain

A

The prime cause of this is patellofemoral
dysfunction pain. It is a benign condition with a
good prognosis.

88
Q

The hip joint is mainly innervated by________ hence
pain is referred from the groin down the front
and medial aspects of the thigh to the knee

A

L3,

89
Q

It is not uncommon for children with a
slipped upper femoral epiphysis to present with a
_______

A

limp and knee pain

90
Q

Patients with disc lesions may notice that
__________ hurts the knee,
whereas walking does not because of the L3 innervation

A

sitting, coughing or straining

91
Q

L3 nerve root pressure from an L2–3 disc prolapse
(uncommon) and L4 nerve root pain will cause
_________

A

anteromedial knee pain

92
Q

L5 reference from an L4–5

disc prolapse can cause _______

A

anterolateral knee pain,

93
Q

S1 reference from an L5–S1 prolapse can cause pain

at the_______

A

back of the knee

94
Q

A UK study highlighted the fact that the commonest

causes of knee pain are ______ and ______due to overstress of the knee or other minor trauma

A

simple ligamentous strains

and bruises

95
Q

Low-grade trauma of repeated overuse, such as
frequent kneeling, may cause ___________
known variously as ‘housemaid’s knee’ or ‘carpet
layer’s knee’.

A

prepatellar bursitis

96
Q

________ is referred to as ‘clergyman’s knee

A

Infrapatellar bursitis

97
Q

The most common overuse problem of the knee
is the________________(often
previously referred to as chondromalacia patellae).

A

patellofemoral joint pain syndrome

98
Q

MC mets to the knees

A

The commonest neoplasias are secondaries from the

breast, lung, kidney, thyroid and prostate

99
Q

Septic arthritis from blood-borne infection can be of the primary type in children, where the infection is either ______, _______ and _______ in adults.

A

staphylococcal or due to Haemophilus influenzae, or gonococcal arthritis

100
Q

________ should be kept in
mind with a fleeting polyarthritis that involves the
knees and then affects other joints

A

Rheumatic fever

101
Q

Red flag pointers for knee pain

A
  • Acute swelling with or without trauma
  • Acute or acute on chronic erythema
  • Systemic features (e.g. fever) in absence of trauma
  • Unexplained chronic, persistent pain
102
Q

A ruptured_______ will cause severe pain
behind the knee and can be confused with deep
venous thrombosis

A

Baker cyst

103
Q

The sudden onset of painful swelling (usually within

60 minutes) is typical of________

A

haemarthrosis

104
Q

Causes of hemarthrosis?

A

Torn cruciate ligaments, esp. ACL
Capsular tears with collateral ligament tears
Peripheral meniscal tears
Dislocation or subluxation of patella
Osteochondral fractures
Bleeding disorders (e.g. haemophilia), anticoagulants

105
Q

Causes of recurrent pain and swelling

A 
• patellofemoral pain syndrome
• osteochondritis dissecans
• degenerative joint disease including degenerative
meniscus tears
• arthritides
106
Q

________ usually means a sudden inability to extend
the knee fully (occurs at 10–45 ° , average 30 ° ) but
ability to flex fully

A

Locking

107
Q

Causes of true locking

A 
• torn meniscus (bucket handle)
• loose body (e.g. bony fragment from
osteochondritis dissecans)
• torn ACL (remnant)
• flap of articular cartilage
• avulsed anterior tibial spine
• dislocated patella
• synovial osteochondromatosis
108
Q

Causes of pseudolocking

A
  • patellofemoral disorders
  • first or second degree medial ligament tear
  • strain of ACL
  • gross effusion
  • pain and spasm of hamstrings
109
Q

_________ of the knee implies that the patient
feels that something is ‘getting in the way of joint
movement’ but not locking

A

‘Catching’

110
Q

_________ may be due to an abnormality such as
patellofemoral maltracking or subluxation, a loose
intra-articular body or a torn meniscus, but can
occur in normal joints when people climb stairs or
squat

A

Clicking

111
Q

Causes of anterior knee pain

A
  • patellofemoral syndrome
  • osteoarthritis of the knee
  • patellar tendonopathy
  • osteonecrosis
112
Q

Common causes of lateral knee

A
  • osteoarthritis of lateral compartment of knee
  • lesions of the lateral meniscus
  • patellofemoral syndrome
113
Q

What ligaments are affected by these tests

A

Adduction (varus) and abduction (valgus) stresses of the tibia on the femur are applied in full extension and then at 30 ° flexion with the leg over the side of the couch

114
Q

What indicates damage in the ligament test

A

firmness indicates stability, ‘mushiness’ indicates damage

115
Q

Stability of the ACL can be tested with the_______

A

anterior drawer test

116
Q

What test?

The tibia is pulled forwards off the femur and in
the presence of a cruciate ligament injury there will
be increased gliding of the tibia on the femur

A

anterior drawer test

117
Q

In the presence of ______ injury, the increased
external rotation of the tibia against the femur may
add to the positive drawer sign

A

medial ligament

118
Q

What test?

The patient lies on the couch and the flexed knee is rotated (internally and externally) in varying degrees of abduction as it is straightened into extension. A hand over the affected knee feels for ‘clunking’ or tenderness

A

McMurray test.

119
Q

What test?

At 15–20° flexion,
attempt to push the patella laterally and note the
patient’s reaction.

A

Patella apprehension test

120
Q

If the Q angle is >15 ° in men and >19 ° in women

there is a predisposition to____ and ______

A

patellofemoral pain and instability.

121
Q

________ excellent for diagnosing cartilage and
menisci disorders and ligament damage;
the investigation of choice for internal
‘derangement

A

MRI:

122
Q

What dxtic:

_________ good for assessment of patellar
tendon, soft tissue mass, fluid collection,
Baker cyst and bursae

A

ultrasound:

123
Q

When is CT useful in knee conditions?

A

useful for complex fractures of tibial
plateau and patellofemoral joint special
dysfunction

124
Q

A painful knee during the first decade of life (0–10
years) in non-athletes is an uncommon presenting
symptom, but_____ and ______ have to be considered

A

suppurative infection and juvenile

chronic arthritis

125
Q

__________which is often seen around
4–6 years, may predispose to abnormal biomechanical
stresses, which contribute to overuse-type injuries if
the child is involved in sport

A

genu valgum,

126
Q

Pain in the knee presents most frequently in the second

decade and is most often due to the _______

A

patellofemoral

syndrome

127
Q

In children in their 20s, An important problem is subluxation of the patella, typically found in teenage girls. It is caused by _____________without complete dislocation of the patella

A

maltracking of the patellofemoral mechanism

128
Q

OSD is common in pre-pubertal adolescent boys

but can occur in those aged_____

A

10–16 years

129
Q

__________ is a traction
apophysitis resulting from repetitive traction stresses
at the insertion of the patellar tendon into the tibial
tubercle, which is vulnerable to repeated traction in
early adolescence

A

Osgood–Schlatter disorder (OSD)

130
Q

SSx of OSD

A

• Localised pain in region of tibial tubercle during
and after activity
• Aggravated by kneeling down and going up and
downstairs

131
Q

Pain character of OSD

A

Pain reproduced by attempts to straighten flexed

knee against resistance

132
Q

T or F, in OSD

Corticosteroid injections should be avoided

A

T

133
Q

T or F, in OSD

Plaster cast immobilisation should also be avoided

A

T

134
Q

This commonly occurs in adolescent boys aged 5–15
years whereby a segment of articular cartilage of the
femoral condyle (85%) undergoes necrosis and may
eventually separate to form an intra-articular loose
body

A

Osteochondritis dissecans: juvenile form

135
Q

Osteoarthritis is the most common cause and

excellent results are now being obtained using ____________ in those severely affected

A

total knee replacement

136
Q

________typically a disorder of the elderly with
about 50% of the population having evidence of
involvement of the knee by the ninth decade.

Most cases remain asymptomatic but patients (usually
aged 60 or older) can present with an acutely hot, red,
swollen joint resembling septic arthritis.

A

Chondrocalcinosis of knee

pseudogout

137
Q

Possible associated DO of Chondrocalcinosis of knee

pseudogout

A

haemochromatosis, hyperparathyroidism or

diabetes mellitus

138
Q

Tx of pseudogout

A

The treatment is similar to acute
gout although colchicine is less effective. Acute
episodes respond well to NSAIDs or intra-articular
corticosteroid injection.

139
Q

Spontaneous osteonecrosis of the knee (SONK) is
more common after the age of 60, especially in females;
it can occur in either the _____ and ______

A

femoral (more commonly)

or tibial condyles

140
Q

The sudden onset of pain in the knee, with a normal joint

X-ray, is diagnostic of _______

A

osteonecrosis

141
Q

Surgical Mx of osteonecrosis

A

Surgery in the form of subchondral drilling may be

required for persistent pain in the early stage

142
Q

The adult form occurs more often in males and may
be the result of cysts of osteoarthritis fracturing into
the joint

A

Osteochondritis dissecans:

adult form

143
Q

This common complaint is usually a result of a
pedunculated fibrous lump in the prepatellar bursa,
often secondary to trauma, such as falls onto the knee.

A

The knee ‘mouse

144
Q

T or F

The medial meniscus is three times more likely to
be torn than the lateral

A

T

145
Q

Suspect these injuries when
there is a history of injury with a twisting movement
with the foot firmly fixed on the ground

A

Meniscal tears

146
Q

What are the signs of Parrot beak tear of lateral meniscus:?

A 
— pain in the lateral joint line
— pain radiating up and down the thigh
— pain worse with activity
— a palpable and visible lump when the knee is
examined at 45°
147
Q

How to manage Parrot beak tear of lateral meniscus:?

_________ offers relief.

The peripheral meniscus is vascular and can be
repaired within________weeks of injury

A

Arthroscopic partial meniscectomy

6–12

148
Q

Sx of Cleavage tear of medial meniscus

A

— pain in medial joint line
— pain aggravated by slight twisting of the joint
— pain provoked by patient lying on the side
and pulling the knees together
— pain worse with activity

149
Q

Mx of medial meniscus tear

A

Arthroscopic meniscectomy is appropriate
treatment, but some do settle with a trial of
physiotherapy

150
Q

Possible mechanisms of Anterior cruciate ligament rupture?
1
2
3

A

• Sudden change in direction with leg in momentum
• Internal tibial rotation on a flexed knee
(commonest) (e.g. during pivoting)
• Marked valgus force (e.g. a rugby tackle)

151
Q

What is the ‘unhappy triad’

A

ruptured ACL, medial meniscus tear and medial collateral ligament tear.

152
Q

This is a very serious and disabling injury that may
result in chronic instability. Chronic instability can
result in degenerative joint changes if not dealt with

A

Anterior cruciate ligament rupture

153
Q

DDx of Anterior cruciate ligament rupture

A

subluxed or dislocated

patella

154
Q 
What are the tests for subluxed or dislocated
patella?
1
2
3
A

— anterior drawer: negative or positive
— pivot shift test: positive (only if instability)
— Lachman test: lacking an end point

155
Q

What test?

This test is emphasised because it is a sensitive and
reliable test for the integrity of the ACL. It is an
anterior draw test with the knee at 15–20 ° of flexion.
At 90 ° of flexion, the draw may be negative but the
anterior cruciate torn.

A

The Lachman test

156
Q

Functional instability due to anterior cruciate
deficiency is best elicited with the _________
This is more difficult to perform than the Lachman
test.

A

pivot shift test.

157
Q

This is an important test for anterolateral rotatory
instability. It is positive when anterior cruciate injuries
are sufficient to produce a functional instability.

A

Pivot shift test

158
Q

Sx Mx of ACL tears

A

This usually involves reconstruction of the ligament using patellar or preferably hamstring tendons

159
Q

How to MX ACL injury with a significant medial

ligament injury

A

The presence of an ACL injury with a significant medial
ligament injury will necessitate reconstructive surgery
but this is probably best delayed for some weeks as the
subsequent incidence of knee stiffness is high.

160
Q

Mechanisms of PCL injury

A
  • Direct blow to the anterior tibia in flexed knee
  • Severe hyperextension injury
  • Ligament fatigue plus extra stress on knee
161
Q

Mx of PCL injury

A

• Usually managed conservatively with
immobilisation and protection for 6 weeks
• Graduated weight-bearing and exercises

162
Q

__________calcification in haematoma at

upper (femoral) origin of MCL

A

Pellegrini–

Stieda syndrome—

163
Q

Mx of MCL rupture

A

If an isolated injury, this common injury responds
to conservative treatment with early limited motion
bracing to prevent opening of the medial joint line.

164
Q

Always think of an _________ in a young boy
with severe bone pain in a leg (especially at night)
that responds nicely to aspirin or paracetamol or
other NSAID

A

osteoid osteoma

165
Q

If a patient presents with a history of an audible
‘pop’ or ‘crack’ in the knee with an immediate
effusion (in association with trauma) he or she has
an _________ until proved otherwise

A

ACL tear

166
Q

Haemarthrosis following an injury should be
regarded as an ________ until proved
otherwise

A

anterior cruciate tear

167
Q

The ‘movie theatre’ sign, whereby the patient seeks
an aisle seat to stretch the knee, is usually due to
__________

A

patellofemoral pain syndrome

168
Q

The ‘bed’ sign, when pain is experienced when the

knees touch while in bed, is suggestive of a _______

A

medial

meniscal cleavage tear

169
Q

A__________(medial pain on full squatting)
indicates a tear of the posterior horn of the medial
meniscus.

A

positive squat test

170
Q

________ should not be performed on the

young athlete with an acute knee injury

A

Joint aspiration

171
Q

If an older female patient presents with the sudden

onset of severe knee pain think of _____

A

osteonecrosis.

172
Q

Reserve intra-articular corticosteroid injections

for inflammatory conditions such as ______

A

rheumatoid

arthritis or a crystal arthropathy:

173
Q

When not give IA injections?

A

inflammation is acute and diffuse or in the early stages of injury

MC (90 decks)

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