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Musculoskeletal > Lower Limb Conditions > Flashcards

Lower Limb Conditions Flashcards

1
Q

what is avascular necrosis

A

loss of blood supply, most commonly to the femoral head

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2
Q

how is avascular necrosis of the hip managed

A

pre-collapse of femoral relieve pressure by air holes

once collapsed the only option is THR

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3
Q

what is trochanteric bursitis

A

inflammation of the bursa surrounding the greater trochanter as the tendons around the abductor muscles are under great stress

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4
Q

pain around the greater trochanter and pain on resisted abduction is suggestive of what

A

trochanteric bursitis

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5
Q

describe the management of trochanteric bursitis

A

analgesics
steroid injection
physiotherapy

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6
Q

list some pre-disposing factors to knee arthritis

A

previous meniscal or ligamentous injury

malalignment eg valgus or varus

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7
Q

what is the function of the menisci

A

to act as shock absorbers and distribute load from fmeoral condyles to flat tibial articular surfaces

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8
Q

the medial meniscus is fixed/mobile and under lots/little stress

A

fixed and under a lots of stress

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9
Q

describe the mechanism of injury that occurs with meniscal tears

A

occurs with twisting force on a loaded knee - playing sport

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10
Q

describe the presentation of a meniscal tear

A

pain localised to medial/lateral joint line
sense of knee locking
cannot fully extend the knee 15 degree block
steinmanns test positive

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11
Q

describe the blood supply to the meniscus

A

only peripheral third of the meniscus has blood supply therefore tears dont always heal well

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12
Q

what investigation is carried out for suspected meniscal tear

A

MRI - showing the location and degree of the tear

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13
Q

describe a bucket handle tear

A

large longitudinal tear causing fragment to come out of normal position and displacing anteriorly

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14
Q

what is the treatment for a meniscal tear

A

vascular ones can be treated by suturing the meniscus to the bed
if no blood supply the tears must be removed altogether predisposing to OA

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15
Q

describe a grade 1, 2 and 3 ligament injury

A

1 - sprain with some torn fibres but macroscopically intact
2 - partial tear with fascicles disrupted
3 - complete tear

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16
Q

describe the presentation of ACL rupture

A

occurs on rotating body laterally with foot planted, internal rotation on the tibia
hear a pop when injury occurs
development of haemarthrosis
long term feeling of instability

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17
Q

what is a haemarthrosis

A

effusion due to bleeding within the joint

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18
Q

what is the management for ACL rupture

A

rest and physio best option in elderly etc

if young and active attempt reconstruction of ligament with tendon graft from patella

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19
Q

what mechanism causes an MCL rupture

A

valgus stress - usually contact sports

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20
Q

what is the management for MCL rupture

A

rarely surgery - usually knee brace if no other ligament injuries

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21
Q

what causes a PCL rupture

A

direct blow to anterior tibia eg motor cycle crash

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22
Q

the PCL is more or less common to rupture than the ACL and why

A

less common as is a thicket ligament

23
Q

list the structures in the extensor mechanism from proximal to distal

A 
quadriceps 
quadriceps tendon 
patella 
patella tendon
tibial tuberosity
24
Q

list some of the risk factors for developing extensor mechanism ruptures

A 
chronic steroid use 
diabetes 
chronic renal disease 
previous tendonitis 
quinolone antibiotics - increases tendonitis risk
25
Q

patella rupture commonly occurs in which age group

A

<40s

26
Q

quadriceps rupture commonly occurs in which age group

A

> 40s

27
Q

straight leg raise is positive in which condition

A

extensor mechanism rupture - cannot lift leg on extension

28
Q

describe the management of extensor mechanism rupture

A

surgical tendon to tendon repair or reattach tendon to patella

29
Q

what is hallux valgus

A

lateral deviation of the great toe with medial deviation of the first metatarsal head

30
Q

list the risk factors for developing hallux valgus

A

female > male
wearing shoes
familial history
inflammatory arthritis and MS

31
Q

describe the presentation of hallux valgus

A

pain around first MTP
development of bunion - shoes rubbing to cause inflamed bursa
rubbing of great toe against second toe causing skin break and ulceration

32
Q

describe the management of hallux valgus

A

conservative - wear accomodating shoes, use of spacer between first and second toe
surgical - osteotomies to realign bones and soft tissue procedures to release tight tissues

33
Q

what is hallux rigidus

A

osteoarthritis of the first MTP

34
Q

describe both the conservative and surgical management for hallux rigidus

A

conservative - wearing of stiff soled shoes to prevent movement
surgical - arthrodesis to prevent motion and alleviate pain or MTP ceramic joint replacement

35
Q

which nerves are affected in mortons neuroma

A

plantar interdigital nerves overlying the intermetatarsal ligaments

36
Q

how does mortons neuroma present

A

burning pain and tingling commonly in the third toe
loss of sensation of webbed space
positive mulders test

37
Q

describe mulders test

A

click heard when compressing MTPs medio-laterally means mortons neuroma

38
Q

what is used to diagnose mortons neuroma

A

ultrasound showing swollen nerve

39
Q

what is the treatment for mortons neuroma

A

conservative - steroid or local anaesthetic in injections to relieve pain
surgical - excision of neuroma but high rates of recurrence

40
Q

where are metatarsal stress fractures most likely to occur

A

second and third MTPs

41
Q

how is a stress fracture diagnosed

A

x-ray may not show fracture until 3 weeks after injury when calluses are formed - must re-do then

42
Q

what is the management of metatarsal stress fracture

A

prolonged rest for 6-12 weeks in a rigid soled boot

43
Q

what increases risk of developing achilles tendonitis

A

quinolone antibiotics
RA and gout
repetitive strains from sports

44
Q

tendonitis can be treated with steroid injection true/false

A

false as increases risk of ruptures

45
Q

describe simmonds test when assessing for achilles tendon rupture

A

loss of plantarflexion when squeezing the calf

46
Q

plantar fasciitis is a self-limiting condition true/false

A

true - caused by repetitive stress and overload on the foot

47
Q

what are the risk factors for developing plantar fasciitis

A

obesity
excessive walking
diabetes

48
Q

how does plantar fasciitis present

A

pain felt walking on the instep of the foot
localised tenderness on palpation
pain is worst in the morning taking first steps

49
Q

how is plantar fasciitis managed

A

rest and achilles stretching, corticosteroids can also improve pain

50
Q

what is pes cavus

A

abnormally high arched feet

51
Q

how is pes cavus managed

A

soft tissue releases and tendon transfers if supple

osteotomies if more rigid

52
Q

describe claw toes appearance

A

hyperextension at MTP

hyperflexion at PIP and DIP

53
Q

describe hammer toes appearance

A

hyperextension at MTP
hyperflexion at PIP
hyperextension at DIP

54
Q

describe mallet toes appearance

A

fixed flexion deformity of the DIP, manage with flexor tenotomy and joint arthrodesis at DIP

Musculoskeletal (11 decks)

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