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Phase 2- MSK > Lower Limb Pathologies > Flashcards

Lower Limb Pathologies Flashcards

1
Q

What is osteoarthritis of the hip?

A

A degenerative disease of the synovial joint which results in the progressive loss of cartilage

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2
Q

Give 4 risk factors for hip osteoarthritis

A 
Trauma
Muscle weakness
Manual job 
High impact sports player
Paediatric hip conditions
Family history
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3
Q

Describe the pathophysiology of osteoarthritis

A

Over time there is less water and fewer proteoglycans in collagen
In the synovium this causes inflammation to occur
The synovium becomes more thick and vascularised over time
The bone tries to remodel and forms lytic lesions with sclerotic edges
In late disease, bone cysts can form around the joint

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4
Q

Give 3 symptoms of hip osteoarthritis

A

Limiting hip pain
Pain at night and at rest
Hip stiffness
Hip locking and instability

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5
Q

What will be found on examination of the hip joint in hip osteoarthritis?

A

Altered gait
Leg length discrepancy
Unable to fully flex and extend
Limited internal rotation

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6
Q

What is seen on x-rays in osteoarthritis?

A

Joint space narrowing
Osteophytes
Sclerosis
Bone cysts

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7
Q

Give 4 non-operative ways hip osteoarthritis can be managed

A 
NSAIDs
Walking aids 
Weight loss
Activity modification 
Physiotherapy
Steroid injections
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8
Q

Give 4 ways hip osteoarthritis can be managed operatively

A 
Debridement of the joint 
Osteotomy 
Femoral head resection 
Hip resurfacing 
Total hip arthroscopy
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9
Q

When do neck of femur fractures occur?

A

Low energy falls in the elderly

High energy trauma in young patients

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10
Q

Why do NOF# take a long time to heal?

A

Surrounded by a capsule
Bathed in synovial fluid
No periosteal layer –> limits callus formation

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11
Q

Why is the mortality for NOF# so high?

A

Patients have long stays in hospital where they are immobilized and at risk of infections

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12
Q

Give the main symptom of a NOF#

A

Pain in the groin referred to medial thigh and knee

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13
Q

What finding will be present in a patient with a NOF#?

A

Leg shortened and externally rotated and abducted

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14
Q

How are intracapsular NOF# classified?

A

Garden Classification

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15
Q

What is a Garden stage 1 NOF#?

A

Fracture is nondisplaced and incomplete

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16
Q

What is a Garden stage 2 NOF#?

A

Undisplaced but complete fracture

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17
Q

What is a Garden stage 3 NOF#?

A

Complete fracture but incompletely displaced

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18
Q

What is a Garden stage 4 NOF#?

A

Complete fracture which is completely displaced

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19
Q

What may be seen on x-ray of a NOF#?

A

Can see fracture line

Break in Shenton’s line

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20
Q

How is an undisplaced intracapsular NOF# treated?

A

Internal fixation with screws

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21
Q

How is a displaced intracapsular NOF# treated?

A

Arthroplasty (either hemi or THR)

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22
Q

How is an extracapsular peritrochanteric NOF# treated?

A

Dynamic hip screw or intramedullary nail

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23
Q

How is an extracapsular subtrochanteric NOF# treated?

A

IM nail

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24
Q

Give 2 potential complications of a NOF#

A

Avascular necrosis
Nonunion
Dislocation
Failure of surgery

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25
What is the Nottingham Hip Score?
A score which predicts mortality following a hip fracture
26
What elements are included in the Nottingham Hip Score?
``` Age (66-85 +3, >86 +4) Sex (if male +1) Admission haemoglobin (if <10g/dL, +1) Mini-mental test score (if <6/10, +1) Living in an institution (+1) Number of comorbidities (if >2 +1) Malignancy (+1) ``` A score of above 6 puts patients at high risk of mortality from hip fracture
27
Why are hip dislocations rare?
Hip joint is very stable and supported by soft tissue constraints
28
In which direction do 90% of hips dislocate?
Posteriorly | Usually due to hitting a flexed knee on a dashboard in a car crash
29
How will a posterior hip dislocation present?
Hip and leg in flexion Adduction and internal rotation May be sciatic nerve injury
30
How will an anterior hip dislocation present?
Hip and leg in flexion Abduction External rotation
31
Give 4 possible complications after a hip dislocation
Post-traumatic hip arthritis Femoral head osteonecrosis Sciatic nerve injury Recurrent dislocations
32
What is sciatica?
Sciatica is the term used to describe discomfort from compression of the sciatic nerve
33
Give 3 symptoms of sciatica
``` Pain in buttocks and back of leg Pain worse when sitting for long periods of time Weakness in the calf muscles Back pain Tingling in legs ```
34
Which test can be done to assess sciatic pain?
Straight leg raise (sciatic stretch test)
35
Give 3 potential causes of sciatica
``` Spinal stenosis Spondylolisthesis Spinal injury Spinal tumour Cauda equina Bone spurs Piriformis syndrome ```
36
How is sciatica managed?
NSAIDs, stay active, heat/cold packs, physiotherapy, steroid injections, amitriptyline, gabapentin, diazepam If a spinal cause is found, lumbar decompression surgery can be done
37
Give 4 risk factors for knee osteoarthritis
``` Articular trauma Repetitive knee bending Muscle weakness Obesity Metabolic syndrome Female Elderly Family history ```
38
Give 4 symptoms of knee osteoarthritis
``` Limiting knee pain Pain at night or at rest Activity induced swelling Instability Locking Catching sensation ```
39
How is knee osteoarthritis managed?
Nonoperatively --> NSAIDs, rehabilitation, education, weight loss Operatively --> High tibial osteotomy, unicompartmental arthroplasty, total knee arthroscopy
40
What movement may cause a ruptured ACL?
High twisting force to the bent knee
41
What are the symptoms of a ruptured ACL?
Load crack heard Pain Rapid joint swelling Poor healing
42
What movement may cause a ruptured PCL?
Hyperextension of the knee
43
What movement may cause a ruptured MCL?
Leg forced into valgus from a blow to the lateral knee
44
What are the symptoms of a meniscal tear?
Delayed knee swelling Joint locking Recurrent episodes of pain and effusions after minor injury
45
What will be seen on examination of a patella fracture?
Palpable patella defect | Unable to raise leg
46
Give 4 complications of a patella fracture
``` Weakness and anterior knee pain Loss of reduction Nonunion Osteonecrosis Infection Stiffness ```
47
What nerve can be damaged in a dislocated patella?
Common peroneal nerve
48
Give 2 common mechanisms for dislocating the patella
Dashboard injury in RTA | Fall from a height
49
What is dimple sign in a patella dislocation?
Buttonholing of the medial femoral condyle through the medial capsule
50
Give 4 complications of a patella dislocation?
``` Stiffness Laxity Instability Peroneal nerve injury Vascular compromise ```
51
What is prepatellar bursitis?
Inflammation of the prepatellar bursa in the knee (Housemaid's Knee)
52
How is prepatellar bursitis managed?
Compression wrap NSAIDs Immobilisation Can be aspirated
53
What is Osgood-Schlatters disease?
Also known as tibial tubercle traction apophysitis. Inflammation and swelling at the distal attachment area of the patellar tendon
54
How does Osgood-Schlatter disease present?
Pain on anterior knee worse on kneeling | Common in children and athletes who jump (basketball players)
55
What is Sinding-Larsen-Johansson Syndrome?
Overuse injury causing pain at the inferior pole of the patella at the proximal attachment point of the patella tendon.
56
What kind of fracture pattern are common in tibial fractures?
Spiral
57
What classification system is used for tibial shaft fractures?
Tscherne Classification
58
What is a grade 0 closed tibial fracture?
Minimal soft tissue injury, indirect injury, simple fracture pattern
59
What is a grade 1 closed tibial fracture?
Superficial abrasion or contusion, mild fracture pattern
60
What is a grade 2 closed tibial fracture?
Deep abrasion, skin or muscle contusion, severe fracture pattern, direct trauma
61
What is a grade 3 closed tibial fracture?
Extensive skin contusion or crush injury, severe damage to underlying muscle, compartment syndrome, subcutaneous avulsion
62
What is a grade I open tibial fracture?
Open fracture with a small puncture wound without skin contusion, negligible bacterial contamination, low-energy fracture pattern
63
What is a grade II open tibial fracture?
Open injuries with small skin and soft tissue contusions, moderate contamination, variable fracture patterns
64
What is a grade III open tibial fracture?
Open fractures with heavy contamination, extensive soft tissue damage, arterial or neural injuries
65
What is a grade IV open tibial fracture?
Open fractures with incomplete or complete amputations
66
What are the Ottawa ankle rules?
Rules for determining which patients with foot or ankle problems require an x-ray
67
When does a patient with traumatic ankle pain qualify for an x-ray?
Point tenderness on lateral malleolus Point tenderness on medial malleolus Inability to weight bear for 4 continuous steps immediately after injury
68
When does a patient with traumatic foot pain qualify for an x-ray?
Point tenderness on the base of the 5th metatarsal Point tenderness on the navicular Inability to weight bear for 4 continuous steps immediately after the injury
69
How is a medial malleolus fracture treated?
Short leg walking cast or boot | ORIF
70
How is a lateral malleolus fracture treated?
Short leg walking cast or boot | ORIF
71
How are bilateral malleolus fractures treated?
Total contact casting | ORIF
72
How is a posterior malleolus fracture treated?
Short leg walking cast or boot | ORIF
73
How is an open malleolus fracture treated?
Emergency operative debridement ORIF External fixation
74
What is a Webers A ankle fracture?
Fracture is below the ankle syndesmosis
75
What is a Webers B ankle fracture?
Fracture at the level of the syndesmosis
76
What is a Webers C ankle fracture?
Fracture above the ankle syndesmosis
77
What is the most common direction for an ankle to dislocate?
Medial (80%)
78
How will a medial ankle dislocation present?
Locked in supination
79
How will a lateral ankle dislocation present?
Locked in pronation
80
What is a high ankle sprain?
Syndesmosis injury to the soft tissue around the ankle. Commonly from external rotation injuries
81
What signs will be found on examination of a high sprain injury?
Positive Hopkins test --> compression of tibia and fibula at the mid-calf causes pain at the syndesmosis Pain over syndesmosis is elicited with external rotation of the foot with the knee and hip flexed at 90 degrees
82
What is a low ankle sprain?
Injury to the anterior tibiofibular ligament and calcaneofibular ligament.
83
How is a low ankle sprain managed?
RICE, Elastic bandage, 1 week of immobilisation
84
Describe the phases of gait
Stance phase --> foot is on the floor | Swing phase --> foot is moving forward
85
In gait what is the difference between a stride and a step?
Stride --> distance between consecutive ground contact of the same foot Step --> distance between consecutive ground contact of alternating feet
86
What is a hallux valgus?
Valgus deviation of the phalanx which promotes varus positioning of the metatarsal. Metatarsal head displaces medially and the sesamoid complex is laterally translated. This causes pain due to a shift in weight bearing.
87
Give 2 symptoms of hallux valgus?
Difficulty wearing shoes Obvious foot deformity Pain
88
How is hallux valgus managed?
Shoe modification Pads Spacers Can have surgical correction
89
What is achilles tendonitis?
Gradual onset of posterior heel pain worse following activity
90
Give 2 risk factors for achilles tendon rupture
Quinolone antibiotics Hypercholesterolaemia Steroid injections Athletes who do not train regularly
91
How will an achilles tendon rupture present?
``` Hear a pop Weakness Difficulty walking Pain in heel Sudden onset ```
92
What test is done to assess for an achilles tendon rupture?
Thompson/Simmonds test | Lack of plantar flexion when the calf is squezed
93
How is an achilles tendon rupture managed?
Functional bracing | Surgical repair of the achilles tendon
94
What is plantar fasciitis?
Inflammation of the plantar fascia aponeurosis at its attachment point on the calcaneus
95
What patients are more at risk of plantar fasciitis?
Runners Dancers Obese people Inactive patients
96
What is the pathophysiology of plantar fasciitis?
Microtears in the plantar fascia from overuse lead to inflammation and chronic inflammation.
97
Give 3 risk factors for plantar fasciitis
``` Excessive pronation High arches Tight gastrocnemius and soleus Prolonged standing Leg length discrepancy Unsupportive footwear ```
98
What are the symptoms of plantar fasciitis?
Sharp pain in the heel Worse in the morning and evening Pain relieved when walking on heels and on ambulation
99
How is plantar fasciitis managed?
``` Pain control Splinting Good footwear Steroid injection Gastrocnemius recession Plantar fasciotomy ```
100
What is claw toe?
MTP hyperextension and PIP and DIP flexion
101
What is a hammer toe?
PIP flexion, DIP extension, MTP neutral
102
What is a mallet toe?
Hyperflexion of the DIP joint
103
What is morton's neuroma?
Compressive neuropathy of the interdigital nerve. Thickening of tissue around the nerve.
104
Give 3 causes of morton's neuroma?
``` Wearing tight, pointed shoes Being active Flat feet High arches Bunion Hammer toes ```

Phase 2- MSK (7 decks)

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