Lower Limb Pathologies Flashcards
What are some of the likely complications from hip arthroplasty?
Infection, dislocation, nerve injury , leg length discrepancy, splitting of the femur, inflammatory reaction from cement, can get PE, MI, Chest infections
Man of 40 years presents with insidious onset of groin pain on his right side, he cannot weight bear of the right side without extreme pain. You do an MRI which shows sclerosis of the femoral head with a lytic zone underneath. What is the likely diagnosis?
Avascular necrosis where the microcirculation of the femoral head compromised so get necrosis
What is the treatment for avascular necrosis?
If head collapsed then total hip replacement
If head still intact then decompression, biphosphonates (decreased bone resorption), and maybe bone grafting
Young female hockey player presents with pain and tenderness on her lateral proximal thigh. She has pain on resisted abduction. Likely diagnosis?
Trochanteric bursitis
Due to active young patient, morelikely in females due to anatomy, bursa underneath greater trochanter becomes inflamed
Treatment for trochanteric bursitis?
Analgesia, NSAIDs, physiotherapy, steroid injections
What type of femoroacetabular impingement syndrome is common in males with previous SUFE? What movment impinged?
CAM type, with shape of femoral head becoming ovular so impinges on acetabulum during flexion
What type of femoroacetabular impingement syndrome is common in females?
Pincer type where the acetabulum overhangs onto the femoral head causing pain on abduction
Active male rugby player presents with c-sign positive pain around his hip, it is worse when sitting. Likely diagnosis?
Femoroacetabular impingement syndrome CAM type (flexion worse)
What is the treatment for femoroaetabular impingement syndrome??
Arthroscopic surgery to remove lesion
Name the ligaments in the knee
Lateral/ medial collateral
Meniscal
Anterior/ posterior cruciates
Man of 45 years presents with localised medial joint line pain in the left knee with difficulty straightening his knee. He was doing football then suddenly turned his leg and then felt pain. On examination his knee is swollen with a positive gutter sweep test and steinmenns test. What is the likely diganosis?
Medial meniscal tear
Young rugby player presents with a deep pain in his knee, it is hot, swollen and describes his knee as giving way while he tries to walk. He was playing rugby then twisted his knee and felt a ‘pop’ soon after getting really swollen. On examination there is positive lachmans test. Likely diagnosis? Treatment?
Anterior cruciate ligament tear. Surgical reconstruction using patellar tendon or gracilis
What is the treatment for collateral ligament tears? (Get pain with valgus/varus stress and tenderness)
Hinged knee brace
Reconstruction
60 year old diabetic man presents with difficulty walking and bruising superior to his patella. On examination he is unable to do a straight leg raise. Diagnosis and treatment
Quadriceps tendon rupture
Surgical repair
What epidemiological group is likely to have extensor mechanism rupture
Tendonitis history, chronic steroid abuse, diabetes, rheumatoid arthritis, renal failure, ciprofloxacin use, OA of patellar tendon
What was do patella usually dislocate? Medial or lateral?
Lateral due to shallower cup
What are the tendons that run posterior to the medial malleolus
Tibialis posterior
Flexor digitorum longus
Flexor hallus longus
What is a hallux valgus deformity?
Where there is deformity of the great toe causing medial deviation of the 1st metatarsal and lateral deviation of the toe itself
What is the treatment for hallux valgus deformity?
Wearing wider/ deeper shoes
Spacer in first web
Women of 50 years presents with sharp burning tingling pain in her right foot radiating to her 3 and 4th digits. On examination she has lost sensation in the 3/4th web space,and compression of the metatarsal heads producing mudlers click. On ultrasound there is a swollen nerve in this area. Diagnosis? Treatment?
Mortons neuroma
Metatarsal pad/ offloading insole, steroid and local anaesthesia injections or excision as last resort
Male athlete presents with extremely painful calf that occured when he was running. It felt like someone shot him in the back of the leg. He has recently been on ciprofloxacin. On examination simmonds test was positive. Treatments?
Achilles tendon rupture
So rest, can be surgical or use casts
Simmonds test where heels off bed supine and you squeeze the calf to see if there is plantar flexion if not then positive sign
What is pes planus?
Flat foot
Obese female aged 50 presents with pain and swelling posterior to the medial malleolus of her left foot. She says she feels like its been getting flatter. From behind you compare her feet and they are assymetrical with more toes seen on the left foot. Likely diagnosis? Treatment?
Tibialis posterior tendon dysfunction
Phsyiotherapy and insoles
You suspect osteoporosis in a patient. What do you advise them to do/ prescribe?
Increase dietary calcium intake to 700mg a day Weight bearing exercises Avoid excess alcohol Avoid smoking Falls prevention
Calcium and vit D supplements, bisphosphonates
