Lower Limb Pathology Flashcards
(77 cards)
What is ususally the first clinical sign of hip pathology?
reduced range of motion with loss of internal rotation usually the first sign
What conditions may give shortening of the limb?
SUFE Perthes Severe OA AVN Fracture
Give some early local complications of a replaced joint?
infection dislocation nerve injury leg/arm length discrepancy medical complications - MI, chest ifection, UTI, blood loss, hypovolaemia, DVT, PE
Give examples of late local complications of a replaced joint?
early loosening late infection (haematogenous spread from a distant site) late dislocation (due to complonent wear)
What can cause AVN of th hip joint?
primary/idiopathic 2y to: - alcohol abuse - steroids - hyperlipidaemia - thrombophilia
What are the radiographic chnages of AVN?
Early cases may only be seen on MRI
Later cases may show patchy sclerosis of the weight bearing are of the femoral head with a lytic zone underneath formed by granulatio tissue from attempted repair
What are the treatment options for AVN of the head of the femur?
Detected early enough - holes drilled to alleviate pressure, promote healing and prevent collapse
Late detection - surgery of THR
What is trochanteric bursitis?
the broad tendinous insertion of the abductor muscles is under considerable strain which can lead to tendonitis and degradation, tendon tears.
The trochanteric bursa can also become inflammed.
How does throchanteric brursitis present? What treatment is used?
pain and tenderness in the region of the greater trochanter with pain on resisted abduction.
Analgesia, anti-inflams, physio and steroid injections
Is there a use of surgery in trochanteric bursitis?
No - no surgical tretament has a proven benefit
What is a Morton’s neuroma?
Plantar interdigital nerves are subjected to repeated trauma, become inflammed and swollen creating a neuroma.
What kind of pain is associated with a Morton’s neuroma and how is this treated?
Burning pain and tingling radiating into the affected toes.
Metatarsal pad or offloading insoles can be used. Steroid and local anaesthetic injections. Excision (may continue to have pain and there is a risk of recurrence)
Where do metatarsal stress fractures most commonly occur?
In the 2nd metatarsal followed by the 3rd.
What can predispose to tendonitis?
Quinolone antibiotics
RA
Other inflam arthropathies
Gout
What is the treatment for tendinitis of the achilles tendon?
rest
physiotherapy conditioning
use of a heel raise
use of a splint or boot
What des tendonitis predispose to and what does this have to do with steroids?
Tendonitis predisposes to tendon rupture.
Steroid injection should not be administered around the achilles tendon due to risk of rupture.
What is tendon rupture usually due to?
degenerative changes within the tendon or
recent tendinitis
Describe plantar fasciitis.
A self-limiting repetitive stress/overload or degenerative condition of the foot.
What could be causitive factors for plantar fasciitis?
Diabetes
obesity
frequent walking on hard floors with poor cushioning in shoes
What can be used to treat plantar fasciitis?
rest
achilles and plantar fascia stretchig exercises
gel filled heel pad
corticosteroid injections
What are people with pes planus at higher risk of?
tendonitis of the tibialis posterior tendon
What can cause acquired flat foot?
tibialis posterior tendon stretch o rupture
RA
Diabetes with Charcot foot (neuropathic joint destruction)
What is pes cavus?
Abnormally high arch of the foot
What can cause pes cavus?
Idiopathics
often related to neuromuscular conditions - hereditary sensory and motor europathy, CP, polio (unilateral) and spinal cord tethering from spina bifida occulta
