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Flashcards in Lower Limb Pathology Deck (77):
1

What is ususally the first clinical sign of hip pathology?

reduced range of motion with loss of internal rotation usually the first sign

2

What conditions may give shortening of the limb?

SUFE
Perthes
Severe OA
AVN
Fracture

3

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

4

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)

5

What can cause AVN of th hip joint?

primary/idiopathic
2y to:
- alcohol abuse
- steroids
- hyperlipidaemia
- thrombophilia

6

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

7

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

8

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.

9

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

10

Is there a use of surgery in trochanteric bursitis?

No - no surgical tretament has a proven benefit

11

What is a Morton's neuroma?

Plantar interdigital nerves are subjected to repeated trauma, become inflammed and swollen creating a neuroma.

12

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)

13

Where do metatarsal stress fractures most commonly occur?

In the 2nd metatarsal followed by the 3rd.

14

What can predispose to tendonitis?

Quinolone antibiotics
RA
Other inflam arthropathies
Gout

15

What is the treatment for tendinitis of the achilles tendon?

rest
physiotherapy conditioning
use of a heel raise
use of a splint or boot

16

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.

17

What is tendon rupture usually due to?

degenerative changes within the tendon or
recent tendinitis

18

Describe plantar fasciitis.

A self-limiting repetitive stress/overload or degenerative condition of the foot.

19

What could be causitive factors for plantar fasciitis?

Diabetes
obesity
frequent walking on hard floors with poor cushioning in shoes

20

What can be used to treat plantar fasciitis?

rest
achilles and plantar fascia stretchig exercises
gel filled heel pad
corticosteroid injections

21

What are people with pes planus at higher risk of?

tendonitis of the tibialis posterior tendon

22

What can cause acquired flat foot?

tibialis posterior tendon stretch o rupture
RA
Diabetes with Charcot foot (neuropathic joint destruction)

23

What is pes cavus?

Abnormally high arch of the foot

24

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

25

What kind of toes usualy accompany pes cavus?

Claw toes

26

What kind of alignment do most arthritic knees give?

Varus alignment

27

What may predispose a patient to early OA of the knee?

Previous meniscal tears
Ligament injuries
Malalignment

28

What are the mechanisms of injury for MCL, ACL, LCL, PCL and meniscal tears?

Valgus - MCL
Twisting - ACL or meniscal injury
Varus - LCL
Dashboard/ hyperextension - PCL
Getting up from squatting - Meniscal tear

29

If the ACL ruptures what is commonly heard?

Pop

30

What are onlay devices?

Plates and screws

31

What are inlay devices?

IM nails

32

How do patellar dislocations occur? What direction?

Sudden quaricepts contraction with a flexed knee
Always lateral

33

On examination what would you expect in a patellar dislocation?

Medial pain
effusion
Positive patellar apprehension test
Can't SLR

34

In a soft tissue knee injury, pain along either joint line suggests what pathology?

Meniscal tear

35

If the pt has damaged their extensor mechanism, what will they not be able to do?

Straight leg raise

36

What is the test for an MCL injury?

Valgus stress with knee at 30degrees flexion

37

What is the test for an LCL injury?

Varus stress at 30degrees

38

What is the test for an ACL injury?

Anterior drawer test at 90degrees
Lachmanns test at 30degrees

39

What is the test for a PCL injury?

Posterior sag at 90degrees and posterior drawer at 90degrees

40

How do meniscal tears usually occur?

Sporting injuries in young patients or atraumatic spontaneous degenerate tears in older patients (>40)

41

What imaging modality is used for a suspected meniscal tear?

MRI

42

What part of the meniscus has a blood supply? What does this mean?

Only peripheral 1/3rd has a blood supply meaning radial tears won't heal

43

What does an acute locked knee suggest? What is required?

Displaced bucket handle meniscal tear
Urgent surgery is required

44

What are the 3 grades of knee ligament injury?

1 - sprain
2 - partial tear
3 - complete tear

45

If a pt has sustained a ACL and MCL rutures, what should be considered?

Early ACL reconstruction and MCL repair

46

ACL is the main stabiliser against what?

ACL is the main stabiliser against internal rotation of the tibia

47

What treatment is required for ACL rupture?

1/3rd of pts can compensate
1/3rd of patients can avoid instability by avoiding certain manoeuvres
reconstruction with auto- or allograft

48

What is the failure rate of ACL reconstruction?

10%

49

Is LCL rupture common?

No

50

What is a complication of LCL rutpure?

Common peroneal (femoral) nerve palsy

51

When a LCL rupture does occur, what does it usualy occur with?

PCL or ACL injury

52

What causes a PCL rupture?

Direct blow to the anterior tibia (dashboard/motorbike) or hyperextension injury

53

PCL instability can make the patient feel what?

Recurrent hyperextension or feeling of unstable when going down stairs

54

Is dislocating a knee common?

No

55

Give the complications of knee dislocation.

Popliteal artery injury
commpn peroneal nerve injury
compartment syndrome
Arthrofibrosis and stiffness

56

How does a patellar dislocation occur?

Sudden quads contraction with a flexed knee
Rapid turn or direct blow

57

What are the risk factors for a patellar dislocation?

Female
adolescent
ligamentous laxity/ hypermobility
valgus knee
Increased femoral neck anteversion
torsional abnormalities
underdeveloped (hypoplastic) lateral femoral condyle

58

Extensor mechanism rupture occurs in those with what?

previous tendonitis
on steroids
chronic renal failure
on ciprofloxacin

59

What is the treatment for extensor mechanism rupture?

Surgical repair

60

What imaging modality is used to confirm an extensor mechanism rupture?

USS

61

What imaging modality is used to confirm a ligament tear?

MRI

62

What imaging modality is used to confirm damage to the hyaline cartilage?

MRI

63

What imaging modality is used to confirm an undisplaced fracture of the knee?

MRI

64

Ankle injury is usually caused by what movements?

Inversion or eversion

65

A non-uniform joint space in an ankle injury indicates what?

Instability

66

A tri-malleolar fracture involves what? These fractures have a tendency to what?

Medial malleolus
Lateral malleolus
Posteroinferior tibia (posterior malleolus)
These fractures have a tendency to instability

67

Fractures of the 5th metatarsal base are always in what direction and should not be confused with what?

Always transverse and should not be confused with normal longitudinal adolescent ossification centre

68

How does a calcaneal fracture usually occur?

Following axial compression (e.g. fall from height onto heel)

69

What xray vies are required to assess a midfoot injury completely?

AP - 1&2 TMT joint
Oblique - 3&4 TMT joint

70

Lisfranc injuries usuall involve what?

Several TMT joints with multiple ligamentous avulsion fractures
Seen best on CT

71

What should not be given to extensor mechanism knee rupture or achilles tendonitis/rupture?

Steroid injection! - risks tendon rupture

72

Management of a patella dislocation?

Reduce with knee extension
Aspiration
Brace
Physiotherapy

73

What urgent management is required for a knee dislocation?

Reduction under sedation
Stabilise in splint or externa-fixator
Definitive surgery - sequential ligamentous repair

74

Dislocating a hip is common. True or false.

False - occur in high velocity injuries - RTA dashboard injury, fall from height

75

What direction do hips most commonly dislocate?

Posterior

76

If a hip is dislocated how does the pateints leg look?

Flexed
Internally rotated
Adducted knee

77

Complications of hip dislocation.

Scaitic nerve palsy
Avascular necrosis of the head of the femur
Secndary OA of the hip
Myositis ossificans