MSK pathology (LL) Flashcards
(27 cards)
What is greater trochanter pain syndrome (trochanteric bursitis)?
common condition that complicates many total hip replacements
inflammation of the bursa between the greater trochanter and fascia late caused by acute or repetitive trauma
more common in women, active patients and bilateral in 50%
What are the symptoms of trochanteric bursitis?
hip pain that may radiate down the lateral aspect of the thigh to the knee
pain worse on movement and at night, especially when they lie on affected side
How is trochanteric bursisitis confirmed on examination?
point tenderness when palpating the greater trochanter
further confirmation can be achieved by active adduction of slightly flexed hip past the midline (with knee slightly flexed) and this will exacerbate the pain as it tightens the fascia late over the bursa
How is trochanteric bursisitis managed?
corticosteroid injections are helpful
physiotherapy (to stretch basic data and relieve pressure on bursa)
surgical management (fascia late release and excision of bursa) is rare
What is Osgood Schlatter’s disease?
Common in adolescents, a traction injury of the patellar ligament leading to prominent and tender tibial tuberosity
How is Osgood Schlatter’s disease managed?
Spontaneous recovery takes time and restricting sporting activity is wise
What are the causes of a meniscal tear?
classically occurs when there is twisting strain on a flexed, weight bearing knee
little force is required in older adults and degenerative tears are seen in knee OA
Where are medial meniscal tears most common?
medial meniscus is most commonly affected as it is less mobile and they are associated with ACL tears
meniscus is mainly avascular so will not repair spontaneously after a tear or heal after surgery
How do meniscal tears present?
symptoms are initial pain which can be intermittent and swelling hours later
What are the mechanical symptoms of a meniscal tear?
locking of the knee (blocked extension giving fixed flexion)
spontaneous ‘giving way’ of the knee
What is seen on examination in a meniscal tear?
effusion and fixed flexion deformity with medial joint line tenderness
What investigations are used in medial meniscal tears?
X-ray will be normal but important to exclude fractures/OA
MRI - mainstay of imagiing
How are meniscal tears managed?
arthroscopic repair is indicated in many patients, especially young and active
tears in the vascular zone are more amenable to repair
degenerative tears secondary to OA should be treated conservatively until joint replacement is needed anyway
How are meniscal tears managed when they are in the avascular zone?
partial meniscectomy is the treatment of choice, to prevent ongoing mechanical symptoms
total meniscectomy is avoided due to a high risk of secondary OA
What causes ligament injuries?
occur when force greater than tensile strength of the ligament occurs in sporting injuries or trauma
What is the most common ligament tear?
ACL tear
MCL second most common
multiple ligaments may be involved and collateral ligament damage is more common when the knee is in extension
What are the important questions to ask in a ligament tear history?
full mechanism of injury
swelling in first hour - indicated complete rupture
patients describe ‘pop’ at time of injury
patients cannot weight bear and knee feels unstable
What would be seen on examination in a ligament tear?
There will be a firm end point when testing the ligament
partial tears do not give increased mobility but pain when testing
Lachman’s test is more sensitive than anterior draw test for ACL pathology
What are the investigations required for a ligament tear?
x-ray (excludes OA and fractures)
MRI
Diagnostic arthroscopy if clinical signs but MRI shows intact ligaments
How are ligament tears managed conservatively?
sprains/partial tears will spontaneously heal with physiotherapy as the intact fibres splint the torn ones
adhesions complicate the process so active movement with a brace is encouraged
physiotherapy and patient education about activity limitations should be used
How are ligament tears managed surgically?
ACL - tendon graft repair
PCL - bony avulsion
Collateral ligaments - surgical repair should be performed within 2 weeks
What causes pre-patellar bursitis?
housemaids knee
unaccustomed kneeling
presents with anterior knee pain and fluctuant swelling
What causes infra-patellar bursitis?
unaccompanied kneeling
presents with anterior knee pain and fluctuant swelling
How is pre/infra patellar bursitis managed?
avoidance of kneeling
corticosteroid injection for troublesome symptoms
