What does an apparent shortening or lengthening in leg length disparity indicate?
Apparent shortening = pelvic tilt upwards or fixed adduction deformity
Apparent lengthening = pelvic tilt downwards or fixed abduction deformity
What deformity would Thomas’ test show?
Fixed flexion deformity - affected leg will lift off the couch
What would a positive Trendelenburg test indicate? Causes
Normal for pelvis to rise on side of the lifted leg
POSITIVE = pelvis falls on the side of the lifted leg
Abductor muscle paralysis (gluteus medius and minimus)
Upward displacement of the greater trochanter (severe coxa vara, dislocated hip)
Absence of a stable fulcrum
What is Coxa Vara? Causes and consequences?
Hip in which angle of the neck and shaft of the femur is <125 degrees
Congenital
SUFE
fracture
softening of bones (rickets, osteomalacia, Paget’s disease)
true shortening of limb - Trendelenburg dip on walking = limp
What would swelling in knee indicate?
0-2 hrs = haemarthrosis
6-24 hrs = effusion
> 24 hrs = septic/inflammatory arthritis
What tests can be done to test the cruciate ligaments and meniscus of the knee?
Anterior/posterior draw for cruciate
Lachmans for ACL
McMurray’s - unreliable way of detecting peduculated meniscal tears
Thessalys for meniscal
What can cause collateral ligament damage?
Medial ligament injuries occur with a lateral blow (valgus stress), twisting injury or with cruciate/meniscal injuries- SKIING
Lateral - occurs with a medial blow but is rare
How would a medial collateral ligament injury present?
Pain Rapid swelling Hear a pop medial joint line tenderness difficulty walking - pain and instability
How would you treat a medial collateral ligament rupture?
Non-weight bearing, bracing and surgery
Surgery -repair and reconstruction
How do ACL injuries occur?
Usually younger people playing football/basketball
usually with a valgus twisting to bent knee = non-traumatic pivot injury
assoc. with meniscal injury
How would an ACL injury present?
Pain Rapid swelling --> haemarthrosis Loss of ROM Joint line tenderness discomfort whilst walking
How would you investigate an ACL injury?
anterior draw test/Lachman positive
MRI - GS
Management of ACL?
Reconstruction/Repair + Physio
Tissue graft to help ligament regrow
How does a PCL injury occur?
direct blow from front of knee to proximal tibia flexion - leg bent
hyperextension injuries = dashboard injury
How does meniscal damage occur?
Rotational sporting injuries - cutting/pivoting - often with ACL
How does meniscal damage present?
Acute Pain Later Onset Swelling Popping Locking/clicking Knee giving way
Management of meniscal damage?
RICE
rehab + physio
Surgery
What is osteochondritis dissecans?
subchondral bone becomes avascular, may progress to fragments of bone and overlying cartilage
What are some causes of loose bodies in the knee joint?
Osteochondritis dissecans 3 bodies
Osteoarthritis 10 bodies
Chip fractures of joint surfaces 3 bodies
Synovial Chondromatosis >50 loose bodies
What can loose bodies in the knee joint present as ?
Knee locking - all movements
Effusion/swelling
How would you investigate and treat loose bodies in the knee joint?
Arthroscopy and removal
What are the kinds of bursitis?
Pre-patellar bursa (housemaid’s knee) - inflammation and fluid in bursa due to kneeling
Infra-patellar bursa (clergyman’s knee)
Semimembranous bursa (popliteal fossa) - popliteal cyst
Treatment of bursitis?
Aspiration
Hydrocortisone injection
Excision
NSAIDs
What are differentials for heel pain?
Diseases of calcaneum Rupture of calcaneal tendon Postcalcaneal bursitis Plantar fasciitis Lymphoma Arthritis of subtalar joint Tender heel pad Infection
