week 4: Lower Limbs

Question 1

hip pain will typically produce pain in the groin that may radiate to the ______, due to the ______ nerve supplying both

Answer 1

knee

obturator

Question 2

other than hip pathology, which 2 areas can also cause buttock pain

Answer 2

lumbar spine

Sacroiliac joint problems

Question 3

hip pathology can also present just as knee pain partiularly in

Answer 3

SUFE

Question 4

hip pathology will typically show what in examination

Answer 4

loss of internal rotation (1st sign)
pain exacerbated by rotational movements
abductor weakness may show if longterm

Question 5

name given to sign showing abductor weakness

Answer 5

trendelberg gait

Question 6

2 muscles which abduct the hip

Answer 6

gluteus medius and minimus

Question 7

in severe OA, Perthes, SUFE or AVN,____ ____ may be seen

Answer 7

limb shortening

Question 8

other than hip pathology/spine problems, give 4 causes of groin pain

Answer 8

hernia (inguinal/femoral)
tendonitis (adductor)
pubic symphysis dysfinctiom
high lumbar disc prolapse

Question 9

type of surgery for primary OA/arthritis due to RA/ sero -ve inflam. arthropathy/AVN/Dysplasia/ PErthes/SUFE

Answer 9

THR

Question 10

what causes loosening of compenents in THR

Answer 10

wear particles from bearing surface causing inflammatory response at implant interface

Question 11

early local complications of THR 4

Answer 11

infection
dislocation
nerve injury (sciatic)
leg length shortening

Question 12

AVN can be primary, idiopathic or 2ndary due to ____ ____, ____, ______ or ______

Answer 12

alcohol abuse
steroids
hyperlipidaemia
Thrombophilia

Question 13

AVN may present as ____ ___

Answer 13

groin pain

Question 14

hanging rope sign is the classic sign for AVN on X-ray. describe

Answer 14

patchy sclerosis due to weight bearing area of the femoral head
lytic zone formed underneath by granulation tissue from attempted repair
the lytic zon gives the hanging rope look

Question 15

in AVN, femoral head may collapse, giving rise to _____ _____

Answer 15

2ndary OA

Question 16

if AVN is detected early (pre-collapse), ____ ____ can be made in the femoral neck and abnormal area in head. This may ____ ____, ____ ___ and ___ ____

Answer 16

drill holes
relieve pressure
Promote healing
prevent collapse

Question 17

trochanteric bursitis will present as

Answer 17

pain/tenderness in region of greater trochanter

pain on resisted abduction

Question 18

trochanteric bursitis is similar to ____ ___ ___ of the shoulder

Answer 18

rotator cuff problems

Question 19

t/f surgery can help relieve pain/pressure in trochanteric bursitis

Answer 19

false - no proven benefit

analgesic + anti-inflame + physio + steroid injection is the treatment

Question 20

another name for trochanteric bursitis

Answer 20

gluteal cuff syndrome

Question 21

the ACLs role is to prevent internal rotation of the tibia, however how is its function tested clinically

Answer 21

by assessing anterior translation of the tibia

Question 22

PCL prevents ____ and anterior translation of the ____

Answer 22

hyperextension

femur

Question 23

how is PCLtested

Answer 23

posterior translation of the tibia

Question 24

MCL resists ___ force whilst the LCL resists ___ force and abnormal external rotation of the tibia

Answer 24

valgus

varus

Question 25

early OA of the knee may be predisposed by previous ____ ___, ___ ____ and ____

Answer 25

meniscal tears ligament injuries (ACL esp) malalignment

Question 26

if the patient is young, and the OA is isolated to medial compartment, they may be helpd by ____. What does this do?

Answer 26

osteotomy shifts load to lateral compartment

Question 27

knee replacement considered if

Answer 27

patient in conservative pain/disability + conservative management no longer effective

Question 28

meniscal injuries occur usually due to twisting force on a loaded knee (football, squatting) describe the signs you would expect

Answer 28

``` localised pain to medial (majority)/lateral joint line effusion develops (24hrs post) locking - difficulty straightening knee (15deg block) ```

Question 29

true knee locking is defined as a mechanical block to full extension, what causes

Answer 29

torn meniscus flips over and gets suck in the joint line can get meniscal tear without true locking

Question 30

other than meniscal tear, what else can cause a locking feeling

Answer 30

Patient with arthritis (+others( feel knee become stuck after rising from sitting pseudo-locking will either spontaneously resolve/trick manoeuvre

Question 31

ACL is seen in skiing, due to a higher ___ ___, turning the upper body ___ on a planted foot q

Answer 31

rotational force | laterally

Question 32

patients decribe ACL as having a ___

Answer 32

pop - heard/felt

Question 33

ACL rupture will usually cause 2

Answer 33

haemarthrosis | deep pain in knee

Question 34

rotational instability may be a chronic problem for ACL ruptures, with their knee giving way, this occurs when

Answer 34

turning on a planted foot (excessive internal rotation of the tibia)

Question 35

valgus stress injuries will usually tear ___

Answer 35

MCL | if high enough force can damage ACL and risking lateral tibial plateau fracture

Question 36

how could the PCL rupture

Answer 36

direct blow to anterior tibia when knee flexed (motorcycle) | hyperextension

Question 37

varus stress injury may rupture the

Answer 37

LCL

Question 38

what may be found in a clinical examination of a meniscal tear

Answer 38

effusion joint line tenderness pain on tibial rotation localising to affected compartment (steinmann's test) locked knee w/ displaced bucket handle meniscal tear will have a 15deg springy block to full extension

Question 39

meniscal tear can occur in various patterns (longlitudinal, radial, obliqur, horizontal). large longlitudinal tears may result in 'bucket handle tear' describe

Answer 39

large fragment is able to flip out of normal position, displace anteriorly/into interondylar notch (knee locks) - inability to fullyextend

Question 40

_____ ___ are th 1st stage in (many) cases of knee OA

Answer 40

degenerative tears distinguished by acute tears - steinmanns -ve

Question 41

meniscal repair is only considered if it is reasonably fresh, longlitudinal, andf involving the outer 1/3 of the meniscus, why

Answer 41

only arterial supply from outer third limited healing potential 90% unsuitable