Conditions Of The Hip Flashcards
(43 cards)
What is at risk when administrating IM injections in the gluteal region? 1️⃣
Injury to the sciatic nerve
When is the dorsogluteal site used? 1️⃣
In children 3-7
When is the ventrogluteal site used? 1️⃣
Children >7 and adults
Site is further from neurovascular structures but requires better patient compliance
How is the ventrogluteal site located? 1️⃣
- place palm over greater trochanter
- point thumb towards inguinal region
- point index finger toward anterior superior Iliad crest
- spread index and middle fingers to make a V
- inject between the proximal interphalangeal joints of the fingers, into the gluteus medius
What does a superior gluteal nerve lesion lead to? 2️⃣
Superior gluteal nerve supplies hip abductors therefore lesion leads to weakness in thigh abduction at the hip
How can the superior gluteal nerve be injured? 2️⃣
- complication of hip surgery
- injections into buttock
- # of greater trochanter (insertion site of gluteus medius)
- hip joint dislocation
What prevents hip tilting when standing on one leg? 2️⃣
Standing erect with one foot lifted off ground:
- gluteus medius and minimus is supporting limb usually contract
- prevents tilting of pelvis towards unsupported side
Describe a postitive Trendelenburg sign 2️⃣
Person with superior gluteal nerve palsy asked to stand on injured lower limb:
-pelvis on unsupported side descends
When does a hamstring injury tend to occur (‘pulled hamstrings’) 3️⃣
During sudden muscular exertion that results in stretching of the posterior thigh muscles :
- jumping
- sprinting
- lunging
Relatively common in athletes and footballers esp in absence of a proper warm up
What occurs in a hamstring injury? 3️⃣
- sudden tension in hamstrings results in either a muscle sprain, partial tear or a complete tear of the origin of the hamstrings from the ischial tuberosity
- sometimes accompanied by avulsion of a fragment of bone
What is the pathological definition of osteoarthritis? 4️⃣
A degenerative disorder arising from the breakdown of articulate hyaline cartilage
What is the clinical definition of osteoarthritis? 4️⃣
A clinical syndrome comprising joint pain accompanied by functional limitation and reduced QoL
What joints are most commonly affected by OA? 4️⃣
- hips
- knees
- cervical spine
- lumbar spine
- small joints of the hands
Describe the features of OA 4️⃣
- chronic disease of musculoskeletal system
- without systemic involvement
- non-inflammatory
- in comparison to some other inflammatory arthropathies, ankylosis (bone fusion across a joint) is very rarely seen
Difference between primary and secondary OA 4️⃣
Primary OA: unknown cause
Secondary OA: known precipitation cause
What are some risk factors for primary OA? 4️⃣
- age
- female sex
- ethnicity (increased in African-Americans, American Indians and Hispanics)
- Genetics (OA) runs in family
- Nutrition (consumption of antioxidant-rich diet may provide some protection)
Give examples of specific causes of secondary OA 4️⃣
- obesity
- trauma
- malalignment
- infection e.g septic arthritis and tuberculosis
- inflammatory arthritis e.g RA
- metabolic disorders affecting joints e.g gout
- haematological disorders e.g haemophilia with haemarthrosis
- endocrine abnormalities e.g diabetes with neurovascular impairment leading to chronic malalignment of articular surfaces
State some symptoms of OA 4️⃣
- deep aching joint pain, exacerbated by use
- reduced range of motion and crepitus
- stiffness during rest i.e morning stiffness
What do precipitating risk factors of OA cause? 4️⃣
Lead to excessive or uneven loading of the joint
Leads to damage to the hyaline cartilage covering articular surface
Describe what happens to hyaline cartilage in OA 4️⃣
- initially becomes swollen due to increased proteoglycan synthesis by chondrocytes with increased numbers of chondrocytes differentiating from chondroprogenitor cells
- this stage reflects an attempt to repair the cartilage damage and can continue for several years
Describe what happens to the hyaline cartilage as the disease progresses 4️⃣
- proteoglycan content falls
- causes cartilage to soften and lose elasticity
- microscopically, flaking and fibrillation develop along the normally smooth articular surface
- over time, the cartilage becomes eroded down to the subchondral bone, resulting in loss of joint space
What does the surface changes in hyaline cartilage cause? (Eburnation)4️⃣
- alters the distribution of biomechanical forces and trigger further active changes in the tissues
- subchondral bone responds with vascular invasion and increased cellularity, becoming thickened and denser at areas of pressure
= eburnation - manifests as subchondral sclerosis on x rays
What else happens to the traumatised subchondral bone in OA? 4️⃣
May undergo cystic degeneration to form subchondral bone cysts
Attributable to either issues necrosis secondary to chronic impaction or to the intrusion of synovial fluid
How do the osteophytes form? 4️⃣
At areas along the articular margin, osseous metaplasia of connective tissue occurs, leading to irregular outgrowth of new bone
