limbs and back week 6 Flashcards
What bones form the hip joint?
The head of the femur and the acetabulum f
of the pelvic bone
why does the hip bone have a more limited range of movement than the shoulder?
It is designed for stability and weight bearing
what contributes to the stability of the joint?
The acetabulum almost entirely encompasses the hemispherical head of the femur.
The lunar surface is covered by hyaline cartilage and is broadest superiorly
What part of the head of femur is not covered by hyaline cartilage?
the fovea
What is the fibrocartilaginous collar of the rim of the acetabulum called?
The labrum
What is the ligament of the head of the femur?
A flat band of delicate connective tissue that attaches at one end to the fovea of the head of the femur and at the other end to the acetabular fossa. It carries a small branch of the obturator artery, which contributes to the blood supply of the head of the femur.
What three ligaments reinforce the external surface of the fibrous membrane and stabilise the hip joint?
iliofemoral ligament
pubofemoral ligament
ischiofemoral ligament
How are the fibres of these ligaments orientated?
in a spiral fashion around the hip so that they become taught when the hip is extended
this stabilises the joint and reduces the amount of energy required to maintain standing
What articulations form the knee joint?
femur and tibia - weight bearing
patella and femur - allows the quadriceps muscle to be directed over the knee to tibia without tendon wear
What are the basic movements of the knee joint?
a hinge joint which allows mainly flexion and extension
What are the main ligaments of the knee?
Reinforced by collateral ligaments (MCL, LCL)
Cruciate ligaments (ACL, PCL) maintain opposed positions if femur and tibia during movement
has efficient “locking Mechanism” to reduce muscle energy required to keep joint extended when standing
Why is the lateral meniscus more mobile?
It is not attached to the capsule whereas he medial meniscus is attached around its margin to the capsule.
How are the two menisci connected?
They are interconnected anteriorly by the transverse ligament if the knee
the lateral ligament is also connected to the tendon of the popliteus muscle
What separates the synovium from the patellar ligament?
The infra patellar fat pad
What is the innervation of the knee?
obturator, femoral, tibial and common fibular nerves
what is a hallux-vagus?
The great toe migrates laterally. Adduction of the first metatarso-phalangeal joint
What is osteoarthritis?
A degenerative disease of the joints that affects all of the weight-bearing components
What are the main signs of OA?
thickened capsule
shelving “fibrillated” cartilage
cyst formation and sclerosis of subchondral bone
osteophytic lipping
synovial hypertrophy
altered contour of bone
eburnation - “joint mice”
What happens to the articular cartilage in OA?
increased swelling
change in colour
cartilage fibrillation
cartilage erosion down to subchondral bone
What causes the decrease in water content in OA?
Decreased proteoglycan synthesis
decreased collagen cross-linking
decreased size of aggrecanm GAG and hyaluronic acid
traumatic damage
What are the non-operative treatments of OA?
medications, physiotherapy, walking aids, joint injections
What are the surgical treatment options for OA?
arthroscopy, cartilage transplantation, joint replacement
List some methods for avoiding falls at home
immediately mopping up spillages
remove clutter, trailing wires, frayed carpet
use non-slip mats and rugs
high wattage lamps
organise home so climbing, stretching and bending are minimised
get help to do things that aren’t safe
don’t wear loose fitting, trailing clothes
wear well fitting shoes that support the ankles
foot care
strength and balance training
sight tests
home hazard assessment
personal alarms
alcohol
What are common complications of untreated hip fractures?
avascular necrosis and non-union
what are the surgical options for repairing a hip fracture?
internal fixation can be performed with multiple pins
inter medullary hip screws
cross screw-nails or compression with a dynamic screw or plate
replacing the femoral head is achieved either by hemioarthroplasty and total hip replacement
What is the general rule for deciding what surgical options to take for hip fractures?
internal fixation is recommended for young, otherwise hip patients at low risk of AVN
prosthetic replacement is reserved for the elderly and for fractures with a high risk of AVN