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
What are common surgical complications in the elderly?
infection
DVTs
pressure ulcers
What is involved in the rehabilitation from hip surgery?
physiotherapists
occupational therapists
weight bearing exercises
strength and balance training
What is the normal percentages of bone and muscle in young adults?
bones - 15%
Muscle 30-40%
What is the rate of muscle and bone turnover in young adults?
20%
what does the mass of muscle and bone reflect?
a couple interaction of mechanical demand, dietary, genetic and endocrine factors
What do remodelling processes rely on?
sufficient nutrients and a balance of parathyroid hormone,calcitonin and vitamin D
What is the homeostatic balance of bone remodelling disturbed by?
diet and lifestyle (rickets)
mechanical factors (disuse)
endocrine disorders
What are the physiological consequences of a prolonged space flight?
fluid shifts
negative energy balance
skeletal and cardiac muscle atrophy
bone mineral degradation
radiation exposure
what are the consequences of suboptimal energy intake?
increased protein turnover
decreased weight and muscle mass
decreased muscle protein synthesis
In what way is the world’s population growing?
exponentially
what is the current rate of population growth?
1.13%
When will the world’s population have doubled by?
62 years
What determines the growth or decline of populations?
births
deaths
migration
what are demographics?
the scientific study of human populations especially with reference to their size, structure and distribution
what is a demographic transition?
transition from high birth and death rates as a country develops from pre-industrial to an industrialised economic system
what is epidemiology?
the science and practise which describes and explains disease patterns in populations
what are epidemiological transitions?
long term shift in the pattern of disease in a country from infectious disease to degenerative disease
What is meant by an ageing population?
it is a global phenomenon occurring based in low and middle income countries. In scotland older people form an increasingly large part of our population
What does an ageing society have impacts on?
implications for the old-age dependency ratio (the ratio of people over 65 years in the population to the size of the economically active segment of the population
what is compression of mortality?
a greater proportion of deaths occur during a narrow time period at the upper limit of a human life span
What is compression of morbidity?
optimistic scenario which increasing proportion of population will live a ling, healthy life in which death will be preceded by a very short period of ill-health
what are incidence rates?
the number of new events occurring in a specific time in a defined population
what is prevalence?
the number of cases of disease or other health outcome present in a specific period of time in a defined population.
What is ageing associated with?
progressive, generalised impairment of functioning resulting in a loss of adaptive response; lung function, circulation, muscles, nerves, immune system etc
What have impacts on the rate of ageing?
genetic component
social determinants of health
slow/ step wise decline
how is health measured?
functional status
activities in daily life
well being
Wear is quality of life?
the satisfaction of an individual’s values, goals and needs through the actualisation of their abilities or lifestyles
According to WHO what needs to be considered in quality of life?
physical
environmental
social relationships
level of dependence
spiritual
What effects can muscle-skeletal diseases have on people’s health?
leading cause of chronic morbidity
severe long term pain
long term active limitation
sleep disturbance
exacerbate symptoms of anxiety and depression
accessibility problems
social interactions
drug side effects
What is a QAly?
a year of full quality life
age context
content specific
long-term care
reliability and validity
What are examples of early interventions to improve the quality of life of older people?
older people at the heart of the community
understand the plan for the needs of older people
value their contribution to society
provide good affordable health care
What is the scottish government aiming for to improve the health of older people?
contribution of older people is valued
age is not used to define or make assumptions
people with more years of healthy life and are able to manage long term conditions
people are entitled to work, in a way that suits them
older people have access to IT and internet
What are the main functions of the musculoskeletal system?
enables efficient limb movement
acts as protection
serves as reservoir for calcium
provides environment for marrow
What occurs in bone ageing?
reduced bone tissue, relative decline in trophic factors favouring osteoclastic activity. diminished differentiation of bone marrow stem cells
What occurs in chondroid tissue ageing?
reduced ability to form large hydrophilic complexes resulting in decreased swelling pressure, predisposing to OA and IVD degradation
What occurs in the ageing of ligaments?
altered collagen synthesis leading to reduced elasticity
what happens as muscles age?
loss of muscle mass and decreased power due to loss of fibre number and fibre atrophy
What is sarcopenia?
a syndrome associated by progressive and generalised loss of skeletal muscle mass and strength associated with ageing, with risk of adverse outcomes such as physical disability, poor quality of life and death
what are factors which affect sarcopenia?
age
activity
disease
nutrition
lack of exercise
endocrine
neurodegenerative disease
cachexia
disuse
What are consequences of MSK ageing?
altered gait and balance leading to falls or fear of falls
increased risk of injury - fractures
chronic pain
social isolation if living independently
admission to care home
