PBL 41 Flashcards
The hip joint is a ball and socket joint, what is the ball and socket?
Ball = head of femur Socket = acetabulum
What is the acetabulum?
Cup-like depression located on the inferolateral aspect of the pelvis
What is the name of the fibrocartilaginous collar which deepens the acetabulum?
Acetabular labrum
The acetabulum and head of femur are covered in … cartilage which is thicker at the places of …
- Articular cartilage
- Weight bearing
The ligaments of the hip joint act to increase…
Stability
The ligaments of the hip joint can be classed as intracapsular and extracapsular, give the names of all relevant ligaments to each class
Intracapsular: ligament of head of femur
Extracapsular: Iliofemoral, pubofemoral, ischiofemoral
The ligament of the head of femur encloses which artery?
The obturator artery AKA the artery to the head of femur
The iliofemoral ligament arises from the ASIS and has which shape?
- Y shape
Which is the strongest of the 3 extracapsular hip ligaments? What does this ligament act to prevent?
Iliofemoral ligament
- Prevents hyperextension of the hip joint
The pubofemoral ligament has which shape? What does this ligament act to prevent?
A triangle
- Excessive abduction and extension
The ischiofemoral ligament has which shape? What does this ligament act to prevent?
- Spiral orientation
- Prevents hyperextension and holds the femoral head in the acetabulum
The arterial supply to the hip is largely via the…
Medial and lateral circumflex arteries
The medial and lateral circumflex arteries are branches of the…
Deep femoral artery (profunda femoris)
The medial and lateral circumflex arteries …. at the base of the … to form a ring, from which smaller arteries arise to supply the hip joint itself
Anastomose
Femoral neck
The … artery is responsible for the majority of the arterial supply to the hip joint
Medial circumflex
Why is it that the medial circumflex artery is responsible for the majority of supply to the hip joint and less so the lateral circumflex artery?
The lateral circumflex artery has to penetrate through the thick iliofemoral ligament
Damage to the medial circumflex artery can result in…
Avascular necrosis of the femoral head
The hip joint is innervated by which nerves?
Sciatic, femoral and obturator
Movements of the hip joint?
Flexion Extension Abduction Adduction Lateral rotation Medial rotation
The proximal aspect of the femur consists of which landmarks?
Head Neck Greater trochanter Lesser trochanter Intertrochanteric line (anteriorly) Trochanteric crest (posteriorly)
On the posterior surface of the femoral shaft, there are roughened ridges of bone, called the…
Linea aspera (latin for rough line)
The medial and lateral borders of the linea aspera become…
The pectineal line and the gluteal tuberosity
Which muscle attaches to the gluteal tuberosity?
Gluteus maximus
The distal end of the femur has which landmarks?
Medial and lateral condyles
Medial and lateral epicondyles
Intercondylar fossa
The gluteal muscles are divided into 2 groups, what are they?
Superficial and deep
The superficial gluteal muscles act to…
Abduct and extend the lower limb at the hip joint
The deep gluteal muscles act to…
Laterally rotate the lower limb
What is the blood supply to the gluteal muscles?
Branches of the internal iliac = superior and inferior gluteal arteries
What are the superficial muscles in the gluteal region?
Gluteus maximus
Gluteus medius
Gluteus minimus
Tensor fascia lata
What is the action and innervation of the gluteus maximus?
Action: Main extensor of the thigh, assists with lateral rotation
- Only used when force is required
Innervation: inferior gluteal nerve
What is the action and innervation of the gluteus medius?
Action: abducts and medially rotates the lower limb
- Prevents pelvic drop
Innervation: Superior gluteal nerve
What is the action and innervation of the gluteus minimus?
Action: abducts and medially rotates the lower lim
- Prevents pelvic drop
Innervation: Superior gluteal nerve
What is the action and innervation of the tensor fascia lata?
Action: Assists gluteus medius and minimus in abduction and medial rotation of the lower limb
Innervation: Superior gluteal nerve
Trendelenburg gait is caused by damage to which nerve? What is this characterised by?
Superior gluteal nerve
- Characterised by pelvic drop of the opposite leg when standing on one leg
The deep gluteal muscles are a smaller set of muscles, located underneath the gluteus minimus. What is the general action of these muscles?
Lateral rotation and stabilising the hip joint
How do the deep gluteal muscles stabilise the hip joint?
Pull the femoral head into the acetabulum of the pelvis
What are the different deep gluteal muscles?
Piriformis
Obturator internus
Superior and inferior Gemelli
Quadratus femoris
What is the action and innervation of the piriformis?
Action: Lateral rotation and abduction
Innervation: Nerve to piriformis
What is the most superior muscles of the deep gluteal muscles?
Piriformis
What is the action and innervation of the Obturator internus?
Action: lateral rotation and abduction
Innervation: Nerve to obturator internus
The superior and inferior gluteal nerves are branches of…
The sacral plexus
What is the action and innervation of the superior and inferior gemelli?
Action: lateral rotation and abduction
Innervation: Superior gemelli = nerve to obturator internus
Inferior gemelli = nerve to quadratus femoris
What is the action and innervation of the quadratus femoris?
Action: lateral rotation & adduction
Innervation: Nerve to quadratus femoris
Pathophysiology of osteoporosis
Imbalance between bone resorption and bone formation
The three mechanisms are:
- Inadequate peak bone pass
- Excessive bone resorption e.g. lack of oestrogen, excessive PTH
- Inadequate formation of new bone during remodelling e.g. calcium deficiency and vitamin D
Drug treatment for osteoporosis
Biophosphates
Hormones: oestrogen
Denosumab
Mechanism of biophosphates for osteoporosis treatment & side effects of daily use
Mechanism: Inhibit digestion of bone by encouraging osteoclast apoptosis, slowing bone loss
Side effects of daily use: poor compliance and gastric problems
Social consequences of hip fractures in the elderly
- Psychological problems: fear of falling, self imposed activity restriction, social isolation, depression
- Increase in dependency and disability
- Impact on carers
- Institutionalisation: Admission to nursing home
Ethical issues around confused people and their decision making
Just because a person is confused and forgetful doesn’t mean they lack capacity
Issues:
- Find it difficult to make decisions
- Vulnerable to abuse and exploitation
- Vulnerable to being stigmatised and stripped of their personhood
What are the 3 main DMARDs?
- Sulphasalazine
- Methotrexate
- Hydroxychloroquine
Class and action of methotrexate
Folate antagonist
- Inhibits folic acid reductase which converts folic acid to tetrahydrofolic acid
- Tetrahydrofolic acid is required for both purines and pyrimidine biosynthesis so you can’t proceed with DNA synthesis
- It affects rapidly dividing cells
Class and action of sulphasalazine
Immunomodulatory agent
- Anti-inflammatory agent used to treat ulcerative collitis and RA
- MOA unknown
Class and action of hydroxychloroquine
DNA/RNA synthesis inhibitor & anti-inflammatory agent
- MOA unknown for RA
- MOA for malaria is to inhibit parasitic enzyme heme polymerase, causing a build up of toxic heme within the parasite
Definition of disability?
Any restriction or lack of ability to perform an action in the manner considered normal for a human being
Definition of impairment?
Any loss or abnormality of psychological, physiological or anatomical structure or function
Impact of disability on life
- Mental health issues: anxiety and depression
- Loss of freedom and independence
- Reliance on others
- Unemployment
- Problems with learning & academic study
- Loss of self-esteem and confidence –> Isolation
