front 1 profunda femoris (deep femoral artery) | back 1 responsible for blood supply to femoral head |
front 2 branch of obturator artery | back 2 within ligament to head of femur |
front 3 joint capsule | back 3 acetabular lip or labrum fibrous capsule strong @ dense covers entire femoral head and neck capsule thinner and looser posterio-inferiorly |
front 4 joint capsule (cont'd) | back 4 deeper circular fibers form collar around neck longitudinal fibers thicker anteriorly trochanters are extracapsular |
front 5 ligamentum teres | back 5 ligaments to head of femur fat pad in acetabalum partial vaccum within joint |
front 6 anterior ligaments of hip joint | back 6 iliofemoral ligament pubofemoral ligament |
front 7 posterior ligaments of hip joint | back 7 ischiofemoral ligament iliofemoral ligament |
front 8 ligamentum teres (cont'd) | back 8 least important for stability & fat pad changes shape with movement of femoral head |
front 9 movements of hip joint | back 9 flex, extend, abduct, adduct, circumduction, medial and lateral rotation |
front 10 angle of inclinication | back 10 125 degrees, angle often decreases with age due to loss of bone mass (osteopersosis, arthritis, etc.) |
front 11 > 125 degrees | back 11 coxa valga (away from center) |
front 12 < 125 degrees | back 12 coxa varum (towards center) |
front 13 angle of torsion | back 13 twisting or turning, usually 15 degrees |
front 14 anteversion | back 14 > 15 degrees of torsion, toe in when hip aligned |
front 15 retroversion | back 15 < 15 degrees of torsion, toe out when hip aligned |
front 16 labral tear causes | back 16 sports, torsional movements, idiopathic |
front 17 labral tear symptoms | back 17 normal radiographs, anterior hip or groin pain, clicking/locking/giving way, normal ROM, pain w/ hip flex, adduction, IR, and SLR |
front 18 labral tear treatment | back 18 NSAIS, rest, protective WB, surgery |
front 19 osteoarthritis causes | back 19 primary- unknown secondary- trauma, infection, hemarthrosis, osteonecrosis |
front 20 osteoarthritis symptoms | back 20 gradual onset of pain that may radiate to groin/knee, altered gain, limited ROM IR and extension, general weakness @ hip |
front 21 osteoarthritis treatment | back 21 NSAIDS, lose weight @ hip (obesity), strengthening, hip replacement, assistive devices, hip resurfacing (newer treatment) |
front 22 bursitis causes | back 22 trauma, friction |
front 23 bursitis symptoms | back 23 lateral hip pain(may radiate to groin, glutes, knee), increased pain over greater trochanter especially with side lying on affected side, ^ pain with abduction and rotations |
front 24 bursitis treatments | back 24 remove irritating cause, heat, stretching/strengthening, steroid injection |
front 25 piriformis syndrome | back 25 12% of population gets it, common fibular nerve pierces piriformis which may cause entrapment |
front 26 piriformis syndrome symptoms | back 26 pain in ass, restricted IR and ER, sciatic nerve pain, increased pain w/ sitting |
front 27 piriformis syndrome treatment | back 27 stretching, ice, NSAIDS, botox to nerve |
front 28 congenital dislocation of hip | back 28 8:1 female to male, ligamentous laxity, in utero positioning, breach presentation @ birth unilateral (L>R) or bilateral range of severity: acetabular dysplasia, subluxation, dislocation |
front 29 congenital dislocation of hip diagnosis | back 29 physical exam, asymmetrical thigh/inguinal folds, flex hip & knee in supine, abducts thigh, resistance to abduction or adductor spasm , Ortolani's sign (clicking), telescoping of femur ultrasound of hip joint |
front 30 congenital dislocation of hip treatment | back 30 reduce hip w/ positioning or bracing, double/triple diapers, Pavlick harness or abduction splint, pressure of femoral head in acetabalum promotes growth and deepening of socket in time. or surgery |
front 31 osteochondrosis | back 31 damage or injury to the growth portion of bone in a growing child. (epiphysitis, aseptic necrosis, osgood schlatter, legg calve parthes) |
front 32 posterior hip dislocation (car crash knees hit dashboard) | back 32 fibrous capsule ruptures inferiorly and posteriorly when femur driven rearward, femoral head lies posterior to acetabalum, potential damage to sciatic nerve |
front 33 anterior hip dislocation (car rear-ends you) | back 33 forces hip into extension, abduction, and lateral rotation femoral head lies inferior to acetabalum frequently fractures acetabalum margins |
front 34 central hip dislocation | back 34 blow to lateral aspect of hip especially in abduction, femoral head driven deeper into acetabalum, comminuted fracture of acetabular wall |
front 35 treatment for hip dislocations | back 35 depends on severity, closed/open reduction, immobilization, compensatory methods to resume ADL's, remobilization and strengthening |
front 36 when is bone density at its peak? | back 36 20's, as we age there is more calcium release and less rebuilding which leads to bone loss... happens more to women due to hormones |
front 37 when is muscle lost? | back 37 4-6% loss per decade > age of 40, decrease in total fibers, fiber size, and excitation |
front 38 joints/CT, fascia, articular cartilage, ligaments and tendons become less tensile? | back 38 loss of ROM, increased stiffness!! |
front 39 fibrinogen theory | back 39 ^ fibrin and macrophages leads to ^ adhesions and stiffness |
front 40 bone and soft tissue | back 40 aging collagen causes ^ muscle stiffness. articular cartilage breaks down and there is less water to distribute forces across the joint. Tendons lose tensile strength, decreased integrity of joint capsule and increase in calcium crystal formation |
front 41 fracture | back 41 > 50% of injuries in US are MSK, of that 50%... 50% are sprains, fractures, and dislocations. pattern of the fracture is determined by viscoelastic properties of bone and biomechanics of load load can be compressive, bending, or torsional |
front 42 fracture sites | back 42 diaphyseal, metaphyseal, epiphyseal, intra-articular |
front 43 fracture extent | back 43 complete or incomplete |
front 44 fracture configuration | back 44 transverse, oblique, spiral |
front 45 transverse fracture | back 45 easy to reduce, heals well, straight across |
front 46 oblique fracture | back 46 angled across, unstable, more difficult to reduce |
front 47 spiral fracture | back 47 torsional |
front 48 displaced | back 48 bone has moved on either side of the fracture |
front 49 open fracture | back 49 compound/bone sticks out of skin |
front 50 simple fracture | back 50 2 fracture parts, comminuted |
front 51 comminuted fracture | back 51 bone has been shattered w/ two or more fragments |
front 52 greenstick fracture | back 52 incomplete, occurs in children bc flexible bone |
front 53 pathological fracture | back 53 fracture due to tumor or pathologic process, decrease of bone density in imaging as well |
front 54 avulsion fracture | back 54 fragment of bone torn off at site of tendon or ligament insertion |
front 55 stress fracture | back 55 caused by repeated stress, x ray often normal, movement is painless but increases with WB, fracture line becomes more visible after inflammatory phase |
front 56 compression fracture | back 56 2 bones crushing a bone between |
front 57 colles fracture | back 57 specific to distal radius |
front 58 jones fracture | back 58 specific to 5th metatarsal |
front 59 signs and symptoms of a fracture | back 59 pain/tenderness, deformity, edema, ecchymosis, loss of general function and mobility, radiographs reveal break in continuity |
front 60 5 phases of fracture healing | back 60 hematoma formation, cellular proliferation, callus formation, ossification, consolidation/remodeling |
front 61 hematoma formation | back 61 inflammatory stage: disruption of periosteum, blood vessels and cortex, 48-72 hours, formation of hematoma, can last 1-2 weeks, clotting factors initiate fibrin meshwork @ each bony end of fracture site |
front 62 cellular proliferation | back 62 osteogenic cells proliferate, osteoblasts and chondroblasts differentiate from granulation tissue and form fibrocartilage collar around the fracture |
front 63 callus formation | back 63 osteoblasts move in and cartilage is replaced by bone |
front 64 ossification | back 64 thickened deposition of calcium and osteoblasts move to site |
front 65 consolidation and remodeling | back 65 callus reabsorbed, woven bone transformed into mature bone and reshaping occurs in response to stresses, can last months to years |
front 66 fracture healing in children | back 66 4-6 weeks |
front 67 fracture healing in adolescents | back 67 6-8 weeks |
front 68 fracture healing in adults | back 68 10-18 weeks |
front 69 closed reduction fracture treatment | back 69 traction & non-operative realignment traction: weights applied to fracture to attain proper realignment (Buck's traction), immobilization |
front 70 open reduction fracture treatment | back 70 surgical intervention, ORIF, replacement hemi or total joint, external fixation |
front 71 fixation fracture treatment | back 71 casting and functional bracing, biomechanics of fixation devices casts, rods, pinscrews, wires, external fixators are all stress sharing devices, callus then forms, heals fast, usually enables early WB, plates are stress yielding devices |
front 72 fracture complications | back 72 visceral injury, vascular injury, compartment syndrome (swelling/disruption of blood flow), etc |
front 73 fall risk factors | back 73 advanced age, osteoperosis, arthritis, etc. |
front 74 hip fracture complications | back 74 infection, avascular necrosis of femoral head, nonunion/fusion, degenerative joint disease of hip, chronic pain |
front 75 avascular necrosis of femoral head is also associated with | back 75 hip dislocation, decompression sickness (bends), sickle cell, radiotherapy, Gaucher's disease, diabetes, corticosteroids |
front 76 total hip replacement | back 76 head and neck of femur removed, joint disarticulated, metal or ceramic prosthesis inserted in femur, acetabalum replaced with metal or plastic cup in THR not partial HR |
front 77 precautions following THR (posterior approach) | back 77 no hip flex > 90 degrees, no hip IR, no adduction beyond neutral, no crossing legs ANTERIOR APPROACH ALLOWS immediate flexion and less precautions |