Supracondylar Fracture Featured Image (2)

Supracondylar Fracture of the Humerus in Children

 

Supracondylar fractures constitute approximately 50% of all elbow fractures. The supracondylar region is thin and weak and thus it can fracture easily.

Fracture Types:

  1. Extension fracture
  2. Flexion fracture

Extension type fracture:

  • Most common type (95-98%)
  •  Occurs due to falling onto an outstretched hand.
  •  The distal fragment displaces posteriorly.
  •  Anterior interosseous neurapraxia (AIN) is the most common nerve palsy occurring with supracondylar fractures.
  •  Injury to the anterior interosseous nerve will lead to weakness of the flexor digitorum profundus muscle to the index finger and the flexor pollicis longus (FPL) muscle.
  • The patient cannot do the OK sign or bend the tip of his index finger.
  • Radial nerve neurapraxia is the second most common palsy and is evident by weakness in wrist and fingers extension.

Extension-type-supracondylar-fracture

 

Flexion Type Fracture:

  • It is rare and occurs due to falling directly on a flexed elbow.
  • The distal fragment is displaced anteriorly.
  •  This type of fracture may be accompanied by Ulnar nerve neurapraxia.
  •  Injury of the Ulnar nerve will lead to loss of sensation along with the little finger.
  •  Later on, the patient may also have weakness of the intrinsic hand muscles and claws.

Flexion-type-supracondylar-fracture

 

Garland’s Classification System:

 

Garland’s classification for supracondylar elbow fractures,

Type 1: This is a Non-displaced fracture.
Type 2: Is angulated with an intact posterior cortex
Type 3: This is a fracture showing complete displacement.
Type 4: Complete periosteal disruption and shows instability in both flexion and extension.

Garland’s Classification System:
Garland’s Classification System:

Radiology:

 

Plain Anterior-Posterior (AP) and lateral X-rays should be obtained.

A posterior fat pad sign seen on a lateral view X-ray should increase your suspicion of an occult fracture around the elbow.

 

Anterior humeral line:

 

  • On a lateral view X-ray, the anterior humeral line is drawn along the anterior border of the distal humerus.
  • Normally the anterior humeral line should run through the middle third of the capitellum.
  • In extension type fractures the capitellum will be displaced posteriorly relative to the anterior humeral line.

Humerus Children Fracture

 

Baumann’s Angle:

 

  • Is formed by a line perpendicular to the axis of the humerus and a line going through the physis of the capitellum.
  • Normally, Baumann’s angle should measure at least 11 degrees.

 

Examination:

  • It is very important to assess the neurovascular structures.
  • The Anterior interosseous nerve is assessed by asking the patient to do the OK sign with his hand.
  • The Radial nerve is assessed by asking the patient to extend the wrist and fingers.
  • The Ulnar nerve is initially assessed by loss of sensation along with the little finger. Later on, the patient may also have weakness of the intrinsic hand muscles and claws.

 

Treatment:

1. Non-operative treatment:

  • Indicated for type 1 fractures.
  • Usually consists of splinting or casting the elbow for a duration of 3-4 weeks.
  • It is very important to remember not to flex the elbow in the splint or cast beyond 90 degrees in order to avoid vascular compromise and compartment syndrome.

2. Operative treatment:

  • Type 2 and 3 fractures are usually treated by closed reduction and percutaneous pinning.
  • During reduction, pronation of the forearm during elbow flexion helps to correct a Varus deformity.
  • After reduction, check for a gap in the fracture.
  • The neurovascular bundle may be trapped.
  • Free the brachialis muscle from the fracture site, if it is inter-positioned.
  • Fixation is usually achieved with 2-3 divergent lateral pins, depending on stability.
  • Medial pins can also be added depending on stability.
  • Open reduction is indicated only when closed techniques are unable to achieve the appropriate reduction of the fracture.
  • Avoid posterior dissection to preserve vascularity of the fractures segment.
  • Fracture reduction and fixation should be done emergently in cases of vascular compromise.

 

 

If you have any questions about Supracondylar Fracture please feel free and leave a comment.

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    Muscle of Hip And thigh Featured Image

    Muscles of the hip and Thigh – Human Anatomy?

    Muscles of the hip:

    Anterior hip muscles: Large one you can see from an anterior perspective and highlight in green, which is the psoas major muscle. The psoas major originates from the bodies of the vertebrate T12 to L4 and the costal processes of the vertebrae L1 to L5.

    vertebrae L1 to L5

     

    Located a bit more laterally, we find another muscle which is known as the iliacus muscle.

    iliacus muscle

     

    The iliacus muscle originates from the iliac fossa. The psoas major and the iliacus are usually distinguished as one muscle, and this is known as the iliopsoas muscle.

     

    iliopsoas muscle

    These muscles have different points of origin, however, they come together to pass underneath the inguinal ligament and into the region of the thigh to insert onto the lesser trochanter of the femur.

     

    trochanter of the femur

     

    The last muscle of the anterior hip, we are going to be talking about is the psoas minor muscle. This is a small muscle that runs along the surface of the psoas major. This muscle is sometimes not mentioned as it is often absent. Around about 40%-70% of people do not have this muscle.

    psoas minor muscle

    Anterior Hip Muscles: Function/Innervation/Blood Supply

     

    • Function: The iliopsoas is the most powerful flexor of the thigh at the hip joint.
    • Innervation: The lumbar plexus innervates the psoas major and psoas minor muscles.
    • Blood Supply: The iliopsoas muscle receives its blood supply from the iliolumbar artery and the medial femoral circumflex artery.

     

    Muscles of the hip: Superficial gluteal muscles

    There are four superficial gluteal muscles,

    1. Gluteus maximus muscle:

    It’s the most famous muscle that defines the buttocks. The gluteus maximus originates from the surface of the ilium posterior to the posterior gluteal line and the posterior inferior surface of the sacrum and the coccyx.

    Gluteus maximus muscle

     

    It inserts onto the gluteal tuberosity of the femur and the iliotibial tract.

    2. Gluteus medius muscle:

    The gluteus medius originates from the gluteal surface of the ilium and inserts onto the greater trochanter.

    Gluteus medius muscle

    3. Gluteus minimus muscle:

    Deep to the gluteus medium muscle, we find the gluteus minimus. The gluteus minimus also originates from the gluteal surface of the ilium. Inserts onto the greater trochanter of the femur.

    Gluteus minimus muscle

     

    4. Superficial gluteal muscle:

    The muscle extends from its origin at the anterior superior iliac line to its insertion at the iliotibial tract.

    Superficial gluteal muscle

    Muscles of the hip: Superficial gluteal muscles (Function/Blood Supply)

    Function: Extension, Abduction, Rotation of the thigh at the hip joint, Stabilize the pelvis.

    Blood supply: The muscles receive their blood supply from the superior gluteal artery and the inferior gluteal artery.

     

    Muscles of the Hip Deep Gluteal:

     

    Piriformis muscle: The muscle originates from the pelvic surface of the sacrum and is insert onto the greater trochanter of the femur.

    Obturator internus muscle: The obturator internus originates from the obturator membrane and inserts onto the greater trochanter and trochanteric fossa.

    Superior gemellus muscle: This muscle originates from the ischial spine and inserts onto the greater trochanter of the femur.

    Inferior gemellus muscle: The inferior gemellus originates from the tuberosity of the ischium and inserts onto the greater trochanter.

    Quadratus femoris muscle: This muscle originates from the tuberosity of the ischium and inserts into the intertrochanteric crest.

     

    Muscles of the Hip Deep Gluteal: (Function/Innervation/Blood Supply)

     

    Functions: lateral rotation of the thigh at the hip joint.

    Innervation: Is supplied by the sacral plexus.

    Blood supply: The muscle receive their blood supply from the superior gluteal artery and the inferior gluteal artery.

     

    Muscles of the Thigh: Anterior Compartments

     

    Sartorius muscle: This is the longest muscle in the human body and it extends from its origin at the anterior superior iliac spine. All the way to its insertion on the medial surface of the tibia.

    This muscle has various functions including flexion of the thigh and knee, lateral rotation of the thigh, and medial rotation of the knee.

     

    Quadriceps femoris muscle: The muscle is formed by four muscles –the rectus femoris, vastus lateralis, vastus intermedius, and vastus medialis.

    These muscles all have different sites of origin. However, they all insert into the quadriceps tendon.

    Let’s take a look at these muscles individually, located most anteriorly, we have the rectus femoris muscle, and this muscle originates from the anterior inferior iliac spine and the supraacetabular sulcus.

    supraacetabular sulcus

    The vastus lateralis muscle is located laterally and it originated from the linea aspera femoris and the greater trochanter.

    vastus lateralis muscle

    In the middle, we can see another vastus which is known as the vastus intermedius muscle, and this muscle originates from the shaft of the femur.

    vastus intermedius muscle

    The next muscle is found medially and is known as the vastus medially muscle. This muscle originates from the linea aspera femoris and the intertrochanteric line.

    vastus medially muscle

    The last muscle of the anterior compartment is the articularis genu muscle, and it lies deep to the vastus intermedius

    articularis genu musclearticularis genu muscle

    This small flat muscle originates from the anterior distal femoral shaft and inserts onto the knee joint capsule.

    Muscles of the anterior compartment:

    Function:

    • Extension of the leg at the knee joint.
    • Flexion the thigh at the hip joint.

    Innervation:

    These muscles receive their innervation from the femoral nerve and their blood supply from the femoral artery and the deep femoral artery.

     

    Muscles of the thigh: Medial compartment

    Obturator externus muscle: This muscle originates from the obturator foramen and the obturator membrane and inserts at the trochanteric fossa.

    Obturator externus muscle

    The pectineus muscle originates from the iliopubic eminence and the pectineal line of the pubic bone and inserts at the linea asper femoris and the pectineal line of the femur.

    pectineus muscle

    Located most medially, the gracilis muscle is an exception within this group of the thigh muscles because it inserts on the tibia. The muscle originals from the inferior pubic ramus insert on the proximal medial surface of the tibia.

    Gracilis Muscle

    Adductors of the Thigh:

     

    Adductor Brevis muscle: The word Brevis means ‘short’ in Latin and adductor brevis is quite a short muscle. This muscle originates from the inferior pubic ramus and inserts on the linea aspera femoris.

    Adductor brevis muscle

    Adductor longus muscle: The adductor longus originates from the pubic symphysis and the superior pubic ramus and inserts on the linea aspera femoris.

    Adductor longus muscle

    Adductor Magnus muscle: This muscle originates from the inferior pubic ramus, ramus of the ischium, and tuberosity of the ischium. It inserts on the linea aspera femoris and the adductor tubercle.

    Adductor Magnus muscle

    Adductor minimus muscle: The adductor minimus originates from the inferior pubic ramus and inserts on the linea aspera femoris.

    Adductor minimus muscle

    Muscles of the Thigh: Posterior compartment

     

    The muscles of the posterior compartment are also known as the hamstring muscles.

    Biceps femoris muscle: It originates from the Sacrotuberous ligament, linea Aspera femoris, and tuberosity of the ischium. It then inserts onto the head of the fibula.

    Biceps femoris muscle

    Semitendinosus muscle: This muscle is located medially, and muscle originates from the sacrotuberous ligament and tuberosity of the ischium and it inserts on the proximal tibia medial to the tibial tuberosity.

    Semitendinosus muscle

    Semimembranosus muscle: This muscle originates from the tuberosity of the ischium and inserts on the medial condyle of the tibia and the oblique popliteal ligament.

    Semimembranosus muscle

     

     

    For further advice do reach out to your local doctor or family doctor.

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    Hip Joint Featured Image

    Hip Joint – Bones, ligaments, blood supply and innervation |Anatomy|

    We are going to be looking at the hip joint, its articulations, movements, blood supply, and innervation.

    So, the hip joint is a ball and socket synovial joint, forming the connection between the lower limb and the pelvic girdle.

    And the hip joint is also multi-axial meaning that it rotates on more than one axis. Which allows for a wider range of movement. Of course, the hip joint is designed for stability and weight-bearing.

    Hip joint

    The head of the femur articulates with the lunate surface of the acetabulum of the pelvis.

    Head of femur

    The lunate surface is concave, which is like the shape of a crescent moon as the name lunate suggests. And the hip joint can also be referred to as the acetabulofemoral joint.

    lunate surface

     

    Both the lunate surface of the acetabulum and the head of the femur are covered by hyaline cartilage. And hyaline cartilage is simple cartilage found on many articulating surfaces.

    So, the acetabulum is the part of the pelvis where the ilium, ischium, and pubis bones merge and its concave almost entirely encompasses the head of the femur. Which contributes to the stability of the joint.

    Hip-Bones-Pelvic-Girdle

    At the center of the acetabulum is a non-articulating surface which is known as the acetabular fossa. This part of the acetabulum contains loose connective tissue.

    acetabular fossa

     

    The acetabular labrum is the fibrocartilaginous collar or lip that surrounds the bony rim of the acetabulum and it bridges across the acetabular notch.

    acetabular notch

     

    The labrum of the acetabulum increases the stability of the hip joint by deepening the acetabulum and increasing the area of articulation with the head of the femur.

    labrum of the acetabulum

     

    The ball of the ball and socket hip joint is the rounded head of the femur. Which sits within the concavity of the acetabulum, which is our socket of the joint.

    The head of the femur is entirely covered by hyaline cartilage except for an area called fovea capitis femoris.

    fovea capitis femoris

     

    This is where the ligament of the head of the femur connects the femur at the fovea to the acetabular fossa, the transverse acetabular ligament, and the margins of the acetabular notch.

    margins of the acetabular notch

     

     Capsule OF the Hip Joint:

    So, the joint capsule of the hip joint attaches to the acetabular labrum and the transverse acetabular ligament proximally but is underneath the fibrous capsule.

    underneath the fibrous capsule

    The joint capsule is a strong fibrous capsule that can accommodate a wide range of movements and the capsule is strengthened and reinforced by the help of three ligaments.

    Anteriorly and superiorly by the iliofemoral ligament, which connects the anterior and inferior iliac spine and the acetabular rim to the femoral intertrochanteric line. The iliofemoral ligament is the strongest of the hip joint ligaments.

    iliofemoral ligament

     

    Inferiorly and anteriorly, the pubofemoral ligaments arise from the obturator crest and the superior ramus of the pubis and blend with the capsule and the medial part of the iliofemoral ligament.

    ischiofemoral ligament

     

    Posteriorly, the ischiofemoral ligament seen here from a posterior view connects the ischial part of the acetabular rim of the neck of the femur.

    The fibers from the three ligaments are arranged in a spiral fashion around the hip joint which helps stabilize the joint by pulling the head of the femur medially into the acetabulum.

    This reduces the amount of muscle energy required to maintain a standing position and prevents the hyperextension of the hip as well as excessive abduction.

     

    Movements of the Hip Joint:

    So the range of hip movement in the hip joint include

    • Flexion – Movement of the leg forward
    • Extension – Movement of the leg backward
    • Abduction – Movement of the leg laterally
    • Adduction – Movement of the leg medially towards the midline of the body
    • Medial rotation – Internal rotation of the thigh towards the midline.
    • Lateral rotation – Outward rotation of the thigh from the midline of the body.
    • Circumduction – Conical precise 360degree movement of the leg.

    Hip Movement

     

    Blood Supply of the Hip Joint:

    Blood is supplied to the hip joint primarily by the medial and lateral circumflex femoral arteries – the medial shown on the left and the lateral shown on the right. Both of these arise from the deep femoral artery.

    deep femoral artery

    And also by the artery to the head of the femur which runs within the ligament of the head of the femur which is shown in green and the artery to the head of the femur is a branch of the obturator artery.

    obturator artery

     

    Innervation of the Hip Joint:

    (Green color indicates nerve)

    1. Innervation of the hip joint comes anteriorly from the femoral nerve. 

    anteriorly from the femoral nerve

    2. Inferiorly from an articular branch of the anterior division of the obturator nerve.

    anterior division of the obturator nerve

    3. Poster superiorly from the superior gluteal nerve.superior gluteal nerve
    4. Laterally from the articular branch of the sciatic nerve.

    sciatic nerve.

     

     

    For further advice do reach out to your local doctor or family doctor.

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    Scapula Anatomy featured Image (Final)

    Anatomy and Function Of The Scapula – Human Anatomy

     

    Let’s talk about the scapula and answer the question what is the scapula? What are its primary bony landmarks?

    What is Scapula?

    The Scapula also called the shoulder blade lies on the posterior part of the body. The scapula is a flat triangular bone placed in the thoracic cage (human rib cage).

    Extending from the level of the second rib to the seventh rib. It provides support to the muscles of the forelimb. Articulation for the humerus (upper arm bone) at the glenoid cavity and it is joined to the clavicle in front.

    The scapula or shoulder blade is a major bony component of the shoulder and functions to connect the upper extremity with the trunk of the body.

    The scapula articulates with two other bones:

    1. Laterally with the humerus at the glenoid cavity.
    2. Superiorly with the clavicle at the acromial process.

     

    Side Determination of Scapula:

    How do we determine the side of the scapula? Basically, the spinous process should always face backward. The glenoid cavity should face laterally that is away from the body.

    The lateral border is always thick while the medial border is thin.

     

    Anatomical Features of the Scapula:

     

    Surfaces:

    The costal surface is concave and it faces the thoracic cage. It has three longitudinal ridges and gives attachment to the intermuscular septa. There is another thick ridge adjoining the lateral border. This part of the bone is almost rod-like. It acts like a lever for the action of the serratus anterior in the overhead abduction of the arm.

    The dorsal surface gives attachment to the spine of the scapula which divides the surface into a smaller supraspinous fossa and a larger infraspinous fossa. The two fossa are connected to each other by the spinal glenoid notch. It is situated between the spine of the scapula and the glenoid angle.

    Angle: 

    The angle includes the superior angle, inferior angle, and lateral angle.

    • The superior angle is covered by the trapezius.
    • The inferior angle is covered by the latissimus dorsi and it lies just opposite to the superior angle it moves forwards around the chest. When the arm is abducted.
    • The lateral angle or the glenoid angle faces laterally and away from the body.

     

    Borders:

    • The medial border is the longest and faces the vertebral column. It’s on the medial side of the bone, so it’s called the medial border of the scapula. It’s also the border that is closest to the vertical column, so it’s also called a “vertebral border”.
    • The lateral border is the border of the scapula facing the humerus. It’s also close to your armpit, so it’s called “axillary border” as well.
    • The superior border, which is the shortest and thinnest.

     

    Bony Features of the Scapula:

    The acromion also articulates with the clavicle and so between the acromion and clavicle there is a joint it’s called the acromioclavicular (AC) joint. It’s a synovial plane joint. The clavicle articulates with the scapula. It allows you to move your arm up and down and the clavicle and scapula label to move your arm so it gets mobility.

    Acromioclavicular (AC) joint

     

    The spine of the scapula has the trapezius muscle that is anchors to give support to the scapula.

    Spine of the scapula

     

    The fossa is a shallow concave surface, so this fossa is on the back of the scapula and above the spine of the scapula so it’s called a supraspinous fossa.

    supraspinous fossa

    The infraspinous fossa is the fossa below the spine of the scapula.

    Infraspinous fossa

    The glenoid fossa of the scapula or the glenoid cavity is a part of the shoulder. It is shallow, which is located on the anterior side of the scapula.

    Glenoid cavity fossa

    Supraglenoid tubercle has found small projection found at the superior margin of the glenoid cavity. The supraglenoid tubercle is the origin point of the long head of the biceps.

     

    Supraglenoid tubercle (bicep)

    On the inferior margin of the glenoid cavity, you will find the infraglenoid tubercle. This is also an important landmark to remember since the long head of the triceps arises from the structure.

    Infraglenoid tubercle

    This coracoid process is important for muscle attachment, in fact, three muscles are the pectoralis minor muscle, the short head of the biceps muscle, and the coracobrachialis muscle all have attachments to the coracoid process.

    Coracoid process

    On the suprascapular notch, we have a ligament called the suprascapular ligament that goes across. So, you have the suprascapular artery that goes to the ligament.

    Suprascapular notch

     

     

    If you have any questions about Scapula Anatomy please feel free and leave a comment.

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    Knee Featured Image

    Anatomy Of The Knee

    For the anatomy of the knee joint, we’ll begin by looking at an anterior view of the right knee.
    The knee joint is made up of three bones femur, patella, and tibia. There are also medial condyle and lateral condyle. The patella articulates with the femur and the patella is the biggest sesamoid bone in the body.

    There is a small amount of fibula which does not make up the knee joint. Rather it articulates with the tibia (Shinbone), which does make up the knee joint.

    The tibia has a tibial tuberosity which can get inflamed when it gets inflamed it is known as Osgood-Schlatter disease (OSD).

    anterior knee view

    The knee joint is special because there between the joints is a fibrocartilaginous structure called the meniscus. There is medial and lateral meniscus and these menisci are basically shock absorbers and help stabilize join.

    It also has a role in the distribution of the synovial fluid. The knee joint is further stabilized by many ligaments the lateral collateral ligament and the medial collateral ligament.

    The quadriceps tendon essentially attaches and overlies the patella bone and then forms the patella ligaments. The patella bone has a patella ligament that runs and attaches to the tibial tuberosity which can get inflamed.

    The patella ligament is actually the continuation of quadriceps tendons formed by the rectus femoris muscle and the vastus muscles of the thigh.

    knee

    The side view of the knee joint and introduce the bursa, the bursa is fluid-filled sacs that help reduce friction. So, the femur, tibia, and the patella.

    The meniscus is the fibrocartilaginous structure that sits between the joints. The Quadriceps tendon comes down over and basically encapsulates the patella in front, forming the patella ligament.

    Sometimes the patella ligament is also known as the patella tendon and essentially onto the tibial tuberosity.

    Side view of the knee

    The bursa can get inflamed because of irritation between the skin and bone from overuse and friction. The pre patella bursa can get inflamed this is known as housemaid’s knees. This is because supposedly house-maid are on their knees and scrub the floor.

    This will cause friction between the skin and the patella leading to inflammation of the bursa between the two.

    The knee joint is the largest joint in the human body. The function of the knee joint is to allow movement of the leg.

    The popliteal artery is a continuation of the femoral artery. This artery supplies blood to the knee joint through numerous small branches.

    Inside the knees, you will find the smooth articular cartilage that covers the joint surface.

    Symptoms:

    Some of the associated symptoms for knee pain are,

    • Swelling
    • Instability
    • Weakness
    • Stiffness

     

    Causes:

    The incongruent surface is the biggest reason why the knee is more prone to develop injury and pay. However, are the reasons which one can experience knee pain is due to malalignment or poor tracking of patella bone. Due to tightness and weakness of the thigh muscles, due to degenerative changes in the joint also called arthritis of the joint.

    Due to repeated injury and sometimes due to some systemic diseases.

     

    For further advice do reach out to your local doctor or family doctor.

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    Spine Featured Image

    Vertebral Column Anatomy

    Your spine is also called your backbone or vertebral column is composed of 33 bones called vertebrae. Which provides your body with support and protects your spinal cord from injury.

    The vertebrae can be divided into five group’s cervical, thoracic, lumbar, sacral, coccyx. Each of which has unique features suited to its functions there are

    • 7 Cervical vertebrae numbered C1 to C7.
    • 12 Thoracic vertebrae numbered T1to T12.
    • 5 Lumbar vertebrae numbered L1 to L5.
    • 5 Sacral vertebrae numbered S1 to S5.
    • Coccyx

    The upper 24 vertebrae are articulating separated by intervertebral discs the sacral vertebra and the bones of the coccyx are fused.
    The cervical vertebrae (neck) which are the vertebrae of your neck support your head. Which weighs around 10 to 13 pounds.
    C1 and C2 are specialized Vertebrae,

    • Allow for the greatest range of motion of all the vertebrae
    • C1 is called “ATLAS”. Ring Shaped and attaches directly to your skull
    • C1 allows you to nod your head
    • C2 is called “AXIS”. Serves as an axis around which C1 pivots
    • C1 is able to pivot on C2 thanks to a specialized process called DENS, or ODONTOID process

    The Thoracic vertebrae are the vertebrae of your mid and upper back. Hold the ribcage and protect your heart and lungs. They have a limited range of motion.

    The Lumbar vertebrae are the vertebra of the lower back. Bear the weight of your upper body and are larger in order to support the stress. Especially when you lift something heavy.

    The Sacral vertebrae connect your spine to your hip bones these vertebrae are fused together with your hip bones, they form the pelvic girdle.

    The coccyx or tailbone is made up of four fused which provide an attachment point for ligaments and muscles of the pelvic floor.

    Parts of a Vertebra:

    A vertebra has three parts

    1. Body
    2. Vertebral arch
    3. Processes

    Spine 2

    The body bears weight, the vertebral arch houses, and the spinal cord and the processes allow for muscle attachment. The vertebral arch is made up of two supporting pedicles and two laminae.

    Space inside which houses the spinal cord is called the vertebral foramen. Under each pedicle spinal nerves exit and pass through the intervertebral foramina.

    Seven bony processors arise from each vertebral arch to form facet joints and processes for muscle attachment.

    Facet joints allow for back motion each vertebra has two pairs of facet joints one pair connects to the vertebra above and one pair that connects to the vertebra below.

    There is also a pair of transverse processes and a spinous process.

    Between the vertebras are the intervertebral discs, which provide cushioning and prevent the bones from rubbing together.

    Discs are composed of an annulus. Which is made up of several layers or lamina of fibrocartilage.

    Criss-crossing fibrous bands attach between the bodies of the vertebrae above & below and a gel-filled center called the nucleus.

    The nucleus distributes the pressure evenly within each disc during compression.

    The nucleus is full of proteoglycans large molecules with sugar subunits that are very hydrophilic. This structure swells with water unless it experiences constraints from the surrounding tissues.

    spine 3

    Hence, the nucleus absorbs fluid at night or when you are lying down and then this fluid is pushed out during the days. When you are upright and pressure is applied to the intervertebral discs. We shorten as we age because the discs lose the ability to reabsorb fluid during rest and they flatten and become more brittle.

     

     

    If you have any questions about Vertebral Column please feel free and leave a comment.

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    Bone Cancer Signs (Featured Image)

    10 Signs Of Bone Cancer

     

    Bone cancer is a malignant form of cancer that begins in the bone and destroys normal bone cells. This unusual kind of cancer affects both adults and children.

    Most people who have a disease in their bones develop it from the secondary spread of another cancer. This condition is called Metastasis.

    Some of the common risk factors associated with the development of bone cancer previous chemotherapy, diseases such as hereditary retinoblastoma, tuberous sclerosis, or prior treatment with radiation therapy.

    Keep reading to learn more about the symptoms of bone cancer.

     

    1. Bone Pain:

    One of the most common complaints of patients with bone cancer is consistent pain in the affected bone. The pain may not be constant at first, it can come and go but gradually becomes chronic.

    Typically, the pain is worse at night. However, it can also ache during the day, such as pain in the legs while walking.

    As cancer spreads the pain tends to remain there all the time. With more physical activity, it increases more.

     

    2. Swelling and Redness:

    You will experience swelling and tenderness in the affected area if you develop bone cancer. However, inflammation may not be visible in the early stages of cancer.

    It usually shows up after a few weeks. You may fee a lump or mass deposition on the site of the tumor. If a bump develops in the bones of the neck, then inflammation can occur in the back of the throat. This condition will lead to problems swallowing.

     

    3. Fractures Due Bone Weakness:

    Abnormal growth of cells weakens the bone as the disease grows. In most cases, the bones do not fracture or break.

    However, you might complain of sudden severe pain in your limb. This sign is especially notable after it has been tender for a few months. Bone cancer can make the bones weak that they can break even after a minor fall.

     

    4. Limping:

    Limping is a common symptom seen majorly in people who develop bone cancer in the leg. It is a condition where a person is not able to walk correctly.

     

    5. Unexplained Weight Loss:

    Sudden loss of weight that is not caused by stress, physical workouts, or a changed diet plan can be a sign of bone cancer.

    Typically, you will experience weight loss along with bone pain. This state requires immediate medical attention. As the body won’t be able to get rid of wastes easily, you will experience constipation.

    A loss of appetite will follow, leading to unintended weight loss.

     

    6. Fever:

    Among the set of different complications associated with bone cancer, contracting a low-grade fever is a telling sign. Though not every time, but in a lot of cases, bone cancer can trigger a fever. Not only will you have a temperature, but other symptoms as well.

    The temperature is usually low-grade, from mild to moderate. It should be around 99 degrees but can be higher in some cases.

     

    7. Anemia:

    If you have been running short of breath and feeling tired for a few days now, there is a possibility that you are anemic. Anemia is a telling sign of cancer, including bone cancer.

    It occurs with the scarcity of red blood cells in the body. As the bones weaken, the body produces white blood cells to combat the abnormal cells causing cancer in the body, which reduces the red blood cells count.

    Mild anemia may not be as bothersome as moderate anemia, which can cause headaches and weakness.

     

    8. Loss Of Appetite:

    You might experience weight loss as the body remains exhausted all the time. When the cancerous tumor starts spreading in the body, you might lose your willingness to eat.

    Food might begin tasting bad or lose its flavor. As the cancerous cells in the body suck all nutrients from the meal, it leaves you drained out and disinterested in food.

     

    9. Disturbed Sleep:

    Trouble in sleeping or disturbed sleep is another symptom of bone cancer. This symptom occurs because of episodes of pain in the bones. You can have difficulty falling asleep.

    You might also wake up multiple times in the night. Once you wake up in the middle of the night, you might lay awake.

     

    10. Fatigue:

    As with other types of cancer, bone cancer leads to fatigue and weakness. This symptom can certainly impact your quality of life. Physical and mental fatigue with any underlying cause can be a sign of a condition like cancer. You may have persistent tiredness for a long period of time.

     

    Diagnoses

    Bone cancer can be preliminary diagnose with the analysis of bone X-ray or MRI image. An X-ray image provides a low-priced diagnostic tool for diagnosis and visualization of bone cancer as compared to MRI.

     

    We recommend you to take your doctor’s advice for proper guidance and discuss these symptoms with your doctor.

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    Fibula: Feature, Fracture Types, and Symptoms

     

    The ankle is made up of three bones the tibia or shin bone, the fibula or calf bone, and the talus. The most common ankle fracture usually involves the fibula.

    Side Determination of Fibula:

     

    How do we determine the side of a fibula? The upper end of the head is slightly expanded in all directions. The lower end or lateral malleolus is expanded anteroposterior and flattened from side to side.

     

    fibula lower end

    On the medial side of the lower end, there is a triangular articular facet anteriorly and a deep malleolar fossa facing posteriorly.

     

    Features of Fibula:

     

    The Fibula has an upper end, a shaft, and a lower end.

    Fibula upper.end

    Now let’s look at the upper end of the fibula. The upper end is slightly expanded in all directions.

    The fibula is the cylindrical lateral bone of the leg that is very small and thin. If you look at the placement of this bone which is parallel to the tibia. The tibia is the main part with the fibula acting as a pin that has to be inserted in the loop.

    It is also called the calf bone because it’s present at the back of the leg. The fibula bone it’s not weight-bearing. The tibia is the weight-bearing bone of the leg.

    The fibula is so non-weight bearing that it can be taken out of it and use if for bone reconstruction elsewhere in the body.

    So its main functions are is forming the ankle joint. And a site of muscle attached as we have got lots of muscles attached to the fibula and the tibia and the interosseous membrane. So muscle attachments forming the ankle joint.

    Basically, fibula fractures are very common, and fibular fractures commonly happen due to minor trauma.

    The fibula is the lateral and smaller bone of the leg. It is very thin as compared to the tibia.

     

    What are the types of fibula fractures?

     

    Fibula fractures occur around the knee, ankle, and middle of the leg. There are types of fracture, which can also affect recovery and treatment. These types include:

    1. Avulsion fracture – a fracture in which a small part of the bone gets pulled off.
    2. Lateral malleolus fracture – a break around the ankle.
    3. Fibular head fracture – a break near the knee.
    4. Shaft fracture – a break that often affects the middle of the leg due to direct impact.
    5. Stress fracture – a hairline fracture due to repetitive injury e.g. Soccer, rugby, and snowboarding.

     

    What are the symptoms of a fracture?

     

    Other than pain and swelling, other signs of a fibula fracture include:

    • bruising and tenderness
    • deformity in the lower part of the leg
    • pain that gets worse when putting pressure on the leg
    • tingling or numbness, which usually happens if there is a neurovascular injury

    Other joints and bones involved, such as the tibia.

     

    Educational fibula fracture platting procedure:

     

    First, the surgeon will make an incision over the fracture and a clamp (surgical tool) is used to hold the broken bone in place using special instruments a hole is drilled in the bone and a screw is used to hold the fracture in the correct position.

    Next, the distal fibula plate is placed onto the bone and held with two pins then using special instruments screws are inserted through the plate to hold it onto the bone. After the ankle fracture has been fixed with a plate. Your surgeon drills holes in both the fibula and the tibia just above the ankle joint. The implant is inserted through the holes until it reaches the other side. Then your surgeon pulls back on the handle positioning the button against the bone.

    Finally, the round button is placed against the plate and your surgeon pulls on each suture (Thread-like material) until the desired tension is achieved. This completes the ankle fracture repair.

     

     

    We recommend you to take your doctor’s advice for proper guidance.

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    Clavicle Fracture: Symptoms, Causes and Recovery/Rehabilitation

    Most clavicle fractures will heal without an operation. They quite often managed in either a sling or brace to try to help support the weight of the arm to prevent the fracture from displacing and this also provides pain relief.

    You have sustained a fracture to the middle portion of your collarbone also known as the clavicle.

    Clavicle Fracture

     

    As the above picture demonstrates that there is a common injury and it will heal itself naturally with the passage of time this normally, takes approximately six weeks but pain and swelling can be ongoing for three to six months because of the nature of the injury. There may always be a lump in this area it should however not be painful and have no long-term effects.

    fracture sling

     

    You will have been provided with a sling. This should be worn for the first two weeks. Only it should be removed regularly to perform the exercises.

    You may need to take painkillers or anti-inflammatories, especially in the early stages. Some of these injuries require a follow-up appointment with an upper limb specialist. Certain injury types can lead to delayed healing.

    • One of the things that can slow down healing is smoking. If you do smoking it would be advisable to stop at least for the duration of the healing process.
    • You can start driving again when you can comfortably control the car. And obviously, you can’t drive if you’re still in the sling.
    • You can return to work when you feel comfortable and sports can be resumed at six weeks. Keep in mind though that pain and swelling can be ongoing. When you start impact activities.

     

    Symptoms

     

    • Pain that increases with shoulder movement
    • Swelling
    • Tenderness
    • Bruising

     

    Causes

     

    • Falls- Such as falling onto your shoulder or onto your outstretched hand.
    • Sports injuries- Such as a direct blow to your shoulder on the field, rink, or court.
    • Vehicle trauma- From a car, motorcycle, or bike accident.

     

    Initial Exercises to be taken as part of your rehabilitation:

     

    It’s really important in the first stage of your rehabilitation to remove your sling to do the following exercises three to four times a day.

    1.  Hand and Wrist Exercise: You can move your wrist in upwards and downwards position getting a good stretch of that joint. You can use a pair of socks that you make a ball and hold and squeeze to add some resistance to this exercise. This is good to help to reduce the swelling.
    2.  Elbow Exercise: You need to practice straightening your elbow and bending it towards your mouth. Elbow also works in rotation and moves your hand from facing palm up to palm down.
    3.  Rollback Shoulder Exercise: You should bring your shoulders back so that, you get a stretch across the front of your chest. You should hold this position for approximately 30 seconds and repeat this four to five times a day.
    4.  Pendulum exercises: Hold on to a firm surface bring your feet into a step starts position and gently lean forward letting your arm come forward with it. You can then move your arm in forwarding and backward momentum. Just like the pendulum from a clock and also do with sideways movement, clockwise rotation. Do this exercise for a minute or a minute and a half again four to five times a day.

     

    These exercises are only to be undertaken after 3 weeks:

     

    The next stage of your rehabilitation is about gently starting to move your shoulder. This exercise is known as an active-assisted range of movement.

    The first movement direction is to hold on to your hand with your good arm and gently guide it up in the air. You should repeat this 10 times nice and slowly and thinking about the quality of the movement.

    The second movement is a rotational way for this get a stick and place your arm firmly with an overhand grip onto the stick. Use your arm in a sideways outer movement. Keep your elbow close by your side.

    The exercise you should do about 10 repetitions on both exercises about 4 to 5 times a day.

     

    These exercises are only to be undertaken after 6 weeks:

     

    The third stage of rehabilitation is about regaining the range of movement and strength in your shoulder.

    The first exercise is bringing your arms straight up in front of you as far as you can do comfortably. It’s important to focus on your posture while doing it.

    The second exercise is to your thumb outwards and do a similar movement but in a big arc. Once again just go as far as you feel able to and each day hopefully this will improve a little bit.

     

     

    We recommend you to take your doctor’s advice for proper guidance.

    Do share this blog with your friends and family!

     

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    Osteoporosis – causes, symptoms, diagnosis and treatment

     

    Osteo refers to bones and porosis means pores. So, osteoporosis is when there’s a higher breakdown of bone. A decrease in bone density to the point of potential fracture.

    Looking at a cross-section of a bone, there’s a hard-external layer known as the cortical bone and a softer internal layer of spongy bone that is composed of trabeculae. The trabeculae are like a framework of beams that give structural support to the spongy bone. The cortical bone, in turn, is made up of many functional, pipe-like units called osteons, which run through the length of the bone.

    In the center of these osteons, there are hollow spaces called Haversian canals, which contain the blood supply and innervation for the bone cells. Around the Haversian canals, there are concentric lamellae, which look a bit like tree rings.

    The lamellae have an organic part, which is mostly collagen, and an inorganic part called hydroxyapatite, which is mostly calcium phosphate. In between neighboring lamellae, there are spaces called lacunae, which contain bone cells called osteocytes.

    Osteoporosis

    At first glance, the bone may appear motionless and unchanging, but it’s actually a very dynamic tissue.

    Bone Remodeling:

    In fact,

    • Spongy bone is replaced every 3 to 4 years.
    • Compact bone is replaced every 10 years.

    In a process called bone remodeling which has two steps:

    1. Bone resorption: when specialized cells called osteoclasts break down bone.
    2. Bone formation: which is when another type of cells called osteoblasts form new bone.

     

    Bone remodeling as a whole is highly dependent on serum calcium levels, which, in turn, are kept in the normal range by a balance between parathyroid hormone (PTH), Calcitonin, and Vitamin D.

    Parathyroid hormone is produced by the parathyroid glands in response to low serum calcium, and it increases bone resorption to release calcium into the bloodstream.

    On the other hand, calcitonin is produced by the thyroid gland in the response to high serum calcium, so it opposes the action of PTH- therefore promoting bone formation and decreasing bone resorption.

    Finally, vitamin D promotes calcium absorption in the gut, so it increases serum calcium, promoting bone formation and decreasing bone resorption.

    Peak Bone Mass

    The balance between their regulatory factors results in a peak bone mass, usually by age 20 to 29 and this usually occurs earlier in females than in males. Factors that determine the peak bone mass are genetics. For example, people of African descent tend to have greater bone mass and nutrition.

    Finally, strength training increases peak bone mass, as well as hormones like estrogens and androgens that inhibit bone resorption.

    When osteoclasts break down bone faster than the osteoblasts can rebuild, it results in the lowering of the bone mass and eventually in osteoporosis.

    Causes

    Spongy bone and cortical bone, these bone changes increase the risk of fracture, and they are known as fragility or pathologic fractures. Some bones like the vertebrae, shoulder blades, and ribs consist mainly of spongy bone, so they are at great risk of fragility fractures.

    Factors that accelerate bone mass loss and increase the risk of osteoporosis are low estrogen levels, like after menopause, and low serum calcium.

    Additional factors include alcohol consumption, smoking, drugs that decrease calcium absorption from the gut through antagonism of vitamin D, and drugs like heparin and L-thyroxine.

    Another factor is physical inactivity, as seen in astronauts in a zero-gravity environment where they just don’t use their musculoskeletal system as hard as when they’re on earth. As a result, bone deposition decreases due to a lack of stress, while resorption increases.

    There are also diseases that can cause osteoporosis like

    • Turner syndrome
    • Hyperprolactinemia
    • Klinefelter syndrome
    • Cushing syndrome
    • Diabetes mellitus.

     

    Now, the two most common types of osteoporosis are

    1. Postmenopausal osteoporosis

    In postmenopausal osteoporosis, decreased estrogen levels lead to increased bone resorption.

    2. Senile osteoporosis

    People with senile osteoporosis don’t usually have symptoms until a fracture occurs.

    Symptoms

    The most common type of fractures are vertebral fractures, also known as compression fractures, and it occurs when one or more bones in the spine weaken and shatter. Vertebral fractures cause back pain, height loss, and a hunched posture.

    Femoral neck fractures and distal radius fractures can also occur, and they’re often associated with postmenopausal osteoporosis.

    Diagnosis

    Osteoporosis is usually diagnosed with a dual-energy X-ray absorptiometry or DEXA scan which tests for bone density.

    Treatment  

    Treatment for osteoporosis usually relies on bisphosphonate drugs like Alendronate and Risedronate. If osteoporosis is really advanced, teriparatide, a recombinant parathyroid hormone can be used.

     

     

    We recommend you to take your doctor’s advice for proper guidance.

    Do share this blog with your friends and family!

     

     

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