pol group 15 case 5
TRANSCRIPT
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POL GROUP 15POL GROUP 15
CASE 5CASE 5Stefan Flowers
Marlon GoldsonPatrick McNaughton
Sidyq Mohammed
Nisha Potopsingh
Leah Reid
Kristy SewlalMoina Spencer
Onalenna Tema
Dacia Thomas
Oarabile Tome
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CASEA fifty-year old man came to see his physician with the
following complaints: tenderness and swelling in theleft buttock area and a limp. The patient informedthe physician that over the last four months he hadreceived a series of intramuscular injections.
On physical examination it was found that the swellingwas tender and fluctuant. The patient was first asked
to stand on both legs and then, on his right leg only.No abnormality was noted but when asked to standon his left leg, he sags to the right.
Aspiration of the swelling produces thick fluid which is
sent for culture.
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ExaminationSwelling was tender and fluctuant
Had a positive Trendelenburg sign
Aspiration of the swelling produces thick fluid
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FindingsChronic inflammation
Oedema
Limp
There is pelvic instability
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Cause
Symptoms and signs occurred as a result of the
intramuscular injections.
Introduction of foreign substance into the muscle
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DiagnosisGluteal Abscess
Possible nerve damage
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IP JOINTIP JOINT
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Articulation of Hip
Joint:o Articulation between; Acetabulum Head of femur
o Synovial Joint: Ball and socket variety. Multiaxial
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Stability of the Hip JointThe hip joint is a very strong and stable
articulation joint.
dense fibrous capsule.
strong intrinsic ligaments.
articulating bones
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LigamentsThe Transverse Ligament -fibrous tissue
The Iliofemoral Ligament
The Pubofemoral Ligament
The Ishiofemoral Ligament
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MusclesThe gluteals: Maximus, Medius, Minimus.
Lateral rotator group : the externus and internusobturators, the piriformis,
the superior and inferior gemelli, tensor fasic
latae.
Iliotibial tract
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H E M IC R O S C O P IC H E M IC R O S C O P ICN A T O M Y O FN A T O M Y O FK E LE TA L M U S C LEK E LE TA L M U S C LE
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MUSCLE TISSUEMuscle tissue generates the forces necessary for
cellular contraction, which derives movement
within certain organs and the body as a whole.
The are three (3) types:
i) Skeletal ii) Smooth iii) Cardiac
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Features of Skeletal
MuscleElongated or tubular
Multinucleated
Peripheral nuclei
Striated
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Muscles:
Parallel or Fusiform: Eg: Sartorius.
Convergent: Eg: Pectoralis Major
Pennate: There are three types of pennate
muscle:
1) Unipennate 2)Bipennate 3)Multipennate
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Locations of the Shapes
of Skeletal Muscle
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OrganizationEpimysium external sheath of dense,
irregular connective tissue surrounding the
entire muscle
Perimysium connective tissue which extends
inwards dividing interior into fascicles
Endomysium surrounds each muscle fiberand is composed mainly of basal lamina andreticular fibers
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Organization of Skeletal
Muscle
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Muscle Fiber
OrganizationSarcolemma - plasma membrane
Sarcoplasm - cytoplasm
Sarcoplasmic reticulum - endoplasmic reticulum
Sarcosomes - mitochondria
Sarcomeres repeating contractile units along each
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Muscle Fiber
OrganizationEach muscle fiber is composed of the following
subunits:
Myofibrils extend the length of the fiber and
are composed of myofilaments.
Myofilaments formed from actin and myosin.
The fibers are maintained by a meshwork of
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Cross-Striations in
Skeletal MuscleDark A bands and
Light I bands.
The A bands are bisectedby the H zone runningthrough the center ofwhich is the M line.
The I bands are bisectedby the Z disk.
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Electron Micrograph of
Skeletal Muscle
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MANANGEMENTANANGEMENTOf the patient..
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MANANGEMENT
involves:Explanation
Advice and counseling
Prescribing
Observation & follow-up
Prevention
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FACTS ABOUT THE
PATIENTSwelling and tenderness = inflammation
received a series of gluteal intramuscular
injections= location of the superior gluteal nerve
Test positive for Trendelenburg sign= glutealmediusmuscle tissue damage or/and superiorgluteal damage.
swelling produces thick fluid=inflammation
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PLANIncision and Drainage (I&D) of the abcess
Non-steroidal Anti-inflammatory drugs eg ibuprofen
Broad Spectrum anti-biotics (until lab cultureanalysed) eg penicillins, amoxicillin
Antiseptics
Referral to a physical therapist.
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IbuprofenWill take care of re-inflammation after the
abcess drainage.
There are Cardiovascular and Gastrointestinal
Risks
1000 mg per day oral administration--200mg
per caplet---2 caplet for every 6hours.
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AmoxicillinWill get rid of any bacterial in the system
which maybe the underlining cause of theimflammation..
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Advice and councilling
No pressure/weight on the left buttock
Take only the prescribed Medicine
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Physical therapy
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OverallThe patient will be sent home to rest and if there
is no improvement to his condition he must come
in.Also an appointment is made after two days.. By
then, the results from the lab will be ready, and if
he is not improving a specific antibiotic will be
administered..