Pol Group 15 Case 5

8/14/2019 Pol Group 15 Case 5

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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..

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Pol Group 15 Case 5