Head of the module Ass.prof. Aušra Burkauskienė, Institute of Anatomy

Transcription

1 1. Head of the module Ass.prof. Aušra Burkauskienė, Institute of Anatomy Coordinators of the module As.prof.Vytautas Gedrimas. Institute of Anatomy Ass.prof. Rimvydas Miliauskas, Institute of physiology and pharmacology Clinics and departments par ticipating: Institute of Anatomy Department of an enviromental and occupational medicine Department of the general surgery Department of Biochemistry Institute of Biology Institute of Physiology anr Pharmacology Department of Hystology and embriology The Sports institute Clinic of the Orthopedics and traumatology Clinic of the Radiology Department of Nursing and care Contents 1. General information 2. General contents of the module 3. Module objectives and tasks 4. Tutorials 4.1. First problem. Painfull falling down 4.2. Second problem. An insecure kick 4.3. Third problem. Degenerative changes of hip joint structural components Stagnation and pain of the hip joint 4.4. Fourth problem. The loin (law back) pain 4.5. Fifth problem. Appe s hand 4.6. Sixth problem. Advanced weakness of muscles. 6. Practical s 6.1. Functional anatomy of the vertebral column (3 hours) 6.2. Functional anatomy of the knee, hip and shoulder joints (3 hours) 1

2 4. Tutorials 4.1. First problem. Painfull falling down 75-years-old pensionier woman A.G. lived on her own and was of small built (body height - 1,6 m and mass - 49 kg ). She had been having a history of the continuing, gnawing loin (lumbar) pain for the past 15 years. Due to this pain, the woman was having a diffulty in walking: she had cramp pains in legs at night whenever she walked. Therefore, she tried to walk as little as possible and did not visit her doctor. The only woman s entertainment was coffee drinking. In the evening being unable to sleep because of pain, A.G. got up and went for her painkillers but stumbled over the carpet and fell down. By falling she leaned on her hand that led to a sharp pain. The woman observed that her hand involuntary moved outside, there also was an increase in the circumference of the wrist region, accompanied by oedema and deformation. Next day A.G. was referred to a traumatologist, who after examination advised to make x-ray of the hand. What caused lesion of the wrist and palmar region? Was it possible to prevent such lesion? What could be a reason of the loin ( lumbar) pain? 2

3 4.2 Second problem. An insecure kick A 26-year-old patient P.M., who had played football for 10 years, visited a doctor because of the pain and disorder of function of the left knee joint. During the match another player had kicked him in the medial side of the left knee. P.M. fell and turned his leg; he wanted to rise up and leaned on the left leg. The patient felt a severe pain in the area of the left knee. The sportsman having severe pain and limping left the football field. Despite the pain and oedema of the knee joint the patient did not visite a doctor for two days, cooled the knee area, then fixed the joint region with elastic bandage and used antiinflamatory painkillers. The pain subsided, oedema diminished. But on the second day when P.M. began to walk oedema and the pain reoccurred accompanied by decreased motion of the knee joint. He decided to visit a doctor. Walking down the stairs P.M. felt a severe pain accompanied by a symptoms of locking of the left knee joint. After the medical examination doctor understood reasons of the pain and administered clinical tests. What was the cause of the pain and why did the patient felt locking of the knee joint? What is a medical treatment and principles of joint restoration? 3

4 4.3 The third problem. Pain and stagnation of the hip joint A 70-year-old retired woman J.C. working as a plasterer until she was 62. She had an increased body mass (height 1, 60m, weight- 88kg). The patient saw a doctor because of the pain in her right hip joint, stagnation (stifness) in the morning and limited motions. She had done heavyweight manual job all her life, had had a normal weight but after menopause her weight increased. First she felt the pain during the job in the right hip joint 10 years ago. After few years the pain was brought on not only on exertion but also at night, while resting. The pain was accompanied by stiffness in the joint in the morning and weakness of the muscles of the thigh. Recently, the patient began to suffer from severe pain, particularly on exertion. Being unable to sleep she felt the pain radiating to the thigh, groin, buttocks the woman began to use the painkillers, which helped a little. The patient also complained of the cramp pain in the muscles around the joint, increased siffeness in the morning, a limited amplitude of motion in the hip joint. Besides she saw pendulous right skirt. After examination the doctor suspected chronical pathology of the right hip joint. What was the cause of the pain and why did dysfunction of the hip joint occur? Explain the mechanism of the development of these changes. What are principles of treatment, rehabilitation and prevention in case of this pathology? 4

5 4.4 The fourth problem. The loin (low back) pain A 40-year-old builder K. M. with an increased body mass (height - 1,78 m, weight kg) complained of the loin (low back) pain, which radiated to the right leg up to the foot, muscle weakness in the leg and muscles dysfunction. The patient had suffered from the continuing pain in his low back for 2 years. Exertion made the pain worse. A year ago, after exertion he felt a severe pain in his low back that made him unable to move. A doctor advised to decrease exertion and administered nonsteroid anti- inflammatory drugs and myorelaxants. After acute phases of the disease physiotheraphy, massage, special exercises were administered. The pain subsided and the patient carried on with his daily work till the last accident. During inspection found - patient s right hip and knee joints were kept in the flexion position, the right sole (foot) was pendent, patient cannot raise it and to make extension (dorsal flexion) of the right sole and big toe. He felt a difference in medical style touching of both legs, difference of temperature reception in the right big toe, lateral side of the foot and sole.the doctor administered clinical analyses and recomended patient for other specialists consultations. Why did the pain in the loin ( low back) occur? Determine single muscles and the groups of the muscles and innervation of muscles, which are involved in dysfunction. Determine principles of treatment of such pathology 5

6 4.5 The fifth problem. Ape s hand A 54-year-old lecturer at medical university G.Č. has been preparing a manuscript of monograph and after long lasting writing began to feel intensive, especially at night, burning pain, oedema, numbness of the right hand and I-III fingers, he saw oedema in the region of the palmar area. Patient has insomnia because of the pain and numbness of the hand, he tried to help himself making massage, walking in the bedroom. Thinking that all these disturbances were related to writing of the monograph the patient did not seek medical advice and began to worry only when complains became stronger. Visually comparing both own hands he saw the changes and differences in relief of his right hand, the right thenar eminences became flat; the right hand was like the appe s hand which image he had seen in medical atlas. G.Č. decided to visit a doctor. Examination in the clinic revealed atrophy of muscles of thenar eminence of the right hand, skin dryness. Patient cannot successfully make fist (he cannot make flexion of I-III fingers), to keep paper list between I and II fingers, to move II finger on the table surface. Doctor found a decrease in skin sensation of I-III fingers and of the lateral side of the IV finger. A pain and numbness was intensified, when the flexion of the hand in the radiocarpal joint was made. The doctor diagnosed compression of one of the peripheral nerves. After nerve decompression surgery skin sensation disorders and numbness disappeared, muscle atrophy did not progress. Which peripheral nerve was involved? Why did the thenar eminence muscles waste away? Why did after nerve compression parasthesia, numbness, pain, muscle weakness occur? Why did these sensations intensify after bending of the hand in the wrist joint? 6

7 4.6 The sixth problem. Progressing muscle weakness. An 18-year-old schoolboy J. S. was admitted to the hospital because of the history of breathlessness and muscle weakness at the quietness. Mother of J.S. noticed first evidence of problems when a boy was 5-years-old, he had suffered from difficulty in standing up, walking, particularly in climbing stairs. At age of 7 years diagnosis of congenital weakness of the muscles was made. Weakness and atrophy of muscles and problems of walking advanced, and finally since he was 13-years-old he was able to move only in a electric wheelchair. Weakness of muscles of upper limb advances, amplitude of movements decreased. Gradually kyphoscoliosis and contractures in many of joints develops. Mother of J.S. told that brother of this guy died when he was 24-years-old and progress of disease was very alike. Why did the skeletal muscles become weak? Why did dyspnea occur? Is it possible to help the patient? 7

8 6.2. Functional anatomy of the knee, hip and shoulder joints (3 hours) 8. Module exam program 8.1 Anatomy 1. Partition of the human skeleton. Peculiarities of the different parts of the vertebral column, curves (flexures) of the vertebral column, joints of vertebrae 2. Main structural components and adnexa of the knee joint, biomechanical peculiarities of the knee joint 3. Main structural components and adnexa of the hip (coxal) joint, biomechanical peculiarities of the hip joint. 4. Function, vascularization and innervation of the muscles taking part in breathing (respiration) 5. Morphofunctional description, vascularization and innervation of the deep back muscles 6. Morphofunctional description, vascularization and innervation of the abdominal muscles 7. Armpit (axillary) fossa, composition of the walls, foramena, content. 8. Muscles of the forearm, function, vascularization, innervation, topography 9. Muscles of the hand (manus), function, vascularization, innervation, topography 10. The wrist (carpal) canal, walls, content 11. Muscles of the pelvis and thigh (femoral muscles), function, vascularization, innervation 12. The adductor canal of the thigh, composition of the walls, content 13. Muscles of the leg and foot, function, vascularization, innervation, topography 14. Popliteal fossa, muscles bounded popliteal fossa, content 15. Cruropopliteal canal of the leg, walls, openings of the canal, content. 16. Main structural components and adnexa of the shoulder joint, biomechanical peculiarities of the shoulder joint. 8