fatima's soft bones

fatima's soft bones

1. Causes of bone pain

   • Osteoporosis
   • Bone tumor
   • Bone infection (osteomyelitis)
   • Hypercalcemia
   • Rickets and osteomalacia
   • Paget disease of the bone

2. OSTEOPOROSIS

   • Types of osteoporosis
     • Localized osteoporosis:
       • e.g. disuse osteoporosis in a limb.
     • Generalized osteoporosis:
       • secondary
         • Due to: -Endocrine disorder: Hyperparathyroidism -Neoplastic: Multiple metastatic carcinoma. -Gastrointestinal:
       • Primary(Commonest Type)
         • Senile form: affects elderly people of both sexes
         • Postmenopausal form: It occurs in post menopausal women
   • Morphology
     • whole skeleton is affected cortex and trabeulae are thinned haversian systems widened normal composition
   • Pathogenesis
     • Decrease in total bone mass and density.
   • Risk factors
   • Type 2 diabetes and osteoporosis
     • previously believed to provide bone protection because of its associated normal to increased BMD. When considering all of the risk factors , patients with diabetes generally have an increased risk of falling because of peripheral neuropathy, possible hypoglycemia, and visual impairment.
   • Investigations
     • Complete Blood Count
     • Electrolyte test
     • Blood Sugar Test
     • Thyroid Hormone Test
     • Screening Test
       • Bone Mineral Density FRAX tool- Ultrasound
   • Management of Osteoporosis
     • Pharmacological treatment
       • Bisphosphonates
       • Selective estrogen receptor modulators
       • Calcitonin
       • Denosumab
       • Teriparatide
     • non-pharmacological
       • Nutrition therapy
         • CALCIUM
         • Vitamin D
     • hormone Replacement Therapy
       • increase bone density reduce the rate of fracture useful for women who have undergone early menopause (before 45 years of age) increased the risk of heart disease and stroke
     • Physiotherapy
       • Help strengthen your bones & muscles. Prevent bone thinning Improve your balance>reduce falls
   • Most common Fractures
     • Vertebral Fractures
     • Non-vertebral Fractures(Hip , wrist , Arm )
       • Hip Fracture
         • possible complications after a hip fracture
           • Blood clots Pneumonia Post-operative infection
   • definition
     • A term denoting increased porosity of the skeleton and increased bone fragility due to reduction in bone mass.
   • Quality of life
     • 1. Impaired physical ability
     • 2. Reduced social activity
     • 3. Poor well being
     • 4. Depressed mood

3. Physical Examination of the Hip

   • inspection: Position (deformity) : the hip may show : flexion deformity adduction deformity abduction deformity rotation (internal or external)
   • palpation: Palpate for the temperature around the joint Palpate the bony contour & muscles. Using the thumb & index fingers, bilaterally palpate the relation between ASIS and (Palpation) the greater trochanters & compare either sides. During palpation you look for any tenderness, Swellings, or Atrophy.
   • movement: Both active & passive movements are tested for ROM
   • Special tests:
     • Thomas’ test :
     • Trendelenburg test:

4. Treatment of Hip Bone Fracture

   • Arthroplasty
     • In this surgical procedure, a joint can be restored by resurfacing the bones or replacing all or parts of the hip joint with a man-made joint. This artificial joint is called a prosthesis .

5. anatomy

   • hip bone
   • femour
   • Ligaments of Hip Bone
   • Blood Supply to the head and neck of femur
   • Femoral Triangle Region
   • Gluteal Region

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