The hip its make-up and complications.
The skeleton comprises of 206 bones. Including but not limited to long bones, ribs, vertebrae, metacarpals metatarsal’s and the skull bones. The main functions of the skeleton are to provide support & shape, protection, allow movement by forming joints and attaching to muscle and tendons, storage of minerals and production of erythrocyte’s and leukocyte’s (red and white blood cells) When bones meet a joint is formed. There are different types of joints. These joints can be categorised as fibrous joints, cartilaginous joints and synovial joints.
Fibrous joints are bonded by strong fibrous structures and are immovable. Joints in this category include the bones of the skull or tibia and fibular. Cartilaginous joints are formed with fibrocartilage padding the joint and acting as a shock absorber. These joints are immoveable or have limited movement such as the joints of the spine. Synovial joints include the knee, shoulder and the hip. They all have space between the bones. They are held together by a fibrous membrane known as the synovial membrane. They are lubricated by a fluid known as synovial fluid. Synovial joints are the most mobile joints in the body.
(Waugh, 2014)
Bones can be categorized as long, short, flat, irregular and sesamoid.
Long bone consists of a long shaft and extremities. They are mainly found in the limbs and include the femur to be fibula radius and humorous. The shaft is mainly made of compact bone with a central medullary canal containing yellow fatty marrow. The extremities have an outer casing of compact bone with spongy bone underneath.
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The two main types of tissue that make up bone are compact bone and spongy bone.
The outer layer of all bones made up of compact bone and the majority of the long bones. As the name suggests is very compact and has very few spaces. Compact bone protects and supports the bone and allows it to bear weight. Osteon is the building blocks of bone as amino acids are the building blocks of muscle. It is laminated in layers much like rings of a tree. Osteoblasts form bone when they get trapped and turning into osteocytes. The osteocytes are linked by haversian canals where they get the nutrientes needed. When the bone need to remodel or repair osteoclasts absorb damaged celled so they can be reformed.
(Britannica, 2016)
Spongy bone is made up of irregular columns called trabeculae. Sometimes the space is filled with red bone marrow.
Ligaments are tough fibrous connective tissue that holds bone together in proper alignment at the joint. (Encyclopaedia Britannica, 2016)
Tendons are the connective tissue that connects muscle to bone. Allowing muscle forces to move the bone. (Encyclopaedia Britannica, 2016)
The Muscles are formed around the joint in opposing positions attached by tendons to allow the joint its range of movement.
(Waugh, 2014)
The hip is the largest Weight-bearing joint in the body. It allows us to stand, walk, run, climb, squat and even sit. The range of movement the hip has is abduction, adduction, Flexion, extension, Lateral rotation and medial rotation.
The hip joint is a ball and socket joint. The femoral head or head of femur is the ball and the acetabulum is the socket in the pelvis. Articular cartilage covers the articular parts of the acetabulum known as the lunate surface and end of the femoral head. The articular cartilage provides cushioning and allows the joint to move easily.
The Labrum which is a thickened piece of Fibro cartilage that deepens the acetabulum. As the labrum crosses the acetabulum fossa it forms a ligament called the transverse acetabulum ligament. Together with the capsular ligament this forms a strong capsule. That is reinforced by the lliofemoral, pubofemoral and ischiofemoral ligaments. The capsule is lined by the synovial membrane. This produces synovial fluid that lubricates the joint.
(anatomy zone, 2012) (Waugh, 2014)
Intercapsular or inside the capsule the ligament to the head of the femur attaches the femur to the acetabulum. It attaches at the acetabulum fossa to the fovea of the femur which is a small indentation on the head of the femur. It carries the obtarator artery which allows a small portion of the head of femurs blood supply. Attached via tendons are the muscles of the hip. The main muscle groups involved in allowing the hip its full range of movement are the gluteus muscles, the abductor muscles and the lliopsoas muscles.
(Oxford University hospitals NHS trust, 2016)
A common malfunction of the hip is Femoro Acetabular impingement (FAI) also known as Hip Impingement. Femoro Acetabular impingement is a condition where the hip is abnormally shaped. The abnormally can be on the head of femur, femur head neck junction and/or the acetabulum. It is thought to affect 30% of the general population and around 90% of people that take part in particular sports such as football, rugby and hockey regularly. However, it can go undetected in the early stages due to it being pain free.
Hip impingement is categorized as one of three causes CAM, PINCER or MIXED impingement. In a normal hip the femoral head moves smoothly in the acetabulum
CAM impingement is cause by jamming or a squeeze during some movements caused by anomalies in the shape of the head and/or head neck junction into the acetabulum.
PINCER impingement happens when there is direct contact with the femoral head or head neck junction with the acetabulum edge and labrum. The acetabulum will appear over deep. Mixed impingement is a combination of cam and pincer
(OUH, 2016)
These can result in mild or severe stiffness resulting in limited range of movement, mild or severe pain. FAI can limit the sufferer’s quality of life tremendously. Not only can it cause pain and stiffness it can stop a person doing certain activities. This can lead to them suffering from other illnesses such as depression. Due to the lack of or the limiting of activity people with FAI can gain weight which may cause more pain and thus limiting the person further.
FAI
(OUH, 2016)
Treatment for FAI can be surgical and non-surgical.
Non-Surgical options include
Analgesia (such as co-codamol, Paracetamol and tramadol) and/or Anti-inflammatory medication (such as ibuprofen, diclofenac or naproxen)
Activity modification such as changing daily routine, limiting particular activity or stopping particular activity.
Physiotherapy and/or sports rehabilitation. This can strengthen the muscles stabilizing the joint. Expanding the range of movement.
Injection this comprises of two parts a local anaesthetic (normally lignocaine) and a corticosteroid. The local anaesthetic relieves pain and the cortical steroid reduces inflammation in the joint. This can also be used as a diagnostic method. As if it is successful it rules out referred pain from the back or other hip complications.
Surgical
Arthroscopic surgery normally shaving off the extra bone or reshaping the bone.
Full hip replacement (this is normally a last resort).
(OUH, 2016)
In conclusion the hip is the most stable joint in the body. Made of bone at is made up of osteon in the form of compact bone and spongy bone. The hip has a number of ligaments stabilising it and forming a capsule. And muscles opposing to allow movement. However a complication with the hip is Femoro Acetabular impingement or hip impingement. This can have a big impact on the sufferers quality of life and has a range of treatments.