POL GROUP 15

CASE 5
Stefan Flowers
Marlon Goldson
Patrick McNaughton
Sidyq Mohammed
Nisha Potopsingh
Leah Reid
Kristy Sewlal
Moina Spencer
Onalenna Tema
Dacia Thomas
Oarabile Tome
CASE
A fifty-year old man came to see his physician with the
following complaints: tenderness and swelling in the
left buttock area and a limp. The patient informed
the physician that over the last four months he had
received a series of intramuscular injections.

On physical examination it was found that the swelling
was 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 stand
on his left leg, he sags to the right.

Aspiration of the swelling produces thick fluid which is
sent for culture.

Examination
Swelling was tender and fluctuant

Had a positive Trendelenburg sign

Aspiration of the swelling produces thick fluid




Findings
Chronic inflammation

Oedema

Limp

There is pelvic instability



Cause

Symptoms and signs occurred as a result of the

intramuscular injections.

Introduction of foreign substance into the muscle
Diagnosis
Gluteal Abscess

Possible nerve damage
HIP JOINT
Articulation of Hip
Joint:
o Articulation between;

Acetabulum

Head of femur


o Synovial Joint:

Ball and socket variety.

Multiaxial

Stability of the Hip Joint

The hip joint is a very strong and stable

articulation joint.

dense fibrous capsule.

strong intrinsic ligaments.

articulating bones
Articular Capsule

Acetabular labrum

Fibrocartilage

Fibrous capsule: a cylindrical sleeve that encloses
the hip joint and most of the neck of the femur.
Ligaments
The Transverse Ligament

-fibrous tissue


The Iliofemoral Ligament


The Pubofemoral Ligament

The Ishiofemoral Ligament
Muscles
The gluteals: Maximus, Medius, Minimus.

Lateral rotator group : the externus and internus
obturators, the piriformis,
the superior and inferior gemelli, tensor fasic
latae.

Iliotibial tract

 T H E M IC R O S C O P IC
A N ATO M Y O F
S K E L E TA L M U S C L E
MUSCLE TISSUE
Muscle 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

Features of Skeletal
Muscle

Elongated or tubular

Multinucleated

Peripheral nuclei

Striated



Longitudinal Section of
Skeletal Muscle
Shapes of Skeletal
Muscles:
 Parallel or Fusiform: Eg: Sartorius.


 Convergent: Eg: Pectoralis Major


 Pennate: There are three types of pennate
muscle:

1) Unipennate

2)Bipennate

3)Multipennate

Locations of the Shapes
of Skeletal Muscle
Organization
Epimysium – 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 fiber
and is composed mainly of basal lamina and
reticular fibers
Organization of Skeletal
Muscle
Muscle Fiber
Organization


Sarcolemma - plasma membrane


Sarcoplasm - cytoplasm

Sarcoplasmic reticulum - endoplasmic reticulum

Sarcosomes - mitochondria

Sarcomeres – repeating contractile units along each
Muscle Fiber
Organization

Each 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
Cross-Striations in
Skeletal Muscle


Dark A bands and

Light I bands.

The A bands are bisected
by the H zone running
through the center of
which is the M line.

The I bands are bisected
by the Z disk.

Electron Micrograph of
Skeletal Muscle
MANANGEMENT
Of the patient..
PATIENT
MANANGEMENT
involves:
Explanation

Advice and counseling

Prescribing

Observation & follow-up

Prevention
FACTS ABOUT THE
PATIENT
Swelling and tenderness = inflammation

received a series of gluteal intramuscular
injections= location of the superior gluteal nerve

Test positive for Trendelenburg sign= gluteal
mediusmuscle tissue damage or/and superior
gluteal damage.

swelling produces thick fluid=inflammation

PLAN
Incision and Drainage (I&D) of the abcess

Non-steroidal Anti-inflammatory drugs eg ibuprofen


Broad Spectrum anti-biotics (until lab culture

analysed) eg penicillins, amoxicillin

Antiseptics

Referral to a physical therapist.

Ibuprofen
Will 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.
Amoxicillin
Will get rid of any bacterial in the system
which maybe the underlining cause of the
imflammation..

Advice and councilling


No pressure/weight on the left buttock


Take only the prescribed Medicine


Physical therapy
Overall

The 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..
