Question

Case scenario

Mr. C, 50 years old, is an amateur soccer player who regularly plays with his friends over weekend. He has chronic anterior right hip pain and weakness over his groin region for 5 years.

One day, when he was playing soccer, he was injured by another player who crushed on him from lateral side of his left leg. Then, he fell down on the grassland after twisting his left knee and ankle due to the crush. He started to feel pain and weakness over his left leg from knee to ankle. He could not move his left leg to stand up. When he fell down, he fell on the leg of that player which caused pain, swelling, numbness and weakness over the posterior side of his own left leg. Then, he was send to the emergency room of a nearby hospital. The doctor of the emergency room of the hospital assessed his legs and arranged X-ray check for him.

Your supervisor asked you to identify all key anatomical structures in the initial assessment that are related to his hip, knee and ankle discomfort according to the above information. You need to provide clear rationale to support your answers when you report to your supervisor.

Please answer according to the following guidance:

1a. What bone(s), bony landmark(s) and joint(s) can be involved in his hip, knee and ankle problems? Please list out accordingly and support with corresponding reasons.

b. What muscle(s) and soft tissue(s) can be involved in his hip, knee and ankle problems? Please list out accordingly and support with corresponding reasons. The relevant origin and insertion should be included.

c. What nerve (nerves) can be involved in his hip, knee and ankle problems? Please list out accordingly and support with corresponding reasons.

Answer 1

The bones which involved in hip is ilium ischium pubis may be the chances of fracture at hip bone or hip joint mainly fracture takes place at two sites one is femoral neck and other is intertrochanteric site

The bony landmarks are present hip bone is

Ilium have two surfaces

Inner surface and external surface

Inner surface have iliac gussa. External surface have gluteal surface

Posteiorly there is greater sciatic notch

Pubis have different parts these are pubis body inferior pubic ramus and posterior pubic ramus

The joint involved in hip is hip joint which is formed by the articulation of femur head if there is any injury at  hip joint there may b chances of dislocation of joint or minor fracture movements is restricted not properly movement seen due to injury of hip joint

The knee bones have four types of bone one is thigh bone tbia bone knee cap and patella and condylar bone also

If any injury takes place at knee joint there is restrictions of movement and not much mobility of movement is seen

Distal end forms several parts where articulation takes place these are lateral and medial epicondyles

Patella has triangular having anterior and posterior surface posterior surface related with medial and lateral facet in which there is articulation of medial and lateral condyles

The muscles involved in hip bone where it provides attachment to muscle these are gluteus medius gluteus maximus sensor faciae late these muscles get affected when any pressure produces at these muscles

Origin of gluteus maximus is lateroposterior surface of sacrum and cocyx

Insertion of gluteus maximus is iliotbial tract gluteal tuberosity of femur

Innervation is inferior gluteal nerve

Muscles of knee are quadriceps and hamstrings muscles which flex the knee joint if any injury takes place in knee joint there is restrictions of movement of knee

Muscles of ankle are peroneus longus and brevis ankle joint is type of hinge synovial joint articulation of talus tibia and fibula bones

Nerve involved in hip is femoral sciatic and obturator nerves

Knee nerves are politely vessels which are divided into tibial and common peroneal nerves