Exam

• - transfer body weight from trunk to legs
• - allows to adopt numerous positions neded for: standing, walking, running, stairs

• Femoral neck angle 126* to shaft and 12* to frontal plane
• - head faces acetabulum medially, cranially and slightly
• Pelvis-acetabular labrum continuous with rim- makes the socket deeper. Transverse acetabular ligament completes circle. Acetabular notch permits vessels and nerves to pass in ligament of head. Articular fat pad moves in/out notch with pressure
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- Short ones usually tear

NAVEL

• - quads will have numbness
• - loss of knee ext
• - weakene hip flexion
• - atrophy of ant thigh
• - disabling for standing from seated position, climbing stairs, kicking, fast movement

• Clinical test- test skin within femoral distribution
• - test active knee ext

- affects adductors, atrophy of medial thigh, loss of hip/thigh adduction, cutaneous sensory loss in medial thigh

Clinical test- test skin of medial thigh, adduct thigh against resistance

• - everts and PF
• - common peroneal and (eversion/ DFL)
• - Tibial N (PIFI ankle, flexion of toes

• - glutes must be able to exert 2x bodyweight in unilateral stance in order to maintain pelvis at equilibrium
• - glutes arehelped by ITB-helps stabilise and hold pelvis in single leg stance. static stabiliser during unilateral stance- tension band: protects femur from excessive medial bending deformation- converts tensile load into compression load along lateral femoral cortex- if amp below knee loss of this stabilisation
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• - position in which the capsule is most relaxed
• - minimal contact
• - maximal joint place (accessory movements)
• i this position is like sitting cross leg
• - flexion 30 degrees
• - abduction 30*
• - slight ext rot

• - position in which capsule is maimally tensed- most stable
• - maximal jt contact
• - minial jt palay (accessory movement)- hard to do a jt glide

• This position involves
• - maximal ext
• - slight internal rotation
• - slight abduction

• - characteristic pattern of decreased movements due to entire capsule being shortened. If jt was swollen the capsule would become tight tight and short. This is the same for each jt
• - gross limitation of flexion, abduction, int rotation
• - slight limitation of ext
• - little or no limitation of ext rot

• - not a common area of treatment
• - if sporting injury usually soft tissue (mm) or referral from Lsp
• - If OA usually gross degeneration before presentation for treatment- maybe ready for hip replacement

• - groin/ inguinal area
• - greater trochanter area
• - posterior buttock in hamstring area
• - not usually below the knee
• - usually deep pain
• - may be intermittent click/ clack
• - sometimes ITB is tight andclick across the greater trochanter

• - sit to stand
• - weight- bearing after sitting
• - squat
• - walking long distances
• - slopes and stairs
• - rot in WB
• - lying on that side in bed

• - AM: stiff; pain first few steps
• - Pm: can't lie on it thou occasionally prefers to lie on as hip in mid position
• - Day: worse if WB

• - hip and groin pain due to urogenital or abdominal organ disease eg appendicitis
• - disease of local structures eg lymphadenopathy
• - referred pain from knee, SIJ (butt pain), L1- L2 radiculopathy (into groin), and somatic lumbar, dysfunction/ arthritis

• - groin or lateral thigh pain commonly
• - butt or posterior thigh pain infrequently
• - may radiate anteriorly to just above knee as far as the shin
• - extent of radiation related to degree of inflammation
• - Bursitis (trochanteric, psoas, ischial)
• - tendinopathies common (painful static mm test), tender to palpate, pain on stretching
• - hip OA common in elderly
• - tumours
• - peripheral nerve entrapment
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• - compressed by inguinal ligament
• - all nerve pains- burning, tingling, or itchiness in ant thigh (meralgia paraesthetica)
• - no motor loss
• - ext aggravates
• 

• - avoid aggravating activities/ postures
• - local massage (free up the lig)
• - cortisone injection
• - microsurgery to decompress nerve

• - greater trochanter very tender
• - associated with gluteal tendinitis
• - pain may radiate to lateral thigh
• - pain lying on side
• - pain on abduction of thigh
• - common in athletes and middle aged women

• - stretch
• - biomechanics of fott: orthotics, heel wedge etc
• - tape patella
• - mobilise patella
• - abductors may be weak

• - biomechanical abnormalities? eg leg length discrepancy, pronated feet
• - avoid painful activities
• - EPA (eg heat and ice)
• - tendon stretches
• - deep friction massage
• - NSAIDs
• - Corticosteroid injections

• - friction between ITB and lateral epiconyle of femur
• - Common in runners (running down hll), cyclists, repetive stair walking, running on uneven camber (longer side gets stretched)
• - Ober's test for tightness of ITB

• Snapping hip: ITB slips over greater or lesser trochanter and makes snapping noise
• - local: gull, deep ache
• - hip pain in young people
• - treatment- stretch psoas
• - can be connecte with bursitis

• - 50 year plus
• - pain and xray changes poor correlation
• - pain related to WB
• - worsens with activity and eased by rest
• - loss of ROM; wasting
• - flexion, LR deformity
• - anttalgic, swinging or trendelenburg gait
• Stick used for OA hip to help take load off and pelvic will drop

• - pt education
• - leg length eg heel raise
• - weight los
• - passive jt mobs: eg traction
• - exercise: increase ROM, strengthen glutes and quads
• - OT eg home modifications
• - analgesics, NSAIDS
• - walking stick
• - THR- total hip replacement

• 8-12 age
• - child with a limp
• - may have hx of truma
• - transient virus or synovitis (inflammation)

• 37° flexion
• 15° extension
• 7° abduction
• 5° adduction
• 4° internal rotation
• 9° external rotation

• 67* flexion up
• 36* flexion down

• 129° flexion
• 18° abduction
• 13° external rotation

• - science or study of drugs/ medicines
• - action/ effect on body
• - how this is produced
• - properties of drugs

• - micro-organism- penicillum, cytosporin drugs
• - plants- pawpaw, fox glove
• - synthesised in the lab

• - tradename- panadol
• - generic name- paracetamol

• - same drug, dosage form and strength
• - different trade names

• - small quantity- supermarkets
• - OTC in pharmacies
• - Prescription

• - Aust has a subsidised med scheme
• - PBS- pharmaceutical Benefits Scheme
• - provides timely, affordable access to wide range of medicines for all australians
• - over 50- set up under National health act 1953

• - pt make contribution govt pays the rest
• - 170 million prescriptions per yr
• -cost about 6 billion/ yr

• - theraputic drugs administration (TGA)
• - Commonwealth Agency regulates meical devices and drugs
• - Administers the Therapeutic goods act 1989
• - national system of controls relating to Quality, safety, efficacy and timely availability of therapeutic drugs used in Aust, whether produce in Aust or else where or exported

• - prescription and over the counter meds which meet with aust standards of qualitiy, safety and eficacy
• - lawful supply of any therapeutic good in aust requires the product to be on the list

• Meds may be:
• - registered (Aust R number)
• - Listed (aust L number)

• - this means the meds have evidence supporting what they claim to do
• - meds that are registered include:
• - almost all prescription meds
• - products such as vaccines
• - almost all conventional OTC meds eg packs of asprin, paracetamol sold in supermarkets
• - very small number of complementary meds where TGA is satisfied that specific claims of efficacy in treatment or preventio of disease are supported by adequate evidence
• - approval of AUST R products based on satisfactory assessment of their quality, efficacy and safety

• Quality and safety
• - Consist mainly of complementary meds
• - herbal meds, most vitamin and mineral supplements
• - other nutritional supplements
• - traditional meds (eg Chinese meds, aromatherapy oils)
• - means regulating prodcuts that seem by their nature to have low risk of causing adverse effects
• -sponsors of products must hold evidence to sustantiate their claims
• - make sure you don't get adverse efects

• - sponsor (pharmaceutical company) applies to TGA to register new drug or new presetation of drug or new indication
• - Australian Drug Elevation Committee (ADEC) advises TGA on quality, safety, efficacy
• - once approved by TGA, the pharmaceutical company can market the drug for approved indications; GPs can prescribe on private prescription only

• - pharmacetical company may then apply to Dept Health and Aged Care of listing on the PBS
• - Pharmaecutical Benefits Advisory Commitee (PBAC) advises Minster for Health on comparative safety, efficacy, cost- effectiveness, and clinical use for new drug relative to existing therapies
• - if PBS listing is recommeneded, the pahrmaeutical company negotiates the PBS listed price with the Pharmaceutics Benefit Pricing Authority

• - private prescriptions (pay full cost)
• - Pharmacetical Benefits (subsidised)
• - Sometimes require Authority (Dr obtains this by contacting HIC)- though health insurance commision
• - sometimes only for specific purpose

• - originator- only one company has a right to the particular drug
• - One pharmaceutical company produces new drug product
• - pt for number of yrs
• - off pt; other companies make own brand
• - if demonstrate bioequivalent, can interchange
• - bioequivalent; same formulation, same dose, demonstrate similar pharmacokinetics and effect
• - attain similar concentrations in body at similar times and no clinically important differneces between therapeutic and adverse effects

• - Schedule 1: Not currently in use
• - Schedule 2: Pharmacy Medicine
• - Schedule 3: Pharmacist only medicine
• - Schedule 4: Prescription Only meds or prescription animal remedy
• - Schedule 5: Caution
• - Schedule 6: Posion
• - Schedule 7: Dangerous posion
• -Schedule 8: Controled Drugs- morphine toxiodon- drugs addiction- opiode type

• - Controlled drugs (drugs of additiction)
• - morphine, xycodone, methadone, fentanyl, pethidine
• -suply by medical practioners, authorise nurse practioners, authorised midwife practioners and veterinary surgeons
• - all transactions recorded in drug register
• - Authenticity of prescription must be verified
• - illegal to have pssession unless prescribed for or authorised to have in possession

• - pharmacy only meds
• - must be purchased from a pharmacy where professional advice is available

• - pharmacist only medicine
• - pharmacist must personally hand to customer
• - give customer opportunity to seek advice on use
• - stored in enclosed area to which public do not have access
• - S3R class which must be recorde in prescription book or approved recording system (cough/ cold preparations containing pseudoephedrine) + asthma inhalers

• - prescription only medicines
• - supply by medical practioners, authorise nurse practioners, authorised midwife, dentist, vet, optometrists

• - move over last 10+ yrs to provide unifrom scheduling of drugs throughout states and territories of Aust
• - prior to this many anomalies state to state
• - state expect to move towards adhering to them
• - many states expected / territories have adopted standard either completely or partly
• - also attempting to unify scheduling and control of poisons and drugs between Aust and NZ
• - referred to as trans tasman harmonisation

- all info about drugs

• - plasma drug concentration
• - how body affects drug after administration
• - absorption
• - distribution
• - metabolism
• - excretion
• - time course of drug in body

• - IV (intravenous)
• - oral, IM, SC, rectal
• - topical- on top of skin
• - above 2- slow effects

• - tetracycline: not given to children, distributes to teeth, bones
• - Anaesthesia- fat soluble and distributes to brain rapidly
• - blood brain barrier- protets brain by limiting substances entering, enothelial cells covere with fatty sheath of glial cells, tight intracellular junctions
• - placental barier- separates blood vessels of mother and foetus. Enzymes in placenta can metabolise some substances, some drugs can cross
• - drugs can distribute into breast milk

• - foreign substances
• - inactive or less active metabolites (usually)
• - not always the case
• - morphine M3G (not active) and M6G (24 x more potent
• - prodrugs metabolised to active drug

• - unchanged drug excreted in urine (kidneys)
• - also in expired air )lungs)
• - sweat
• - bile (Gi tract)

• - what drugs do in the body
• -response (effect) and relate to dose administered
• - where do the drugs act
• - proteins such as enzymes, ion channels, carriers/ transporters, receptors in body
• - can bind to produce direct or indirect effect
• - most drugs bind to specific proteins called receptors

• - opiod receptors, beta receptors
• - beta blockers (propranolol
• - beta 2 agonist: salbutamol (asthma)

• - morphine, heroin
• - produce respiratory depression (and analgesi etc)
• - overdose
• - administer naloxone- helps unblock receptors people can breath
• - anatogonist
• - reverses effect of morphine, heroin

• - disease (ADME)
• - renal disease- elimination reduced
• - liver disease and metabolism
• - age affect organ function
• - may need to reduce dosage
• - pharmacodynamic response also modified
• - advanced age- less receptors, reduced response
• - tolerance (bigger doses required to give same effect)
• - compliance
• - drug interactions
• - increase of decrease effect of other drug
• - probenecid (penecillin) and penicillin (used beneficially)
• - genetic effects
• - poor metabolisers and ectensive metabolisers
• - codeine, isoniazid

• - has the pt had medicine before
• - allergic
• - what other medications is pt taking
• - what concurrent illnesses/ disease
• - age
• - preg or breast feeding
• - what is evidence that drug is the best choice for treating the problem
• - need to e aware of side effects

• - paracetamol
• - NSAIDS- aspirin, nonselective and selective NSAIDS
• - opiods

• - MIMS
• - Aust handbook
• - therapeutic guidelines
• - CMI can bedownloaded
• - pharmacists