placement of pedicle screws in the thoracic and lumbar spine. Accurate screw placement is dependent on the exposure and identification of the posterior elements including the lateral border of the pars interarticularis, the entire transverse process and the caudal and cephalad facet joints(13). The pedicle entry point is at the intersection of the vertical line that forms the extension of the facet joint in line with the bony crest coming from the superior articular facet, and the horizontal line that passes through the middle of the transverse process insertion, or 1-2mm below the joint line(14). In Patel?s retrospective cohort study, they demonstrated statistically significant higher blood loss in patients who underwent open posterior lateral or posterior lumbar interbody fusion, compared to minimally invasive techniques(15). The open technique of placing pedicle screws therefore requires much dissection to expose the posterior vertebral elements and is associated with more blood loss and complications when compared to minimally invasive procedures.
21 J. H. Lee et al. determined the relationships between the degree of forward scapular posture and the pectoralis minor index, the strength of the serratus anterior, the thoracic spine angle and posterior shoulder tightness. The adjusted coefficient of determination r2 was 0.78 (F=59.50, p =0.000) for the simple regression of the forward scapular posture on the pectoralis minor index. The pectoralis minor accounted for 78% of the variance in forward scapular posture. The total explained variance in the forward scapular posture was 93% (F = 29.42, p =0.000).
Postural kyphosis is caused by poor posture and the weak back muscles. Although postural kyphosis is the most common, it usually does not appear until later in life. Other factors that cause kyphosis during old age is disk degeneration. Between the spinal vertebrae, there are softy cushiony disks that allow movement of the vertebrae and prevent them from rubbing against one another. However, as someone ages, the intervertebral discs shrink in size and results in excessive curvature of the spine.
P4 – Describe the three structures of the skeletal muscle (Epimysium, Perimysium and Endomysium) There are three structures of the skeletal muscle: Epimysium is a thick layer of irregular connective tissue that pulls the entire muscle as well as protecting the muscle from friction that may be caused by other muscles and bones surrounding them. Also, it is the fibrous tissue which covers and surrounds skeletal muscles. The Epimysium carries on past the end of bones in order to create muscle tendons. Perimysium surrounds a bundle of muscle fibres, it is a casing of connective tissue. Endomysium is found within a muscle and it contains nerves and capillaries.
By looking at Mr Jensen’s post-operative vital assessment data, his hypovolemia is able to be classified as a stage two. Stage two hypovolemia is characterized by the loss of 15-30% of the total blood volume, or between 750 and 1500 mL. By this stage, cardiac output cannot be maintained by arterial constriction, resulting in tachycardia (>100bpm), increased respiratory rate (over 20 breaths/minute) and a slight decrease in blood pressure. The patient’s pulse may become narrow and skin becomes excessively pale The patient can present symptoms of anxiety and feeling restless. The capillary refill may be delayed and the urine output is reduced to 20-30 mL/h (Brown & Edwards, 2013).
There is tenderness of the paraspinal region at L5 bilaterally, and at the right sacroiliac joint. Active range of motion (ROM) shows flexion of 50 degrees and extension of 5 degrees, with pain. Motor strength shows 4/5 with right ankle dorsiflexion tibialis anterior and great toe extension extensor hallucis longus. Sensation is decreased over the lateral leg and dorsum of the foot. There is atrophy of the right calf.
Before discussing an injury to a ligament in the knee, it is helpful to know the anatomy of the knee. The knee joint is made up of four bones. These include the femur (with a lateral and medial femoral condyle at the distal end), the patella, the tibia, and the fibula. There are also four ligaments in the knee. These include the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the lateral collateral ligament (LCL), and the medial collateral ligament (MCL).
Each compartment encompasses a certain amount of fluid proportionate for the size of one’s body and the size of the compartment. The extracellular fluid holds 20% of one’s body weight and the intracellular contains 40%. The amount of fluid in one’s body must be maintained for adequate function. If the fluid becomes excessive then it will dilute the sodium inside the body and cause electrolyte imbalances which will affect systems such as the central nervous system and cardiovascular system. This is a result of the extracellular space containing more fluid than the intracellular space in relation to fluid movement trying to maintain balance due to the lack of sodium and excess fluid.
The ankle is where three bones meet, the tibia and fibula of your lower leg and the talus of your foot. These three bones are held together at the ankle joint by ligaments. Tendons attach muscles to the bones to do the work of making the ankle and foot move, and help stabilize the joints (“Norwood,Karriem Ankle