2024
October 5-6
▪️ Anatomy Upper Limb
▪️ Fryette's Law
▪️ Cervical Plexus
Fryette's Law
Fryette's Laws describe how the vertebrae of the spine move, particularly in the context of osteopathic manual therapy. These laws were developed by Dr. Harrison Fryette in the early 20th century and are commonly applied in osteopathic medicine to understand spinal mechanics.
Fryette's Laws of Spinal Motion:
1. First Law (Type I Mechanics):
- When the spine is in a neutral position (not flexed or extended), and sidebending is introduced, rotation of the vertebrae occurs to the opposite side.
- This typically applies to groups of vertebrae (e.g., thoracic and lumbar regions).
2. Second Law (Type II Mechanics):
- When the spine is in a non-neutral position (flexed or extended), and sidebending is introduced, rotation occurs to the same side.
- This law generally applies to single vertebral segments.
3. Third Law:
- If motion is introduced in one plane, it will modify (reduce) motion in the other two planes.
- For example, if a vertebra is flexed, its ability to sidebend or rotate is decreased.
Application in Osteopathic Practice:
Fryette's Laws are foundational for diagnosing and treating somatic dysfunctions in the spine. They help osteopaths understand how different segments of the spine will react to movements and manipulations, aiding in the formulation of treatment plans for conditions like back pain, scoliosis, and other musculoskeletal issues.
These laws are particularly useful when performing techniques such as muscle energy, high-velocity low-amplitude (HVLA) thrusts, and other manual therapies.
Cervical Plexus
The cervical plexus is a network of nerves formed by the anterior rami (branches) of the first four cervical spinal nerves (C1-C4). It is located in the neck, deep to the sternocleidomastoid muscle. The cervical plexus is primarily responsible for providing sensory and motor innervation to parts of the neck, shoulders, and diaphragm.
Key Components of the Cervical Plexus
1. Sensory Branches:
The sensory branches of the cervical plexus primarily supply the skin of the neck and the back of the head.
- Lesser Occipital Nerve (C2): Innervates the skin of the scalp posterior and superior to the ear.
- Greater Auricular Nerve (C2-C3): Supplies the skin over the parotid gland, the auricle (external ear), and the area from the angle of the mandible to the mastoid process.
- Transverse Cervical Nerve (C2-C3): Innervates the skin over the anterior and lateral aspects of the neck.
- Supraclavicular Nerves (C3-C4): Divided into medial, intermediate, and lateral branches, these nerves supply the skin over the clavicle and shoulder.
2. Motor Branches:
The motor branches primarily innervate muscles in the neck and some other areas.
- Ansa Cervicalis (C1-C3): A loop of nerves that innervates most of the infrahyoid muscles, which are responsible for movements of the hyoid bone and larynx, important in swallowing and speech. The muscles innervated include the sternohyoid, sternothyroid, and omohyoid muscles.
- Phrenic Nerve (C3-C5): Although primarily associated with the cervical plexus, the phrenic nerve is a crucial nerve that innervates the diaphragm, the primary muscle of respiration. It originates mainly from the C4 nerve, with contributions from C3 and C5.
3. Muscular Branches:
These branches directly innervate several muscles in the neck.
- Prevertebral Muscles: Innervation to muscles like the longus capitis and longus colli, which are involved in neck flexion and stabilization.
- Scalene Muscles: Although not directly from the cervical plexus, the anterior, middle, and posterior scalene muscles receive motor innervation from cervical spinal nerves, aiding in neck movement and assisting in respiration by elevating the first and second ribs.
Functions of the Cervical Plexus
- Sensory Function: Provides sensation to areas of the neck, shoulder, and upper chest.
- Motor Function: Supplies motor innervation to muscles that control movements of the neck and diaphragm.
- Autonomic Functions: Some branches of the cervical plexus contribute to the sympathetic nervous system, affecting blood vessels, sweat glands, and other autonomic functions in the neck.
Clinical Relevance
- Nerve Blocks: The cervical plexus is often targeted for nerve blocks in surgeries or procedures involving the neck and shoulder region to provide anesthesia or pain relief.
- Injury: Damage to the cervical plexus, particularly the phrenic nerve, can result in diaphragmatic paralysis, leading to respiratory difficulties. Injury to other branches can cause sensory loss or weakness in the neck and shoulder muscles.
- Referred Pain: Issues with the cervical plexus can sometimes cause referred pain in areas supplied by its branches, such as the ear, jaw, or shoulder.
2024
November 9-10
▪️ Revise C/sp, T/sp
▪️ Parkinson's
▪️ MND
Parkinson's Disease
Parkinson's disease is a progressive neurodegenerative disorder that primarily affects movement. It is characterized by the gradual loss of dopamine-producing neurons in a region of the brain called the substantia nigra. This leads to a variety of motor and non-motor symptoms.
Key Points about Parkinson's Disease:
1. Symptoms:
- Tremor: One of the most common symptoms, often starting in a limb, such as a hand or fingers. The tremor is typically a "resting tremor," meaning it occurs when the muscle is relaxed.
- Bradykinesia: Slowness of movement. Over time, simple tasks may take longer to complete, and there may be a reduction in spontaneous movement.
- Rigidity: Muscle stiffness, which can occur in any part of the body. This stiffness can be painful and restrict the range of motion.
- Postural Instability: Impaired balance and coordination, leading to a tendency to fall.
- Gait Disturbances: Shuffling walk, reduced arm swing, and difficulty starting or stopping walking.
2. Non-Motor Symptoms:
- Cognitive Impairment: Memory problems, difficulty with concentration, and, in later stages, dementia.
- Mood Disorders: Depression, anxiety, and apathy.
- Sleep Disorders: Difficulty sleeping, vivid dreams, and REM sleep behavior disorder.
- Autonomic Dysfunction: Issues such as constipation, urinary problems, low blood pressure, and excessive sweating.
- Loss of Sense of Smell: Often one of the earliest signs of Parkinson's.
3. Causes:
- The exact cause of Parkinson's disease is not known, but it is believed to involve a combination of genetic and environmental factors.
- Certain genetic mutations are associated with Parkinson's, but these are responsible for only a small percentage of cases.
- Environmental factors, such as exposure to pesticides or head trauma, have also been linked to an increased risk of developing the disease.
4. Diagnosis:
- Parkinson's disease is primarily diagnosed based on medical history, symptoms, and a neurological examination.
- There are no definitive tests for Parkinson's, but imaging tests like MRI or DaTscan can support the diagnosis by ruling out other conditions.
5. Treatment:
- Medication: The primary treatment involves medications that increase dopamine levels or mimic dopamine effects, such as levodopa, dopamine agonists, and MAO-B inhibitors.
- Deep Brain Stimulation (DBS): A surgical treatment option for patients who do not respond well to medications. Electrodes are implanted in the brain to regulate abnormal signals.
- Physical Therapy: Helps improve mobility, flexibility, and balance. Speech therapy and occupational therapy are also important aspects of care.
- Lifestyle Changes: Regular exercise, a healthy diet, and managing stress can help manage symptoms and improve quality of life.
Parkinson's disease is a chronic condition that progresses over time, and while there is no cure, treatments can significantly improve symptoms and quality of life. Ongoing research aims to better understand the disease and develop more effective treatments.
MND - Motor Neuron Disease
MND stands for Motor Neuron Disease. It is a group of neurodegenerative disorders that affect the motor neurons, which are the nerve cells responsible for controlling voluntary muscles in the body. As motor neurons degenerate, their ability to transmit signals from the brain and spinal cord to the muscles deteriorates, leading to muscle weakness and wasting.
Key Points about Motor Neuron Disease:
1. Types of MND:
- Amyotrophic Lateral Sclerosis (ALS): The most common form of MND, also known as Lou Gehrig's disease. It affects both upper and lower motor neurons, leading to a combination of spasticity and muscle weakness.
- Progressive Bulbar Palsy (PBP): Affects the muscles involved in speech, swallowing, and breathing.
- Primary Lateral Sclerosis (PLS): Affects the upper motor neurons, leading to stiffness and spasticity without the muscle wasting seen in ALS.
- Progressive Muscular Atrophy (PMA): Affects the lower motor neurons, leading to muscle wasting and weakness without the spasticity seen in ALS.
2. Symptoms:
- Muscle Weakness: Often begins in the limbs and can lead to difficulties in walking, using hands, or speaking.
- Muscle Atrophy: Wasting of muscles due to disuse as the disease progresses.
- Fasciculations: Involuntary muscle twitching.
- Spasticity: Increased muscle tone and stiffness, particularly in ALS.
- Difficulty Speaking and Swallowing: Especially in cases where bulbar muscles are involved.
- Breathing Difficulties: As respiratory muscles weaken, leading to respiratory failure in advanced stages.
3. Causes:
- The exact cause of MND is not fully understood, but it is believed to involve a combination of genetic and environmental factors.
- In about 5-10% of cases, MND is inherited (familial MND). The other cases are sporadic, with no clear family history.
4. Diagnosis:
- Diagnosis is primarily clinical, based on symptoms, neurological examination, and ruling out other conditions.
- Tests such as electromyography (EMG), nerve conduction studies, and MRI scans may be used to support the diagnosis.
5. Prognosis:
- MND is a progressive and currently incurable disease. The rate of progression can vary, but it often leads to significant disability and, eventually, death.
- The average life expectancy after diagnosis is typically 3-5 years, though some patients live longer.
6. Management:
- Supportive Care: Includes physical therapy, occupational therapy, speech therapy, and nutritional support to manage symptoms and maintain quality of life.
- Medications: Riluzole is the only drug approved by the FDA that has been shown to slightly extend survival in ALS. Other medications may be used to manage symptoms such as spasticity, pain, and excess saliva.
- Respiratory Support: As the disease progresses, non-invasive ventilation or, in some cases, tracheostomy may be required to assist with breathing.
- Palliative Care: Focuses on providing comfort and support as the disease progresses.
Motor Neuron Disease, particularly ALS, has gained more awareness in recent years due to campaigns and advocacy, but it remains a challenging condition with limited treatment options. Research continues into potential therapies and understanding the underlying mechanisms of the disease.
2024
December 7-8
▪️ Pathophysiology
▪️ Rheumatology
▪️ L/SP
Rheumatology
Rheumatology is a branch of medicine that focuses on the diagnosis and treatment of rheumatic diseases, which are autoimmune and inflammatory conditions that primarily affect the joints, muscles, and bones. Rheumatologists, the specialists in this field, also manage systemic autoimmune conditions that can affect multiple organ systems, including the skin, eyes, internal organs, and blood vessels.
Key Points about Rheumatology:
1. Common Rheumatic Diseases:
- Rheumatoid Arthritis (RA): An autoimmune disorder where the immune system attacks the lining of the joints, causing inflammation, pain, and eventually joint damage.
- Osteoarthritis (OA): A degenerative joint disease characterized by the breakdown of cartilage and underlying bone, leading to pain and stiffness, commonly in the hips, knees, and hands.
- Systemic Lupus Erythematosus (SLE): A chronic autoimmune disease that can affect any part of the body, most commonly the skin, joints, kidneys, brain, and other organs.
- Ankylosing Spondylitis (AS): A type of arthritis that primarily affects the spine, leading to severe, chronic pain and discomfort, and potentially causing the vertebrae to fuse.
- Gout: A form of inflammatory arthritis characterized by sudden, severe attacks of pain, redness, and tenderness in joints, often the joint at the base of the big toe.
- Psoriatic Arthritis: An inflammatory arthritis associated with psoriasis, a skin condition that causes red, scaly patches.
- Sjogren’s Syndrome: An autoimmune disease characterized by dry eyes and dry mouth, often associated with other autoimmune disorders like RA or lupus.
2. Symptoms of Rheumatic Diseases:
- Joint pain, swelling, and stiffness, particularly in the morning or after periods of inactivity.
- Fatigue and general malaise.
- Redness and warmth in the affected areas.
- Reduced range of motion in the affected joints.
- Systemic symptoms like fever, weight loss, and organ involvement in some autoimmune diseases.
3. Diagnosis:
- Rheumatologic diseases are diagnosed based on a combination of patient history, physical examination, laboratory tests, and imaging studies.
- Blood Tests: Rheumatoid factor (RF), anti-CCP antibodies, antinuclear antibodies (ANA), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) are commonly tested to detect inflammation and specific autoimmune activity.
- Imaging: X-rays, MRIs, and ultrasounds can be used to assess joint damage and inflammation.
4. Treatment:
- Medications: Treatment often involves a combination of medications including nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and biologic agents that target specific pathways in the immune system.
- Physical Therapy: Helps maintain joint function and mobility, and reduces pain through exercise, stretching, and other techniques.
- Lifestyle Changes: Diet, regular exercise, stress management, and avoiding activities that strain the joints can be crucial in managing symptoms.
- Surgery: In severe cases, surgical interventions like joint replacement may be necessary.
5. Challenges and Considerations:
- Rheumatic diseases are often chronic and can significantly impact quality of life. Early diagnosis and aggressive treatment are important to prevent long-term damage.
- The treatment of rheumatic diseases often requires a multidisciplinary approach, involving not just rheumatologists, but also physical therapists, orthopedic surgeons, and sometimes other specialists depending on the organs involved.
- Many rheumatic diseases have flares (periods of increased disease activity) and remissions (periods of reduced or no symptoms), making long-term management challenging.
Rheumatology is a complex field due to the wide variety of conditions it covers, many of which involve the immune system in intricate ways. Advances in understanding the underlying mechanisms of these diseases have led to more effective treatments, particularly with the development of targeted biologic therapies.
2024
January 11-12
▪️ C/SP MET
▪️ Circle of Willis/Headache
▪️ Cranial Nerve
The Circle of Willis is a circular network of arteries located at the base of the brain. It plays a crucial role in ensuring that the brain receives a consistent blood supply, even if one part of the system becomes blocked or narrowed. Understanding the Circle of Willis is important when studying neurological conditions, including certain types of headaches.
Circle of Willis
1. Anatomy:
- The Circle of Willis is formed by the joining of the internal carotid arteries and the basilar artery.
- It includes several key arteries:
- Anterior cerebral arteries (left and right)
- Anterior communicating artery (connecting the two anterior cerebral arteries)
- Internal carotid arteries (left and right)
- Posterior cerebral arteries (left and right)
- Posterior communicating arteries (left and right)
- These arteries encircle the pituitary gland and the optic chiasm.
2. Function:
- The primary function of the Circle of Willis is to provide collateral circulation. This means that if one part of the brain's blood supply is reduced, the Circle of Willis can maintain blood flow by redirecting it through the other arteries.
- This redundancy is vital for protecting the brain from ischemia (lack of blood supply), which can lead to stroke.
Headache and the Circle of Willis
1. Types of Headaches:
- Vascular Headaches: These headaches are directly related to the blood vessels in the brain, including the arteries in the Circle of Willis. The most common vascular headache is a migraine.
- Migraine: A severe type of headache that is often accompanied by nausea, vomiting, and sensitivity to light and sound. Changes in blood flow in the brain, including in the Circle of Willis, are thought to play a role in migraines.
- Cluster Headaches: These are excruciating headaches that occur in cyclical patterns or clusters. They are believed to be associated with the dilation of blood vessels, potentially involving those in the Circle of Willis.
- Tension Headaches: While primarily related to muscle tension, reduced blood flow or changes in blood vessel function can contribute to the pain experienced in tension headaches.
2. Aneurysms in the Circle of Willis:
- An aneurysm is a bulge in the wall of an artery. In the Circle of Willis, aneurysms are particularly concerning because if they rupture, they can cause a subarachnoid hemorrhage, leading to a sudden, severe headache often described as "the worst headache of your life."
- These aneurysms are a critical focus in neurology because of the potential for severe brain damage or death if they burst.
3. Headache Management:
- Medications: Treatment for headaches related to the Circle of Willis often involves medications that target blood vessels. For migraines, triptans, which constrict blood vessels, are commonly used.
- Lifestyle Changes: Managing stress, avoiding certain triggers (like specific foods, lack of sleep, or dehydration), and regular exercise can help reduce the frequency and severity of headaches.
- Surgical Intervention: In the case of an aneurysm, surgical options such as clipping or endovascular coiling may be necessary to prevent rupture.
Conclusion
The Circle of Willis is an essential part of the brain's vascular system, providing a backup route for blood flow in case of arterial blockage. Its involvement in various types of headaches, especially those with a vascular component, underscores its importance in neurology.
Cranial nerves are a set of twelve paired nerves that arise directly from the brain and primarily serve the head and neck region. Each cranial nerve has a specific function, which can be sensory, motor, or both. Here's an overview of each cranial nerve:
Cranial Nerves Overview
1. Olfactory Nerve (CN I):
- Function: Sensory
- Role: Responsible for the sense of smell.
- Pathway: Originates in the nasal mucosa and passes through the cribriform plate of the ethmoid bone to the olfactory bulb.
2. Optic Nerve (CN II):
- Function: Sensory
- Role: Responsible for vision.
- Pathway: Carries visual information from the retina to the brain.
3. Oculomotor Nerve (CN III):
- Function: Motor
- Role: Controls most of the eye's movements, including constriction of the pupil and maintaining an open eyelid.
- Pathway: Innervates the majority of the extraocular muscles.
4. Trochlear Nerve (CN IV):
- Function: Motor
- Role: Controls the superior oblique muscle of the eye, which helps in downward and lateral eye movement.
- Pathway: The only cranial nerve that exits from the dorsal aspect of the brainstem.
5. Trigeminal Nerve (CN V):
- Function: Both sensory and motor
- Role: Sensory input from the face and head; motor control of the muscles involved in chewing.
- Pathway: Divides into three branches—ophthalmic (V1), maxillary (V2), and mandibular (V3).
6. Abducens Nerve (CN VI):
- Function: Motor
- Role: Controls the lateral rectus muscle, responsible for lateral eye movement.
- Pathway: Originates from the pons and controls the outward movement of the eye.
7. Facial Nerve (CN VII):
- Function: Both sensory and motor
- Role: Controls muscles of facial expression; provides taste sensations from the anterior two-thirds of the tongue; controls some glands (like salivary and lacrimal glands).
- Pathway: Travels through the facial canal in the temporal bone before branching out to various parts of the face.
8. Vestibulocochlear Nerve (CN VIII):
- Function: Sensory
- Role: Responsible for hearing and balance.
- Pathway: Consists of two components—the cochlear nerve (for hearing) and the vestibular nerve (for balance).
9. Glossopharyngeal Nerve (CN IX):
- Function: Both sensory and motor
- Role: Taste from the posterior third of the tongue; monitors carotid body and sinus (regulating blood pressure); motor control of some muscles in swallowing.
- Pathway: Exits the brainstem from the sides of the upper medulla.
10. Vagus Nerve (CN X):
- Function: Both sensory and motor
- Role: Extensive role in parasympathetic control of the heart, lungs, and digestive tract; motor control of the muscles of the larynx (voice box) and pharynx.
- Pathway: The longest cranial nerve, extending from the brainstem to the abdomen.
11. Accessory Nerve (CN XI):
- Function: Motor
- Role: Controls the sternocleidomastoid and trapezius muscles, which are involved in head movement and shoulder elevation.
- Pathway: Originates from the spinal cord and passes through the jugular foramen.
12. Hypoglossal Nerve (CN XII):
- Function: Motor
- Role: Controls the muscles of the tongue, which are crucial for speech and swallowing.
- Pathway: Arises from the medulla and exits the skull through the hypoglossal canal.
Functions and Clinical Relevance
- Sensory Nerves: Include nerves such as the olfactory, optic, and vestibulocochlear nerves, which are responsible for smell, vision, and hearing/balance, respectively.
- Motor Nerves: Include nerves like the oculomotor, trochlear, abducens, accessory, and hypoglossal nerves, which control various muscles.
- Mixed Nerves: Include nerves such as the trigeminal, facial, glossopharyngeal, and vagus nerves, which have both sensory and motor functions.
Clinical Examination
- Cranial nerve examination is a crucial part of a neurological assessment and helps diagnose various neurological disorders.
- Deficits in any of these nerves can result in specific symptoms, such as double vision (CN III, IV, VI), loss of facial sensation or movement (CN V, VII), or problems with speech and swallowing (CN IX, X, XII).
Understanding the cranial nerves is essential for diagnosing and managing neurological conditions, as these nerves control many of the body's critical functions, particularly in the head and neck region.
2024
January 25-26
▪️ Pharmacology OTC meds
▪️ Prescribed meds
▪️ T/SP METS
Pharmacology is the study of drugs and their effects on the body. Over-the-counter (OTC) medications are drugs that can be purchased without a prescription and are commonly used to treat a variety of minor health issues. Understanding the basic pharmacology of OTC medications is important for safe and effective use.
Categories of OTC Medications
1. Analgesics (Pain Relievers):
- Acetaminophen (Tylenol): Used to relieve mild to moderate pain and reduce fever. It is generally well-tolerated but can cause liver damage if taken in excessive amounts.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Include ibuprofen (Advil, Motrin) and naproxen (Aleve). These drugs reduce pain, inflammation, and fever. Long-term use or high doses can lead to gastrointestinal issues, such as ulcers, and increase the risk of cardiovascular events.
- Aspirin: Another NSAID that also has blood-thinning properties. It's often used for pain relief, inflammation, and reducing the risk of heart attacks and strokes. However, it can cause gastrointestinal bleeding and should be used cautiously in certain populations.
2. Antihistamines:
- Diphenhydramine (Benadryl): Commonly used to treat allergic reactions, hay fever, and motion sickness. It can cause drowsiness and dry mouth.
- Loratadine (Claritin) and Cetirizine (Zyrtec): These are second-generation antihistamines used to treat allergy symptoms without causing significant drowsiness.
3. Decongestants:
- Pseudoephedrine (Sudafed): Used to relieve nasal congestion caused by colds, allergies, or sinus infections. It can raise blood pressure and cause jitteriness or insomnia.
- Phenylephrine: A less effective alternative to pseudoephedrine, also used for nasal congestion.
4. Cough Suppressants and Expectorants:
- Dextromethorphan (Robitussin, Delsym): A common cough suppressant used to relieve a dry cough. It acts on the brain to reduce the urge to cough.
- Guaifenesin (Mucinex): An expectorant that helps thin mucus, making it easier to cough up.
5. Antacids and Acid Reducers:
- Calcium Carbonate (Tums) and Magnesium Hydroxide (Milk of Magnesia): Antacids that neutralize stomach acid, providing quick relief from heartburn and indigestion.
- H2 Blockers (Ranitidine, Famotidine): Reduce stomach acid production and are used for longer-lasting relief from heartburn.
- Proton Pump Inhibitors (Omeprazole, Lansoprazole): More potent acid reducers used for conditions like GERD (gastroesophageal reflux disease) and ulcers.
6. Laxatives:
- Bulk-Forming Laxatives (Psyllium, Metamucil): Increase stool bulk, making it easier to pass.
- Stimulant Laxatives (Bisacodyl, Senna): Stimulate bowel movements, used for short-term relief of constipation.
- Osmotic Laxatives (Polyethylene Glycol, Miralax): Draw water into the intestines to soften stools.
7. Antidiarrheals:
- Loperamide (Imodium): Slows down gut movement to reduce diarrhea.
- Bismuth Subsalicylate (Pepto-Bismol): Used to treat diarrhea, nausea, and stomach upset. It also has mild antibacterial properties.
8. Topical Medications:
- Hydrocortisone Cream: A mild steroid used to reduce inflammation and itching from skin irritations like eczema or insect bites.
- Antibiotic Ointments (Neosporin): Used to prevent infection in minor cuts, scrapes, and burns.
Considerations for OTC Medication Use
- Dosage: Always follow the recommended dosage on the label to avoid potential side effects or toxicity.
- Drug Interactions: Some OTC medications can interact with prescription drugs, other OTC medications, or underlying health conditions.
- Side Effects: Be aware of possible side effects, even with OTC medications, and seek medical advice if you experience any adverse reactions.
- Duration of Use: OTC medications are generally intended for short-term use. Prolonged use, especially without consulting a healthcare provider, can lead to complications.
- Special Populations: Certain populations, such as children, pregnant or breastfeeding women, and individuals with chronic health conditions, should be especially cautious when using OTC medications.
Prescribed medications are drugs that require a prescription from a licensed healthcare provider. These medications are used to treat a wide range of health conditions and are regulated to ensure they are safe and effective for use under medical supervision. Here's an overview of some common categories of prescribed medications:
Categories of Prescribed Medications
1. Antibiotics:
- Penicillins (e.g., Amoxicillin): Used to treat bacterial infections such as strep throat, ear infections, and pneumonia by interfering with the bacteria's cell wall synthesis.
- Macrolides (e.g., Azithromycin): Effective against respiratory infections, skin infections, and sexually transmitted diseases by inhibiting bacterial protein synthesis.
- Quinolones (e.g., Ciprofloxacin): Broad-spectrum antibiotics used for urinary tract infections, respiratory infections, and some types of gastroenteritis by inhibiting bacterial DNA replication.
2. Antihypertensives:
- ACE Inhibitors (e.g., Lisinopril): Used to treat high blood pressure and heart failure by relaxing blood vessels and reducing blood pressure.
- Beta-Blockers (e.g., Metoprolol): Reduce heart rate and blood pressure by blocking the effects of adrenaline on the heart, commonly used for hypertension, angina, and heart rhythm disorders.
- Calcium Channel Blockers (e.g., Amlodipine): Lower blood pressure by relaxing the muscles of the heart and blood vessels.
3. Statins:
- Atorvastatin (Lipitor) and Simvastatin (Zocor): Used to lower cholesterol levels and reduce the risk of heart disease and stroke by inhibiting an enzyme responsible for cholesterol production in the liver.
4. Antidiabetic Medications:
- Metformin: First-line treatment for type 2 diabetes, it reduces glucose production in the liver and improves insulin sensitivity.
- Insulin: Used for both type 1 and type 2 diabetes to regulate blood sugar by allowing glucose to enter cells.
- Sulfonylureas (e.g., Glipizide): Increase insulin production from the pancreas.
5. Antidepressants:
- Selective Serotonin Reuptake Inhibitors (SSRIs) (e.g., Sertraline, Fluoxetine): Used to treat depression, anxiety, and other mood disorders by increasing serotonin levels in the brain.
- Tricyclic Antidepressants (e.g., Amitriptyline): An older class of antidepressants that are effective but often have more side effects.
- Monoamine Oxidase Inhibitors (MAOIs): Another older class of antidepressants, less commonly used due to dietary restrictions and interactions with other medications.
6. Pain Medications:
- Opioids (e.g., Morphine, Oxycodone): Used for severe pain management by binding to opioid receptors in the brain to reduce the perception of pain but carry a risk of dependence and addiction.
- Non-Opioid Analgesics (e.g., Tramadol): Used for moderate pain and have a lower risk of addiction compared to traditional opioids.
7. Anticonvulsants:
- Gabapentin and Pregabalin: Used to treat seizures and neuropathic pain by stabilizing electrical activity in the brain.
- Carbamazepine: Used to treat epilepsy and bipolar disorder by reducing the spread of seizure activity in the brain.
8. Anticoagulants and Antiplatelets:
- Warfarin (Coumadin): Used to prevent blood clots in conditions like atrial fibrillation, deep vein thrombosis, and pulmonary embolism by inhibiting vitamin K-dependent clotting factors.
- Direct Oral Anticoagulants (DOACs) (e.g., Apixaban, Rivaroxaban): Used as alternatives to warfarin with fewer dietary restrictions and less need for monitoring.
- Aspirin and Clopidogrel: Antiplatelet drugs used to prevent heart attacks and strokes by preventing platelets from clumping together.
9. Psychotropic Medications:
- Antipsychotics (e.g., Risperidone, Olanzapine): Used to treat schizophrenia, bipolar disorder, and severe depression by altering the effects of neurotransmitters in the brain.
- Benzodiazepines (e.g., Lorazepam, Diazepam): Used for anxiety, insomnia, and seizure disorders by enhancing the effect of the neurotransmitter GABA, but they carry a risk of dependence.
10. Steroids:
- Corticosteroids (e.g., Prednisone): Used to reduce inflammation in conditions such as asthma, rheumatoid arthritis, and inflammatory bowel disease. Long-term use can lead to side effects like osteoporosis and weight gain.
Considerations for Prescribed Medications
Dosage and Administration: It is essential to follow the prescribed dosage and timing exactly as directed to ensure effectiveness and reduce the risk of side effects.
Drug Interactions: Prescribed medications can interact with other drugs, including over-the-counter medications, supplements, and certain foods. It's important to discuss all current medications with your healthcare provider.
Side Effects: Be aware of potential side effects, which can vary widely depending on the medication. Some side effects may be mild and temporary, while others could be serious and require medical attention.
Monitoring: Some medications require regular monitoring of blood levels, kidney function, liver function, or other parameters to ensure safety and efficacy.
Adherence: Consistently taking prescribed medications as directed is crucial for managing chronic conditions and preventing complications.
Surface Markings
The Cervical Spine
1. The Hyoid bone – C3
2. Superior thyroid cartilage
3. Inferior thyroid cartilage
4. First cricoid ring – C6
5. Carotid Tubercle – C6
6. Occiput
7. Inion
8. Super nuchal line
9. Mastoid process
10. Spinous process of cervical spine
11. Transverse process of cervical spine
12. Facet joints
13. Sternocleidomastoid muscle
14. Carotid pulse - next to carotid tubercle (c6)
15. Parotid gland – angle of mandible
16. Supraclavicular fossa
17. Greater occipital nerves
18. Superior nuchal ligament
Shoulder
1. Suprasternal notch
2. Sternoclavicular joint ( SC joint)
3. Clavicle
4. Coracoid process
5. Lateral border of scapula
6. Inferior angle (T7)
7. Medial border of scapula
8. Superior angle (T2)
9. Spine of scapula (T3)
10. Acromion process
11. Acromioclavicular joint
12. Greater tuberosity
13. Bicipital groove
14. Lesser tuberosity
Elbow & Wrist
1. Radial styloid process
2. Scaphoid
3. Trapezium
4. Trapezium/ first metacarpal articulation
5. Lister tubercle
6. Capitate
7. Lunate
8. Ulnar styloid process
9. Triquetrum
10. Pisiform
11. Hook of hamate
12. Metacarpals
13. Metacarpophalangeal joints
14. Phalanges
15. Anatomic snuff box
Hip
1. L4/ L5 interspace – same level as the tops of the iliac crests
2. Palpation of the spinous processes
3. Sacral spinous process- the S2 spinous process lies on the middle
of a line drawn between the posterior superior iliac spine.
4. Sacral base
5. Interior angles of sacrum
6. Coccyx
7. Iliac tubercles
8. Greater trochanters
9. Ischial tuberosities
10. Supraspinous and the interspinous ligaments
11. Palpation of the paraspinal muscles
12. Sciatic nerve palpable at the midpoint between the ischial tuberos-
ity and greater trochanter. Hip must be flexed to palpate the nerve.
Knee
Medial Aspect
1. Tibial tuberosity
2. Patellar tendon
When you reach the joint gap, push downward you will feel the sharp ridge of
3. Tibial plateau
4. Medial femoral condyle
5. Medial femoral epicondyle
6. Adductor tubercle
Rotate the tibia medially, and you will feel the
7. medial meniscus & coronary ligament.
Move inferiorly, laterally toward tibial tuberosity; you should feel
8. Pes anserine insertion ( Tendons of sartorius, gracilis, Semitendinosus)
Lateral Aspect
1. Tibial tuberosity
2. Patellar tendon
3. Tibia plateau
4. Lateral condyle of the femur
5. Epicondyle of femur
Come back to the joint gap, externally rotate the tibia, and you will feel
6. the lateral meniscus.
Move inferiorly, draw a big circle, and you will find the
7. fibula head
Go inferiorly around the neck of the fibula, and you will find
8. common peroneal nerve
Foot & Ankle
Medial aspect
1. Head of first metatarsal bone and the first metatarsal phalangeal joint
2. First metatarsal cuneiform
3. Navicular tubercle
4. Head of the talus
5. Medial malleolus
6. Sustentaculum tali
7. Medial tubercle of talus – posterior distil end of the medal malleolus
Lateral aspect
1. Fifth metatarsal bone: fifth metatarsophalangeal joint
2. Styloid process
3. Groove for peroneus longus
4. Calcaneus
5. Peroneal tubercle
6. Lateral malleolus
7. Sinus tarsi – anterior lateral malleolus – ext digitorum brevis
8. Inferior tib/fib joint
Hind Foot
1. Dome of calcaneus
2. Medial tubercle
Plantar Surface
1. Sesamoid bones
2.Metatarsal heads
Orthopaedic Testings
Cervical Spine
1. Compression test to reproduce pain to the upper extremities so as to locate its origin
2. Distraction test → to demonstrate the effect that Neck traction may have on relieving pain
3. Valsalva test → increase intrathecal pressure
4. Swallowing test → to check for anterior herniated disc tumour
5. The Addsons test → to determine the state the subclavian artery which may be compressed by an extra cervical rib
Shoulder
1. Compass Test - This is a muscle locking test to check the stability of each joint.
2. The Yergason Test - To check the stability of the biceps tendon in the bicipital groove.
3. Empty can test - Supraspinatus
4. Drop arm test - Supraspinatus
5. Apley's scratch test - range of motion test
6. Sternoclavicular joint stress test - S/C ligament sprain
7. Acromio-clavicular joint distraction/compression test - A/C ligament sprain
8. Apprehension test (anterior/posterior)
9. Anterior/Posterior drawer test
10. Adson test - to check if there is compression of the subclavian artery
11. Brachial plexus stretch test
Elbow & Wrist
Wrist
1. Tap or percussion test
2. Compression test
3. Finkelstein test
4. Phalen test
5. Tinel test
6. Forments test
7. Digital Allen test
8. Bunnel Littler test
Elbow
1. Tennis elbow test (Cozens test)
2. Passive tennis elbow test
3. Varus/valgus stress test
4. Tinel test
5. Pinch grip test
Back
1. Standing flexion test - to check for a restriction of the ilium on the sacrum.
2. Seated flexion test - to check for a restriction of the sacrum on the ilium.
3. Babinski - to check for an upper motor neuron lesion damage to the brain or spinal cord.
4. The straight leg raise test
5. The well leg raise test
6. The slump test
7. The Kernig test
8. The Milgram test
9. The Valsava manoeuvre
10. The Hoover test
Hip
1. Inguinal ligament & groin strain I
2. Inguinal ligament & groin strain II
Knee
1. Mc Murray's test (Medial & Lateral meniscus tear)
2. Apley's compression test for meniscus tear
3. Anterior/ Posterior drawer test
4. Anterior/ Posterior Lachman test
Foot & Ankle
1. Homan's Sign: Although this test is more commonly used to assess for deep vein thrombosis (DVT) in the calf, it can still be relevant for the foot and ankle by indicating if there's any associated swelling or vascular issues that could affect the lower leg and foot.
2. Anterior Drawer Test (Ankle): This version of the anterior drawer test assesses the integrity of the anterior talofibular ligament (ATFL), a common site of injury in ankle sprains. The foot is placed in a slight plantarflexion, and the examiner pulls the heel forward while stabilizing the tibia. Excessive forward movement suggests an ATFL injury.
3. Talar Tilt Test: This test evaluates the stability of the ankle by checking the integrity of the lateral ligaments, particularly the calcaneofibular ligament. The foot is inverted, and if there’s excessive tilt of the talus within the ankle mortise, it indicates a ligamentous injury.
4. Thompson Test: This test checks for an Achilles tendon rupture. The patient lies prone with their foot off the edge of the table. The examiner squeezes the calf muscle; if the foot doesn’t plantarflex in response, this indicates a rupture of the Achilles tendon.
5. Tap or Percussion Test: Specifically for the foot and ankle, this test can be used to detect stress fractures. Tapping on the heel or metatarsals can produce pain at the site of a fracture, indicating a positive test.
6. Feiss Line: This test assesses the height of the medial longitudinal arch of the foot. The position of the navicular tuberosity relative to the line drawn from the medial malleolus to the head of the first metatarsal indicates whether the arch is normal, too low (flatfoot), or too high (pes cavus).
7. Interdigital Neuroma Test : This test is used to detect Morton’s neuroma, which often occurs between the third and fourth toes. The examiner squeezes the forefoot and applies pressure between the metatarsals. A click or pain suggests the presence of a neuroma.
8. Compression Test (Ankle): This test is used to assess for syndesmotic injury (high ankle sprain) or fractures. The examiner compresses the tibia and fibula together above the ankle. Pain in the ankle area can indicate a syndesmotic injury or fracture.
9. Long Bone Compression Test: For the foot and ankle, this test can be used to detect metatarsal fractures. The examiner compresses the long bones (metatarsals) along their length. Pain at a specific site suggests a possible fracture.
Adjustments & Manipulations
MET
Human Pathophysiology
1. Neurodegenerative Diseases (MS, Parkinson's Disease)
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Multiple Sclerosis (MS)
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Definition: A chronic autoimmune disease affecting the central nervous system, where the immune system attacks the myelin sheath of nerve fibers.
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Relevant Anatomy/Physiology: CNS (brain, spinal cord), myelin sheath, oligodendrocytes.
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Pathophysiology: Demyelination leads to disrupted neural transmission.
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Clinical Presentation: Symptoms vary, including visual disturbances, muscle weakness, coordination issues, and cognitive impairment.
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Osteopathic Management: Focus on maintaining mobility, managing spasticity, improving circulation, and supporting overall well-being.
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Parkinson's Disease
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Definition: A progressive neurodegenerative disorder primarily affecting movement.
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Relevant Anatomy/Physiology: Basal ganglia, substantia nigra, dopamine production.
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Pathophysiology: Loss of dopaminergic neurons leads to motor control issues.
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Clinical Presentation: Tremors, bradykinesia, rigidity, postural instability.
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Osteopathic Management: Techniques to enhance mobility, reduce muscle rigidity, and improve quality of life.
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UMN vs. LMN Lesions
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Upper Motor Neuron (UMN) Lesions: Characterized by spasticity, hyperreflexia, and muscle weakness without atrophy.
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Lower Motor Neuron (LMN) Lesions: Flaccid paralysis, muscle atrophy, hyporeflexia.
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Relevant Anatomy/Physiology: UMN are located in the brain and spinal cord, LMN in the anterior horn of the spinal cord and peripheral nerves.
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2. Liver and Gallbladder Pathology
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Cholecystitis
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Definition: Inflammation of the gallbladder, often due to gallstones.
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Relevant Anatomy/Physiology: Gallbladder, bile ducts, liver.
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Pathophysiology: Blockage of bile ducts by stones leads to inflammation.
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Clinical Presentation: Right upper quadrant pain, fever, nausea, vomiting.
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Osteopathic Management: Techniques to enhance lymphatic drainage, support liver function, and reduce visceral restrictions.
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Cholangitis
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Definition: Inflammation of the bile ducts, usually due to bacterial infection.
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Pathophysiology: Obstruction leads to bile stasis and bacterial overgrowth.
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Clinical Presentation: Charcot's triad—fever, jaundice, right upper quadrant pain.
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Osteopathic Management: Similar to cholecystitis, focusing on improving bile flow and lymphatic drainage.
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Portal Venous System
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Anatomy/Physiology: Portal vein, liver sinusoids, systemic circulation.
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Relevance: Key in liver function, often involved in liver pathologies like cirrhosis.
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3. Seronegative Arthritis and Related Conditions
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Seronegative Arthritis
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Definition: A group of arthritic diseases that are negative for rheumatoid factor.
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Examples: Ankylosing spondylitis, psoriatic arthritis, reactive arthritis.
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Clinical Presentation: Joint pain, stiffness, inflammation, with extra-articular manifestations like uveitis.
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Rheumatoid Arthritis (RA)
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Definition: A chronic autoimmune disorder affecting joints, with a positive rheumatoid factor.
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Pathophysiology: Inflammation of the synovial membrane leading to joint destruction.
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Clinical Presentation: Symmetrical joint pain, swelling, morning stiffness, deformities.
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Ankylosing Spondylitis
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Definition: A type of seronegative arthritis affecting the spine and sacroiliac joints.
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Pathophysiology: Chronic inflammation leading to fusion of vertebrae.
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Clinical Presentation: Lower back pain, stiffness, reduced spinal mobility, possible eye inflammation.
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Osteopathic Management: Focus on spinal mobility, posture, and reducing pain.
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