Title: Essentials of Human Anatomy
1NEED OF ANATOMY IN UNDERGRADUATE COURSES
EXAMPLES FROM PRACTICE IN RELATION TO JOINTS AND
MUSCLES
DR V. K. CHAUHAN PRINCIPAL Dr. B.R.Sur
Homoeopathic Medical College, Hospital Research
Centre, Nanak Pura, New Delhi Email
vkchauhan2002_at_yahoo.com
2 MEDICAL SCIENCE
Medical Science (whether allopathic, ayurvedic or
homoeopathic) is the art and science of healing.
It encompasses a range of health care practices
evolved to maintain and restore human health by
the application of health science, biomedical
research, and medical technology to diagnose and
treat injury and disease, typically through
medication, surgery, or some other form of
therapy, prevention and treatment of illness.
3HOMOEOPATHY
- The word Homeopathy is derived from the Greek
homoi similar, plus Pathos suffering.
- In the early 19th century Dr. Samuel Hahnemann,
developed a medical therapy, and put into words
the basic principal Similia Similibus Curentur. - In the ear of 1850 Symptoms were the focus of
study in in reference to diseasedisease
4EDUCATIONAL NEEDS OF HOMOEOAPTHIC CURRICULUM
- Homoeopathy is having a distinctly peculiar and
individualistic approach to treat the sick. - Therefore its educational training needs are also
distinctly different.
Ref http//cchindia.com/hdc4.htm
5EDUCATIONAL NEEDS OF HOMOEOAPTHIC CURRICULUM
- Keeping in mind the peculiar needs for the
training of a homoeopathic physician CCH evolved
a course curriculum for BHMS degree course.
Ref http//cchindia.com/hdc4.htm
6EDUCATIONAL NEEDS OF HOMOEOAPTHIC CURRICULUM
- It starts from the basic pre-clinical subjects
and then encompasses the para-clinical followed
by clinical subjects.
Ref http//cchindia.com/hdc4.htm
7BHMS COURSE CURRICULUM
- CCH Approved Subjects for study and examination
for the B.H.M.S. (Degree) course are as under- - THE PRECLINCIAL SUBJECTS ARE TAUGHT IN FIRST
YEAR - A . Core subject in Pre-Clinical Medicine include
as - Anatomy
- Physiology including Biochemistry.
- B. The core subjects of homoeopathic speciality
initiated and further followed up-till 4th BHMS
include as - Organon of Medicine, Homoeo. Philosophy
Psychology. - Homeopathic Pharmacy.
- Homeopathic Materia Medica Therapeutics.
Here one finds Anatomyis one first and
foremostsubjects to start with.
Ref http//cchindia.com/hdc4.htm
8BHMS COURSE CURRICULUM
- CCH Approved Subjects for study and examination
for the B.H.M.S. (Degree) course are as under-
- THE PRECLINCIAL SUBJECTS ARE TAUGHT IN 2nd Year
YEAR - A . Core Para clinical subject in Medicine
include in 2nd BHMS study are as - Pathology and Microbiology.
- Forensic medicine and Toxicology.
Ref http//cchindia.com/hdc4.htm
9BHMS COURSE CURRICULUM
- CCH Approved Subjects for study and examination
for the B.H.M.S. (Degree) course are as under- - THE Clincial Subjects are taught in 3rd and
4th year which essentially are applied part of
basic preclinical disciplines and are as under - Practice of Medicine.
- Surgery.
- Obstetrics and Gynecology.
- Community Medicine.
- Case taking and repertory
- During the course of Internship the final
brushing and polishing is undertaken which
incarporates all the areas of homoeopathic
medical education undergone i.e., preclinical,
paraclinical and clinical.
Ref http//cchindia.com/hdc4.htm
10AIM OF BHMS COURSE CURRICULUM
- Basic objectives of education and training in a
Homoeopathic institution is to prepare competent
Homoeopathic Physicians who are competent of
functioning independently and effectively under
Rural and Urban setups to meet the current
medical needs of the country. - For this, the educational process shall be
perceived as an integrated evolving process and
not merely as an acquisition of a large number of
data and facts.
Ref http//cchindia.com/hdc4.htm
11ANATOMY
- The first day that you look at or place your
hand on a patient, you require a basic knowledge
of anatomy to interpret your observations. - It is in the anatomy department that you learn
the basic medical vocabulary that you will carry
with you throughout your professional career and
that will enable you to converse with your
colleagues. - Anatomy can be a boring subject clinical anatomy
is fascinating......... - ..........Richard S. Snell
12ANATOMY THE LEVELS OF ORGANIZATION
- Atoms are the simplest level.
- Two or more atoms comprise a molecule.
- Macromolecules are large, biologically important
molecules inside cells. - Organelles are aggregates of macromolecules used
to carry out a specific function in cell. - Cells are the basic living unit.
- Tissues are groups of cells functioning together.
- Groups of tissues form organs.
- Groups of organs function together as organ
systems. - Organ systems functioning together make up an
organism.
Human body is sum of its parts at different
levels of organization.
13ANATOMY AS BASIC FOUNDATION FOR PRACTICE OF
MEDICINE
- Entire edifice of medicine rests on the
understanding of four foundations, listed in
descending order of importance - Structure of human body (Anatomy)
- Function of human body (Physiology)
- Disease processes that ravage structure and
function (Pathology) - Intervention / means for preventing or treating
disease (Medical / Surgical)
14ANATOMY AND ITS MEDICAL DIMENTIONS
- Anatomy is the study of the structure
(morphology) of the body and the physical
relationships involved between its parts, in
other words, what are things called? - Physiology studies functions of these parts, in
other words, how the parts of the body work and
the ways in which they cooperate together to
maintain life and health of the individual? - Pathology is the study of abnormalities and how
they affect body structure and functions, often
causing illness, in other words, it is abnormal
anatomy and physiology. - Building on the normal and abnormal anatomy and
physiology, relevant illnesses are assessed.
15ANATOMY AND ITS MEDICAL DIMENTIONS
- All disciplines are closely inter-related because
the functional role of a part depends on how it
is constructed. - To understand function, we must first comprehend
structure. We cannot hope to unravel the effects
of disease processes without first learning the
structure and function of man. - Finally, our success in treating the patient is
directly proportional to our mastery of all the
four elements.
16WHY STUDY ANATOMY?
- Anatomy is obviously essential for surgeons but
also has value for anyone who performs a
procedure on a patient analyses radio-logical
imaging performs a physical examination of a
patient refers a patient to another doctor or
explains a procedure to a patient. These tasks
are common to all branches of medicine. - Provides an education rather than training, i.e.
you can train a monkey to do surgery but the
monkey cannot fix a problem when it arises.
17INTERNATIONAL UNIFORMTIY OF COMMON ANATOMICAL
TERMS
- It is essential that all medical professionals
understand the terms used for describing the
structure and function of different regions of
gross anatomy. - Without these terms, it is impossible to describe
in a meaningful way the composition of the body.
- Moreover, the physician needs these terms so that
anatomic abnormalities found on clinical
examination of a patient can be accurately
recorded. - Moreover we must understand the normal situation
to be able to compare it with and recognize the
abnormal.
18INTERNATIONAL UNIFORMTIY OF COMMON ANATOMICAL
TERMS
- The accurate use of anatomic terms by medical
personnel enables them to communicate with their
colleagues both nationally and internationally. - Without anatomic terms, one cannot accurately
discuss or record the abnormal functions of
joints, the actions of muscles, the alteration of
position of organs, or the exact location of
swellings or tumors.
19WHAT IS MINIMUM BASIC ANATOMY FOR A PRACTICING
HOMOEOPATH
- Basic anatomy is the study of the minimal amount
of anatomy consistent with the understanding of
the overall structure and functioning of the
human body. - Anatomy should be studied in a way that so as to
learn more of applied aspects than a multitude of
minor anatomical details. - A minimum working knowledge should be that which
enables an independent practitioner to practice
safely, and to communicate with other medical
professionals and patients effectively.
William BOERICKE(1849-1929, US)
20RELEVANCE OF DISSECTION
- The term Anatomy instantaneously brings to mind
following things - Dissection
- Skeleton
- Mummified body
- Study of the cadaver is only a
- means to this end.
- Much of that is at present taught by the
dissection could be demonstrated as usefully
through prepared dissected specimens, three
dimensional models, plastination, virtual
dissection, simulated surgery and multi-media
classroom teaching.
21RELEVANCE OF DISSECTION
- Though dissection of the body is essential for
the preparation of the student for his clinical
studies, Major emphasis is placed on functional
anatomy of the living subject and on general
anatomical positions and broad relations of the
vicera, muscles, blood-vessels, nerves and
lymphatics.
22RELEVANCE OF DISSECTION
The Anatomy Lecture of Dr. Nicholaes
TulpRembrandt van Rijn (Dutch, 1606-1669)1632,
Oil and Canvas, 169.5 cm by 216.5 cmMauritshuis,
The Hague, Netherlands
- The purpose of dissection is not to create
technically expert but to give an understanding
of the body in relation to its functional, and
the dissection should be designed to achieve this
end.
23CLINICAL ANATOMY
- Clinical anatomy is the study of the macroscopic
structure and function of the body as it relates
to the practice of medicine and other health
sciences.
24CLINICAL ANATOMY
- The pre-clinical subjects Anatomy and Physiology
paves the way in a continuity, and in an
evolutionary and progressive pattern to
understand Para-clinical subjects like alteration
in anatomy (Pathology) and alteration in function
(Pathophysiology).
Wilhelm Heinrich Erb (November 30, 1840 - 1921)
was a German neurologist
25CLINICAL ANATOMY
- Anatomy is, and shall always remain the
foundation on which the towering edifice of
clinical medicine, in all its myriad forms, is
built.
Bell's palsy
26CLINICAL ANATOMY
- What has changed, for the better, is its teaching
methodology. - Today, the study of Anatomy is better integrated,
both horizontally and vertically, not only with
other basic sciences, but with clinical sciences
as well.
27MORBID ANATOMY
- Morbid Anatomy, now called Pathology or
Pathological Anatomy, refers to 'abnormal'
structure and function.
- As examples of relevance of Anatomy, reference
is invited to all -graphies, -scopies, -centeses,
-otomies, -ostomies, -ectomies, radical
resections, endoscopies, biopsies, FNACs, Plastic
and Reconstructive Surgery.
28MORBID ANATOMY
- Also, at another level, is exfoliative cytology
(Pap. Smears), tissue culture and the entire
Genetic Engineering Technology, PCRs, 'Blots' and
Immunoflorescence techniques. - The scope of Anatomy in pathology is unending and
all-embracing.
Exfoliative Pulmonary Cytology- ...
29SURGICAL ANATOMY
- Two living 18-month old miracles stand testimony
to the relevance of knowledge of Anatomy in
Surgery.
- Dr. Keith Goh Dr. Chumpon Chan with their
teams, in Singapore, performed a 99-hour
operation, longest surgery in history, on Ganga
and Jamuna, Nepali twins born with craniopagus or
conjoined skulls, with entwinning brains, and
successfully separated them. This involved months
of studying three dimensional images of
bewildering anatomy of their brains (Reader's
digest, April 2003). - Would this have been possible without a thorough
knowledge of Anatomy, first the normal, then
recognizing the abnormal, and finally performing
the miracle of restoring the normal?
30APPROACHES TO STUDY OF ANATOMY
- Systemic Anatomy
- Study of one system at a time, e.g. osteology
(all bones studied together), myology (all
muscles studied together), splanchnology (study
of viscera), etc.
31APPROACHES TO STUDY OF ANATOMY
- Regional Anatomy
- All structures within a certain region are
studied together, e.g. thoracic region, abdomen,
head, neck, back, etc.
32APPROACHES TO STUDY OF ANATOMY
- Topographic Anatomy
- Structures on the surface of the skin can be used
to identify and locate deeper structures, organs,
and tissues beneath the skin.
33APPROACHES TO STUDY OF ANATOMY
- Practical, Dissectional, Cross-sectional,
Radiological, Artificial, Classic, Corrosion
- Collectively, they give a three-dimensional
orientation about the spatial organization of
various body parts, and it is the visual images
acquired during a study of these, that are
crucial in the further understanding of diagnosis
and treatment. - They are the traditional methods of study by
prosections, aided by corrosion casts, charts,
modes, and various imaging techniques.
34APPROACHES TO STUDY OF ANATOMY
- Minute, Histological, Microscopic
- As one gains greater insight into the functioning
of the body at cellular and sub-cellular levels,
these aspects of Anatomy become more pertinent. A
sound basis in microanatomy is essential for a
clear understanding of the Pathology of disease.
ImageTesticle-histology-
35APPROACHES TO STUDY OF ANATOMY
- Morphological, Comparative, Ontogenic,
Developmental, Embryological, Temporal (Tempus
Time) and Phylogenetic - These include the time dimension, with reference
to human evolution, life span of an individual
and intrauterine growth and development.
36HISTORICAL OVERVIEW
37Pre-historic Medicine
- Growth and evolution of anatomy as a science is
an interesting story, it dates back to
prehistoric age when primitive man lived for
himself. - The fundamental urge was hunger and animals were
killed for food. Thus it was necessary to know
the vital parts of animals, that is heart area,
liver area which they used to strike in order to
kill the animals. - This laid the foundation of topographical
anatomy.
38Palaentological Medicine
- Evidence for trepanning, the surgical procedure
of cutting a hole in the skull, dates back 4,000
to 5,000 years.
- Some anthropologists speculate that Stone Age
societies performed trepanning on people with
mental illnesses to release evil spirits or
demons from their heads. - In the absence of written records, however, it is
impossible to know why the operation was
performed.
39Early Phase of Medicine
- With the growth of civilization men became more
conscious about their environment. They learned
to live in society and to help each other in
distress.
- A class of people acquired art of healing which
urged them to know about human body. - To start with it was for the people who used to
detail out anatomical facts in relation to
diseases and thus anatomy used to be learned as a
by-product of clinical practice.
- During this period there was no scope for
studying human anatomy due to religious
impositions and superstitious beliefs.
40Primitive medicine
- For the primitive man illness was due to the
vagaries of Gods, demons and supernatural forces.
The treatment was done by the medicine men called
shamans through whom the spirits were believed
to speak. The primitive society did not
distinguish between magic, religion, and medicine
or between the physical and psychological
illnesses.
Shamanism in Siberiaexcerpts from Aboriginal
Siberia
41Medicine in Dark ages
- People used sacrificial animals and began
experimenting on animals to learn anatomy. - Zeal for learning anatomy grew to such a
magnitude that some inquisitives resorted to
stealing dead body from graveyard or to commit
murder for this purpose and thus purposeful
anatomy came into existence.
- The science developed slowly and a number of
personalities came into prominence for their work
on the subject, and Anatomy emerged from myths
into a definite science.
42"Anatomy is the foundation of medicine" the
classical Greek physician Hippocrates declared,
"and should be based on the form of the human
body Hippocrates is regarded as father of
medicine and founder of anatomy. His writings
contained directions for dissections and use of
scalpels. His study was based on human bodies
collected from battle fields.
43The start of any medical career begins at the
dissecting table so it is fitting that medicine
itself began with the study of anatomy.
Galen practiced medicine in 3rd century and was
one of the most influential physicians of all
time. Many of his anatomic principles were based
on animal dissection with the liver felt to be
the seat of soul. His teachings remained the
foundation of medical care for almost 1500 years
known as Galenic Age.
44- According to Galen a Greek Physician who lived in
2nd century AD the illnesses resulted from
disequilibrium, in the body, of the distribution
of one or more of the four humors or fluids,
i.e. blood (from heart), phlegm (from organs),
yellow bile (from liver), and black bile (from
spleen). - The idea was derived from a philosophical notion
that all matter was composed of earth, air, fire
and water, and possessed the qualities cold, dry,
hot and moist. - Blood was hot and moist,
- phlegm cold and moist,
- yellow bile hot and dry and
- black bile was cold and dry.
- When the humors were well blended the body was
healthy. - However, an excess or deficiency of any one or
more resulted in disease, e.g. excess of blood
caused apoplexy (stroke), excess of yellow bile
caused jaundice while excess of black bile
brought out melancholia (depression). Too much of
phlegm in the lungs caused consumption
(tuberculosis) and too much in the bowels caused
dysentery.
45The Four Humors
- Galen (130-201 AD) was the physician to Marcus
Aurelius and became the heir to Hippocrates and
one of the most influential physicians of all
times. - He taught the importance of maintaining balance
between the four bodily fluids, or "humors" (2)
blood, phlegm, yellow bile, and black bile. Each
fluid was associated with a specific personality
characteristic.
2) Galen's Four Humors
46The Four Humors
- Blood was associated with a sanguine personality,
that is laughter, music, and a passionate
disposition. - Someone with a phlegmatic personality was
sluggish and dull, - Yellow bile represented an individual quick to
anger or choleric (cholera meaning yellow as in
yellow fever). - Lastly, black bile represented a melancholic or
depressed personality, melan meaning black.
2) Galen's Four Humors
47Four Humors and Blood Letting
- It was the job of the physician to restore
harmony in those four humors by the use of
emetics, cathartics, purgatives, and by
bloodletting. - Bleeding was used to reduce excess circulation,
to slow the pulse, and to "reduce irritation",
all felt to be the cause of inflammation. - Dr. Benjamin Rush, a signer of the Declaration of
Independence, was a major figure in colonial
American medicine and was an important proponent
of bleeding, though unfortunately he mistakenly
thought that the body held 12 instead of 6
quarts. - Shortly before his death, George Washington was
bled 4 quarts in 24 hours for an infected
throat and died not long after.
G. Washington After Being Bled
48- In the centuries that followed, there were few
prohibitions to human dissection though specimens
were hard to come by and preservation was
inadequate. - Mondino de Luzzi was first to illustrate Galen's
teachings by dissecting a human cadaver in 1315
and produced first dissecting manual
ANATHOMIA. His famous dissection in Bolognia
remains a landmark.
49- Leonardo da Vinci (1452-1519) studied anatomy as
an art form. - His drawings were designed to guide other artists
and they marked the beginning of systemic study
of the human body. - His were the first correct drawings of fetus and
he first demonstrated the link between brain and
peripheral nerves.
Da Vinci Foetus
Da Vinci Bones
Da Vinci Muscles
50- Da Vinci's sketches were on loose leaf and were
the result of 30 careful human dissections. - Many of these works are present at Royal Library
of Windsor. - Early anatomic investigation was opposed by many
religious groups and da Vinci left Vatican to
avoid prosecution.
"Dispel from your mind the thought that an
understanding of the human body in every aspect
of its structure can be given in words the more
thoroughly you describe, the more you will
confuse... I advise you not to trouble with words
unless you are speaking to blind men." ..........
Leonardo da Vinci
51- Andreas Vesalius 1514 - 1564 Father of modern
anatomy remained a teacher and bachelor
throughout his life. He did not accept anything
left as a legacy of any previous worker without
meticulous dissection. - He brought medicine into the modern era with his
monumental work De Humani Corporis Fabrica Libri
Septum (1543), now considered one of the
greatest books in the history of medicine.
52- Andreas Vesalius contested the accepted teachings
of Galen and started his independent studies in
medicine, and indeed put scientific
investigation, on the road that has led to
today's incredible achievements. - The magnificent illustrations are classics in
medicine.
Vesalius Muscleman
Vesalius, Skeleton
53- The next great landmark came in 1628 by William
Harvey when he wrote Exercitatio Anatomica de
Motu Cordis et Sanguinis in Animalibus. - He conducted experiment of movement of heart and
blood in animals.
This study of circulatory physiology
revolutionized medical investigation by use of
scientific method and was major departure from
Galen, who taught that blood ebbed and flowed
throughout body, beginning in liver.
54- The finest anatomic work of 17th century was
Anatomia Humani Corporis (1685) written by Govert
Bidloo with 105 copperplate engravings drawn by
Gerard de Lairesse. - These great examples of Dutch baroque art
generated one of the most famous controversies in
history of medicine when Bidloo accused William
Cowper of plagiarism. - Original plates of Bidloo's figures found their
way into Cowper's The Anatomy of Human Bodies in
1698 after Cowper purchased those plates from
engraver and reissued them under his own name.
55- Art of medical illustration reached its zenith
with 11-volume compendium by Bourgery, Claude
Bernard, and N.H. Jacob written between 1866 and
1871. - The coloured illustrations of anatomy and surgery
in Traite Complete de L'Anatomie de L'Homme are
unsurpassed and are a necessary part of any
medical art or instrument collection.
Bourgery, Face
Bourgery, Head
Musculature
Skeleton
Bourgery, Torso
Bourgery, Skull
Bourgery, Face
56- Dissection sets were made throughout 19th century
and could be found at students' side as well as
in hands of early pathologists. - Cadavers for dissection remained difficult to
obtain and in fact families of deceased often had
to pay for protection from "resurrectionists" or
grave robbers, who supplied medical schools and
anatomists.
Dissection Set
Autopsy
Post Mortem, Open
57- Italian craftsmen of 18th century created some of
the finest wax anatomic models ever made and many
of those works can now can be found on display at
Museo di Zoologia, or "La Specola" of University
of Florence. - Louis Auzoux (1797-1880) was a French medical
school graduate and was the pre-eminent maker of
paper mache models during 19th century, supplying
medical schools in Europe, England, and U.S.
La Specola, Head
La Specola, Abdomen
58- Artisans turned elsewhere in 20th century when a
growing population and economic pressures made
anatomic study more available through mass
production. - The artistry of wax and paper mache figures was
lost forever, though many still try to recreate
these beautiful forms of past. - "Flap" anatomic models were very popular as
deeper and deeper structures were displayed by
turning pages.
Auzoux, Female
Auzoux, Back
59EXAMPLES FROM PRACTICE IN RELATION TO JOINTS AND
MUSCLES
60Importance in Clinical Decision Making
Causes of Pain in around Joint 1. Muscular
pain 2. Bursitis 3. Stretching of joint
capsule 4. Synovial effusion. 5. Stretching of
synovial membrane 6. Ligament strain /
tendinitis 7. Periostitis 8. Destruction of
articular cartilage (causes no pain) 9. Raised
pressure in subchondral bone
7
1
2
8
3
4
5
9
6
61DIAGNOSTIC IMPORTANCE
62DIAGNOSTIC IMPORTANCE
63IMPORTANCE IN GENESIS OF DISEASEEXAMPLE OF
OSTEOARTHROSIS
- The self neglect occurs in food, clothing,
cleanliness, and physical fitness. This lack of
exercise and neglect in balanced and nutritious
food results in feebleness of muscle tone and
ligaments. The most commonly involved area is the
vertebral column as long erector spine muscles
and ligaments in the region of cervical and
lumbar spine become lax.
Predominant psoric somatotype is ectomorphic. The
subject is lean, thin, tall usually engaged in
sedentary habits and as per his nature commits
self-neglect.
64IMPORTANCE IN GENESIS OF DISEASEEXAMPLE OF
OSTEOARTHROSIS
- Thus the periarticular components of the joint,
getting weak and lax, cannot support the joint.
The surfaces in mal-alignment further cause joint
surface degeneration and osteoarthritic changes.
These osteoarthritic changes more frequently
affect the cervical spine and lumbar spine,
leading to cervical spondylosis and lumbar
spondylosis.
Such a subject is forced to adapt a poor posture
unknowingly while at work and otherwise during
the daily routine.
65IMPORTANCE IN GENESIS OF DISEASEEXAMPLE OF
OSTEOARTHROSIS
- These changes ultimately result in typical stoop
shouldered deformity which becomes apparent in
the predominantly psoric subject. - Surprisingly, such patients develop changes late
in life and do not suffer more serious affections
of degenerative arthrosis.
The most benign course of degenerative arthrosis
is seen in subject having preponderance of Psoric
miasm.
66IMPORTANCE IN GENESIS OF DISEASEEXAMPLE OF
OSTEOARTHROSIS
- Predominant sycotic somatotype is endomorphic,
with poor musculature. - Such a constitution has overweight which causes
stress on big weight bearing joints and bloated
abdomen puts drag on lumbar spine leading to
lumbar ligament strain and early degenerative
changes.
Apart from constitutional predisposition, other
associated sycotic disorders as Diabetes
Mellitus, Hypothyroidism, Gout, will modify
onset, course and prognosis.
67IMPORTANCE IN GENESIS OF DISEASEEXAMPLE OF
OSTEOARTHROSIS
- Occupation plays a great role in the genesis of
O.A., e.g. prolonged table work, working with
computers, which cause strain to cervical and
lumbar spine. - Occupations which involve repetitive joint
strain, e.g. porter, labourers, sports also
predispose to O.A. - Traumatised joint is most vulnerable to O.A.
Mesomorphic somatotype has well developed
muscular physique, along with an inborn liking
for strenuous physical activity which make them
prone to sports related injuries, development
of O.A.
68IMPORTANCE IN DISEASE STAGING EXAMPLE OF
SPONDYLOSIS
1
1
1
2
2
2
Primary Stage
Secondary Stage
Tertiary stage
1. Loss of inter- vertebral space
1. Normal lordotic curvature
1. Loss of normal lordosis
2. Narrowed inter- vertebral space
2. Osteophyte formation
2. Encroachment of osteophytes in
Intervertebral foramen
69Primary Stage
PROGNOSTIC IMPORTANCEEXAMPLE OF RHEUMATOID
ARTHRITIS
- Pathology reversible.
- Disease activity
- mild to severe.
- Primary sycotic
- manifestations.
- Therapeutic aim is to
- Control disease activity
- and progression.
- Achieve remission.
- Prevent relapse.
70PROGNOSTIC IMPORTANCEEXAMPLE OF RHEUMATOID
ARTHRITIS
Secondary Stage
- Pathology irreversible.
- Disease activity
- progressive.
- Sycotic Syphilitic
- (early) manifestation.
- Therapeutic aim is to
- Control disease
- progression.
- Preserve function.
- Prevent complications.
71PROGNOSTIC IMPORTANCEEXAMPLE OF RHEUMATOID
ARTHRITIS
Tertiary Stage
- Pathology advanced.
- Burnt-out phase,
- Inflammation minimal.
- Mixed syco-syphilitic
- manifestation.
- Therapeutic aim is to
- Provide symptomatic
- relief.
- Minimise disability.
- Rehabilitation.
72IMPORTANCE IN MEDICINE SELECTION
- Insertional
- Affection at point of insertion of ligaments
and tendons in bone. - e.g. Tennis Elbow, Golfers Elbow.
- (Phyto., Ruta)
- Synovial
- Affection of synovial lining of bursae and
tendon sheaths. - e.g. Housemaids knee, Olecranon bursitis.
- (Apis, Bry., Phyto.)
73IMPORTANCE IN MEDICINE SELECTION
- Nerve Root Affection
- Irritation to nerve root due to compression at
intervertebral foramen. - e.g. Prolapse disc, C.S., L.S.
- (Arnica, Gnaph., Hyper.)
- Nerve Entrapment
- Nerve compression subsequent in its course.
- e.g. Carpal tunnel syndrome.
- (Caust., Hyper., Phyto., Rhus tox.)
74IMPORTANCE IN MEDICINE SELECTION
- Degenerative arthrosis
- Focal cartilage loss.
- New bone formation.
- (Ang. vera, Calc. fluor., Caust.)
- Inflammatory Arthritis
- Synovitis.
- Synovial effusion.
- (Apis, Bry., Form. acid, Form. rufa, Gaulth.)
75PATHOLOGICAL IMPORTANCE EXAMPLE OF MUSCULAR
DYSTROPHY
- Muscular dystrophy is a characterised by
- Progressive muscle weakness loss of muscle
tissue. - Muscle deformities.
- Contracture deformities (clubfoot, clawhand,
etc.) - Scoliosis.
- Enlargement of calf muscles (pseudohypertrophy)
- Because these are inherited disorders, risk
include a family history of muscular dystrophy.
76PATHOLOGICAL IMPORTANCE EXAMPLE OF MUSCULAR
DYSTROPHY
- A positive Gower's sign reflects more severe
impairment of lower extremities muscles. Child
helps himself to get up with upper extremities
first by rising to stand on his arms and knees,
and then "walking" his hands up his legs to stand
upright.
77PATHOLOGICAL IMPORTANCE EXAMPLE OF MUSCULAR
DYSTROPHY
- Creatinine Kinase (CPK-MM) levels in the blood
stream are extremely high. - An electromyography (EMG) shows that weakness is
caused by destruction of muscle tissue rather
than by damage to nerves. - Genetic Testing can reveal genetic errors in the
Xp21 gene. - Muscle biopsy or genetic test confirms the
absence of dystrophin.
78MEDICOLEGAL IMPORTANCE EXAMPLE OF RIGOR MORTIS
- A few hours after a person dies, joints of body
stiffen and become locked in place. This
stiffening is called rigor mortis. - Depending on temperature and other conditions,
rigor mortis lasts approximately 72 hours. - The phenomenon is caused by skeletal muscles
partially contracting. Muscles are unable to
relax, so joints become fixed in place.
Rigor mortis is used to estimate time of death.
Maximum stiffness is reached around 12-24 hours
post mortem. After 72 hours general tissue decay
leaking of lysosomal intracellular enzymes
cause muscles to relax.
79MEDICOLEGAL IMPORTANCE EXAMPLE OF CADAVERIC
SPASM
- Cadaveric spasm, also known as instantaneous
rigidity, is a form of muscular stiffening that
occurs at the moment of death and persists into
the period of rigor mortis and can be mistaken
for rigor mortis. - It is usually associated with violent deaths
happening with intense emotion. - It may affect all muscles in body, but typically
only groups, such as forearms, or hands. - It is seen in cases of drowning victims when
grass, weeds, roots other materials are clutched,
and provides proof of life at time of entry into
water.
Cadaveric spasm often crystallizes the last
activity one did prior to death and is therefore
significant in forensic investigations, e.g.
clinging on a live electrical wire tightly.
80LEGAL IMPORTANCE EXAMPLE OF JUDICIAL HANGING
- Hangmans knot is a well-known knot most often
associated with its use in hanging. - The knot of rope is typically placed under or
just behind left ear. - As the blow when the condemned drops to the end
of rope is supposed to break the neck (for modern
"long-drop" hangings), this knot adds additional
striking force against the head and neck.
81LEGAL IMPORTANCE EXAMPLE OF JUDICIAL HANGING
- When the body is released from a relatively high
position, death is usually caused by the odontoid
process severing the spinal cord between C1 and
C2. High C1-C2 fracture has been called the
hangmans fracture in medicine, even when it
occurs in other circumstances.
The mechanical stimulation of the carotid sinus
in the neck brings on terminal cardiac arrest.
In the absence of fracture and dislocation,
occlusion of blood vessels becomes the major
cause of death, rather than asphyxiation.
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