Deep lumbar spine & disc anatomy

The best post on internet I have found related to lumbar spine & disc anatomy. Offered by Dr. Douglas M. Gillard, DC, Associate Professor of Clinical Sciences, Published Spine Researcher.

Medical Embryology - Development of the Pharyngeal Arches

This video goes in to the pharyngeal arches, an odd group of folds that contribute a variety of structures to the face and neck. We discuss the arches and their muscular, bony, and nervous features. We then talk about the grooves (outside) and pouches (inside) that create the ears and various glands. I hope you find it helpful!

The Histology guide

An amazing Histology guide offered by Leeds University.

What the site should do for you ...

The main aim of this website is to give you a virtual experience of using a microscope rather than just trawling through text and figures, or even a set of powerpoint slides.

The site is divided into topics, which may be worked through in any order. You can see histological slides on the pages and can turn labels on or off to help them identify features. In some cases, there is a section like a 'virtual microscope' - you can scan around a large picture using the mouse and try to identify features. This emulates as closely as possible the experience of using a microscope. We've also recently introduced a new feature, where the students can also zoom in on a slide, having identified an area of interest. Finally, there are several quizzes to try when you feel you have worked through the topic.

Atlas of knee MRI anatomy

A beautiful navigation through a complete knee MRI in all three planes. Thanx to http://w-radiology.com.

Embryogenesis and organogenesis

Online course in embryology for medicine students developed by the universities of Fribourg, Lausanne and Bern (Switzerland) with the support of the Swiss Virtual Campus © Copyright protected.

Joint Play Techniques In Assessment And Therapy For Upper And Lower Extremities

Beautiful and very detailed website to provide both students of physiotherapy and physiotherapists alike, with an interactive online information source for manual mobilization of the extremities.

Applied anatomy YouTube channel

A wonderful YouTube channel with detailed videos on applied anatomy. These videos were originally filmed for some students DPT class, but its become so popular.

Dream Anatomy

The interior of our bodies is hidden to us. What happens beneath the skin is mysterious, fearful, amazing. In antiquity, the body's internal structure was the subject of speculation, fantasy, and some study, but there were few efforts to represent it in pictures. The invention of the printing press in the 15th century-and the cascade of print technologies that followed-helped to inspire a new spectacular science of anatomy, and new spectacular visions of the body. Anatomical imagery proliferated, detailed and informative but also whimsical, surreal, beautiful, and grotesque — a dream anatomy that reveals as much about the outer world as it does the inner self.

Over the centuries anatomy has become a visual vocabulary of realism. We regard the anatomical body as our inner reality, a medium through which we imagine society, culture and the human condition.

Drawn mainly from the collections of the National Library of Medicine, Dream Anatomy shows off the anatomical imagination in some of its most astonishing incarnations, from 1500 to the present.

Patient education by Tony Tannoury

A very useful list of high quality guidelines and informational brochures for several spine problems/disorders created by Tony Tannoury, MD and his team.

Innerbody.com

Explore the human body like never before! With hundreds of interactive anatomy pictures and descriptions of thousands of objects in the body, InnerBody.com will help you discover what you want to know about human anatomy, right here at your fingertips.

Join the millions of students, patients and inquisitive visitors – start your anatomy exploration by clicking on any of the systems above.

Anatomy drill and practice

Wiley's Global Research business is a provider of content-enabled solutions to improve outcomes in research, education and professional practice with online tools, journals, books, databases, reference works and laboratory protocols.

This website offers amazing quizzes and sources to practise your knowledge on basic anatomy and physiology.

Anatomy of the brain

A beautiful section in Mayfield Clinic website dedicated in the anatomy of the brain. Presented in a simple and easy to understand way with beautiful pictures.

Suggested by my classmate Bita Loftalief.

PhysioTutors: Anatomy - Planes & Axis

In this video Kai from PhysioTutors talks you through the different anatomical planes and corresponding axis.

The osteotendinous junction

The osteotendinous junction (OTJ), or enthesis, is the site of connection between tendon and bone and is also called the tendon insertion site. The unique cellular and molecular composition of the enthesis provides a gradual transition from tendinous to bone tissue. The enthesis is virtually divided into four zones: zone one, starting at the tendon side, consists of aligned collagen I fibers and decorin, and exhibits tendon properties only. The second zone contains collagen types II and III, aggrecan and decorin, resembling fibrocartilage composition. Zone three is defined as mineralized fibrocartilage and is comprised of collagen types II and X and aggrecan. Finally, zone four is composed of mineralized collagen type I and is considered to be a bone protrusion, providing a dedicated connection point. The molecular mechanisms responsible for the formation of this gradient are mostly unknown. However, it was demonstrated in the mouse forelimb model that Bmp4, produced and secreted by maturing tendon cells under Scleraxis transcriptional regulation, is responsible for initiation of bone tuberosity outgrowth at a site of tendon attachment. Other studies reveal the essential contribution of muscle contractions on the formation of bone ridge.

source: http://discovery.lifemapsc.com/in-vivo-development/tendons-ligaments/osteotendinous-junction

Mechanisms of somatic pain

This article, by the University of Utah pain research center, is very interesting but a little bit too detailed. But is worths reading it once and keeping in mind the  summary points:

1. Somatic pain is normally triggered by the activation of nociceptors. Particular types of nociceptors have been well characterized in cutaneous, articular and muscle nerves.
2. The activation of cutaneous Ad nociceptors causes a sensation of pricking pain, whereas stimulation of C polymodal nociceptors elicits burning pain. Muscle nociceptors produce aching pain.
3. Unlike sensitive mechanoreceptors and thermoreceptors, nociceptors can be sensitized by damaging stimuli. Sensitization appears to be triggered by the release of chemical substances, such as prostaglandins, bradykinin, serotonin, and histamine, into the environment of peripheral nociceptor terminals. Some nociceptors are quite unresponsive until they are sensitized.
4. Nociceptors project to particular laminae in the spinal cord dorsal horn. Cutaneous Ad nociceptive fibers end in laminae I, II, and V, whereas cutaneous C polymodal nociceptors end chiefly in lamina II. Fiber, joint, and muscle afferents project to laminae I and V.
5. Fine afferent terminals, presumably of nociceptors, in the dorsal horn contain peptides, such as substance P and CGRP, and also excitatory amino acids. Both classes of substances are likely to be released during intense noxious stimulation.
6. Noxious stimuli trigger both excitatory and inhibitory events in the dorsal horn. Inhibition is likely to be mediated by such agents as inhibitory amino acids and inhibitory peptides. The circuits may be local or involve a supraspinal loop.
7. STT cells that project to the ventral posterior lateral thalamic nucleus in monkeys and rats have response properties that suit them for a role in the sensory-discriminative aspects of pain. Their input can be from cutaneous, articular, muscle and/or visceral receptors. Convergent inputs may account for pain referral.
8. The responses of STT cells are altered by pathological processes. These neurons become more responsive following damage of the skin by intense mechanical, thermal, or chemical stimuli. A similar change occurs during the development of experimental acute arthritis. It is proposed that sensitization of STT cells helps account for the development of primary and secondary hyperalgesia and allodynia following damage.
9. The mechanism of sensitization of STT cells is likely to involve excitatory amino acid and NK1 receptors.
10. Experimental models of painful neuropathy are being developed by several groups. The responses of STT cells in these models are altered in a fashion consistent with the development of spontaneous pain, allodynia, and hyperalgesia.

The spinal cord and spinal tracts by Professor Fink

In Part 1 of Professor Fink's 2-Part Series on the Spinal Cord, he reviews the anatomy of the Spinal Cord and the functional organization at each segmental level. Professor Fink describes the horizontal flow of sensory information into the Spinal Cord and the flow of motor commands out of the Spinal Cord. Reference is made to Gray Matter, White Matter, Spinal Nerves, Dorsal Root Ganglion, Ventral Root, Commissures, decussation, Somatic Reflexes, Dorsal (Posterior) Gray Horn, Ventral (Anterior) Gray Horn, Lateral Gray Horn.

In Part 2 of Professor Fink's 2-Part Series on the Spinal Cord, he reviews the anatomy of the Sensory and Motor Tracts located in the White Matter of the Spinal Cord, describing the transmission of signals vertically within the CNS. Reference is made to the Spinothalamic Tract, Dorsal White Columns (Fasciculus Gracilis & Fasciculus Cuneatus), Spinocerebellar Tract, Corticospinal (Pyramidal) Tract, Extracorticospinal (Extrapyramidal) Tract, Spinal Cord Injuries (Lesions), Herniated Disk, paralysis.

You can also read my own work on the most basic material you need to know on neurology as a Physical therapy student.

Kevin Stone: The bio-future of joint replacement

Arthritis and injury grind down millions of joints, but few get the best remedy -- real biological tissue. Kevin Stone shows a treatment that could sidestep the high costs and donor shortfall of human-to-human transplants with a novel use of animal tissue.

Inspired by www.thestudentphysicaltherapist.com.

Shoulder disclocation

Anterior (forward)

Anterior dislocations are usually caused by a direct blow to or fall on an outstretched arm. The patient typically appears holding their arm externally rotated and slightly abducted.

Posterior (backward)

Posterior dislocations are occasionally due to electric shock or seizure and may be caused by strength imbalance of the rotator cuff muscles. Patients typically present holding their arm internally rotated and adducted, and exhibiting flattening of the anterior shoulder and a prominent coracoid process.

Inferior (downward)

Inferior dislocation is the least likely form, occurring in less than 1% of all shoulder dislocation cases. This condition is also called luxatio erecta because the arm appears to be permanently held upward or behind the head. It is caused by a hyper abduction of the arm that forces the humeral head against the acromion.

The anatomical snuff box

This small cavity that appears at the radial side of the hand when we fully extend and abduct our thumb is call "anatomical snuff box" or "tabatiere anatomique".

The bony borders of this cavity are:

(bottom surface) the trapezium and scaphoideum

(proximally) the styloid process of the radius

(distally) the apex of the muscle tendons triangle

Three tendons define the borders of this cavity, as seen in the picture above:

1. Extensor pollicis longus

Origin: dorsal surface of the ulnar & the membrana interossea

Insertion: phalanx I (dorsally at the base of the distal phalanx)

Action: wrist: RAD DIV, EXT - thump: EXT at the metacarpophalangeal and the interphalangeal joints

While abductor pollicis brevis and adductor pollicis, both attached to the extensor pollicis longus tendon, can extend the thumb's interphalangeal joint to the neutral position, only extensor pollicis longus can achieve full hyperextension at the interphalangeal joint

Innervation: n. Radialis (C7-C8)

2. Extensor pollicis brevis

Origin: dorsal surface of the radius & the membrana interossea

Insertion: phalanx I (dorsally at the base of the proximal phalanx)

Action: wrist: RAD DIV - thump: EXT at the carpometacarpal and the metacarpophalangeal joints

Innervation: n. Radialis (C7-C8)

3. Abductor pollicis longus

Origin: dorsal surface of the ulnar & the radius & the membrana interossea

Insertion: base of the metacarpi I

Action: wrist: RAD DIV - thump: ABD at the carpometacarpal joint

Innervation: n. Radialis (C7-C8)

Besides, the radial artery of the forearm passes through this cavity. It runs distally on the anterior part of the forearm. There, it serves as a landmark for the division between the anterior and posterior compartments of the forearm, with the posterior compartment beginning just lateral to the artery. The artery winds laterally around the wrist, passing through the anatomical snuff box and between the heads of the first dorsal interosseous muscle.

The dorsal (superficial) cutaneous branch of the radial nerve can be palpated by stroking along the extensor pollicis longus with the dorsal aspect of a fingernail.

Pathology

1. Scaphoideum fracture

In the event of a fall onto an outstretched hand, the articulation between the scaphoideum and the radius is the area through which the brunt of the force will focus. In case the force is big enough the scaphoideum may fracture. There are two anatomical peculiarities that make this fracture quite dangerous and difficult to treat:

a. The size of the scaphoideum - the scaphoid is a small, oddly shaped bone whose purpose is to facilitate mobility rather than confer stability to the wrist joint. In the event of inordinate application of force over the wrist, this small scaphoid is clearly likely to be the weak link.

b. The vascularization of the scaphoideum - blood enters the scaphoid distally. Consequently, in the event of a fracture the proximal segment of the scaphoid will be devoid of a vascular supply, and will - if action is not taken - avascularly necrose within a sufferer's snuffbox.

2. DeQuervain’s tenosynovitis

DeQuervain's tenosynovitis is an inflammation of the fluid-filled sheath (called the synovium) that surrounds the tendons of the muscles mentioned above. Mostly, the extensor pollicis brevis and the abductor pollicis longus are the muscles affected in that case. The main reason for this inflammation is overuse syndromes. The main symptoms are pain, tenderness, and swelling over the thumb side of the wrist, and difficulty gripping. The Finkelstein's test may be positive.

3. Cheiralgia paresthetica

Cheiralgia paresthetica or Wartenberg's syndrome is the compression of the radial nerve along its course in the forearm. The area affected is typically on the back or side of the hand at the base of the thumb, near the anatomical snuffbox, but may extend up the back of the thumb and index finger and across the back of the hand. The most common cause is thought to be constriction of the wrist, as with a bracelet or watchband. Symptoms include numbness, tingling, burning or pain. Since the nerve branch is sensory there is no motor impairment.

There might be other injuries that can cause symptoms around the region as well like osteoarthritis, carpal instabilities, or cervical radiculopathy (C7-8). However, these were the 3 main problems that can appear and a Physical Therapist should at least be aware of in order to successfully assess a patient.

The bones of the carpus

Difficult to learn them, but it can become easy if you use these pictures:

Picture 1 (left) - view from below

Picture 2 (right) - view from below

A: Scaphoideum, B: Lunate, C: Triquetrum, D: Prisiform, E: Trapezium, F: Trapezoideum,

G: Capitatum, H: Hamatum

A file I have created with all the muscles of the upper limbs is here.