Essentials of Human Anatomy

1
NEED 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.
3
HOMOEOPATHY

• 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

4
EDUCATIONAL 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
5
EDUCATIONAL 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
6
EDUCATIONAL 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
7
BHMS 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
8
BHMS 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
9
BHMS 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
10
AIM 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
11
ANATOMY

• 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

12
ANATOMY 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.
13
ANATOMY 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)

14
ANATOMY 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.

15
ANATOMY 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.

16
WHY 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.

17
INTERNATIONAL 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.

18
INTERNATIONAL 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.

19
WHAT 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)
20
RELEVANCE 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.

21
RELEVANCE 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.

22
RELEVANCE 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.

23
CLINICAL 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.

24
CLINICAL 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
25
CLINICAL 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
26
CLINICAL 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.

27
MORBID 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.

28
MORBID 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- ...
29
SURGICAL 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?

30
APPROACHES 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.

31
APPROACHES TO STUDY OF ANATOMY

• Regional Anatomy
• All structures within a certain region are
  studied together, e.g. thoracic region, abdomen,
  head, neck, back, etc.

32
APPROACHES 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.

33
APPROACHES 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.

34
APPROACHES 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-
35
APPROACHES 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.

36
HISTORICAL OVERVIEW
37
Pre-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.

38
Palaentological 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.

39
Early 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.

40
Primitive 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
41
Medicine 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.
43
The 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.

45
The 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
                     
46
The 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
                     
47
Four 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
59
EXAMPLES FROM PRACTICE IN RELATION TO JOINTS AND
MUSCLES
60
Importance 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
61
DIAGNOSTIC IMPORTANCE
62
DIAGNOSTIC IMPORTANCE
63
IMPORTANCE 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.
64
IMPORTANCE 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.
65
IMPORTANCE 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.
66
IMPORTANCE 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.
67
IMPORTANCE 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.
68
IMPORTANCE 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
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Primary 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.

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PROGNOSTIC 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.

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PROGNOSTIC 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.

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IMPORTANCE 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.)

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IMPORTANCE 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.)

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IMPORTANCE 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.)

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PATHOLOGICAL 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.

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PATHOLOGICAL 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.

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PATHOLOGICAL 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.

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MEDICOLEGAL 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.
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MEDICOLEGAL 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.
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LEGAL 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.

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LEGAL 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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QUERIES?
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