Dynamic Motion X-ray

Dynamic Motion X-Ray (DMX) Imaging Visualises Spinal Movement


“The Digital Motion X-Ray (DMX) imaging at the American private spinal surgery company ‘NeuroSpine Institute‘ is being used to identify injuries from a car accident or disc injury often missed by traditional X-rays and MRIs. The doctor can access diagnostic information in minutes instead of hours or days.”

N.B. C2/3 and L sidebending /rotation restriction? Also, interesting to see the stability of the C1/2 segment during movement in the intra-oral section, and how the upper cervical segments do most of the work of rotation, as expected.

….I bet they don’t have one at the local hospital though 🙁

 

REFERENCES

Neuro Spine Institute http://www.neurospineinstitute.org/

Stillness

‘Poetry in Water’ – ‘Hybrid’ CST Video

Although we don’t talk about CST very often, this film is well worth watching.

The practitioner in this short film, Steve Karle, says he is synthesising Biodynamic Craniosacral Therapy with a number of other approaches, including Alexander Technique and elements of dance ‘based on on alignment, precision and neutrality’.

Watching the film, I found myself fascinated with the therapeutic relationship encapsulated in the moment, and the obvious journey and quietness that the woman experienced.

However, from an osteopathic point of view, I was also wondering about how to create a fulcrum and maintain boundaries in such a weightless, dynamic environment: it would be a whole new skill.

 

REFERENCES

‘Stillness’ Vimeo.com – Steve Karle

Dural Venous Sinuses

The RTM and Venous Sinuses

Dr. Robert Acland narrates a video illustrating the anatomy of the dural venous sinuses, and the related neurological and osteological structures. Particularly interesting to see the Cavernous Sinus in coronal cross-section at 5:40.

 

REFERENCES

Dr. Robert Acland, ‘Acland’s Video Atlas of Human Anatomy Neuroanatomy’ YouTube standard license https://aclandanatomy.com/

The TMJ

TMJ Anatomy And Function

I see a lot of patients with varying grades of TMJ dysfunction – from vague aching following dental intervention or bite change, to disc disorders in the joint and associated complexes of muscle tightness and pain with wider musculoskeletal consequences.

The TMJ joint demonstrates a two-phase mechanical movement during opening, mainly consisting of hinging then sliding/hinging movements of the mandibular condyle in the glenoid fossa of the temporal bone. In cases of dysfunction, the articular disc often becomes displaced and degenerated, so that a common presentation is TMJ clicking and even locking.

This video presents moving dissections of the joint, demonstrating normal function, opening and closing, medial and lateral disc displacements and posterior disc ligament ruptures. If you excuse the *slightly* dated music at the beginning and end of the film, it is a very clear demonstration of the anatomy of TMJ disorder.

0:38 – The Anatomy of the Joint

2:46 – The Normal TMJ Joint

3:30 – The Biconcave Disc – showing small central perforation

5:08 – Anterior Disc Displacement – clicking on closing AND opening

6:15 – Anteromedial Disc Displacement – showing biplanar disc and medial/lateral movement of the disc

7:30 – Medial Disc Displacement

8:25 – Anterior Disc displacement – disc consistently anterior to the condyle

9:25 – Degenerative Joint – large perforation

 

 

REFERENCES:

YouTube – TMJ Anatomy – Standard YouTube License

Sagittal section of the articulation of the mandible – Wikimedia Commons License

The Rhoton Collection - The Anterior Skull Base

The Rhoton Collection – State-Of-The-Art Dissection

The renowned neurosurgeon, Albert J. Rhoton Jnr M.D. presents this incredible series of dissections of the anterior skull base. Intended for use as revision for neurosurgeons involved with learning an endoscopic approach, the anatomy presented here helps to illustrate the relationship between these structures and shows just how closely-packed the cranial contents are.

Anatomy As You’ve Never Seen It Before…

For those who have an interest in being able to visualise the anatomy they are working on, these slides are invaluable. As Dr. Rhoton says, we need to develop “see through x-ray vision”.

Of particular interest to osteopaths in this video, at 16mins 25 secs there begins a detailed run-through of the osteology of the anterior neurocranium, including the bony sinuses.

This video – The Anterior Skull Base – is part of a playlist of 14 comprehensive presentations covering all parts of the skull and brain – check the ‘Playlist’ on the top left of this video window or click here for the full collection on YouTube. Again, the quality can be switched up to 720p for high quality viewing by clicking the ‘cog’ icon at the bottom-right of the player window.

The Anterior Skull Base – Part 1

 

REFERENCES

‘The Anterior Skull Base’ – Part of the Rhoton Collection (2D) – YouTube

Treatment Is Simple

Osteopathic Thought For The Day – Treatment Is Simple

If you understand the mechanism, the treatment is simple
Cranial Foramen

Cranial Foraminae And Their Contents – HD Anatomy

An understanding of the anatomy of the skull is essential when working with the cranial mechanism. Learning the skull foraminae and their contents provides a particular challenge, but is also absolutely fundamental in this approach.

It has been said that the most effective way to learn this is to sit down in front of a skull specimen with a copy of Gray’s in one hand, and a glass of wine in the other (!)

However, the video above, clearly demonstrates the various foramen of the skull, and playback can be viewed in high resolution, (after pressing play click on the cog icon on the bar at the bottom and choose the quality from the list).

Once again, this is only an introduction to cranial anatomy relevant to osteopathic practice, and much more detail is available on our upcoming (July) 5-day course:

 

REFERENCES

YouTube – “The Skull Bones – Cranial Foraminae And Contents” RobbieGVT

Featured Image‘Skull and brainstem inner ear.svg’ Patrick J. Lynch, medical illustrator – Creative Commons License 2.5

The Sphenoid from Gray's Anatomy

The Sphenoid Bone – Quick Anatomy

While learning skull osteology, students often have trouble in orientating the sphenoid in relation to the other bones of the neurocranium and viscerocranium, and learning its many foraminae and features. This is perfectly understandable, as the sphenoid is an anatomically complex bone that fulfils many roles – housing the pituitary, forming part of the orbit, allowing many traversing nerves etc.

The junction with the occiput at the spheno-basilar symphysis particularly causes problems, (a common mistake is to place the basilar part of the occiput against the dorsum sellae) as well as the harmonic articulation of the pterygoid processes in the groove-like bone of the perpendicular plate of the palatine (part of the ‘speed reducers’ system as Sutherland called them).

The video above goes some way to helping us to visualise the sphenoid in situ. Labelled parts of the sphenoid are seen from 1min 33secs onwards, but for those that wish to enjoy guided tutorials on the osteology of the skull, you might like to consider taking part in our upcoming 5-day course in July (shameless plug!)

 

 

REFERENCES:

Video – YouTube: ‘Bone around Sphenoid bone’

‘Sphenoid’ Image – lithograph plate from Gray’s Anatomy – public domain – http://commons.wikimedia.org/wiki/File:Gray145.png

 

Fear - light at the end of the tunnel

The Vagus Nerve – Anxiety, Un-learning Fear and PTSD

The vagus nerve has multiple branches that innervate many of our organs, including the heart, lungs and stomach, and much more. However, a new Swiss study by Melanie Klarer et al published in May this year in the Journal of Neuroscience, has shown how afferent vagus pathways are able to modulate our fear and anxiety response, and also affect our ability to ‘un-learn’ previously conditioned fear responses.

Around 80% or more of the vagus nerve fibres are dedicated to sending signals to the brain about the state of the viscera and it is known that healthy vagus nerve communication from gut to brain helps to slow down the fear response, by using neurotransmitters such as acetylcholine and GABA – lowering heart rate and blood pressure and encouraging the parasympathetic response of ‘rest and digest’.

So, for this study, the team at ETH Zurich dissected these afferent nerve fibres to the stomach, to study how interrupting this feedback loop might affect brain and cognitive function.

The researchers were especially interested in the link between innate anxiety and ‘learned’ or ‘conditioned’ fear – in the tests the brain was still able to send signals to the stomach but the brain could not ‘hear’ the stomach’s vagal response.

In anxiety-behaviour experiments, rats without vagal feedback from the gut demonstrated two main findings – a reduced innate fear (e.g. to bright lights, open spaces etc) but also a longer retention of previously learned fears. This confirms the importance of healthy vagal tone to overcome fear conditioning.

Furthermore, the loss of the gut vagus signal altered the production of adrenaline and GABA in the brain, meaning that the rats took much longer to re-associate sounds previously associated with a negative stimulus with a new ‘safe’ or neutral situation.

The Implications for PTSD

Hence these new findings may eventually shine a light on developing new treatments for PTSD (post-traumatic stress disorder) – stimulation or normalisation of the vagus nerve may help people to reassociate non-threatening stimuli which became traumatically associated with triggering fear/anxiety, with a new neutral or non-traumatic experience/response. Vagus nerve stimulation (VNS) is currently used to treat epilepsy and depression, but its efficacy remains controversial.

In a press release Urs Meyer stated:

“We were able to show for the first time that the selective interruption of the signal path from the stomach to the brain changed complex behavioural patterns. This has traditionally been attributed to the brain alone. The study shows clearly that the stomach also has a say in how we respond to fear; however, what it says, i.e. precisely what it signals, is not yet clear.”

This short video from 2011 also discusses the possible use of VNS for patients with PTSD:

 

Read here, from half way down the page ‘Activating the Vagus Nerve Without Machinery‘ for a quick run-down of some ways to improve vagus function or to stimulate the vagus pathway:
Insightful Nutrition – Orthomolecular Health and Nutrition – ‘Activating the Vagus Pathway’

REFERENCES

1. Klarer, M. et al. Gut Vagal Afferents Differentially Modulate Innate Anxiety and Learned Fear. J. Neurosci. 34 , 7067–7076 (2014).

Brain in a drop of water

Brain Anatomy 101

Grab a cup of coffee, and in just under 20 minutes you will have completed a basic primer in brain anatomy, provided by these two videos from Anatomy Zone on YouTube.

Once you’re done, you can test yourself at this site run by the University of Utah (part of the Visible Human Project), which challenges you with a labelled dissections quiz.

Basic Parts of the Brain – Part 1

Basic Parts of the Brain – Part 2

 

REFERENCES:

Videos by Anatomy Zone on YouTube

Leaf-Brain photo by Vancanjay on freeimages.com