The Rule of Threes?

    Dr. F.L. Mitchell first described the "rule of threes" in 1979 to help clinicians landmark the transverse processes (TP's) of the thoracic vertebrae. The TP's are quite a deep structure and palpation can be difficult, so having a method to locate them is a valuable tool for any practitioner involved in physical medicine. Using the more easily palpable spinous processes (SP's) of the thoracic vertebrae, the rule of threes has been helping clinicians locate the TP's for many years but a pilot study from 2005 shows that the validity of that rule may not hold true.

    The "rule of threes" states that to find the TP's of the thoracic vertebrae (T1-T12), one can follow this system:

1.) T1-T3 have the palpable tip of the SP's in the same plane as their TP's.2.) T4-T6 have SP's that project slightly downward and the tip is in a plane halfway between their own TP's and the TP's of the vertebrae below it.3.) T7-T9 have SP's that project more downward and line up in the same plane of the TP's of the vertebrae below it.4.) T10-T12 have characteristics of the three previous groups. T10 is similar to T9 with the SP in line with the TP's of the vertebrae below it; T11 SP is halfway between it's own TP's and the TP's of the vertebrae below (T12); T12 SP is in the plane of it's own TP's.

Landmarks of the spine including the Rule of Threes in the thoracic spine

    As nice as it would be if our bodies appeared exactly as they did in textbooks, that just isn't the case. Anatomical variations are well known in the body (the sciatic nerve is a great example) and it appears that the TP's of thoracic vertebrae are similar in that their arrangement differs in person to person. The paper by Dr. Geelhoed and Patricia Brewer shows that thoracic vertebra can differ greatly in where their TP's and SP's line up from T1-T12. They used 5 cadavers in their experiment, each displaying different alignment of SP's to the successive TP's. Some appeared where you may think they should, but others were far off. If you didn't click on the link above, click here to look at the paper. There may be a few limitations to the study (only using 5 cadavers, the age and physical condition of cadavers before death may affect results as well, and I'm guessing the dissections were done with the cadaver laying prone instead of upright) but it is still interesting to see these results and remember how different each patient is. 
    And remember to swing by the updated Professional Health Systems website. Lots of great learning tools, resources and other materials for everyone.

Subway Rides for Squats

    This has been making the rounds on Facebook lately, so perhaps you've seen this but if not it is definitely worth checking out. In an effort to boost the country's morale and whip them into shape for the upcoming 2014 Sochi Winter Olympics, the Russian Olympic Committee installed ticket vending machines that accepted 30 squats instead of 30 rubles for one ticket. It's a great idea and maybe something Translink in Vancouver should consider before it launches the new Compass system... 30 squats for a ticket, yoga class for an all-day ticket, run a marathon for a month pass? Could be a hit around these parts. If not, maybe we could all start busting out some squats before hopping on the train anyways? Let me know if you're with me.

    Check out the video here!
   
    Have a great weekend everyone!

Something new (sort of...) to learn about the knee!

Hello everyone!
The semester came out swinging on these bloggers and before we knew it, two months had gone by without getting our first post up when we wanted it. Sorry about that, but going forwards into the end of 2013 and the start of 2014 we can keep you updated with what sort of fun stuff we're doing at Naturopathic Med school, tips to study and any other interesting articles in regards to anatomy, medicine and health.

    Hopefully everyone heard and got as excited about the anterolateral ligament (ALL) as me when this study was published by researchers in Belgium. However, turns out (as their abstract states) this structure had been observed as early as 1879 by Paul Segond, a surgeon from France. He described a 'pearly, resistant, fibrous band' at the anterolateral aspect of the knee, but it took until 2013 for these researchers to provide a full anatomical description.

    They found that in 40/41 (97%) of cadavers dissected, the ALL was 'a well-defined ligamentous structure, clearly distinguishable from the anterolateral joint capsule,' and that it ran from the lateral femoral epicondyle to the anterolateral tibia with firm insertions to the lateral meniscus along the way. 

Image of an exposed ALL. Taken from MedicalXpress.

    So what's important about this? Researchers believe that the ALL plays an important role in patients ACL tears. The Belgian doctors were finding that even after patients had reconstructive ACL surgery, they still experienced pivot shift episodes where the knee would give out and they would lose stability. Due to the common nature of these tears in athletes playing a wide variety of sports, fully understanding this ligament may allow doctors to treat patients with ACL tears more effectively in the future. 

If you're interested in reading more about this 're-discovery', make sure to check out the abstract at the top and take a read through this New York Times article. 

For more information on the knee and performing a proper knee exam, check out Pro Health System's website! 

The Importance of a Good Physical Exam

Another link for people to check out this week as we steadily progress through exams... I can see the light!
This clip may deal with the relationship between Radiology and the Emergency Room, but that is just one situation where a good clinical exam is so important. Having the skills to properly inspect a patient is something every physician requires or you might end up in a frustrating conversation like this... Let's just hope that one of you aren't the one with the IQ of french fries. Enjoy!

http://www.youtube.com/watch?v=Es1TtaVXO2I&feature=youtube_gdata_player

Fibrodysplasia Ossificans Progressiva

Hello there! Finals are upon us at Boucher and as such, everyone is in a bit of a time crunch. This week I'm linking you to an interesting article I read on The Atlantic which consistently has well-written articles on health, wellness and medicine. I found this one to be particularly fascinating as we were covering bone and bone development at the time in our Biomed class.

It's a little bit of a read, but well worth it. Click here to read about FOP and the girl who turned to bone. 

Osgood-Schlatter Disease

Having sore knees is both painful and frustrating whether you're a 75 year old out for a walk or a 12 year old sidelined at football practice. I was the latter- for a few summers, I was the husky youngster that over-exerted myself and wound up with Osgood-Schlatter disease. Luckily, mine was a very minor case and after football practice I recovered with adequate rest and ice. Others, however, may take weeks to months for recovery and could possibly deal with this issue well into adulthood.

What is it?

Osgood-Schlatter disease is characterized by:

• An enlargement of the tibial tuberosity, just below the patella, that is painful and tender
• Knee pain that worsens with activity- running, jumping, climbing etc- and improves with rest
• Tightness of the surrounding muscles, especially the thigh muscles

A typical image of someone suffering from Osgood-Schlatter disease
Source: http://louisvilleorthopedics.com/

How does it happen?

A nice side angle showing where the patellar
ligament pulls away from the tibial tubercle.
Source: http://www.laserhealthsolutions.com

Osgood-Schlatter disease happens by repeated stress on the tibia by the patellar ligament (also known as the patellar tendon), which is pulled by the quadriceps every time they are engaged. As the quads are used and pull on that tendon, it may pull away from the tibial tuberosity (or tubercle), resulting in the pain and swelling that is common with the disease. If the issue is not treated, it may progress far enough to be a full avulsion fracture. Overtime, the adolescent's bone may try to heal itself and close that gap with new bone growth- this is going to result in a bony lump at that spot. 

Contraction of the powerful quadricep muscles
will cause irritation of the patellar tendon and
tibial tuberosity.
Source: http://activerelease.ca/wordpress/

How to treat it

For most kids, R.I.C.E. (see our previous post to refresh your memory on dealing with inflammation) will do the trick. The period of rest will differ for each young athlete- in my case, I would usually need a few days between practices or games to feel ready to run again, others may take as long as 4 weeks. In mature patients, surgery does become an option if the skeleton is fully grown but the knees are still bothered by Osgood-Schlatters.

For more information on Osgood-Schlatter disease and many others, check out the Professional Health Conditions Manual.

Also, if you're looking to take your studying with you on the go,  download the new ProHealth App from the iTunes store FOR FREE until the end of the month! It's an easy to use and informative app that lets you take much of the Professional Health Muscle Manual with you on your iPhone or iPad. All you have to do is search "ProHealth" on iTunes to find it and you will be on your way with an excellent new tool to excel in your studies.

ProHealth App

Good evening everyone! Exciting news from Professional Health Systems. Our new app is up and running on iTunes for you to download, and make sure you do it soon as it is FREE until the end of the month. The app includes flash cards that will help you study or brush up on your anatomy wherever you are. If you're the type of person who suddenly has the urge to know which muscles help you chew or what the anconeus muscle does, then this app is for you.
If you download it and have any feedback at all, we would love to hear it! Get back at us on the blog with any comments you may have.