Finite Element Analysis of Load Transition on Sacroiliac Joint During
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The Structure and Function of Breathing
CHAPTERCONTENTS The structure-function continuum 1 Multiple Influences: biomechanical, biochemical and psychological 1 The structure and Homeostasis and heterostasis 2 OBJECTIVE AND METHODS 4 function of breathing NORMAL BREATHING 5 Respiratory benefits 5 Leon Chaitow The upper airway 5 Dinah Bradley Thenose 5 The oropharynx 13 The larynx 13 Pathological states affecting the airways 13 Normal posture and other structural THE STRUCTURE-FUNCTION considerations 14 Further structural considerations 15 CONTINUUM Kapandji's model 16 Nowhere in the body is the axiom of structure Structural features of breathing 16 governing function more apparent than in its Lung volumes and capacities 19 relation to respiration. This is also a region in Fascla and resplrstory function 20 which prolonged modifications of function - Thoracic spine and ribs 21 Discs 22 such as the inappropriate breathing pattern dis- Structural features of the ribs 22 played during hyperventilation - inevitably intercostal musculature 23 induce structural changes, for example involving Structural features of the sternum 23 Posterior thorax 23 accessory breathing muscles as well as the tho- Palpation landmarks 23 racic articulations. Ultimately, the self-perpetuat- NEURAL REGULATION OF BREATHING 24 ing cycle of functional change creating structural Chemical control of breathing 25 modification leading to reinforced dysfunctional Voluntary control of breathing 25 tendencies can become complete, from The autonomic nervous system 26 whichever direction dysfunction arrives, for Sympathetic division 27 Parasympathetic division 27 example: structural adaptations can prevent NANC system 28 normal breathing function, and abnormal breath- THE MUSCLES OF RESPIRATION 30 ing function ensures continued structural adap- Additional soft tissue influences and tational stresses leading to decompensation. -
Sacrospinous Ligament Suspension and Uterosacral Ligament Suspension in the Treatment of Apical Prolapse
6 Review Article Page 1 of 6 Sacrospinous ligament suspension and uterosacral ligament suspension in the treatment of apical prolapse Toy G. Lee, Bekir Serdar Unlu Division of Urogynecology, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston, Texas, USA Contributions: (I) Conception and design: All authors; (II) Administrative support: All authors; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: All authors; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Toy G. Lee, MD. Division of Urogynecology, Department of Obstetrics and Gynecology, The University of Texas Medical Branch, 301 University Blvd, Galveston, Texas 77555, USA. Email: [email protected]. Abstract: In pelvic organ prolapse, anatomical defects may occur in either the anterior, posterior, or apical vaginal compartment. The apex must be evaluated correctly. Often, defects will occur in more the one compartment with apical defects contributing primarily to the descent of the anterior or posterior vaginal wall. If the vaginal apex, defined as either the cervix or vaginal cuff after total hysterectomy, is displaced downward, it is referred to as apical prolapse and must be addressed. Apical prolapse procedures may be performed via native tissue repair or with the use of mesh augmentation. Sacrospinous ligament suspension and uterosacral ligament suspension are common native tissue repairs, traditionally performed vaginally to re-support the apex. The uterosacral ligament suspension may also be performed laparoscopically. We review the pathophysiology, clinical presentation, evaluation, pre-operative considerations, surgical techniques, complications, and outcomes of these procedures. -
Vertebral Column and Thorax
Introduction to Human Osteology Chapter 4: Vertebral Column and Thorax Roberta Hall Kenneth Beals Holm Neumann Georg Neumann Gwyn Madden Revised in 1978, 1984, and 2008 The Vertebral Column and Thorax Sternum Manubrium – bone that is trapezoidal in shape, makes up the superior aspect of the sternum. Jugular notch – concave notches on either side of the superior aspect of the manubrium, for articulation with the clavicles. Corpus or body – flat, rectangular bone making up the major portion of the sternum. The lateral aspects contain the notches for the true ribs, called the costal notches. Xiphoid process – variably shaped bone found at the inferior aspect of the corpus. Process may fuse late in life to the corpus. Clavicle Sternal end – rounded end, articulates with manubrium. Acromial end – flat end, articulates with scapula. Conoid tuberosity – muscle attachment located on the inferior aspect of the shaft, pointing posteriorly. Ribs Scapulae Head Ventral surface Neck Dorsal surface Tubercle Spine Shaft Coracoid process Costal groove Acromion Glenoid fossa Axillary margin Medial angle Vertebral margin Manubrium. Left anterior aspect, right posterior aspect. Sternum and Xyphoid Process. Left anterior aspect, right posterior aspect. Clavicle. Left side. Top superior and bottom inferior. First Rib. Left superior and right inferior. Second Rib. Left inferior and right superior. Typical Rib. Left inferior and right superior. Eleventh Rib. Left posterior view and left superior view. Twelfth Rib. Top shows anterior view and bottom shows posterior view. Scapula. Left side. Top anterior and bottom posterior. Scapula. Top lateral and bottom superior. Clavicle Sternum Scapula Ribs Vertebrae Body - Development of the vertebrae can be used in aging of individuals. -
Peripartum Pubic Symphysis Diastasis—Practical Guidelines
Journal of Clinical Medicine Review Peripartum Pubic Symphysis Diastasis—Practical Guidelines Artur Stolarczyk , Piotr St˛epi´nski* , Łukasz Sasinowski, Tomasz Czarnocki, Michał D˛ebi´nski and Bartosz Maci ˛ag Department of Orthopedics and Rehabilitation, Medical University of Warsaw, 02-091 Warsaw, Poland; [email protected] (A.S.); [email protected] (Ł.S.); [email protected] (T.C.); [email protected] (M.D.); [email protected] (B.M.) * Correspondence: [email protected] Abstract: Optimal development of a fetus is made possible due to a lot of adaptive changes in the woman’s body. Some of the most important modifications occur in the musculoskeletal system. At the time of childbirth, natural widening of the pubic symphysis and the sacroiliac joints occur. Those changes are often reversible after childbirth. Peripartum pubic symphysis separation is a relatively rare disease and there is no homogeneous approach to treatment. The paper presents the current standards of diagnosis and treatment of pubic diastasis based on orthopedic and gynecological indications. Keywords: pubic symphysis separation; pubic symphysis diastasis; pubic symphysis; pregnancy; PSD 1. Introduction The proper development of a fetus is made possible due to numerous adaptive Citation: Stolarczyk, A.; St˛epi´nski,P.; changes in women’s bodies, including such complicated systems as: endocrine, nervous Sasinowski, Ł.; Czarnocki, T.; and musculoskeletal. With regard to the latter, those changes can be observed particularly D˛ebi´nski,M.; Maci ˛ag,B. Peripartum Pubic Symphysis Diastasis—Practical in osteoarticular and musculo-ligamento-fascial structures. Almost all of those changes Guidelines. J. Clin. Med. -
Pelvic Anatomyanatomy
PelvicPelvic AnatomyAnatomy RobertRobert E.E. Gutman,Gutman, MDMD ObjectivesObjectives UnderstandUnderstand pelvicpelvic anatomyanatomy Organs and structures of the female pelvis Vascular Supply Neurologic supply Pelvic and retroperitoneal contents and spaces Bony structures Connective tissue (fascia, ligaments) Pelvic floor and abdominal musculature DescribeDescribe functionalfunctional anatomyanatomy andand relevantrelevant pathophysiologypathophysiology Pelvic support Urinary continence Fecal continence AbdominalAbdominal WallWall RectusRectus FasciaFascia LayersLayers WhatWhat areare thethe layerslayers ofof thethe rectusrectus fasciafascia AboveAbove thethe arcuatearcuate line?line? BelowBelow thethe arcuatearcuate line?line? MedianMedial umbilicalumbilical fold Lateralligaments umbilical & folds folds BonyBony AnatomyAnatomy andand LigamentsLigaments BonyBony PelvisPelvis TheThe bonybony pelvispelvis isis comprisedcomprised ofof 22 innominateinnominate bones,bones, thethe sacrum,sacrum, andand thethe coccyx.coccyx. WhatWhat 33 piecespieces fusefuse toto makemake thethe InnominateInnominate bone?bone? PubisPubis IschiumIschium IliumIlium ClinicalClinical PelvimetryPelvimetry WhichWhich measurementsmeasurements thatthat cancan bebe mademade onon exam?exam? InletInlet DiagonalDiagonal ConjugateConjugate MidplaneMidplane InterspinousInterspinous diameterdiameter OutletOutlet TransverseTransverse diameterdiameter ((intertuberousintertuberous)) andand APAP diameterdiameter ((symphysissymphysis toto coccyx)coccyx) -
The Influence of the Rib Cage on the Static and Dynamic Stability
www.nature.com/scientificreports OPEN The infuence of the rib cage on the static and dynamic stability responses of the scoliotic spine Shaowei Jia1,2, Liying Lin3, Hufei Yang2, Jie Fan2, Shunxin Zhang2 & Li Han3* The thoracic cage plays an important role in maintaining the stability of the thoracolumbar spine. In this study, the infuence of a rib cage on static and dynamic responses in normal and scoliotic spines was investigated. Four spinal fnite element (FE) models (T1–S), representing a normal spine with rib cage (N1), normal spine without rib cage (N2), a scoliotic spine with rib cage (S1) and a scoliotic spine without rib cage (S2), were established based on computed tomography (CT) images, and static, modal, and steady-state analyses were conducted. In S2, the Von Mises stress (VMS) was clearly decreased compared to S1 for four bending loadings. N2 and N1 showed a similar VMS to each other, and there was a signifcant increase in axial compression in N2 and S2 compared to N1 and S1, respectively. The U magnitude values of N2 and S2 were higher than in N1 and S1 for fve loadings, respectively. The resonant frequencies of N2 and S2 were lower than those in N1 and S1, respectively. In steady-state analysis, maximum amplitudes of vibration for N2 and S2 were signifcantly larger than N1 and S1, respectively. This study has revealed that the rib cage improves spinal stability in vibrating environments and contributes to stability in scoliotic spines under static and dynamic loadings. Scoliosis, a three-dimensional deformity, prevents healthy development. -
Lower Back Pain and the Sacroiliac Joint What Is the Sacroiliac Joint?
PATIENT INFORMATION Lower Back Pain and the Sacroiliac Joint What is the Sacroiliac Joint? Your Sacroiliac (SI) joint is formed by the connection of the sacrum and iliac bones. These two large bones are part of the pelvis Sacroiliac and are held together by a collection of joint ligaments. The SI joint supports the weight of your upper body which places a large amount of stress across your SI joint. What is Sacroiliac Joint Disorder? The SI joint is a documented source of lower back pain. The joint is the most likely source of pain in 30% of patients with lower back pain. Pain caused by sacroiliac joint disorder can be felt in the lower back, buttocks, or legs. Sacroiliac joint fixation is indicated in patients with severe, chronic sacroiliac joint pain who have failed extensive conservative measures, or in acute cases of trauma. What are potential symptoms? • Lower back pain • Lower extremity pain (numbness, tingling, weakness) • Pelvis/buttock pain • Hip/groin pain • Unilateral leg instability (buckling, giving away) • Disturbed sleep patterns • Disturbed sitting patterns (unable to sit for long periods of time on one side) • Pain going away from sitting to standing How is Sacroiliac Joint Disorder diagnosed? Sacroiliac joint disorder is diagnosed by the patient’s history, physical findings, radiological investigations and SI joint injections. Sacroiliac injection, which is the gold standard for confirming SI joint disorder will be delivered with fluoroscopic or CT guidance to validate accurate placement of the needle in the SI joint. What is the Orthofix SambaScrew®? Your surgeon has chosen the SambaScrew because it utilizes a minimally invasive surgical technique to sacroiliac fixation. -
Trans-Obturator Cable Fixation of Open Book Pelvic Injuries
www.nature.com/scientificreports OPEN Trans‑obturator cable fxation of open book pelvic injuries Martin C. Jordan 1*, Veronika Jäckle1, Sebastian Scheidt2, Fabian Gilbert3, Stefanie Hölscher‑Doht1, Süleyman Ergün4, Rainer H. Mefert1 & Timo M. Heintel1 Operative treatment of ruptured pubic symphysis by plating is often accompanied by complications. Trans‑obturator cable fxation might be a more reliable technique; however, have not yet been tested for stabilization of ruptured pubic symphysis. This study compares symphyseal trans‑obturator cable fxation versus plating through biomechanical testing and evaluates safety in a cadaver experiment. APC type II injuries were generated in synthetic pelvic models and subsequently separated into three diferent groups. The anterior pelvic ring was fxed using a four‑hole steel plate in Group A, a stainless steel cable in Group B, and a titan band in Group C. Biomechanical testing was conducted by a single‑ leg‑stance model using a material testing machine under physiological load levels. A cadaver study was carried out to analyze the trans‑obturator surgical approach. Peak‑to‑peak displacement, total displacement, plastic deformation and stifness revealed a tendency for higher stability for trans‑ obturator cable/band fxation but no statistical diference to plating was detected. The cadaver study revealed a safe zone for cable passage with sufcient distance to the obturator canal. Trans‑ obturator cable fxation has the potential to become an alternative for symphyseal fxation with less complications. Disruption of the pubic symphysis is commonly seen in pelvic ring injuries of trauma patients 1,2. Te disrup- tion of the anterior pelvic ring might occur in combination with a posterior pelvic ring impairment of variable severity. -
Yoga for the Sacroiliac Joint (PDF)
Yoga for the Sacroiliac Joint Exploring Anatomy and Healthy Movement Patterns Jenny Loftus (she/her) RN, BSN, LMT, E-RYT 500, YACEP www.jennyloftus.com Anatomy of the SI Joint ● The SI joint is a very stable joint between the sacrum and the ilium of the pelvis held together by many ligaments. ● The articulating surfaces of the SI joint are rough and cratered, meant for stickiness, not glide. ● The joint should not have much movement, generally our focus in practice should be on stabilization, not mobilization. ● Significant weight bearing joint, transmits force from ground,legs and pelvis and supports weight from spine and structures above. Ligaments Supporting the SI joint ● Ligaments connect bone to bone, for SI joint, sacrum to pelvis (ilium) ● Ligaments are hypovascular and therefore do not heal well ● Sacroiliac Ligament: connects the sacrum to the ilium ● Sacrotuberous Ligament: connects the sacrum to the ilium and the ischium ● Sacrospinous Ligament: connects the sacrum to the spine of the ilium ● Iliolumbar ligament: Connects the Lumbar Spine to the Ilium Regional Muscles to Stabilize SI joint ● Piriformis~ stabilizes SI joint, crosses the SI joint and the hip joint, abduction, ext. rotation (int. rotation with hip flexion) only “deep 6 lateral rotator” to connect to the sacrum, creates force closure of SI joint ● Psoas~ contributes to force closure of SI joint, walking dance with piriformis ● Multifidus~ nutation of sacrum ● Pelvic Floor muscles~ counternutation of sacrum ● Quadratus Lumborum ● Transverse Abdominus ● Adductors/Abductors -
International Journal of Musculoskeletal Disorders
International Journal of Musculoskeletal Disorders Mahmood S, et al. Int J Musculoskelet Disord: IJMD-109. Review Article DOI: 10.29011/ IJMD-109. 000009 Coccydynia: A Literature Review of Its Anatomy, Etiology, Presen- tation, Diagnosis, and Treatment Shazil Mahmood, Nabil Ebraheim, Jacob Stirton, Aaran Varatharajan* Department of Orthopedic Surgery, University of Toledo College of Medicine, Toledo, USA *Corresponding author: Aaran Varatharajan, Department of Orthopedic Surgery, University of Toledo College of Medicine, To- ledo, USA. Tel: +12482280958; Email: [email protected] Citation: Mahmood S, Ebraheim N, Stirton J, Varatharajan A (2018) Coccydynia: A Literature Review of Its Anatomy, Etiology, Presentation, Diagnosis, and Treatment. Int J Musculoskelet Disord: IJMD-109. DOI: 10.29011/ IJMD-109. 000009 Received Date: 31 July, 2018; Accepted Date: 06 August, 2018; Published Date: 15 August, 2018 Abstract Purpose: This literature review is intended to provide oversight on the anatomy, incidence, etiology, presentation, diagnosis, and treatment of coccydynia. Relevant articles were retrieved with PubMed using keywords such as “coccydynia”, “coccyx”, “coccyx pain”, and “coccygectomy”. Methods: Literature accumulated for this study was accumulated from PubMed using sources dating back to 1859. All sources were read thoroughly, compared, and combined to form this study. Images were also added from three separate sources to aid in the understanding of the coccyx and coccydynia. Focal points of this study included the anatomy of the coccyx, etiology and presentation of coccydynia, how to properly diagnose coccydynia, and possible treatments for the variety of etiologies. Results: The coccyx morphology is defined using different methods by different authors as presented in this study. There is no conclusive quantitative data on the incidence of coccydynia; however, there are important factors that lead to increased risk of coccydynia such as obesity, age, and female gender. -
Parts of the Body 1) Head – Caput, Capitus 2) Skull- Cranium Cephalic- Toward the Skull Caudal- Toward the Tail Rostral- Toward the Nose 3) Collum (Pl
BIO 3330 Advanced Human Cadaver Anatomy Instructor: Dr. Jeff Simpson Department of Biology Metropolitan State College of Denver 1 PARTS OF THE BODY 1) HEAD – CAPUT, CAPITUS 2) SKULL- CRANIUM CEPHALIC- TOWARD THE SKULL CAUDAL- TOWARD THE TAIL ROSTRAL- TOWARD THE NOSE 3) COLLUM (PL. COLLI), CERVIX 4) TRUNK- THORAX, CHEST 5) ABDOMEN- AREA BETWEEN THE DIAPHRAGM AND THE HIP BONES 6) PELVIS- AREA BETWEEN OS COXAS EXTREMITIES -UPPER 1) SHOULDER GIRDLE - SCAPULA, CLAVICLE 2) BRACHIUM - ARM 3) ANTEBRACHIUM -FOREARM 4) CUBITAL FOSSA 6) METACARPALS 7) PHALANGES 2 Lower Extremities Pelvis Os Coxae (2) Inominant Bones Sacrum Coccyx Terms of Position and Direction Anatomical Position Body Erect, head, eyes and toes facing forward. Limbs at side, palms facing forward Anterior-ventral Posterior-dorsal Superficial Deep Internal/external Vertical & horizontal- refer to the body in the standing position Lateral/ medial Superior/inferior Ipsilateral Contralateral Planes of the Body Median-cuts the body into left and right halves Sagittal- parallel to median Frontal (Coronal)- divides the body into front and back halves 3 Horizontal(transverse)- cuts the body into upper and lower portions Positions of the Body Proximal Distal Limbs Radial Ulnar Tibial Fibular Foot Dorsum Plantar Hallicus HAND Dorsum- back of hand Palmar (volar)- palm side Pollicus Index finger Middle finger Ring finger Pinky finger TERMS OF MOVEMENT 1) FLEXION: DECREASE ANGLE BETWEEN TWO BONES OF A JOINT 2) EXTENSION: INCREASE ANGLE BETWEEN TWO BONES OF A JOINT 3) ADDUCTION: TOWARDS MIDLINE -
Vertebral Column
Vertebral Column • Backbone consists of Cervical 26 vertebrae. • Five vertebral regions – Cervical vertebrae (7) Thoracic in the neck. – Thoracic vertebrae (12) in the thorax. – Lumbar vertebrae (5) in the lower back. Lumbar – Sacrum (5, fused). – Coccyx (4, fused). Sacrum Coccyx Scoliosis Lordosis Kyphosis Atlas (C1) Posterior tubercle Vertebral foramen Tubercle for transverse ligament Superior articular facet Transverse Transverse process foramen Facet for dens Anterior tubercle • Atlas- ring of bone, superior facets for occipital condyles. – Nodding movement signifies “yes”. Axis (C2) Spinous process Lamina Vertebral foramen Transverse foramen Transverse process Superior articular facet Odontoid process (dens) •Axis- dens or odontoid process is body of atlas. – Pivotal movement signifies “no”. Typical Cervical Vertebra (C3-C7) • Smaller bodies • Larger spinal canal • Transverse processes –Shorter – Transverse foramen for vertebral artery • Spinous processes of C2 to C6 often bifid • 1st and 2nd cervical vertebrae are unique – Atlas & axis Typical Cervical Vertebra Spinous process (bifid) Lamina Vertebral foramen Inferior articular process Superior articular process Transverse foramen Pedicle Transverse process Body Thoracic Vertebrae (T1-T12) • Larger and stronger bodies • Longer transverse & spinous processes • Demifacets on body for head of rib • Facets on transverse processes (T1-T10) for tubercle of rib Thoracic Vertebra- superior view Spinous process Transverse process Facet for tubercle of rib Lamina Superior articular process