Let the learning begin…

If you have been following my blog you will be aware that over the past five years I have been studying for a bachelors (hons) degree in osteopathic medicine. I am very pleased to announce that this has finally come to an end and my qualification will be awarded this summer.

It has been a hard but very enlightening five years where I have learned so much about my own health, both mental and physical. This has caused me to adopt new attitudes towards maintaining both and I hope to be able to pass on what I have learned to my future patients in order to help them take control of their own well-being.

Currently I am working under supervision with a very good friend of mine at Streatham Osteopaths, South London. The clinic is an integrated health clinic with various styles of Osteopathy as well as Chinese medical practitioners, Hypnotherapists, Psychologists and Massage Therapists. I feel honoured to be given the chance of being part of something like this and would highly recommend the service provided by these professionals.

If you are one of my followers or happen to be in the London area of a weekend, get in touch to book an appointment with us!

 

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orthopedic tests

Rather than listing and describing regional orthopedic tests, I’d like to share a few videos I found. The anatomy and test are well described so I found them easy to follow. I hope these help you the way they have helped me. Corrections are welcome!

**NB the thomas test displayed is done incorrectly. Patient should be supine with both knees and hips flexed initially, extending one leg to test. The shown test can give false positive results**

Obstetric Disorders

Condition Signs/symptoms Risk factors Diagnosis Complications
Pre-eclampsia

 

Severe headaches

Visual disturbances

Upper abdominal pain

Dyspnoea

Reduced urination

Nausea/vomiting

Proteinuria

Other kidney symptoms

Reduced blood platelets

 

 

Age < 40 years

Multiple pregnancy

First pregnancy

History of preeclampsia

Obesity

History of hypertension

History of migraines

Diabetes type 1 or 2

Kidney diseases

Lupus

Blood tests

Urine analysis

Foetal ultrasound

Nonstress test

Reduced blood flow to the placenta

Placental abruption

HELLP syndrome

Eclampsia

Cardiovascular disease

 

Gestational

diabetes

Dry mouth

Increased thirst

Polyuria

Nocturia

Recurrent infections

Blurred vision

Tiredness

Age > 25

Family history

Obesity

Nonwhite race

Glucose challenge tests

 

Hypertension

Pre-eclampsia

Future diabetes

————————

Excessive birth weight

Pre-term birth

Respiratory distress syndrome

Hypoglycaemia

Anaemia Pale skin, lips and nails

Tiredness

Weakness

Dyspnoea

Rapid heart beat

Trouble concentrating

Multiple pregnancy

Excessive vomiting

Teenager

Previous anaemia

Lack of consumption

Haemoglobin test

Haematocrit test

Pre-term birth

Low birth weight

Anaemic baby

Developmental delays

Postpartum depression

Hyperemesis gravidarum Vomiting > 4 daily

Constant nausea

Loss of 5% body weight

Low blood pressure

Dizziness

Dehydration

Constipation

Ketoacidosis

Thrytotoxicosis

Nutritional deficiency

 

Family history

Previous HG

Multiple pregnancy

Obesity

Premigravida

Blood pressure check

Blood and urine hydration tests

Further tests to rule out gastrointestinal cause

Intravenous fluids

Anti-nausea drugs

Ectopic pregnancy Increased human chorionic gonadotropin

Vaginal bleeding

Acute, severe abdominopelvic pain

 

Pelvic Inflammatory disease (PID)

Intrauterine device (IUD)

Endometriosis

Previous EP

Smoking

Tubal ligation

Transvaginal Ultrasound

Laparoscopy

Rupture

Hypovolemic shock

Death

 

Female Gynaecology Red Flags

Symptom Causes
Menorrhagia Uterine Fibroids

Uterine polyps

Pelvic inflammatory disease

Adenomyosis

Intrauterine Device (IUD)

Anti-coagulant medications

Anti-inflammatory medications

Miscarriage
Uterine Cancer

Amenorrhea Pregnancy

Breast feeding

Menopause
Contraceptives
Polycystic ovary syndrome
Uterine scarring
Hyper/hypothyroidism

Stress
Pituitary tumour

Irregular menses Stress

Polycystic ovary syndrome

Endometriosis

PID
Birth control pills

Intermenstrual bleeding Recent contraceptive change < 3/12

– IUD

– Birth control pill
– Implant
– Injection
– Patch

Miscarriage

Ectopic pregnancy

Uterine fibroids

PID

Foreign object

Cervical/Uterine Cancer

Post coital bleeding Infections

Cervical ectropion

Cervical/uterine polyps

Trauma

Vagina/cervical cancer

Dyspareunia Trauma

PID

Vaginismus (spasm)

Congenital abnormality

Endometriosis

Uterine prolapse

Ovarian cysts

Fibroids

Retroverted uterus

Uterine cancer

Postmenopausal bleeding Uterine polyps

Endometrial atrophy (thinning of inner layer)

Endometrial hyperplasia (thickening)

Endometrial cancer

Maternal changes during pregnancy

Trimester Structural Endocrine Systemic
First (1/52 – 12/52) Reduced lordosis

Posterior rotation of pelvis

Breast growth

Larger areolae

Uterus growth

Weight gain

Oestrogen

Myometrium thickening

Blood vessel growth

Milk duct development

Ligament laxity

Progesterone (Corpus luteum)

Decidualisation of endometrium

Mature endometrium to secretory

Myomterial contraction inhibition

Breast tissue preparation

Relaxin (Corpus luteum & decidua)

Decidualisation of endometrium

Ligament laxity

Human chorionic gonadotropin (hCG)

(Placenta)

Maintains corpus luteum, peaks 10/52

Increased cardiac output (50%)

Reduced peristalsis (progesterone)

Constipation (uterus growth, reduced peristalsis)

Polyuria (uterus growth)

Morning sickness.

Second (13/52 – 28/52) Expanding waistline

Mild anterior rotation of pelvis

Increased lordosis

Weight gain (back ache, see above)

Ligaments stretch to support the uterus (pelvic/abdominal ache)

Uterus to the height of naval

Visible bump at end of trimester.

HCG levels out

Progesterone and oestrogen gradually increase

Constipation (uterus growth)

Polyuria (uterus growth)

Bladder/kidney infection (uterus growth)

Heartburn

Gum bleeding (increased blood to mucous membranes)

Nasal congestion and nosebleeds (increased blood to mucous membranes)

Dizziness (vasodilation, lower blood pressure)

Third (29/52 – 40/52) Umbilicus protrudes

Weight gain

Back ache (hyperlordosis)

Ligament laxity (relaxin, weight)

Symphysis pubis dysfunction (SPD)

Progesterone and oestrogen at highest level Constipation (uterus growth)

Polyuria (uterus growth)

Kidney/bladder infection (uterus growth)

Braxton hicks (contractions)

Anaemia

Oedema (poor venous return)

Blood pressure increase – 140/90 (pre-eclampsia)

Heart rate increase (80-90 bpm)

Gestational Diabetes

Heartburn (cavity pressure)

Dyspnoea (cavity pressure)

Foetal development

Trimester Weeks Structures Sensory Motor
First 01/12/16 Placenta 3/52

Heart 4/52

Brain 4/52

Spinal cord 4/52

Olfactory nerve 7/52

Semicircular canals 8/52

Limbs and digits 8/52

Major organs 8/52

Sex organs 8/52

Olfactory bulb 8-9/52

Cochlear 10/52

Taste and smell (olfactory)

Hearing (cochlear)

Sight (rods and cones)

Sensation:

touch

pain

temperature

proprioception

Neurological and musculoskeletal coordination (closed fist)
Second 13-28 Muscle and bone

Skin

Taste buds

Eyebrows and lashes

Finger/toe nails

Hair on head

Lanugo (fine hair covering body)

Vernix (waxy protective skin covering)

Hearing Swallowing

‘Fluttering’/’quickening’

Sucking reflex

Startle reflex

Third 29-40 Rapid weight gain

Loss of lanugo (fine hair)

Thickening vernix

Bones fully formed

Stress:

Increased cortisol and adrenaline of the mother pre sets baby at a higher level.

– anxious

– clingy

– colicky

Forecful kicks

Regular breathing movements

Ascending Spinal tracts

Tract Functions Path Decussation Tests
Dorsal Columns:

Fasciculus Cuneatus (UEX)

Fasciculus Gracilic (LEX)

Fine touch

Discriminatory touch

Proprioception

Cuneatus:

Fibres from UEX enter at upper thoracic and cervical levels.

Gracilis

Fibres from LEX enter at lower thoracic,lumbar and sacral levels.

Both:

Travel between dorsal median sulcus and horn.Terminate at corresponding nuclei at medulla oblongata.

Medulla Oblongata 2 point discrimination

Joint position

Spinothalamic Pain

Temperature

Pressure

Coarse touch

Fibres ascend in ventral half of lateral funinculus.

Terminates at the thalamus.

Ventral white commisure Neuotips

Cold tuning fork

Spinocerebellar Muscle and joint receptors to cerebellum Cell bodies originate from base of dorsal horn. Fibres pass through dorsolateral and ventrolateral spina cord.
Terminates at the cerebellar cortex.
Ventral:
Anterior white commisure

Dorsal:

No decussation

Joint position test

Finger to nose

Heel to shin