Outcomes - COMPAS

Modules

Year GEP 1 GEP/M&P: Movement and Posture

Dr Lesley Robson
l.g.robson@qmul.ac.uk

Introduction

Disorders of the locomotor system are extremely common in the community. They account for up to 30% of General Practitioner consultations and result in huge costs to the economy in terms of time lost from work, costs to industry and the individual as well as significant disability. Some locomotor diseases may also reduce life span significantly. This module is designed to introduce you to the normal structure and function of the locomotor system.

Learning delivery will be via lectures, practicals, computer assisted learning (CAL), clinical demonstrations, PBL and self-directed learning.

Sessions

Lecture: Introduction to Movement and Posture
Teaching Material for this Session
1. To explain the parts of the musculoskeletal system, including the axial and epaxial skeleton, and the major types of skeletal muscle.
2. To explain how muscles are named anatomically.
3. To explain the anatomical position and language of anatomy.
Lecture: Introduction to Skin
Lecture: Joint Structure and Function
Teaching Material for this Session
1. To explain the 3 major categories of joints
2. To understand and explain how the synovial fluid and articular cartilage contribute to synovial joint function
3. Be able to identify the three main types of joints and how, structurally, they influence the amount of movement possible
4. To understand the basics of how joints are affected by disease
5. Understand how the articular cartilage and synovial fluid contribute to the function of synovial joints
Lecture: Introduction to Imaging
Teaching Material for this Session
1. Describe the uses of, and the differences between, the following medical imaging techniques: plain (X-Ray) films; computerised tomography (CT); magnetic resonance imaging (MRI) and ultrasound
2. Discuss why knowledge of anatomy is vital to appreciate the applications of imaging to medicine.
3. Discuss the use of contrast: Barium, iodine, gadolinium
Lecture: Articular Cartilage and Synovium
Teaching Material for this Session
1. To describe the normal microanatomy of the articular cartilage and how this changes with normal ageing and in disease states
2. Understand the main biochemical components of synovial fluid
3. Understand how glycosaminoglycans contribute to lubricating properties of the synovial fluid
4. Understand how synovial fluid is produced
5. To be aware of the changes in disease states
Lecture: Peripheral Vasculature
Teaching Material for this Session
1. To describe the peripheral vasculature of the upper and lower limbs
2. To describe the arterial system and how collateral circulation maintains the blood supply of the limbs during movement
3. To describe both the deep and superficial venous return of the blood from the periphery
Lecture: Bone Metabolism and Growth
Teaching Material for this Session
1. To explain the process of intramembranous and endochondral bone development
2. To explain how bones grow postnatally both in length and width
Lecture: Muscle - Structure and Function
1. Understand the structure of skeletal muscle
2. Understand the physiology of the skeletal muscle fibre
3. To describe how the muscle fibre contracts
Lecture: The Neuromuscular Junction
Teaching Material for this Session
1. Understand the anatomy of the neuromuscular junction
2. Understand the pharmacology of the neuromuscular junction
3. Understand the physiology of the neuromuscular junction
Lecture: Deratomes, Peripheral Nerves & Plexi
Teaching Material for this Session
1. To describe the peripheral nervous system is composed of both sensory and motor components
2. To describe the structure of a typical spinal nerve
3. To describe how spinal nerves contribute to nerve plexi
4. To define a dermatome and to describe the dermatome map
Lecture: Pelvis and Hip
Teaching Material for this Session
1. Understand the arrangement of the pelvic girdle in relation to the hip joint
2. Describe the hip joint and the functional anatomy that provides it with stability
Lecture: Action & Membrane Potentials
1. Describe the structure of a typical cell membrane
2. Explain the origin of osmotic forces acting in the cell
3. Explain the different ways in which plant and animal cells cope with osmotic forces
4. Explain why there is an imbalance in potassium concentration inside and outside animal cells
5. Explain the necessity for a sodium pump
6. Describe the special features of voltage gated sodium channels
7. Draw a diagram of the ionic currents occurring during an action potential
Lecture: Muscles of Hip and Neurovascular Supply to Thigh
Teaching Material for this Session
1. Understand the movements possible at the hip joint and the muscles that produce these movements.
2. To review the major arteries in the lower limb
3. Identify the positions where arterial pulsations may be felt in the lower limb
4. Understand the mechanisms of how blood returns from the veins of the lower limb to the heart
5. Describe the formation of the lumbar and sacral plexi
6. Describe the course of the nerves in the lower limb
7. Understand the functional problems arising from damage to these nerves
Lecture: Muscle in Health and Disease
Teaching Material for this Session
1. To review normal muscle anatomy and physiology
2. To describe what happens to muscle in normal ageing and in myopathies
3. To examine common endocrine and metabolic muscle disorders
4. Appreciate clinical features of fibromyalgia
5. Therapies for muscle disorders
Lecture: Clinical Conditions of Hip
Teaching Material for this Session
1. Describe the clinical features of OA of the hip
2. Describe the clinical anatomy of hip dislocations
3. Describe the clinical anatomy of fractures of the neck of the femur
Lecture: Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
1. To understand the mechanism of action of NSAIDs
2. To understand when and why NSAID would be used
3. To understand the side-effects and how newer drugs can reduce side effects
Dissection 1 - Gluteal Region
Teaching Material for this Session
Lecture: Femoral Triangle
Teaching Material for this Session
1. Describe the anatomy of the femoral triangle: including its borders and structures that pass through
2. Describe the clinical anatomy of the femoral triangle and why it if the most operated on region
Dissection 2- Fermoral Triangle
Lecture: Paediatric Condtions of the Hip
Teaching Material for this Session
1. Describe the common paediatric conditions of the hip
2. Explain the anatomy and possible consequences of congenital dysplasia of the hip
3. Explain the anatomy and possible consequences of Perthes' disease
4. Explain the anatomy and possible consequences of slipped upper femoral epiphysis
Lecture: Metabolic Conditions of Bone
Teaching Material for this Session
1. To describe the changes in bone metabolism with age
2. To describe the changes in the bone in rickets and osteomalacia
3. To describe the changes in the bone in Paget's disease of the bone
4. To describe the treatment options for osteoporosis, Paget's disease and osteomalacia
Lecture: Popliteal Fossa
Teaching Material for this Session
1. Describe the anatomical boundaries of the popliteal fossa
2. Describe the structures that pass through the popliteal fossa
Lecture: Clinical Conditions of the Knee
Teaching Material for this Session
1. Describe the common injuries of the knee and understand the underlying anatomical reasons for these
2. Describe the un-happy triad
3. Describe the signs and symptoms of osteoarthritis of the knee
4. Describe the common paediatric conditions of the knee such as Blounts and Osgood
Lecture: Surface Anatomy of Knee
Teaching Material for this Session
1. Describe the surface features of the knee and how they relate to the underlying anatomy
2. Describe the surface anatomy of the popliteal fossa and how they relate to the underlying anatomy
3. Describe the how the knee is examined
Lecture: Ankle and Foot
Teaching Material for this Session
1. Understand the ankle joint proper (talocrual joint) and the sub-talar joints to the movements of the ankle and foot
2. Understand the functional anatomy of the foot and the role of the arches
Dissection 3 - Popliteal Fossa and Knee
Teaching Material for this Session
Lecture: Overview of the Lower Limb & Lymphatics
Teaching Material for this Session
1. Review the anatomy and function of the lower limb
2. Describe the lymphatic drainage of the lower limb
3. Describe the location of the lymph nodes that drain the lower limb
4. Describe briefly how the lymph drains in the rest of the body
5. Describe the clinical problems that can arise from problems of the lymphatic drainage
Lecture: The Knee
1. Describe the anatomy of the articular surfaces of the femur and tibia that contribute to the knee joint
2. Describe the anatomy of the ligaments that help stabilise the knee joint
3. Describe the anatomy of the menisci of the knee joint
Lecture: Gait Walking and Posture
Teaching Material for this Session
1. List the functions of the lower limb and the anatomical specializations stabilize that the lower limb
2. Describe the changes from a double support to a single support
3. Describe the events in the normal walking cycle
4. Describe the action of the main muscles involved
5. Analyse some types and causes of abnormal gait
Dissection 4 - Lower Leg and Dorsum of Foot
Teaching Material for this Session
Dissection 5 - Calf and muscle
Lecture: Bone Fractures and Fracture Healing
Teaching Material for this Session
1. To describe the different types of fractures
2. To describe the main treatment options for dealing with bone fractures
3. To describe how bones repair themselves after a fracture
Lecture: Degenerative Bone and Joint Conditions
Teaching Material for this Session
1. Osteoarthritis - causes, pathology and symptoms.
Lecture: Basic Immunolgy and Joint Diseases
Teaching Material for this Session
1. To understand the basic inflammatory processes that affect the joint in disease
Lecture: Joint and Bone Infections
1. To explain the pathophysiology of septic arthritis
2. To explain the pathophysiology of acute and chronic osteomyelitis
3. To explain the pathophysiology of prosthetic joint infections
4. To briefly look at the treatment options for these conditions
Lecture: Pectoral Girdle Shoulder and Arm
1. To describe the bones and joints of the pectoral girdle
2. To describe the glenohumeral joint
3. To describe the action of the muscles around the shoulder region and how they act of the pectoral girdle and shoulder joints
4. To describe the muscles and related structures that are located in the arm
Lecture: Rheumatoid Arthritis
1. To understand changes in joints, synovial membrane and synovial fluid with disease
2. Describe the changes in the synovial membranes of joints in inflammatory diseases
Lecture: Brachial Plexus and Axilla
1. To describe the spinal nerve roots that contribute to the brachial plexus
2. To describe how the brachial plexus results in the 5 terminal nerves of the upper limb
3. To describe the path of these nerves through the pectoral region and axilla into the arm
4. To describe the boundaries of the axilla and the structures that pass through
Lecture: Disease Modifiying Antirheumatics
1. To understand the pharmacology of the typical DMARDs for RA
2. To understand the new biological treatments for RA
Lecture: Elbow and Cubital Fossa
1. To describe the elbow joints and the movements possible at the elbow
2. To describe the muscles that act on the elbow joints to bring about these movements
3. To describe the boundaries and contents of the cubital fossa, both deep and superficial
Lecture: Clinical Problems of the Shoulder and elbow
Teaching Material for this Session
1. To describe the anatomical implications of fractures to the clavicle
2. To describe the anatomical implications of dislocations of the glenohumeral joint
3. To describe the rotator cuff anatomy to clinical problems
4. To describe the anatomical relationships of nerves and blood vessels that could be compromised by fractures to the humerus
Lecture: Forearm and Hand
1. To describe the osteology of the forearm, carpals and hand
2. To describe the muscles that are located in the forearm and their actions
3. To describe the contents of the carpal tunnel and its boundaries
4. To describe the arrangement of the long flexor tendons at the wrist and in the hand and how this influences the movements they produce and how they are protected.
Lecture: Crystal Arthropathies
1. To describe the metabolism of uric acid and how it precipitates in the joints to cause gout
2. To describe the pathophysiology of calcium salt precipitation in joints.
3. To describe the treatment options for these arthropathies
Lecture: Orthopaedics
1. To describe the common orthopaedic procedures
2. To understand internal fixation and joint replacement
3. To understand the range of orthopaedic procedures
Lecture: Intervertebral Discs and Movements of the Back
Teaching Material for this Session
1. Describe the features typical of vertebra
2. To be aware of the atypical vertebrae
3. To describe the different types of joints connecting the adjacent vertebrae with special attention to the intervertebral disc
4. To describe the movements of the vertebral column
Lecture: Clinical Back Problems
1. To be aware of the extent of back problems in the general population
2. To describe the pathophysiology of herniated discs
3. To describe age related changes and conditions that affect the vertebral column
4. To be aware of ankylosing spondylitis and DISH
Lecture: Analgesia and Pain Management
1. Types of analgesia advantages and disadvantages
2. Fitting the analgesia to the condition
Lecture: Movements of the Hand and Functional Anatomy of the Upper Limb
1. Define the term opposition of the hand
2. Understand the movements that are possible at the various joints of the hand
3. Understand the 2 main categories of grip and the main sub-divisions within each
4. Understand how nerve damage can affect the function of the hand
5. To understand the functional anatomy of the upper limb
6. To understand the modifications for movement and the clinical relevance of these modifications
Lecture: Treatment options for Osteoarthritis
Teaching Material for this Session
1. To understand the pharmacological treatments for OA
2. To understand the alternative treatment options for OA
3. To understand surgical options for OA
Histology: Bone, Muscle and Myotendinous Junctions
Microanatomy: Epithelia
1. Recognise the various epithelial cell types in photomicrographs and predict their function from their structure
2. Understand and master the use of the system for classifying different types of lining epithelia based on number of layers and shape of cells.
3. Recognise, name and understand the function of different components of the basement membrane.
4. Recognise glandular tissue in photomicrographs, indentify the gland type and its likely function.
5. Recognise the basement membrane and list its function
Microanatomy: Locomotor
CAL: Self Directed Learning - Spinal Cord
GEP1 - PBL1: JENNIFER AND HER FAMILY
Teaching Material for this Session

Martha is a normal height (1m 60cm) 34 year old woman she is expecting her 1^st child and is at 10 weeks gestation.As Martin her husband, who is a financial advisor for a bank, has achondroplasia, the family were referred to a clinical geneticist. Martin agreed to a genetic test and after PCR and sequencing was found to be heterozygous for the mutation c.1138G>A (p.Gly380Arg) in the FGFR3 gene.The family were offered prenatal diagnosis but, after much discussion, they declined. At 34 weeks, Martha had ultrasonography of the fetus that revealed frontal bossing with depressed nasal bridge, representing midfacial hypoplasia, contracted scull base shortened long bones while crown-rump length was within the normal range.A healthy baby girl was born and named Jennifer, by caesarian section. As Jennifer grew up she developed bow-legs (genu-varum), a marked sway (lordosis) to her lower back with a small thoracic hump (kyphosis), she also had an operation to enlarge the foramen magnum and decompress the cervical spinal cord.She had above normal intelligence and went to a regular primary school and stated that she wanted to become a doctor when she grew up.
GEP1 - PBL2: A MUSCLE PROBLEM
Teaching Material for this Session

Sonia is a 25 year old who is referred by her GP for electromyography and nerve conduction studies (EMG and NCS) because of a 9 month history of low back pain and difficulty in walking. The symptoms have become progressively worse since their onset. There is associated pain in the right anterior thigh which Sonia says is moderate in severity and is dull in quality while the low back pain was severe and sharp in nature. The pain increased with activity. What prompted Sonia to go to her GP in the 1^stinstance was that a week after the symptoms began she noticed that her legs would “give way”, especially involving the right side more than the left, but now both sides are equally affected, and have resulted in numerous falls. Sonia also now has problems going up and down stairs and of getting in and out of chairs. She has had physiotherapy sessions over the last few months but without any improvement. Her GP prescribed diclofenac for the pain. She now has an appointment with the neuromuscular laboratory for EMG and NCS assessment. On physical examination, her blood pressure is 110/70 mmHg, heart rate 80 beats per min. There is no cervical lymphadenopathy. Her cardiac, respiratory and abdominal examinations were unremarkable. There is no fever or erythema of any joint adjacent skin in all extremities. Her range of motion of neck, shoulders and all major joints of the upper and lower extremities was normal bilaterally. Coordination, pin-prick, light touch, joint position and vibration sensation in the upper and lower limb are also all normal. Motor examination revealed 4/5 strength in the upper and lower limbs, except for 2/5 bilateral hip extensor and abductor strength. The quadriceps and Achilles reflexes were absent, the biceps reflex was present. She displayed a bilateral Trendelenberg gait with an extension lurch and a wide base of support. The elctrodiagnostic results suggest presynaptic neuromuscular junction disorder and specifically Lambert-Eaton myasthenic syndrome, confirmed by tests for antibodies to P/Q calcium channels being positive while those to acetylcholine receptors were negative. Sonia was admitted to the hospital and was given a course of intravenous immunoglobulin after which she showed a marked improvement of her muscle fatigue and gait dysfunction.
GEP1 - PBL3: THE SNAPPING HIP
Teaching Material for this Session
GEP1 - PBL4: PAGET'S DISEASE OF THE BONE
Teaching Material for this Session
GEP1 - PBL5: THE DANGERS OF SKINNY JEANS: THE FASHION VICTIM
Teaching Material for this Session

Kate is a 35 year old who is brought into the Accident and Emergency department with severe weakness of both ankles around midnight. When her history is taken she reports that she was helping her younger sister move house all day and that this meant she had been squatting for a considerable amount of time as she emptied cupboards and filled cardboard boxes. She is wearing a pair of skinny jeans that she has been wearing all day and reports that her jeans have felt increasingly tight and uncomfortable during the day. That night while she had walked home and she had noticed that she was dragging her toes and stumbled a few times. When she got home the bilateral foot drop got worse and she had fallen and her partner had to help up as she could not get up on her own. The weakness in her ankles had continued to get worse and so her partner has brought her in to the hospital.

On examination her lower legs were markedly oedematous bilaterally, with the swelling worse on the right side. She is still wearing the skinny jeans and these had to be removed by cutting them off. There was bilateral severe global weakness of the ankle and toe movements with less movement possible on the right. Muscle power at the hips and knees was normal, the knee jerk reflex was normal but the ankle jerk reflex were absent. Sensation was impaired over the lateral aspects of both lower legs and the dorsum of the foot and the sole of the foot. All peripheral pulses were normal and the feet were warm and well perfused.

Blood was taken and results showed markedly elevated creatine kinase (73,215 IU/L normal range for women 24-170 IU/L). Renal function was normal but her urine was darker in colour and contained traces of myoglobin. A CT scan was performed and showed marked oedema and hypoattenuation of the posterior calf muscles, worse on the right, consistent with myonecrosis. Nerve conduction studies showed a conduction block in both common peroneal nerves between the popliteal fossa and fibular head. Compound muscle action potential amplitudes of the tibial nerves were also diminished with stimulation in the popliteal fossa, compared with the ankle.Sural and superficial peroneal sensory action potentials were normal amplitude bilaterally, but the right medial plantar sensory action potential was absent and the reduced on the left.

She was started on intravenous isotonic saline.The oedema and neurological function of the lower limbs improved over the 4 days she was in hospital that she was discharged and was able to walk unaided.
GEP1 - PBL6: TREVOR AND HIS BAD HIPS
Teaching Material for this Session

Trevor is a 66 year old male with a history of severe COPD with hyper-responsiveness and emphysematous bullae in both lung apices.He is following oxygen therapy at home (15 hrs per day) combined with bronchodilators, diuretics and steroids (prednisolone 10mg) on alternate days. He had been referred a year ago to the rheumatologists because of referred pain in the central lumbar region and in both hips especially when he walks, the pain is less when he is sitting or lying down. A pelvic radiograph showed spondylolysis with spondylolisthesis of L5 and osteoarthritis of the hip. Six months later the pain had increased and Trevor now needed a wheelchair as he found it hard to stand and move due to intense pain in both hips. A follow up radiograph was taken and showed destruction of both femoral heads and acetabulums.The most significant finding of the blood tests was leukocytes (9.5x10-3/mm3 (48.4% neutrophils), Hb 12mg/dL, Hct 36, platelets 355x10-3/mm3, ESR 32 mm/hr, and Antinuclear Antibodies, antiphospholipid antibodies and rheumatoid factor were negative). Trevor was referred to the orthopaedics team and underwent an uncemented bilateral total hip replacement, using the minimal posterior approach. During the operation no crystals were observed in the synovial fluid and cultures for bacteria and fungi were negative. The extracted femoral heads were sent for histological analysis and showed severe degenerative joint disease, avascular bone necrosis and chronic synovial inflammation.

Trevor recovery was uneventful and with physiotherapy there was significant improvement in muscular balance and pain free walking. Apart from walking with the aid of canes he has few restrictions.
GEP- PBL 7: BELLA
Teaching Material for this Session

Bella is a 34 year old lady who was diagnosed with seropositive rheumatoid arthritis (RA) six years ago and is now under the care of the rheumatology team. Her RA was initially treated with methotrexate and sulfasalazine, which brought the disease under control. Bella now receives maintenance methotrexate and monthly blood tests at her GPs to monitor her condition. Periodically, she has flares of her disease. She has ready access to her RA specialist nurse, and when these flares occur the rheumatology team manages these, usually by adding prednisolone, an NSAID and PPI, and increasing the dose of her methotrexate and/or adding another disease-modifying anti-rheumatic drug (DMARD). Recently, Bella has had several flares very close together and this has resulted in her having several spells of corticosteroid therapy as well as her other treatments.

Bella is now suffering from a prolonged flare of her RA which is not responding well to the synthetic DMARD treatment (methotrexate, sulfasalazine, etc.) that she is on. The rheumatology team now reviews the situation and determine that she fulfils the NICE requirements for the inclusion of a biological therapy. Her rheumatologist suggests commencing treatment with infliximab in addition to methotrexate. The team discusses the new treatment with Bella.
GEP- PBL 8: THE RUGBY TACKLE
Teaching Material for this Session

Matthew is an 18 year old university rugby player who attends the student health centre 6 days after an anterior dislocation of his right shoulder. He had dislocated his shoulder by being tackled by two players from the other team while playing at the weekend. He had been taken to the Royal London accident and emergency department to reduce the shoulder where the shoulder x-ray and examination had shown an anterior dislocation of the right glenohumeral joint with no fractures of the humerus and pectoral girdle, but Matt did reported numbness over his right deltoid and some tingling in his right hand, it was therefore decided to reduce the shoulder immediately while he was conscious but with anaesthesia by ultrasound guide brachial plexus nerve block. After the shoulder was reduced Matt still reported a significant amount of pain in the right shoulder and so he was advised to take diclofenac for the pain. At this presentation Matt reported that the pain was now gone, so that he no longer needed to take the diclofenac but that the he still experienced occasional paresthesia in his right ring and little fingers, but had full feeling over his right deltoid. At this examination of the shoulder there is minimal swelling but the range of movement of the right shoulder was significantly reduced, particularly abduction and external rotation. His supraspinatus muscle was also weak and caused Matt considerable pain when tested for strength, but both anterior and posterior parts of the deltoid were intact. A neurovascular exam reveals no significant deficits. Matt was sent for an MRI and this showed an anterior labral tear, and a supraspinatus tendon tear. Matt was referred to the orthopaedic team and underwent arthroscopic examination which found an extensive detachment of the glenoid labrum anteriorly and a 2 cm full thickness supraspinatus tear both of which the orthopaedic team repaired. Postoperatively Matt’s range of movement of the shoulder continued to improve and by 1 year after his operation Matt had a full range of movement and no pain and he had 90-95% of his supraspinatus strength and was given the all clear to take part on contact sports again.
GEP- PBL 9: MONTY'S ELBOW
Teaching Material for this Session

Monty was a previously healthy, 7-month-old boy who is admitted for evaluation of swelling, pain, and immobility of his left elbow, which had developed over the preceding 24 hours. His parents also report that he has also had a fever that started 36 hours before they brought him in. His parents had been giving him paracetamol for his fever.

Physical examination revealed a well-developed and well-nourished infant. He was alert and in mild distress. Monty’s vital signs were: temperature 38.9°C, pulse rate 135/min, and respiratory rate 34/min. There was diffuse swelling throughout the left upper limb extending from the mid-humeral area to the left hand, with focal swelling near the left elbow. The left arm was erythematous and painful to manipulation. The patient held the elbow at approximately 135° but could flex it to 90° but most other movements of the left elbow were limited. Radial pulses were present and there were no signs of trauma. All other examinations were normal. A blood sample was taken and showed that Monty’s white blood cell count was 43.1 x 10⁹/L, with 44% neutrophils, with 19% band neutrophils, 28% lymphocytes, and 9% monocytes; hematocrit 29.9%; and platelet count 710 x10⁹/L. The erythrocyte sedimentation rate and C-reactive protein (CRP) level were elevated at 42 mm/hr and 24.6 mg/dL, respectively. Approximately 3 mL of grossly purulent fluid was aspirated from the elbow joint initially and a Gram stain was conducted, it was sent for culturing, and sensitivity testing. Radiograph of the left humerus showed soft tissue swelling with no evidence of fracture or bone involvement. Monty was started on amoxicillin and ceftriaxone, before blood culture findings were ready. Subsequent cultures from the aspirate revealed gram-positive cocci, identified as penicillin resistantStreptococcus pneumonia (PRSP). Blood culture remained negative for organisms throughout.

Monty was sent for surgical irrigation and debridement of the left elbow. The elbow was approached from the poaterolateral aspect, which allowed exposure of the entire distal humerus as well as radial head, radial neck, and biceps tuberosity; and arthrotomy were performed. Pus was aspirated however, exploration of the elbow joint revealed no signs of chondral or osseous damage. Intravenous antibiotic therapy (ceftriaxone and vancomycin) was started after initial identification of the organism. Postoperatively, Monty remained afebrile for 48 hours, and CRP decreased to normal within several weeks. Range of motion and function also returned to normal on follow-up examination.
GEP- PBL 10: THE BAD BACK
Teaching Material for this Session
GEP- PBL 11: MARTY & MANDY
Teaching Material for this Session

Marty is a 2-year-old toddler brought into the emergency department by his distraught 16 year old single mother Mandy.

Mandy had been heating some chicken soup in the microwave in their council flat in Whitechapel, when her friend Tracey had rung Mandy’s mobile. Mandy left the boiling soup on the kitchen table leaving Marty alone in the kitchen. Mandy hearing Marty’s scream rushed back into the kitchen to find that Marty must have reached up and tipped the soup over himself mainly over his chest and torso.

Mandy immediately removed Marty’s clothes, and wrapped him in a damp towel, and called for an ambulance. When Marty reaches the Royal London Accident and Emergency he is in considerable pain and is given an analgesic and started on intravenous fluids.

Marty is assessed and found to have second-degree partial thickness burns over both of his upper arms and lower abdomen and second degree deep partial thickness burns on his upper chest. At the periphery of these second degree burns are first-degree burns with large blisters developing some of which have burst. In total approximately 30% of Marty’s BSA is affected.

Mandy is distraught and wants to know if Marty will be scarred for life.
Lecture: Intro - Fascia, Compartments, Muscle Functions
Teaching Material for this Session
1. To describe the structure and anatomical location of the superficial and deep fascia of the lower and upper limb and the structures that are related to these fascial layers
2. To describe how the deep fascia leads to the formation of muscular compartments
3. To explain how muscle function is enhanced by the fascia
Surface Anatomy of the Foot & Ankle
Surface Anatomy - Shoulder & Elbow
Clinical Anatomy of the Upper Limb : Orthopaedics and paediatric Conditions
Surface Anatomy - Wrist & Hand
EMG
Osteology Vertebrae, Imaging Vert Column, Surface Anatomy Back:
Q & A Revision Session
1. To describe the bones and joints of the pectoral girdle
2. To describe the glenohumeral joint
3. To describe the action of the muscles around the shoulder region and how they act of the pectoral girdle and shoulder joints
4. To describe the muscles and related structures that are located in the arm
In-Course Assessment: Movement and Posture
Spotter Examination: Movement and Posture
Formative OSCE Examination
Dissection 6 - Back, Shoulder and Triceps
Dissection 7a - Pectoral Region
Dissection 7b - Axilla and Anterior Compartment of the Arm
Dissection 8 - Cubital Fossa, Flexors of the Arm and Carpal Tunnel
Dissection 9 - Extensors and Hand

Modules

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Year GEP 1 GEP/M&P: Movement and Posture

Introduction

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