DidacticsOnline

Cranial Resources

DidacticsOnline — Thu, 24 May 2012 20:37:30 +0000

Cranial osteopathy is often a difficult concept to grasp and comprehend the various motions. There are many questions on the COMLEX and various other exams concerning cranial motion and cranial strain patterns. We hope to shed some light on the concept here with these videos and diagrams.

Cranial Intro Video

Cranial Strain Patterns

There are also some great videos from another user on YouTube at http://www.youtube.com/user/jvh981/videos. DidacticsOnline has no affiliation with this person.

Stroke and Transient Ischemic Attack (TIA)

DidacticsOnline — Mon, 07 May 2012 19:47:27 +0000

Brandon Masi Parker discusses stroke and TIA. The podcast focuses on management of patients presenting with signs of stroke and TIA as well as epidemiology, pathophysiology and current updates on evidence based approaches to stroke and TIA patients.

Stroke and TIA podcast

STROKE AND TIA POWERPOINT COMING SOON

Treatment for acute LBP in active military personnel; a journal review

DidacticsOnline — Wed, 25 Apr 2012 01:31:52 +0000

Brandon Masi Parker provides a journal review for the article A randomized, controlled trial of osteopathic manipulative treatment for acute low back pain in active duty military personnel, by

des Anges Cruser, Couglad Maurer, Kendi Hensel, Sarah K Brown, Kathryn White, Scott T Stoll in the Journal of Manual & Manipulative Therapy, Volume 20, Number 1, 2012 , pp. 5-15(11).

This article is a crucial randomized and controlled study analyzing the effectiveness of Osteopathic Manipulative Treatment (OMT) for acute low back pain (LBP) in active military personnel. The article analyzes pain, functionality and a few other parameters. I make the assertion that this unique subset of population may provide a model for other LBP patients that have physically demanding lifestyles with limited possibility for rest.

OMT for acute LBP in military personnel; journal review podcast

Prostate Disease

DidacticsOnline — Sun, 15 Apr 2012 19:54:56 +0000

Randal Davis discusses prostate disease pathology, clinical presentation and management. There is also a discussion on Osteopathic approach to patients with prostate disease.

Prostate Disease podcast

Stomach Cancer Education Symposium

DidacticsOnline — Wed, 11 Apr 2012 16:40:44 +0000

For those in the Ft. Lauderdale area, we would like to notify you of the 2nd annual Stomach Cancer Education Symposium in Hollywood, Fl.

On April 21 from 10am-3pm at the Westin Diplomat on 3555 South Ocean Drive in Hollywood, Fl 33019.

Symposium Flyer

Back Pain Etiologies and Pathophysiology interview with Dr. Fossum

DidacticsOnline — Wed, 28 Mar 2012 16:38:45 +0000

We interview Dr. Christian Fossum DO of Norway on several topics relating to back pain. We cover etiologies, pathophysiolgies, osteopathic treatments as well as an intervational take on Osteopathy.

Back pain interview with Dr Fossum

Clinical Approach to Muscle Function interview with Dr. Danto

DidacticsOnline — Wed, 28 Mar 2012 16:33:19 +0000

We interview Dr. Jay Danto DO while at the American Academy of Osteopathy Convocation on several topics relating to muscle function. We touch on muscle firing pattern, approach to a patient with musculoskeletal pain, acupuncture and more.

Interview with Dr. Danto on Muscle Function

Upcoming Interviews

DidacticsOnline — Fri, 23 Mar 2012 18:12:57 +0000

We are currently in Louisville, Kentucky at the AAO Convocation. We have a few interviews planned with some brilliant leaders in the Osteopathic community and we are excited to post them shortly.

Please stay tuned and come say hi if you see us walking around in our stylish DidacticsOnline shirts.

Anemia

DidacticsOnline — Fri, 16 Mar 2012 01:24:02 +0000

Nick Camposeo provides us with a quick overview of the important anemias. Anemia is a huge topic and very important in clinical practice and at all levels of board studying. This podcast includes pathophysiology, etiology, clinical presentation and management of microcytic, normocytic and macrocytic anemias.

Anemia Podcast

Diabetes Mellitus

DidacticsOnline — Sat, 03 Mar 2012 00:00:31 +0000

Meighan O’Connor leads a discussion on Diabtes Mellitus, covering pathophysiology, clinical presentation and patient management.

Diabetes Podcast

Diabetes mellitus Powerpoint

Cranial’s Effect on Cerebral Tissue Oxygenation; Journal Review

DidacticsOnline — Fri, 02 Mar 2012 01:54:26 +0000

Rob Kawa leads a journal review discussion on the “Effect of Cranial Osteopathic Manipulative Medicine on Cerebral Tissue Oxygenation”

Cranial’s Effect on Cerebral Tissue Oxygenation Journal Review Podcast

Cranial Article Journal Review Powerpoint

Xiangrong Shi, PhD; Seth Rehrer, OMS IV; Parna Prajapati, MBBS, MPH; Scott T. Stoll, DO, PhD; Russell G. Gamber, DO, MPH; and H. Fred Downey, PhD. (2011). Effect of Cranial Osteopathic Manipulative Medicine on Cerebral Tissue Oxygenation. Journal of the American Osteopathic Association 111(12), 660-666.

Irritable Bowel Syndrome (IBS)

DidacticsOnline — Mon, 27 Feb 2012 02:17:38 +0000

Tara Nowakhtar discusses Irritable bowel syndrome. This podcast includes pathogenesis, clinical presentation, and management including Osteopathic approach.

Irritable Bowel Syndrome Podcast

IBS Powerpoint

Prolotherapy

DidacticsOnline — Tue, 21 Feb 2012 23:57:53 +0000

Brandon Parker interview Dr. Sandhouse DO on prolotherapy (proliferative injection therapy, regenerative injection therapy, sclerotherapy). We discuss indications, contraindications, mechanism and evidence. We compare Prolo to PRP and trigger points. There is a bonus section on Orthokine, the treatment used by Kobe Bryant and Alex Rodriguez.

Prolotherapy Interview Podcast

In the interview we discuss a case where prolotherapy is used on a young male with an ACL tear. Below are the MRI images from before and after a prolotherapy regimen.

HAPPY MARDI GRAS POST

Effects of Manipulation

DidacticsOnline — Fri, 17 Feb 2012 21:47:12 +0000

Brandon Parker interviews Dr. Peter Sprague PT, DPT, OCS, MTC. Dr. Sprague is a board certified Orthopedic Clinical Specialist and shares his wealth of knowledge on the physiology of manipulation with us. We discuss goals of manipulation, evidence for specific manipulative modalities, what exactly is that HVLA ”pop,” the anatomy and physiology of the spinal and abdominal musculature in low back pain population, and neural plasticity including long-term potentiation (LTP) and long-term depression (LTD).

Effects of Manipulation Podcast

Peripheral Vascular Disease

DidacticsOnline — Fri, 17 Feb 2012 01:10:27 +0000

Rob Kawa leads a discussion on peripheral vascular disease. We discuss the pathophysiology of the disease, clinical presentation and treatment of the disease. There is also a great discussion on the definitions of arteriosclerosis, atherosclerosis and arteriolosclerosis.

Peripheral Vascular Disease Podcast

Peripheral Vascular Disease Powerpoint

Coronary Artery Disease

DidacticsOnline — Sat, 11 Feb 2012 23:03:34 +0000

Randy Davis leads a discussion on Coronary Artery Disease. All aspects of the disease process are discussed including spectrum of the disease, pathophysiology, clinical presentations and management.

Coronary Artery Disease Podcast

Migraine

DidacticsOnline — Wed, 08 Feb 2012 03:32:10 +0000

We speak with with Dr. Paul Winner, DO, FAAN, FAAP, FAHS about migraines. We discuss migraine pathophysiology, etiology, genetic components, information on auras, and migraine management. Dr. Winner is a leading mind on migraines and provides great information on the topic.

Migraine Interview Podcast

American Headache Society

American Headache Society Committee on Headache Education (ACHE)

Dr. Winner’s website

Osteoporosis

DidacticsOnline — Wed, 01 Feb 2012 01:08:58 +0000

Nick Camposeo discusses Osteoporosis. Nick discusses pathophysiology, epidemiology, clinical presentation, risk factors and treatment and management of the patient.

Osteoporosis podcast

Osteopathic Medicine for Pneumonia; an article review

DidacticsOnline — Wed, 01 Feb 2012 01:04:42 +0000

Audio podcast for Osteopathic Medicine for Pneumonia Article Review

Tara Nowakhtar reviews the article by Donald Noll et al, Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial published in Osteopathic Medicine and Primary Care in 2010.

Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial.

Noll DR, Degenhardt BF, Morley TF, Blais FX, Hortos KA, Hensel K, Johnson JC, Pasta DJ, Stoll ST.

Osteopath Med Prim Care. 2010 Mar 19;4:2.

Asthma

DidacticsOnline — Sun, 15 Jan 2012 02:39:10 +0000

Brandon Parker diiscusses Asthma. This episode includes epidemiology, pathophisiology, clinical presentation, diagnosis, treatment and Osteopathic approach.

Asthma Podcast

Asthma Powerpoint

Dizziness and Vertigo

DidacticsOnline — Fri, 06 Jan 2012 18:27:50 +0000

Meighan O’Connor discusses the clinical presentation, management and Osteopathic approach to patients complaining of dizziness or vertigo.

Dizziness and Vertigo podcast

Dizziness and Vertigo Powerpoint Presentation

Carpal Tunnel Syndrome

DidacticsOnline — Tue, 03 Jan 2012 02:23:13 +0000

Brandon Masi Parker discusses Carpal Tunnel Syndrome (CTS). The CTS discussion includes definition, epidemiology, pathophysiology, clinical presentation, diagnosis and treatment.

Carpal Tunnel Syndrome podcast

Video for Provocative Maneuvers in CTS diagnosis

Carpal tunnel syndrome (CTS) is the most commonly diagnosed and treated nerve entrapment syndrome, affecting approximately 3-6% of the population.¹ CTS can present as an acute form caused by a major trauma, or more often as a chronic condition.²Although the etiology of CTS varies, the most common cause is repetitive stress injury to the wrist, leading to flexor tenosynovitis.³The symptoms of CTS are caused by compression of the median nerve at the wrist, with ischemia and impaired axonal transport of the median nerve across the wrist.⁴The standard first line treatment for CTS is rest, immobilization, avoiding aggravating activities and modifying physical activities, and nonsteroidal anti-inflammatory drugs (NSAIDs). Conservative treatment is effective in approximately 80% of patients but if these modalities fail, positive results ranging from 56-73% of patients treated has been seen with local anesthetics and corticosteroid injections.⁵ If these treatment options are unsuccessful then surgery is indicated. Studies comparing surgical versus non-surgical patients have shown symptoms improving in both groups but with surgical treatment leading to a better outcome than current nonsurgical.⁶ Complications among these surgical procedures are uncommon. Approximately 1-2% of patients, experience nerve, tendon, and blood vessel laceration, infection, scar tenderness, damage to the median nerve, pain, hematoma, reflex sympathetic dystrophy, and potential repeat surgery if the procedure is unsuccessful.^7,8

Among the non-surgical techniques available is osteopathic manipulative treatment (OMT), which was shown to be a safe and effective method of treatment for mild to moderate CTS.⁹The goal of OMT in the treatment of CTS is to stretch soft tissues, release tissue adhesions, free restricted metacarpal and carpal bones, increase range of motion, strengthen the muscles, and remove edematous fluid, resulting in improvement in circulation and nerve function.³Sucher was able to show through MRI measurements that manipulation is capable of increasing the transverse and AP dimensions of the carpal canal. Sucher also showed improvement in nerve conduction studies within 1-3 months of manipulative treatment.⁹Median sensory and motor nerve conduction studies have been shown as valid and reproducible clinical laboratory studies that confirm a clinical diagnosis of CTS with a high degree of sensitivity and specificity.¹⁰ However, Sucher’s studies were conducted with small sample sizes, with test groups ranging from 4-9 patients and a control group of 13 patients. Although multiple studies have shown the effectiveness of osteopathic manipulative medicine for CTS, future research to enhance the clinical efficacy is still warranted.³

1) Atroshi, I., et al. Prevelance of carpal tunnel syndrome in a general population. Jama 282, 153-158 (1999)

2) Naranjo A, Ojeda S, MendozaD, et al. What is the diagnositc value of ultrasonography compared to physical evaluation in patients with idiopathic carpal tunnel syndrome?. Clin /exp Rheumatol. Nov-Dec 2007; 25(6): 853-9.

3) Siu, G. Osteopathic Manipulative Medicine for Carpal Tunnel Syndrome. AOCPMR.

4) Lundborg G, Dahlin LB. The pathophysiology of nerve compression. Hand clin. May 1992; 8(2): 215-27

5) Dammers, J.W., Roos, Y., Veering, M.M. &Vermeulen, M. Injection with methylprednisolone in patients with carpal tunnel syndrome: a randomized double blind trial testing three different doses. J. Neurol 253, 574-577 (2006)

6) Jarvik JG, Comstock BA, Kliot M, Turner JA, Chan L, Haegerty PJ, et al. Surgery bersus non-surgical therapy for carpal tunnel syndrome: a randomized parallel-group trial. Lancet. Sep 26 2009; 374 (9695): 1074-81

7) Gerritsen, A.A., et al. Splinting vs surgery in the treatment of carpal tunnel syndrome : a randomized controlled trial. JAMA 288, 1245-1251 (2002)

8) Boeckstyns, M.E.& Sorensen, A.I. Does endoscopic carpal tunnel release have a higher rate of complications than open carpal tunnel release? An analysis of published series. J Hand surgery 24, 9-16 (1999)

9) Sucher BM. Palpatory diagnosis and manipulation management of carpal tunnel syndrome. Journal of American Osteopathic Association 1994; 94;647-663

10) Jablecki CK, AndaryMT, So YT, WilkinsDE, Williams FH. Literature review of the usefulness of nerve conduction studies and electromyography for the evaluation of patients with carpal tunnel syndrome. AAEM Queality Assurance Committee. Muscle Nerve 1994. Dec; 17 (12): 1490-1

Osteopathic Medicine and Surgery

DidacticsOnline — Thu, 15 Dec 2011 23:26:22 +0000

In this episode we discuss applying Osteopathic practices and principles to surgery with Dr. Boesler DO. We discuss the usefulness of applying osteopathic practices and principles in a surgical setting. We offer anecdotal accounts and information from clinical research to support the effectiveness of applying and understanding Osteopathy’s effect in the surgical field.

Osteopathic Medicine and Surgery Podcast

Below are some cited resources:

Jarski RW et al. The effectiveness of osteopathic manipulation treatment as complementary therapy following surgery: a prospective, match-controlled outcome study. September 2000 77-81

O-Yurvati, A. et al. Hemodynamic Effects of Osteopathic Manipulation Treatment Immediately After Coronary Artery Bypass Graft Surgery. J Am Osteopath Assoc. October 2005 10:105

Stiles, EG. Osteopathic manipulation in a hospital environment. J Am Osteopath Assoc. December 1, 1976 76:243

Sleszynski & Kelso. Comparison of thoracic manipulation with incentive spirometry in preventing postoperative atelectasis. J Am Osteopath Assoc. August 1, 1993 93:834

Knee Pain

DidacticsOnline — Thu, 15 Dec 2011 01:13:07 +0000

Audio Podcast for Knee Pain

The knee is the largest joint in the human body when considering volume and surface area of articular cartilage and the size and complexity of the articulation lend to susceptibility to acute injury, chronic wear and tear and arthritis (inflammatory and septic). It is important to recognize the various etiologies of knee pain. This podcast aims to provide an overview of the topic of knee pain and help you develop a differential diagnosis. We also have a section at the end specifically discussing the somatic dysfunctions of the knee.

Video for Orthopedic Exam of the Knee

Bell’s Palsy Case Study

DidacticsOnline — Mon, 12 Dec 2011 00:53:33 +0000

Audio Podcast for Bell’s Palsy

Scott Sandilands OMS III discusses a pediatric case study with us on Bell’s Palsy. We also discuss some etiologies, approach to diagnosis and treatment of both adult and pediatric Bell’s Palsy cases as well as some success that Osteopathic manipulation has had with these patients.

Venous Thromboembolism (VTE)

DidacticsOnline — Sun, 04 Dec 2011 15:42:12 +0000

Audio Podcast for Venous Thromboembolism

John Gentile OMS III discusses Venous Thromboembolism. In this podcast the etiologies, clinical management and risks of Deep Venous Thrombosis and Pulmonary Embolisms will be discussed. Please join in the discussion with any questions or comments. We hope to act as a source for review and summary on these topics as well as a catalyst for further discussion on these very pervasive and dangerous pathologies.

Vascular Etiologies of Musculoskeletal Pain

DidacticsOnline — Sat, 26 Nov 2011 22:40:05 +0000

Audio Podcast for Vascular Etiologies of MSK Pain

Musculoskeletal pain is a very common complaint. Vascular etiologies consist of a wide variety of pathologies included in MSK pain ranging from the benign to the life threatening. Some of the etiologies discussed in this podcast are vasculitides, ischemia/infarction (including carpal tunnel syndrome and thoracic outlet syndrome) and coagulopathies.

•Where is the pain?

–Localized or Diffuse?

–If localized: is it joint pain (skeletal), muscular, or at the enthesis?

•Quick overview of Myalgias…

•Differential Diagnosis for Localized Myalgia

•Unusually strenuous exercise or overuse

•Trauma

•Pyoyositis

•Myofascial pain syndrome

•Muscle infarction

•Compartment syndrome

•Differential Diagnosis for Diffuse Myalgia (much more variable)

•Infection

•Fibromyalgia

•Systemic rheumatic diseases

-including vasculitis

•Metabolic syndromes

•Endocrinologic syndromes

•Medication side effects

•Psychiatric

•Myalgia but not myalgia

•Referral Pain

–Can present as “muscle or joint pain” when they origin is visceral or distant somatic

–“Back pain”

•Any retroperitoneal organ will refer pain to back

•Dissecting Aortic aneurysm

−Distal to Left Subclavian will refer to back and proximal to L subclavian will refer to chest

•Kidney disease

–“Arm or jaw pain”

•MI

•Vascular Causes of Musculoskeletal pain

•Vasculitides

•Ischemia/infarction

–Compression of vessel/blockage of vessel/systemic hypotension

•Coagulopathy

–DVT

•Quick overview of Vasculitides

•Small vessel

–Henoch-Schonlein purpura, hypersensitivites, vasculitis secondary to viral infection (hep, HIV, parvo)

–Palpable purpura normally due to type III hypersensitivity

•Medium sized vessel (muscular arteries)

–Polyarteritis nodosa, kawasaki

–Rash, infarction, MI, swelling

•Large vessel (elastic arteries)

–Takayasu, Giant cell

–Pulselessness, stroke

•Vasculitides

•Skeletal muscle vasculitis

•Usually presents in association with systemic vasculitis or isolated peripheral nervous system vasculitis

–Major peripheral clinical manifestation is often due to associated vasculitic neuropathy

•About 55% of patients will have significant myalgias and some degree of muscle weakness

–About 20% will have parasthesia due to associated peripheral neuropathy

•Temporal Arteritis

•Elderly females

•Most Common Vasculitis; affecting medium and large arteries

•HA, Jaw CLAUDICATION, decreased vision

•50% of patients with temporal arteritis (TA) will have PMR and 15% of patients with PMR will also have TA

•TREATMENT:

–Steroids

•Henoch-Schonlein purpura

•MC systemic vasculitis in children

–Affects small vessels of SKIN, GI and JOINTS

–Skin rash, abdominal pain, melena and ARTHRALGAS

•Follows URI

•Up to 44% in one study had a mutation in the MEFV gene, the familial Mediterranean fever gene

•IgA immune complexes

ARTHRITIS:

–Usually transient or migratory and typically oligoarticular

–It usually affects the lower extremity large joints (hips, knees, and ankles),

–There is usually swelling and tenderness, but normally no joint effusion, erythema, or warmth.

–Severe decreased ROM, especially in younger children

–No chronic damage, sequelae or joint deformity.

•TREATMENT:

•Supportive care for all systemic issues (renal, GI…)

•NSAIDS for arthritis

-NSAIDS are NOT shown to increase GI bleeds in HSP patients

•Use of Glucocorticoids is warranted if NSAIDS fail

•Buerger’s disease

•Seen in heavy smokers

•Intermittent claudication of muscles

•Severe pain with thrombosis/infarction of arteries

•TREATMENT:

–Smoking cessation

•Polyarteritis nodosa

•Immune-copmplex mediated transmural vasculitis

•Systemic symptoms due to small and medium artery inflammation

•Fever, weight loss, abdominal pain, melena, HA, nuerologic dysfunction, rash, MYALGIA, associated with Hep B

•TREATMENT:

–Corticosteroids, cyclophosphamide

•Takayasu’s arteritis

•Asian females >40 years old

•“Pulseless disease” affecting medium and large arteries

•Fever, night sweats, skin nodules, dyspnea, brain and ocular involvement (carotid arteries) weak pulses in UE, ARTHRITIS AND MYALGIA

•TREATMEANT:

–Glucocorticoids and symptomatic treatment as they arise

•Ischemia/Infarction

•Compartment syndrome

•Due to increased pressure within a facial compartment.

–Compromises the circulation and function of the tissues within that space.

•Most commonly presents after trauma as an acute presentation (anterior leg most common)

•May also present in young athletes as Chronic exertional compartment syndrome

•Compartment syndrome’s pathophysiology is cellular anoxia

•Regardless of the mechanism, the common end point is ischemia and subsequent reperfusion injury (particularly in cases of vascular injury) to the muscles in the affected compartment.

•TREATMENT

•Two Incision Fasciotomy

•Thoracic Outlet Syndrome (TOS)

•Compression of the neurovascular bundle as it passes through anterior and middle scalene muscles in the superior thoracic outlet

•Pain, tingling and coolness in the upper extremity may be present

–Pain can also be found in the lateral neck, the pectoral area, the axilla, and the upper back

•TREATMENT of TOS

•Most patients respond to conservative treatment: stretching, posture exercises and Osteopathic manipulative treatment

•Goals of OMT

–Treat hypertonic muscles

–Release tissue adhesions

–Balance the surrounding structures

•Patients who fail conservative treatment may require more invasive procedures: cortisone or Botox injections or first rib resection and scalenectomy

•Carpal Tunnel Syndrome (CTS)

•Most common peripheral neuopathy

•Compression of a peripheral nerve induces marked changes in intraneural microcirculation and nerve fiber structure, impairment of axonal transport, and alterations in vascular permeability, with edema formation and deterioration of nerve function (Lundborg and Dahlin, 1992).

•Presents as parasthesia in the median nerve distribution with accompanying ache and occasional weakness.

–There can be sensory loss across the first three digits while sparing the thenar eminence

-palmar sensory cutaneous nerve arises proximal to the wrist and passes over, rather than through, the carpal tunnel

•TREATMENT of Carpal Tunnel Syndrome

•Conservative treatment includes splinting, glucocorticoids, yoga and osteopathic manipulative treatment (OMT).

•Surgical decompression of the median nerve is appropriate in moderate to severe CTS to prevent permanent damage to the median nerve

•OMT for CTS

•Goals of OMT in CTS

–Stretch soft tissues

–Release tissue adhesions

–Free restricted metacarpal and carpal bones, increase range of motion

–Strengthen the muscles

–Remove edematous fluid

•Results: improvement in circulation and median nerve function

•OMT has been shown to be a safe and effective method of treatment for mild to moderate CTS (Sucher 1994).

•Coagulopathy

•Deep Venous Thrombosis (DVT)

•Manifestation of Venous thromboembolism (VTE)

–Most commonly seen in lower extremity

•Presents as acute onset of swelling, pain, and erythema of the involved extremity

–Important to recognize risk factors for VTE

•TREATMENT of DVT

•Heparin

–May be administrered as LMH Heparin, fondaparinux, unfractionated heparin or adjusted-dose subcutaneous heparin

–For most patients warfarin should be started simultaneously

–Heparin can be discontinued on day 5-6

•The use of thrombolytic agents, surgical thrombectomy, or percutaneous mechanical thrombectomy must be taken in to consideration when Heparin use is not favorable (hemodynamically unstable PE)

•Subclavian Steal syndrome

•Most commonly caused by atherosclerosis in the subclavian artery but can be due to an occlusion

•If the occlusion or stenosis is proximal to the origin of the vertebral artery you will get this phenomenom

•Ischemia of the ipsilateral upper extremity can lead to exercise-induced arm pain, fatigue, coolness, paresthesias, or numbness.

•Ischemic and trophic changes are rare

•Vascular Causes of Skeletal Pain

•Osteonecrosis (Avascular necrosis)

–Localized pain exacerbated by movement

–Can be asymptomatic

•Vasoocculsive

–Sickle Cell

•Osteonecrosis (AVN)

•Caused by various traumatic and nontraumatic stressors that ultimately lead to decreased blood circulation within the bone

–This leads to hyperemia in adjacent areas which results in demineralization and trabecular thinning

-If the bone is then stressed it can result in collapse

•Seen commonly in adults with extensive glucocorticoid use or traumatic femoral neck fractures

•Osteonecrosis in Children

•Legg-Calve-Perthes

–Idiopathic AVN of hip seen in children 3-12 years old

–Presents as hip pain or limp of acute onset

–Males>Females (4:1)

–African-Americans are rarely affected

–Higher incidence in children infected with HIV

•Slipped ephiphysis

–Slipped capital femoral epiphysis (SCFE)

•Posterior slip of femoral epiphysis

•Results in limp and reduced internal rotation

•Common presentation is obese child around 10-12 years old

–Osteonecrosis is most serious complication of SCFE; occurring in up to 20% of severe slips

•TREATMENT of Osteonecrosis

•Conservative treatment:

–Rest, partial weight bearing as tolerated, NSAIDS and other analgesics

–Bisphosphonates help slow resorption of necrotic bone

•Joint preserving procedures (decompression, osteotomy, marrow grafts)

•Joint replacement

•Vasoocclusive crisis (VOC) in Sickle Cell

•Bone and joint problems are the most common manifestations of sickle cell disease

•Hypoxia-induced polymerization of abnormal Hemoglobin results in sickling of red blood cell

–Causes microvascular occlusion which presents clinically as a painful episode or crisis

•Can lead to AVN of femoral or humeral head, collapsed vertebral bodies, dactylitis, osteomyelitis and septic arthritis

•TREATMENT of VOC

•Hydration

•Warm packs on affected areas

•NSAIDS

•Hydroxyurea

•Surfactants that inhibit cell adherence and aggregation

•Analgesics (opioids)

–Special care has to be given to monitor cardiopulmonary function on opioids (incentive spirometry and ambulation)

•Overview of Osteopathic approach to musculoskeletal pain

•History and Physical

•Palpatory skills are key in differential

•Recognize pain’s impact on all aspects of life and address all components

•Work to normalize sympathetic tone

•Musculoskeletal pain of vascular origin Resources

•Lundborg G, Dahlin LB. The pathophysiology of nerve compression. Hand clin. May 1992; 8(2): 215-27

•Sucher BM. Palpatory diagnosis and manipulation management of carpal tunnel syndrome. Journal of American Osteopathic Association 1994; 94;647-663

•Jay Allan Liveson (25 September 2000). Peripheral neurology: case studies. Oxford University Press US. pp. 255–. ISBN 9780195135633. http://books.google.com/books?id=nARrfwZPVH8C&pg=PA255. Retrieved 4 August 2010.

•Elliott KG, Johnstone AJ. Diagnosing acute compartment syndrome. J Bone Joint Surg Br 2003; 85:625.

•Mankin HJ. Nontraumatic necrosis of bone (osteonecrosis). N Engl J Med 1992; 326:1473.

•Sherry, DD, Malleson, PN. Nonrheumatic musculoskeletal pain. In: Textbook of Pediatric Rheumatology, 4th ed, Cassidy, JT, Petty, RE (Eds), WB Saunders, Philadelphia 2001. p. 362.

•Platt OS, Thorington BD, Brambilla DJ, et al. Pain in sickle cell disease. Rates and risk factors. N Engl J Med 1991; 325:11.

•http://www.uptodate.com.ezproxylocal.library.nova.edu/contents/myopathies-of-systemic-disease/abstract/46

•Kuchera, DO, Michael L. Applying Osteopathic Principles to Formulate Treatment for Patients With Chronic Pain. J Am Osteopath Assoc, Nov 2007; 107: ES28 – ES38

By Brandon Masi Parker

Connective Tissue Disorders

DidacticsOnline — Sat, 26 Nov 2011 22:38:11 +0000

Audio Podcast for Connective Tissue Disorders

Nick Camposeo leads a discussion focusing on Collagen and Elastin and various patholgies associated with each tissue. Collagen is the most abundant protein in the body and disorders affecting the integrity of this protein can disrupt a wide variety of processes throughout numerous organ systems.

By Nick Camposeo

Fibromyalgia

DidacticsOnline — Sat, 26 Nov 2011 22:37:00 +0000

Audio Podcast for Fibromyalgia

Randal Davis leads a discussion on Fibromyalgia. Fibromyalgia is a common cause of chronic widespread musculoskeletal pain with unknown etiologie. The patient presentation offers a unique set of unknowns and social uneasiness that create a difficult environment to treat in.

By Randal Davis

Psychological Etiologies of Musculoskeletal Pain

DidacticsOnline — Sat, 26 Nov 2011 22:35:35 +0000

Audio podcast for Psychologic Entities of MSK Pain

Robert Kawa leads a discussion on the Psychological etiologies of MSK pain. Psychology and Somatic pain blend together on a spectrum of presentations. It is important to recognize the Psychological etiologies of MSK pain as well as the commonly seen psychological components of chronic and life-altering pain.

By Robert Kawa

Common Musculoskeletal Referral Patterns

DidacticsOnline — Sat, 26 Nov 2011 22:34:23 +0000

Audio podcast for Common MSK Referral Patterns

Tara Nowahktar leads a discussion spanning trigger points, disc herniation, impingement syndromes and other categories. The pathology, clinical presentation and approach to the patient will be discussed.

By Tara Nowahktar

Intro to DidacticsOnline.com

DidacticsOnline — Thu, 24 Nov 2011 20:59:37 +0000

Audio Podcast for Intro to Didacticsonline

The goal of DidacticsOnline.com is to provide reviews and comments on various topics in medical discussion. We hope to add what we refer to as an “Osteopathic voice.” We will include information on Osteopathic practices and principles; including approach to patient, use of Osteopathic manipulative therapy and various aspects of the Osteopathic profession.
Didacticsonline does not aim to replace other more comprehensive resources. We hope to be a supplement resource and a catalyst for further discussion.

Didacticsonline will cover a variety of medical pathologies, chief complaints and we hope to include as many interviews with experienced physicians as possible. We also hope this blog and podcast further the awareness of the value of Osteopathy in a wide range of scenarios

Our intended audience is medical students and anyone else interested in participating in medical didactic discussions with the goal of learning and reviewing various medical topics

I first had the idea to create this blog after discovering the usefulness of podcasts as a medical student. While nothing can replace the comprehensiveness of reading textbooks and current studies, I have found podcasts extremely helpful in providing concise reviews and summaries while on the go in the car or in the gym or even sitting at a desk when my eyes start to bleed from reading too much.

There were many podcasts and several well-developed medical blogs and podcasts inspired me to start my own podcast where I hope to add to the medical discussion in whatever way a medical student can

The content on this blog is developed by all the fellows with the assistance of our attending physicians.

Didactics online is NOT AFFILIATED WITH AND DOES NOT REPRESENT THE VIEWS OR OPINIONS OF OUR SCHOOL, NOVA SOUTHEASTERN UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE.