Author: Anatomy Fundamentals

Last month a class member asked me about the pelvic joints. A friend of theirs had injured themselves skiing in Sweden and had been told by the physio there to rest to give the joint time to recover. Upon returning to the UK they were told that the joint was not moveable and so to be active. The question was simple – was the joint at the back of the pelvis moveable. The answer is not so simple.

The pelvis is such a crucial bony girdle for our upright posture that it is maybe not surprising that people have lots of different ideas about it. It starts its life as a number of separate bones. The ilium, the ishium and the pubis – this set of three on each side and then the sacrum and coccyx at the rear (there is a philosophical debate as to whether the sacrum and coccyx are part of the pelvic girdle or part of the spine but for now lets consider the pelvic girdle to be the complete ring and include these bones).

We will know the ilium from the ridges at the top of our hips or the anterior superior iliac spine (ASIS) that we are told to point in certain directions in exercise classes. We will know the ishium from the ishial tuberosities or sit bones on which we are told to sit. All 3 bones come together to make the acetabulum or socket for the ball and socket hip joint. It is not until the early 20’s that all of these bones are fully fused together and it is hormonal levels that affect the shape, with oestrogen giving the wider pelvic openings required for childbirth.

At the back of the pelvis, the iliums join the sacrum at the sacroiliac joint (SI joint – said as two separate letters not as my exasperation has spelt it above).

The joints are highlighted here in yellow.

They are synovial joints with cartilage on both side (different types of cartilage which is quite unusual). Strong ligaments abound in the pelvis as you would expect from something that is weight bearing. The pelvis is usually depicted as a bowl but in life the sacrum is almost parallel to the ground giving the bowl a forward tilt.

Can those joints move? If you ask an anatomist then the answer will probably be no. They are very strong joints, tightly bound and weight bearing. If they could move at birth (and these are all separate bones at birth so I am not sure that is a particularly good argument) then they fuse at some point. It is the weight bearing joint in the body – would you want it to move.

However – we have the motion of nutation and counter nutation. These are the names given to the movement of the sacral bone in relation to the pelvic bones. Why would someone name something that doesn’t exist? If you have found discussion about these movements then you are probably on a yoga or manual therapy website. The movement claimed is in the region of 2mm.

If you have severe lower back and pelvic pain there is an option of SI joint fusion surgery. Why fuse something that doesn’t move.

So – does the SI joint move? The answer, as with so many things in anatomy, is it depends. I think it probably does move to begin with. I think if you keep moving it it probably retains its movement for longer than if you don’t. I think different people have different ranges of movement and I suspect that most of the bodies donated to anatomists may well have a very limited range of motion if any due to their age.

If you want a clear yes or no answer then you won’t get it studying something as diverse as the human body.

I’m delighted to announce that a small group of us (depicted above as our favourite avengers) have been awarded a sum of money from the American Association for Anatomy to develop resources for public engagement.

We have an interesting time ahead as we try to canvas opinion as to what it is important to highlight to the public and we are joined by our anatomist colleagues across the globe to try and deliver entertaining events that increase everybody’s knowledge of their bodies.

Watch this space!

My combat class recently started back after the Christmas break. We finished the first class with a cool down called stick wrestling. It’s not what it sounds like and it certainly isn’t the activity you see if you google that term.

Two people grasp a stick and the aim of the practice is to make your opponent let go of the stick. This is not a test of brute strength, it’s not a case of throwing your opponent around. It looks like a dance, it’s a flow of allowing your opponent to move the stick around whilst being aware of what they are trying to do. Each of you are trying to move the stick into a position where the anatomy of your opponent’s body simply means they have to let go. I woke up the next morning and it felt like every muscle in my body had had a total workout – and that was because it had.

Often the trend when you go to a gym to workout is to isolate the one muscle group you are working on. People strap themselves into machines and think they are experiencing the pinnacle of exercising. Often you see the person doing the bicep curl but using momentum, the person doing the lat pull down but actually using their lower back, the person doing the stomach crunch but actually using their arm to move that weight, the list goes on.

What they are missing is that the body is not a series of independent muscles, it is one form that has to work together. This is the argument about using free weight over machines. If I am strapped in machine and doing the exercise correctly then I am working minimal muscles. If I do a bicep curl with free weights then I am using my legs, if I am working alternate sides then all of the muscles at the front back and side of my body are working to hold myself upright as I move that weight around. I don’t pick up the dumb bell and droop down to that side, my alternate side contracts so that I stay upright. Every muscles in your body can offer stability to the structure.

These sort of conversations lead us into the subject of core.

If you google core then often you get a picture like this. (notice the slight twist to make the muscles stand out more).

To most this is what they think of when they think of core muscles. Working your core is sit ups, crunches, hollow man exercises. It’s all about the abs with possibly the more enlightened also working the lower back.

What if we thought of core more like this

Everything that goes up and down your body, almost everything apart from your limbs. The movement of any part of your body affects every other part of your body and we need to stop thinking about it as a pile of parts. Nothing I could do in a gym would prepare me for stick wrestling. Stick wrestling prepares you for stick wrestling. Its time we thought more about functional fitness, the body working as a whole with stability coming from within rather than straps to hold you in the correct place.

I couldn’t resist a title like that with the New Year around the corner and a number of projects about to launch but what I really want to talk about is the TV series Limitless.

The series sees Chris Hemsworth push his body beyond what anyone could reasonably expect.

My attention was drawn to the series by some colleagues who helped out with the science side of things. Their contributions have been replaced with voice overs by the actor but I think they way the science is explained throughout the programs is good and easy to relate to.

The body is pushed with a number of things we probably all encounter in some ways

Stress – I am sure we all have a fair amount of stress although walking out on a beam projecting from a tall building is not the sort of stress most of us suffer from. It was interesting to see the techniques they used to try and help someone who doesn’t like heights step out above the city skyline. Particularly interesting when he got to the end of the beam and started to freak out – should have really seen that one coming in the risk assessment.

Shock – which was cold water swimming. I swim in the North Sea but luckily no one has put me through special forces drowning training.

Fasting – there is much debate on whether intermittent fasting is good for you or not. In this programme they undertook a 4 day fast. That would be challenging enough but they broke the fast by free diving down to a barrier reef and spear fishing for their tea. Missing breakfast will never seem so important again.

Strength – The. number of people I know who can successfully climb a rope is few, even smaller is the number of places where you could practice it so when the task is to climb 100 feet up a rope they had to come up with some innovative ways to practice. As if that wasn’t hard enough they then dangled the rope under a cable car.

Memory – this programme saw them navigating across the outback from memory. I very rarely drive anywhere without a SatNav now and I don’t even attempt to remember peoples phone numbers – I don’t need to they are all saved in my phone. Maybe if we didn’t rely on technology so much to do things for us we wouldn’t have to go trekking across the outback to try and preserve our memory. This episode was made more poignant by the fact revealed during the series that Chris has been found to be carrying two copies of the gene APOE4. This makes him 10 times more likely to develop Alzheimers disease. Something he had seen in his relatives.

Acceptance – the final episode was a tear jerker. They built a whole retirement village and placed the actor in a special suit which limited the use of his body in line with ageing. At first he struggled against it but eventually he had to accept that he could not do what he used to be able to do and adapt. With some fancy prosthetics they aged his wife and brought her on as a special guest before taking him through an immersive piece of work that played out his death.

There are many things you could take away from this series but what I take away is that the body is an amazing piece of kit which a lot of people do not fully understand. If we were to be able to explain to people what they had at their disposal then maybe we could enhance their understanding of their own anatomy in a way that could only improve their lives.

If that doesn’t set us up for a 2023 of some Anatomical Public Engagement then I don’t know what does.

I have recently started a new combat class.

I haven’t fully divulged my past TKD experience and I haven’t disclosed I am an anatomist (why would you, these things don’t come up)

This week though my questions almost gave me away. We were looking at solar plexus strikes and I asked the question ‘and where are you saying the solar plexus is?’ I sometimes struggle with the solar plexus because its not an anatomical feature and yet, as anyone who has ever been hit in it can tell you, it does exist.

Most anatomists have assumed that when people talk about the solar plexus they are talking about the Celiac plexus – a complex combination of nerves that is made up mainly from the greater and lesser splanchnic nerves with parasympathetic innervation from both branches of the vagal nerves. It is surrounded by 10 secondary plexus so you can understand the idea that this is a central nerve plexus with radiating nerves that affect multiple parts of the body – hence the name solar with nerves radiating out.

Kudos to any non anatomists who can see the circular structure with radiating nerves in this picture!

One of the troubles that I have with the solar plexus is the mixture of worlds. If you google solar plexus then you may get one link to an anatomical site but the majority of the sites are about chakras and blocking and unblocking energy paths. I guess that is my problem with being in two social worlds that view the world differently; are you striking an energy source or an anatomical structure?

The second problem I have is that the bundle of nerves is at the back of the body just in front of the spine. To have an effect on it then you must have compressed everything in front of it. We know that can happen because we all know people who have had the wind knocked out of them – that is a sign of a blow to the solar plexus and yet we struggle with massage therapists who claim they can release the psoas by massaging the front of the body.

The body continues to pose problems for us to ponder

I recently took part in the International Feltmakers Association Felt Swap for 2022.

Every year the organisation matches up felt makers across the world and provides a theme. Each feltmaker creates something and sends it off to their partner.

This year the subject was structure.

Obviously as an anatomist there are so many things I could do about structure but I was limited by the feltmakers being mainly wet felters as opposed to needle felting which is how I produce most of my items.

I have been experimenting with a wet felted skull but it is still in its embryonic stages (ironically something else I am also experimenting with) and even with a wet felted cranium a lot of the facial bones have to be needle felted.

I decided on trying to make a model of the structure of a cell.

This is the finished structure of my cell.

The external membrane was made by wet felting around a balloon using different colours of wool to try and show the lipid bilayer.

The nucleus was my first attempt at wet felting a ball and I was very pleased with how hard the final version was until I remembered I had to get a needle through it to hold everything in place!

The nuclear envelope is essentially a small wet felted bowl. I have been trying since to recreate it in a more useful size and failing miserably.

The organelles are various wet felted shapes with the stripes of the endoplasmic reticulum (one of my favourite words mainly because my lecturer was a Geordie and it sounds even better than CurlyWurly with that accent) being a cut strip of wet felted purple wool.

The cytoplasm was my first attempt at Nuno felting. This is where wool is felted on to a thin piece of silk and the contraction of the wool as it felts pulls the material into this puckered appearance. I am thinking it might be a good way to produce a greater omentum for a project next year.

The finished project was boxed up and sent off to Switzerland where it was received with much joy.

It’s interesting to have to come up with something based on a theme and this has certainly given me lots of ideas for projects that will hopefully appear n 2023

The name Leonardo can man different things to different people.

To some it is the Renaissance polymath, to some it is a floppy haired Oscar nominated actor and to some it is a martial arts loving turtle.

To me, he was always someone who dabbled in lots of things. The sort of things you would love to do now but unfortunately you have to pick one thing that pays the wages. This image was enhanced by the TV series Leonardo.

This image was further confirmed by binge watching DaVinci’s Demons in which he single handedly saved Florence on multiple occasions. The producers of this series claim an 85% historical accuracy but I feel this must have been focused on costume and set design rather than plot line.

Entertaining but probably not historically accurate.

Leonardo has featured in the data collection for my PhD. He is mentioned as an example of an artist who dissected. Would we allow that to happen now? Although various dramas are vague on the history, we know that Leonardo was employed as an artist. He may or may not have been employed to develop military weapons and he doesn’t appear to have claimed to have been a medic or an anatomist. He was just interested in lots of things. He was an artist who anatomised as opposed to an anatomist who drew, although I agree those two categories probably meet somewhere.

Leonardo is someone to turn to when your confidence is feeling low. A bit like Thomas Eddison, everyone remembers the things that they got right, be it the light bulb or a fantastic drawing of the human heart. Everybody forgets the thing that they got wrong; the concept that the electric chair was a good idea or his depiction of the ventricles of the brain or those tendons that support the uterus (but are found in cows not humans).

Last night I was fortunate enough to be invited along to the preview for a new exhibit at the National Museum of Scotland. This long awaited display looks at the history of anatomy teaching and dissection in Edinburgh bringing it all the way up to modern times and the need for continued body donation.

It had the potential to dwell on the gory history of Edinburgh and the body trade and yet it didn’t.

Starting with Leonardo Da Vinci – as so much seems to – the exhibitions took us through developments in Leiden and Padua with an actual copy of Versalius’ Fabrica – the first real anatomy book.

How many anatomists aren’t aware of the drawings with Clara the Rhino, and yet to see the actual picture and appreciate the size of it was amazing. Also to see the sketch on the page opposite where the arms appear to be a reasonable length as opposed to the picture with Clara where they seem very long.

There were so many images that I had seen before but had never seen the real thing and appreciated the real size. The classic picture of Hunter teaching anatomy with the model in front of the class with his arm up by Johann Zoffany, I don’t know how many times I have seen that image but to see it close up was amazing. We spent some time looking at that picture as the skeleton on the right hand side seems to have too many ribs – maybe it was a trick of the light.

The picture of Munro lit properly and behind its protective panel looked so much more impressive than where I normally see it hanging outside the staff canteen where I could walk up and actually touch it.

It was a truly cross disciplinary exhibition. Yes there were lots of anatomy pictures, a few models concentrating on the artistic aspects, but there was also a collection of costumes – robes worn by judges in the 1800s, the uniform of the town guard, there were leech pots and charms, collections of silverware belonging to clubs, complete wall sections covered with old images of Edinburgh and a mort safe (hats off to the team who installed that on the first floor).

The west port murders had to be covered – they are such an iconic part of the history but they were covered in a very unsensational way – the facts of the case, a large screen short film. It left you to ponder on what Burke and Hare were doing; killing people for medical teaching, and in a way that allows the horror of the story to sink in far better than any sensational images.

The skeleton of Burke had moved across from our museum to feature in the display but it was installed in a corner of the room, no more attention directed to it than to any other item and it completed the story and allowed you to move on.

The modern section was very well done. Three talking heads – the current Professor of Anatomy – Tom Gillingwater, a lady whose husband had donated and who was herself on the register and a 4th year medical student. They all explained the importance of dissection for education and the process of donating. The holding film between the presentation was of the names being written into the book of remembrance by the calligrapher. I wasn’t ready to see my mother in laws name been written across the screen, she donated in 2019, but I am so pleased that her donation featured in this exhibition.

The final piece was the open book of remembrance, her name again on display with all the other donors from 2019 onwards. I think she would be amused at being featured in a display at the national museum, she used to take my husband there as a child – mainly to play with the fish in the large pond in the entrance hall, but I am sure she would be honoured to be part of an exhibition that deals with anatomy and the journey of body supply in such a sensitive and informative manner.

If you can make it to see this exhibition then I would suggest you do.

The brachial plexus is an anatomical icon.

Often produced as an interview challenge, the teaching of the crossing of fibres can have some people Reaching To Drink Cold Beer or trying to recall a story about two people dancing and someone else kicking them. However you chose to learn it, the complexity of explaining it to someone else can lead to confusion.

I first tried to image the brachial plexus at a glass workshop

The vertebrae of the spine are represented on the right hand side and the five nerves of the arm appear on the left. between them is the complex crossing of the nerve fibres. The limited colours belay the complexity and as a flat object it’s hard to convey anterior and posterior aspects but it worked wonders as a science communication piece. Most people think it is some attempt at a tube map and so it can be a conversation starter.

For some time I have been mulling over the idea as to how to develop this.

As a child I was in the Guides and Scouts. I was the only person I knew who had achieved the ridiculously hard knotters badge and I was frequently incorporated into camping teams as the person who could tie knots. One of my memorable moments is tying a massive sheepshank in a field with my father so that we could launch a glider that had landed and needed a shorter tow rope. For years I wondered about how to merge the macrame plant holders you see and the brachial plexus. Macrame is too complex for this – it tends to have two strands down the middle that are hidden from view – for this I needed all of the strands to be on display – I needed decorative knotting, plaiting and braiding.

This structure would be 3D – I would be able to show anterior and posterior, medial and lateral and I could use the pots to separate out the strands and hold them in place. I could have taken a knife to a plastic pot but I went a bit further and used a ‘Sculpd’ pottery kit so that I could create two pots, one with 3 holes and one with 5 holes to hold the strands apart and display the plexus.

The result is this

The 5 strands at the top represent the nerves coming from the spine. They are made up of two different colours of string (multiple strands of each) to represent the nerves that will make the medial, lateral and posterior cords – these are the three structures that pass through the first pot.

The 5 branches, musculocutaneous, axillary, median, radial and ulnar are the strands that pass through the second pot.

By using the different colours of strings it is possible to see that each final nerve is made up of components of the spinal nerves and so explain that should any spinal nerve get damaged it would not stop the nerves of the arm from working.

It took longer to figure out how to do it than to actually produce it. My house was littered with bits of string as I learnt how to braid with 2, 3, 4, 5 and 6 strands.

I’m working on writing out the instructions – I’ll add them to the web page when I get it done.

I’m also looking at the possibility of making it into a workshop so we can have more braided plexus’ out there.

Following on from my visit to the Post Mortem live event, I attended another event also entertaining and educating the public with post mortems – this one was run by Suzy Lishman CBE who has conducted hundreds, if not thousands of post mortems and the event was part of a tour to mark the 60th Anniversary of the Royal College of Pathologists. A little different from the previous event.

The two events were really chalk and cheese.

The audience was different – its hard to put your finger on what was different. This audience were maybe more professional, older, more couples rather than groups of young people. This audience looked more like the sort of people you would expect to give up a mid week evening to attend the Royal College of Surgeons, the previous audience looked like people who went to a budget hotel on the outskirts of town. (something to remember with public engagement – just because you open your doors to the public does not mean a cross section of the public walks in, sometimes you need to go to your audience)

Fifteen minutes in and it was made clear that there were no human parts being used in this event (there were a couple of museum pieces on a table behind but that was unusual for events in this tour). It wasn’t explain why, other than stating that that clearly wasn’t appropriate. Everyone seemed to agree.

They did have a model human, but in the same way that Kate Moss is a model. When the body was uncovered the person beside me commented on how real it looked just before they revealed it was actually a real person. They had apparently had someone freak out at an earlier event when the person sat up at the end and so now felt the need to tell the audience that this was a real person. This person was drawn on to show the typical incisions which were explained in detail, drawing attention to the fact that all of the incisions could be concealed so that the fact the body had gone through the post mortem process did not need to be seen. A general thread of respect that ran through this event and was missing from the previous one.

Suzy Lishman went through all of her tools, explained all the different sort of pathologists, explained she wasn’t like silent witness or Quincey and then went through what she would be looking for in each organ, the common points of failure in the human body. She spent over two hours taking us on a detailed description of what she does everyday at her work. It was fascinating. It wasn’t dressed up to be anything it wasn’t. It is what she is trained to do and does for a living.

She talked about the texture of the brain, the slicing of every organ, the reason they don’t cut the top of the head straight off but leave a little upturn at the back. She could have made it sensational – but she didn’t – because it’s not appropriate.

In the questions at the end she was asked whether she had seen any surprising things. She said she had seen some truly amazing things but they were so amazing it might be possible to identify the person and therefore she wouldn’t be talking about them.

The thing that struck me is that this is a person who deals with dead bodies for a living. They have an inbuilt sense of what is appropriate and what is not. They can still make the human body fascinating because their own passion shines through. There is no need to dress it up as something it is not or to sensationalise it in any way. The body is amazing and we should appreciate it for what it is.

At a fifth of the price of the other post mortem event this is where you should go if you want to learn about post mortems. If you want to dissect organs then there are other events for that that make it clear they are using by products of the animal food industry.