Anatomy and Physiology

20/04/2026

Orthodox medicine only sees structures. There are the large structures of lumps, bumps and tubes. Then there are the very small structures of cells and chemicals; hence even human emotions it sees in terms of chemicals in the brain. But you cannot see the whole by cutting it into smaller and smaller pieces. Medicine also only sees you in terms of normality or disease, here with an unspoken emphasis on the latter.
We all have belief systems and what we believe, knowingly or unknowingly, defines how we look at and understand things; they define all our relationships. We also have relationships with our happiness and suffering as well. These are our human emotions. They are our expression of the moment.
I have found in myself and in my patients, by experiencing them in the moment we can change the nature of the suffering. Medicine has an opinion, but it is not the only one. This is a second opinion.

How do we feel about having good health and disease? Do we even understand good health or disease? A relationship we usually perceive as something between us and something outside of us; but do we have a relationship with our good health or disease? It has a review of medicine, and its history is...

18/04/2026

The Vertebral Artery Anatomy & Clinical Significance

The vertebral arteries are the foundation of the posterior circulation of the brain. They are responsible for supplying the cervical spinal cord, the brainstem, the cerebellum, and the posterior aspects of the cerebral hemispheres.

1. Anatomical Course
The vertebral artery follows a unique and protected path through the neck to reach the cranium:

Origin: Arises from the first part of the subclavian artery.

Cervical Ascent: It travels upward through the transverse foramina of the cervical vertebrae. It typically enters at C6 and skips the transverse foramen of C7.

Cranial Entry: The bilateral arteries enter the skull through the foramen magnum.

Formation of the Basilar Artery: Both vertebral arteries converge along the ventral surface of the medulla to form the basilar artery at the junction of the medulla and pons.

2. Major Branches and Territories

Anterior Spinal Artery: Supplies the anterior two-thirds of the spinal cord and medial structures of the medulla, including the pyramids, medial lemniscus, and the hypoglossal nucleus (CN XII).

Posterior Spinal Artery: Supplies the posterior one-third of the spinal cord and the caudal/dorsal medulla, including the gracile and cuneate nuclei and the spinal trigeminal nucleus.

Posterior Inferior Cerebellar Artery (PICA): Supplies the inferior cerebellum, the choroid plexus of the fourth ventricle, and the posterolateral medulla. This includes the spinothalamic tract and the nucleus ambiguus.

3. Clinical Correlate: Subclavian Steal Syndrome
This condition occurs when there is a high-grade narrowing (stenosis) or occlusion of the subclavian artery proximal to the origin of the vertebral artery.

The Mechanism: Because the pressure in the affected arm is low, blood flow is "stolen" from the brain. Blood travels up the healthy contralateral vertebral artery, reaches the basilar junction, and then flows retrograde (backward) down the ipsilateral vertebral artery to supply the arm.

The Trigger: Vigorous muscular effort of the affected upper limb.

Symptoms: When the arm diverts too much blood, the patient may experience lightheadedness or syncope due to insufficient blood flow to the brainstem.

Clinical Pearl
"In your clinic, be extremely cautious when performing cervical manual therapy or high-velocity thrusts in the upper cervical spine. The vertebral artery makes a sharp 90-degree turn as it exits the C1 (atlas) transverse foramen to enter the foramen magnum. This 'kink' makes it vulnerable to arterial dissection if aggressive rotation is applied. Always screen for the '5 D's and 3 N's' (Dizziness, Drop attacks, Diplopia, Dysarthria, Dysphagia; Nausea, Numbness, Nystagmus) before proceeding with neck treatments."

16/04/2026

Anterior Muscle Compartment of the Arm { Clinical Anatomy }

The anterior compartment of the arm contains three primary muscles: the Biceps Brachii, Coracobrachialis, and Brachialis. Collectively, these muscles are the powerhouse flexors of the upper arm and are primarily innervated by the musculocutaneous nerve.

1. Biceps Brachii: (Two heads in the arm) The "Two-Headed" Biarticular Muscle
The biceps is unique because it spans both the shoulder and elbow joints.
On this point, it is described as a muscle that functions singularly across the elbow. However, both heads arise from the scapula, above the shoulder. As an aside here, the same might be said of the long head of triceps as it arises from the infraglenoid tubercle
Hence, it has actions across the glenohumeral joint as well, it is just never described as such. Some authorities also claim that the long head also functions with the rotator cuff muscles, stabilising the humeral head in the glenoid fossa.

Long Head: Arises from the supraglenoid tubercle and superior labrum (forming the bicipitolabral complex). It is intra-articular but extrasynovial. It travels through the bicipital groove, stabilized by the "biceps reflective pulley" (SGHL and coracohumeral ligament).

Short Head: Arises from the coracoid process via a common tendon shared with the coracobrachialis.

Distal Insertion: The two heads twist 90° before inserting into the radial (bicipital) tuberosity and the bicipital aponeurosis.

Function: A powerful supinator of the forearm (especially when the elbow is flexed) and an elbow flexor.

2. Coracobrachialis:
This muscle is often overlooked but serves as an important landmark in the axillary region.

Origin: The apex of the coracoid process, where it shares a conjoint tendon with the short head of biceps.

Insertion: The middle third of the humeral shaft.

Clinical Landmark: The musculocutaneous nerve typically pierces this muscle. The brachial artery pulse can be palpated in the depression just posterior to its muscle belly.

Function: Flexion and adduction of the arm at the shoulder.

3. Brachialis: The "Workhorse" of Elbow Flexion
The brachialis lies deep to the biceps and is actually the strongest flexor of the elbow.

Origin: The distal half of the anterior humeral shaft.

Insertion: The ulnar tuberosity and the coronoid process of the ulna.

Dual Innervation: While primarily supplied by the musculocutaneous nerve, the lateral portion often receives a contribution from the radial nerve.

Function: Pure elbow flexion, regardless of whether the forearm is pronated or supinated (unlike the biceps, which is position-dependent).

4. Clinical Anatomy & Variations
Third Head of Biceps: A common variant (7% of cases) usually arising from the humerus between the coracobrachialis and brachialis.

Bicipital Aponeurosis: Also known as the "lacertus fibrosus," this fascial expansion protects the underlying brachial artery and median nerve in the cubital fossa.

SLAP Tears: Throwing athletes often injure the "bicipitolabral complex" where the long head of the biceps anchors to the superior labrum.

12/04/2026

I have read Dark Matter, by Dr James Kinross, with great interest. It talks about the gut microbiome. Not just there, though, but those bacteria in all other parts of the body which we need to function healthily!
In it he talks, briefly, about vaccination and how it has been the saviour of the human race, blah blah.
As a mainstream orthodox medical doctor, I suppose he is obliged to support this MO.
There is always another part of the story, though

In this interview, I sit down with Joachim Gerlach, the lead author of a provocative new paper exploring whether persistent spike protein exposure may be dri...

10/04/2026

Brachial Plexus Anatomy Explained

The brachial plexus begins with the spinal nerve roots C5, C6, C7, C8, and T1. These roots are the starting point of the plexus. Effectively, these nerves come together, then separate. Then they come together again, then separate.
The roots emerge, then join to form three trunks: the upper trunk is formed by C5 and C6, the middle trunk is formed by C7 alone, and the lower trunk is formed by C8 and T1.
Each trunk then splits into an anterior division and a posterior division. These divisions are named in their relation the the subclavian artery, and reorganize to form the lateral cord, posterior cord, and medial cord.
Finally, these cords give rise to the terminal branches, and the brachial plexus also gives off nonterminal branches from the roots, trunks, and cords.

09/04/2026

ANKLE LIGAMENTS LATERAL SIDE

This is a useful list of the ligaments in the lateral side of the ankle:
1. Anterior inferior tibiofibular ligament
Avulsion of this ligament in adolescents is called the Tillaux fracture.
Avulsion of this ligament from the tibia in adults is called the Chaput fracture.
Avulsion of this ligament from the fibula is called the Wagstaffe fracture.
The inferior part of this ligament is called the Basset ligament, which can cause ankle impingement.
2. Posterior inferior tibiofibular ligament
Avulsion of this ligament is called the Volkmann fracture.
3. Anterior talofibular ligament
This is the most commonly injured ligament.
4. Calcaneofibular ligament
This ligament is assessed with inversion or talar tilt and is taut in dorsiflexion.
5. Posterior talofibular ligament

Watch out in an exam: discriminate between the tibiofibular ligaments and the talofibular ligaments.

06/04/2026

Clinical Anatomy of The Ulnar Canal (Guyon’s Canal)
Understanding the boundaries of the Ulnar Canal is essential for diagnosing compression syndromes at the wrist. While we call it a "canal," it is more of a covered transit area approximately 4 cm long.

The Boundaries
To visualize the canal, think of it in terms of its "walls":

Roof: Superficial part of the flexor retinaculum, palmaris brevis, and the ulnar fat pad.

Floor: Deep part of the flexor retinaculum, pisohamate ligament, and (distally) the flexor digiti minimi.

Medial Wall: Flexor carpi ulnaris (FCU), the pisiform bone, and abductor digiti minimi.

Lateral Wall: Fibers of the flexor retinaculum and the hook of the hamate.

Nerve Division & Clinical Significance.
The ulnar nerve divides within the canal at the level of the pisohamate ligament. This is where the "Zone" of compression determines the patient's symptoms:
Proximal Compression: Both motor and sensory (cutaneous) fibers are affected.

Distal to Bifurcation:
Deep Branch: Affects motor function as it passes radially around the hook of the hamate.

Superficial Branch: Affects sensation as it passes distally and ulnarwards.

Clinical Takeaway
When a patient presents with ulnar-sided hand weakness or numbness, always palpate the area between the pisiform and the hook of the hamate. Identifying the exact site of compression is the key to an effective treatment plan.

04/04/2026

As I was taught, C: 3, 4, 5 keeps the diaphragm alive

Phrenic Nerve
This image illustrates the Phrenic Nerve, which is the primary motor supply to the diaphragm.
The phrenic nerve has a very specific "map" it follows to keep you breathing.
​Here is a breakdown of how the diaphragm gets its instructions:

​1. The Origin: "C3, 4, 5 keep the diaphragm alive"
​The phrenic nerve originates in the neck from the cervical plexus. It specifically draws fibers from the third, fourth, and fifth cervical spinal nerves (C3, C4, and C5). This is why neck injuries can be so dangerous for respiratory function.

​2. The Pathway
​The nerve travels down through the thoracic cavity (the chest), passing between the heart and the lungs.

​Location: It runs along the mediastinum.
​Protection: It is tucked behind the pleura (lung lining) and the pericardium (heart lining).

​3. Inner-Vation (The "Supply")
​Once it reaches the diaphragm, it branches out to provide two types of signals:
​Motor Supply: This is the "action" signal. It tells the diaphragm muscle to contract and flatten, which draws air into the lungs. This is the only motor supply to the diaphragm.
​Sensory Supply: It also carries sensory information (pain and touch) from the central part of the diaphragm back to the brain.

04/04/2026

🧠 Spinal Cord – Structure & Functions (Quick Clinical Guide)

📍 What is the Spinal Cord?
🔷The spinal cord is a long, cylindrical part of the central nervous system (CNS) that connects the brain to the body.
It runs from the medulla oblongata to about L1–L2 vertebral level in adults.

🧩 Basic Structure:
🔹 Segments
• Cervical (C1–C8) → upper limbs
• Thoracic (T1–T12) → trunk
• Lumbar (L1–L5) → lower limbs
• Sacral (S1–S5) → pelvis
• Coccygeal (Co1)

🔹 Cross-section Anatomy
• 🟤 Gray Matter (center)
• Dorsal horn → sensory
• Ventral horn → motor
• Lateral horn → autonomic (T1–L2)
• ⚪ White Matter (outer)
• Ascending tracts (sensory)
• Descending tracts (motor)

🔹 Roots
• Dorsal root → sensory input
• Ventral root → motor output
• Combine → spinal nerve

⚙️ Main Functions:
1️⃣ Sensory Function (Afferent)
• Carries signals from body → brain
• Examples:
• Touch
• Pain
• Temperature
• Proprioception

2️⃣ Motor Function (Efferent)
• Sends commands from brain → muscles
• Controls:
• Voluntary movement
• Muscle tone

3️⃣ Reflex Function (Very Important 🔥)
• Rapid, automatic responses
• No brain involvement initially

👉 Example:
• Touch hot object → withdraw hand instantly

🔁 Reflex Arc (Step-by-Step)
1. Receptor detects stimulus
2. Sensory neuron → spinal cord
3. Interneuron processes signal
4. Motor neuron activated
5. Effector (muscle) responds

🧠 Major Pathways:
🔼 Ascending (Sensory)
• Spinothalamic → pain & temperature
• Dorsal columns → fine touch & vibration

🔽 Descending (Motor)
• Corticospinal tract → voluntary movement

⚠️ Clinical Importance:
🚨 Spinal Cord Injury
• Loss of movement & sensation below level of lesion
• Severity depends on level & completeness

🔍 Common Clinical Points
• C3–C5 → diaphragm (phrenic nerve)
👉 “C3,4,5 keep the diaphragm alive”
• Reflexes used in neurological exams
• Upper vs lower motor neuron signs

💡 Important Points:
👉 The spinal cord is not just a pathway—
it is a processing center for movement, sensation, and reflexes.

📢 Notes
Your spinal cord is your body’s communication highway 🚦
Cut the signal → everything below changes.

03/04/2026

🔍 What is it?

🔷A Hill-Sachs lesion is a compression fracture (dent) on the posterosuperior humeral head caused when it forcefully impacts the anterior glenoid rim during an anterior shoulder dislocation.

⚙️ Mechanism (Why it happens)

➡️ Shoulder dislocates anteriorly
➡️ Humeral head slams into glenoid rim
➡️ Soft bone gets indented (compression fracture)
➡️ Leads to structural instability

⚠️ Why it matters
• Present in ~80% of recurrent dislocations
• Key cause of chronic shoulder instability
• Often occurs with:
🔴 Bankart lesion (labral tear)

🚨 Symptoms
• Shoulder pain
• Feeling of slipping / instability
• Clicking or catching sensation
• ⚡ Apprehension in abduction + external rotation (throwing position)

🧪 Diagnosis
• X-ray → initial detection
• MRI / CT → assess size + engagement
• Important concept:
👉 “Engaging lesion” = higher risk of recurrence

🛠️ Treatment
🟢 Small lesions (

03/04/2026

Innervation in the Quadrangular & Triangular Space of the Shoulder ✅

03/04/2026

Somatic Nervous System (SNS) { Clinical Summary }

The Somatic Nervous System is the division of the Peripheral Nervous System (PNS) responsible for our voluntary interactions with the external environment. It provides the "wiring" for both the movement of our muscles and the sensations from our skin and joints.

Unlike the Autonomic Nervous System (which uses a two-neuron chain), the Somatic Motor system uses a single neuron to travel from the CNS directly to the skeletal muscle.

1. Functional Divisions of the SNS
The SNS is categorized by the direction in which electrical impulses travel:

General Somatic Efferent (GSE) — Motor
Direction: Outward (CNS → Muscle).

Function: Transmits impulses to striated, skeletal muscles.

Action: Responsible for voluntary movements (like reaching for a cup) and involuntary reflex arcs (like pulling your hand away from a hot stove).

General Somatic Afferent (GSA) — Sensory
Direction: Inward (Body → CNS).

Function: Carries two main types of information:

Exteroceptive: Sensations from the outside world, including pain, temperature, pressure, and touch.

Proprioceptive: "Body position" data from muscles, tendons, and joints. This tells your brain where your limbs are in space without you having to look at them.

2. Anatomy of the Spinal Nerve
To understand how these fibers travel, we must look at the structure of a typical spinal nerve:

Ventral Root: Carries the Motor (GSE) fibers out of the spinal cord.

Dorsal Root: Carries the Sensory (GSA) fibers into the spinal cord. (Note the Dorsal Root Ganglion, which houses the cell bodies of these sensory neurons).

Spinal Nerve: The point where the ventral and dorsal roots merge. This is a "mixed" nerve containing both motor and sensory fibers.

Rami (Branches):

Dorsal Ramus: Supplies the skin and deep muscles of the back.

Ventral Ramus: Supplies the rest of the trunk and the limbs. Most major plexuses (like the Brachial or Lumbar plexus) are formed by ventral rami.

3. Clinical Implications
Reflex Testing: When a clinician taps a tendon (like the patellar reflex), they are testing the entire somatic arc: the GSA fibers carrying the stretch signal in, and the GSE fibers carrying the contraction signal out.

Proprioceptive Deficits: Patients with poor proprioception often have a "stamping" gait because they cannot sense where their feet are in relation to the floor, a common finding in sensory neuropathies.

Nerve Root Compression: Because the spinal nerve is "mixed," compression (like a herniated disc) often results in both weakness (motor) and numbness/pain (sensory) in a specific dermatomal or myotomal pattern.

Clinical Pearl
"When assessing a nerve injury, always distinguish between a Root issue and a Ramus issue. If a patient has sensory loss on their back and their chest, the lesion is likely at the Spinal Nerve or Root. If the back is perfectly normal but the chest is numb, the lesion is further out in the Ventral Ramus."