Background/Purpose:

Knowledge of musculoskeletal anatomy (MSA) is essential for physicians such as rheumatologists, orthopedic surgeons, physiatrists, generalists, and other professionals for whom a musculoskeletal-centered physical examination is a central component of their patient assessments. Teaching methods of MSA range from cadaver dissection to technology-heavy virtual anatomy. Large student classes, a shortage of instructors, and a dearth of available cadavers have shifted anatomical education from the former to the latter and other innovative methods. To these, we are adding deductive anatomy by self-examination (DASE), which is based on self-inspection, self-palpation, plus an additional channel the other ancillary methods lack, self-perception by the explored structure. The objective of this presentation is to introduce the concept of DASE and describe exercises using DASE that explore the upper and lower extremities.

Methods:

DASE exercises follow a set pattern. 1. The targeted anatomical items involved are described. 2. The re-arrangement brought by the motion of the related joint(s) of the targeted items is hypothesized. 3. The targeted items are analyzed through inspection, palpation and the explored items perception during motion of one’s own body part. 4. The new geometrical arrangement is understood. 5. The clinical applications of the exercise are correlated. Filmed exercises will be shown.

Results:

Thirty-seven DASE exercises were designed by authors consensus. In the upper extremity, they included, as examples, the palpatory recognition of the lateral bands of the digital extensor mechanism, the action of interosseal and lumbrical muscles, a functional distinction of the flexor and the extensor wrist pulleys, and abstruse functions such as prono-supination and the external rotation of the humerus required for arm elevation. In the lower extremity, examples include the ischiotibial muscles and the hip abductors during ambulation, re-arrangement of items caused by knee flexion, and the co-ordination of leg muscles during ankle motion. The above exercises elucidate anatomic relationships during normal movement and help understand the deformities caused by joint, capsule, or tendon damage, some shoulder limitations, gait disorders, and more.

Conclusion:

We propose DASE as an N=1 supplementary strategy to current teaching of MSA. DASE provides unlimited opportunities to reinforce knowledge at no cost, and the understanding of complex anatomical regions may be improved. Enthusiastic feedback obtained at recent seminars suggest the potential utility of DASE in medical school and postgraduate curricula at a time in which more active learning and teaching techniques are being encouraged and incorporated, but controlled studies of the educational outcomes and reproducibility will be needed.

Acknowledgement:

We thank Fernando Peña for expert movies production.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/deductive-anatomy-by-self-examination-a-novel-method-to-reinforce-traditional-teaching-of-musculoskeletal-anatomy/