Musculoskeletal Anatomy Research Articles

Musculoskeletal ultrasound: a technical and historical perspective.

During the past four decades, musculoskeletal ultrasound has become popular as an imaging modality due to its low cost, accessibility, and lack of ionizing radiation. The development of ultrasound technology was possible in large part due to concomitant advances in both solid-state electronics and signal processing. The invention of the transistor and digital computer in the late 1940s was integral in its development. Moore's prediction that the number of microprocessors on a chip would grow exponentially, resulting in progressive miniaturization in chip design and therefore increased computational power, added to these capabilities. The development of musculoskeletal ultrasound has paralleled technical advances in diagnostic ultrasound. The appearance of a large variety of transducer capabilities and rapid image processing along with the ability to assess vascularity and tissue properties has expanded and continues to expand the role of musculoskeletal ultrasound. It should also be noted that these developments have in large part been due to a number of individuals who had the insight to see the potential applications of this developing technology to a host of relevant clinical musculoskeletal problems. Exquisite high-resolution images of both deep and small superficial musculoskeletal anatomy, assessment of vascularity on a capillary level and tissue mechanical properties can be obtained. Ultrasound has also been recognized as the method of choice to perform a large variety of interventional procedures. A brief review of these technical developments, the timeline over which these improvements occurred, and the impact on musculoskeletal ultrasound is presented below.

Learner Preference on the Teaching Modalities in Musculoskeletal Anatomy in the New Normal: A Cross-sectional Study Comparing Dissection Educational Videos and Self-directed Manual to Proctor-assisted Cadaver Dissection.

The COVID-19 pandemic affected all medical education because of the suspension of face-to-face learning and stringent protocols. Various methods of teaching were introduced to augment anatomical learning. As we enter the transition period and loosening of protocols for face-to-face learning, we want to know if these modes of teaching are still preferred and suitable or the traditional proctor-assisted dissection is preferable among first year medical students. This descriptive cross-sectional study recruited first-year medical students currently enrolled at the University of the Philippines College of Medicine during the Department of Anatomy Learning Enhancement Program (LEAP) from June 13-17, 2022. One station caters to musculoskeletal anatomy. The musculoskeletal station is further divided into four mini stations: a prosected lower extremity cadaver with labels of must know anatomic structures for the proctor-assisted cadaver dissection; a prosected lower extremity with a self-directed manual for the students to follow; a large screen television for the dissection educational videos focusing on the shoulder girdle; and lastly, skeletons for osteology. Thirty minutes were allotted per sub-station in the musculoskeletal station of LEAP. After completing the station, the students were provided with evaluation forms and a 30-item survey to determine the preferred teaching modality in musculoskeletal anatomy. A total of 145 students out of the 178 students participated and answered the survey and evaluation form. Ninety-nine percent of the students rated the proctor-assisted dissection station great and excellent (13% and 86%, respectively) and that 86% of the students preferred proctor-assisted dissection among the teaching modalities. Additionally, 89% (46% strongly disagreed and 43% disagreed) and 83% (55% strongly disagreed and 28% disagreed) of the students disagreed that they prefer self-directed module or dissection educational videos over traditional dissection, respectively. Most of the students also agreed that the inability of face-to-face dissection will affect their medical education (35% agreed and 64% strongly agreed) and majority of them thinks that cadaver dissection is vital in their medical education and towards becoming a doctor (14% agreed, 86% strongly agreed). With the plethora of teaching modalities introduced during the pandemic, medical students still preferred the traditional proctor-assisted dissection. However, they see the value of the other teaching modalities as an added armamentarium in enhancing anatomical knowledge.

Evaluation of Modified Thiel Soft-embalmed Cadavers as a Novel Teaching Model for Musculoskeletal Ultrasound and Anatomy among Rehabilitation Medicine Residents.

This study aimed to determine the perceptions of rehabilitation medicine resident trainees on using modified Thiel soft-embalmed cadavers as a learning tool in acquiring knowledge on musculoskeletal ultrasound (MSK-UTZ) and anatomy. This descriptive cross-sectional study used total enumeration to recruit residents in training under the rehabilitation medicine department of a tertiary referral hospital. An online survey tool was self-administered to determine their perceptions on the use of MSK-UTZ on Thiel-embalmed cadavers. Pre- and post-test scores were compared to determine if their knowledge has improved. Fifteen participants were recruited, who answered the pre- and post-test, and the online survey. The mean pre-test score of participants was 5.87 (±1.68), and the mean post-test score was 6.87 (±2.00). There was no statistically significant difference (P = 0.20) using a paired t-test. At an arbitrary passing rate of 70%, only 5/15 participants passed the pre-test while 10/15 passed the post-test. A chi-square test of independence showed that there was no significant association between the number of participants who passed or failed on the pre- and post-test, X2 (1, N = 15) = 3.3, p = .0.068. Most of the perceptions of the participants were positive in terms of the use of modified Thiel soft-embalmed cadavers as a learning tool, its relevance in the training of a rehabilitation medicine resident, and the overall experience on its use. Thiel-embalmed cadavers as a learning tool was well-accepted, having generally positive perceptions from the participants mainly in terms of perceived enhancement of the understanding of the anatomical basis of musculoskeletal ultrasound, perceived improvement in skills in performing musculoskeletal ultrasound, and most even recommended that it be part of their training as rehabilitation medicine residents. In terms of acquiring knowledge on musculoskeletal ultrasound (MSK-UTZ) and anatomy, no significant improvement in knowledge was noted. Further studies with larger sample sizes are recommended to yield more statistically significant improvement in knowledge and to observe trends in the perceptions of participants.

Pedagogical impact of integration of musculoskeletal anatomy blended learning on physiotherapy education.

In physiotherapy education, blended learning is recognized to be more effective compared to traditional teaching. The aim of this study was to assess the consequences of a musculoskeletal anatomy blended learning program on skills developed by students. We conducted an observational retrospective monocentric study in a French physiotherapy school named "X." Ninety-two first-year students in the 2017-18 baseline group (students with traditional face-to-face learning), and ninety-eight first-year students and ninety-five second-year students in the 2018-19 and 2019-20 blended learning experimental groups was included. A success rate of the anatomy final written exam, defined by the percentage of students scoring 50% or above, was analyzed between 2017 and 2020. We also evaluated the pedagogical value of musculoskeletal e-learning and its usefulness for preparing the student for their anatomy final written exam at «X». We observed an improvement in the success rate of the anatomy final written exam between the 2017-18 baseline group, 2018-19 and 2019-2020 experimental groups during first (Kruskal-Wallis = 74.06, df = 2, p < 0.001) and second semester (Kruskal-Wallis = 173.6, df = 2, p < 0.001). We obtained a data survey and questionnaire response rate of 74% (n = 89/120) for the 2018-19 and 62% (n = 72/116) for the 2019-20 experimental groups. Concerning questionnaire response, they were no significant statistical difference between 2018-19 and 2019-20 experimental groups. Blended learning could improve student success rate of the anatomy final written exam and learning of professional physiotherapy skills.

Play in the reading room: Utilizing soft modeling compound to teach musculoskeletal anatomy and pathology.

Musculoskeletal (MSK) anatomy and pathology from a radiology perspective can be difficult to conceptualize and understand due to the challenge of visualizing 3D structures in stacks of 2D imaging. Consequently, trainees may benefit from inexpensive methods that can help trainees better visualize MSK anatomy and pathology. The purpose of this study is to provide proof of concept for inexpensive methodology to help learners such as radiology residents quickly and inexpensively understand musculoskeletal anatomy and pathology. This can help trainees become better at applying musculoskeletal knowledge to clinical practice. Soft-modeling compounds such as Play-Doh® was utilized in a variety of colors with pottery tools to recreate 3D models of challenging MSK anatomy and pathology for trainees. Qualitative feedback from the residents was collected. Eighteen different pathological conditions across six major bone structures were modeled with a soft modeling compound. Residents qualitatively identified the experience as educational in terms of helping them better understand MSK pathology and positive in terms of making learning fun, less stressful, and memorable due to uniqueness of the learning modality. Residents report challenges modeling complex anatomical features and pathology via this methodology. Radiology residents and other learners can enhance their knowledge of musculoskeletal anatomy and pathology via utilization of inexpensive soft modeling compounds. This may offer a cheaper and more time sensitive alternative to current 3-dimensional hardware and software technologies being developed for educational purposes. Additional work needs to be done to examine the utility of this methodology across larger and diverse groups of learners.

Gross and Applied Anatomy Pedagogical Approaches in Occupational Therapy Education: A Scoping Review.

Introduction. With technological advancements, anatomy teaching approaches in occupational therapy education have expanded. However, uncertainty remains regarding the approaches that best optimize academic and practice outcomes in student occupational therapists (OTs). Purpose. This scoping review mapped the pedagogical approaches used to teach musculoskeletal anatomy to student OTs. Methods. A scoping review was conducted, with a consultation exercise involving Canadian occupational therapy educators. Six databases were searched, with terms related to student OTs, anatomy, and education. Included articles were available in English, full text; featured empirical research of any study design and/or gray literature; featured a pedagogical approach used to teach anatomy; and targeted student OTs with the pedagogies. Results. Twenty-eight reports between 1978 and 2021 were included. Although technology-based pedagogies became more common with time, historically used pedagogies (e.g., lectures and labs) remained prominent and most common. Narrative synthesis regarding the effectiveness of anatomy pedagogical approaches identified five main factors: (a) anatomy competency; (b) teaching method diversity; (c) learner psychological considerations; (d) interprofessional education; and (e) optimal academic outcomes. Implications. This review demonstrates the importance of anatomy knowledge to occupational therapy education and practice. A diversity of pedagogical approaches, with and without technology, may foster better outcomes by addressing diverse learning needs.

Body painting, ultrasound, clinical examination, and peer-teaching: A student-centered approach to enhance musculoskeletal anatomy learning.

The presented course, established 2016 as a compulsory elective for 22nd-year bachelor medical students, aimed to enhance deep learning of upper and lower limb anatomy from a clinical perspective by a maximum of student-centered activities combining hands-on skills training with team-learning. Three cohorts (in total 60 students) participated in this study. Students rotated through body painting, ultrasound, and clinical investigation supervised by faculty or an experienced clinician. Teams of 3-4 students prepared presentations on clinical anatomy and pathological conditions, which by teacher- and peer assessments on average achieved >85% (mean 17.8/20 points ± 1.06). After each activity session, the students reported their learning experience through a reflective diary. Fifty students (83%) evaluated the course by a voluntary anonymous questionnaire combining Likert-type scale and free-text questions to assess, predominantly, perception of course activities and their perceived influence on learning anatomy. Journal reports and questionnaires revealed that the students highly valued the course, and 92% (29 females, 17 males) rated group work satisfying or well-perceived. The highest appreciation achieved ultrasound followed by clinical examination and body painting, which one third proposed to integrate into the regular dissection course. All students recommended the course to their younger peers. This course was feasible to integrate in the pre-existing curriculum. Limiting factors to offer this elective course to more students are availability of clinical teachers, technical equipment, and education rooms. Being student-directed tasks, body painting and reflective diary-writing would be feasible to implement without additional faculty, which we recommend to educators for student engagement activation.

A surrogate forelimb: Evolution, function and development of the avian cervical spine.

The neck is a critical portion of the avian spine, one that works in tandem with the beak to act as a surrogate forelimb and allows birds to manipulate their surroundings despite the lack of a grasping capable hand. Birds display an incredible amount of diversity in neck morphology across multiple anatomical scales-from varying cervical counts down to intricate adaptations of individual vertebrae. Despite this morphofunctional disparity, little is known about the drivers of this enormous variation, nor how neck evolution has shaped avian macroevolution. To promote interest in this system, I review the development, function and evolution of the avian cervical spine. The musculoskeletal anatomy, basic kinematics and development of the avian neck are all documented, but focus primarily upon commercially available taxa. In addition, recent work has quantified the drivers of extant morphological variation across the avian neck, as well as patterns of integration between the neck and other skeletal elements. However, the evolutionary history of the avian cervical spine, and its contribution to the diversification and success of modern birds is currently unknown. Future work should aim to broaden our understanding of the cervical anatomy, development and kinematics to include a more diverse selection of extant birds, while also considering the macroevolutionary drivers and consequences of this important section of the avian spine.

Using represented bodies in Renaissance artworks to teach musculoskeletal and surface anatomy.

Surface anatomy is an important skill for students in preparation for patient care, and peer examination is often used to teach musculoskeletal and surface anatomy. An alternative pedagogical approach is to use bodies represented in artworks. Represented bodies display fictive anatomy, providing students with the opportunity to apply their musculoskeletal knowledge and to think critically when evaluating the anatomical fidelity of a represented body. An elective course at the University of Michigan enabled undergraduate students to analyze the musculoskeletal and surface anatomy depicted in Renaissance artworks. Students traveled to Italy in 2018 (n = 14) and 2022 (n = 15) to analyze the fictive anatomy portrayed in artistic sculptures and musculoskeletal structures depicted in wax anatomy models and sculpted skeletons. In assignments, students were asked to identify musculoskeletal structures as portrayed in the context of represented anatomy created by Italian Renaissance artists and to assess the fidelity of the depicted anatomy. The students also applied their knowledge of musculoskeletal anatomy to describe body position and evaluate muscle function in their assessments of the accuracy or inaccuracy of the fictive anatomy. The students reported that evaluating the anatomical fidelity of represented bodies in artworks supported their learning of musculoskeletal and surface anatomy, and that their critical thinking skills improved in the course. Evaluation of the anatomical fidelity of represented bodies in artworks is an effective pedagogical approach that can be implemented in art museums as an adjunctive learning experience to deepen students' musculoskeletal and surface anatomy knowledge and further develop their critical thinking skills.

Consolidation Carnival: A Case-Based Approach to Reviewing Musculoskeletal Anatomy in an Undergraduate Medical Curriculum.

Recent changes in undergraduate medical curricula have resulted in time constraints that are particularly challenging, especially when students must learn large blocks of musculoskeletal anatomy content. Consequently, students have resorted to rote memorization to cope, which counteracts our established collaborative self-directed learning model. For a 6-week musculoskeletal anatomy course, two structured case-based review sessions are described, each following the completion of two five-hour lab sessions, two on the upper extremities and two on the lower extremities. These largely self-directed review sessions consisted of 6 students rotating through 7 to 8 stations every 10 minutes where clinical cases with follow-up questions were projected on large screens. The students were expected to work collaboratively to solve the cases utilizing the prosected specimens provided and discuss the accompanying answers at the end of each case. Ninety-four per cent of the students who participated in this study agreed that the case-based review sessions provided a helpful overview of musculoskeletal anatomy content. Student performance on the open-ended, case-based musculoskeletal examination questions showed no significant difference in performance on shoulder, hand, hip, thigh, and leg questions. There was, however, a statistically significant decrease in the students' scores on a forearm question in 2021 compared to 2019. This paper describes our integrated, collaborative musculoskeletal course, including case-based review sessions, which was positively received by students as having value in reviewing the musculoskeletal content though it was not found to improve examination performance.

Considerations for the Value of Dynamic Virtual Models for Clinical Musculoskeletal Anatomy Education.

Considerations for the Value of Dynamic Virtual Models for Clinical Musculoskeletal Anatomy Education.

Pathophysiologic Spine Adaptations and Countermeasures for Prolonged Spaceflight.

Low back pain due to spaceflight is a common complaint of returning astronauts. Alterations in musculoskeletal anatomy during spaceflight and the effects of microgravity (μg) have been well-studied; however, the mechanisms behind these changes remain unclear. The National Aeronautics and Space Administration has released the Human Research Roadmap to guide investigators in developing effective countermeasure strategies for the Artemis Program, as well as commercial low-orbit spaceflight. Based on the Human Research Roadmap, the existing literature was examined to determine the current understanding of the effects of microgravity on the musculoskeletal components of the spinal column. In addition, countermeasure strategies will be required to mitigate these effects for long-duration spaceflight. Current pharmacologic and nonpharmacologic countermeasure strategies are suboptimal, as evidenced by continued muscle and bone loss, alterations in muscle phenotype, and bone metabolism. However, studies incorporating the use of ultrasound, beta-blockers, and other pharmacologic agents have shown some promise. Understanding these mechanisms will not only benefit space technology but likely lead to a return on investment for the management of Earth-bound diseases.

3D atlas of tinamou (Neornithes: Tinamidae) pectoral morphology: Implications for reconstructing the ancestral neornithine flight apparatus.

Palaeognathae, the extant avian clade comprising the flightless ratites and flight-capable tinamous (Tinamidae), is the sister group to all other living birds, and recent phylogenetic studies illustrate that tinamous are phylogenetically nested within a paraphyletic assemblage of ratites. As the only extant palaeognaths that have retained the ability to fly, tinamous may provide key information on the nature of the flight apparatus of ancestral crown palaeognaths-and, in turn, crown birds-as well as insight into convergent modifications to the wing apparatus among extant ratite lineages. To reveal new information about the musculoskeletal anatomy of tinamous and facilitate development of computational biomechanical models of tinamou wing function, we generated a three-dimensional musculoskeletal model of the flight apparatus of the extant Andean tinamou (Nothoprocta pentlandii) using diffusible iodine-based contrast-enhanced computed tomography (diceCT). Origins and insertions of the pectoral flight musculature of N. pentlandii are generally consistent with those of other extant volant birds specialized for burst flight, and the entire suite of presumed ancestral neornithine flight muscles are present in N. pentlandii with the exception of the biceps slip. The pectoralis and supracoracoideus muscles are robust, similar to the condition in other extant burst-flying birds such as many extant Galliformes. Contrary to the condition in most extant Neognathae (the sister clade to Palaeognathae), the insertion of the pronator superficialis has a greater distal extent than the pronator profundus, although most other anatomical observations are broadly consistent with the conditions observed in extant neognaths. This work will help form a basis for future comparative studies of the avian musculoskeletal system, with implications for reconstructing the flight apparatus of ancestral crown birds and clarifying musculoskeletal modifications underlying the convergent origins of ratite flightlessness.

Ultrasound versus videos: A comparative study on the effectiveness of musculoskeletal anatomy education and student cognition.

Ultrasound imaging is a dynamic imaging technique that uses high-frequency sound waves to capture live images of the structures beneath the skin. In addition to its growing use in diagnosis and interventions, ultrasound imaging has the potential to reinforce concepts in the undergraduate medical curriculum. However, research assessing the impact of ultrasound on anatomy learning and student cognition is scarce. The purpose of this study was to compare the impact of ultrasound-based instruction versus narrated videos on students' understanding of anatomical relationships, as well as the role of intrinsic motivation, self-efficacy beliefs, and students' attitudes in this process. A booster course on anterior leg and wrist anatomy was offered to second-year medical students. A randomized controlled trial with a cross-over design allocated students to either an ultrasound-based teaching condition (cohort A) or a narrated anatomy video condition (cohort B). Next, participants were crossed to the alternative intervention. At the start of the study (T0), baseline anatomy knowledge, intrinsic motivation, self-efficacy beliefs, and spatial ability were measured. After the first intervention (T1) and at the end of the study (T2), both cohorts were administered an anatomy test, an intrinsic motivation scale, and a self-efficacy scale. In addition, each student was asked to fill out a perception survey after the ultrasound intervention. Finally, building on the cross-over design, the most optimal sequence of interventions was examined. A total of 181 students participated (cohort A: n = 82, cohort B: n = 99). Both cohorts performed comparably on the baseline anatomy knowledge test, spatial ability test, intrinsic motivation, and self-efficacy scale. At T1, cohort B outperformed cohort A on the anatomy test (p = 0.019), although only a small effect size could be detected (Cohen's d = 0.34). Intrinsic motivation and self-efficacy of both cohorts were similar at T1. At T2, the anatomy test, intrinsic motivation, and self-efficacy scale did not reflect an effect after studying either sequence of the interventions. Students reported favorably about the ultrasound experience, but also mentioned a steep learning curve. Medical students found the hands-on ultrasound sessions to be valuable, increasing their interest in musculoskeletal anatomy and ultrasound imaging. However, the addition of ultrasound did not result in superior spatial anatomy understanding compared to watching anatomy videos. In addition, ultrasound teaching did not have a major effect on student cognition. Ultrasound-based teaching of musculoskeletal anatomy is regarded as difficult to learn, and therefore it is hypothesized that too high levels of cognitive load might explain the presented results.

A theory of physiological similarity in muscle-driven motion

Muscle contraction is the primary source of all animal movement. I show that the maximum mechanical output of such contractions is determined by a characteristic dimensionless number, the "effective inertia," Γ, defined by a small set of mechanical, physiological, and anatomical properties of the interrogated musculoskeletal complex. Different musculoskeletal systems with equal Γ may be considered physiologically similar, in the sense that maximum performance involves equal fractions of the muscle's maximum strain rate, strain capacity, work, and power density. It can be demonstrated that there exists a unique, "optimal" musculoskeletal anatomy which enables a unit volume of muscle to deliver maximum work and power simultaneously, corresponding to Γ close to unity. External forces truncate the mechanical performance space accessible to muscle by introducing parasitic losses, and subtly alter how musculoskeletal anatomy modulates muscle performance, challenging canonical notions of skeletal force-velocity trade-offs. Γ varies systematically under isogeometric transformations of musculoskeletal systems, a result which provides fundamental insights into the key determinants of animal locomotor performance across scales.

Low morphological disparity and decelerated rate of limb size evolution close to the origin of birds.

The origin of birds from theropod dinosaurs involves many changes in musculoskeletal anatomy and epidermal structures, including multiple instances of convergence and homology-related traits that contribute to the refinement of flight capability. Changes in limb sizes and proportions are important for locomotion (for example, the forelimb for bird flight); thus, understanding these patterns is central to investigating the transition from terrestrial to volant theropods. Here we analyse the patterns of morphological disparity and the evolutionary rate of appendicular limbs along avialan stem lineages using phylogenetic comparative approaches. Contrary to the traditional wisdom that an evolutionary innovation like flight would promote and accelerate evolvability, our results show a shift to low disparity and decelerated rate near the origin of avialans that is largely ascribed to the evolutionarily constrained forelimb. These results suggest that natural selection shaped patterns of limb evolution close to the origin of avialans in a way that may reflect the winged forelimb 'blueprint' associated with powered flight.

Ultra-high-field MRI of postmortem human fetal wrist joints: initial experience

BackgroundThis study aimed to assess the feasibility of postmortem ultra-high-field magnetic resonance imaging (UHF-MRI) to study fetal musculoskeletal anatomy and explore the contribution of variation in iodine and formaldehyde (paraformaldehyde, PFA) treatment of tissue.MethodsSeven upper extremities from human fetuses with gestational ages of 19 to 24 weeks were included in this experimental study, approved by the Medical Research Ethics Committee. The specimens were treated with various storage (0.2–4% PFA) and staining (Lugol’s solution) protocols and the wrist joint was subsequently imaged with 7.0 T UHF-MRI. Soft-tissue contrast was quantified by determining regions of interest within a chondrified carpal bone (CCB) from the proximal row, the triangular fibrocartilage (TFC), and the pronator quadratus muscle (PQM) and calculating the contrast ratios (CRs) between mean signal intensities of CCB to TFC and CCB to PQM.ResultsUHF-MRI showed excellent soft-tissue contrast in different musculoskeletal tissues. Increasing storage time in 4% PFA, CRs decreased, resulting in a shift from relatively hyperintense to hypointense identification of the CCB. Storage in 0.2% PFA barely influenced the CRs over time. Lugol’s solution caused an increase in CRs and might have even contributed to the inversion of the CRs.ConclusionsUHF-MRI is a feasible technique to image musculoskeletal structures in fetal upper extremities and most successful after short storage in 4% PFA or prolonged storage in 0.2% PFA. The use of Lugol’s solution is not detrimental on soft-tissue MRI contrast and therefore enables effectively combining UHF-MRI with contrast-enhanced micro-computed tomography using a single preparation of the specimen.Relevance statementUHF-MRI can be performed after CE-micro-CT to take advantage of both techniques.Key points• UHF-MRI is feasible to study human fetal cartilaginous and ligamentous anatomy.• Storage in low PFA concentrations (i.e., 0.2%) improves soft-tissue contrast in UHF-MRI.• Limited preservation time in high concentrations of PFA improves soft-tissue contrast in UHF-MRI.• Prior staining with Lugol’s solution does not reduce soft-tissue contrast in UHF-MRI.Graphical

Residents' Perceptions of a Novel Virtual Livestream Cadaveric Teaching Series for Musculoskeletal Anatomy Education.

Musculoskeletal anatomy education is essential to many healthcare providers but has consistently been considered difficult for various reasons. Traditional methods have focused on in-person cadaveric teaching, which became inaccessible during the COVID-19 pandemic; therefore, new teaching methods were developed to address this gap in education. This project implemented novel virtual livestream musculoskeletal anatomy teaching methodology with cadaveric prosections and evaluated the efficacy of this modality compared with traditional in-person cadaveric teaching. A targeted musculoskeletal anatomy curriculum was developed and delivered via livestream to 12 Canadian physiatry residents. Upon completing the virtual curriculum, residents completed an anonymous survey assessing this new virtual livestream cadaveric methodology compared with previous experiences with traditional in-person anatomy teaching. The survey response rate was 92%. Most participants (73%) rated the virtual livestream sessions as better than traditional in-person teaching. Reasons included better visualization of cadaveric anatomy and easy discussion among the group. T test analysis comparing both methods demonstrated the livestream method was equivalent or better across several domains. Virtual livestream teaching is a viable method for teaching the important subject of musculoskeletal anatomy. Educators should consider how to best integrate this approach into future anatomy curricula.

Ontogeny of cranial musculoskeletal anatomy and its relationship to allometric increase in bite force in an insectivorous bat (Eptesicus fuscus).

Bite force is a performance metric commonly used to link cranial morphology with dietary ecology, as the strength of forces produced by the feeding apparatus largely constrains the foods an individual can consume. At a macroevolutionary scale, there is evidence that evolutionary changes in the anatomical elements involved in producing bite force have contributed to dietary diversification in mammals. Much less is known about how these elements change over postnatal ontogeny. Mammalian diets drastically shift over ontogeny-from drinking mother's milk to feeding on adult foods-presumably with equally drastic changes in the morphology of the feeding apparatus and bite performance. Here, we investigate ontogenetic morphological changes in the insectivorous big brown bat (Eptesicus fuscus), which has an extreme, positive allometric increase in bite force during development. Using contrast-enhanced micro-computed tomography scans of a developmental series from birth to adult morphology, we quantified skull shape and measured skeletal and muscular parameters directly related to bite force production. We found pronounced changes in the skull over ontogeny, including a large increase in the volume of the temporalis and masseter muscles, and an expansion of the skull dome and sagittal crest that would serve to increase the temporalis attachment area. These changes indicate that development of the jaw adductors play an important role in the development of biting performance of these bats. Notably, static bite force increases with positive allometry with respect to all anatomical measures examined, suggesting that modifications in biting dynamics and/or improved motor coordination also contribute to increases in biting performance.

Medical Student-Run Free Orthopaedic Clinic: Impact of Coordinator Role on Specialty Selection

Background: Medical student-run free clinics provide opportunities for future physicians to accrue practical experience early in their medical education. Subspecialty clinics including orthopaedics provide a unique opportunity to gain exposure to musculoskeletal anatomy and pathology. These clinics are organized and managed by a student clinic coordinator. In this study, we seek to understand the impact that being the clinic coordinator of the musculoskeletal clinic plays in specialty selection. &#x0D; Methods: A descriptive study was conducted by gathering electronic survey responses from former student clinic coordinators at the Penn State College of Medicine student-run musculoskeletal clinic from years, 2009 to 2017. The respondents described the influence of the coordinator role on residency selection. Additionally, the survey consisted of a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree) regarding the student’s motivation for participating in the clinic as a coordinator.&#x0D; Results: From 2009 to 2017, there were 18 LionCare Orthopaedic Surgery Clinic Coordinators with a male-to-female ratio was 1.25:1. Residency specialty selection was Orthopaedic Surgery (n=8, 44.4%), Physical Medicine &amp; Rehabilitation (4, 22.2%), Family Medicine (2, 11.1%), Cardiothoracic Surgery (1, 5.6%), General Surgery (1, 5.6%), Obstetrics &amp; Gynecology (1, 5.6%), and Emergency Medicine (1, 5.6%). The most commonly cited reason for participation as clinic coordinator was “interest in helping an underserved population.” &#x0D; Conclusions: The study illustrates an association between the role of orthopaedic clinic coordinator and entering a specialty focused on musculoskeletal care. More than half of the students who participated as a clinic coordinator pursued specialties involving musculoskeletal care (Orthopaedics and Physical Medicine &amp; Rehabilitation). Student-run medical clinics present an opportunity to provide early exposure to musculoskeletal medicine and potential avenue for orthopaedic education and mentorship.