The Dissection Class Layout
Livestream class – The Joints of the body.
Six days starting 17th October 2022
The livestream day will start with a covering of what we have done the day before, or in the case of the first day, an introduction into what will be happening each session. A lot of this will be covered and explained in the orientation videos so it’s a good idea to check those out before the sessions start.
The process of dissection is generally quite slow and not always that interesting to watch, so for the new sessions I’m going to be starting a few days in advance, taking the layers around each area away and filming the entire process as I go along. That way I will be able to jump ahead when we get to the livestreams and show you a more prepared dissection, but without you missing what has happened or anything I might have found.
Once I’ve shown you the process of how we got to a specific point, I’ll work on the cadavers that we have in front of us and keep the exploration going, looking at movement, connections, fascia and so forth. The whole session will be live, it’s just that I’ll be showing you some of the recorded highlights first. I can stop and start as I need to and answer any questions you might have, also having the capacity to go back and see certain things again.
During an in person class each day starts with a circle time where we touch base with each other, check in, see how we all are and share any thoughts or experiences. Obviously this isn’t going to work when we have lots of people all over the world tuning in, but I will encourage people to send in questions, comments and thoughts that can be relayed through the chat function, or through me reading things out.
The livestream sessions will last around two and a half hours each, after which I think that most people struggle to maintain focus for online content. All the sessions will be recorded and then made permanently available to watch again and again. I’ll be adding chapters as well, so that you’ll be able to navigate to key elements within the sessions.
Day One. The Knees
No matter how much anatomy you’ve studied, stepping into a dissection lab, even one that is a virtual one, is challenging. I’ll lead you in as gently as I can to the process and introduce you to the environment for a few minutes before we get fully going, but it’s important to pace yourself as we go along and take breaks when you need to.
I have created a series of orientation videos that will help to explain this and these are available when you sign up for the class.
I will introduce you to the donor forms (the cadavers) that we are working with and show you what we might have discovered during the initial assessment, where we will have looked for scarring, variations of movement and size and feeling for what is familiar under our hands. We always give our donors a name that allows us to refer to them in a way that is respectful and try to keep this as neutral as possible.
Having removed the layer of skin we will observe the deep fascia and the continuity of this around the knee, moving the knee around at all the stages of the dissection. I’m going to be dissecting the knee as a continual structure, rather than just focussing on the actual bones that make up the joint. This is an important aspect, as it’s the influences of the muscles, fascia and tissues above and below any joint, that provide the way the joint moves or becomes dysfunctional or painful.
I’ll be looking at the knee from the mid thigh to mid shin and considering all the tissues in that area as being relevant to the knee. I want to show the variations that there are of the fatty tissues around this area and how they start to change as the descend down the leg.
Once the deep fascia is reflected and revealed we will examine the muscular structures that cross and blend through and over the knees, as well as looking at how the fascia lata of the leg is continuous with the crural fascia of the lower limb.
As we examine the ligaments of the medial and lateral knee we will consider what tissues directly blend onto or around these and the tissues that also have an affect on the rest of the lower limb and its function will be established.
Fibularis and the connection to the biceps femoris will be seen and the role of the three muscles attaching to the tibia known as pez anseurnis will be dissected and discussed.
Finally we will examine ligaments of the knee such as the cruciate ligament. It is not uncommon for us to find total knee replacement skin our donors and if this is the case we will examine the process of surgery and the associated scarring in the area.
Day Two. The Hip Joint
The skin and superficial fascia and it’s blending into the underline layers around the gluteus is unique and seems to create a tensional band which blends into the thoracolumbar fascia. Its potential role in back pain is something I have been considering. I will show you the various stages of this area as it is dissected and explain how this may affect hip and lower back function.
The hips and the tissues that surround them, will be reflected and discussed on both the anterior, lateral and posterior aspects of the donors.
The iliotibial band and its impact on function and range will be discussed and the way that this tissue blends with the rest of the lower limb fascia will be examined.
I will look at the overlying lateral rotators of the hip such as obturator internus and piriformis and quadratus femoris, before examining the labrum which wraps around the head of the femur to enclose the hip joint.
From here we will look at blood supply to the joints as we open up the joint capsule. We regularly encounter hip replacement surgeries in donors and will look at the effects of this compare this from side to side in terms of connective tissue, scarring and fascia if we do happen to encounter such surgery.
The sciatic nerve is ever present in this area and we will look at some of the branches and some anterior nerves that tend not to get looked at to the same degree.
Day Three. The Sacroiliac – SI Joint
There are a lot of ideas and misconceptions that surround the SI joint and how much movement exists within this relationship. We will examine the joint having removed the strong connections of the thoracolumbar fascia to the gluteus muscles and will also consider the role of the video lumbar ligament in stabilising the sacrum pelvis.
Where possible we will consider the SI joints from its anterior position, although this requires considerable reflection of the internal pelvic structures and reproductive organs this may not be possible in the timescale and have.
We will take the soft tissue back as far as possible to the joint to examine the degree to which movement is present in our donors and consider the depth of tissue that overlays this structure.
At each stage we will mobilise through the joint and will also be showing the comparisons of recording mobilisation at each stage
Day Four. The Shoulder Joint and Rotator Cuff
The shoulder is the most mobile joint in the body and as such tends to have less in the way of deep fascia that sits across the top of it. We will examine the depth of skin and superficial fascia in this area before reflecting the deltoid and trapezius to look at the scapular and its mobility in relation to each shoulder.
The short and long head of the biceps have enormously strong tendonous connections over the top of the joint and we will look at these as well as exploring the glenoid labrum that sits around the shoulder joint which also incorporates the glenohumeral ligaments.
We will examine sample of the nervous tissues and nerves that run into the shoulder and will constantly assess movement and functional range as we progress.
Structures that contribute to shoulder stability and function such as teres major and minor will also be considered and reviewed.
Day Five. The Ankle Joints
The four main areas of consideration this dissection will be the relationships between the tibia, the fibula, the calcaneus, and the navicular.
We will look at the role of the long muscular levers and ligaments that descend from the middle of the lower leg and cross over these bones and will consider how foot positioning, gait and loading might affect function and performance throughout the body.
The retinacular fibres that form part of the fascia of the lower limb will be compared and discussion relating to the superficial and plantar fascia, as well as an examination of the nerves that innervate the foot, will be part of this session.
We will be looking at the attachment of the Achilles tendon the role of the plantaris which if present is embedded into the fabric of the Achilles.
Day Six. Spinal Joints
In this last session we will look at spinal discs and how they are embedded and attached between spinal joints.
We will look at the ligaments that travel across the spine, both deep to the abdminal cavity but also on the superificial aspect of the spine.
The facet joints are an often misunderstood and neglected aspect of the spine and we will look at the depth of some of these as well as the attachments around them.
Similarly the costovertebral joints and the degree to which they move and flex, are often missed when considering pain and restriction. We will look at these and take the microscope into the soft tissue to examine the fine connections and tissues that blend in and across the joints.