ultrasound pathology of renal dysfunctions and the...
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Ultrasound Pathology of Renal Dysfunctions and the Impact of Osteopathic Manual Therapy
Dr. med. Rainer Heller D.O.M.
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Philosophy of Osteopathy A.T. Still (1897) lack of knowledge about the kidney
At what time was the man and woman born that knew and left on record a true and reliable knowledge of the renal capsule.
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Agenda
The relevance of kidneys in different medical systems
Sonographic examples of normal and dysfunctional kidneys
Pilotstudy: Ultrasound mobility of kidneys with Somatic Dysfunction (SD) before and after osteopathic manipulative treatment (OMT)
Results
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Kidney - Physiology
The whole blood volume of the body circulates 300 times per day through the kidneys adding up to 1800 l, thus filtrating 170 l of primary urine
20% of cardiac output is circulating through both kidneys
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In TCM we are confronted with the idea of Qi,
which represents the essential energy which flows in the meridians
The kidney has a dominant role within this system Direct Guidebook of Medicine ◦ „the lung is the governor of Qi and the kidney is the root
of Qi“ Xinnong, Chinese Acupuncture and Moxibustion, p32-35:1990
TCM
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mod. T. Myers, Anatomy Trains, p.182: 2009
The correlation of the kidney-meridian and the myofascial system
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Litvinov, I.A.: Osteopathic Lecture Notes
The Kidney –Fulcrum of the Central Myofascial Web ?
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Symptoms reported with Renal Somatic Dysfunction N=31 Pts.
Primal Picture Ltd., 2001; mod. T. Myers, Anatomy Trains, p.182: 2009
Headaches (4) ENT (7) TMD (6) Cervicodorsalgia (8) SHP & Arms (7) Chest & Lung (4) Abdominal Syndrome/Digestion (9)
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Symptoms reported with Renal Somatic Dysfunction N=31 Pts.
Back- or Groinpain (12) Ischialgia (2) Knee (6) Ankle&Foot (6) Anogenital
Syndrome (1) Recurrent
Cystitis (3)
mod. T. Myers, Anatomy Trains, p.182: 2009
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Internal & Neurological Findings Hypertension: 9 pts Threoid Disorder: 8 pts Nephrology : 2 pts
(kidney stones and renal insufficieny)
Hypospermatogenesis: 1 pt Parkinson´s Disease: 1 pt Hx of Phlebothrombosis: 1 pt Primary Biliary Cirrhosis: 1 pt chronic Hepatitis C : 1 pt
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Agenda
The relevance of kidneys in different medical systems
Sonographic examples of normal and dysfunctional kidneys
Pilotstudy: Ultrasound mobility of kidneys with Somatic Dysfunction (SD) before and after OMT
Results
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The Kidneys - Fascias
transversal fascia dorsal and ventral
layer of renal fascia
cranial adherence to diaphragm
layers of renal fascia are filled with brown adipose tissue (capsula adiposa)
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Perirenal Fat is organized as pericapsular appendices
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Normal Right Kidney ©dpa
dpa (2011)
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Right Kidneys Sonographic Mobility - Sagittal Plane
Paoletti, S.: Les fascias, 84 (1998)
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Normal Left Kidney with overlying Left Colonic Flexure
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Adhesions
frequently found in sites of the „renal junction lines“ (interrenuncular embryological seams)
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Adhesion after OMT
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Adhesion after Tumor Resection
Female pt,, 67y, complaining of backpain. History of renal cell carcinoma (left kidney, Resection 25y ago. Consecutive Skoliosis
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Kidney Stones with Hydronephrosis
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Renal Contusion and Rupture
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Contusion of Right Kidney
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Agenda
The relevance of kidneys in different medical systems
Sonographic examples of normal and dysfunctional kidneys
Pilotstudy: Ultrasound mobility of kidneys with Somatic Dysfunction (SD) before and after OMT
Results
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Ultrasound Mobility of Kidneys with Somatic Dysfunction before and after OMT - a prospective and controlled Pilotstudy
Purpose: To evaluate the influence of OMT on ultrasound mobility and ultrasound behavior of kidneys with osteopathic somatic dysfunctions
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Ultrasound Mobility of Kidneys with Somatic Dysfunction before and after OMT - a prospective and controlled Pilotstudy
Design:
Setting:
Prospective, controlled and non randomized study
Private Office for Internal Medicine and Osteopathic Manipulative Medicine
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Ultrasound Mobility of Kidneys with Somatic Dysfunction before and after OMT - a prospective and controlled Pilotstudy
Participants: 31 consecutive patients with various complaints and fascial pull to one kidney on consultation, 21 in Control Group (opposite kidney)
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Methods (1) Ultrasonographic examinations were performed in 31
restricted kidneys and in 21 opposite kidneys serving as controls.
Standard ultrasound access was used in supine or lateral succumbent position.
Sites of restricted motion with respiration were registered.
Clips were recorded within one cycle of a standardized respiratory maneuver
The excursions of the upper and lower poles were measured by postprocessing of the clips with the ultrasound machine´s calculation programs (ROM pre).
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Methods (2) Standardized multitechnique OMT was applied to the
restricted kidney.
Reevaluation was performed with same access, body position and respiratory maneuver.
Clips were recorded again. The excursions of the upper and lower poles were
measured (ROM post).
Statistical evaluation of data for intraobserver reproducibility, consistency and comparison of means was performed with SPSS® 18 (IBM®).
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Intervention
Multitechnique OMT applied to restricted kidney ◦ Functional manipulation of the lumbus ◦ HVLA/MET of the lower thoracic spine ◦MET of the renal fascia (stretch) ◦ Visceral renal mobilisation
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Agenda
The relevance of kidneys in different medical systems
Sonographic examples of normal and dysfunctional kidneys
Pilotstudy: Ultrasound mobility of kidneys with Somatic Dysfunction (SD) before and after OMT
Results
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Mobility & Restriction Site before OMT
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Viscoelasticity after OMT
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Results
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Conclusions
Ultrasound seems capable to depict SD of the kidneys as far as impairment of mobility and viscoelasticity is concerned
OMT improved sonographic findings
OMT significantly improved ROM in kidneys with SD
OMT significantly improved ROM compared to the non-treated side
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Conclusions OMT did not affect the ultrasound behavior
of the non-treated kidney
OMT of kidneys with SD improved clinical outcome
The OMT protocol of the study should not be applied to very mobile kidneys
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Bibliography A.D.A.M. MediaPro: Clinical Illustrations for Powerful Presentations
(1998) dpa (2011) Klinke/Silbernagl: Lehrbuch der Physiologie, Thieme (1997) McMillin, D.: Early American Manual Therapy V.6.0 (2008) Millard, F.R.: Anatomy of the Lymphatics (1922) Litvinov, I.A.: Osteopathic Lecture Notes Myers, T.: Anatomy Trains (2009) Paoletti, S.: Les fascias (1998) Primal Pictures: Complete Human Anatomy (2001) Primal Pictures: Interactive Functional Anatomy (2005) Private Archives IBM Statistical Package for Social Sciences 18.0 for MacOsX Still, A.T.: Philosophy of Osteopathy (1897) Still, A.T.: Autobiography (1897) Xinnong,C.: Chinese Acupuncture and Moxibustion (1990)
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Publications Ayoub, J., R. Cohendy, et al. (1997). "Non-invasive quantification of
diaphragm kinetics using m-mode sonography." Canadian journal of anaesthesia = Journal canadien d'anesthesie 44(7): 739-744.
Bih, L. I., Y. T. Wu, et al. (2004). "Comparison of ultrasonographic renal
excursion to fluoroscopic diaphragmatic excursion for the assessment of diaphragmatic function in patients with high cervical cord injury." Archives of physical medicine and rehabilitation 85(1): 65-69.
Jousela, I., A. Makelainen, et al. (1992). "Diaphragmatic movement using
ultrasound during spontaneous and mechanical ventilation: effect of tidal volume." Acta anaesthesiologica Belgica 43(3): 165-171.
Jousela, I., J. Tahvanainen, et al. (1994). "Diaphragmatic movement
studied with ultrasound during spontaneous breathing and mechanical ventilation with intermittent positive pressure ventilation (IPPV) and airway pressure release ventilation (APRV) in man." Anaesthesiologie und Reanimation 19(2): 43-47.
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Publications Morgan, R. A. and P. A. Dubbins (1992). "Pancreatic
and renal mobility." Clinical radiology 45(2): 88-91. Tozzi, P., D. Bongiorno, et al. (2011). "Fascial release
effects on patients with non-specific cervical or lumbar pain." Journal of bodywork and movement therapies 15(4): 405-416.
Yamaguti, W. P., E. Paulin, et al. (2007). "Ultrasound
evaluation of diaphragmatic mobility in different postures in healthy subjects." Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 33(4): 407-413.