Anatomy Flashcards
The student is able to describe the concepts “tangential surface”, “normal”, “capsular pattern”, “closed pack position” and “maximal loose pack position”.
Tangential surface → the straight line you could draw from one edge of the concave part to the other.
Normal → perpendicular to the tangential surface
Capsular pattern → Order of movement limitations in a joint typical to inflammation of the entire joint capsule .
Closed pack position → Maximal fitting ball and socket;
Capsular ligament system maximally contracted; stability
Maximal loose pack position → All other positions: loose-packed positions; MLPP / resting position: great mobility; important position for examinations and treating the joint (non-specific traction and translation techniques)
The student is able to describe the arthrokinematic movements based on the convex/concave rule, for every joint to which this rule applies.
When changing the angle of the convex (=roll), translation takes place in the opposite direction (=slide)
When changing the angle of the concave (=swing), translation takes place in the same direction (=glide)
convex → complex → opposite
concaaf → braaf → same direction
The student is able to name the following aspects of art. humeri.
- Ball/socket
- Capsular pattern
- Normal/traction direction
- Ligaments and inhibitions of these ligaments
Ball → Caput Humeri
Socket → Caritas Glenoidale
Capsular pattern → Exo, abd, endo
Normal/traction direction → ventrolateral somewhat cranial
Ligaments and inhibitions of these ligaments →
Lig. glenohumerale superior: inhibits exo
Lig. glenohumerale mediale: inhibits exo and abd
Lig. glenohumerale inferior: inhibits exo and abd
Lig. coracohumerale anterior: inhibits retroflexion
Lig. coracohumerale posterior: inhibits anteflexion
The student is able to name the following aspects the SC joint
- Ball/socket
- Capsular pattern
- Normal/traction direction
- Ligaments and inhibitions of these ligaments
Ball → depression/elevation: Extremitas sternalis
protraction/retraction: Incisura clavicularis
Socket → dep/elv: Incisura clavicularis
pro/ ret: Extremitas sternalis
Capsular pattern → Max ROM and pain
Normal/traction direction → Lateral somewhat cranial from sternum
Ligaments and inhibitions of these ligaments →
Lig. interclaviculare: depression
Lig. costoclaviculare: elevation, protraction, axial rotation
Lig. sternoclaviculare anterius: retraction, axial rotation
Lig. stenroclaviculare posterius: protraction, axial rotation
The student is able to name the following aspects of the AC joint (if applicable).
- Ball/socket
- Capsular pattern
- Normal/traction direction
- Ligaments and inhibitions of these ligaments
Capsular pattern → Max ROM and pain
Normal/traction direction →
from acromion: medial, dorsal, caudal
from clavicle: lateral, dorsal, cranial
Ligaments and inhibitions of these ligaments →
Lig. acromioclaviculare: stabilize AC gewricht
Lig. coracoclaviculare: both stabilize AC gewricht
lig. conoideum and lig. trapezoideum
The student is able to name the following values of art. humeri
- The different movement possibilities of the joint
- CPP/MLPP
- Normal/traction direction
- ROMs of the different movements of the joint
- Directions of translation for the different movements
The different movement possibilities of the joint →
Anteflexie/retroflexie
Abductie/adductie
Endorotatie/exorotatie
CPP/MLPP →
CPP: max abd +exo + horizontal extension
MLPP: 60°abd ,60°antflex ,30°exo
Normal/traction direction → ventrolateral somewhat cranial
ROMs of the different movements of the joint → Anteflexie: 150°-170° Retroflexie: 40° Abductie: 180° Adductie: 20°-40° Endorotatie: 7° Exorotatie: 60°
Directions of translation for the different movements → Anteflexion: spin Retroflexion: spin Abduction: caudal Adduction: cranial Endorotation: dorsal somewhat medial Exorotation: ventral somewhat lateral
The student is able to name the following values of the SC joint
- The different movement possibilities of the joint
- CPP/MLPP
- Normal/traction direction
- ROMs of the different movements of the joint
- Directions of translation for the different movements
The different movement possibilities of the joint →
Elevation/depresion
Retraction/protraction
Axial rotation
Normal/traction direction → Lateral somewhat cranial (from sternum)
ROMs of the different movements of the joint → Elevation:40° Depression:10° Protraction:30° Retraction:25° Axial rotation: 45°
Directions of translation for the different movements → Elevation: caudal somewhat lateral Depression: cranial somewhat medial Protraction: ventral Retraction: dorsal Axial rotation: spin
The student is able to name the following values of the AC joint (if applicable).
- The different movement possibilities of the joint
- CPP/MLPP
- Normal/traction direction
- ROMs of the different movements of the joint
- Directions of translation for the different movements
The different movement possibilities of the joint →
Elevation/depression
Protraction/retraction
Lateral rotation/medial rotation
Normal/traction direction →
From acromion: medial, dorsal, caudal
From clavicle: lateral, dorsal, cranial
The student is able to name the functional anatomy of the high-cervical area.
The high-cervical area consist of C0 - C2. Between C1 and C2 is no disc. C0 = os occipital
→ C1 = Atlas
• The lack of a vertebral body
• Upper articular surfaces are concave
• Lower articular surfaces of C1 are convex
• Rudimentary spinous process
• Relatively large transversii process with a foramen
• C0 on C1 is a roll-slide movement through convex on concave. At C1 and C2, this is convex on convex, so there is no real roll-slide movement.
→ C2 = Axis
• The dens the tooth of the turner
• Anterior and posterior articular fascia
• Superior and inferior articular fovea
• Powerful spinous process
• Weak transverse process
• If the dens is not held in place by the transversum atlantis ligament, the dens can damage the spinal cord that lies behind it. Then there is high cervical instability. For this, high cervical stability tests are performed.
→ High cervical ligaments
- ligg. alaria (left/right): From the dens to the side of the foramen Magnum skull. Inhibits movability of the dens.
- lig. cruciforme atlantis: crosses behind dens. transversum atlantis and faciculi longitudinale. Inhibits movement dens. Right lig inhibits lateroflexion left.
- lig. apicis dentis. From top dens to sides of foramen magnum skull. Inhibits movement dens.
→ C2 = Axis
• The dens the tooth of the turner
• Anterior and posterior articular fascia
• Superior and inferior articular fovea
• Powerful spinous process
• Weak transverse process
• If the dens is not held in place by the transversum atlantis ligament, the dens can damage the spinal cord that lies behind it. Then there is high cervical instability. For this, high cervical stability tests are performed.
→ Mobility C0-C2
• Flexion Extension 45 degrees
• Rotation 83 degrees (le and right)
• Lateroflexion 8 degrees (le and right)
Flexion extension 45 degrees of which:
29 degrees between C0-C1
16 degrees between C1-C2
Rotation li-re → 83 degrees rotation of which:
2 degrees between C0-C1
81 degrees between C1-C2
Lateroflexion left/right →8 degrees 9 small
C0-C1 and C1-C2 together to left and right 8 degrees
The student is able to describe the structure of the vertebral joints
Facetjoints
- art. symphysis intervertebralis = the anterior intervertebral joint; This joint consists of 2 corpora + the intermediate discus
- art. zygapophysialis = posterior intervertebral joint
This joint consists of the superior articular process and the inferior articular process
The student is able to describe the structure of the costovertebral joints
The ribs are attached to the spine by art. costovertebralis:
- art. capitis costae joint consists of:
• caputcostae
• corpus vertebrae
• intervertebral disc - art. costotransversal joint consists of:
• tubercle costae
• transversus process
The student is able to list the movement possibilities of the vertebral joints.
• Cervical vertebrae:
- Facet joint in transversal plane
- longitudinal axis
- movement rotation
• Thoracic vertebrae:
- Facet joint in fontal plane
- sagital axis
- movement lateral flexion
• Lumbar vertebrae:
- Facet joint in sagital plane
- transversal axis
- movement flexion and extension
The intervertebral foramen becomes smaller with extension and with flexion the intervertebral foramen widens
The student is able to list the movement possibilities of the costovertebral joints.
The ribs move mainly during breathing:
Insulation: ribs move to: ventrally, laterally and cranially
Exhalation: ribs move towards: medial, dorsal and caudal
The following ribs are synchronic (less movement possible):
Rib 1: because it is attached directly to the manubrium sterni via the cartilage without there being a synovial joint in between (the art. sternocostalis).
Ribs 6 and 7: there is also no synovial joint in between, these ribs attach directly to the sternum
The student is able to list the movement possibilities of the SI joint.
- Nutation: the promoter moves forward, pelvic entrance becomes smaller, pelvic exit increases. (flexion of the sacrum)
- Contranutation: the promoter moves posteriorly, os coxygis moves forward, iliac crest moves laterally. Pelvic entrance gets bigger, pelvic exit gets smaller. (extension of sacrum)
The student is able to describe the structure of the disc of the front intervertebral joint.
art. symphysis intervertebralis = the anterior intervertebral joint
This joint consists of 2 corpora + the intermediate disc
Discus consists of:
• Outer layer: anulus fibrosis (sitting a lot
collagen fibers) good resistance pulling
• Inner layer; nucleus pulposus
(jelly-like core), there is also a bit of movement in this. (impact resistant).
When you flex the spine, the nucleus pulposus moves backward. A hernia usually occurs at the back of the spine because that is where the spine is most stressed.
The student is able to describe the histology and functioning of the nucleus and anulus fibrosus.
Nucleus pulposus (inner layer) The nucleus contains GAGs (glycosaminoglycans), these GAGs are hydrophilic. This means that the GAGs attract moisture. There is a constant balance between external forces (gravity/muscle strength, etc.) that push the fluid out of the nucleus and the GAGs that ensure that sufficient fluid is attracted to the nucleus. When glycosaminoglycans decrease in the intervertrablis disc, the disc shrinks. This makes you smaller. Because the disc becomes smaller, the collagen fibers hang slack, giving less stability to the vertebrae. The elderly are at greater risk of vertebral instability.
Anulus fibrosis (outer layer) The anulus fibrosis has a number of layers of lamellae (10 to 12), in which the collagen fibers in each lamella always lie in opposite directions. The function of this is that the anulus fibrosis can provide resistance in both directions of rotation. A rotation ensures that there is both stretch when relaxation occurs on the collagen fibers.
The student is able to identify the systems of the back muscles.
→ Spinal system
runs between spinosus processes.
bilateral: extension
unilateral: extension, a little lateral flexion
- mm. Interspinous: extension. Runs from spinous process to spinous process
- m. spinalis: extension and a little lateral flexion. Runs from spinous processes to spinous processes with an arc up.
→ Transverse Spinal System
runs from transverse process to spinous process
bilateral: extension
unilateral: hetero/contra lateral rotation
• mm rotatores longi (2 up)
• mm rotatores brevis (1 up)
• m. multifidi (provides stability to the spine) lumbar thoracic (4 up)
• m. semispinalis (cervicsis and capitis) function: extension, lateral flexion, rotation towards
contra/hetero lateral (6 up)
All these are innervated by Ramus dorsals
→ Lateral System
located around the transverse process, ribs and part of the ilium.
bilateral: extension
unilateral: Lateroflexion
• m. iliocostalis (lateral, runs from the ilium to the costae)
• m. longissimus (medially, running from lateral side of sacrum and transversus process to other transversi processes and the matoideus processes of the head)
• mm. intertransversarii. Function: stability of the vertebrae and small role in extension
and lateral flexion. Runs upwards between each processus transversus.
→ Spinotransverse system
runs from spinous process to lateral side and the transverse process.
bilateral: extension (applies to all systems).
unilateral: homo/ipsilateral rotation and lateral flexion.
• m. splenius (capitis and cervicis) bilaterally: extension head and neck. Unilateral: ipsilateral rotation and lateral flexion of neck and head
- Cervisis: origin: spinous process, insertion on transversus process
- Capitis: insertion on the mastoid process.
→ Dorsal Spine Muscle Functions
• Do not work in isolation
• All: extension (bi) and lateral flexion (uni)
• Rotation: difficult to measure for transversospinal system m. splenius and m.
longissimus rotate head homolateral
• Transversospinal system stabilizes the spine (core stability) m. multifidi
• Proprioceptive info. (transverse spinal system)
The muscles of the dorsal spine do not work in isolation. They are tensed at the same time as muscles that have the same function (this is also called synergy).
The student is able to describe the function of the muscle corset of the trunk in relation to stability
core stability = the stability of the lower vertebrae: lumbar, sacral and pelvis. The vertebral column must be stable because many muscles attach to it. During movement, the muscles shorten and pull on the vertebral column. Because of this, the vertebra must be punctum fixum. The muscle corset must provide stability.
Muscle corset of the trunk, is a collaboration of: • Diaphragm • Abs • Pelvic floor muscles • Back muscles
→ Diafragma
Functie: inademing
Innervatie: n. phrenicus (C3-C6)
→ Abs
- m. rectus abdominis
- m. obliquus abdominis externus
- m. obliquus abdominis internus
- m. transversus abdominis
→ Pelvic floor muscles - m. levatori ani: • m. puborectalis • m. pubococcygeus • m. iliococcygeus Innervation: sacral plexus
→ Back muscles The transversospinal system stabilizes the vertebra collumn, especially the multifidi. - mm rotatores longi - mm rotatores brevis - m. multifidi - m. semispinalis
The student is able to name the three regulatory systems according to the stabilising system.
According to panjabi (1992) a joint is stabilized via 3 systems:
• Neural system: CNS + peripheral nerves
• Active system: muscles and tendons
• Passive system: vertebrae, discs, ligaments, facet joints
Panjabi described that instability of the lumbar spine was due to the failure of the 3 systems to hold the neutral zone, within the physiological limits
The student is able to explain the concepts of instability
→ Mechanical instability:
inability of the vertebra column to withstand forces (presumably they mean passive structures such as: ligg, disci, capsule)
→ Clinical instability: clinical consequences of a neurological disorder and/or pain (presumably they mean here: active structures: muscles, tendons)
The student is able to explain the concepts of the neutral zone
There is a neutral zone in the spine: this is the part that is not absorbed by passive structures.
E.g. when the spine is in a neutral position, the passive structures are inactive. The active structures now ensure that the spine remains in the correct position: this is done by the local (small) muscles. Outside the neutral zone, the large muscles will be needed to maintain stability. Ligaments and capsules are thus relaxed in the neutral zone.
The student is able to explain the concepts of motor control impairment
The inability to keep joints or bone structures stable in relation to each other during a movement: when the large muscles (global muscles) make the movement, and the small muscles (local muscles) offer too little stability.
Local muscle system:
•Located deep
•Bridging 1 or a few vertebrae Small moment arm
•Control of small intervertebral movements
Eg: mm. Multifidi , m. transversus abdominis, mm. intertransversarii
Global Muscle System: •Superficial location •Bridge many vertebrae •Big moment arm •Major movements of the spinal column Eg: rectus abdominis m, obliquus externus m, erector spinae m
The student is able to list the possible movements in art. coxae and understands the limiting elements of these movements.
Anteflexion - retroflexion
Abduction - adduction
Internal rot - external rot
Lig. iliofemorale pars superior - retro, add, exo
Lig. iliofemorale pars inferior - retro, add, exo
Lig. pubofemorale pars superior - retro, abd, exo
Lig. pubofemorale pars inferior - retro, abd, exo
Lig. ischiofemorale - retro, abd, endo
Lig. inguinale - Ensures that underlying structures remain in place. It also forms a channel through which structures such as lymphatics run.
The student is able to name the different muscles that have a function in the knee.
Ventral muscles upper leg • m. sartorius • m. vastus medialis • m. rectus femoris • m. vastus lateralis • m. vastus intermedialis
Dorsal muscles upper leg(hamstrings) • m. biceps femoris caput breve • m. biceps femoris caput longum • m. semitendinosus • m. semimembranosus
Medial muscles upper leg
• m. adductor magnus
• m. gracilis (enige biarticulaire adductor)
• m. adductor longus
Calf muscles • m. gastrocnemius lateralis • m. gastrocneium medialis • m. popliteus • m. plantaris
