Final Exam Flashcards
1
Q
What does the pelvis consist of?
A
Sacrum, Coccyx, Hips
2
Q
Large, superior portion of the hip bone
A
Ilium
3
Q
Posterior, Inferior portion of the hip bone
A
Ishium
4
Q
Anterior, Inferior portion of the hip bone
A
Pubis
5
Q
How is the greater sciatic notch converted into a foramen?
A
Sacrospinous Ligament
6
Q
What passes the the greater sciatic notch?
A
- Sciatic Nerve
- Piriformis
7
Q
Which way does the acetabulum face? How does the fovea?
A
Acetabulum: Laterally, Inferiorly, Anteriorly
Fovea: Medially, Superiorly, Anteriorly
8
Q
What goes from the ASIS to the pubic tubercle?
A
Inguinal Ligament
9
Q
The inguinal region, or groin, is located where?
A
The depression between the abdomen and the thigh
10
Q
A.ka for the patellar surface. Where is it located?
A
Trochlear Groove. Center to the Medial/Lateral Condyle of the inferior, anterior portion of the femur
11
Q
Intercondylar Notch A.k.a and location
A
Intercondylar Fossa, Center to the Medial/Lateral Condyle of the inferior posterior portion of the femur
12
Q
Explain a condyloid joint
A
- Biaxial
- Flexion/Extension, Abduction/Adduction
- Knuckles
13
Q
Explain a saddle joint
A
- Biaxial
- Opposing surfaces are shaped like saddles
- Concave and convex articulate with each other
- Thumb
14
Q
Closed-packed position
A
- ligaments/joint capsule are tight
- maximal articular surface contact
- increased stability, decrease mobility
15
Q
Loose-packed position
A
- ligaments/joint capsule are loose
- joint has maximal space and available movement
- increased mobility, decrease stability
16
Q
Anterior Ligaments of the hip
A
- Iliofemoral Ligament (Y lig)
2. Pubofemoral Ligament
17
Q
Posterior Ligaments of the hip
A
Ishiofemoral Ligament
18
Q
Attaches the AIIS, Acetabular Rim– Intertrochanteric Line of the Femur
A
Iliofemoral Ligament
19
Q
Iliofemoral Ligament Checks..
A
Extension, Abduction, Lateral Rotation
20
Q
Attaches Superior Pubic Ramus– Iliofemoral Ligament
A
Pubofemoral Ligament
21
Q
Pubofemoral Ligament Checks..
A
Abduction
22
Q
Ischial Part of the Acetabular Rim– Femoral Neck and Medial Greater Trochanter
A
Hyperextension
23
Q
Bursa overlying the Ischial Tuberosity
+ its inflamed name
A
Ishiogluteal Bursa
-Weaver’s Bottom
24
Q
Bursa between the iliopsoas muscle and iliopubic eminence
A
Iliopectineal Bursa
25
What relaxes during pregnancy to allow passage of the fetus?
Vertebropelvic Ligaments, Pubic Symphysis
26
- This ligament attaches TVPs of L4, L5 to the posterior iliac crest
- Key stabilizer of L5
- Checks lateral Flexion
Iliolumbar Ligament
27
This type of movement is used to control or act as a brake (slow not stop)
Eccentric Contraction
28
IT Band
- CT, not a mm
- Thickening of the fascia lata (fascia of the thigh) on the lateral side of the leg.
- Attachmentes: tubercle of iliac crest--Gerdy's tubercle and patella
Sidelying, find BiFem tendon, slide anteriorly to the lateral thigh, Move proximal/Distal, feel ITband, Abduct and relax
29
PSOAS MAJOR
Sides of T12-L5 vertebrae and associated intervertebral discs--Lesser Trochanter of femur
Lies just lateral to the abdominal aorta
Vertical
```
Hip Flexion (PM)
Lumbar Spine Flexion
```
Knee bolstered, supine, ASIS to Navel, fingers between, slowly sink in, flex hip
30
ILIACUS
Iliac Fossa--Lesser Trochanter of the femur
Lies just lateral to the abdominal aorta
Fanshaped
```
Hip Flexion (Synergist to Psoas)
Hip Anterior Tilt
```
Knee bolstered, supine, slowly sink fingers into iliac fossa, flex hip
31
GLUTEUS MAXIMUS
External, posterior ilium, Post sacrum and coccyx, sacrotuberous ligament--3/4 fibres IT band, remaining gluteal tuberosity
Inferolateral
Hip Extension (PM)
Hip Lateral Rotation
Hip Abduction
Prone, Knee flexed (eliminate hamstrings), Extend leg
32
GLUTEUS MEDIUS
External Ilium (anterior 2/3rds), Lateral surface of greater trochanter
Weak Glute Med results in Trendelenburg Gait
Fanshaped
Hip Abduction (PM)
Pelvic Support in weight bearing
AF: Hip Flexion, Medial Rotation
PF: Hip Extension, Lateral Rotation
Sidelying, Hands on both attachments, Abduct
33
Attachments of Glute Minimus
- External Ilium (deep to med)
| - Anterior surface of greater trochanter (deep to med)
34
Actions of Glute Minimus
Hip Abduction
Hip Medial Rotation
AF: Hip Flexion
35
TENSOR FASCIA LATA
Outer ASIS, IT band 1/3rd down thigh
Inferolateral
Hip Flexion
Hip Abduction
Hip Medial Rotation
Supine, find ASIS, move hand posterior/distal, medially rotate, feel oval mound beneath hand
36
PIRIFORMIS
Anterolateral Sacrum through greater sciatic notch--Posteromedial aspect of the Greater Trochanter
Short-Hip Lateral Rotator (mindful of sciatic nerve)
Inferolateral
Hip Lateral Rotation
(Hip 60' flx) Abduction
(
37
QUADRATUS FEMORIS
Lateral aspect ischial tuberosity-- Intertrochanteric crest
Short-Hip Lateral Rotator
Horizontal
Hip Lateral Rotation
Prone, distal/posterior portion of GreatTro and lat ishtube, lat rot, feel rectangle-shaped belly
38
What part of the patella articulates with the femur?
Medial and lateral facets of the patella articulate with the medial and lateral condyles of the femur
39
Gerdy's Tubercle
Lateral and superior to Tibial tuberosity
40
Knee Joint consists of two joints
Tibiofemoral and Patellofemoral Joints
| Modified Hinge
41
What type of joint is the Tibiofemoral Joint?
Modified Hinge
42
Why is the Tibiofemoral joint considered a modified hinge joint?
Only performs Int/Ext Rotation while the knee is flexed
43
Describe the Q-Angle
Two lines: ASIS through patella, Tibial Tuberosity through patella
Normal usually 15'
44
How does the patella move in knee extension?
Superiorly and Laterally
45
What prevents the patella from moving too far laterally?
Lateral femoral condyle projects farther anteriorly
46
Attachments of the Lateral Collateral Ligament of the Knee. Check?
Lateral Epicondyle of femur to Fibular Head
| Checks Varus Deviation
47
Attachments of the Medial Collateral Ligament of the Knee. Check?
Medial Epicondyle of femur to Medial Condyle of the tibia (deep fibres attach to the meniscus)
Valgus Deviation
48
Anterior Cruciate Ligament Attachments. When slack, taut?
Anterior intercondylar area of tibia-- Posterior medial side of the Lateral femoral condyle
Slack: Flx
Taut: Extension
49
Posterior Cruciate Ligament Attachments. When slack, taut?
Posterior intercondylar area of the tibia--Anterior and lateral surface of the Medial femoral condyle
Slack: Ext
Taut: Flexion
50
Suprapatellar Bursa
Between Quads Tendon and Femur
| Held in place by articularis genu
51
Subcutaneous Prepatellar Bursa
Between Skin and Patella
| "Housemaid's Knee"
52
Subcutaneous Infrapatellar Bursa
Between Skin and Prox Tibia
| "Clergyman's Knee," "Carpetlayer's Knee"
53
Deep Infrapatellar Bursa
Between Quads Tendon and Anterior Tibia
54
Pes Anserine Bursa
Between Pes Anserine muscles and the medial tibia
| "Goose's Foot"
55
Medial Semimembranosus
Between tendons of medial semimembranosus and medial gastrocs
"Baker's Cyst"
56
Bursa Deep to the IT Band
Between IT band and lateral femoral epicondyle
| "Runner's Knee"
57
RECTUS FEMORIS
Quads Muscles--Only one to cross hip
AIIS, through quads tendon to Tibial Tuberosity
Bipennate
Knee Extension
Hip Flexion
Supine, knee bolstered, locate AIIS and patella, flex hip off table to feel medial end, extend knee to feel distal end
58
VASTUS LATERALIS
Quads Muscle
Lateral lip of linea aspera--Tibial tuberosity through quads tendon
Vertical
Knee Extension
Side lying, feel lateral side of leg, extend relax knee *note superficial ITband
59
VASTUS MEDIALIS (+VMO)
Quads Muscles
Medial Lip of the linea aspera--Tibial tuberosity through quads tendon
(Medial, distal femur, VastMed, AddMag--Medial Patella)
Vertical
Knee Extension
(Pulls patella medially)
Supine, knee bolstered, extend knee
60
Vastus Intermedius Attachments
Proximal 2/3rds of Femur--Tibial tuberosity
61
Articularis Genu Attachements
Anterior, distal femur-- Proximal articular capsule of the knee joint
62
Articularis Genu Actions
Pulls knee joint capsule of the proximally during knee extension to prevent pinching of the capsule
63
SARTORIUS
Pes Anserine, Longest Muscle in body
ASIS--Proximal, Anteromedial Tibia
Inferomedial
```
Hip Flexion
Hip Abduction
Hip Lateral Rotation
Knee Flexion
Knee Medial Rotation
```
Supine, rest foot on opposite knee, lift knee towards ceiling. Feel large RecFem and slim belly of sartorius. Approx 2 fingers wide
64
PECTINEUS
Adductor
Anterior pubic bone-- just inferior to the lesser trochanter
Inferolateral
Hip Adduction
Hip Flexion
Located in centre of femoral triangle (iguinal lig base, sartorius, adductor longus)
Supine, Hip slightly flexed and laterally rotated, hands middle of medial thigh, adduct, move superolateral off Adductor longus. Sink into belly
65
Adductor Brevis Attachments
Anterior Pubic Bone-- Proximal Linea Aspera
66
Adductor Brevis Movements
Hip Adduction
| Hip Flexion
67
Adductor Longus Attachments
Anterior Pubic Bone-- Linea Aspera (middle 1/3rd)
68
Adductor Longus Actions
Hip Adduction
| Hip Flexion
69
GRACILIS
Adductor, Only adductor to cross knee, Pes Anserine
Anterior Pubic Bone--Proximal Anteromedial Tibia
Vertical
Hip Adduction
Knee Flexion
Knee Medial Rotation
Supine, knee bolstered, laterally rotated, adduct hip
- slide fingers proximally to ant pubic bone, feel taut gracilis and longus, follow distally, one that passes middle thigh is gracilis
- Medial tendon to Semitendinosus, palpate up
70
Adductor Magnus Post Fibres
Adductor
Ischial Tuberosity--Adductor Tubercle
Vertical
Hip Adduction
Hip Flexion
Sidelying, top leg flexed, adduct slightly, feel between attachments
71
BICEPS FEMORIS
Hamstrings
2 Heads: (LH) Ischial Tuberosity (SH) Linea Aspera (mid shaft)-- Fibular Head
Vertical
(LH) Hip Extension
Knee Flexion
Knee Lateral Rotation
Prone, Lateral Tendon posterior knee
72
SEMITENDINOSUS
Hamstrings
Ischial Tuberosity--Proximal Anteromedial Tibia
Vertical
Hip Extension
Knee Flexion
Knee Medial Rotation
Prone, Medial, Superficial Tendon behind knee
73
SEMIMEMBRANOSUS
Hamstrings
Ischial Tuberosity-- Posterior aspect of the medial condyle of the tibia
Vertical
Hip Extension
Knee Flexion
Knee Medial Rotation
Prone, Medial tendon deep to semitendinosus
74
What consists of the hindfoot?
Talus and Calcaneus
75
What consists of the midfoot?
Navicular, Cuboid, Cuneiforms
76
What consists of the forefoot?
5 MTs and 14 Phalanges
77
What consists of the ball of the foot?
Padded potion of the sole of the foot at the MT heads
78
Pronation of the foot
"Up and Out"
| Dorsiflexion, Eversion, Abduction
79
Supination of the foot
"Down and In"
| Plantar Flexion, Inversion, Adduction
80
Proximal Tibiofibular Joint:
| Where, Type, Actions, Ligaments
- Head of the fibula w/ lateral condyle of the tibia
- Synovial Plane
- Superior, Inferior Glide w/ Dorsi/plantar flexion
- Anterior/Posterior Ligament of Fibular Head
81
Distal Tibiofibular Joint:
| Where, Type, Ligaments
- Distal ends of fibula and tibia articulate
- Fibrous
- Interosseous Ligament (thickening interosseous membrane at its distal end)
- Anterior/Posterior Tibiofibular Ligament
82
Ankle Joint
Talocrural
83
Talocrural Joint:
| Where, Type, Actions, Ligaments
- Distal ends of tibia and fibula articulate with trochlea of talus
- Synovial, Hinge
- Dorsiflexion, Plantarflexion
- Deltoid Ligament, Anterior Talofibular Ligament, Calcaneofibular Ligament
84
Describe the Deltoid Ligament
| Names, Attachments, Checks
4 Ligaments
1. Anterior Tibiotalar
2. Tibionavicular
3. Tibiocalcaneal
4. Posterior Tibiotalar
Attaches: Medial Malleolus--Tarsal bones of the medial foot
Checks: Eversion
85
Describe the Anterior Talofibular Ligament
| Attachments, Checks
Attaches: Lateral Malleolus--Neck of the Talus
Checks: Inversion (Esp in plantar flexion)
86
Describe the Calcaneofibular Ligament
| Attachments, Checks
Attaches: Lateral Malleolus--Lateral Calcaneus
Checks: Inversion (When in neutral)
87
What is the most commonly injured ligament in the foot? (95%)
Anterior Talofibular Ligament
88
What are the Intertarsal joints?
Subtalar, Talocalcaneonavicular, Calcaneocuboid
89
Describe the Subtalar Joint
- Inferior aspect of Talus with superior aspect of Calcaneus
- Synovial, Plane
- Inversion/Eversion
- Talocalcaneal Ligaments
90
Describe the Talocalcaneonavicular Joint
- Talus, Calcaneus, Posterior aspect of Navicular
- Synovial, Ball and Socket
- Plantar Calcaneonavicular Ligament
91
Describe the Plantar Calcaneonavicular Ligament
"Spring Ligament"
Attaches: Sustentaculum Tali--Posteroinferior surface of Navicular
-Maintains Longitudinal Arch
-When ligament is stretched, Talus sinks can sink resulting in flat foot (weight bearing)
92
Describe the Calcaneocuboid Joint
- Calcaneus and Cuboid
- Synovial, Plane
- Long Plantar Ligament
93
Describe the Long Plantar Ligament
(Calcaneocuboid Joint)
Attaches: Plantar surface of Calcaneus--Cuboid and bases of 2nd-4th MTs
--Forms a tunnel for peroneus longus
-Helps maintain arches of the foot
94
What is the Transverse Tarsal Joint?
Talocalcaneonavicular and Calcaneocuboid Joint together
A.k.a Midtarsal Joint
-Helps increase inversion/eversion range by allowing abduction/adduction of the forefoot
95
Describe the Tarsometatarsal Joint
Distal 4 Tarsal bones w/ bases of MT
- Synovial, Plane
- Limited movement due to tight binding bones
- Dorsal, Plantar, Interosseous Ligaments
96
Describe the Intermetatarsal Joint
Bases of the MTs
- Synovial, Plane
- Limited movement due to tight binding bones
- Bases of 2nd-5th MT bound by Dorsal, Plantar, Interosseous Ligaments
97
Describe the Metatarsophalangeal Joint
Heads of MTs w/ bases of Proximal Phalanges
- Synovial, Condyloid
- Flexion/Extension, Abduction/Adduction
- Collateral Ligaments
- Plantar surface of Joint Capsules are thickened to form plantar plate ligaments
98
Describe the Interphalangeal Joints
Head of one phalanx w/ base of distal phalanx
- Synovial, Hinge
- Flexion/Extension
- Collateral Ligaments
99
Arches of the foot serve as..
Shock Absorbers
| -they distribute stress
100
What are the arches of the foot called?
1. Medial Longitudinal Arch
2. Lateral Longitudinal Arch
3. Transverse Arch
101
What are the arches supported by?
1. Shape of interlocking bones (primary)
2. Ligaments
3. Fascia
4. Action of the muscles
102
Bones of the Medial Longitudinal Arch
Calcaneus, Talus, Navicular, 3 Cuneiforms, MTs 1-3
103
Bones of the Lateral Longitudinal Arch
Calcaneus, Cuboid, MTs 4-5
104
Bones of the Transverse Arch (anterior, middle, posterior)
Anterior: Head of 1st-5th MTs
Middle: Cuneiforms and Cuboid
Posterior: Navicular and Cuboid
105
Attachments of Plantar Fascia
Medial Calcaneal Tubercle--Proximal Phalanx of each toe
106
Windlass Mechanism
- Toes Extend--Plantar Fascia Tightens
- Pulls Calcaneus anteriorly--elevates arches
- Puts food in Supination position
107
Screw Home Mechanism
Knee is fully extended, Tibia rotates laterally locking the knee
-Popliteus medially rotates the tibia to unlock and allow the knee to flex
108
What are the compartments of the leg?
1. Anterior
2. Lateral
3. Superficial Posterior
4. Deep Posterior
109
TIBIALIS ANTERIOR
Anterior Compartment--Extensor Retinacula
Anterior Superolateral 1/2 Tibia, interosseous membrane--Base of 1st MT, 1st Cuneiform
Vertical
Dorsiflexion
Inversion
Supine, Knee bolstered, feet over edge of table, Dorsiflex, feel belly into tendon. Tendon anterior to medial malleolus through extensor retinaculum
110
EXTENSOR HALLUCIS LONGUS
Anterior Compartment--Extensor Retinacula
Anterior, middle fibula and interosseous membrane--base of the distal phalanx of 1st toe (dorsal surface)
Vertical
1st toe extension
Assists Dorsiflexion
Supine, Knee bolstered, feet over edge of table, extend 1st toe, see/feel tendon of EHL. Middle of the tendons through extensor retinacula
111
EXTENSOR DIGITORUM LONGUS
Anterior Compartment--Extensor Retinacula
Proximal 3/4 of the anterior fibula, interosseous membrane--Middle/Distal, lateral 4 phalanges (dorsal surface)
Vertical
2nd-5th Toe Extension
Dorsiflexion
Eversion
Supine, Knee bolstered, feet over edge of table, extend lateral 4 toes. Tendon lateral of extensor retinacula tendons, follow proximally to muscle belly. Very slender betweeen TibAnt and Peroneals
112
Peroneus Tertius
Not everyone has.
Would see another tendon going towards the base of the 5th MT
Dorsiflexion
Eversion
113
Where are the tendons located in the extensor retinaculum
(Medial) Tibialis Anterior, Extensor Hallucis Longus, Extensor Digitorum Longus
114
PERONEUS LONGUS
Lateral Compartment--Stirrup w/ TibAnt
Lateral, proximal 2/3rds of fibula--Base of the 1st MT, 1st Cuneiform
Vertical
Plantar Flexion
Eversion
Sitting, Do actions, Feel tendon, posterior to lateral malleolus go to the plantar surface, feel head of the fibula, move along. All are the peroneals, proximal is longus.
115
PERONEUS BREVIS
Lateral Compartment
Lateral, distal 2/3rds of fibula--Tuberosity of 5th MT
Vertical
Plantar Flexion
Eversion
Sitting, Do actions, Feel tendon, posterior to lateral malleolus to the styloid process, feel head of the fibula, move along. All are the peroneals, Distal is brevis
116
GASTROCNEMIUS
Superficial Posterior Compartment
2 Heads attach to Medial/Lateral femoral condyles--through achilles tendon--calcaneus
Vertical
Knee Flexion
Plantar Flexion
Prone, Feet off end of table, plantar flex onto my thigh,
117
SOLEUS
Superficial Posterior Compartment
Proximal Posterior Fibula, Soleal Line (Tibia), Middle 1/3rd of medial border of Tibia--through achillies tendon--calcaneus
Vertical
Plantar Flexion
Prone, Bend knee to eliminate gastroc, plantar flex into my forearm
118
Gastrocs and Soleus together are known as..
Triceps Surae
119
TIBIALIS POSTERIOR
Deep Posterior Compartment *flexor retinaculum
Posterior Tibia, Interosseous Membrane, Fibula--Navicular Tuberosity and surrounding bones
Vertical
Inversion
Plantar Flexion
Behind medial malleolus, most anterior tendon. Proximal is distal muscle belly w/ other flexors
120
FLEXOR HALLUCIS LONGUS
Deep Posterior Compartment*flexor retinaculum
Lower 2/3rds posterior fibula, interosseaous membrane--Plantar surface of 1st distal phalanx
Vertical
1st MTP, 1st IP Flexion
Plantar Flexion
Inversion
Lateral Tendon behind Medial malleolus . Proximal is distal muscle belly w/ other flexors
121
FLEXOR DIGITORUM LONGUS
Deep Posterior Compartment *flexor retinaculum
Posterior middle Tibia--Plantar surface of distal phalanges of lateral 4 toes
Vertical
2nd-5th PIP/DIP/MTP Flexion
Plantar Flexion
Inversion
122
What is the 1 Intrinsic Foot Muscle? Actions, Attachments
Extensor Digitorum Brevis
Anterior dorsal surface of calcaneus--medial distal 4 phalanges
Extension of medial 4 toes
123
Muscles of the 1st layer of the Foot
1. Abductor Hallucis
2. Flexor Digitorum Brevis
3. Abductor Digiti Minimi
124
Actions of Abductor Hallucis
(1st Layer)
| Abduction of 1st toe
125
Actions of Flexor Digitorum Brevis
(1st layer)
| Flexion 2nd-5th toes
126
Actions of Abductor Digiti Minimi
(1st layer)
| Abduction of 5th Toe
127
Muscles of the 2nd Layer of the Foot
1. Quadratus Plantae
2. Lumbricals
(also FHL and FDL)
128
Actions of Quadratus Plantae
Assists FDL in flexion of lateral 4 digits
129
Actions of Lumbricals
Flexion of the MTP Joint and extension of PIPs/DIPs
130
Muscles of the 3rd Layer of the Foot
1. Flexor Hallucis Brevis
2. Adductor Hallucis
3. Flexor Digiti Minimi Brevis
131
Actions of Flexor Hallucis Brevis
Flexion of 1st MTP joint
| two sesamoid bones to protect tendons from pressure during standing/walking
132
Actions of Adductor Hallucis
Adducts 1st Toe
| Helps maintain transverse arch
133
Actions of Flexor Digiti Minimi Brevis
Flexion of 5th MTP joint
134
Muscles in the 4th Layer of the Foot
1. Dorsal Interossei
| 2. Plantar Interossei
135
Actions of Dorsal Interossei
Abduction of 2nd-4th MTP joints
136
Actions of Plantar Interossei
Adduction of 3rd-5th MTP joints
137
Describe the Sternoclavicular Joint
Sternal end of the clavicle w/ the manubrium
- Synovial, Saddle
- Superior/Inferior Glide, Anterior/Posterior Glide, Rotation
- Anterior Sternoclavicular Lig
- Posterior Sternoclavicular Lig
- Interclavicular Lig
- Costoclavicular Lig (inferior clavicle-1st rib)
138
When you fall on an outstretched hand, what absorbs the shock?
An articular disc in the Sternoclavicular Joint
139
Describe the Acromioclavicular Joint
Acromial end of clavicle w/ acromion of scapula
- Synovial, Plane
- Anterior/Posterior Glide, Rotation
- Acromioclavicular Lig
- Coracoacromial Lig
- Coracoclavicular Lig
- Trapezoid Lig
- Conoid Lig
140
Difference between the Surgical and Anatomical Neck
On Humerus
Anatomical Neck: Superior to the greater/lesser tubercle
Surgical Neck: Inferior to the greater/lesser tubercles
-Common fracture point
141
Describe the radial groove
Groove on the posterior, mid humerus for the radial nerve to pass through
142
Describe Scapulohumeral Rhythm
0'-15': no movement of scapula
15'-120': 2GH:1ST
120'-Full: 1GH:1ST
143
During abduction, what must the humerus do? Why?
External Rotation at about 90'-120'
| -So the greater tubercle clears the coracoacromial arch
144
What are the two weakest spots in the Glenohumeral Joint capsule?
Inferiorly: Axillary Recess
Anteriorly: Foramen of Weitbrecht
145
Number of Vertabrae in all segments
```
7 Cervical
12 Thoracic
5 Lumbar
5 Fused Sacrum
4 Fused Coccyx
```
146
Difference between SP and TVP
SP: Posterior prominence
TVP: Lateral prominence
147
UPPER TRAPEZIUS
Extrinsic Back
- Middle 1/3 superior Nuchal line, inion to C7 SP, via Nucal Ligament
- Lateral clavicle and acromion
Inferolateral
H/N Fixed:
ST Upward Rotation
ST Elevation
Scap Fixed:
Bilateral Neck Extension
Contralateral Rotation
Ipsilateral Lateral Rotation
Seated, Lower fibres by elevation, upper fibres w/ contralateral rotation
148
MIDDLE TRAPEZIUS
Extrinsic Back
- SP C7 to T5
- Superior lip of the spine of the scapula
Horizontal
ST Retraction
Prone, locate spine of scapula, slide medially onto traps. Stay superficial as to not feel rhomboids. Perform retraction (can you lift your shoulders off the table)
149
LOWER TRAPEZIUS
Extrinsic Back
- T6 to T12 SP
- Root of Spine of Scapula
Superolateral
ST Upward Rotation
ST Depression
Prone, Imagine Line between Root of spine to T12. Ask partner to lift hands over head. Feel for superficial Traps
150
LATISSIMUS DORSI
Extrinsic Back
- SP T6 to iliac crest, , lumbar/sacral vertebrae through thoracolumnar fascia, 9-12 ribs, inferior angle of the scapula
- Floor of Bicipital Groove
Superolateral
GH Internal Rotation
GH Adduction
GH Extension
Prone, Arm off side of table, find scapula's lateral border, grab tissue lateral to the border, Medially rotate or extend to feel contract. May also be parts of Teres Major
151
RHOMBOIDS
Extrinsic Back *Helps SerrAnt hold scapula to ribs
- SP C7 to T5
- Root of the spine to the inferior angle
Inferolateral
ST Retraction
ST Downward Rotation
ST Depression
Prone, Find medial border and C7-T5, feel superficial traps, sink deeper for rhomboids. Partner's hand on small of back, elbow to ceiling
152
LEVATOR SCAPULA
Extrinsic Back
- TVPs of C1-C4
- Superior Angle to the Root of the spine
Inferolateral
H/N Fixed:
ST Downward Rotation
ST Elevation
Scap Fixed:
Bilateral Neck Extension
Ipsilateral Rotation
Ipsilateral Lateral Flexion
Inferior portion is deep to Upper Traps, so palpate for the Upper portion. Belly approx 2 fingers wide, fibres twist around themselves
153
PECTORALIS MAJOR
Chest & Thorax *Deltopectoral Triangle
- Clavicular Head (UF): Anterior, Medial 1/2 of clavicle
- Sternocostal Head (LF): Sternum, Anterior costal cartilage of ribs 2-6
- Lateral Lip of Bicipital Groove
Fanshape
```
GH Horizontal Adduction
GH Adduction
GH Internal Rotation
GH Flexion (from full extension)
GH Extension (from full flexion)
```
Supine w/ arm slightly abducted. Thumb into axilla, grab muscle. Medially Rotate.
154
PECTORALIS MINOR
Chest & Thorax *Tipping Scapula w/ tight
- Coracoid Process
- 3-5 Ribs
Inferomedial
ST Protraction
ST Depression
ST Downward Rotation
Scap Fixed: Elevate Ribs with forced inhalation
Supine w/ arm abducted. Find lateral edge of major and slide underneath in the direction of coracoid process along ribs. Slightly depress shoulders, "press your shoulders to your hip"
155
SERRATUS ANTERIOR
Chest & Thorax *winging scapula
- Anterior surface of the medial border of scapula
- Lateral surfaces of upper 8 ribs
Fanshape
ST Protraction
ST Upward Rotation (LF)
*Holds medial border of the scapula flat against ribs
Supine, Feel along upper 8 lateral ribs. Arm straight up, push fist up into hand
156
DELTOIDS
Shoulder/Scapular Region *Deltopectoral Triangle
AH: Anterior, lateral 1/3 Clavicle
MH: Lateral Acromion
PH: Spine of the Scapula
-Deltoid Tuberosity
Fanshape
GH Abduction (PM)
AH: Flexion, Internal Rotation, Horizontal Adduction
PH: Extension, External Rotation, Horizontal Abduction
Seated, Make V of attachments for entire belly. Abduct for all, flex/extend for ant/post Fibres
157
What is the deltopectoral triangle? Relevance?
Divergence of PecMajor, Anterior Delt, and Clavicle
- Cephalic Vein lies within
- Easy access point for the coracoid process
158
SUPRASPINATUS
Rotator Cuff Muscles
- Supraspinous Fossa
- Superior Facet of the Greater Tubercle of the humerus
Horizontal
GH Abduction
-Stabilizes GH joint by tucking the head of the humerus into the glenoid fossa
Prone, find spine of scapula, move superior, sink into supraspinous fossa, move laterally until it tucks under the acromion. Abduct arm
159
INFRASPINATUS
Rotator Cuff Muscles
- Infraspinous Fossa
- Middle Facet of the Greater Tubercle of the humerus
Superolateral
GH External Rotation
Prone w/ arm off table, find spine of scapula, move inferiorly to sink into the infraspinous fossa. Externally Rotate
160
TERES MINOR
Rotator Cuff Muscle
- Lateral, middle border of the scapula
- Inferior Facet of the Greater Tubercle of the humerus
Superolateral
GH External Rotation
Prone w/ arm off table, find superior portion of the lateral border of scapula. Slide off border onto teres minor. Externally Rotate
161
SUBSCAPULARIS
Rotator Cuff Muscle
- Subscapular Fossa
- Medial Lip of the Bicipital Groove (lesser tubercle)
Horizontal
GH Internal Rotation
Sidelying, pull arm into protraction, other hand-thumb into axilla to the lateral border of the scapula, curl thumb into subscapular fossa, Internally Rotate
162
TERES MAJOR
Shoulders/Scapular Region
- Posterior Surface of the Inferior Angle of the Scapula
- Medial Lip of the Bicipital Groove (Lesser Tubercle)
Superolateral
GH Internal Rotation
GH Extension
GH Adduction
Prone w/ arm off the side of the table, grab lats, move medially to find lateral border, Internally Rotate
163
What does the elbow joint consist of?
Humeroulnar and Humeroradial Articulations
164
Humeroulnar Articulation
Posteriorly:
-Olecranon on Ulna/Olecranon Fossa on Humerus
Anteriorly:
-Trochlea on the Humerus/ Trochlear Notch on Ulna
165
Humeroradial Articulation
Capitulum articulates with the head of the radius
166
```
Elbow Joint
(type, movements, ligaments)
```
Synovial, Hinge --Very Stable!
Flexion/Extension
Lateral Collateral Ligament
-Lateral Epicondyle--Annular Ligament of Radius
Medial Collateral Ligament
-Medial Epicondyle--Coronoid process, Olecranon process
167
What do the Lateral and Medial Collateral Ligaments of the Elbow check?
Lateral Collateral Lig: Cubitus Varus Deviation
| Medial Collateral Lig: Cubitus Valgus Deviation
168
Proximal Radioulnar Joint
| attachments, type, movements, ligaments
Head of the radius w/ the radial notch of the ulna
Synovial, Pivot
Pronation/Supination
Annular Ligament
- Anterior surface of radial notch around head of the radius to posterior surface of radial notch.
- Holds head in place, allows movement
169
Distal Radioulnar Joint
| attachments, type, movements, ligaments
Head of the ulna w/ the ulnar notch of the radius
Synovial, Pivot
Pronation/Supination
Palmar and Dorsal radioulnar ligaments
-Distal Ulna-Distal Radius
* Also an articular disc
- Binds distal radius and ulna
- Ulna doesnt articulate directly with carpal bones
170
CORACOBRACHIALIS
Anterior Arm
- Coracoid Process
- Middle, medial humerus
Vertical
GH Flexion
GH Adduction
Palpate?
171
BICEPS BRACHII
Anterior Arm
*Tendon in Cubital Fossa
- LH: Supraglenoid Tubercle (through bicipital groove)
- SH: Coracoid Process
- Radial Tuberosity, Bicipital Aponeurosis
Vertical
```
GH Flexion (LH)
Elbow Flexion in Supination
```
172
Coracoid Process is the attachment of many things. What is at 4 o'clock, 7 o'clock, 10 o'clock, 11/12 o'clock
4: PecMinor Tendon
7: Coracobrachialis, Biceps Brachii Tendons
10: Coracoacromial Ligament
11/12: Coracoclavicular Ligament
173
BRACHIALIS
Anterior Arm
*FLoor of cubital fossa w/ supinator
- Anterior, distal half of humerus
- Ulnar Tuberosity, Coronoid Process
Vertical
Elbow Flexion in Pronation
174
TRICEPS BRACHII
Posterior Arm
LH: Infraglenoid Tubercle
LAH: Posterior, Proximal 1/2 of Humerus
MH: Posterior, Distal 1/2 of Humerus
-Olecranon Process
Vertical
```
GH Extension (LH)
Elbow Extension
```
175
What muscle assists triceps?
Anconeus
176
Name all the carpal bones
| +any special characteristics
```
Proximal Row (lateral-medial):
Scaphoid--tubercle, most common fracture
Lunate--most common dislocation
Triquetrum--has sesamoid bone (pisiform)
Pisiform--is a sesamoid bone on the Triquetrum
Distal Row (lateral-medial)
Trapezium--tubercle
Trapezoid
Capitate
Hamate--Hook of the hamate (tunnel for ulnar nerve)
```
177
Explain Carpal Tunnel
-Carpal bones have natural anterior concavity
Flexor Retinaculum attaches:
Laterally: Tubercles of the Scaphoid and Trapezium
Medially: Hook of Hamate and Pisiform
-Retinaculum forms a tunnel for structures to pass
178
```
Radiocarpal Joint
(attachments, type, movements, ligaments)
```
Distal radius and articulating disc (distal radioulnar joint) w/ Proximal carpal bones
Synovial, Condyloid
Flexion/Extension, Ulnar/Radial Deviation, Circumduction
Palmar/Dorsal Radiocarpal Ligs
179
```
Ulnomeniscotriquetral Joint
(attachments, type, movements)
```
Ulna w/ articulating disc--w/ Triquetrum
Synovial
Flexion/Extension
180
```
Midcarpal Joint
(attachments, type, movements, ligaments)
```
Proximal row of carpals w/ distal carpal row
Synovial, plane
Increases Flexion/Extension, Increase Radial Deviation
Dorsal and Palmar Intercarpal Ligaments
181
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Intercarpal Joint
(attachments, type, movements, ligaments)
```
Between carpal bones
Synovial, Plane
Interosseous Intercarpal Ligs
182
```
Carpometacarpal Joint (1, 2-5)
(attachments, type, movements, ligaments)
```
Distal Row w/ metacarpals
1st Carpometacarpal Joint:
- Trapezium w/ base of 1st MC
- Synovial, Saddle
2nd-5th Carpometacarpal Joint:
- Distal carpals w/ bases of metacarpals 2-5
- little mvmnt
- dorsal/palmar/interosseous ligs
183
```
Intermetacarpal Joint
(attachments, type, movements, ligaments
```
Between bases of medial 4 metacarpals
Synovial, Plane
Interosseous Ligaments
Deep Transverse Metacarpal Ligament
-between heads of medial 4 Metacarpals
184
```
Metacarpophalangeal Joints
(attachments, type, movements, ligaments
```
Heads of MC w/ bases of proximal phalanges
Synovial, Condyloid
Flexion/Extension, Abduction/Adduction (reference 3rd)
Medial/Lateral Collateral Ligaments
Palmar Ligaments--check hyperextension
185
```
Interphalangeal Joints
(attachments, type, movements, ligaments
```
Head of proximal phalanx w/ base of next distal phalanx
Synovial, Hinge
Flexion/Extension
Medial/Lateral Collateral Ligaments
186
What are the muscles of the Superficial Anterior Arm?
1. Pronator Teres
2. Flexor Carpi Radialis
3. Palmaris Longus
4. Flexor Carpi Ulnaris
187
What muscles have a common tendinous attachment at the medial epicondyle of the humerus? What is the tendon called?
Common Flexor Tendon
Pronator Teres, Flexor Carpi Radialis, Palmaris Longus, Flexor Carpi Ulnaris
188
What is the common flexor tendon's inflammed name?
CFTitis, "Golfer's Elbow"
189
PRONATOR TERES
Anterior Forearm, Superficial Layer
*Medial side of cubital fossa
- Medial Epicondyle of Humerus, Coronoid Process of Ulna
- Middle, lateral surface of the radius
Inferolateral
```
RU Pronation
Elbow Flexion (weak)
```
Elbow at 90', shake hands, find biceps brachii tendon, move distally, pronate
190
FLEXOR CARPI RADIALIS
Anterior Forearm, Superficial Layer, Flexors
- Medial Epicondyle
- Base of 2nd MC, slip to the 3rd
Vertical
RC Flexion
Radial Deviation
Elbow Flexion (weak)
Lateral Tendon at the wrist, follow up to belly, Flex/Deviate
191
PALMARIS LONGUS
Anterior Forearm, Superficial Layer, Flexor
- Medial Epicondlye
- Palmar Aponeurosis
Vertical
```
RC Flexion
Elbow Flexion (weak)
```
Medial Tendon at wrist, follow to muscle belly *not everyone has tendon-14% of population do not. Can be absent on 1 or both sides, usually left
192
FLEXOR CARPI ULNARIS
Anterior Forearm, Superficial Layer, Flexor
*makes pisiform a sesamoid bone
(HH) Medial Epicondyle
(UH) Olecranon, Upper 1/2 of posterior ulna
-Pisiform, Hook of the Hamate, Base of 5th MC
Vertical
RC Flexion
Ulnar Deviation
Elbow Flexion (weak)
Shaking hands, elbow flexion 90', supinate arm. Find pisiform, slide proximally onto tendon (superficial), ulnar deviate, feel contract, follow to belly
193
Muscles of the Intermediate Anterior Forearm.
1. Flexor Digitorum Superficialis
| * Superficial to another flexor
194
Attachments of Flexor Digitorum Superficialis
(HH) Medial Epicondyle, Coronoid Process of Ulna
(RH) Anterior/Superior Radius
-->passes deep to flexor retinaculum
-Sides of the bases of intermediate phalanges of the medial 4 digits
195
Actions of Flexor Digitorum Superficialis
```
Flexion 2nd-5th CMC, MCP, PIP joints
RC Flexion
Elbow Flexion (weak)
```
196
Important to note about Flexor Digitorum Superficialis tendon
- Through Carpal Tunnel
| - It bifurcates around FDP
197
Muscles of the Deep Anterior Forearm
1. Flexor Digitorum Profundus
2. Flexor Pollicis Longus
3. Pronator Quadratus
198
Flexor Digitorum Profundus Attachments
- Proximal, anterior surface of the ulna and interosseous membrane
- ->passes deep to flexor retinaculum
- Bases of distal phalanxes of medial 4 digits
199
Flexor Digitorum Profundus Actions
Flexion 2nd-5th CMC, MCP, IP joints
| RC Flexion
200
Flexor Pollucis Longus Attachments
- Anterior, middle surface of radius and interosseous membrane
- ->passes deep to flexor retinaculum
- Base of distal phalanx of thumb
201
Flexor Pollucis Longus Actions
Flexion IP of 1st digit
| MCP, CMC joint flexion of 1st digit
202
Pronator Quadratus Attachements & Action
- Distal, Anterior Ulna
- Distal Anterior Radius
Pronation
203
MM Rotate the Forearm
Pronator Teres, Pronator Quadratus
204
MM that Flex the Hand
Flexor Carpi Radialis, Flexor Carpi Ulnaris, Palmaris Longus
205
MM that Flex the Digits
Flexor Digitorum Superficialis, Flexor Digitorum Profundus, Flexor Pollucis Longus
206
Tendons in Carpal Tunnel
Flexor Digitorum Superficialis, Flexor Digitorum Profundus, Flexor Pollucis Longus
(Median Nerve)
207
Explain the Cubital Fossa
Triangular Space at Front of Elbow
Superiorly: Line between medial/lateral epicondyles
Medially: Pronator Teres
Laterally: Brachioradialis
Floor: Brachialis, Supinator
Roof: Fascia, Bicipital Aponeurosis
-Contains biceps tendon, brachial artery, brachial vein, median nerve
208
MMs of Superficial Posterior Forearm
1. Brachioradialis
2. Extensor Carpi Radialis Longus
3. Extensor Carpi Radialis Brevis
4. Extensor Digitorum
5. Extensor Digiti Minimi
6. Extensor Carpi Ulnaris
209
Wad of 3 MMs
Brachioradialis
Extensor Carpi Radialis Longus
Extensor Carpi Radialis Brevis
210
BRACHIORADIALIS
Posterior Forearm, Superficial Later
* Lateral side of cubital fossa
* Drinking Muscle
* Wad of 3
- Lateral Supracondylar Ridge of humerus (prox part)
- Lateral Distal Radius
Vertical
Elbow Flexion in neutral
Shake hands, flex elbow 90', forearm neutral. Flex elbow against resistance. Brachioradialis will bulge on the lateral side (or start at lateral supracondylar ridge, move distal). Feel belly!
211
EXTENSOR CARPI RADIALIS LONGUS
Posterior Forearm, Superficial Layer
* Wad of 3
* extensor retinaculum
- Lateral Supracondylar Ridge (Distal Part)
- ->through extensor retinaculum
- Base of 2nd MC (Posterior)
Vertical
RC Extension
Radial Deviation
Shake hands, elbow 90', locate brachioradialis, slide medially on ECRL/B Fibres. Abduct to be sure.
212
MMs w/ Common Tendinous Attachment at the Lateral Epicondyle. What is the tendon called?
Common Extensor Tendon
Extensor Carpi Radialis Brevis, Extensor Digitorum, Extensor Digiti Minimi, Extensor Carpi Ulnaris
213
EXTENSOR CARPI RADIALIS BREVIS
Posterior Forearm, Superficial Layer
*Wad of 3
- Lateral Epicondyle
- ->through extensor retinaculum
- Base of 3rd MC
Vertical
RC Extension
Radial Deviation
Shake hands, elbow 90', locate brachioradialis, slide medially on ECRL/B Fibres. Abduct to be sure. Brevis will be more medial of the two
214
EXTENSOR DIGITORUM
Posterior Forearm, Superficial Layer
- Lateral Epicondyle
- ->through extensor retinaculum
- Distal Phalanges of Medial 4 Digits
Vertical
Extension MCP, IP joints 2-5
RC Extension
Shake hands w/ partner, flex elbow to 90', slide laterally off the ECRL/B fibres onto ED's flat surface. Extend wrist and fingers
215
Extensor Digiti Minimi Attachment and Action
-Lateral Epicondyle
-5th Digit
Extension of 5th Digit
216
EXTENSOR CARPI ULNARIS
Posterior Forearm, Superficial Layer
- Lateral Epicondyle
- Base of 5th MC
Vertical
RC Extension
Ulnar Deviation
Shake hands, elbow 90' flexion, Locate ulnar shaft. Slide laterally off shaft, adduct wrist
217
MMs of the deep posterior forearm
1 .Supinator
2. Extensor Indicis
3. Abductor Pollicis Longus
4. Extensor Pollicis Brevis
5. Extensor Pollicis Longus
218
Indicis Refers to...
Index Finger
219
Supinator Attchments
(SL) Lateral Epicondyle
(DL) Supinator Fossa
-Anterior, lateral, posterior parts of proximal radius
220
Extensor Indicis Attachments/Action
-Posterior Middle Forearm
-Extensor expansion of 2nd Digit
Extends 2nd Digit
221
Abductor Pollicis Longus Attachments/Actions
-Posterior, Middle Forearm
-Base of 1st MC
Abduction 1st CMC
222
Extensor Pollicis Brevis Attachments/Actions
-Posterior, Middle Forearm
-Base of proximal phalanx of thumb
Extension of 1st CMC, MCP
223
Extensor Pollicis Longus Attachments/Actions
-Posterior, Middle Forearm
-Base of distal phalanx of thumb
Extension of 1st IP, MCP
224
Describe the Anatomical Snuff Box
Lateral Aspect at the base of the thumb
Anterior Border: APL, EPB
Posterior Border: EPL
Floor: Scaphoid
225
Intrinsic Hand MMs
The Thenar Muscles
The Hypothenar Muscles
Deep Muscles
226
Thenar MMs
(Thumb-adductor)
- Opponens Pollicis
- Abductor Pollicis Brevis
- Flexor Pollicis Brevis
227
Hypothenar MMs
(pinky + palm)
- Opponens Digiti Minimi
- Abductor Digiti Minimi
- Flexor Digiti Minimi Brevis
- Palmaris Brevis
228
Deep Intrinsic Hand MMs
- Adductor Pollicis
- Lumbricals
- Dorsal Interossei
- Palmar Interossei
