lecture 10- 21 Flashcards
spine anatomy
8 pairs cervicle
12 thoracic
5 lumbar
5 sacral
coccygeal 1
motor and descending ()
sensory and ascending ()
efferent
afferent
axillary nerve
shoulder dislocation
radial nerve injury
can be injured with a mid-humeral fracture
ulnar
can be entrapped at the elbow or the wrist
median
entrapped at the cubital fossa, or pronator teres, carpal tunnel
musclocutaneous nerve damage
(elbow/ shoulder flexion)
entrapped at caracobrachails
elbow flexion with the forearm supinated
musclocutaneous nerve
elbow flexion with the forearm pronated
radial nerve
waiters tip deformity
Erb’s palsy results from injury to nerve roots C5 and C6, with C7
arm hangs limply from the shoulder with internal rotation of the forearm plus wrist and finger flexion
radial nerve m
damage to your ulnar nerve, which controls muscles in your ring and pinkie fingers. If your ulnar nerve is damaged, the muscles it controls don’t get some or all of the electrical signals that tell them to straighten
what actions can we perform with our shoulder gridle
elevation/depression
upward/ downward
rotation
protraction / retraction
intervertable joints
articulation between adjacent vertebral bodies
type: cartilaginous
movement: minimal/ slight
movements of the spine
extension/ flexion
lateral flexion and extension
rotation of teh head and neck
rotation of the upper trunk
what motions are possible at the cervicle spine? joints?
flexion/ extension, lateral flexion, rotation
atlanto-occipitial joint
atlanto-axial joint
sternocleidomastoid
origin: mandbrium and medial portion of the clacivle
insertion: mastoid process of the temporal bone, superior nuchal line
innervation:accessory nerve
actions:unilaterally contralateral cervical rotation, ipsilateral flexion of the cervicle head
bilaterally: cervicle flexion, assists with forced exhalation by elevating the sternum
scales
scalnes
(ant, middle, post)
origin: cervicle vertebrae (C2-C7)
insertion: first and second ribs
innervation: cervicle nerves (C3-C6)
actions: elevtation of the first and second ribs. lateral flexion of the neck. assists with forced inhalation
errector spine muscles
illocostalis: most lateral group, extends and laterally flexes the vertebral column
longissimus: middle group, extends and laterally flexes vertebral column
spinalis: most medial extends vertebral column
illiocostralis& longissimus thoracic portion
75% slow twicth fibers (type 1= mitchondria dominated)
line of action is parallel to spine
greatest mechanical advatnage for extension
lumbar portion of the errector spine
even mixed slow and fast twitch fibers
line of action oblique (posteriorcaudal)
extension of the vertebrea
create shear forces against anterior shear forces during flexion
note* oblique line is lost during flexion
netural lumbar spine versus flexed lumbar spine
netural spine- oblique 45 degree angle from the spine. resistance between anterior shear force provides acceptable levels of compression
flexed lumbar spine compressive force is much greater compressing verterbral column together and can cause repture to disc no resistance to anterior shear force provides excessive leveles of compression
RDLs
flextion with posterior hip rotation= lumbar spine is flexed; at risk of repturing disk cant counteract anterior shear force
versus
without: netrual healthy shear force
nerve supply to the errector spinae
posterior root ganglion
anterior root
posterior ramus: innervates deep back of spinal nerves
anterior ramus: upper limbs of lower back
multifidus
span of only a few vertebrae
extension but… forces affect only local areas of the spine. thereforce, provide ability for corrections at specific joints
rotators
usually descirbed as rotators of the spine.
but so small that contribution to twisting is limited
have a propreceptive function (brain telling us hwere our spine is in space)
quadratus lumborum
origin: illiac crest and illiolumbar ligament
insertion: base of 12th rib and transverse proceses of the lumabr vertbrea
innervation: ventral rami of T12-L4
action: unilaterally= lateral flexion of the vertbral column
bilaterally: depression of the rib cage
help stabilize lumbar spine
rectus abdominis
origin: crest of the pubis
insertion: costal cartlidges of ribs 5-7, xiphod process
innervation: thoracic abdominal nerves T7-T1 and subcostal nerve T12
actions: flexion of the lumbar spine
made up of tendoincles insertions (muscle belly) allows us to flex down pulls the spine into flexion, allows for greater fold and range of motion
external oblique
origin: ribs 5-12
insertion: illiac crest, pubic tubercule, linea alba
innervation: thoracoabdominal nerves T7-11 and subcostal nerve T12
actions: contralateral rotation of torso
runs medially
internal oblique
origin: ingunial ligament, iliac crest and the lumbodorsal fascia
insertion: linea alba, and ribs 10-12
innervation: thoracabdominal T7-T11 subcostal
actions: unilaterally ipsilateral trunk rotation
bilaterally: compresses abdomnen
fiber direction- runs upward
transverse abdominus
origin: iliac crest, inguinal ligament, thoracolumbar fascia, and costal cartlidges 7-12
insertion: xiphoid process, linea alba, pubic crest
innervation: thoracoabdominal T7-T11 subcostal T12 iliohypogastric L1 and illioinguinal L1
actions: cpmpresses abdominal caviy
movements of the spine
A. flexion (starting from extended position)
B. netural
c. extension (starting from flexed position)
d. lateral flexion bends to opposite
e. rotation contract to rotate to the left
draw the brachial plexus
vertebrae review
cervicle
7 vertebrae
thoracic
12 vertebrae
lumbar
5 vertebrae
sacrum
5 vertbrae
coccyx
1 vertebrae
direction of fascets
cervicle= SAF posteriorup IAF= anterior down outward slightly
thoracic= SAF= posteriorly IAF= in frontal plane
lumbar= SAR= medially IAF= sagiattal plane
ONLY THE THORACIC ARE ARTICULAR FASECT FOR RIBS
atlanto-occipital joint
articulation between the atlas and the occipital bone
pair of joints
type: synovial
subtype: condyloid
movements: flexion and extension 10-15 degrees
slight lateral motion
atlantoaxial joint
articulation of the atlas C1 and the axis C2
type synovial
sub-type: pivot
movements: rotation of the head 50 degress
unconvertebral joint
luschkas joint
articualtions between vertebral body of C3-C7 and the uncinate process
type: synovial & cartilaginous
movement: flexion extension and some rotation
prevents any excessive bending
costavertebral and costotransverse joints
costovertebral joints: articulation between the head of the rib and the body of the thoracic vertebrae
costotansverse joint: articualtion between the tubercule of the rib with the transverse process of the thoercic vertebrae
synovial plane joints
allows glidling to move ribs superiorly and posteriorly, to increase the volume of the ribcage
zygapophyseal facet joint
articualtion between the inferior articulating facet of the superior vertebrae to the superior articualting facet of the inferior vertbrae
synovial
movements: guide and limits the movements of the segments of spinal column
prevents hyper-extension, hyperflexion and herniation of intervertbral discs
intervertebral joint
articualtion between adjacent vertebral bodies
type: cartilaginous
movement: minimal/ slight movement
lumbrosacral joint
articualtion between L5 and the first segment of the sacrum S1
L5-S1
type: cartilaginous symphysis
movement: slight movement
sacroiliac joint
articualtion between the coxal bone and the sacrum
type: synovial plane in children
cartilaginous- adult
movement
very slight movement
spine ROM
2-3 between each
flexion-40 -60 degrees
extension- 20-35
lateral-15-20
rotation-3-18
intervertebral discs
aka- cartlidge
each disc consists of an outer annulus fibrosus (several layers of fibrocartlidge) and an inner nucleus pulposes (loose fibers suspended in a mucoprotein)
shock absorber: pressure distrubted evenly across disc
cues of vertebral column
born with a kyphotic c-shaped spine
S-shaped
each curve has 20-40 degrees in the cervicle spine
20-40 degrees T spine
30-50 degrees in L spine
development of spinal curvature
lordotic curve- concave development occurs- when an infant lifts their head
when an infant learns to walk
kyphotic curve- convex development occurs during fetal development
ligaments
cruciate= cross shaped
transverse ligament on atlas strongest part of the cruciate
interspinous ligament
connnects adjacant posterior spines
alrge angle of obliquity
limit flexion
helps facet joints stay in contact
ligamentum flava
connects lamine of vertebrae
80% elastin, 20% collagen
function= limits flexion, highly elastic, elastin prevents buckling into the spinal canal during extension
ligaments
posterior and anterior longitudal lig
ribbon like
attach at vertebral bodies and annulus
anterior resists excessive extension
posterior resits excessive flexion
ligaments
supraspnious
connects tips of spinous process
fucntion= resists excessive flexion
a small angle of insertion
rotary component
compressive component
main fucntion is stabilization of spine
why do we require a strong core
prevents back injuires
because the center of mass dips below the hip
what actions can we do with the hip
flexion/ extension
ab/ad
medial/ lateral
circumduction
what muscules felx the hip
psoas major
illiacus
minor flexors: rectus femoris, sartorious
knee extensors
glute max
hamstrings 3
minor hip flexors= gluteus max, adductor magnus
hip adductors
adductor magnus
adductor longus
adductor brevius
pectineus
gracilis
hip abductors
gluteus maximus
gluteus medius
gluteus minimus
tensor fascia lata
medial rotators of the hip
gluteus medius
gluteus minmius
TFL
minor: adductor brevius and longus
superior portion of adductor magnus
actions of gluteus medius
abducts the hip joint
anterior fibers medially medially rotate and may help with flexion of the hip
posterior fibers laterally rotate and may assist with extension of the hip
important role in stabilizing the hip and rotating the plevius during gait
lateral rotators of the hip
piriformis
gemellus superior
obturator internus
gamellus inferior
quadratus femoris
obturator externus
others: sartoris
male vs female Q angle
male= 12 degrees
female= 16 degrees
hip joint- acetabulum
lined with articualr cartlidge
70% of femur articulates with the acetabulum
hip joint: capsule and ligament
capsule surrounds joint (chinese finger puzzle) rinforced by ligaments and psoas muscle tendon
3 ligments blend with capsule
-iliofemoral
pubofemoral
ischiofemoral
lumbar plexus
femoral nerve L2-L4
primarily supplies quadriceps group
Obturator Nerve L2-L4
primarily supplies the Adductor group
Sacral plexus
sciatic nerve L4-S3
in the posterior thigh the nerve consists of two distinct portions: tibial n & common fibular (peroneal)
Responsible for the hamstring group and the muscles of the leg
ischiofemoral
located on posterior side
resists: extension, adduction and internal rotation
movement
flexion/ extension
flexion 120-125
primarily limited by soft tissue
greater range of flexion if knees bent otherwise limited by hamstrings
hamstrings also cross knee joint. therefore under greater stretch if knee is straight limiting their ability to stretch
extension 10-15
limited by anterior portion off joint capsule, hip flexor muscles and ligaments (iliofemoral)
pelvofemoral rhythm
posterior and anterior tilt of pelvis with flexion and extension respectively
movements adduction abduction meidal& lateral rotation cirumduction
abduction: 30-40
limited by adductor muscles greater Rom if externally rotate femur first (the thigh bone rotates internally toward our midline)
adduction 15-30
limited by antagonist muscles and ligaments
greater ROM with thigh flexion
medial & lateral rotation
importance of hip abductors
iliotibial tract
avoid paralyzed abductors of the thigh
hip injuries
a) head of femur is driven posteriorly, out of acetabulum
b) posterior dislocation of right hip joint
hip replacement
acetabular component
plastic liner
femoral head
femoral stem
what actions are possible at the knee
locking and unlocking the knee
femur rotates medially to lock the knee
laterally rotates to unlock
tibia
proximal features
fibular facet
medial bone in crural region
proximal features: medial and lateral condyles: smooth surfaces for articulation with femur
fibular articular facet: articulation site for head of fibula under lateral condyle
rough anterior projection inferior to condyles; can be palpated just inferior to the patella for attachment of patellar ligament
tibial tuberosity
ridge along anterior surface extending from tuberosity distally; the “shin”
tibial border
proximal head with flat articular facet for articulation with the tibia
narrow neck and slender shaft
distal and expands into lateral malleolus
fibula
why do we have a fibula
1) provides a site for muscle attachments
2)I provides lateral stability to the ankle joint
3) with the tibia and fibula has an interosseous membrane (site for muscle attachments)
patella
crest mode bone= develops with tendon (2 years) formed through tendon/stress load
actions of the knee
flexion: hamstrings, gastrocnemius, sartorius, gracilis
extension: quadriceps femoris, rectus femori, vastus (3), popliteus
LCL
various force pushing on the knee laterally, outside adduction
thinner than MCL
MCL
valgus force: out force translates knee to the midline ABduction
valgus stress test
brace the lateral side pull laterally on the distal shin try to Abduct positive MCL tear= ability to abduct
ACL
anterior cruciate ligament
provides primary 85% anterior tibial translation
tight when knee is in extended position
ACL test
pull superior portion calf pull anteriorly shift he tibia anteriorly
PCL
primary restraint to posterior movement of the femur
contents of the popliteal fossa
tibial nerve
common fibular nerve
popliteal vein
small saphenous vein
popliteal artery
lumbar plexus
femoral nerve (L2-L4) primarily supplies quadriceps
obturator nerve (L2-L4) primarily supply the adductor
sacral plexus
sciatic nerve (L4-S3)
in the posterior thigh the nerve consitis of two distinct portions: tibial and common fibular nerve (peroneal)
responsible for the hamstring group and muscles of the leg
soleus
flexed knee: plantar flexion
lumbar plexus
femoral nerve (L2-L4) primarily supplies quadriceps group
obturator nerve (L2-L4)
primarily supplies the adductor group
sacral plexus
sciatic nerve (L4-S3)
in the posterior thigh the nerve consists of two distinct portions: tibial and common fibular (personal nerve) responsible for the hamstrings group muscles for the leg
synovial hinge joints
femur, tibia, patella, largest and most complex joint in body with: medial and lateral menisci
tibiofemoral joints (menisci)
composed of fibrocartilage
wedge shaped with greater thickness in the periphery
blood supply to the periphery but not to the inner portion
explain:
enhance stability
shock absorption
enhances lubrication of joint
limits movement between tibia and femur
enhance stability: deepening the contact surface f the tibia
shock absorption: increases contact area between the tibia and femur transmitting force over a larger surface of the joint
enhances lubrication of joint: acts as a space-filling mechanism which allows the dispersal of move synovial fluid to surface of the tibia and femur
limits movement between tibia and femur: fills in space between tibia and femur by moving posteriorly with flexion a the knee and anteriorly with extension
LCL
various=protects against lateral movement (imposed from a force on the medial side)
MCL
valgus= protects against medial movement (imposed from a force on the lateral side)
ACL
provides the prime 85% restraint against anterior movement of the tibia
tight when knee is extended
PCL
provides primary restraint to posterior movement of the femur
flexion at knee patella moves…
inferiority and towards the lateral condyle of femur
popliteal fossa
tibial nerve
common fibular nerve (peroneal)
popliteal nerve
small saphenous vein
popliteal artery (femoral artery)
gastrocnemius and soleus
crosses knee
felt knee: planter flexion
knee extended: testing plantar flexion
Jugular notch
sternal angle at manubriosternal joint
xiphisternal joint
throastic vertebrae T5-T9
veins
blood towards the heart
artery’s
carry oxygenated blood away from the heart
diaphragm dome shaped structure comprised of muscle and connective tissue
anteriorly it attaches to the diploid process and along the costal margin
laterally it attaches to ribs 6-12
posteriorly it attaches to T12, with “legs or crus” that attach the body ofL1 & L2
converges on to central tendon
external intercostals
internal intercostals
used during quiet and forced inhalation
used during forced exhalation
