Muscles and ligaments Flashcards
TMJ
Depress
- lateral pterygoid
- suprahyoid
- infrahyoid
Elevate
- Temporalis
- Masseter
- Medial pterygoid
Protrusion
- Masseter
- Lateral pterygoid
- Medial pterygoid
Retraction
- Temporalis
- Masseter
- Digastric
Side to side
- Medial pterygoid
- Lateral pterygoid
- Masseter
- Temporalis
Cervical Intervertebral Joints- Flexion
- Sternocleidomastoid
- Longus colli
- Scalenus muscles
Cervical Intervertebral Joints- Extension
- Splenius cervicis
- Semispinalis cervicis
- Iliocostalis cervicis
- Longissimus cervicis
- Multifidus
- Trapezius
Cervical Intervertebral Joints- Rotation and Lateral Bending
- Sternocleidomastoid
- Scalenus muscles
- Splenius cervicis
- Longissimus cervicis
- Iliocostalis cervicis
- Levator scapulae
- Multifidus
Thoracic and Lumbar Joints- Flexion
- Rectus abdominus
- Internal oblique
- External oblique
Thoracic and Lumbar Joints- Extension
- Erector spinae
- Quadratus lumborum
- Multifidus
Thoracic and Lumbar Joints- Rotation and lateral bending
- Psoas major
- QL
- External and internal oblique
- Multifidus
- Longissimus thoracis
- Iliocostalis thoracis
- Rotatores
Scapula- elevation
- Rhomboid
- Levator scapulae
- Upper trap
Scapula- depression
- Lower trap
- Pectoralis minor
Scapula- protraction
- serratus anterior
- pec min
Scapula- retraction
- middle trap
- rhomboid
Scapula- upward rotation
- lower trap
- serratus anterior
- upper trap
Scapula- downward rotation
- rhomboid
- levator scap
- pec minor
Shoulder- Flexion
- coracobrachialis
- anterior delt
- pec major clavicular head (1st 60° 0-60°)
- biceps brachii assists
Shoulder- Extension
- pec major sternal head (1st 60° 180°-120°)
- post delt
- teres major
- lat dorsi
- triceps brachii long head assist
Shoulder- Abduction
- Middle delt
- Anterior delt
- Posterior delt
- Supraspinatus
Shoulder- Adduction
- Teres major
- Lat dorsi
- Pec major
Shoulder- Horizontal abduction
- teres minor
- infraspinatus
- post delt
Shoulder- Horizontal adduction
- ant delt
- pec major
Shoulder- ER
- teres minor
- infraspinatus
- post delt
Shoulder- IR
- subscapularis
- pec major
- lat dorsi
- ant delt
- teres major
Elbow- Flexion
- Biceps brachii
- Brachioradialis
- Brachialis
Elbow- Extension
- Triceps brachii
- Anconeus prevents impingement of the annular ligament during elbow extension
Wrist- Flexion
- FCU
- FCR
- Palmaris Longus
Wrist- Extension
- ECU
- ECRL
- ECRB
Radial Deviation
- FCR
- ECRL
Ulnar Deviation
- FCU
- ECU
Hip- Flexion
- Iliopsoas
- Sartorius
- Pectineus
- Rec fem
- TFL
- Glute min
- Glute med anterior fibers
- Adductor magnus superior fibers
- Adductor longus
- Adductor brevis
Hip- Extension
- Glute max
- Semitendinosus
- Semimembranosus
- Glute med posterior fibers
- Adductor magnus inferior fibers
- Biceps femoris long head
Hip- abductors
- Glute med
- TFL
- Glute min
- Piriformis
- Sartorius
Hip- Adduction
- Adductor brevis
- Adductor longus
- Adductor magnus
- Pectineus
- Gracilis
Hip- ER
- Glute max
- Glute med posterior fibers
- Piriformis
- Sartorius
Hip- IR
- Glute min
- TFL
- Glute med anterior fibers
Knee- Flexion
- Semitendinosus
- Semimembranosus
- Plantaris
- Gastrocnemius
- Biceps femoris (both heads)
- Gracilis
- Sartorius
- Popliteus (unlocks the knee to initiate knee flexion)
Knee- Extension
- Rec fem
- Vastus medialis
- Vastus lateralis
- Vastus intermedius
Ankle- Plantarflexion
- Gastrocnemius
- Soleus
- Plantaris
- Tibialis posterior
- Flexor hallucis longus assists
- Flexor digitorum longus assists
- Peroneus Longus
- Peroneus Brevis
Ankle- Dorsiflexion
- Anterior tibialis
- Extensor hallucis longus assists
- Extensor digitorum longus assists
- Peroneus tertius assists
Ankle- Inversion
- Tibialis anterior
- Tibialis posterior
- Flexor hallucis longus assists
- Flexor digitorum longus assists
- Extensor hallucis longus assists
Ankle- Eversion
- Peroneus Longus
- Peroneus Brevis
- Peroneus Tertius
GH joint overview
Loose packed position: 55° abduction, 30° horizontal adduction
Close packed position: abduction and lateral rotation
Capsular pattern (proportional motion restriction that indicates irritation of the entire joint): The shoulder joint has a capsular pattern where external rotation is more limited than abduction which is more limited than internal rotation (ER limitations > ABD limitations > IR limitations)
Sternoclavicular joint overview
Formed by the medial end of the clavicle and the manubrium of the sternum. Saddle shaped synovial joint with three degrees of freedom. A fibrocartilagenous disc between the sternum and the clavicle enhances the stability of the joint and acts as a shock absorber, also serves as the axis of rotation.
Osteokinematic motions: elevation, depression, protraction, retraction, medial rotation, and lateral rotation
Loose packed position: arm resting by side
Close packed position: maximum shoulder elevation
Capsular pattern: pain at extremes of range of motion
Acromioclavicular joint overview
The joint is a plane synovial joint with 3 degrees of freedom.
Osteokinematic motions: anterior tilting, posterior tilting, upward rotation, downward rotation, protraction, retraction
Loose packed position: arm resting by the side
Close packed position: arm abducted to 90°
Capsular pattern: pain at extremes of range of motion
Scapulothoracic articulation overview
formed by the body of the scapula and the muscles covering the posterior chest wall. Motion consists of sliding of the scapula on the thorax. The articulationis not a true anatomical joint.
Acromioclavicular ligaments
the acromioclavicular ligaments surround the acromioclavicular joint on all sides and help to control horizontal movements of the clavicle
Coracoacromial ligament
The coracoacromial ligament attaches between the coracoid process and the acromion and forms the roof over the humeral head. The ligament helps to limit superior translation of the humeral head and also helps to prevent seperation of the acromioclavicular joint.
Coracohumeral ligament
attaches proximally to the coracoid process and splits distally to attach to the greater and lesser tuberosities. This ligament is found between and helps to unite the supraspinatus and the subscapularis tendons. It limits inferior translation of the humeral head
Costoclavicular ligament
attaches between the medial portion of the clavicle and the first rib. This ligament is the primary supporting ligament for the sternoclavicular joint.
GH ligaments
The GH ligaments consist of the superior, middle, and inferior GH ligaments.
Superior GH ligament
One of three GH ligaments
Limits adduction of the shoulder as well as lateral rotation with the shoulder in 0-45° of abduction.
Middle GH ligament
One of three GH ligaments
Limits lateral rotation with the shoulder in 45-90° of of abduction.
Inferior GH ligament
One of three GH ligaments
The inferior GH ligament has an anterior and a posterior band that limits lateral rotation and medial rotation, respectively, above 90° abduction. Between the two bands is an axillary pouch that limits inferior translation when the shoulder is above 90° of abduction.
Glenoid labrum
The glenoid labrum is a fibrocartilaginous structure that serves to deepen the glenoid fossa and increases the size of the articular surface. The glenoid labrum consists of a dense fibrous connective tissue that is often damaged with recurrent shoulder instability.
Joint capsule of the shoulder
The joint capsule arises from the glenoid fossa and the glenoid labrum to blend with the muscles of the rotator cuff. The capsule is reinforced by the GH ligaments and the coracohumeral ligament.
Subacromial bursa
Subacromial bursa extends over the supraspinatus tendon and the distal muscle belly, beneath the acromion and deltoid muscle. The bursa facilitates movement of the deltoid muscle over the fibrous capsule of the shoulder joint and supraspinatus tendon. The bursa is often involved with impingement beneath the acromial arch.
Transverse humeral ligament
The transverse humeral ligament attaches between the greater and lesser tubercle of the humerus, spanning over the bicipital groove. This ligament helps to maintain the tendon of the long head of the biceps within the bicipital groove.
Elbow
synovial joint consisting of 3 bones and 3 primary articulations (radiohumeral, ulnohumeral, proximal radioulnar) classified as the hinge joint
Radiohumeral joint
Osteokinematic motions: flexion, extension, pronation, and supination
Loose packed position: full extension, supination
Close packed position: 90° of flexion, 5 degrees supination
Capsular pattern: flexion, extension, supination, pronation
Ulnohumeral joint
Formed by the hourglass-shaped trochlea of the humerus and the trochlear notch of the ulna.
Osteokinematic motions: flexion and extension
Loose packed position: 70° elbow flexion, 10° supination
Close packed position: extension
Capsular pattern: flexion, extension
Proximal radioulnar joint
concave radial notch of the ulna and the convex rim of the radial head
Osteokinematic motions: pronation, and supination
Loose packed position: 70° of elbow flexion, 35° of supination
Close packed position: 5 degrees supination
Capsular pattern: supination, pronation
Annular ligament
band of fibers that surrounds the head of the radius. It allows the head of the radius to rotate and retain contact with the radial notch of the ulna.
Cubital fossa
triangular space located at the anterior elbow that is bordered by the brachioradialis, pronator teres, brachialis, and a horizontal line passing through the humeral epicondyles. The cubital fossa contains several structures, including the biceps brachii tendon, median nerve, radial nerve, brachial artery, and median cubital vein,
Cubital tunnel
A space formed by the ulnar collateral ligament the flexor carpi ulnaris, the medial head of the triceps, and the medial epicondyle. The ulnar nerve runs through the cubital tunnel. The tunnel becomes smallest with full elbow flexion.
Olecranon bursa
Lies posterior to the olecranon process and us considered the main bursa of the elbow. This bursa often becomes inflamed with direct trauma to the elbow due to its superficial position.
Radial (lateral) collateral ligament
Radial (lateral) collateral ligament extends from the lateral epicondyle of the humerus to the lateral border and olecranon process of the ulna and to the annular ligament. It is a fan-shaped ligament that prevents adduction of the elbow joint, and provides reinforcement for the radiohumeral articulation.
Ulnar (medial) collateral ligament
Ulnar (medial) collateral ligament runs from the medial epicondyle of the humerus to the proximal portion of the ulna. The ligament prevents excessive abduction of the elbow joint.
The distal radius articulates with the…
scaphoid, lunate, and triquetrum
Radiocarpal joint overview
Loose packed position: neutral with slight ulnar deviation
Close packed position: extension with radial deviation
Capsular pattern: flexion and extension equally limited
Anatomic snuffbox
depression found on the dorsal surface of the wirst near the distal radius. Bordered by the tendons of the abductor pollicis longus, extensor pollicis brevis, and extensor pollicis longus. Location used to palpate suspected scaphoid fracture.
Carpal tunnel
Located close to the deep surface of the flexor retinaculum. The median nerve enters the palm through the carpal tunnel. Any condition that narrows the size of the carpal tunnel (e.g. tenosynovitis, inflammation of the flexor retinaculum) my result in compression of the median nerve.
Dorsal radiocarpal ligament
origin: posterior surface of the distal radius/styloid
insertion: lunate and triquetrum
action: limits wrist flexion
Extensor retinaculum
ligamentous structure that crosses the dorsum of the wrist, covering the tendons of the wrist extensors. The retinaculum precents the tendons from “bowstringing” as the wrist is extended.
Flexor retinaculum (transverse carpal ligament)
ligamentous structure that crosses the palmar aspect of the wrist, forming the most anterior aspect of the carpal tunnel. The structure prevents the wrist flexor tendons from “bowstringing” with wrist flexion. It also serves as an attachment site for the thenar and hypothenar muscles.
Interosseous membrane
band of fibrous CT that runs obliquely from the radius to the ulna. The structure spans from the proximal radioulnar joint to the distal radioulnar joint and serves as a stabilizer against axial forces applied to the wrist.
Radial collateral ligament
Limits ulnar deviation, becomes taunt with exteme flexion or extension. Originates from the styloid process of the radius and attaches to the capitate, triquetrum, and scaphoid
Tunnel of Guyon
The tunnel of Guyon is a space that is located between the hook of hamate, pisiform, palmar carpal ligament, and flexor retinaculum. It provides passage for the ulnar nerve and artery as they enter the hand. Compression of the nerve in this location may result in ulnar tunnel syndrome.
injury of elbow ligaments
The ulnar and radial collateral ligaments can become stretched, frayed, or torn through the stress of repetitive throwing motions. A fall on outstretched arm can also cause injury to these ligaments.
Iliofemoral joint
Consists of the acetabulum, which is oriented laterally, inferiorly, and anteriorly, and the femoral head.
Iliofemoral joint overview
Loose packed position: 30° of flexion, 30° abduction, slight lateral rotation
Close packed position: full extension, medial rotation
Capsular pattern: flexion, abduction, medial rotation (sometimes medial rotation is the most limited)
Acetabular labrum
fibrocartilagenous rim around the acetabulum, functions to increase the depth of the hip socket
Articular capsule of the hip
extends from the rim of the acetabulum to the neck of the femur. The capsule is reinforced by the iliofemoral, pubofemoral, and ischiofemoral ligaments.
Femoral triangle
space located in the anterior hip that is bordered by the inguinal ligament, sartorius, and adductor longus. Within this space the femoral artery and lymph glands can be palpated. the femoral nerve and vein also pass through this space.
Iliofemoral ligament
consists of a thickened portion of the articular capsule that extends from the anterior inferior iliac spine of the pelvis to the intertrochanteric line of the femur. The structure is considered to be the strongest ligament in the body and serves to prevent excessive hip extension and assists to maintain upright posture.
Ischiofemoral ligament
consists of a thickened portion of the articular capsule that extends from the ischial wall of the acetabulum to the neck of the femur. The structure is the weakest of the main hip ligaments, however, it serves to reinforce the articular capsule
Ligamentum teres
provides physical attachment between the head of the demur and the inferior rim of the acetabulum. Blood vessels and nerves travel with the ligament in a sheath to the head of the femur. Provides minimal stability to the hip.
Pubofemoral ligament
Thickened portion of the articular capsule that extends from the pubic portion of the rim of the acetabulum to the neck of the femur. Prevents excessive abduction and extension of the hip.
Knee joint
synovial hinge joint
Anterior cruciate ligament
May be injured through non-contact twisting injury associated with hyperextension and varus or valgus stress to the knee. May also be injured by tibia being driven anteriorly on the femur or the femur posteriorly on the tibia or severe knee hyperextension. Tests include anterior drawer test, Lachman test, lateral pivot shift test, and Solcum test.
Runs from the anterior intercondylar area of the tibia to the medial aspect of the lateral femoral condyle in the intercondylar notch.
Posterior cruciate ligament
May be injured when the superior portion of the tibia is struck while the knee is flexed, like in a MVA. Other MOI include the tibia being driven posteriorly on the femur, the femur being driven anteriorly on the tibia or severe knee hyperflexion. Special tests include posterior drawer test and posterior sag sign.
Runs from the posterior intercondylar area of the tibia to the lateral aspect of the medial femoral condyle in the intercondylar notch.
Medial collateral ligament
May be injured with pure valgus load at the knee without rotation. This type of injury is often sustained with contact activities such as a lateral blow to the knee during a football game. Injury to the MCL often involves injury to other structuressuch as the ACL or medial meniscus. A valgus stress test can assess the integrity of the MCL.
Lateral collateral ligament
May be injured with a pure varus load at the knee without rotation. This type of injury is often sustained with contact activities such as a medial blow to the knee. The LCL is rarely completely torn without a concurrent injury to the ACL or PCL. A varus stress test can assess the integrity of the LCL
Tibiofemoral overview
Osteokinematic motions: flexion, extension, medial and lateral rotation
Loose packed position: 25° flexion
Close packed position: full extension, lateral rotation of the tibia
Capsular pattern: flexion, extension
LCL
Runs from the lateral femoral epicondyle to the fibular head. Prevents varus displacement of the tibia.
MCL
Runs from the medial femoral epicondyle to the medial shaft of the tibia. The deep capsular fibers are attached to the medial meniscus. The MCL prevents excessive valgus displacement of the tibia relative to the femur.
Menisci
medial and lateral menisci attatched to the proximal surface of the tibia. Function to deepen the articular surfaces of the tibia, act as shock absorbers and contribute to lubrication and nutrition of the joint.
Pes Anserine
Common insertion point for the gracilis, semitendinosus, and sartorius muscles. Located medial and distal to the tibial tuberosity. Pain and/or swelling in this area may indicate pes anserine bursitis.
Plicae
extensions of the synovial membrane sometimes found on the anterior knee. They don’t serve a function but can be a source of anterior knee pain.
Retinacula
medial and lateral retinacula are ligamentous structures that attach the patella to the femur, tibia, and menisci. The lateral retinaculum is the stronger of the two and plays a larger role in patellar positioning.
Talocrural joint
formed by articulation between distal tibia, talus, and fibula. The joint is a synovial hinge with one degree of freedom. Offers significant stability in DF but becomes more mobile with PF.
Loose packed position: 10° PF
Close packed position: maximum DF
Capsular pattern: PF, DF
Subtalar joint
formed between the talus and calcaneus. The joint has one degree of freedom.
Loose packed position: midway between the extremes of ROM
Close packed position: supination
Capsular pattern: limitation of varus ROM
Anterior talofibular ligament
taut during PF and resists inversion of the talus and calcaneus. The ligament also resists anterior translation of the talus on the tibia.
Calcaneofibular ligament
Extracapsular ligament that resists inversion of the talus within midrange of talocrural motion
Deltoid ligament
provides medial ligamentous support by resisting eversion of the talus.
Ankle ligaments
the majority of the ligaments of the ankle are areas of increased density within the joint capsule. As a result, damage to the ankle ligaments typically produces damage to the joint capsule and irritation of the synovial lining.
Plantar fascia
Thick layer of fascial tissue on the plantar aspect of the foot that originates on the calcaneal tuberosity and inserts into the plantar forefoot, The plantar fascia plays a role in supporting the weight of the body and also helps to support the arch of the foot for improved propulsion during gait.
Posterior talofibular ligament
resists posterior displacement of the talus on the tibia
Atlanto-occipital joint
A condylar synovial joint that permits flexion and extension of the cranium.
Atlantoaxial joint
A plane synovial joints that permit flexion, extension, lateral flexion and rotation of the cervical spine. The majority of the rotation of the skill on the spinal column occurs at the atlantoaxial joints.
Alar ligaments
attach the dens of the axis to the occipital condyles. these ligaments resist flexion, contralateral side bending, and contralateral rotation,
Anterior longitudinal ligament
limits extension of the spine and reinforces the anterior portion of the intervertebral disks and vertebrae.
Interspinous ligaments
located between the spinous processes and serve to limit flexion and rotation of the spine.
Ligamentum flavum
connects the lamina of one vertebra to the lamina of the vertebra above it. The structure serves to limit flexion and rotation of the spine
Ligamentum nuchae
restricts flexion in the cervical spine
Posterior longitudinal ligament
limits flexion of the spine and reinforces the posterior aspect of the intervertebral disks
Anterior sacroiliac ligament
connects the anterior surface of the ilium to the anterior sacrum. It is a thickening of the joint capsule and is considered the weakest of the sacroiliac ligaments.
Lumbar plexus
formed by the nerve roots of T12 and L1-L4, innervates the anterior and medial muscles of the thigh and the dermatomes of the medial leg and foot.
Ribs
ribs 1-10 articulate with the thoracic vertebrae through the costovertebral joints and the costotransverse hoints, Ribs 1-7 are attached to the sternum through costal cartilage and ribs 8-10 join with the costal cartilage of ribs 1-7. Ribs 11-12 articulate only with the the vertebral bodies of T11-T12, but not with the transverse processes of the same vertebrae. Ribs 11-12 are classified as floating because they do not attach to the sternum or the costal cartilage at their distal end.
Sacral plexus
formed by the lumbosacral trunk, the ventral rami of S1-S3, and the descending portion of S4. The plexus supplies the muscles of the buttocks , and through the sciatic nerve innervates the muscles of the posterior thigh and lower leg.
Supraspinous ligament
restricts flexion in the thoracic lumbar spine
Thoracolumbar fascia
functions to provide stability to the spine, transmit forces, resist lumbar flexion, and provide a site for muscular attachment
Lower quarter screening
rapid assessment of mibility and neurologic function of the lumbosacral spine and LEs. Traditionally performed with the pt seated or standing. Components of LE screening:
• Posture
•ROM
-AROM and PROM overpressure lumbosacral spine and LEs
