Units 1 and 2_Intro and UE Flashcards
scapular rotators - upward rotators
upper part of trapezius, lower part of trapezius, serratus anterior
scapular rotators - downward rotators
levator scapulae, pectoralis minor, rhomboids
scapulohumeral rhythm (2:1)
for GH joint to have full range of motion, scapula must move 1 degree on thorax for ever 2 degrees that humerus moves on surface of glenoid cavity (e.g. to achieve 180 degrees shoulder flexion, humerus moves 120 and scapula moves 60)
- if doesn’t happen, greater tubercle hits the acromion
vertebrae - numbers
cerval - 8, thoracic - 12, lumbar - 5, sacral - 5, coccygeal - 4
kyphosis
flexion of vertebrae (thoracic and sacral)
lordosis
extension of vertebrae (cervical and lumbar); called sway back (opposite of flat back)
scoliosis
curved spine in frontal plane
facet
joint between - where articular processes meet
- joint type: plane (ex. costal facet where vertebra touch rib)
intervertebral disc
between bodies of vertebrae
spinal nerves
paired set come out of intervertebral foreman (cervical-8, thoracic-12, lumbar-5, sacral-5, coccygeal-1) - total 31
rotator cuff muscles (4) and tendons (3)
muscles: supraspinatus, infraspinatus, teres minor, subscapularis
tendons: supraspinatus, infraspinatus, teres minor
sternoclavicular joint and relation to axial skeleton
only place where UE is he’d to body
Bone layers
compact bone - dense outer covering
spongy bone - inner region; medullary cavity in long bones (marrow)
periosteum - outer connective tissue covering (highly vascularized)
endosteum - inner connective tissue covering (lines medullary cavity)
Bone development
derived from neural crest mesenchyme (head) and somite and lateral plate mesenchyme (body)
two processes of bone development
endochondral ossification (from cartilage) intramembranous ossification (between layers of membrane)
endochondral ossification
forms first, long bones; develop by gradual replacement of cartilaginous model with bone; primary ossification (in middle) and secondary ossification (at ends)
- epiphyseal cartilage / plates - site of elongation between ossified regions
intramembranous ossification
form later; flat bones (skull, clavicle, mandible); develop by accretion on surfaces and edges of embryonic mesenchyme plate; growth occurs on outside while inside is resorbed
anatomy of long bone
diaphysis - shaft
epiphysis - one end of long bone
epiphysial line - formed from location of epiphyseal plate (where bone growth occurs); secondary ossification occurs here
metaphysis - growth plate region; where endochondral ossification occurs
fascia
thick layer of dense, irregular CT organized into sheet to tubes; membrane that surrounds structures like nerves, muscles, vessels, and organs
- superficial: sheet of CT between dermis and underlying deep fascia covering muscle (cutaneous nerves are here)
- deep: surround muscle on both sides
bursae
closed, fluid-filled sacs of CT; serve to reduce friction between tendons, ligaments, bones, and muscles
aponeurosis
modified tendon made from same type of CT as tendons but has broad, thin, sheet-like structure
muscle action over joints
had potential to influence moment over ever joint it crosses; primary action usually at most distal joint
muscle types
cardiac - heart and great vessels; transverse stripes; single nucleus; involuntary
smooth - walls of viscera and vessels, etc.; no striations; central nucleus; involuntary by autonomic NS
skeletal - striated; multi-nucleated; voluntary by somatic NS
symphysis
type of joint (ex. intervertebral)
plane / gliding
type of joint (ex. costal facet, acromioclavicular, 2-5 carpometacarpal)
sellar
type of joint with gliding and rotation; moment more complicated than plane joint (ex. sternoclavicular, first carpometacarpal)
ball & socket
type of joint; allows all moments plus circumduction (ex. glenohumeral)
hinge (ginglymus)
type of joint (ex. elbow, interphalangeal)
pivot (trochoid)
type of joint (ex. proximal and distal radio-ulnar)
ellipsoidal
type of joint (ex. radoiocarpal, metacarpophalangeal)
sternoclavicular jointn”SC”
example of sellar joint; movement is complex and different between anterior and posterior compartments (separated by articular disc)
- stabilized by two ligaments: costoclavicular; sternoclavicular
acromioclavicular joint “AC”
plane (gliding) joint; injury can effect subacromial space
- stabilized by ligament: acromioclavicular
- supported by ligaments: coracoclavicular (trapezoid and conoid
- anterior / posterior gliding and rotation
- injury: ligaments team with FOOSH; danger to subacromial space
glenohumeral joint
multi-axis ball and socket; large range of motion due to shallow gleaned and large head, loose capsule, and limited ligamental support; allows circumduction
- stabilized by ligaments: glenohumeral ligament around jt. capsule (anterior), coracohumeral ligament with coracoacromial ligament as supporting arch (superior), joint capsule only (posterior)
- muscular support: rotator cuff and deltoid
- injury: supraspinatus impingement: ss tendons become thickened and get caught in subacromial space; impinges on bursa and cause pain
- injury: should dislocation occurs inferior / posterior since lack of support; can injure structures in axilla
labrum
upper rim of glenoid cavity that deepens socket by 75%
scapulothoracic joint
pseudo joint between scapula and thoracic wall (muscular joint with no supporting ligaments)
- moments: elevation, depression, protraction, retraction, abduction, adduction
- movement at this joint needed for full range of motion at GH joint (scapular humeral rhythm)
elbow joint
three articulations:
humeroulnar - hinge
humeroradial - plane or gliding
proximal radioulnar - pivot / trochoid
injury: bursitis due to large # of bursa
injury: dislocation of radial head (called subluxation / moves inferiorly)
joints in wrist and hand
radiocarpal: ellipsoidal
carpometacarpal: sellar (1) and plane / gliding (2-5)
metacarpophalangeal: ellipsoidal
interphalageal: hinge / ginglymus
unipolar neuron
sensory; cell body in dorsal root ganglia
multipolar
neurons are motor; cell body in CNS; inverse skeletal muscle
motor neuron
multi-polar; cell body in CNS; efferent signal travels away form CNS; exit through ventral root of spinal cord
sensory neuron
psuedounipolar; cell body in PNS; afferent signal travels towards CNS; simple job is sensation from skin; enter spinal cord though dorsal root
ganglion
group of nerve cell bodies outside CNS
exteroceptors
afferent structures that receive stimuli form skin
proprioceptors
afferent estrutures that receive stimuli from joints and muscles
somatic
structures that arise from somites, including bone, skeletal muscle, and skin
visceral
structures that arise from non-somite embryotic tissue, including organs, glands, vessels, and tracts
spinal cord meninges
dura matter: thick, tough outer layer
arachnoid matter: middle layer; CSF located b/t pia and arachnoid
pia matter: delicate, transparent covering of brain and spinal cord
plexus
ventral rami of spinal nerves converge to form plexuses and axons are redistributed; plexuses supply nerve to extremities. Thus, peripheral nerves contain multiple segments of spinal nerves (except intercostal nn. T1-T12)
dermatome
area of skin supplied by 1 spinal nerve
myotome
set of muscles innervated by single spinal nerve; tendon tap would test this
cutaneous nerve distribution
multiple spinal nerves can influence cutaneous nerves; opposite of dermatome
G.S.E.
general somatic efferent
somatic NS scheme; motor signals to skeletal muscle
G.S.A.
general somatic afferent
somatic NS scheme; sensory info (pain, proprioception, temp, tough) from sensory receptor to CNS
somatic NS
controls interaction with external environment; well localized and under conscious control
autonomic NS
regulates internal environment; poorly localized; unconscious control
G.V.E.
general visceral efferent
motor signal to internal organs and parietal distribution
development of NS - embryology (day 16-20)
triaminar disc forms with 3 germ layers; each gives rise to different structures:
- ectoderm: CNS, PNS, etc.
- mesoderm: bone, cartilage, connective tissue, muscle, etc.
- endoderm: lining of respiraotry and GI tracts, etc.
development of NS - embryology (day 20-26)
mesoderm divides into cuboidal structures to for paired somites
development of NS - embryology (day 26-30)
somites (from mesoderm of triaminar) differentiate into dermatome (skin), myotome (muscle), and sclerotome (skeleton - cartilage, bones, tendons)
development of NS - embryology (day 32)
all somites formed; paired somites associated with adjacent portions of neural tube (from ectoderm) and specific spinal nerve axon pathways
- this creates segmental innervation pattern of NS!!
anastomosis
connection of arteries to provide blood to needed areas around a joint; pressure gradient can change and blood can flow opposite normal direction
vessel layers
tunica adventitia: collagen covering; most exterior
tunica media: smooth muscle; controlled by autonomic NS
tunica intima: endothelium; inner most layer, single-cell and intimate with blood
venae comitantes
arrangement of two or more veins surrounding a single artery
functions of lymphatic system
- return plasma proteins and fluids that have escaped circulatory system to venous blood
- return lymphocytes from recirculating pool to blood
- add antibodies formed in nodes to blood
- transport lipids from digestive tract to venous drainage
chyle
lymph in GI tract that is high in lipids
lymphatic system patters of drainage
superior right quadrant - drains into rt. subclavian/internal jugular vein via right lymphatic duct
rest of body drains into lt. subclavian/internal jugular vein via thoracic duct
cisterna chyli
large dilation or sack in abdomen that empties into thoracic duct
external signs of carcinoma of breast
skin dimpling, edema of skin (dots), nipple retraction and deviation, abnormal contours
rotator cuff muscles
supraspinatus, infraspinatus, teres minor, subscapularis (work as stabalizers to pull head of humerus into glenoid fossa)
subacromial space
located below coracromipal arch (acromion, coracoacromial ligament, coracoid process)
- bursa here
intermuscular septums (medial and lateral)
formed by deep brachial fascia; septette arm into anterior and posterior compartments
flexor retinaculum transverse carpal ligament
from pisiform and hamate to trapezium and scaphoid; serves as attachment for thinner ad hypothenar muscles; maintains carpal arch; prevents bowstringing of flexor tendons; protects medial nerve
- carpal tunnel associated with this
TFCC
triangular fibrocartilage complex; space between ulna and carpals articular disc here degenerates over time
tenodesis
when wrist flexes, fingers extend and visa versa
finger motions
MP: abduct/adduct; flexion/extension; rotations
PIP and DIP: flex/extend
thumb motions
carpometacarpal jt: radial abduction and adduction; extension and opposition; palmar abduction/ adduction
MOP joint: flexion/extension
extensor compartments
- abductor pollicis longus and extensor pollicis brevis (deQuervain’s tenosynovitis - radial wrist pain)
- extensor carpi radialis longus and brevis (tennis elbow)
- extensor pollicis longus (lister’s tubercle/dorsal tubercle) (tendon takes 45 degree angle)
- extensor digitorum and extensor indicis
- extensor digiti minimi
- extensor carpi ulnaris (can also be issues with TFCC)
palmar fascia
very thick; continuous with anti brachial fascia of forearm
palmar aponeurosis
flat sheet art palm of hand; continuous with tendon of palmaris longs and flexor retinaculum
juncturae tendinum
attached tendons together on posterior side of hand; limits independent extension of ulnar 3 digits
flexor tendons and nutrients
flexor digitorum profundus and superficialis (FDP and FDS) get nutrients from vinculum
extensor hood
located on dorsal side of hand; extensor digitorum inserts into this
synovial joint characteristics
capsule, synovial membrane, joint cavity, articular cartilage, fibrocartilage (articular disc / meniscus)
subacromial space
tendons of rotator cuff muscles; tendon of long head of biceps brachii
greater tubercle clearance
lateral rotation of humerus necessary for clearance of greater tubercle as it passes under coracoacromial arch (lesser tubercle will fit, but greater tubercle would hit acromion)
