Dermatomes and Myotomes

Anatomy

• Dermatome refers to a sensory area supplied by one spinal nerve.
• Myotome is the motor area supplied by a single spinal nerve.
• Cutaneous refers to the peripheral nerve and the area it innervates.

Dermatomes

• C1, C2 and C3 cover the face and neck.
• C4 covers the tops of the shoulders.
• C5 relates to the deltoid.
• C6 relates to the thumb.
• C7 relates to the middle finger.
• C8 relates to the pinkie finger.
• T1 is the medial forearm.
• L1 is the greater trochanter.
• L2 is the anterior thigh.
• L3 is the medial knee.
• L4 is the medial lower leg.
• L5 covers the top of the foot.
• S1 relates to the lateral ankle.
• S2 is the posterior medial thigh.

Myotomes

• C1-C2 allows for cervical flexion and extension.
• C3 allows for cervical side bending and rotation.
• C4 allows for shoulder elevation.
• C5 allows for shoulder abduction.
• C6 allows for elbow flexion and wrist extension.
• C7 allows for elbow extension and wrist flexion.
• C8 allows for thumb extension.
• T1 allows for finger abduction.
• L1-L2 allows for hip flexion.
• L3 allows for knee extension.
• L4 allows for ankle dorsiflexion.
• L5 allows for great toe extension.
• S1 allows for ankle plantarflexion.
• S2 allows for knee flexion.

Muscle Insertions / Origins

• AIIS (Anterior Inferior Iliac Spine) refers to the point of origin for rectus femoris, a muscle that crosses the hip.
  • Rectus femoris allows for knee extension and hip flexion.
• Semimembranosus is located medially to semitendinosus.
• Pes Anserine includes the sartorius, gracilis, bursa, and semitendinosus.
• Gastroc crosses the knee and soleus doesn't flex the knee, but enables plantarflexion.
• Minor over major refers to the relationship between the rhomboids and teres.
• Lats (swimmer muscle) are located at the intertubercular groove of humerus.
• The muscles that originate at the medial epicondyle include pronator teres, FCR, palmaris longus, and FCU.
• PAD and DAB both refer to interossei muscles.
  • PAD refers to plantar adduction.
  • DAB refers to dorsal abduction.

Muscle Innervation

• Biceps femoris has two heads with different innervations.
• The short head is innervated by the tibial division of the sciatic nerve.
• The long head is innervated by the common fibular division of the sciatic nerve.
• Semimembranosus and semitendinosus are innervated by the tibial division of the sciatic nerve.
• The anterior compartment of the leg is innervated by the deep peroneal nerve.
• The lateral compartment of the leg is innervated by the superficial peroneal nerve.
• The posterior compartment of the leg is innervated by the tibial nerve.
• Most foot muscles are innervated by lateral plantar, but 3 muscles are innervated by medial plantar.
• Abductor hallucis, FDB, and the 1st lumbrical.
• Traps (trapezius muscle) are innervated by the spinal accessory nerve (CN XI).
• SITS muscles (supraspinatus, infraspinatus, teres minor, subscapularis).
• These are innervated by the suprascapular nerve and the subscapular nerve.
  • The teres minor is innervated by the axillary nerve (with the deltoid).
• Triceps are innervated by the radial nerve.
• Serratus anterior is innervated by the long thoracic nerve.
• Biceps, coracobrachialis, and brachialis are innervated by the musculocutaneous nerve.
• Forearm flexors are innervated by the median nerve, except for the m. of the pinkie.
• Forearm extensors are innervated by the posterior interosseous nerve, but not the radialis.
• The hand muscles are innervated by the deep branch of the ulnar nerve, except the thumb.
  • Thumb muscles are innervated by the median nerve (think carpal tunnel).

Ligaments

• Iliofemoral, pubofemoral, and ischiofemoral are femoral ligaments.
  • Iliofemoral prevents hyperextension.
• The ligaments of the knee include ACL, PCL, MCL, LCL, and meniscus.
  • ACL restricts anterior movement of the tibia relative to the lateral femur.
  • PCL restricts posterior movement of the tibia in relation to the medial femur.
• Medial meniscus has a C shape, has more blood supply, and doesn't require surgery.
• Ankle ligaments include deltoid (medial) and talofibular/calcaneofibular (lateral).
  • Deltoid includes tibiotalar, tibionavicular, and tibiocalcaneal ligaments.
  • Calcaneofibular restricts inversion.
• Shoulder ligaments include glenohumeral, coracohumeral, transverse humeral, coracohumeral, and labrum.
• AC ligaments include coracoclavicular (trapezius and conoid) and acromioclavicular.
• Elbow ligaments include humeroulnar and humeroradial, and the annular ligament.
• Wrist ligaments include ulnar and radial collateral, and TFCC (triangular fibrocartilage complex – ulnar).

Spaces (VAN drives out)

• Popliteal fossa is made up of semimembranosus/semitendinosus and gastroc.
• Femoral triangle consists of the inguinal ligament, sartorius, adductor longus, and iliopsoas.
• Flexor retinacula includes the tibialis posterior, flexor digitorum longus, tibial nerve, and flexor hallucis longus.
• Quadrangular space contains the teres minor/major, LH, and lateral head of triceps.
• Triangular space contains the teres minor and LH and lateral head of triceps.
• The axilla features the axillary artery and vein, nerves of the brachial plexus, and lymphatics.
• Cubital fossa contains the biceps brachii tendon, brachial artery, and radial and median nerve.
• Snuff box contains the extensor and abductor pollicus longus, scaphoid, and radial nerve.
• Flexor retinaculum contains FDS, FDP, FPL, and the median nerve.

Brachial Plexus

• Musculocutaneous nerve originates from C5-C7.
• Axillary nerve originates from C5-C6.
• Median nerve originates from C5-C8 and T1.
• Radial nerve originates from C5-C8 and T1
• Ulnar nerve originates from C7-C8 and T1.

Spine

• The pedicle connects the transverse process to the spinous process. The lamina connects the body to the spinous process.
  • Laminectomy involves removing the lamina.
• Atlas is C1 (yes), axis is C2 (no).
• Primary curves are kyphosis in the thoracic spine and sacrum.
• Meninges include dura, arachnoid, and pia mater.
• The blood supply to the brain comes from the internal carotid and vertebral artery.
• The iliocostalis, longissimus, spinalis, and multifidus are the I Love Spaghetti Muscles.
• Ligaments of the spine include ALL, PLL, supraspinous, cruciate, and alar.

Upper Extremity

• Tight pecs and upper trap with weak neck flexors and scapular stabilizers contribute to upper cross syndrome.
• Lower cross syndrome involves tight hip flexors and lumbar extensors with weak abdominals and glutes.

Cyriax Pain

• Pain before resistance indicates acute inflammation.
• Pain at resistance indicates subacute inflammation.
• Pain after resistance or over pressure indicates chronic inflammation.
• Painful and strong result indicates a minor lesion.
• Painful and weak result indicates a major lesion.
• Painless and weak result indicates a complete rupture.

FITT principle

• Strength training involves 60-100% with 1-12 reps.
• Endurance training involves <70% with 15-25 reps.
• Power training involves 60-90% with 2-6 reps.

Joint Mobility Scale

• A score if 0-2 indicates hypomobility.
• A score of 3 indicates normal mobility.
• A score of 4-6 indicates hypermobility.

Joint Mobilizations

• Grades 1 and 2 are for pain management.
• Grades 3 and 4 increase mobility.
• Grade 5 is manipulation.

Shoulder

• RTC (rotator cuff) impingement / tendinopathy features two types of causes.
  • Intrinsic causes from age.
  • Extrinsic causes from overuse.
• Other symptoms include a painful arc, ER weakness, and empty can test result.
• Biceps tendinopathy can be evaluated by Yergason's and Speeds tests/
  • Palpable tenderness in the bicipital groove can indicate biceps tendinopathy.
• An RTC (rotator cuff) tear can be evaluated by drop arms, lag sign, belly press, lift off.
• Bankart lesions may feature an anterior inferior labrum and hill sacks lesion from anterior dislocation.
  • Other evaluations include anterior apprehension, relocation, and load/shift tests.
  • ER can be limited post operatively.
• SLAP lesions are often found in throwers
  • It's a superior labrum tear from anterior to posterior (bicep tendon).
    • Bicep activity is limited post operatively.
    • Evaluations include biceps load II, O Brien, anterior apprehension, and speeds.

Instability

• Tests for posterior instability include posterior apprehension and load shift.
  • Posterior dislocation and reverse hill-sacks lesion are uncommon.
• Multidirectional instability can be evaluated with the Beighton scale, sulcus sign, and amongst females.

Adhesive Capsulitis

• Capsular pattern is ER>ABD>IR.
• Corticosteroids and PT is possible bilateral treatments.

AC Separation

• FOOSH or fall on outstretched hand causes AC separation.
• Evaluations include Piano key, active compression, and cross over sign.
• Grades 4-6 require surgery.

TOS

• Adson, wright and Allen, and Roos tests can evaluate TOS.
• Tight upper trap and levator muscles.

Arthroplasty

• Reverse arthroplasty may be indicated for RTC damage.
• Precautions for arthroplasty include no IR (internal rotation), no cross chest add (adduction), and no pushing up from chair.

Elbow

• Avulsion, salter harris (growth plate), supracondylar, epicondyle, or radial head may indicate fractures.
  • Additionally, a bump leverage test, alignment checks, and full extension.
• Nursemaids elbow – radial head out of the annular ligament indicates dislocations.
• Ulnar (sensory), median (motor), and radial (sensory and motor) indicates neuropathies
• Lateral epicondylalgia is tennis elbow and related to motion for back hand.
  • Indications of LE include grip pain, resisted wrist extension, and passive wrist flexion.
• Medial epicondylalgia is golfer's elbow and wrist flexion for swing.
  • Indications include resisted wrist flexion and passive wrist extension.
• Throwing athletes (tommy john) uses the palmaris longus for reconstruction of the UCL instability.
  • Indications of UCL instability include valgus stress tests.
• Varus stress tests can indicate LCL (Lateral Collateral Ligament) instability.
• Popeye deformity can indicate a distal biceps rupture.
• Indications include elbow flexion and supination is painful.

Wrist And Hand

• Finger extension, shear tests, murphy's sign, and TFCC testing can indicate carpal instability.
• TFCC injury also causes carpal instability.
• FOOSH (skiing) and ulnar side instability can also cause carpal instability.
  • Piano test and supination lift test.
• Scaphoid (snuffbox), colles (dinner fork – posterior), smith (anterior), boxers (5th metatarsal), bennet (1st) may indicate fracture.
• Finkelstein test (pain with thumb opposition, ulnar deviation, and grip) indicates DeQuervain's syndrome.
  • Wartenburg syndrome presents similarly.
• Pain is worse at night from carpal tunnel.
  • Look for thenar mm. atrophy & possible night splints.
  • Tinel's, direct compression, and Phalen's also indicate carpal tunnel
• Four things that cross under the flexor retinaculum includes FPL FDP and FDS and median n.
• Hypothenar eminence and sensory deficits in 4th and 5th digits indicates Guyon canal.
  • Wartenburg sign (5th met abducted) also indicates Guyon canal.
• Hyperextension and abduction of the thumb causes Gamekeepers Thumb.
  • Tearing of the UCL of the thumb can be evaluated with a valgus stress test.
• Forceful flexion while finger is extended can cause mallet finger.
• Examples include housekeeper injury.

Biomechanics of the Shoulder

• Glenohumeral joint is a ball and socket.
  • Flexion involves spin • Abduction involves glide inferior roll superior
  • ER involves glide anterior roll posterior
• Acromioclavicular joint is a synovial plane joint, which can be evaluated with upward/downward rotation.
  • ER and IR, and A/P tilting.
• Sternoclavicular joint is a stable saddle joint.
  • Elevation involves glide inferior and roll superior
  • Depression involves glide superior and roll inferior
  • Retraction involves roll and glide posterior
• Scapulothoracic joint displays force couples.
  • Traps and SA (scapular abduction) - prevent scapular winging
  • SITS and deltoid - prevent downward rotation of scapula
  • Rhomboids and MT and LT - stabilize and oppose SA pull
• Glenohumeral rhythm = 2:1 ratio with upward scapular rotation.

Biomechanics of the Elbow

• Humeroulnar joint involves a concave ulna or convex humerus.
• Humeroradial joint features an anterior roll and glide during flexion, and a posterior during extension.
• Anterior roll and glide = flexion (posterior = extension)
• Proximal radioulnar joint is convex on concave = opposite.
  • Proximal Pronation Posterior glide (anterior roll)
• Distal radioulnar joint is concave on convex = same.
  • Pronation = anterior roll and glide

Biomechanics of the Wrist and Hand

• Distal radioulnar joint allows more motion medially – 4th and 5th more mobile than 2nd and 3rd.
• Midcarpal joint features a concave on convex.
• Radiocarpal joint is convex on concave
  • Flexion = anterior roll posterior glide (extension opposite) • Ulnar deviation = ulnar roll radial glide (radial deviation opposite)
• IP joints are concave on convex = same direction
• CMC joint is a saddle joint.
  • Flexion/extension are opposite
  • Abduction/adduction are the same

Hip

• Developmental Dysplasia
  • Shallow socket
  • More common in females, breech positioning, and higher birthweight
• FAI can feature CAM (femoral head) and Pincer (acetabulum) deformities.
  • Presentation of deep pain at end range, FADIR painful, and C sign.
• Labral Tears cause limping, instability, clicking, and night pain.
  • Can evaluate with FABER to EADIR, Thomas test, and resisted SLR.
  • Increases risk with Pincer deformity.
• Chondral Injury involves rest in ER, abduction, and flexion.
• Ligamentum Teres Rupture features giving way or catching, clicking.
  • Evaluate with O'Donnell's and log roll.
• OA involves morning stiffness, trunk lean during gait, and difficulty donning/doffing shoes.
• Iliopsoas tendinopathy includes pain with extension and resisted flexion, catching, snapping, and popping.
  • Symptoms will recreate with FABER to EADIR.
• Pain that increases with prolonged positions indicates GTPS.
  • Symptoms include difficulty with single leg stance and a positive Ober's test.
  • No foam rolling for lateral hip pain with IT band is advised.
• Quick cutting or repetitive kicking may lead to adductor strain
• Stress fracture involves pain with activity that does not improve with rest.
  • Most often found at the femoral neck.
• Piriformis syndrome includes pain at SIJ that radiates down the leg and is aggravated by sitting.
  • Can evaluate with Piriformis test and FAIR.
• Legg calve perthes disease is avascular necrosis of the femoral head, which is a pediatric hip condition.
• SCFE (slipped capital femoral epiphysis) – fracture of femoral neck and slippage.
  • Symptoms include ice cream cone presentation and toe out gait.

Knee

• ACL injury can be caused by valgus force and hyperextension, involving high weight bearing.
  • Presentation includes immediate effusion, giving way, and poor quad control.
  • Evaluate with Positive Lachman's, anterior drawer, and pivot shift.
    • Available graft types = BPTB, HTA, and QTA
• A hyperflexion injury (e.g. fall on a flexed knee/dashboard injury) can indicate a PCL injury.
• Indicates a positive clancy sign, posterior sag, posterior drawer, and dial test.
• Collateral Ligament Injury
  • Use varus/valgus stress test to identify
• MCL attaches to medial meniscus and triad in injury to ACL, MCL, and medial meniscus

Meniscus Tear

• McMurray, Apley’s, Thessaly’s, and joint line tenderness helps to identify
  • ER (lateral), IR (medial)
  • Outer meniscus heals at a faster rate than the inner
• Forceful eccentric loading and difficulty with TKE indicate quadriceps/patellar tendon.
• Hamstring strain can indicate most common is biceps femoris in sprinters who have had a previous strain.
• Lateral Patellar Instability can be caused by WB in early knee flexion or direct contact.
  • Evaluated with apprehension test
• Anterior Knee Pain (PFPS and IT Band) can occur in activities such as squatting, stairs, and sitting.
  • Evaluation with reproduced pain with resisted knee extension.
  • IT band = noble’s compression, Ober’s, or modified Ober test
• Pediatric knee includes Osgood Schlatter as tibial tuberosity.
  • Sinding Larson Johansson is inferior-inferior patella
• OCD = decreased blood flow

Foot and ankle

• DVT signs/symptoms include active cancer, bedridden, paralyzed, localized tenderness, entire calf swelling, and non-varicose veins.
• Ottowa ankle rules involves palpating Malleoli, navicular, 5th met, and ability for 4 steps.
• Ankle Sprain Grades:
  • 1 = no LOF no laxity no TTP, loss ROM <5 degrees
  • 2 = anterior drawer positive and TTP, loss of ROM 5-10 degrees
  • 3 = anterior drawer +/ talar tilt / Loss ROM >10 degrees
• Chronic Ankle instability >6mths pain/dysfunction, with normal DF in gait
• High ankle sprain is associated with forced DF and eversion as well as external rotation.
  • Tests can be from squeeze to fibular translation.
• Achilles Tendon
• Thompson test - related to Father/Dad injury
• Medial Tibial Stress Syndrome
  • Common to females, pronators, shin splints and poor shoe support
• Posterior Tib Tendinopathy as medial pain with flat foot and plantar fascia pain
• Peroneal Tendinopathy

Plantar Flexion

• Lateral pain, sublux during DF or PF indicates Plantar Flexion in Snap ankle
• Windlass test is pain in big toe extension, worse in morning and with more WB
• FHL tendinopathy = turf toe - hyper ext- pain/ heel of foot
• Tarsal Tunnel syndrome entrapped tibial nerve = burning pain in toes and feet

Hip Biomechanics

• Angle of Inclination = Normal 125-130.
  • < 125 = coxa Vera= shorten the leg more bending forces/less MA.
  • =>125 coxa valga/ lengthened leg
• Femoral Torsion = Normal 10-20.
  • ->20 anteversion- ER toeing and Increased dysplasia risks
  • -<10/ retro version and ER
• Knee Flexion
  • Quad and PWB patellar moves on femur then wb
• WB/ femuor moves on paterlla - prone dislocations at 20-25
• Function as act as the lever arm. Lateral is steeper than medial laterally more prone to Dislocations.
• Tibiofemora- Genu Valgum- knocked knees – WB Lateral
  • Genu Varumaes now leg – wb medial->WB Screw Mechanism

Foot and Ankle

• True joint-Talocrual -Supination = plantar Flex and inversion and adduction
• Pronation - dorsiflexion with eversion and abduction more deltoid ligament
• Why is eversion more stable more delotied ligaments
• Kinematics DF = ant roll/posterior glide PL posterior glide

Gait

• Pronation medial and lateral glide
• Supination-medial /lateral glide
• Phalanges == concave on convex -same direction
• =mobilize= medial and calcaneocuboid - more stable
• Initial response - mid stance and end
• Most gait -one leg
• Force production and anteriority. Hip knees in
• Needs 30 degrees flex/ limb clearance with 10-20 degrees for stance
• Knees needs 60 flexion for feet clearance-Mid swin
• ankles = 10 DF
• phase swing vs no drop plus 20 degrees + push
• 3 types of Ankel : 1st- Heel 2cd ankle Rocker 3cd rocker terminal Stannic Must for push first 55 degrees MTP.

The Lumbar Spine

• Bulging disk from flexion and compress nerves + S/S that are low common L4 and L5
  • Check with radiating pain and positive SLR
• Ddd/stensus- pain during Sten -progress/flex and extension
  • Avoids Extension
• Pary fracture slipping spondylolisthes with pain during
• Stenos progression start from.
• Avoids extensn
• Caunder Equin- bowel/platter changes saddle numbness sexual dysfunction
• Scholiosis -name + scoliosis body 20/40
• Akyosis systemic disease that inflames
• Maipilations - nosymptomsrecent, hyper. hip/ low and ir over degree
• Sbiliato = young gen increase Abbert hyper Symptoms worser with sustained movements

SIJ

• 3 test Clusters distrac-Thrust and fiber
• Test leg length and short long - Prater Anterior rotation resist is hip ext
• Posteri- resist hip felix and out flair reasit.

Vertabrae

• 5 Ds and 3N= dizziness nystagmus , dysrathria dyspia- disphaga-drop off Nness-naseea-
• Test for instable vertebral = art-Sharper. Alar and lig test.
• spine test - 65 and older with ROM. Can rotate at 45

Cervical

• Radiculoplacy = Comppression- and Ultt . Able for rated 60 degrees hernia- stiff-and pain aggravated more commonly with transition con.

Neck Tests

• Stenosis-spinal chord injury , or Foramine
• Cervocoeny head aches test for impaiment that affects face
• Whip lash with stiffness then mussel spine

TMJ

• Method = deranges that affects symptons for derange - dysfunction after 8
• Prostral Synda- is always interment.
• Bio mech for conyal that oping or closing and affect musels

Modalities

• TENS=pain
• ESTIM = pain sensory and more Russian to the TENS or N
• Muslse= for twitches minutes
• intensity=.5 or up to ten with mild

Neruo 1.

• CNS cells
• PNS shwann
• micro-main extracellular environment -Regulation

Coding For Nerulon

• Rate as frequency
• Population
• Temp is time or monition

Sensation

• Affront and sensory= Group 1, 2
• Alpha
• 2 = gamma - Basically =

Stemuli for Receptors:

• = Pacinian-1.5
• touch and vibration touch with muscles - DCML : touch -decuss- with joints and muscles
• AT= with joint and muscles receptors
• Broad Side- touching with butting

Neruon 11 Motors Pools

• Medial= axial proximus ;Lateral= distals ventral /extensors dorsal plexors

Flexion

• Withdrawing = bilateral with pain
• Step with

Basic Pathway

• Rubor spine and vests spinal - test to spinal- spinal

Seceonary

• Lesion- interperate. / sensory motor lesion - 0a
• Frontal decision or temporal striatum- the -Amygdalate the =

Nerys Bio Process Neuro2

• Embryo - form plate with crest and brain-

Process Neuro 2/ Proves

• Over prone schizer / Underprone austim

Spin Test and Nerves

• Occula= tufts of hair - Meninceocle= bulge spine ;
• Cranual Nerve* all = Anatomy - say many but brother matters test
• Olfartary; optic is collical nucle vision-
• Ocular= pupils contraction + Reflex adjust
• Trocha medial= reading adjust for the convergence looks clos

Neuro 2 Conintued.

• Facail and fibers with nerves plus hemi paralysis
• Vestiibbulochachlear =balnace with cohlear
• Gelsso =fiber tongue/taste
• Hype gloss = tongue/ deviator the
• Nervous System always for acetyl all + receptors plus alpha - artierloes/

Neuro and Spinal chords

• Motor/Sensories
• Levels complete S 24-dysfx with B/B dysfunction
• Bilateral =paralysis to = At the level =

Cerebrum

• Slower gaba the excitation
• dopamine - with
• Parkinson = decr cortex with 2 - Hunting-decr Striatum
• Lesions that delayed the onsets / lateral side

##Trauma + Plasitcky

• Learning the senses and halitulation- associate- the operant or classic
• Cells Sproutering spinal Injury-syn -receptors .Synaptic-Trans
• Excess glutante Excitotoxic

Strokes Anterior/Posterior

• Posterior and Aphasisa Lenttculostria the

Vision and Visual

• Contration Vs relation to
• stretch disks =far disc test
• Deiseare -Myopia and Hyper -Focues- is central of colors.

Audio + Vesitubkar

• Stterrocilita- towards excitatory or a way movements monitor the puss andpulls with utrice . Refect and to to right position coding is the
• low - high in

Loss

• Condictite for or more better conductions sensor

Neurological ReHabs

• Control the learning System and to

Motor and Movemnt

• Ananlisystic for a
• Modified with scle with hyper with

Lab Values + Vitals

• Hematocrit - HB plus 3 types of cells more protein
• Max = 2
• Spon2 + enough

###Spinal Chord And Nerves

• mech = and regrow this blt
• Test for motor test. Bowel manages =with nerve functions . Lumto to the Stroke for more
• Hem-with cloft
• and Hem more.
• Aphas for flueny that
• Heme for spastic

More Nervous for the Pst

-Synergy those test and

• Reamister

ReHabs the Test

• Prossion- the
• tips and training the test with deficits the area with more and unaware

Balanicing

• Balancin- with hip and more test the
• More Test the cupolithe
• Test Head Test Saccadic in with the the

Test 4 Trauma -brain

-hallpix withe test with more comp- with that .

Neuro and Alls

• Guils with autoimmune that

• More for motor

PNS Injury Class

• Neurpoxyia and Monor/

More With Tests

Polyneur with test that or syment

• More that For and 4 is time and space and for
• Mptoms- for senses and vision with