Appendicular Musculoskeletal System PDF

Appendicular Musculoskeletal System Skeletal System: Identify bones of the body and their major landmarks by examining 2-D and 3-D...

Appendicular Musculoskeletal System Skeletal System: Identify bones of the body and their major landmarks by examining 2-D and 3-D representations in order to understand the functionality of the skeletal system and to build a foundation for terminology used in other organ systems. Muscular System: Identify the muscles of the body and recall their basic actions to link body mechanics and aid in future diagnoses. Drake et al., (2020) Grey’s Anatomy for Students, Vol 1  Leaning Objectives 5. For the upper and lower limbs: 1. Describe how joints are Identify bone and specified features categorized by their surrounding Identify muscles and their primary actions indicated in red connective tissue and degree of movement Use unique features to orient gross structures shown in the images (medial, 2. List the three types and give lateral, superior, inferior) and depth of structure (deep vs. superficial) examples of fibrous joints Ultimate goal- Link related skeletal and 3. List the two types and give muscular structures examples of cartilaginous joints E.g., Many of the rotator cuff muscles attach to the greater tuberosity of the humerus 4. List the components of synovial 6. Link the clinical correlations to the musculoskeletal structures covered in joints and provide examples Blocks 2 and 3 Joints  LO 1 Joints/Articulations- Categorization Connective Tissue Fibrous joint Movement Dense regular CT Synarthrosis Cartilaginous joint Immobile Cartilage (hyaline or fibrocartilage) Amphiarthrosis Synovial joint Slightly mobile Fluid filled cavity separating cartilage covered articulating Diarthrosis surfaces of bone Freely mobile Enclosed within a joint capsule Bones are joined by ligaments Gray’s Basic Anatomy(2018), Drake et al.  LO 2 Fibrous Joints Dense regular CT Most are synarthrotic or amphiarthrotic Sutures Interlocking irregular edges Joints of the cranium Often ossify with age Synarthrotic Gomphoses “peg in socket” Tooth roots Synarthrotic Syndesmosis Articulating bone joined by strands of dense regular CT Interosseous membranes between long bones Amphiarthrotic Gray’s Basic Anatomy(2018), Drake et al. Syn- together, joined, with  LO 3 Cartilaginous Joint Hyaline cartilage or fibrocartilage Most are synarthrotic or amphiarthrotic Synchondroses (primary cartilaginous joints) Plates or bars of hyaline cartilage Mostly synarthrotic e.g., epiphyseal plates in juveniles Symphyses (secondary cartilaginous joints) Strong, slightly movable Fibrocartilage e.g., pubic symphyses between ossa coxae Gray’s Basic Anatomy (2018), Drake et al.  LO 4 Synovial Joint Components Clinically Oriented Anatomy (2018), Moore et al. a. Articular (joint) capsule Outer fibrous layer Inner synovial membrane b. Joint (articular) cavity Fluid filled c. Synovial membrane Secretes synovial fluid to lubricate, nourished, shock absorber d. Ligaments Extrinsic ligaments- separate, outside Intrinsic ligaments- continuation of joint capsule e. Articular cartilage (hyaline) Avascular Bursa- fibrous sack-like structures filled with synovial fluid Tendons- (muscle to bone) aid in stabilization Fat pads- packing material/protection Paulsen and Waschke, (2013) Sobota Atlas of Human Anatomy, Vol 1 Posterior Musculoskeletal System Upper Limb  Upper Limb and Shoulder Girdle 1. Clavicle 2. Scapula 3. Humerus 4. Radius 5. Ulna 6. Carpals On images: 7. Metacarpals L= lateral; M= medial 8. Phalanges S=superior; I= inferior Gray’s Basic Anatomy (2018), Drake et al.  LO 5 1. Clavicle 2. 3. Scapula Humerus Pectoral/shoulder girdle 4. Sternum Superior view  Sternoclavicular LO 5/4 joint and ligament Clavicle L Superior view Sternal end Coracoclavicular Acromial end M ligaments Coracoacromial ligament Acromioclavicular joint Sternoclavicular L M joint Sternoclavicular Joint and ligament Costoclavicular ligament Superior view  LO 6 Clinical Connection The clavicle is the most commonly fractured bone in the body. Fractures typically occur between the middle and lateral thirds from direct trauma to the shoulder or indirect force from falling on an outstretched upper limb. The proximal clavicle (PC) is pulled superiorly by the sternocleidomastoid (yellow arrow), while the distal clavicle (DC) is depressed inferiorly because of the weight of the upper limb. Brachial plexus divisions and axillary vasculature are at risk of secondary injury. Harrell, K. M., & Dudek, R. (2019). Lippincott¯ illustrated reviews: anatomy, 1e. Lippincott Williams & Wilkins, a Wolters Kluwer business. https://premiumbasicsciences.lwwhealthlibrary.com/book.aspx?bookid=2793&sectionid=0  LO 5 Scapula Glenoid cavity Medial border Lateral borderAnterior Inferior angle  LO 5 Medial border Lateral border Scapula Glenoid cavity Inferior angle  Proximal Humerus LO 5 Head Lesser Anatomical tuberosity Greater neck tuberosity Greater tuberosity Surgical neck Intertubercular sulcus (groove) Deltoid tuberosity Anterior view Posterior view Medial Lateral epicondyle epicondyle Posterior LO 5  LO 4/5 Shoulder Joint Clinical Connection Glenohumeral joint A Ball-and-socket 1 Unstable due to mobility Mostly held by rotator cuff muscles Ligaments attach to margin of glenoid cavity and anatomical neck of humerus Intrinsic ligaments 1. Capsular ligaments= Superior, middle, and inferior glenohumeral ligaments Extrinsic ligament A. Coracohumeral ligament Harrell, K. M., & Dudek, R. (2019). Lippincott¯ illustrated reviews: anatomy, 1e. Lippincott Williams & Wilkins, a Wolters Kluwer business. https://premiumbasicsciences.lwwhealthlibrary.com/ book.aspx?bookid=2793&sectionid=0  LO 6 Clinical Connection The glenohumeral joint is extremely mobile, providing a wide range of movement at the expense of stability. The relatively small bony glenoid cavity, supplemented by the less robust fibrocartilaginous glenoid labrum and the ligamentous support, make it susceptible to dislocation. Anteroinferior dislocation ( Fig. 7.22 ) occurs most frequently and is usually associated with an isolated traumatic incident (clinically, all anterior dislocations are anteroinferior). In some cases, the anteroinferior glenoid labrum is torn with or without a small bony fragment. Once the joint capsule and cartilage are disrupted, the joint is susceptible to further (recurrent) Normal joint dislocations. Fig. 7.22- Anteroinferior dislocation Upper Limb - ClinicalKey Gray’s Basic Anatomy (2018), Drake et al.  LO 5 Distal Humerus Most Turtles Can’t Laugh M L L M Coronoid fossa  LO 4/5 Humeral Landmark Articulation Elbow Joint Olecranon fossa Olecranon process of ulna Articular Trochlea Trochlear notch of Context for anatomical structures ulna capsule related to the elbow joint Capitulum Radial Head Radial collateral ligament Ulnar collateral Annular ligament ligament L M L M Gray's Basic Anatomy (2018), Drake  Anterior view Posterior view LO 2/5 M Olecranon Elbow Joint L M L process Anterior view Trochlear notch Head Radial Coronoid notch process Radial tuberosity Ulnar M L tuberosity Interosseus membrane Lateral view Hinge joint- move in one plane, Medial view flexion and extension only Thin joint capsule but strong ligaments Ulnar Pivot joint- Uniaxial, permits rotation notch Styloid process  LO 6 Ulnar nerve Clinical Correlation traveling through cubital tunnel Posterior to the medial epicondyle of the humerus, the ulnar nerve is bound in a fibro-osseous tunnel (the cubital tunnel) by Flexor carpi ulnaris a retinaculum. Older patients may develop degenerative changes within this tunnel, which compresses the ulnar nerve when the elbow joint is flexed. The repeated action of flexion and extension of the elbow joint may cause local nerve damage, resulting in impaired function of the ulnar nerve. Localized neuritis in this region secondary to direct Posterior view trauma may also produce ulnar nerve of forearm damage. Gray’s Basic Anatomy (2018), Drake et al.  LO 5 Wrist, Hand, and Digits DIP MP- metacarpophalangeal joint PIP PIP- proximal interphalangeal joint DIP- distal interphalangeal joint MP Lateral Medial Palmar surface, right hand  LO 5 Hamate Scaphoid Medial Lateral When falling with your arm outstretched, which of the carpals are likely to fracture? Muscles of the Shoulder  LO 5 Anterior Axio-Appendicular Pectoralis major Act on pectoral girdle and arm, cross from axial to appendicular skeleton Subclavius Serratus anterior Pectoralis minor Anterior view  LO 5 Anterior Axio-Appendicular Muscles 1. Pectoralis major 1 Arm flexion, adduction and 2 medial/internal rotation 2. Pectoralis minor Protract and stabilize scapula 3. Serratus anterior Anterior view Stabilize, retract and superiorly rotate scapula 3 4. Subclavius 4 depress clavicle  LO 5 Posterior Axio-Appendicular Muscles Produce and support upper Levator scapulae limb movements Trapezius Rhomboid minor Rhomboid major Latissimus dorsi- internal rotation and adduction of upper limb Latissimus dorsi  LO 5 Intrinsic Shoulder Muscles (Scapulohumeral) Trapezius Supraspinatus Deltoid Act on arm, cross shoulder joint- Infraspinatus rotate, abduct, adduct Subscapularis Teres minor Teres major Teres major Posterior view Anterior  LO 5 2 Rotator Cuff (RC) + 3 Act on humerus/arm M 3 L 4 Deltoid (previous slide) Flexion, extension, and abduction 5 2. Supraspinatus (RC) Abduction Lateral rotation Posterior view 3. Infraspinatus (RC) 4. Teres minor (RC) 6 Medial rotation 4 5. Teres major Extend Anterior 6. Subscapularis (RC) 5 Abduct  LO 5 Subscapularis Rotator Cuff (RC) + Supraspinatus Infraspinatus Act on humerus/arm Teres minor 1. Deltoid Flexion and abduction 2. Supraspinatus (RC) Abduct Lateral rotation 3. Infraspinatus (RC) Supraspinatus 4. Teres minor (RC) Medial rotation Infraspinatus 5. Teres major Subscapularis Extend Teres 6. Subscapularis (RC) minor Abduct Anterior Posterior  LO 5 Extrinsic Back Muscles- Superficial  LO 6 Clinical Correlation The two main disorders of the rotator cuff are impingement and tendinopathy. The muscle most commonly involved is supraspinatus as it passes beneath the acromion and the acromioclavicular ligament. This space, beneath which the supraspinatus tendon passes, is of fixed dimensions. Swelling of the supraspinatus muscle, excessive fluid within the subacromial/subdeltoid bursa, or subacromial bony spurs may produce significant impingement when the arm is abducted. The blood supply to the supraspinatus tendon is relatively poor. Repeated trauma, in certain circumstances, makes the tendon susceptible to degenerative change, which may result in calcium deposition, producing extreme pain, and may cause partial- or full0thickness tears. Gray’s Basic Anatomy (2018), Drake et al. Muscles of the Arm Upper Limb Fascia Compartmentalize muscles and associated structures Deep fascia Brachial fascia Intermuscular septum Anterior (flexor) compartment Posterior (extensor) compartment Antebrachial fascia Interosseous membrane Anterior (flexor) compartment Posterior (extensor) compartment Flexor and extensor retinaculum  LO 5 Coracoid process Muscles of the Arm Coracobrachialis Act on arm/forearm, cross shoulder/elbow Posterior view Anterior (flexor) compartment Coracobrachialis Biceps brachii Brachialis Brachialis Posterior (extensor) Long head of compartment biceps though intertubercular Triceps Triceps brachii Biceps brachii sulcus Anconeus brachii Deep Anterior view Medial Lateral Medial Lateral Superficial Anconeus  LO 5 Muscles of the Arm Act on arm/forearm, cross shoulder/elbow Anterior (flexor) compartment Coracobrachialis Flex and adduct arm Biceps brachii Flex forearm and arm, weak supinator of forearm Brachialis Flexes forearm Posterior (extensor) compartment Triceps brachii Extends arm and forearm, adducts arm Anconeus Extends forearm Muscles of the Forearm Muscles of the Forearm- Organization Anterior – Flexors Posterior – Extensors Radial side- abduction Ulnar side- adduction Layers Superficial- move wrist/carpals Intermediate- moves digits (as a group or individual) Deep- pronation/supination  Flexors and Extensors of the Forearm Name have a common theme Action, attachment/move, side Extensor/extend Flexor/flex Abductor/abduct Pollicis/thumb Flex your Flexor Carpi/wrist wrist on the Carpi Digitorum/digits/fingers ulnar side Ulnaris Longus/long one Brevis/short one Radialis- thumb/lateral side Ulnaris- pinky/medial side  What muscle in being indicated by the arrow? Flex your fingers with A.Flexor carpi ulnaris the superficial B.Brachioradialis muscle C.Flexor digitorum superficialis D.Flexor digitorum profundus  LO 5 Anterior Compartment- Bicipital Layer 1 aponeurosis Pronator teres Flexor Brachioradialis carpi Primary flexors of the wrist radialis 1. Pronator teres Flexor carpi Palmaris radialis pronates forearm longus Palmaris Flex wrist longus 2. Flexor carpi radialis Flexor carpi abduct wrist Ulnaris Flexor carpi 3. Palmaris longus Ulnaris 4. Flexor carpi ulnaris adduct wrist Flexor retinaculum 5. Brachioradialis Weak forearm flexion 6. Flexor retinaculum Medial Lateral  LO 5 Anterior Compartment- Layer 2 Flexors of the digits Flexor 1. Flexor digitorum superficialis digitorum flex wrist and digits 2 through 5 at superficialis metacarpophalangeal (MP) and proximal interphalangeal (PIP) joints Flexor Flexor pollicis carpi longus Ulnaris Flexor pollicis longus PIP MP Lateral Medial  LO 5 Anterior Compartment- Layer 3 Supinator Flexors of the digits 1. Flexor digitorum profundus Flexor flex wrist and digits 2through 5 at digitorium all joints (MP, PIP, DIP) Flexor profundus pollicis 2. Flexor pollicis longus longus Flexor Flexes all joints of thumb (digit 1) digitorium profundus Flexor pollicis longus (cut) DIP PIP Pronator quadratus MP Lateral Medial  Anterior LO 5 Anterior Compartment- Layer 4 Supinator Pronator 2 1 teres 1. Pronator teres Lateral Medial Pronate 2. Supinator supinate 3. Pronator quadratus 3 Pronator 3 pronate quadratus Lateral Medial  LO 5 Posterior Compartment- Brachioradialis Layer 1 Extensor carpi radialis longus 2 1. Brachioradialis Extensor carpi 3 Extensor Extensors of the wrist and digits ulnaris carpi 2. Extensor carpi radialis longus radialis brevis 6 abduct hand Extensor 4 digiti 3. Extensor carpi radialis brevis minimi Extensor digitorum 5 abduct hand 4. Extensor digitorum Extends all joints of digits 2-5 5. Extensor digiti minimi extends digit 5 Lateral Medial 7 6. Extensor carpi ulnaris adducts hand 7. Extensor retinaculum  LO 5 Posterior Compartment- Layer 2 Anconeus Extensors of digits 1. Abductor pollicis longus Supinator 1 abduct thumb 3 2. Extensor pollicis brevis Extensor pollicis extend MP joint of thumb longus 4 2 3. Extensor pollicis longus Extensor Abductor pollicis extent MP and DIP of thumb indicis longus 4. Extensor indicis Extensor pollicis extend 2nd digit brevis  LO 5 Extensor expansion Intrinsic Muscles of the Hand Lumbricals 1. Thenar - move thumb 2. Hypothenar- move 5th digit Hypothenar Flex MP joint Thenar Lumbricals Extend PIP and DIP joints of digits 2-5 3. Lumbricals Abduct and adduct digits 2-5 Palmar 4. Dorsal interossei (DAB) interossei Dorsal-Abduction Dorsal 5. Palmar interossei (PAD) interossei Palmar- adduction  LO 6 Clinical Correlation A common pathology in athletes is overuse and strain of the origins of the flexor and extensor muscles of the forearm which attach on and round the epicondyles. Pain usually resolves with rest. If pain and inflammation persist, surgical division of the extensor or flexor origin from the bone may be necessary. Typically, in tennis players this pain occurs on the lateral epicondyle and common extensor origin (tennis elbow), whereas in golfers it occurs on the medial epicondyle and common flexor origin (golfer's elbow). Gray’s Basic Anatomy (2018), Drake et al. Musculoskeletal System Lower Limb  LO 5 Gluteal region Lower Limb Ossa coxae Thigh Femur Patella Leg Tibia Fibula Ankle Tarsals Foot Metatarsals Phalanges Gray's Basic Anatomy (2018), Drake  LO 5 Pelvic girdle Os coxa (innominate, pubic bone), lateral  Anterior sacral LO 2/5 Iliac crest foramina Alae /iliac Sacrum Anterior superior fossa iliac spine/ASIS Anterior View Anterior inferior iliac spine/AIIS Superior pubic ramus Acetabulum Obturator foramen Pubic tubercle Superior Ischial tuberosity Pubic pubic ramus symphyses  LO 5 Lateral View ASIS AIIS Greater sciatic notch Ischial Pelvic inlet spine Acetabulum ASIS Posterior superior iliac spine Posterior superior iliac Obturator spine foramen Ischial ramus Ischial spine Lesser sciatic notch  LO 5 Thigh- Femur Head Neck Linea aspera Medial condyle Lateral condyle Intercondylar fossa  LOLO5 6 Tibial plateau Head Medial Tibial malleolus Left tuberosity Lateral Leg L M malleolus Medial Lateral malleolus Fibular notch malleolus Anterior Ant  LO 5 Foot Tarsals Metatarsals (1-5) Phalanges Proximal Intermediate Distal  LO 5 Tarsals Joints and Muscles of the Lower Limb  LO 5/4 Hip Joint- Os coxa, femur Ball-and-socket Designed for stability over a wide range of movement While standing, all weight is transmitted through this joint Anterior  LO 5/4 Anterior Posterior Lateral Ligament of Anterior Iliofemoral the head of ligament Lunate femur Iliofemoral surface ligament Ishchiofemoral Pubofemoral ligament ligament Transverse acetabular ligament Spiral ligaments Iliofemoral ligament- prevents hyperextension Pubofemoral ligament- prevents over abduction  LO 5/4 Anterior view Posterior view Iliofemoral ligament Iliofemoral ligament Greater trochanter Greater Ishchiofemoral sciatic ligament foramen Sacrospinous ligament Obturator Ischial fascia Pubofemoral tuberosity ligament Lesser trochanter Spiral ligaments Iliofemoral ligament- prevents hyperextension Pubofemoral ligament- prevents over abduction  Lower Limb- Fascia and Muscle Organization Deep fascia and intramuscular septa create muscular compartments. Hip flexion and Knee flexion and extension extension Compartments of the thigh- Facia lata Anterior- Hip flexors, knee extensors Posterior- hip extensors, knee flexors Medial –hip adductors Lateral- hip abductor Compartments of the leg Interosseous membrane Anterior- Extensor (dorsiflex) Posterior- Flexor (plantarflex) Lateral- Abductors  Right leg LO 5 Thigh- Anterior Compartment Pectineus Hip/thigh flexors Iliacus Sartorius Psoas Pectineus adduction Psoas Sartorius abducts, laterally rotates Iliacus Right thigh  Anterior thigh LO 5 Tensor Right leg Thigh- Anterior fasciae latae Compartment Rectus Knee/leg extensors femoris Quadriceps femoris Rectus femoris Stabilizes hip; flexes hip Vastus with iliopsoas intermedias Vastus lateralis Vastus lateralis Vastus medialis Vastus intermedias Vastus medialis Vastus Vastus Lateral compartment lateralis medialis Tensor fasciae latae Thigh abduction Superficial Deep  LO 5 Thigh- Medial Obturator Pectineus externus Compartment Adductor Thigh adductors longus Adductor longus Adductor magnus Adductor brevis Gracilis Gracilis helps medially rotate leg Obturator externus laterally rotates thigh Adductor magnus Adducts, flexes, and extends thigh Superficial Deep  ASIS Anterior thigh LO 5 LEFT leg Lateral Medial Superficial Deep Sartorius Pubic symphysis Tensor Vastus fasciae latae lateralis Adductor Rectus IT band longus femoris Vastus Gracilis medialis Vastus intermedias Vastus lateralis Vastus medialis  Gluteus LO 5 Gluteal Region- medius Gluteus minimus Superficial Gluteus maximus Tensor fasciae Hip/thigh extensor latae Gluteus maximus lateral rotation; abduction of Sacrotuberous ligament thigh Abduct and rotate thigh; keep pelvis level when bearing weight on opposite side Gluteus medius Gluteus minimus Tensor fascia latae M L M L Superficial Deep  LO 5 Gluteal Piriformis Superior gemelli Region- Deep Obturator internus Laterally rotate extended Inferior thigh; stabilize femoral Quadratus gemelli head femoris Piriformis Superior and inferior gemelli Obturator internus Quadratus femoris (does not abduct) M L Deep  LO 6 Clinical Connection At times, it is necessary to administer drugs into muscles via injection. This procedure must be carried out without injuring neurovascular structures. A typical site for an intramuscular injection is the gluteal region. The sciatic nerve passes through this region and needs to be avoided. The safest place to inject is the upper outer quadrant of either gluteal region. Gray’s Basic Anatomy (2018), Drake et al.  Thigh- Posterior LO 5 Compartment Main hip extensors and knee flexors 1. Biceps femoris Biceps femoris Semitendinosus lateral rotation when flexed Also rotate knee medially when flexed 2. Semitendinosus Semimembranosus Semimembranosus 3. Semimembranosus Gracilis Beef Steaks Smell Great Superficial Deep LO 5  LO 5 Pes Anserinus Strap muscles that cross both knee and hip joints Work together to add stability to the medial aspect of the extended knee Deep  LO 4/5 Knee Joint- Femur, tibia, patella Anterior Diarthrotic hinge joint Also allows for gliding and rolling Three articulations Medial and lateral femorotibial articulations Femoraopatellar articulation Fibrous capsule Attaches from margins superior to femoral condyles and tibial plateau Patella and associated Lateral Medial ligaments replace fibrous capsule on anterior aspect Lateral Medial  M Anterior view L L Posterior view M LO 4 Knee Joint ACL LO 4/5/6 Anterior cruciate ligament (ACL) TCL Posterior cruciate ligament Lateral (PCL) meniscus PCL allows for more lateral rotation due to arrangement Medial and lateral menisci - Medial FCL TCL comprised of fibrocartilage meniscus Medial meniscus Fibular collateral ligament (FCL) PCL Tibial collateral ligament (TCL) Weaker than FCL and attached to medial meniscus Patellar ligament on Lateral anteriorly reflected patella meniscus Ankle- Plantarflexion vs dorsiflexion Digits- Flexion vs extension  LO 5 Leg- Anterior Compartment Main dorsiflexors (extend) of the ankle joint Tibialis anterior inverts foot Tibialis anterior Extensor hallucis longus extends great toe Extensor digitorum longus extends digits 2-5 Extensor Extensor hallucis digitorum longus longus Tibialis anterior Superficial  LO 5 Leg- Lateral Compartment Fibularis longus, fibularis brevis: Evert foot, weak plantarflexor Fibularis brevis Fibularis longus Superficial  LO 5 Leg- Posterior Compartment, Superficial Plantaris Main plantarflexion of the ankle joint Gastrocnemius Gastrocnemius Soleus plantarflexes when knee is extended; raises heal when walking; flexes leg at knee joint Soleus Calcaneal tendon Plantaris Calcaneal tendon Aids gastrocnemius Superficial Intermediate  LO 5 Leg- Posterior Compartment, Deep Popliteus Main plantarflexion of the toes; aid in flexion of ankle joint FHL Flexor tendon Popliteus digitorum Flexor unlocks knee by rotating femur longus hallucis on tibia, medially rotates tibia longus FDL Flexor digitorum longus Tibialis posterior tendon flexes digits 2-5 Flexor hallucis longus flexes great toe Tibialis posterior plantarflexes foot; inverts foot Deep Superficial FHL Posterior FDL Bone Surface Markings: Processes  Bone Surface Markings: Processes Tuberosity: Named for the bone it is on Notch: Named for what it articulates with