IFS Exam 2 Recording of Themes PDF

Look at the innervation of the back in general (the span of the muscle therefore knowing contribution) - Spinal nerves coming from posterior rami, if muscles innervated - which spinal nerves contributing to that motion? Ex. Erector Spinae (longissimus → spans from lumbar spine...

Look at the innervation of the back in general (the span of the muscle therefore knowing contribution) - Spinal nerves coming from posterior rami, if muscles innervated - which spinal nerves contributing to that motion? Ex. Erector Spinae (longissimus → spans from lumbar spine to the head, Longissimus lumborum at the level of L1-L5 “because that’s the lumbar spine”) Ex. Question: What would be the innervation contribution to the longissimus lumborum? T1 spinal nerve T6 spinal nerve L3 spinal nerve ←- C1 spinal nerve - DON’T MEMORIZE ALL THE ATTACHMENTS/COASTAL ATTACHMENTS OF THE LONGISSIMUS AND ILIOCOSTALIS Know the generality of where it goes to (starts at the ilium “superior sacrum” → Longissimus: Head, Iliocostalis runs laterally to: Ribs, Spinalis runs medial) Ex. Splenius Capitis tells you at the head, goes down to T3 Ex Q: What would be the contribution of spinal nerves to the splenius capitis? T6 spinal nerve T5 spinal nerve L1 spinal nerve T1 spinal nerve ←- Ex. Semispinalis Capitis runs longer than splenius, spans from here to here therefore knowing the origin and insertion, and therefore knowing the palpation Looking at back (shirtless) (“the spine is an axis of rotation”) - Spinalis = close to the spine (most medial) - Longissimus = from ilium to the head - Iliocostalis Ex Q: Which muscle will rotate the spine better? Iliocostalis - Carries innervation from posterior spinal nerves Spine of Scapula = landmark for T3 Lower border (Angle) of Scapula = landmark for T7 - What RAMUS innervates the posterior muscles of the back? The dorsal ramus (posterior ramus) Landmarks - Crease on shoulder (anterior and posterior borders) = deltoid ends there - Crease underneath arm (axillary fold) = can palpate pec major - Inferior border (Angle) of scapula = T7 Postural Analysis of the Spine Alignment & Torque - Spine is the axis and when we move away from that axis, generates more torque - Forward Head Posture = cervical spine will have more torque because they have to work harder - Shoulder protraction = more torque at shoulders - Hunchback = increased kyphosis & lost lordosis of spine (at thoracic level, and some cervical) Deep muscles shortened (due to tilting head): splenius cervicis, 3 muscles that form the cervical triangle (spaces get closer), pectoralis major and minor muscles, internal rotator muscles of the shoulder (subscapularis, teres major)  Longer muscles elongate more (some): rhomboids, latissimus dorsi, splenius, external rotators muscles (infraspinatus “posterior attachment, teres minor “posterior attachment”, fibers of deltiod “posteriorly”) Know Anatomy & Musculature of the Cervical Spine - Where to palpate - Vertebrae Differences: in cervical spine has different features than the thoracis spine and different orientation than the lumbar spine (in general) Cervical spine is unique = has transverse foramina where vertebral arteries go through - From posterior aspect of spine, go VERY deep to deepest layer of muscles of cervical spine - KNOW the cervical triangle (what can’t be seen, what can we elucidate by looking inside that cervical triangle) Ex. When we have elderly people look up “reaching for cupboard” = lose balance due to discs dessicating therefore losing height, losing height means kink from vertebral arteries *arising from subclavian arteries* going through transverse foramina will stop blood flow gong to the brain momentarily - Vertebrae Similarities: lamina found in all, spinous and transverse processes in all Ligaments of the Spine Major ligaments: supraspinous ligament, anterior longitudinal ligament, posterior longitudinal ligament, intertransverse ligament, interspinous ligament, nuchal ligament - PLL: changes name and fuses w/ cervical spine ligaments (becomes tectorial membrane in upper cervical region) - ALL: does something similar (won’t ask where it’s located - too easy) // will ask what it does! Ex. If extending spine, ALL (which runs on anterior bodies of the vertebrae), will limit that extension Therefore, without ALL and PLL ligaments → bodies of vertebrae won’t moves apart UNLESS we start moving - Supraspnous lig: fuses w/ the nuchal ligament (usually ends at C7/T1 level then becomes the nuchal ligament) - Interspinous Lig Ex. If ligament connecting spinous processes (interspinous ligs) = will limit that flexion Bending of Spine Anatomy - Spinous Processes while bending forward (trunk flexion) → will be apart Lateral bending → intertransverse ligaments on one side will be elongated to limit lateral flexion ipsilaterally (UNLESS STATES DIRECTION) while other side compresses - Ex: Lateral flexion to my left = where are the ligaments that limit that movement located? → contralaterally - Ex Q: In lateral flexion, what ligaments are shortened? Ipsilateral side - Body of Vertebrae Forward Flexion → will be closer together anteriorly - Facets  Forward Flexion → move apart by gliding up - Lamina (between spinous and transverse processes) Forward Flexion → move apart Arthrokinematics of Cervical Spine, Thoracic Spine, and Lumbar Spine - Facets = C → 45 degrees, T = 60-90 degrees, L = I I Glides anteriorly and superiorly during forward flexion - KNOW MOTION OF FACETS (will be on exam) Arthrokinematics of Occiput and C1 vs. C1 and C2 - Occiput (head) is a CONVEXITY Flexion in open chain → CV on CC → anterior roll & posterior glide of the occiput on C1 Extension in open chain → CV on CC → posterior roll & anterior glide of the occiput on C1 Lecture Table w/ Biomechanics of Postures and Affects on Spine - Laying on back, sitting, standing straight = good position When starting to get out of the vertical position, moment arm increases and torque works Sitting and leaning forward → anterior pelvic tilt causes intradiscal pressure (safe when maintaining lumbar lordosis) - Look at patterns of intradiscal pressure being relieved vs. increased due to posture Biomechanics of Pelvis on Lumbar Spine - ASIS vs PSIS When in 90 degrees standing, one disappears while the other pushes forward - Pelvic Tilt that moves the force away from fingers.. Anterior pelvic tilt = less pressure from fingers and less pressure on the lower back therefore increasing lordosis at lumbar spine Posterior pelvic tilt = decreases lordosis at lumbar spine - Slouch Decreased lordosis → posterior pelvic tilt = puts anterior pressure on spine, more pressure on sacrum - Stick butt out Increased lordosis → anterior pelvic tilt = puts posterior pressure on spine, more pressure on ischial tuberosities (at sitting, coccyx moves out of seat and is now floating) Musculature of Lower Legs - Hip Hiker Muscle = Quadratus Lumborum attaches to the lumbar spine and to the lower ribs and attaches to the pelvis (posteriorly) Supports us during lateral flexion and trunk extension Very painful to release at QL Connects to vertebrae bodies of L1-L5 and to the transverse processes which sit more laterally away from axis of spine - PSOAS Major muscle (narrow) and effect on lumbar spine (won’t ask about insertions and innvervations, might ask FUNCTION of it) Responsible for trunk flexion Contribution of Latissimus Dorsi, Erector Spinae, Rhomboids in Maintaining the Back Steady - Ex Q: What is the effect of the erector spinae on maintaining stability of the back? Motor function - Ex Q: What is the effect of the multifidi on the stability of the back? Motor function  - The farther it is from the spine (superficial), the less of the contribution to really support the spine // closer (deeper) provides more stability to the spine, especially the multifidi Erector spinae provides stability and mobility of spine Rotatores help rotate the spine BUT DON’T HAVE lever arm to rotate as compared to iliocostalis (Which is farther away) has a better lever arm and causes better toque due to farther distance Biomechanics of Decreased Injury Keeping Weight Closer to You - Weight closer to where he wants to go will decrease risk of injury - Put all forces in best alignment to therefore break our of gravity easier - Want center of mass to line up with center of gravity Create Opposite Lever Arm - Want to reach for bottle on table in front, therefore reaching forward will cause opposite lever arm of leg moving posteriorly to keep balance stable Basics - Protraction - Retraction - Supination - Pronation - Planes of Movement and Anatomical Postion Ex Q: A patient reached forward to pick something up from a cupboard, what plane of motion? sagittal Vestibular System - Provides balance - LVST and MVST → Affect balance (lateral affects balance, Medial does not) UMN and LMN Contributions on our Reflexes - In general, the reflex mechanism of the body… ? Brain and Cerebellum - How does it affect how the body works in general? Ligaments of Shoulder - Subacromial Space = space in which supraspinatus runs through Important for supraspinatus tendon where most injuries happen 3 Spaces (what comes out of it) (important to know because areas for impingement) - Quadrangular Space = axillary N. and PCHA - Triangular Interval = Radial N. and Profunda Brachii A. - Triangular Space = Circumflex Scapular A. and V. KNOW Brachial Plexus from Roots to Elbow Ex Q: Patient comes in and has difficulty raising arm forward to scratch face, what can be affected vis brachial plexus? Biceps = Musuclucutaneous N., internal rotators, flexors (deltoids = axillary N.), Coracobrachialis Look at muscles therefore knowing innervation, cord, division, trunk  Abduction = first 15-30 degrees of ABD is the supraspinatus coming from superior trunk Axillary Artery Boundaries - Starts after 1st rib (originally the Subclavian A.) - Landmark (not necessarily ending of axillary artery) is at the inferior border of Teres Major Biomechanics of Glenohumeral Joint, Clavicle, Scapulothoracic Area - Know the orientation of the proximal aspect of the clavicle Vertical position = CV on CC (when elevating/flexing arm = superior roll with inferior glide) Horizontal position = CC on CV (protraction = anterior roll and glide // retraction = posterior roll and glide) - Lateral End = posterior roll above 90 degrees for flexion and ABDuction Ligaments of the Acromioclavicular (AC) Joint - Attaches to Clavicle = trapezoid and coronoid ligs (that will limit clavicle from separating) // when flex and ext of arm, limits rotation of clavicle - Attaches to Scapula = corocoid process Ligaments of the Glenohumeral Joint and its Functions - Coracohumeral ligament→ restricts GH rotation by preventing the humeral head from moving too far down (inf) - Transverse humeral ligament→ converts the groove into a canal, which holds the synovial sheath and tendon of the biceps brachii in place during movements of the GH joint - Coraco-acromial ligament→ forms a protective arch that overlies the humeral head, preventing its superior displacement from the glenoid cavity, limits external rotation Force Couples Definition: 2 or more forces that cause different translations and same rotations - GH abduction- supraspinatus & middle deltoid m’s - ST upward rotation- upper trapezius, lower trapezius, and serratus anterior m’s - ST downward rotation- rhomboids (major & minor), Latissimus dorsi, and pectoralis minor m’s