Anatomy Notes PDF

 WEEK ONE Intro to anatomy: Osteology, anthology and myology Anatomical position Additional positions Directional terms...

 WEEK ONE Intro to anatomy: Osteology, anthology and myology Anatomical position Additional positions Directional terms Planes of the body Coronal (frontal): Diviues the body into front(anterior) and back (posterior) parts Sagittal: Divides the body into right and left parts Mid-sagittal (median) right and left parts are equal Para-sagittal right and left parts are unequal Transverse divides the body into top (superior) and bottom (inferior) parts Bone markings Distinctive surface features on bones Functions: Attachment sites Articulation sites Projections that serve as attachment sites Passageways for structures Tubercle: small, round projection Broad types: Trochanter: large, round projection (only on femur) Tuberosity: rough projection Projections Epicondyle: raised projection on or above a condyle Depressions Ramus: branch-like projection Openings/spaces Process: any bony prominence Spine: pointed, slender projection Depressions Line: low ridge Fossa shallow depression Crest: prominent ridge Groove shallow furrow Articulation sites Sulcus deep furrow Head round,smooth projection at the end of a long Fovea small, pit-like depression bone Condole round/egg-shaped, smooth projection Opening/spaces Facet small, flat, smooth surface Foramen hole Fissure narrow slit Canal/meatus tubular passageway Sinus space or cavity Arthrology Defining and classifying joint A joint is a union between 2 or more parts of the skeleton Does not necessarily have to be between 2 bones (eg bone and cartilage) Classifies in 2 ways: 1. Structurally: based on the tissue forming the joint 2. Functionally: based on the amount of movement possible Structural and function classification are closely linked Fibrous joints Fibrous tissue (dense irregular connective tissue) uniting the bones Synovial joints Amount of movement possible depends on the length of Cartilaginous joint Joint cavity in between the bones, containing the fibres Cartilage uniting the bones synovial fluid Subtypes: Amount of movement possible depends on the type of cartilage all freely moveable Suture immovable (synarthrosis) Subtypes Syndesmosis slightly moveable (amphiarthrosis) Primary cartilaginous synchondrosis immovable Gomphosis immobile (synarthrosis) Secondary cartilaginous symphysis slightly movable Synovial joint - subtypes Based one two things Joint movements 1. Shapes of articular surfaces Usually paired in opposites 2. Type and degreee of freedom of movement Angular movements: angle between bones increases or decreases Flexion and Extension Lateral flexion Abduction and Adduction Rotational movements: bone rotates around a longitudinal axis Medial/Internal and Lateral/External rotation Pronation and Supination Combination movements: Inversion and Eversion Circumduction Special movements: Plantarflexion and Dorsiflexion (ankle joint) Protraction/Protrusion and Retraction/Retrusion (e.g. scapula, mandible) Elevation and Depression (e.g. scapula, mandible) Opposition and Reposition (thumb) Articular discs Accessory joint structures Padres of fibrocartilage that are situated between the articular surfaces of some joints Ligaments bands of fibrous tissue that Functions occur at joints Act as shock absorbers Functions Increase stability Act as mechanical constraints Assist with lubrication - prevents unwanted movement Permit different movements to occur - limited allowed movement simultaneously in the one joint Sensory - proprioception Are further described at synovial joint Bursae as: Synovial fluid-filled sacs around many synovial Capsular Reinforce the capsule joints (thickenings) Function to reduce friction Extracapsular Lie outside the Located between layers of muscles and capsule between muscles/tendons and bone Intracapsular LIe inside the capsule Myology Skeletal muscle components Tendons composed of dense regular connective tissue Skeletal muscles are considered organs Most commonly rope or cord-like composed of skeletal muscles tissue as well as epithelial, connective and nervous Can also be flat - aponeurosis tissue Connective tissue skeletal muscle is highly organised and supported by connective tissue Muscle belly contractile portion Continuous with the muscles attachments Muscle may have more than 1 belly Attachment sites tendons attaching the muscle to bone - Transfers tension generated by the muscle during contraction to the attachment Origin the fixed attachment (usually the proximal attachment) 1. Epimysium layer of dense irregular connective tissue surrouding whole muscle - blends with deep fascia Insertion the moveable attachment (usually the distal attachment) 2. Perimysium layer of dense irregular connective tissue surrounding muscle fascicles 3. Endomysium layer of areolar connective tissue surrounding individual muscle cells (fibres) Classifying skeletal muscles Types of skeletal muscle contraction Based on fascicle arrangement with 4 main categories 1.Parallel fascicles arranged parallel to the long axis of the muscle Strap narrow and strap like Fusiform spindle-shaped Flat/quadrilateral short and flat 2. Convergent fascicles coverage from a broad origin toward a narrow insertion Also called triangular muscles 3. Oblique fascicles arranged obliquely to the tendon runs the entire length of the muscles Pennate = feather-like Unipennate: fascicles attach to one side of the tendon Example: extensor digitorum Bipennate: fascicles attach to both sides of the tendon Example: rectus femoris Multipennate: multiple bipennate arrangements attaching to one common tendon Example: deltoid 4. Circular fascicles arranged concentrically around an opening Also called sphincters Close the opening they surround by contracting Basic principles of muscle actions EXAMPLE: orbicular oris 1. A muscle must cross a joint in order to act on it 2. Muscle pull and never push Skeletal muscle action vs functions 3. Insertion moves towards origin 4. Action The pure movement produced Agonist The muscle producing (or controlling) the desired movement by contracting when a muscle contracts Can contract either concentrically, eccentrically or isometrically concentrically in isolation Concentrically: muscle overcomes an external force (e.g. gravity) to produce the movement Example: Biceps branching actions Eccentrically: muscle resists an external force (e.g. gravity) to control the movement Forearm flexion at elbow Isometrically: muscle resists an external force (e.g. gravity) to produce the movement Dependent on: Also called prime mover Attachment sites Can sometimes be called an assistant mover Type of joint Example: in a bicep curl, biceps brachii is an agonist during elbow flexion Function (functional role) The role/s a muscle plays in a Antagonist particular movement, in addition to The muscle that must relax to allow the desired movement to occur performing an action Usually the opposite muscle to the agonist Functional roles include: Example: in a bicep curl, triceps branching is an antagonist during elbow flexion, as it must relax Agonist Antagonist Synergist/neutraliser Synergistic/neutraliser A muscle that assists that agonist to produce the desired movement by cancelling out the unwanted actions of the stabiliser/fixator agonist Due to most muscle being multifunctional, when a muscle switches on, it perform all its actions at once To avoid this, we need to recruit other muscle to cancel out the additional actions Stabiliser/fixator A muscle that stabilises a joint so that the agonist can produce the desired movement Improves the efficiency of the agonist Contracts to pull the joint surfaces closer together Fixator eliminates unwanted movement at the agonists origin  The shoulder complex has 3 main bones: 1. Clavicle Shoulder A Pectoral (shoulder) girdle - 2. Scapula & 4 main joints: 3. Humerus 1. Glenohumeral (shoulder) joint Pectoral (shoulder) girdle 2. Scapulothroacic joint Made of the clavicle and scapula Attaches the upper limb to the axial skeleton 3. Sternoclavicular joint Allows for free movement of the upper limb 4. Acromioclavicular joint Bones of the shoulder complex Borders Scapula Borders 1. Superior anterior 2. Suprascapular notch posterior 1. Superior 3. Medial 2. Suprascapular 8. Coracoid process 4. Lateral notch 9 Acromion Angles 3. Medial 10. Glenoid fossa 5. Superior 4. Lateral 15. Supraglenoid tubercle 6.Inferior Angles 1. Infraglenoid tubercle 7. Lateral 5. Superior 2. Processes 6 Inferior 8. Coracoid process 7. Lateral 9 Acromion Processes Fossae 9. Acromion 10. Glenoid fossa (at lateral Fossae angle) 10. Glenoid fossa lateral 11 Sub-scapular fossa 12 Supraspinous 13 Infraspinous Humerus 1. Head Clavicle 2. Anatomical neck Surfaces 3. Surgical neck - Smooth superior surface 4. Greater tubercle - Rough inferior surface 5. Lesser tubercle Ends: 6. Intertubercualr goorve/sulcus - Round medial (sternal) end 7. Shaft - Flat lateral (acromial) end 8. Deltoid tuberosity Curvatures: anterior - Medial 2/3 is convex (outwards) anteriorly - Lateral 1/3 is concave (inwards) anteriorly Joints of the shoulder complex Movements Glenohumeral (shoulder) joint Ligaments Low stability, but high Classification: Synovial, multiaxial, ball and socket Coracoacuromial ligaments mobility Articular surface: From Coracoid process to Acromion Glenoid fossa of scapula of scapula Permits movement of the Head of humerus Coracoid process + Acromion + arm around 3 axes coracoacromial ligament = 1. Flexion and extension Incongruency of articular surfaces confers instability at the coracoacromial arch 2. Abduction and adducition Glenohumeral joint - stabilised by ligaments and muscles Function = prevents superior 3. Medial and lateral rotation dislocation 4. Circumduction Scapulothoracic joint Between scapula and thoracic cage Works in connection with-Glenohumeral joint (as well as the Sternoclavicular joint sternoclaciular and acromioclavicular joint) to increase the ROM of the Classification synovial,biaxial, saddle BUT functions as upper limb a ball and socket joint Allows movement of the clavicle to increase the Scapulohumeral rhythm ROM of the upper limb 2:1 ratio of humeral movement to scapular movement during elevation Articular surfaces: 9flexion or abduction) of the arm Clavicular notch of sternum For every 3 degrees of elevation 2 degrees occurs at the Glenohumeral Sternal end of the clavicle joint (humeral movement) and 1 degree occurs the scapulothroacic joint (scapular movement) Has an articular disc Only articulation between the upper limb and the axial skeleton - very string joint Acromioclavicular joint Classification: synovial, multi axial, plane Articular surfaces: Acromion of scapula Acromial end of clavicle Allows movement of the scapula to increase the ROM of the upper limb - Associated with scapular movement of the scpulothoracic joint Ligaments Acromioclavicular ligaments strengths superior joint capsule Coracoclavicular ligament From Coracoid process of scapula to inferior surface of clavicle 12 2 parts: 1. Trapezoid - attaches to trapezoid line of the clavicle 2. Conoid - attaches to conoid tubercle of clavicle Functions Primary support joint (prevents superior dislocation Passively suspends scapula (and hence free upper limb) from clavicle SUMMARY: The shoulder complex is made up of three bones and four joints The pectoral girdle is made up of the clavicle and the scapula Glenohumeral joint = shoulder joint The scapulothoracic joint is a “physiological joint” All four joints of the shoulder complex work together to allow for the full ROM of the upper limb  WEEK TWO Bones & joints of the arm and forearm Humerus Radius and ulna ner a Joints of the arm and forearm Elbow joint Elbow joint - ligaments Classification synovial, uniaxial, hinge Ulnar (medial) collateral ligaments from the medial Made up of 2 articulations epicondyle of humerus to coronoid process and 1. Humerroradial olecranon of ulnar 2. Humeroulnar Made of 3 bands Articulation surface: Function: prevents abduction of the forearm 1. Humeroradial articulation Radial (lateral) collateral ligament from the lateral - Capitulum of humerus epicondyle of humerus to annular ligament (blends - Head of radius dismally) 2. Humeroulnar articulation Fan-shaped - Trochlea of humerus Function: prevents adduction of the forearm - Trochlear notch of ulna Movements = permits movement around 1 axis Flexion and extension of the forearm Proximal radioulnar joint Ligaments Classification synovial, uniaxial, pivot Annular ligaments attaches to the anterior and Articulation surfaces posterior margins of the radial notch of the ulna Head of radius Encircles the head of the radius to hold it in place Radial notch of ulna Funnel-shaped (wider superior LH than inferior) - helps prevent inferior dislocation of radial head Middle radioulnar joint Ring shaped Classification: Fibrous, syndesmosis Interosseous membrane between the radius and ulnar Fibres run inferior from the radius to the ulna Transmits forces from radius - ulna - humerus - pectoral girdle - axial skeleton Site of muscle attachment Acts as fulcrum for pronation and supination of the forearm Distal radioulnar joint Classifcation: synovial, uniaxial, pivot Articular surfaces: Head of ulna Ulnar notch of radius Has an articular disc From ulnar notch of radius to styloid process of ulnar (NOT between articular surfaces) Main uniting structure of joint Separates the distal radioulnar joint from the wrist joint Proximal and distal radioulnar joint - movements = permits movement around one axis Pronation and supination of the forearm Radius rotates around ulnar  Muscles of the shoulder and arm Muscles of the shoulder and arm 4 main groups 1. Muscles connecting the axial skeleton to the humerus 2. Muscles connecting the axial skeleton to the shoulder girdle 3. Muscles connecting the shoulder girdle to the humerus 4. Muscles connecting the shoulder girdle to the forearm Axio-appendicular muscles: Muscles connecting the axial skeleton to the humerus = Pectoralis major Origin: Sternal (sternocostal) head: anterior manubrium and body of sternum Clavicular head: medial half of anterior clavicle Insertion: lateral lip of intertubercular groove/sulcus of humerus Latissimus dorsi Origin: spinous processes of T6-T12 vertebrae, thoracolumbar fascia, iliac crest and ribs 9-12 Insertion: floor of inter-tubercular groove/sulcus of humerus Muscles connecting the axial skeleton to the shoulder girdle Pectoralis minor Origin: ribs 3-5 (near costal cartilages) Insertion: Coracoid process of scapula Serratus anterior Origin: ribs 1-8 (lateral) Muscles Insertion:l medial border of scapula Trapezius Origin: external occipital protuberance and superior nuchal line of skull, nuchal ligament, spinous processes of C7-T12 vertebrate Insertion: lateral 1/3 of clavicle, Acromion and spine of scapula Levator scapulae Origin: transverse processes of C1-C4 vertebrae Insertion: medial border of scapula superior to root of spine Rhomboid major Origin: spinous processes of T2-T5 vertebrae Insertion: medial border of scapula from root of spine to inferior angle Rhomboid minor Origin: spinous processes of C7 and T1 vertebrae, nuchal ligament Insertion: medial border of scapula at level of root of spine Muscles connecting axial skeleton to shoulder girdle Scapulohumeral muscles: Muscles connecting the shoulder girdle to the humerus Deltoid Origin lateral 1/3 of clavicle, acromion and spine of scapula Insertion deltoid tuberosity of humerus Teres major Origin posterior surface of inferior angle of scapula Insertion medial lip of intertubercular groove/sulcus of humerus  Teres minor Origin: lateral border of scapula Insertion greater tubercle of humerus Supraspinatus Origin supraspinous fossa of scapula Insertion greater tubercle of humerus Subscapularis Origin subscapular fossa of scapula Insertion greater tubercle of humerus Muscles of the arm 2 compartments: Anterior (flexor) compartment muscle connecting the shoulder girldle to the humerus (Scapulohumeral) CORACOBRACHIALIS Origin Coracoid process of the scapula Insertion middle 1/3 of medial shaft of humerus BICEP BRANCHII Origin Long head supraglenoid tubercle of scapula Short head Coracoid process of scapula Insertion radial tuberoisty (and forearm fascia via bicipital aponeurosis) TRICEP BRANCHII Origin long head infraglenoid tubercle of scapula Lateral head: posterior shaft of humerus (superior to radial groove) Medial head: posterior shaft of humerus (inferior to radial groove) Insertion olecranon of ulna  ' WEEK THREE Bones and joint of the wrist and hand CARPALS Some METACARPALS Lovers I Try 2 343 Positions That They TTCH Can't P T Handle SL PHALANGES singular = phalanx WRIST COMPLEX Divided into: Proximal, P Middle, Distal There are 2 joints Digit 1 (thumb) has two D Radio carpal (wrist) joint phalanges (proximal and Classification synovial, biaxial, condyloid (ellipsis) - distal) P Articular surfaces Digits 2-5 have three Distal end of radius P P phalanges each P Distal radioulnar joint articular disc M Each has a base, shaft Proximal row of carpals (except pisiform) and head D M M My Movements: Flexion, extension D D Abduction, adduction Ligaments Circumduction Palmar radiocarpal ligament Mid-carpal joint From radius to carpal bones on anterior (palmar) side of hand Classic action synovial, compound joint Functions: Articular surfaces - Limits extension of the hand Ensures that the hand moves with the Proximal row of carpal (except pisiform) forearm during pronation and supination Distal row of carpal Radial (lateral) collateral ligament - Movements: From radius to carpal bones on anterior (palmar) side of hand Augments movement of the hand at the radiocarpal joint Functions: Limits extension of the hand Ensures that the hand moves with the Joints of the hand forearm during pronation and supination Ulnar (medial) collateral ligament Carpometacarpal joint of the Carpometacarpal joint of digits 2-5 From styloid process of ulna to thumb Classification: synovial, multiaxial, plane triquetrum and pisiform Classification: synovial, biaxial, Articular surfaces: Function: limits abduction of the hand saddle 2nd: trapezoid and base of 2nd metacarpal Metacarpophalangeal joints Articular surfaces: 3rd: capitate and base of 3rd metacarpal Classification: synovial, biaxial, Trapezium 4th: hamate and base of 4th metacarpal condyloid Base of 1st metacarpal 5th: hamate and base of 5th metacarpal Articular surfaces: Movements: Movements: Heads of metacarpals Flexion and extension Small gliding movements Bases of proximal phalanges Circumduction Increasing mobility from lateral to medial Movements (of digits): Abduction and adduction 2nd CMC joint least mobile and 5th Flexion and extension Opposition (and reposition) CMC joint most mobile Abduction and adduction Flexion + abduction + Circumduction adduction + slight rotation Interphalangeal joint Classifcation synovial, uniaxial, hinge Articular surfaces Head of phalanx Base of adjacent phalanx Movements (of digits): Flexion and extension Digit 1 (thumb) has only one interphalangeal joint Digits 2-5 have two interphalangeal joint each Proximal (PIP) Distal (DIP)  Muscles of the forearm Teres Posterior compartment (superficial) Anterior compartment Brachioradialis Pronator teres SUPERFICIAL Origin: lateral supracondylar ridge of humerus Origin medial epicondyle of humerus, Insertion: distal radius, just proximal to styloid coronoid process of ulna Quadratus process Insertion middle of convexity on lateral Actions: flexion of forearm in mid-prone position shaft of radius Supination DEEP Pronator quadratus DEEP Origin: lateral epicondyle of humerus, supinator Origin distal 1/4 of anterior ulna fossa and crest of ulna Insertion distal 1/4 of anterior radius Insertion: proximal 1/3 of lateral, posterior and anterior radius Superficial layer Deep layer SUMMARY: Muscles that pronate and supinate the forearm all attach to the radius The forearm muscles can be divided into anterior and posterior compartments, each with superficial and deep layers Superficial layer Deep layer  WEEK FOUR Muscles/structures of the hand a ddu ction abduction & Surface anatomy of the hand Palmar flexion creases Begin around 12 weeks of gestation Creases reflect the movement of the underlying joints Allows us to squeeze and stretch skin for many hand positions Axis of the hand and thumb Rotated medically through 90 e The nar Pollicis = thumb degrees MCP movements IP movements Muscles of the hand 3x thenar muscles 3x hypothenar muscles 3x ‘in the middle’ muscles Opponens pollicis opponens digiti minimi adductor pollicis Flexor pollicis brevis Flexor digiti minimi Lumbricals Abductor pollicis brevis Abductor digiti minimi Interossei - palmar and dorsal Opponens muscles Abductor muscles Flexor muscles Adductor 1. Opponens pollicis 1. Abductor Opponens policis 2. Opponens digiti 1. Flexor ↓ policis Flexor Abductor pollicis L minimi N policis pollicis brevis ↓ policisis brevis Deep to the other brevis ↑ 2. Abductor opponens muscles of the 2. Flexor policis ↑Flexor digiti minimi eminences digiti ↑ Abductor digiti minimi minimi minimi - Move the CMC joint digiti minim Move the Rotation of Move the MCP and metacarpal MCP joints the CMC (and the joint CMC joint) Adductor pollicis Lumbricals: Palmaris brevis Interossei muscles arises from 1. Dorsal 1. Oblique 2. Palmar Associated with flexor head PAD, the tendons of retinaculum 2. Transverse DAB the FDP and palmar head Attachment Attach to the aponeurosis Move the to the extensor and inserts in MCP joint extensor expansion to skin on (and the expansion Flex the MCP ulnar border CMC joint) Move the joint and extend of hand Brings MCP the IP joints thumb to wrinkles skin on ulnar side joints and Proprioceptive palm of hand Deepened hollow of hand IP joints role Accessory structures Extensor retinaculum attachment - radius, ulna, pisiform, triquetrum, ulnar collateral ligament Septa run to the carpal bone and from separate tunnels for the extensor tendons Flexor retinaculum scaphoid and trapezium to pisiform and hamate Functions of the retinacula general functions - prevent bowstringing, protect underlying structures converts anterior concavity of carpal bones into carpal tunnel, forms the anterior boundary of carpal tunnel provides attachment for muscles  Palmar aponeurosis Triangular shaped sheet of fascia, extends from the flexor retinaculum to the deep transverse metacarpal ligaments Intertendinous connections Protects underlying vessels and nerves fibrous connections between Anchors the skin the bands of the extensor Aids grip digitorum muscles just proximal to the MCP joint Prevents independent Dorsal digital expansion extensor extension of any 1 finger, aponeurosis/extensor expansion/ dorsal ensure hand opens as a unit digital expansion/extensor hood when releasing forms an aponeurosis over the posterior surface of each finger Receives attachment from - ED Lumbricals, Interossei Ensures simultaneous extension of the Synovial flexor sheaths interphalangeal joint in each finger synovial sheaths surround each tendon as it passes under the when releasing grip fibrous sheath Double layered tube Function = allows friction free gliding of the tendon under the fibrous sheath Functional anatomy of the hand Digital sweep describes the path take by the fingertips as the hand closes Desirable to have a long path so that the fingertips make the largest arc possible - allows grip of large objects Role of Lumbricals and Interossei on digital sweep is to moderate the effect of the long flexors and long extensors Positions of the hand Palm hollow Fingers flexed (index least, little REST finger most) Thumb slightly opposed and slightly flexed Functional advantages of position of funcition stable wrist position, ligaments taut, stable base for action of Wrist finger flexors and extensors in slight dorsiflexion long finger flexors are stretched, therefore all force of Fingers contraction exerted at finger joints rather than in taking up slack slight flexion at IP joint in most situations this is the position used for splinting FUNCTION More flexion at MCP joints Thumb allows prehensile grip reduces the occurrence of contractures opposed and slightly flexed Precision Grasp Joint positions thumb opposed opponens pollicus Power flexion at MCP of fingers intrinsics of hand IP’s may be flexed or extended Joint positions depending on the task thumb abducted and adducting Small objects adductor pollicus Lateral digits only flexion at all joints of fingers Limited skin contact, but high sensory ac long flexor muscles palm cupped thenar and hypothenar muscles wrist – dorsiflexion +/- ulnar Release of grip deviation Opening the hand involves: wrist flexors & extensors extrinsic finger extensors working to stabilise wrist thumb abductors Large objects thumb extensors Often considerable force required intertendinous Whole hand connections Maximal skin contact dorsal digital expansion  WEEK FIVE Blood and nerve supply to the upper limb Nervous system Peripheral nervous system: The bodies link to the outside world Somatic Autonomic Cranial nerves nerves that emerge directly from the brain or the brain stem 12 pairs, named and numbered Supply the musculoskeletal structure of the head and neck Supply the visceral of the thorax and abdomen Spinal nerves nerves that emerge from the spinal cord 31 pairs, each is numbered according to the place where it emerges from the spinal cord and vertebral column - 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal supply the structures of the trunk wall and limbs Motor distribution to muscles Sensory distribution makes them contract to skin to glands sensation- hot, cold, touch, pressure, pain (usually) increases secretion from a gland to joints eg- supply to sweat glands produces sweating proprioception- sensation of joint position Plexi Nerves supply to upper limb Brachial plexus Ventral rami from spinal nerves C5, C6, C7,C8 and T1 Mexrge and divide to form a ‘plait’ Provide nerve supply to the upper limb and shoulder region Axillary nerve: Course descends behind axillary artery in front of Radial nerves: subscapularis, running close to the shoulder joint Course winders around the neck of the humerus between the long and medial heads of triceps in the radial groove on shaft of humerus Between brachialis and brachioradilis just above elbow. Crosses anterior aspect of elbow Divides into superficial and deep brackens Deep branch winds around neck of radius to post forearm, passes between 2 heads of supination Runs on post surface of interossesus membranr Musculocutaneous nerve: Course: Lies lateral to axillary artery then descends and pierces corcacobrachialis Runs distally between biceps and brachialis to lateral side of arm Becomes a cutaneous nerve at elbow to supply skin only Median nerves Ulna nerve Course Course medial to brachial artery in lower half of medial to brachial artery in arm arm (more medial than median nerve) behind bicipital aponeurosis, in front of passes through the medial brachialis head of triceps to the lie crosses anterior aspect of elbow, then between the medial epicondyle passes between two heads of pronator and the olecranon (funny bone) teres, then deep to FDS descends on medial forearm on at wrist is between FDS and FCR FDP passes deep to flexor retinaculum to enter enters hand passing anterior to the hand flexor retinaculum, runs around medial side of hook of hamate Vulnerability of peripheral nerves Nerves are particularly susceptible to squashing and to tension internal anatomical arrangements limit vulnerability to tension in normal circumstances severe traction injuries exceed the capacity of anatomical arrangements to protect the nerve Nerves may be squashed where they: lie on a bone are close to the surface pass through a muscle belly Vascular supply to the upper limb Brachiocephalic trunk: “extra plumbing” to take blood to right side splits into common carotid and subclavian- the same as on the left side Subclavian arteries supply blood to upper limbs Common carotid arteries supply blood to same side head and neck structures Arteries of the upper limb Arteries of the upper limb Arteries of the upper limb Veins of the upper limb Arteries of the hand 1. Deep veins run with, and take the names of the arteries e.g. radial veins with radial artery same pattern as the arteries, up to the brachial vein vena commitantes contain valves 2. Superficial veins in the skin, therefore not often seen on the specimens valves (not as many as deep veins) anastomose (communicate) freely with the deep veins best identified in the surface anatomy catalogues  Veins RETURN blood back to the heart so blood flow is in the opposite direction to arteries Dorsal venous arch Basilic and Cephalic veins communicate at the elbow via the Median cubital vein Basilic vein joins the Brachial vein and becomes the Axillary vein Cephalic vein drains in to Axillary vein Axillary vein drains into the Subclavian vein Subclavian vein drains into the Brachiocephalic vein Brachiocephalic vein drains into the Superior Vena Cava Significance of heaving 2 sets of veins: 2 ways to return blood to the heart some in-built redundancy temperature control Quite a bit of individual variation Cephalic vein medial cubital Basilic rein vein  WEEK SIX Bones and joints of the hip and pelvis Bones of the pelvis: Formed by union of the 3 components parts of innominate bone. ONE fifth pubis. TWO fifths ischium. TWO fifths ilium The 3 bones meet through the acetabulum 3 seperate bones, bound by cartilage, until 15-17 years of age Fusion not complete until 20-25 years Pelvic girdle 3 BONES 5 JOINTS The lower are connected to the trunk by the pelvic girdle The pelvic girdle is bony ring made up of the sacrum and 2x hips 1 Pelvis 1 + 2 Sacroiliac joint x2 bones. 2. Pubic 3 Sacrum symphysis These bones are going at the front via the pubic symphysis and the back via the sacroiliac joint 3. Femur 4+ 3 Hip joint x2 Body weight is transferred from the vertebral column through the sacroiliac joints to the pelvic girdle and from the pelvic girdle through the hip joints to the femurs. Pelvis inlet = pelvic brim (pubic crest - pectineal line - arcuate line - sacral alar and promontory Functions of (true) pelvis Pelvic outlet (tip of coccyx - ischial tuberosities - Houses and protects the pelvic contents Innominate inferior part of pubic symphysis) Supports the weight of the head, trunk and arms 28 Allows for weight transference from trunk to lower limb 10 Left innominate bone- Lateral surface Supports the birth canal and provides an exit for the foetus 10 1- Acetabular notch Provides extensive muscle attachment sites 3 3 2- Acetabulum 12 21 3- Gluteal surface 4- Anterior inferior iliac spine 23 ⑳ & z & 20 5- Anterior superior iliac spine 22 Left innominate bone- medial surface 10 2 9- Greater sciatic notch 1- Anterior inferior iliac spine 25 a 11 10- Iliac crest 2- Anterior superior iliac spine 2 I 14 7 13- Inferior ramus of pubis 17 20 & 7- Greater sciatic notch % 15- Ischial tuberosity 13- Ischial tuberosity 7 I 13 19 3 8 18- Superior ramus of pubis Il 16- Obturator foramen 13 19- Obturator foramen 16 25 19- Posterior inferior iliac spine 22- Posterior inferior iliac spine 13 2318 20- Posterior superior iliac spine 23- Posterior superior iliac spine 17 5 o 22 23- Superior ramus of pubis 24- Pubic tubercle 27- Superior pubic ramus Joints 12 13 CLASSIFCATION: synovial, multi-axial, plane Joint surface are smooth in infants, but develop a serious of complementary ridges and depressions with age, more marked in male than female Sacroiliac joint Complementary ridges and depressions interlock and aid joint stability Cavity obliterated with advancing age Large ligaments anterior and posterity Movements = small magnitude gliding and rotations movement Pubic symphysis Fibrocartilaginous joint between the 2 medial symphyseal surfaces of the pubic bones - supported by ligaments - superior pubic ligament - inferior (arcuate) pubic liagment Little to no movement between bones (exception Hip joint in pregnancy) CLASSIFICATION: synovial, multiaxial, ball and socket Movement flexion/extension, abduction/adduction, medial/lateral rotation Articular surfaces Acetabulum semilunar shaped area covered with articular cartilage, acetabular notch Head of femur covered with articular cartilage except for small area on head, 2/3 sphere Inferior/Anterior Anterior · limits extension Limits Posterior · extension - limits extension · Orientation of pelvis Posture Positioning of all body segments at a given point in time Can be interpreted as the body position which requires least amount of muscular support, therefore minimal load on joints, muscles and ligaments Centre of gravity Pelvis Knees Ankles Feet Orientation of the pelvis In the anatomical position ASIS and the pubic tubercles are in the same coronal plane Inferior coccyx and superior pubic symphysis in the same horizontal plane The left and right ASIS are in the same transverse plane Pelvic brim faces anteriorly - tilted at 60 degrees to horizontal Muscles of the hip FLEXING Pectineus Iliopsoas Psoas major lumber vertebrae + lesser trochanter of femur : · & Illiacus ilium + lesser trochanter of femur · · Sartious Anterior superior iliac spine + medial tibia Tensors fascinate latar Anterior superior iliac spine + lateral condole of the tibia via the iliotibial band Rectus femoris Anterior inferior iliac spine + tibial tuberosity Adductor Magnus Pectineus superior pubic ramus + posterior surface of the femur Attachment EXTEND Hamstring group pubic ramus Gluteus maximus Semitendinous extending to Semimembranosus the inferior Attachment Bicep femoris (long part of the from ilium head) ischial and sacrum Attachment all arise tuberosity + (gluteal from the ischial linea aspera surface) + tuberosity + insert into of the fetus gluteal medial side of tibia or and tubersity of fibula adductor femur and = extends hip by pulling tubercle of the iliotibial thigh backwards the femur band ABDUCTORS ADDUCTORS Gluteus medius Attachment Adductor longus Adductor brevis Gracilis gluteal surface of the ilium + greater trochanter of the femur Gluteus minimus Attachment Gluteal surface of the ilium + greater trochanter Attachment ischial Attachment Attachment of the femur ramus + linea aspera ischial ramus Ischial ramus + linea of femur + medial tibia aspera ROTATORS External rotation of the hip Deep Gluteus maximus covered in hip extensors external Sartorius covered in hip flexors rotators Deep external rotators piriformis superior gemellus obturator internus inferior gemellus obturator externus quadratus femoris Internal rotation Gluteus medius Gluteus minimus Tensor fasciae latae WEEK SEVEN The Knee: Bones and joints of leg, ankle and foot Knee joint complex = BONES (Femur, tibia and patella) JOINTS (Tibiofemoral joint = between tibial and femoral condyles and patellofemoral joint = between patellar surface of femur and articulate surface of patella) Bones of the knee Femur/proximal end) A = left femur: posterior view B = left femur: medial view 3A & 2B = greater trochanter 4A & 3B = head 8A & 5B = lesser trochanter 9A = linea aspera 11A & 6B = neck A- Left femur: anterior view B- Left femur: posterior view femur femur 6A & B - Lateral epicondyle 9A & B - Medial epicondyle 4 - Intercondylar fossa Seamoid bone 11A- Patellar surface In trendiness (i.e is embedded with the quadriceps muscles) Articulates with patella surface of femur to form = Patellofemoral joint patella Tibia - proximal Patell