BMS MSK Asynchronous Lecture 13 PDF

Pelvic Girdle joints, Foot Muscles (E-Learning Module) Moore's Clinically Oriented Anatomy, by Arthur F. Dalley II Ph.D. FAAA (Author), Anne M. R. Agur BSc (OT) MSc Ph.D. FAAA (Author), 9th ed. Upper Limb Chapter; Pages: 564 – 566, 778 – 782, Presented By: Dr. M. Doroudi; [email protected] (Boucher...

Pelvic Girdle joints, Foot Muscles (E-Learning Module) Moore's Clinically Oriented Anatomy, by Arthur F. Dalley II Ph.D. FAAA (Author), Anne M. R. Agur BSc (OT) MSc Ph.D. FAAA (Author), 9th ed. Upper Limb Chapter; Pages: 564 – 566, 778 – 782, Presented By: Dr. M. Doroudi; [email protected] (Boucher Campus) Link to this module recording Boucher Campus: https://ccnm.ca.panopto.com/Panopto/Pages/Viewer.aspx?id =4a48a0b0-791f-4a32-bab0af6200814372&instance=Moodle Toronto Campus: https://ccnm.ca.panopto.com/Panopto/Pages/Viewer.aspx?id =48013083-bf06-470a-937eaf6200814e80&instance=Moodle Pelvic Region Ø Pelvic girdle Ø Pelvis support and protection to the pelvic organs Ø Transmits forces from the head, arms, and trunk to the lower extremities Ø Seven Joints of the pelvis region: 1) Lumbosacral 2) Sacroiliac 3) Sacrococcygeal 4) Symphysis pubis 5) Hip 3 Pelvic Region ØHip joints are the most structurally stable, yet mobile, joints in the body Ø Transmits large forces between the trunk and the ground ØSustains more than three times the body weight with each step 4 Sacroiliac (SI) Joint ØThe SI joint can be a sight of low back pain, often following childbirth due to injuries of ligaments, hyper- and hypo-mobility, or inflammatory conditions. ØTypically classified as a synovial planar (gliding) joint made between the auricular surface of the ilium part of the hip bone and sacrum. The sacral surface is covered in hyaline cartilage and the iliac surface is covered in fibrocartilage. 5 Sacroiliac (SI) Joint ligaments ØOn the posterior side of the sacrum, the interosseous ligaments fill the space between the sacrum and the inner side of the iliac tuberosity. ØSeveral layers of the posterior sacroiliac ligaments cover the interosseous ligaments and the posterior aspect of the sacrum. ØOn the anterior aspect lie the anterior sacroiliac ligaments. 6 Sacroiliac (SI) Joint ligaments ØThe sacrotuberous and sacrospinous ligaments are connecting the to the spinous process and ischial tuberosity, providing them with excellent leverage to hold the distal aspect of the sacrum in place against the anterior weightbearing forces. 7 Sacroruberous and sacrospinous ligaments 8 Sacroiliac (SI) Joint Self-Locking Mechanism Because the fibers of the interosseous and posterior sacro-iliac ligaments run obliquely upward and outward from the sacrum, the axial weight pushing down on the sacrum pulls the ilia inward (medially) so that they compress the sacrum between them, locking the irregular but congruent surfaces of the sacro-iliac joints together. The iliolumbar ligaments are accessory ligaments to this mechanism. This is called a self-locking mechanism. 9 Coccygeal Joints ØThe sacrococcygeal joint may be classified as a synovial planar (gliding) joint or as a symphysis (secondary cartilaginous) synarthrosis joint, depending on the subject’s age. ØThe intercoccygeal joints are classified as a synarthrosis. ØMotion increases between these joints during pregnancy, and ossification of the joints occurs with aging. 10 Pubic Symphysis ØThe articulating surfaces of the pubic bones are separated by a fibrocartilaginous interpubic disc, hence its classification as a cartilaginous symphysis (secondary cartilaginous) amphiarthrosis cartilaginous symphysis joint. ØEven small motions occurring at the SI joints must be accompanied by motion at the symphysis pubis, as the symphysis pubis completes the closure of the ring of the pelvic articulations. 11 Dorsum of the Foot Extensor digitorum brevis – Ori: Dorsal surface of calcaneus – Ins: Lateral side of the tendon of extensor digitorum longus for toes # 2 - 4 – Fun: – N: Dorsum of the Foot Extensor hallucis brevis – Ori: Dorsal surface of calcaneus –Ins: Proximal phalanx of big toe. – Fun: – N: Sole of the Foot There are four layer of muscles in this region. 1St Layer 1) Abductor hullucis 2) Flexor digitorum brevis 3) Abductor digiti minimi Plantar Fascia 2nd Layer: The second layer of the muscles in the sole includes two muscles and two tendons: 1) Flexor hallucis longus tendon 2) Flexor digitorum longus tendon 3) Quadratus plantae ( Flexor accessorius) Lumbricals 4) Lumbricals (4 muscles) 3rd Layer 1) Flexor hallucis brevis 2) Adductor hallucis 3) Flexor digiti minimi brevis pedis 4th Layer: Two groups of muscle; 1) Plantar interossei (3 muscles) 2) Dorsal interossei ( 4 muscles) 15 Abductor hallucis – Ori: Medial process of tuberosity of the Calcaneus Plantar fascia – Ins: Base of the proximal phalanx of the big toe. – Fun: – N.: Flexor digitorum brevis Ori: – Medial process of tuberosity of the calcaneus – Plantar fascia – Ins: The sides of the middle phalanx of toe #2-5 – Fun: – N.: Abductor digiti minimi – Ori: Lateral process of the tuberosity of the Calcaneus Plantar fascia – Ins: Base of the proximal phalanx of 5th toe – Fun: – N.: 2nd layer of the sole of the foot Quadratus plantae ( Flexor Accessorius) – Ori: Calcaneus – Ins: Tendon of the flexor digitorum longus – Fun: – N.: 19 2nd layer of the sole of the foot Lumbricals – Ori: Tendon of the flexor digitorum longus – Ins: Dorsal digital expansion of toes #2-5 – Fun: – N.: 20 3rd layer Flexor hallucis brevis – Ori: Cuboid 3rd (lateral) cuneiform – Ins: Medial and lateral sides of proximal phalanx of great toe (the tendon contains sesamoid bones) – Fun: – N.: 21 3rd layer Flexor digiti minimi brevis – Ori: Base of 5th metatarsal Tendon of fibularis longus – Ins: Proximal phalanx of 5th toe – Fun: – N.: 22 Adductor hallucis – Ori: Oblique head: The base of metatarsals # 2 – 4 Tendon of fibularis longus Transverse head : Plantar metatarsophalangeal ligaments – Ins: Base of the proximal phalanx of great toe – Fun: – N.: 23 4th layer Dorsal interossei –Ori: Adjacent sides of metatarsal bones. –Ins: Bases of the proximal phalanges (and dorsal digital expansion). The first is inserted into the medial side of the 2nd toe; the other three are inserted into the lateral sides of the 2nd, 3rd, and 4th toes. – Fun: 24 – N.: 4th layer Plantar interossei – ori: Metatarsal bones #3 - 5 – Ins: Bases of proximal phalanges (and dorsal digital expansion). The first is inserted into the medial side of the 3rd toe; the other two are inserted into the medial sides of the 4th & 5th toes. – Fun: – N.: 25