Functional Anatomy PDF

FUNCTIONAL ANATOMY LEVERS Class Description Advantage Body Diagram 1st Class Load à Fulcrum à Effort Force + Distance 2nd Class Effort à Load à Fulcrum Force 3rd Class Fulcrum à Effort à Load Distance...

FUNCTIONAL ANATOMY LEVERS Class Description Advantage Body Diagram 1st Class Load à Fulcrum à Effort Force + Distance 2nd Class Effort à Load à Fulcrum Force 3rd Class Fulcrum à Effort à Load Distance If in doubt, go with 3rd class. BASIC MOVEMENT ANALYSIS RULES 1. Action + Concentric = Muscle Group Example: flexion + concentric = flexors Key Words: 2. Action + Eccentric = Muscle Group Example: flexion + eccentric = extensors Key Words: 3. If isometric, it is the muscle group working against gravity. Example: Bicep Curl Joint Name Joint Action(s) Contraction Type Muscle Group Agonist(s) Phase 1: Lifting Phase Elbow Flexion Concentric Elbow Flexors Biceps Brachii Brachialis Radiocarpal Flexion Isometric Radiocarpal Flexi Carpi flexors Ulnaris Flexi Carpi Radialis Flexi Digitorium Superficialis Phase 2: Lowering Phase Elbow Extension Eccentric Elbow Flexors Biceps Brachii Brachialis Radiocarpal Flexion Isometric Wrist flexors Flexi Carpi Ulnaris Flexi Carpi Radialis Flexi Digitorium Superficialis Jab in Boxing Phase 1: Jab Joint Joint Action(s) Contraction Type Muscle Group Agonist(s) Shoulder Girdle Protraction Concentric Protractors Serratus Anterior Glenohumeral Flexion Concentric Flexors Deltoid Joint Elbow Joint Extension Concentric Extensors Triceps Brachii Radioulnar Joint Pronation Concentric Pronators Pronator Quadratus BONE REMODELLING Wolff’s Law a bone will respond to the stressors placed upon it. Example (1): The width of the humerus will increase on the dominant hand of a tennis player. Example (2): a ballet dancers metatarsals, tarsals and phalanges will be larger. Bone Resorption breaking down of the bone. Example: an astronaut will experience a reduction in bone density as they are no longer experiencing gravity which results in no pressure on the bones. It takes 7-10 years for a new skeleton. The adult stage of life is the maintenance stage of bones.  BIOMECHANICS OF BONE Loading Mode Pressure Diagram Description/Example Tension 130mpa Pulled on at either end. Elongates. Example: Calcaneal Tensile Fracture. Compression 190mpa Opposite of tension Gravity puts pressure on body. Bulge/widen in middle. Example: Vertebral Compressive Fracture Shear 70mpa Horizontally opposing Example: leg extension machine. Torsion Twisting Fracture line will be diagonal Example: Bending 3 point or 4-point fracture. Example (1): 3-point tendon fracture of the tibia. Example (2): 4-point fracture can be acquired if not careful when moving an already fractured leg. How can Muscle Activity Can Positively Influence Acute Abnormal Loading within a Bone? 1. Tibia falling forward 2. Ski boot in the way 3. 3 points bending which places the posterior tibia under tension 4. Bone is weaker under compression 5. Soleus powerfully contracts to place posterior tibia under compression 6. Less damage occurs during fall. Articular Cartilage is a type of hyaline cartilage that covers the ends of long bones – reduces friction and dissipates load placed on the joint. Articular Capsule holds/seals the joint together, provides some stability by limiting movement. Synovial Fluid the joint is AVASCULAR, synovial fluid allows the cells of the joint to receive nutrients and excrete waste (i.e. transportation). Also lubricates and plays a role in shock absorption. Synovial Membrane secretes synovial fluid.  BONES AND ARTICULATIONS OF THE SHOULDER COMPLEX SHOULDER GIRDLE Shoulder Girdle = scapula + clavicle (sternoclavicular + acromioclavicular) Movements: Protraction/Retraction Elevation/Depression Upward Rotation/Downward Rotation Scapulohumeral Rhythm for every 2° of glenohumeral abduction there is 1° of upward rotation of the shoulder girdle (scapula). GLENOHUMERAL JOINT Glenohumeral Joint = scapula + humerus Movements Flexion/Extension Adduction/Abduction Horizontal abduction/Horizontal adduction Internal rotation/External rotation Circumduction Glenoid Labrum is fibrocartilage that runs around the glenoid cavity creating 50% more depth in the socket. Scapulothoracic articulation = ribs + scapula STRENGTH TO BALANCE RATIO BETWEEN INTERNAL AND EXTERNAL ROTATORS 3:2, internal: external Rotators: Infraspinatus, Teres Minor, Supraspinatus, Subscapularis and Deltoid GLENOHUMERAL ABDUCTION SHOULDER GIRDLE WHAT ARE THE 6 ACTIONS OF THE SHOULDER GIRDLE? Elevation/Depression Retraction/Protraction Upward Rotation/Downward Rotation SCAPULOHUMERAL RHYTHYM For every 2°of glenohumeral abduction, there is 1° upward rotation of scapula. Example: when the glenohumeral joint adducts 180°, the scapula rotates 120°. SPINAL CONTRIBUTIONS TO SHOULDER MOVEMENT How does the body compensate to allow for flexion and hyperextension? Trunk extension & flexion. Which movements of the spine affect the function of the glenohumeral joint? Lateral flexion & rotation.  RANGE OF MOTION Range of Motion (ROM) is the joint flexibility. Measured by the angle, in degrees. Use a double armed goniometer. Active ROM created by the subject contracting the muscles around the joint without assistance. Passive ROM created by an external force pushing the joint segment through the maximal range of motion. Passive ROM will always be greater than active ROM. Movement Test Position Axis Stationary Moving Arm Normal ROM Arm Shoulder Supine with Acromion Parallel to the Lateral 150-180° Flexion hips and knees Process mid-axillary line epicondyle of flexed and feet of the trunk, in the humerus. flat on the line with the table. greater trochanter. Shoulder Prone with Acromion Parallel to the Lateral 50° Hyperextension head well Process mid-axillary line epicondyle of supported. of the trunk, in the humerus. line with the greater trochanter. Shoulder Supine with Olecranon Perpendicular Ulna shaft in 90° Lateral Rotation hips and knees Process of the to the floor. line with ulna flexed and feet Ulna styloid process. flat on the table. Shoulder Supine with Olecranon Perpendicular Ulna shaft in 70° Medial Rotation hips and knees Process of the to the floor. line with ulna flexed and feet Ulna styloid process. flat on the table. a THE ELBOW COMPLEX Elbow consists of 3 synovial joints: 1. Humeroulnar (Humerus à Ulna) a. Anterior: Trochlea to trochlea notch b. Posterior: Olecranon process to olecranon fossa c. Joint: Synovial/Hinge/Diarthrotic/Uniaxial 2. Humeroradial (Humerus à Radius) a. Joint: Synovial/Plane/Diarthrotic/Nonaxial 3. Proximal Radioulnar Joint (Radius à Ulna) a. Anterior: Head of radius to radial notch b. Joint: Synovial/Pivot/Diarthrotic/Uniaxial c. Movement: Supination/Pronation LIGAMENTS 1. Annular Ligament a. Holds the proximal radius against the ulna & permits free rotation of radial head. 2. Radial Collateral Ligament a. Provide stability against inner to outer stress on the elbow. 3. Ulna Collateral Ligament a. Inside area of the elbow. b. Supports the elbow when performing motions. ANGULATION OF ELBOW Valgus is the distal end of the limb is more lateral. Varus distal end is more medial. Elbow naturally directs out laterally, making it valgus. o Trochlea directs and points down on the medial side. o Sends the ulna out laterally. o In flexion, everything will have to shift to fit. Population should fit in within 10-15 degrees valgus.  THE WRIST Triangular Fibrocartilage Complex load bearing structure between the lunate, triquetrum and ulnar head which stabilised the wrist especially during radial deviation. Also acts a pulley. ACTIONS OF THE WRIST Flexion/extension Abduction/adduction LIGAMENTS OF THE WRIST 1. Palmar Intercarpal Ligament (2) 2. Ulnounate 3. Radiolunate STRUCTURE Form a double V system – 2 rows of carpal bones. Intrinsic ligaments run carpal to carpal – Parmar intercarpal. Extrinsic Ligaments run carpal to long bones. ARCHES OF THE HAND 1. Proximal Transverse (carpals à metacarpals) a. Mobility: not very mobile. b. Keystone: capitate. 2. Distal Transverse (Metacarpals à Phalanges) a. Mobility: more mobile. b. Keystone: 3rd metacarpal. 3. Longitudinal (runs the length of the hand) a. Mobility: highly mobile b. Keystone: no keystone Maintained day to day through the intrinsic muscles of the hand.  CARPAL TUNNEL Retinaculum is a ligament that completes carpal tunnel. Which nerve is involved in Carpal Tunnel Syndrome? Median nerve which is major nerve supply to fingers. Inflammation and swelling in carpal Tunnel begins in compress structures in it. What is Phalen’s Test? Allow wrist to fall into maximal flexion op surface. Push dorsal surface of both hands together, hold for 30-60 seconds. PREHENSION Prehension is the act of grasping objects. TYPES OF PREHENSION 1. Power Grip thumb is adducted. Example: karate chop. 2. Precision Grip thumb is abducted.  a. Tip pinch b. Lateral (key) pinch c. Pulp pinch d. Palmar pinch Described as more of a spectrum from power grip to precision. PELVIS, HIP AND KNEE Acetabular Labrum ring of cartilage that surrounds the acetabular labrum. It’s function is to deepen the acetabulum and assist in the stability, lubrication, and sensation of the hip joint. Transverse Ligament surrounds the hip, bridging the acetabular notch, and functions to stabilise the hip while moving. Ligamentum Teres intra-articular, cordlike structure that connects the femoral head to the acetabulum. Critical for stability and blood flow. When are these ligaments the tightest? Hip extension & internal rotation. ALIGNMENT OF THE ACETABULUM ANGLE AVERAGE RANGE IMAGE Centre-edge Angle 35-40 degrees (Angle of Wiberg) Acetabular Anteversion Angle 20 degrees  Angle of Inclination 125 degrees Torsion Angle 15 degrees ACTIVE RANGE OF MOTION NORMAL TEST PRECAUTIONS GONIOMETRIC PHOTO ROM POSITION ALIGNMENT HIP FLEXION 100-135° Supine Allow knee to Axis: greater flex to prevent trochanter of the stretching of femur. the Stationary arm: hamstrings. parallel to the trunk, in line with the greater trochanter. Moving arm: lateral epicondyle of the femur. HIP HYPEREXTENSION 10-30° Supine Keep knee Axis: greater joint trochanter of the extended. femur. Avoid Stationary arm: lumbosacral parallel to the trunk. motion. In line with the greater trochanter.  ASSESSING LEG-LENGTH DISCREPANCY True Leg Length Discrepancy assess whether an actual difference in leg length exists, causing a tilt in the pelvis and secondary compensation of the spinal column. Find the anterior superior iliac spine and medial malleolus. Measure the diperence between these two bony landmarks. Apparent Leg Length Discrepancy assessed to determine whether leg length differences are due to pelvic rotation, sacroiliac dysfunction, foot pronation/supination, or postural abnormalities. Find the umbilicus and medial malleolus. Measure the diperence between these two bony landmarks.’ SURFACE MOTION OF THE KNEE Most motion occurs in the sagittal plane. Flexion: 15° (more mass at hamstrings = less flexion) Extension: 3° FORCES IN THE KNEE JOINT Load bearing properties: Visco elastic properties. Meniscus à fibrocartilage à shock absorption + lubrication Screw Home Mechanism provides information on the normal lateral rotation of the Tibia on the Femur during extension in an open kinetic chain. Absence of this normal rotation may be associated with a torn meniscus or patellofemoral dysfunction.  PATELLA MECHANISM FUNCTIONS OF THE PATELLA 1. Interior protection 2. Leverages quadricep muscle 3. Shock absorption/force distribution 4. Reduces friction PATELLA TRACKING Patella Tracking in full extension, the patella sits lateral to the trochlea. During flexion, the Patella moves medially and comes to lie within the Intercondylar notch until 130° of flexion. During normal tracking both lateral and medial parts of the Patella surface are in contact with the Femur during knee flexion and extension. Patella sits too laterally = muscle imbalance + vastus medialis is weaker = tracking THE Q-ANGLE Position of the tibial tuberosity apects the line of pull of the quadriceps muscles and therefore tracking of the patella. If the tuberosity is located laterally then there is a tendency for lateral patella tracking. If the tuberosity is located medially, then there is a tendency for medial patella tracking. The Q-Angle is a measurement of the angle between the rectus femoris and the patella ligament. Provides an indication of the lateral vector force applied to the patella. Normal value males: 10-15° Normal value females: 10-19° FOOT & ANKLE STRUCTURAL ORGANISATION OF THE FOOT AND ANKLE Medial longitudinal arch higher arch formed by calcaneus, talus, navicular and 3 cuneiforms. Plantar fascia band of connective tissue connecting heel bone to base of your toes. Maintains the medial longitudinal arch, provides static support and dynamic shock absorption. Which bones are in each unit? Rear foot: Calcaneus + Talus Mid foot: rest of tarsal bones inc. cuneiform, cuboid and navicular. Forefoot: metatarsals + phalanges. Windlass Mechanism mechanical model that provides an explanation of the function of the base of the foot. In plantarflexion, the toes are in extension, requiring the plantar fascia to run a longer pathway. Instead of stretching, it will pull the ends of the bones together. Arch height will then increase. What happens to the medial longitudinal arch during ‘toe off’ in the gait cycle? Arch increases. What is the most common injury of the Plantar Fascia? Plantar fasciitis which is inflammation of the plantar Fascia. Caused by: 1. Poor biomechanics (natural or shoes) 2. Age (stiper less hydrated fascia) 3. Weight (larger the body weight, the more loading) KINEMATICS OF THE FOOT AND ANKLE Ankle joint = talocrural joint. Plantarflexion + dorsiflexion occurs around a medial/lateral axis at the Tibiotalar joint = flexion/extension Inversion/eversion = adduction/abduction. Abduction/adduction = medial/lateral rotation. Pronation = dorsi flexion + eversion + abduction. Supination = plantarflexion + inversion + adduction What happens if there is excessive pronation? Misaligned calves Not epective muscle contraction Tibia rotates internally – for every 1 degree of pronation, 4 degrees of internal rotation of the tibia occurs.  BIOMECHANICAL ASSESSMENT OF THE FOOT AND ANKLE Knee to Wall Test assesses ankle dorsiflexion range of motion (ROM). 1. Face wall. 2. Place big toe 5cm from the wall. 3. Push your knee forwards to touch the wall, your heel must remain on the ground. 4. Move 2cm every time you complete this successfully. 5. Record the maximum distance 6. Repeat on other side. Normal ROM: 10-12cm GAIT CYCLE Stance Phase Swing Phase Heel strike Foot flat Heel Push off Toe off Acceleration Toe clearance rise 0% 15% 30% 45% 60% 70% 85% Stride length is the length between an event on one side until the same event on the same side. Step Length is the length between an event on one side until the event on the other side. What is the role of pronation during the gait cycle? Shock absorbing/load bearing Takes the load of the body (heel flat to heel rise) What is the role of the quadriceps and hamstrings at the knee during the swing phase of the gait cycle with reference to the concentric and eccentric contractions? Knee performs extension. 1st half of swing phase à concentric extension = quads 2nd half of swing phase à eccentric extension - hamstrings THE SPINE AND POSTURE LIGAMENTS OF THE SPINE Anterior ligaments = load bearing Posterior ligaments = movement Ligamentum Flavum connect laminae of adjacent vertebrae. 2:1, elastin: collagen More flexible Slows movement rather than stopping it. RANGE OF MOTION OF THE SPINE STATICS AND DYNAMICS OF THE SPINE ANGLES OF LORDOSIS AND KYPHOSIS KYPHOSIS LORDOSIS Neutral Thoracic 20°-45° Neutral Lumbar 20°-40° Kyphosis Lordosis Thoracic 40° hyperkyphosis NORMAL LINE OF GRAVITY FOR THE TRUNK If a person has kyphosis, their line of gravity will shift forward. PELVIC TILT Anterior tilt = increased loads on the lumbar spine. Erector spinae deal with changes in posture, insertion point is on top of each vertebra. Can reduce the load of the body by laying down and resting feet high on a chair. SPINAL NERVES Nerve Plexus is a bunch of nerves. 5 main Plexi formed by the spinal nerves. 1. Cervical Plexus a. Nerve connections to the head, shoulders and neck. 2. Brachial Plexus a. Connections to the shoulders, chest, upper arms, forearms and hands. 3. Lumbar Plexus a. Connections to back, abdomen, groin, thighs, knees and calves. 4. Sacral Plexus a. Connections to posterior thigh, lower leg, foot and part of pelvis. 5. Coccygeal Plexus a. Supplies motor and sensory control of the genitalia and muscles that control defecation. Pairs of spinal nerves: 31 ROLE Receive Integrate Respond From internal or external CNS - brain + spinal PNS system environment cord SPINAL NERVE DIAGRAM Dorsal root contains nerves that carry visceral motor, somatic motor and somatic sensory information to and from the skin and muscles of the back. Aperent Sensory neurons Ventral root contains nerves that serve the ventral parts of the trunk and limbs. Eperent Motor neurons A comes before E à Afferent goes in before efferent goes out. REFLEX ARC Reflex arc is a basic unit of a reflex which involves neural pathways acting on an impulse before that impulse has reached the brain. Inborn (born with) Example: if you throw a ball at a child, their reflex is to dodge the ball. Conditioned (acquired) Example: if you throw a ball at a teenager, their reflex is to catch it. COMPONENTS OF A REFLEX ARC 1. Receptor chemical structure that receives and transduce signals. 2. Sensory Neuron nerve cells that are activated by sensory input from the environment. 3. Integration centre site where sensory neurons transmit their information to motor neurons. Can be spinal cord instead of brain. 4. Motor Neuron nerve cells that form pathway along which impulses pass to reach a muscle or gland. 5. ESector part of the body that carries out the response, e.g. muscle or gland. THE BRACHIAL PLEXUS Runs from C5-T1 Can be palpated superior to the clavicle and at the lateral border of the sternocleidomastoid. Common sign of injury is numbness or loss of feeling in the hand or arm. Nerve Muscles Innervated Axillary Deltoid Teres Minor Musculocutaneous Biceps Brachii Coracobrachialis Brachialis Radial Triceps Brachii (whole back of arm) Anconeus Brachioradialis Supinator Extensor Carpi Ulnaris Extensor Carpi Radialis Extensor Digitorium Extensor Pollicus Longus Ulnar Flexor Carpi Ulnaris Median Flexor Carpi Radialis (Front forearm) Flexor Digitorium Superficialis Flexor Pollicus Longus Pronator Teres Pronator Quadratus THE LUMBAR PLEXUS Runs from L1-L4 Lies within the psoas major Nerve Muscles Innervated Femoral Iliopsoas Rectus Femoris Vastus Lateralis Vastus Medialis Vastus Intermedius Sartorius Obturator Adductor Longus (runs through obturator foramen) Adductor Brevis Gracilis THE SACRAL PLEXUS Arises from L4-S4 Lies within piriformis Longest + thickest SCIATICA Pain along the sciatic nerve. Numbness, shooting pain. 1 leg or 2 legs. Caused by traumatic injury, or disc degeneration/herniation. Nerve Muscles Innervated 1. Tibial (back of leg) Biceps Femoris Semimembranosus Semitendinosus Tibialis Posterior  Flexor Digitorium Longus Flexor Hallicus Longus Short head Biceps Femoris 2. Common Fibular (front of leg) Fibularis Longus Fibularis Brevis Tibialis Anterior Extensor Digitorium Longus Extensor Hallicus Longus Superior & Inferior Gluteal Gluteus Maximus Gluteus Medius/Minimus Tensor Fascia Latae INNERVATION OF SKIN Dermatomes are areas of skin that connect to a specific nerve root on your spine. 30 dermatomes in total Innervated by the aperent nerve fibres from the dorsal root Segmented distribution Dermatomes distributed horizontally 2 POINT DISCRIMINATION TEST Assessment of tactile perception. Use pointed ends of paperclips to press into skin. Patient will try to determine if 1 or 2 paperclips were used. Will depend on the number of sensory receptors in the area being tested. SOMATOTYPING Somatotyping is the quantification of the present shape and composition of the human body. Expressed as a three number rating. 1. Endomorphy is relative fatness. 2. Mesomorphy is relative musculoskeletal robustness. 3. Ectomorphy is relative linearity or slenderness. Endomorph rating à Mesomorph rating à Ectomorph rating e.g. 3 – 5 - 2 Low 0.5-2.5 Moderate 3-5 High 5.5-7 Very High >7.5  MEASURING SOMATOTYPES – HEATH CARTER METHOD 1. Height 2. Body mass 3. Triceps skinfold 4. Subscapular skinfold 5. Supraspinale skinfold 6. Medial calf skinfold 7. Humerus breadth 8. Femur breadth 9. Arm girth 10. Calf girth Take the measurements on the right side of the body. Skinfolds are taken by raising a fold of skin and subcutaneous tissue firmly between the thumb and forefinger before applying the calliper. Triceps = back of arm/halfway line connecting acromion and head of the radius Subscapular = inferior angle of scapula in direction obliquely and laterally at 45 degrees Supraspinale = 5-7cm above anterior superior iliac spine on a line to the axillary border and on a diagonal line going downwards and medially at 45 degrees Medial calf skinfold = medial side of the leg Bone breadth dimensions of the bone. Biepicondylar breadth of humerus = width between medial and lateral epicondyles of the humerus Biepicondylar breadth of femur = knee bent, measure distance between medial and epicondyles of femur. Girth distance around middle. Upper arm = lexes shoulder at 90 degrees and elbow to 45 degrees, contracting muscles. Calf = feet slightly apart, measure the max circumference. Endomorph Calc. Mesomorph Calc. Ectomorph Calc. Triceps Skinfold Height Wegith Subscapular Skinfold Humerus width Height Supraspinale skinfold Femur width Sum Biceps girth Calc girth Use standard deviation Use cube root & division. PLOTTING SOMATOTYPES First word ‘ic’, second word noun, e.g. Ectomorphic Endomorph 1. Central no component dipers by more than one unit from the other two. 2. Endomorph endomoprhy is dominant mesomorphy and ectomorphy are more than one half unit lower. 3. Mesomorph mesomorphy is dominant, endomorphy and ectomorphy are more than one half unit lower. 4. Ectomorph ectomorphy is dominant, endomoprhy and mesomorphy are more than one half unit lower.