Lecture Eleven: The Skeletal System - II PDF

LECTURE ELEVEN THE SKELETAL SYSTEM – II © Dr. Nicole M. Ventura, PhD. © All slides are property of Dr Ventura. Instructor Assistant Professor, Teaching Stream generated course materials are protected by law and...

LECTURE ELEVEN THE SKELETAL SYSTEM – II © Dr. Nicole M. Ventura, PhD. © All slides are property of Dr Ventura. Instructor Assistant Professor, Teaching Stream generated course materials are protected by law and may not be copied or distributed in any form or in any School of Kinesiology & Health Sciences medium without explicit permission of Dr Ventura and/or 3rd party (published texts) where applicable. Faculty of Health, York University LEARNING OBJECTIVES Identify the various surface regions of the upper limb. Identify and describe the bones of the upper extremity, focusing on the skeletal morphology features of each bone discussed (scapula, clavicle, humerus, radius, ulna, and bones of the hand). Classify and describe the articulations, function(s), and movements of the joints of the pectoral girdle, shoulder, elbow, wrist and hand. Discuss the reinforcing structures where listed. Identify and describe the scapulothoracic “joint”. Describe scapulothoracic rhythm. Define the differences between subluxation and dislocation. Discuss the different dislocations of the glenohumeral joint.  THE UPPER EXTREMITY: SURFACE ANATOMY Anterior View Posterior View Shoulder/Deltoid Region Deltoid Axillary Region Anterior Arm Posterior Arm Anterior Elbow Posterior Scapular (Cubital Region) Elbow Region (Cubital region) Anterior Forearm Posterior Forearm Anterior Wrist Posterior Wrist (Carpal region) (Carpal region) Dorsum of the Palm of the Hand Hand Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  SKELETAL COMPONENTS OF THE UPPER EXTREMITY Clavicle Joints of the Shoulder Scapula Humerus The Elbow Joint Ulna Radius The Wrist Joint Carpal Bones Bones of the Hand and Digits Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme Anterior View Posterior View THE PECTORAL GIRDLE: Clavicle and Scapula Scapula Clavicle THE CLAVICLE “collarbone” Sternal Shaft of the Clavicle End Lateral End Medial End Superior Surface Acromial End THE SCAPULA A. “shoulder blade” 3. 1. Angles: 1. Lateral angle 2. Inferior angle 3. Superior angle B. Borders: Responsible for A. Superior border C. attaching the upper B. Medial border limb to the trunk. C. Lateral border 2. Anterior View Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme THE SCAPULA: Bony Prominences Acromion Acromion Coracoid Process Coracoid Process Spine of the Scapula Supra-glenoid Acromion tubercle Coracoid Process Anterior View Infraglenoid Posterior View tubercle Glenoid Fossa Sagittal View Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme THE SCAPULA: Scapular Fossae Spine of the Scapula Subscapular Fossa Supraspinous Fossa Infraspinous Fossa Anterior View Supraspinous Fossa Posterior View Infraspinous Fossa Subscapular Fossa Sagittal View Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme THE PECTORAL GIRDLE: Surface Anatomy Landmarks Vertebral Column (Thorax) TIII TVII Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  THE HUMERUS: Proximal Skeletal Morphology Lesser Tubercle Greater Tubercle Head of the Humerus Greater Tubercle Anatomical Neck Surgical Neck Intertubercular Groove Greater Tubercle Deltoid Tuberosity Deltoid Tuberosity Lateral Medial Medial Lateral Anterior View Posterior View Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  THE HUMERUS: Distal Skeletal Morphology Anterior Posterior Shaft Lateral Medial Supracondylar Supracondylar Ridge Ridge Medial Epicondyle Lateral Epicondyle Lateral Capitulum Trochlea Epicondyle Anterior Trochlea Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme JOINTS OF THE PECTORAL GIRDLE/SHOULDER 2. ACROMIOCLAVICULAR JOINT 1. STERNOCLAVICULAR JOINT Classification: Synovial; Plane/Gliding Classification: Synovial; Saddle 2. Subacromial Space 1. STERNUM THE STERNOCLAVICULAR JOINT Elevation Retraction Protraction Depression minimal rotation “rolling” Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme JOINTS OF THE PECTORAL GIRDLE/SHOULDER 3. GLENOHUMERAL JOINT 4. SCAPULOTHORACIC “JOINT” Classification: Synovial; Ball and Socket No Classification – not a “true joint” “the shoulder joint” Head of Glenoid cavity humerus STERNUM 3. 4. Glenoid labrum Superior View Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  MOVEMENTS OF JOINTS OF THE SHOULDER THE GLENOHUMERAL JOINT Glenohumeral LATERAL Rotation with ABDUCTION (EXTERNAL) flexed elbow ROTATION MEDIAL (INTERNAL) ROTATION EXTENSION FLEXION ADDUCTION THE SCAPULOTHORACIC JOINT UPWARD ROTATION PROTRACTION ELEVATION RETRACTION DEPRESSION Moore: Clinically Oriented Anatomy, 7th Edition. Copyright © 2014 by Lippincott Williams & Wilkins DOWNWARD ROTATION  SCAPULOHUMERAL RHYTHYM: 2:1 degree ratio of glenohumeral to scapulothoracic movement respectively First 30 degrees of Abduction: Moore: Clinically Oriented Anatomy, 7th Edition. Copyright © 2014 by Lippincott Williams & Wilkins movement occurs at glenohumeral joint only https://www.youtube.com/watch?v=H4nfQEeJmFo Beyond 30 degrees of Abduction: movement at glenohumeral joint is possible due to concurrent movements at the sternoclavicular (SC) and scapulothoracic joints Elevation of SC , Upward rotation of Scapula Snell, Clinical Anatomy by Regions. All Rights Reserved. ©2014 by Lippincott Williams & Wilkins  BONES OF THE FOREARM: Radius and Ulna Anterior view Wrench Shape Posterior view Trochlear Notch Olecranon Radial Head Radial Head Radial Neck Radial Neck Coronoid Radial Process Coronoid Tuberosity Process Ulnar Tuberosity Shaft Shaft Radius Ulna Ulna Radius Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  BONES OF THE FOREARM: Radius and Ulna Radius Ulna Radius Ulna Anterior View Styloid process of Radius Head of Ulna Styloid process of Ulna Ulna Radius Posterior View Dorsal Tubercle projects from medial side – palpated medially, extends (Lister’s posteriorly Tubercle) Styloid process of Ulna Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  THE ELBOW JOINT Posterior View Synovial; Hinge Joints HUMERUS HUMERUS Anterior View Coronoid Fossa Radial Fossa (fossa) Olecranon in Humeroulnar Olecranon Trochlea Fossa Trochlear Humeroradial Notch Capitulum Head of Radius RADIUS ULNA ULNA RADIUS Lateral Medial Medial Sagittal View Medial Lateral Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  THE ELBOW JOINT: Ligaments Anterior View Lateral Sagittal View Medial Sagittal View Annular Ligament Ulnar Collateral Ligament Radial Collateral Ligament Annular Ulnar Radial Collateral Ligament Collateral Ligament Ligament Olecranon “Nursemaid’s Elbow” Subluxation of radial head Superior View Reinforcing Structures Radial (Lateral) Collateral Ligament Ulnar (Medial) Collateral Ligament Annular Ligament Annular Ligament Annular ligament Martini, Timmons & Tallitsch: Human Anatomy, Eighth Edition. Copyright © 2013 by Pearson Education Inc.  THE RADIOULNAR JOINTS Olecranon Radius Ulna Head of Radius Proximal Synovial, Pivot Annular ligament Superior/Transverse View Middle Solid, Syndesmosis Interosseous Membrane Inferior/Transverse View Head of Ulna Carpal articular surface Distal Synovial, Pivot Ventral & dorsal radioulnar ligaments Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  THE RADIOULNAR JOINTS Axis of Rotation Radius SUPINATION PRONATION Ulna Radius Radius Ulna Lateral Medial Lateral Medial Moore: Clinically Oriented Anatomy, 7th Edition. Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  III BONES OF THE HAND IV II V Distal I Phalanges Middle Distal (plural for phalanx) Proximal Phalanges Proximal Skeletal morphology Metacarpals (5) for both metacarpal and phalynx bones Carpal Bones (8) Ulna Radius Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  BONES OF THE HAND So = Scaphoid Carpal Bones (8): Proximal and Distal Rows Long = Lunate Capitate To = Triquetrum Trapezoid Hamate Pinky = Pisiform Hook of Hamate Here = Hamate Comes = Capitate Pisiform The = Trapezoid Trapezium Thumb = Trapezium Triquetrum Lunate Common Wrist Injury: Scaphoid Triangular Scaphoid Fractures Fibrocartilaginous Disc Intercarpal Joints: Synovial, Plane/Gliding Gilroy, Anatomy: An Essential Texbook, Copyright © 2013 by Thieme Moore: Clinically Oriented Anatomy, 7th Edition. Copyright © 2014 by Lippincott Williams & Wilkins  THE WRIST JOINT Synovial – Condyloid/Ellipsoid Joint Radius Articulations between distal radius, triangular fibrocartilage TFC Articular Disc (TFC) disc and proximal row of carpals except pisiform! Distal Radius Carpal Bones (proximal row) Proximal row of Carpal Bones Triangular Distal Radius Fibrocartilaginous (TFC) Disc  THE WRIST JOINT: Movement and Ligaments Radial Deviation Ulnar Deviation ABDUCTION ADDUCTION Which movements would these ligaments limit? Radial Collateral Ulnar Collateral Ligament Ligament Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  JOINTS OF THE HAND Posterior View (Dorsum of the Hand) DIP Metacarpophalangeal PIP (MCP) Joints I-V Interphalangeal (IP) Synovial, Condyloid MC and proximal Joints phalange Synovial, Hinge Distal joint (DIP) Proximal joint (PIP) Collateral Ligaments Carpometacarpal (CMC) Carpometacarpal Joints II-V: Synovial, Condyloid/ (CMC) Joint I Ellipsoidal Synovial, Saddle Limited movement 1st MC and Trapezium Gilroy, Anatomy: An Essential Texbook, Copyright © 2013 by Thieme JOINTS OF THE HAND: Movements Metacarpophalangeal (MCP) Joints 1st Carpometacarpal (CMC) Joint Abduction Adduction (Thumb) Flexion/Extension Flexion/Extension Abduction/Adduction Flexion/Extension Interphalangeal Joints (PIP & DIP) Opposition COMMON SKELETAL INJURIES: Acromioclavicular Dislocation Examples here are at the hip joint! Dislocation Subluxation: Dislocation: total partial loss of loss of articular articular congruity congruity Glenohumeral Dislocations Posterior Dislocations: Anterior Dislocations: most common  LECTURE TWELVE THE SKELETAL SYSTEM – III © Dr. Nicole M. Ventura, PhD. © All slides are property of Dr Ventura. Instructor Assistant Professor, Teaching Stream generated course materials are protected by law and may not be copied or distributed in any form or in any School of Kinesiology & Health Sciences medium without explicit permission of Dr Ventura and/or 3rd party (published texts) where applicable. Faculty of Health, York University LEARNING OBJECTIVES Identify the various surface regions of the lower limb. Identify and describe the bones of the lower extremity, focusing on the skeletal morphology (features) of each bone discussed (hip bones, femur, tibia, fibula, bones of the foot). Identify, classify and describe the function(s), movements and reinforcing structures (where listed) of the joints of the lower extremity (joints of the pelvic girdle, hip joint, knee, tibiofibular joints, joints of the foot). Discuss common ankle injuries and foot abnormalities in terms of the arches of the foot. THE LOWER EXTREMITY: SURFACE ANATOMY Gluteal Region Anterior Thigh Femoral Triangle (Trigone) Posterior Thigh Anterior Knee (Genu) Popliteal Fossa Posterior Leg Anterior Leg (Calf) (Shin) Dorsum of the Calcaneal Region Sole of the Foot (Heel) Pansky & Gest, Concise Illustrated Anatomy: Back, Upper and Lower Limb, Copyright © 2012 by Lippincott William & Wilkins Foot  BONES OF THE LOWER EXTREMITY Pelvic Girdle Hip Hip (Innominate) (Innominate) Femur Femur The Hip Joint The Knee Joint Patella Tibia Tibia & & Fibula Fibula Bones of the Foot Bones of the Bones of the Foot Tarsals Metatarsals Phalanges Foot  THE PELVIC GIRDLE Frontal/coronal view Hip Bones False Pelvis inlet True Pelvis Pelvic Brim outlet Sacrum Coccyx Pelvic Outlet Pelvic Brim (Inlet) Inferior View Pelvic inlet vs. Outlet Gilroy, Anatomy: An Essential Texbook, Copyright © 2013 by Thieme  JOINTS OF THE PELVIC GIRDLE LUMBOSACRAL Hip Bones (2) Solid; Symphysis - between LV and SI LIV SACROILIAC JOINTS (2) LV Anterior: synovial Posterior: syndesmosis Sacrum Hip Joint Head of the Femur SACROCOCCYGEAL Solid; Symphysis Femur PUBIC SYMPHYSIS Solid; Symphysis Gilroy, Anatomy: An Essential Texbook, Copyright © 2013 by Thieme  THE HIP BONES: Skeletal Morphology Lateral (Sagittal) View Iliac Crest ILIUM Ala (Wing) of Ilium Anterior Superior Posterior Iliac Spine (ASIS) Superior Iliac Spine (PSIS) Anterior Inferior Body of Iliac Spine (AIIS) Posterior Inferior the Ilium Iliac Spine (PIIS) PUBIS Obturator ISCHIUM Foramen Posterior Anterior Gilroy, Anatomy: An Essential Texbook, Copyright © 2013 by Thieme  The Pelvis – The Hip Bones Lateral (Sagittal) View Anterior ILIUM Posterior Ala (Wing) of Ilium Acetabulum ISCHIUM PUBIS Greater Sciatic Notch Superior Pubic Ramus Ischial Spine Pubic Tubercle Lesser Sciatic Notch Inferior Pubic Ischial Ramus Tuberosity Ischiopubic Ischial Ramus ramus Gilroy, Anatomy: An Essential Texbook, Copyright © 2013 by Thieme  THE HIP BONES: Skeletal Morphology Medial (Sagittal) View Iliac Crest Iliac Fossa Auricular ASIS Surface of Ilium Attachment to Sacrum for sacroiliac joint! AIIS Obturator Pelvic Brim Foramen (Inlet) Anterior Posterior Gilroy, Anatomy: An Essential Texbook, Copyright © 2013 by Thieme  LIGAMENTS OF THE PELVIS Iliolumbar Ligament LV to the Ilium Anterior and Posterior Sacroiliac Ligaments Inguinal Ligament ASIS to pubic tubercle Obturator Membrane covering obturator foramen Anterior View Gilroy, Anatomy: An Essential Texbook, Copyright © 2013 by Thieme Posterior View  LIGAMENTS OF THE PELVIS Anterior View Posterior View Sacrospinous Ligament (SS) Inguinal Ligament ST SS Sacrotuberous Ligament (ST) Function: To prevent upward tilting of the distal sacrum, pulls the pelvis down (anchors sacrum to hip bones) Ligaments help to form the Greater and Lesser Sciatic Foramina Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  THE FEMUR Head Greater Greater Trochanter Trochanter Neck Gluteal Lesser Trochanter Tuberosity Patellar Surface Linea Aspera Shaft Epicondyles Lateral Medial Supracondylar Ridges Medial Lateral Lateral Medial Condyles Medial Lateral Condyles Epicondyles Anterior View Posterior View Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme THE HIP JOINT Acetabular Labrum Acetabular Fossa Lunate Surface Transverse Acetabular Ligament of the Ligament Head of the Femur Fovea Joint Classification: Ball and Socket – Multi-axial Joint Femur Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  MOVEMENTS OF THE HIP JOINT Medial (internal) / Lateral (external) Rotation Extension Flexion Medial Lateral Rotation Rotation Abduction (Ab) / Adduction (Ad) Ad Circumduction During hip flexion Ab While sitting Lateral Ab Medial Ad (External) (Internal) Rotation Rotation Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  BONES OF THE LEG: TIBIA AND FIBULA Proximal Tibiofibular Head Plane/gliding Superior View Tibial Plateaus Neck Lateral Anterior Posterior View View Soleal Line Tibial Condyles Middle Tibiofibular Joint Lateral Medial Syndesmosis Interosseous Membrane Tibial TIBIA Tuberosity Malleoli Anterior View FIBULA Singular = malleolus FIBULA Medial Medial Distal Tibiofibular Lateral Lateral Syndesmosis Pansky & Gest, Concise Illustrated Anatomy: Back, Upper and Lower Limb, Copyright © 2012 by Lippincott William & Wilkins  THE KNEE JOINT Anterior View Lateral (Sagittal) View Large Synovial Cavity Quadriceps tendon JOINT ARTICULATIONS (3): Femoral condyles & Tibial Plateaus (2; right and left) Patellar ligament Patella (sesamoid bone) with the patellar groove of the femur Modified Synovial Hinge Joint Movements: Flexion/Extension Lateral Medial Rotation Rotation Slight Medial and Lateral Rotation Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  THE KNEE JOINT: REINFORCING STRUCTURES CRUCIATE LIGAMENT FUNCTION: Anterior Cruciate Posterior Cruciate Limits anterior (ACL) or posterior (PCL) Ligament (ACL) Ligament (PCL) translation of tibia relative to femur. Both assist in rotational stability of the knee Anterior Drawer Sign Menisci Posterior Drawer Sign Posterior View Anterior Medial Superior View Meniscus Lateral Meniscus Anterior View Medial PCL Lateral Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme Moore: Clinically Oriented Anatomy, 7th Edition. Copyright © 2014 by Lippincott Williams & Wilkins  THE KNEE JOINT: REINFORCING STRUCTURES MCL Lateral Medial Collateral Collateral LCL Ligament Ligament Anterior View Lateral Sagittal View Medial Sagittal View COLLATERAL LIGAMENT FUNCTION: Limits medial (MCL) or lateral (LCL) translation of tibia relative to femur. Both assist in rotational stability of the knee http://www.jenya.wz.cz/fyzioterapie/meislin3.gif Assessment of LCL injury Assessment of MCL injury Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  BONES OF THE FOOT Hallux = Big Toe I II III Distal IV PHALANGES V Proximal Distal (14) Middle Cuneiforms Proximal Intermediate Medial Lateral METATARSALS (5) Navicular Cuboid TARSALS (7) Talus Calcaneus Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  THE TRUE ANKLE JOINT Anterior View DORSIFLEXION Decrease in the angle measuring from the dorsum of the foot PLANTAR-FLEXION Decrease in the angle measuring from the plantar surface of the foot TALUS Deltoid Ligament: (Medial Collateral Ligament) Lateral Collateral Ligament: Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme Moore: Clinically Oriented Anatomy, 7th Edition. Copyright © 2014 by Lippincott Williams & Wilkins  JOINTS OF THE FOOT Condyloid/Ellipsoidal Joints DIP & PIP METATARSOPHALANGEAL JOINTS INTERPHALANGEAL JOINTS Distal & Proximal Abduction Hinge, Synovial Joints Adduction SUBTALAR Talus JOINT Calcaneus Flexion Extension Joints between tarsal bones: plane/gliding Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  MOVEMENTS OF THE SUBTALAR JOINT INVERSION Combination of movements: Lifting the medial SUPINATION: plantar surface of the foot (“pointing in”) plantar-flexion + inversion EVERSION Lifting the lateral plantar surface of the foot (“pointing externally”) PRONATION: dorsiflexion + eversion Schuenke Atlas, Vol 1.. Copyright © 2020 by Thieme Medical Publishers, Inc. https://en.wikipedia.org/wiki/Pronation_of_the_foot COMMON ANKLE INJURIES: ANKLE SPRAIN INVERSION ANKLE SPRAIN EVERSION ANKLE SPRAIN Most Common type of sprain Tearing of the Medial Collateral Ligament - Tearing of the Lateral Collateral Ligaments Deltoid Ligament  FOOT ABNORMALITIES Flat Foot Normal Arch High Arch Longitudinal arches http://www.medicalisland.net/medical-technology/arch-support-for-your-feet-are-they-really-needed PES PLANUS PES CAVUS http://sifalibitkilere.com/wp-content/uploads/Pes-Planus.jpg https://fafysio.files.wordpress.com/2014/05/pes-cavus-snu.jpg?w=500 Over Calcaneal Over Supinated Tendon Pronated (Achille’s Foot Foot Tendon) http://evergreenfootankle.com/wp-content/uploads/2013/08/pediatric-flatfoot-01.jpg https://www.hss.edu/images/articles/posterior-view-cavovarus-foot.jpg  FOOT ABNORMALITIES Dangerous range Safe Range Dangerous range https://www.klmlabstore.com/v/vspfiles/assets/images/FAQ-5.jpg  LECTURE THIRTEEN THE SKELETAL SYSTEM – IV © Dr. Nicole M. Ventura, PhD. © All slides are property of Dr Ventura. Instructor Assistant Professor, Teaching Stream generated course materials are protected by law and may not be copied or distributed in any form or in any School of Kinesiology & Health Sciences medium without explicit permission of Dr Ventura and/or 3rd party (published texts) where applicable. Faculty of Health, York University LEARNING OBJECTIVES Define the term fracture and the various types of bone fractures. Describe the causes, considerations, and common signs and symptoms of bone fractures. Define the terms of classification of bone fractures. Discuss the three common mechanisms of fracture repair. Discuss common bone disorders: osteomalacia (rickets), osteoporosis, osteoarthritis BONE FRACTURES FRACTURE = A BREAK IN A BONE CAUSES: Trauma (fall, accident) SIGNS & SYMPTOMS: ”BROKEN” Twisting (injury, abuse) Bruising with pain and swelling Disease (cancer, osteoporosis) Reduced movement CONSIDERATIONS: Children tend to heal faster Odd appearance Range of healing periods: Krackling sound often 3 to 12 weeks Edema & erythema at the site Complications: infection, compartment syndrome, Neurovascular impairment nerve/vessel damage, fat embolism BONE FRACTURES: TERMINOLOGY / CLASSIFICATION POSITION OF BONE: NON-DISPLACED: Bone ends retain normal position DISPLACED: Bone ends out of alignment COMPLETENESS OF BREAK: COMPLETE: Bone is broken through INCOMPLETE: Bone broken only part of the way through SKIN PENETRATION: CLOSED (SIMPLE): no penetration of the skin OPEN (COMPOUND): open wound, penetration through the skin COMMON TYPES OF BONE FRACTURES: COMMINUTED CRUSH/COMPRESSION COMMON TYPES OF BONE FRACTURES: SPIRAL EPIPHYSEAL COMMON TYPES OF BONE FRACTURES: DEPRESSED GREENSTICK FRACTURE REPAIR CLOSED (EXTERNAL) REDUCTION: Bone ends are manually coaxed back into position Casting is usually placed OPEN (INTERNAL) REDUCTION: Bone ends are secured surgically with pins or wires. Fixation devices -- internally (pins, rods, plates) or externally (metal braces, screws that can be adjusted overtime) TRACTION: aligns bones with steady pulling action Often using weights that hang freely BONE DISORDERS OSTEOMALACIA: softening of bone due to poor/faulty mineralization deficient or impaired metabolism of calcium, phosphate or vitamin D deficiency. RICKETS: analogous disease in children More dangerous since bones are growing rapidly Epiphyseal plate cannot calcify so long bones become enlarged Aung H, et al. 2021. The American Journal of Tropical Medicine and Hygiene. BONE DISORDERS OSTEOPOROSIS: bone density loss (bone resorption > bone deposition). Common in older adults (decreased sex hormones) prevention: adequate nutrition, load-bearing exercise. OSTEOARTHRITIS: degenerative joint disorder causing pain, stiffness and reduced mobility due to the breakdown of cartilage.  LECTURE FOURTEEN THE MUSCULAR SYSTEM – I © Dr. Nicole M. Ventura, PhD. © All slides are property of Dr Ventura. Instructor Assistant Professor, Teaching Stream generated course materials are protected by law and may not be copied or distributed in any form or in any School of Kinesiology & Health Sciences medium without explicit permission of Dr Ventura and/or 3rd party (published texts) where applicable. Faculty of Health, York University LEARNING OBJECTIVES Review details of the muscular system. Define range of motion and discuss the various forms range of motion can be assessed on a patient. Define extrinsic and intrinsic muscles of the back Distinguish between the muscular layers of the back. Identify and describe the origin(s), insertion(s), and action(s)/function(s) of the muscles of the back, neck, shoulder and arm. INTRODUCTION TO MUSCLES Muscles utilize chemical energy (ATP) and convert this into mechanical energy (and heat!) Anatomical terms that begin with “myo” or “mys” = muscle Muscle fiber = myofiber = muscle cell (skeletal or smooth) – they are called “fibers” because they are elongated Cardiac muscle cells are not “elongated” and are also interconnected - thus we typically refer to them as cardiac muscle cells and not fibers! OUR FOCUS FOR THIS UNIT OF KINE 1101 à SKELETAL MUSCLE Skeletal muscle … is consciously controlled (somatic nervous system). is rich with blood supply. contains a nerve ending associated with each muscle fiber (motor unit) – tells muscles to contract!  RANGE OF MOTION (ROM) The measurement of the amount of movement around a specific joint or body part. Active Range of Motion = movement occurring around a joint or body part in which the muscles are activated, independent movement Passive Range of Motion = movement occurring around a joint or body part in which the muscles are not activated, instead the body is manually moved by someone else (health care practitioner) Active-Assisted Range of Motion = movement occurring around a joint or body part in which the muscles are activated, but the movement is still assisted by someone else https://i.pinimg.com/736x/a8/c0/c7/a8c0c776410a95f8d1566cd3cac118f4.jpg  EXTRINSIC vs. INTRINSIC MUSCLES OF THE BACK Intrinsic Muscles of the Back Extrinsic Muscles of the Back Superficial muscles Muscles with attachment sites on the Primary function is vertebrae or ribs movement of upper limb Primary function is movement and support of vertebral column Innervation: Posterior rami of spinal nerves Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme INTRINSIC MUSCLES OF THE BACK ERECTOR SPINAE 3 vertical columns of muscle I L Iliocostalis, Longissimus, Spinalis Iliocostalis S Longissimus “I Like Standing” muscles Spinalis FUNCTION: Bilateral: extension of the spine Unilateral: lateral flexion of spine (iliocostalis) MUSCLES OF THE NECK CAPITIS SPLENIUS CAPITIS and CERVICIS CERVICIS Spinous Capitis: insertion onto the skull (mastoid Processes process) Cervicis: insertion onto TPs of cervical upper cervical vertebrae MASTOID FUNCTION: Bilateral: extension of the spine Unilateral: ipsilateral lateral flexion and rotation of the head and cervical spine  MUSCLES OF THE NECK STERNOCLEIDOMASTOID Origins: Sternum & Clavicle Insertion: Mastoid Process Sagittal View FUNCTIONS: Bilateral: extension of the head/neck; flexion of the neck (inferior cervical vertebrae - sternal head) Unilateral: contralateral rotation, ipsilateral lateral flexion Gilroy, Anatomy: An Essential Texbook, Copyright © 2013 by Thieme  DEEP MUSCLES OF THE NECK: ANTERIOR ACCESSORY MUSCLES OF RESPIRATION FLEXORS of the HEAD LONGUS CAPITIS & NECK Flexion of the head (attachment points between cervical spine and the skull) LONGUS COLLI ANTERIOR SCALENE Flexion of the cervical Insertion on rib 1 spine (neck) MIDDLE SCALENE (attachment along the Insertion on rib 1 cervical spine anteriorly) POSTERIOR SCALENE Insertion rib 2 Gilroy, Anatomy: An Essential Texbook, Copyright © 2013 by Thieme  EXTRINSIC MUSCLES: FIRST LAYER (Superficial) TRAPEZIUS Origin: posterior skull and cervical and thoracic vertebrae Insertion: clavicle, acromion and spine of the scapula. FUNCTION(s): fiber group dependent (1) Elevation of scapula – upper fibers (2) Retraction of the scapula – middle fibers (3) Upward rotation of the scapula during abduction of the arm, depression of scapula – lower fibers Superior View Lateral Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme Martini, Timmons & Tallitsch: Human Anatomy, Eighth Edition. Copyright © 2013 by Pearson Education Inc.  EXTRINSIC MUSCLES: FIRST LAYER (Superficial) LATISSIMUS DORSI Origin: lower thoracic and lumbar vertebrae, the sacrum & iliac crest Insertion: floor of the intertubercular groove of humerus. FUNCTION(s): Extension, adduction and medial (internal) rotation of the arm at the glenohumeral joint Intertubercular Groove of the Humerus Lateral Medial L Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  EXTRINSIC MUSCLES: SECOND LAYER (Superficial) LEVATOR SCAPULAE Origin: cervical spine Posterior Shoulder Insertion: superomedial border of the scapula. Levator Scapula FUNCTION(s): M Elevation of the scapula in or M ajo RHOMBOID MAJOR & MINOR r Origin: cervical and thoracic spine Insertion: medial border of the scapula. FUNCTION(s): Retraction (adduction) of scapula Moore: Clinically Oriented Anatomy, 7th Edition. Copyright © 2014 by Lippincott Williams & Wilkins All contribute to downward rotation of the scapula! Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme EXTRINSIC MUSCLES: THIRD LAYER (Superficial) ACCESSORY MUSCLES OF RESPIRATION * SP = spinous process SERRATUS POSTERIOR SUPERIOR Origin: SPs of lower cervical to upper thoracic spine Insertion: first 4 ribs Function: Elevation of the ribs SERRATUS POSTERIOR INFERIOR Origin: SPs of lower thoracic vertebrae Insertion: ribs 9-12 Function: Depression of lower ribs  MUSCLES OF THE SHOULDER: ANTERIOR PECTORALIS MAJOR Origin: Clavicular and sternal heads Insertion: Lateral lip of the intertubercular groove. FUNCTION(S): Glenohumeral flexion, medial (internal) rotation and adduction of the arm Intertubercular Groove of the Humerus P Lateral Medial Medial (internal) rotation Lateral Medial Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  MUSCLES OF THE SHOULDER: ANTERIOR Clavicle Coracoid Process SUBCLAVIUS Origin: first rib (costal cartilage) Insertion: clavicle (inferior surface). FUNCTION(s): Depression of the clavicle PECTORALIS MINOR Origin: ribs 3-5 Insertion: coracoid process of the scapula. FUNCTION(s): Depression of the scapula Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  MUSCLES OF THE SHOULDER: LATERAL SERRATUS ANTERIOR Origin: lateral borders of the ribs Insertion: anteromedial border of the scapula FUNCTION(s): Protraction of the Scapula Insertion Anterior View Summary Video Of Anterior and Lateral Shoulder Muscles: Sagittal View https://www.youtube.com/watch?v=NCZJNZCyqAw Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  MUSCLES OF THE SHOULDER: LATERAL Posterior Anterior Fibers DELTOID Fibers Origin: clavicle, acromion and spine of the scapula Insertion: deltoid tuberosity on the humerus. Middle Fibers FUNCTION(s): fiber group dependent (1) Glenohumeral flexion (anterior fibers) (2) Glenohumeral abduction (middle fibers) Delta (3) Glenohumeral extension and lateral (external) rotation (posterior fibers) Superior View Lateral Sagittal View Martini, Timmons & Tallitsch: Human Anatomy, Eighth Edition. Copyright © 2013 by Pearson Education Inc. Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  MUSCLES OF THE ROTATOR CUFF Anterior View SUBSCAPULARIS Origin: subscapular fossa Insertion: lesser tubercle of the humerus. FUNCTION(S): Medial (internal) rotation of the glenohumeral joint Common function: S Create a cuff around I S the glenohumeral joint to stabilize the t joint Medial (internal) rotation Sagittal View Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  MUSCLES OF THE ROTATOR CUFF SUPRASPINATUS Origin: supraspinous fossa Insertion: greater tubercle of the humerus FUNCTION(s): Initiation of arm abduction at the glenohumeral joint (~30 degrees). Sagittal View Acromion Posterior View S I S t Acromion Superior View Subacromial posterior anterior Subdeltoid Bursa Bursa Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  Posterior View MUSCLES OF THE ROTATOR CUFF S INFRASPINATUS I Origin: infraspinous fossa Insertion: greater tubercle of the humerus t FUNCTION(s): Lateral (external) rotation of the arm at the Lateral glenohumeral joint (external) rotation TERES MINOR S Origin: lateral scapular border (superior) I S Insertion: greater tubercle of the humerus I t t FUNCTION(s): Lateral (external) rotation of the arm at the glenohumeral joint Sagittal View Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  SUMMARY: THE ROTATOR CUFF Subscapularis on Lesser Tubercle Known as the “S I t S” muscles S.I.T. Insertion on Greater Tubercle Supraspinatus Infraspinatus teres minor (small “t” because minor, not major) S Subscapularis (only muscle located on the anterior scapula) I S t Common function: Create a cuff around the glenohumeral joint to stabilize the joint Summary Video of the Rotator Cuff Muscles https://www.youtube.com/watch?v=qj87kCy5HOk Sagittal View Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme  MUSCLES OF THE SHOULDER: POSTERIOR TERES MAJOR Origin: lateral scapular border (inferior) Insertion: medial lip of the intertubercular groove on the humerus. FUNCTION(s): IN O R M Extension, adduction and medial (internal) rotation of the arm at the glenohumeral joint Intertubercular Groove of the Humerus Teres Major Teres PLT Minor Lateral P L T Medial ** A MISS between two MAJORS ** P = Pectoralis major L = Latissimus Dorsi T = Teres major Gilroy, Anatomy: An Essential Textbook, Copyright © 2013 by Thieme MUSCULAR COMPARTMENTS OF THE ARM ANTERIOR POSTERIOR COMPARTMENT OF COMPARTMENT OF THE THE ARM ARM Flexor Compartment Extensor Compartment “flexion of the forearm at “extension of the the elbow” forearm at the elbow” Biceps Brachii Triceps Brachii (long and short heads) (medial, lateral and long heads) Coracobrachialis, Brachialis  THE ARM: ANTERIOR COMPARTMENT Term Break-down → BI = two, CEPS = heads BICEPS BRACHII Long Head Origins: Long Head - supraglenoid tubercle of scapula Short Head – coracoid process Short Head Insertion: Radial tuberosity FUNCTION: PRIMARY = Supination of forearm Flexion of the elbow joint, accessory flexor of GH joint, Bicipital Anterior View Aponeurosis Gilroy, Anatomy: An Essential Texbook, Copyright © 2013 by Thieme  Supination vs. Pronation Supination Pronation Axis of Rotation Radial Tuberosity In the pronated position, the tendon of the biceps brachii muscle is turned posteriorly - thus impeding on the function of the biceps brachii Radius muscle at the Radius elbow Ulna Lateral Lateral Medial Medial Moore: Clinically Oriented Anatomy, 7th Edition. Gilroy, Anatomy: An Essential Texbook, Copyright © 2013 by Thieme Copyright © 2014 by Lippincott Williams & Wilkins  THE ARM: ANTERIOR COMPARTMENT CORACOBRACHIALIS Origin: coracoid process Insertion: anterior humerus (shaft). FUNCTION(s): Flexion of the arm (at the glenohumeral joint) Anterior View BRACHIALIS Origin: anterior shaft of the humerus Insertion: ulnar tuberosity FUNCTION(s): Flexion of the forearm (at the elbow joint) Radius Ulna Gilroy, Anatomy: An Essential Texbook, Copyright © 2013 by Thieme  EXCEPTION TO ARM COMPARTMENTS BRACHIORADIALIS Stretches across the elbow joint – from the lateral supracondylar ridge of the humerus to the styloid process of the radius FUNCTION(s): Flexion of forearm at the elbow Tested In Neutral Position: Sagittal View Posterior View Gilroy, Anatomy: An Essential Texbook, Copyright © 2013 by Thieme  THE ARM: POSTERIOR COMPARTMENT TRICEPS BRACHII Origins: Long head = infraglenoid tubercle of the Long scapula head Lateral & Medial Heads = (cut) posterior shaft of humerus MEDIAL HEAD Insertion: Olecranon of the Ulna LONG HEAD FUNCTION(s): LATERAL HEAD Extension of the MEDIAL HEAD LATERAL HEAD elbow joint Olecranon Superficial View Deep View Gilroy, Anatomy: An Essential Texbook, Copyright © 2013 by Thieme  Log into iClicker and join today’s session! LECTURE FIFTEEN THE MUSCULAR SYSTEM – II © Dr. Nicole M. Ventura, PhD. © All slides are property of Dr Ventura. Instructor Assistant Professor, Teaching Stream generated course materials are protected by law and may not be copied or distributed in any form or in any School of Kinesiology & Health Sciences medium without explicit permission of Dr Ventura and/or 3rd party (published texts) where applicable. Faculty of Health, York University Multiple Choice Question - iClicker In the image below, the therapist is applying weight to the ankles of the patient to allow them to carry out the exercise you see below. The patient begins by hanging their torso off the edge of the assessment table and is asked to raise their head and chest as high as they can (movement in direction of the red arrow). What muscle(s) would primarily be involved in allowing the patient to carry out this movement? A. Latissimus dorsi Therapist B. Erector spinae Patient C. Trapezius D. Serratus posterior superior & inferior Multiple Choice Question - iClicker The clinician in the image is performing the “Lift Off” test to assess range of motion and or muscle strength. The clinician asks the patient to place their hand behind their back (as demonstrated in image A). The clinician then asks the patient to to attempt to move the dorsal surface of their hand as far away from their back as possible (as shown in image B). Which of the following muscles is the clinician testing by conducting the “Lift Off” test? A. Triceps brachii B. Subscapularis C. Teres minor D. Serratus anterior LEARNING OBJECTIVES Identify and describe the major origin(s), insertion(s), and function(s) of the muscles that comprise the anterior and posterior compartments of the forearm. Identify the carpal tunnel and describe the contents of the tunnel. Identify the surface anatomy of the hand. Identify and describe the function(s) of the muscles that comprise the various compartments/regions of the hand. Identify the location and borders of the anatomical snuff box. MUSCULAR COMPARTMENTS OF THE FOREARM ANTERIOR POSTERIOR COMPARTMENT OF COMPARTMENT OF THE THE FOREARM FOREARM “Flexor Compartment" “Extensor Compartment” Pronators of the forearm Supinators of the forearm Flexors of the wrist Extensors of the wrist Flexors of the digits Extensors of the digits  THE FOREARM: ANTERIOR COMPARTMENT Superficial Layer (4) COMMON ORIGIN **Medial Epicondyle** PRONATOR TERES PALMARIS LONGUS Insertion: radius Insertion: Palmar aponeurosis Function: Weak wrist flexion Function: pronation of forearm FLEXOR CARPI ULNARIS Insertion: Pisiform, hamate metacarpal V FLEXOR CARPI RADIALIS Function: Flexion & adduction (ulnar Insertion: Metacarpals II & III deviation) of the hand at the wrist Function: Flexion & abduction (radial deviation) of the hand at the wrist Lateral Palmar Aponeurosis