Term 1 Anatomy - Lower Limb (16) PDF

Summary

This document provides an introduction to basic human anatomy, focusing on the terminology used to describe body parts, their orientations, and movement. Includes explanations of prefixes and suffixes for anatomical terms, different types of joints, and movement descriptions. Primarily aimed at secondary school students.

Full Transcript

Term 1 Anatomy The lower and upper limb Anatomical prefixes Arthr/o: Joint Bi-: Two Brachi/o: Arm Caud/o: Tail Cephal/o: Head Chondr/o: Cartilage Circum-: Around Epi: Above, upon Faci/o: Face Fasci/o: Fascia Anatomical prefixes cont. H...

Term 1 Anatomy The lower and upper limb Anatomical prefixes Arthr/o: Joint Bi-: Two Brachi/o: Arm Caud/o: Tail Cephal/o: Head Chondr/o: Cartilage Circum-: Around Epi: Above, upon Faci/o: Face Fasci/o: Fascia Anatomical prefixes cont. Hyper-: Excessive, above normal Hypo-: Below, under, deficient Infer/o: Lower, below Infra-: Below, under Inter-: Between Intra-: In, within Iso-: Same, equal Metr/o: Measure My/o: Muscle Nas/o: Nose Anatomical prefixes cont. Neur/o: Nerve Ocul/o: Eye Oste/o: Bone Per-: Through Peri: Around Poly-: Many, much Spondyl/o: Vertebrae Sub-: Under, below Super/o: Upper, above Supra-: Above, excessive, superior Trans-: Across, through Tri-: Three Uni-: One Anatomical suffixes -ceps: Head -itis: Inflammation -ology: The study of -oid: Resembling Anatomical Studies Anatomical Terminology osteology – the study of bones arthrology – the study of joints myology – the study of muscles and muscle tissue neurology – the study of nerves Anatomical Position This is the point of reference for movement (so when movements are described, they are in relation to this standard position) standing feet parallel arms hanging at the sides, palms forward, fingers pointing straight at the floor face directed forwards Anatomical position Directional Terminology (regardless of standing or lying down, these terms don’t change) superior (cranial) (abbr. sup.) – refers to a structure that is closer to the head or higher than another structure Example: the nose is superior to the mouth inferior (caudal) (abbr. inf.) – refers to a structure that is closer to the feet or the lower part of the body than another structure Example: the wrist is inferior to the elbow Directional terminology cont. anterior (ventral, palmar, volar) (abbr. ant.) – refers to a structure that is more ‘in front’ than another structure Example: the abdomen is anterior to the spine posterior (dorsal/dorsum) (abbr. post.) – refers to a structure that is more ‘in back’ than another structure Example: the heart is posterior to the breastbone Directional terminology cont. medial – refers to a structure that is closer to the mid-sagittal plane than another structure Example: the breastbone is medial to the shoulder lateral – refers to a structure that is farther away from the mid-sagittal plane than another structure Example: the eye is lateral to the bridge of the nose Directional Terminology Cont. proximal – it refers to a structure that is closest to its source – primarily used in reference to the limbs (it refers to a structure that is closer to the root of the limb than another structure in the limb) Example: the wrist is proximal to the fingers distal – it refers to a structure that is farther away from its source – primarily used in reference to the limbs (it refers to a structure that is farther away from the root of the limb than another structure in the limb) Example: the knee is distal to the thigh Directional Terminology Cont. superficial – refers to a structure that is closer to the surface of the body Example: the skin is superficial to the muscles deep – refers to a structure that is farther from the surface of the body Example: the lungs are deep to the ribs Directional Terminology Cont. ipsilateral – refers to the same side as the reference point Example: a dysfunctional spleen (an organ on the left side of your abdomen) can refer pain to the left shoulder – it could be said that the spleen refers to the ipsilateral shoulder contralateral – refers to the opposite side as the reference point Example: to stretch the right side of your neck, you move your head to the left – you would move your head to the contralateral side Introduction to Osteology Structures that muscles attach to: tubercle – a small rounded projection/process/eminence tuberosity – a large rounded projection/process/eminence trochanter – a very large, blunt, irregularly shaped process (the only examples are on the femur) crest – a narrow ridge (of bone) line – a narrow ridge of bone, less prominent than a crest spine – a sharp, slender, often pointed projection epicondyle – a raised area on or above a condyle ramus (‘a branch’) – an arm-like bar of bone body – the principle mass of a structure Structures that help form joints Definitions: articulation – location at which 2 or more bones make contact condyle – a rounded articular projection head – a bony expansion carried on a narrow neck facet – a smooth, nearly flat articular surface Structures that allow things (Muscles, nerves, blood vessels…) to pass through: Meatus - a canal-like passageway Sinus - a cavity within a bone, filled with air and lined with mucus membrane Fossa - a shallow depression or hollow generally in a bone Groove - a furrow Fissure - a narrow, slit-like opening Foramen - a round/oval opening through a bone Notch - an indentation Movement terminology: Planes Definition: A plane is an imaginary line ALONG which a movement takes place. 1) mid-sagittal (median) plane runs vertically in an anterior/posterior direction divides the body equally into right and left portions any plane that is parallel to the mid-sagittal plane is called a sagittal plane The sagittal plane Movement terminology cont. 2) frontal/coronal runs vertically in a medial/lateral direction divides the part of the body into anterior and posterior portions The frontal/coronal plane Movement terminology cont. 3) transverse/horizontal runs horizontally divides the part of the body into superior and inferior portions The transverse/horizontal plane Planes of the body combined Movement terminology: Axis Definition: An imaginary line AROUND which a movement takes place. 1) vertical (longitudinal) axis an imaginary line around which movements occur in the horizontal plane The vertical/longitudinal axis Movement terminology cont. 2) medial-lateral (M-L) axis an imaginary line around which movements occur in the sagittal/mid-sagittal plane Movement terminology cont. 3) anterior-posterior (A-P) axis an imaginary line around which movements occur in the frontal plane Movement terminology: Planes and axis combined Movement summary Movements in the sagittal plane happen around a medial - lateral axis. Movements in the coronal/frontal plane happen around an anterior - posterior axis. Movements in the transverse plane happen around a vertical axis. Movement terminology cont. MOTIONS: movements happen at joints (the connection between 2 (or more) bones) actions can be referenced by the movement at the joint OR by the part of the body that is moving movements don’t change if the person is standing, lying supine or prone WHEN IN DOUBT, REFERENCE ANATOMICAL POSITION… Movement terminology 1) Flexion (abbr. fl.) definition #1: a movement along the sagittal plane around a medial - lateral axis that moves the part of the body anteriorly from anatomical position the lower limb is different in that the movement is posteriorly from anatomical position (from the knee down) definition #2: a movement in the sagittal plane around a medial-lateral axis that bends the joint or decreases the angle between body parts (e.g. flexion at the elbow) Movement terminology cont. 2) Extension (abbr. ext.) definition #1: a movement along the sagittal plane around a medial-lateral axis that moves the part of the body posteriorly from anatomical position – the above noted lower limb exceptions apply definition #2: a movement along the sagittal plane around a medial-lateral axis that straightens the joint or increases the angle between body parts (e.g. extension at the knee) Shoulder flexion and extension Hip flexion and knee extension Movement terminology cont. 3) Abduction (abbr. abd.) A movement along the frontal plane around an anterior-posterior axis that moves the body part away from the median plane (e.g. abduction of the arm) horizontal abduction: abduction from a flexed position abduction of the limb does not change to adduction as the limb travels through the range Shoulder abduction Movement terminology cont. 4) Adduction (abbr. add.) is a movement along the frontal plane around an anterior-posterior axis that moves the body part towards the median plane (e.g. adduction of the arm) horizontal adduction: adduction from a flexed position Shoulder adduction Horizontal abduction & adduction of the shoulder Movement terminology cont. 5) Inversion is a movement along the coronal/frontal plane around an anterior-posterior axis that moves the body part inwards/towards the median/midsagittal plane reference the sole of the foot Movement terminology cont. 6) Eversion is a movement along the coronal/frontal plane around an anterior-posterior axis that moves the body part outwards/away from the median/midsagittal plane reference the sole of the foot Inversion & Eversion of the foot/ankle Movement terminology cont. 5) External rotation (lateral rotation) (abbr. ER) is a movement along the transverse plane around a vertical axis that moves the body part outwards (e.g. lateral rotation at the shoulder) this could also be referred to as lateral rotation of the arm Shoulder lateral/external rotation Movement terminology cont. 6) Internal rotation (medial rotation) (abbr. IR) is a movement along the transverse plane around a vertical axis that moves the body part inwards (e.g. medial rotation of the arm) recall that movements can also reference the segment moving (e.g. rotation of the tibia) Shoulder internal/medial rotation Knee medial/internal rotation Movement terminology cont. 7) rotation of the spine is a movement along the transverse plane around a vertical axis direction must be further clarified by ‘left’ or ‘right’ when discussing rotation of the spine, it is the front of the spine (vertebral body) that is the point of reference Rotation of the spine Movement terminology cont. 8) pronation, supination rotational movements in the forearm and foot (explained later) 9) circumduction a combination movement Supination and pronation of the forearm Supination Pronation Movement summary sagittal plane/medial-lateral axis: flexion, extension frontal plane/anterior-posterior axis: abduction, adduction, inversion and eversion transverse plane/vertical axis: rotation, pronation/supination and horizontal abduction/adduction Introduction to arthrology joints (or articulations) are formed where 2 (or more) separate bones connect joints are designed for movement the amount of movement depends on the type of joint Introduction to arthrology cont. uniaxial: one axis of movement biaxial: two axes of movement multiaxial: multiple axes of movement Classifications of joints 1) Fibrous the joint is connected by fibrous tissue the degree of movement at a given joint is determined by the amount of fibrous tissue between the two joint surfaces (or the articulating surfaces) Plate: 16 Fibrous joints cont. (A) sutures only occur in the skull limited movement Plate: 429 Fibrous joints cont. (B) syndesmosis bones are connected by a sheet of fibrous tissue e.g. forearm bones – lots of space between the bones therefore lots of movement Plate: 192, 162 & 334 - Cartilagenous joints (2) Cartilagenous the joint is connected by cartilage or a combination of cartilage and fibrous tissue e.g. cartilage connects the ribs to the breastbone e.g. the vertebrae are connected by fibrocartilagenous intervertebral discs e.g. the pubic symphysis Synovial joints (3) Synovial most common joint type synovial joints have 3 features Synovial joint features (1) a joint cavity space between the 2 joint surfaces (2) articular cartilage shiny, whitish connective tissue protects underlying bone designed to absorb shock (joint forces), allow movement (smooth surface), and to last (very tough) (it can still be damaged/wear away over time) no nerves, no blood vessels usually hyaline cartilage Synovial joint features cont. (3) a joint capsule surrounds and lines the joint does not cover the articular cartilage makes the synovial fluid contained within the joint (synovial fluid has the consistency of egg-white, is clear coloured and is 5x more slippery than ice) friction between the 2 joint surfaces is minimized by lubrication from the synovial fluid and by the articular cartilage Synovial joint Types of synovial joints There are 6 types of synovial joints: (1) condyloid ( meaning knuckle-like) (ellipsoid) biaxial flexion/extension and abduction/adduction (and circumduction) e.g. knuckles Condyloid joints Synovial joints cont. (2) saddle Biaxial opposing surfaces are shaped like saddles concave and convex articulate with each other e.g. thumb Saddle joints Synovial joints cont. (3) ball and socket Multiaxial spheroidal surface articulates with socket of other surface e.g. hip Ball and socket joints Synovial joints cont. (4) plane gliding or sliding movements joint surfaces are flat or almost flat most are uniaxial e.g. acromioclavicular joint Plane joints Synovial joints cont. (5) pivot uniaxial rotation a rounded process rotates within a sleeve or ring e.g. C1-C2 Pivot joints Synovial joints cont. (6) hinge (ginglymus) uniaxial flexion and extension only e.g. humeroulnar joint Hinge joints Plate: 502 Bursa (a greek word for ‘a wine skin’) (pl. bursae) sacs filled with synovial fluid that decrease the friction generated by the motion of one tissue over another normal bursa are flat (the synovial layer is ~ 1 capillary thick) but when inflamed, they can be as big as an egg) Located between: tendons and bony prominences tendons and other tendons bone and overlying skin Plate: 500 Ligaments (abbr. lig.) ligaments connect bone to bone ligaments will check a movement – in other words, prevent excessive movement in a specified direction movement at a joint is normal – but excessive movement at a joint is potentially dangerous/can cause injury Joint positions close-packed position the ligaments and joint capsule are tight the joint has maximal articular surface contact Increase in stability - decrease in mobility loose-packed position the ligaments and joint capsule are loose the joint has maximal space and available movement Increase in mobility - decrease in stability Introduction to myology muscles move the various parts of the body either by making the part move or by allowing it to move tendons connect muscles to bone the connection between a muscle and a tendon is called the musculotendinous junction (MTJ) the connection between a tendon and a bone is called the tendoperiosteal junction (TPJ) the belly is the central portion of the muscle (the meat of it) head: one of at least 2 extensions of a particular muscle belly that attaches via its own tendon Aponeurosis: A sheet-like tendon Introduction to myology cont. Muscle contraction types CONCENTRIC CONTRACTION when a muscle develops tension, it pulls on the attachments of the muscle when the tension is greater than the resistance, the muscle undergoes a shortening or concentric contraction a concentric contraction pulls the two attachments closer together ISOMETRIC CONTRACTION when a muscle contracts against a resistance and there is no visible change in the muscle length (its attachments are NOT drawn together or pulled apart), it is called an isometric contraction (isometric: equal measure) Muscle contraction types cont. ECCENTRIC CONTRACTION when a muscle is generating force but is unable to overcome the force, the muscle will undergo a lengthening or eccentric contraction this type of contraction is effectively used to control movements or to act as a brake to movement in this type of action, the two muscle attachments are moving away from each other Muscle attachment reference to move something, one muscle attachment is usually fixed in position and the other muscle attachment is the one that moves the attachment that is fixed is sometimes called the origin the attachment that is moving is sometimes called the insertion this terminology can be confusing as the fixed-moving attachments can change in general, the proximal attachment is assumed to be the fixed attachment and a contraction is assumed to be concentric unless otherwise stated proximal/distal, superior/inferior, medial/lateral, anterior/posterior terminology can be used to reference to an attachment Origin vs Insertion Muscle functions Prime Mover (a.k.a. the agonist) the primary muscle causing the desired movement example: quadriceps is the prime mover for knee extension there can be more than one prime mover example: hamstrings for flexion of the knee (as compared to the involvement of gastrocnemius) Muscle functions cont. Antagonist the muscle that opposes a specific action example: hamstrings perform knee flexion and are therefore the antagonists to the quadriceps which perform knee extension (the hamstrings are the antagonists to the quadriceps) Muscle functions cont. Stabilizers (a.k.a. fixators) the muscles that stabilize the more proximal joints during actions of the more distal joints example: the low back muscles stabilize the trunk so that the hip flexors can lift the leg (not flex the trunk) Muscle functions cont. Synergists (a.k.a. neutralizers, neutralizing synergists) the muscle(s) that works to assist the prime mover in a given action Example: there are big calf muscles that point the toes - there are small ones that have this ability too and contribute in a weaker way What is the strongest muscle in the human body? Fun facts to follow... THE LOWER LIMB Ankle/Foot Tibia Fibula Patella Femur Hip ‘hip’ – the area between the greater trochanter and the iliac crest thigh – the area between the greater trochanter and the knee leg – the segment of the inferior limb between the knee and the ankle (commonly used to mean the entire lower limb) The bones of the foot - Plates: 515, 516 & 517 We have a total of 26 bones There are 3 sections: tarsal bones (7) metatarsal bones (5) phalanges (14) A phalanx is an ancient Greek military unit that consisted of ranks and files (lines) of soldiers in close array with joined shields and long spears Bones of the foot cont. - Plates: 515, 516 & 517 Terminology dorsal surface = top of the foot (where your shoe laces are) (a.k.a. posterior) plantar surface = sole of the foot (the part you walk on) (a.k.a. anterior) Tarsal bones (1 of 7) - Plates: 515, 516 & 517 Talus most proximal bone of the foot the top of the talus is called the trochlea a.k.a. the dome of the talus the medial aspect of the talus is the facet for the medial malleolus the lateral aspect of the talus is the facet for the lateral malleolus the dome is slightly convex from anterior to posterior the body of the talus is the posterior portion of the bone the head is the most anterior portion the neck is the narrowing between the body and the head Tarsal bones (2 of 7) - Plates: 515, 516 & 517 Calcaneus (‘heel bone’) largest and strongest of the foot bones tuberosity of the calcaneus (this part contacts the ground) medial tubercle (process) and lateral tubercle (process) sustentaculum tali (sustains the talus) - a medially projecting ‘shelf’ of the calcaneus that supports part of the talus (only the back part of the head) fibular (peroneal) trochlea (tubercle) - a small tubercle anterior and inferior to the tip of the lateral malleolus sinus tarsi (aka tarsal sinus) - a hollow on the lateral aspect of the foot formed by the groove of the talus and the groove of the calcaneus note the groove for flexor hallucis longus Tarsal bones (3 of 7) - Plates: 515 & 516 Navicular medial aspect of the foot navicular tuberosity (palpable on the medial side) articulates posteriorly with the talus articulates anteriorly with the 3 cuneiforms Tarsal bones (4, 5, 6 of 7) - Plates: 515 & 516 Cuneiforms (cunei = wedge-shaped) 1st, 2nd, 3rd OR medial, intermediate, lateral They articulate with the numerically corresponding metatarsal Tarsal bones (7 of 7) - Plates: 515 & 516 Cuboid lateral aspect of the foot note the groove for the peroneus longus tendon articulates anteriorly with the 4th and 5th metatarsals articulates posteriorly with the calcaneus Bones of the foot cont. - Plates: 515 & 516 Metatarsals 1st – 5th (numbered from the “big toe” moving laterally) base (proximal end) shaft head (distal end) tuberosity of the 5th (a.k.a styloid process) is located on the lateral side of the base 1st MT - 2 sesamoid bones (Sesamoid= a bone embedded in a tendon) (the distal plantar surface of the head has two small grooves for them) other MTs may or may not have them Bones of the foot cont. - Plates: 515 & 516 Phalanges (toes) total 14 base (proximal end) head (distal end) 3 bones per toe except the 1st (only 2) New movement terminology hindfoot: talus and calcaneus midfoot: navicular, cuboid & 3 cuneiforms forefoot: 5 MTs and 14 phalanges ball of the foot: the padded portion of the sole of the foot at the metatarsal heads (the contact point when you stand on your toes) New movement terminology cont. dorsiflexion: the dorsal surface of the foot moves superiorly (foot up) (sagittal plane, M-L axis) plantar flexion: the plantar surface of the foot moves inferiorly (point your toes) (sagittal plane, M-L axis) inversion: movement of the sole of the foot towards the midsagittal plane (frontal plane, A-P axis) eversion: movement of the sole of the foot away from the midsagittal plane (frontal plane, A-P axis) New movement terminology cont. abduction (of the forefoot): movement of the forefoot away from the midline of the body (transverse plane, vertical axis) adduction (of the forefoot): movement of the forefoot towards the midline of the body (transverse plane, vertical axis) pronation: a combination movement of dorsiflexion, eversion, forefoot abduction supination: a combination movement of plantar flexion, inversion, forefoot adduction The tibia and fibula - Plate: 504 & 505 Tibia shin bone primary weight bearing bone of the leg (recall ‘leg’) Fibula (‘skewer’ also ‘clasp’ or ‘brooch’) carries ~1/6th body weight (previously thought to be non-weight bearing) Fibula - Anterior view - Plate: 504 & 505 apex (a.k.a. styloid process) head neck shaft (not listed in Netter) interosseous border lateral malleolus (little hammer) – this is the lateral projection of your ankle Tibia - Anterior view Plate: 504 & 505 lateral condyle (part of the tibial plateau) intercondylar eminence (with medial and lateral intercondylar tubercles) medial condyle (part of the tibial plateau) the medial and lateral condyles articulate with the femoral condyles Gerdy’s tubercle aka the lateral tibial tubercle – a large prominence lateral and superior to the tibial tuberosity Tibia - Anterior view cont. Plate: 504 & 505 shaft (not listed in Netter) interosseous border medial malleolus (normally lies anterior and superior to the lateral malleolus) Tibia - Posterior view Plate: 504 lateral condyle intercondylar eminence medial condyle shaft (not listed in Netter) interosseous border medial malleolus soleal line The Proximal Tibiofibular Joint - Plate: 500, 504 & 505 The head of the fibula articulates with the lateral condyle of the tibia there is a flat oval/circular facet on the fibular head which articulates with a similar facet on the tibia synovial plane AVAILABLE MOVEMENTS limited superior and posterior glide (with dorsiflexion) limited inferior and anterior glide (with plantar flexion) Ligaments at the proximal tibiofibular joint - Plate: 505 Anterior ligament of the fibular head attaches: anterior proximal tibia ⬄ anterior proximal fibula Posterior ligament of the fibular head attaches: posterior proximal tibia ⬄ posterior proximal fibula The distal tibiofibular joint - Plate: 505 the distal end of the fibula articulates with the distal end of the tibia fibrous strong connective tissue between the tibia and the fibula which thickens at the distal end - the interosseous membrane anterior tibiofibular ligament attaches: anterior distal tibia ⬄ anterior distal fibula posterior tibiofibular ligament attaches: posterior distal tibia ⬄ posterior distal fibula The Talocrural joint - Plate: the distal ends of the tibia and fibula articulate with the trochlea (dome) of the talus synovial hinge AVAILABLE MOVEMENTS dorsiflexion plantar flexion note: during dorsiflexion, the talus forces the tibia and fibula apart which affects the proximal and distal tibiofibular joints Ligaments of the ankle - Plate: 518 The deltoid ligament four ligaments (anterior tibiotalar, tibionavicular, tibiocalcaneal, posterior tibiotalar) attaches: medial malleolus ⬄ tarsal bones of the medial foot checks: eversion of the ankle very strong ligament and focused attachment point on the medial malleolus can lead to an avulsion fracture Ligaments of the ankle cont - Plate: 518 The anterior talofibular ligament (ATFL) attaches: lateral malleolus ⬄ neck of the talus checks/restricts: inversion (especially when the ankle is plantar flexed) palpated through the sinus tarsi most commonly injured ligament in the foot (95% of ankle sprains) Ligaments of the ankle cont - Plate: 518 The calcaneofibular ligament attaches: lateral malleolus ⬄ lateral calcaneus checks: inversion (when the ankle is in neutral) Bursa of the heel - Plate: 520 Subcutaneous calcaneal (a.k.a. retrocalcaneal) between the Achilles tendon and the overlying skin Subtendinous calcaneal between the Achilles tendon and the calcaneus The subtalar joint - Plate: 515, 516, 517 & 518 The inferior aspect of the talus articulates with the superior calcaneus synovial plane AVAILABLE MOVEMENTS inversion eversion The talocalcaneonavicular joint - Plate: 515, 516, 517 & 518 the articulation between the talus the calcaneus and the navicular technically the head of the talus (the ball) articulates with the pocket formed by the posterior surface of the navicular, the superior surface of the spring ligament, the sustentaculum tali and the articular surface of the calcaneus (the socket) synovial ball and socket helps increase the inversion/eversion range Ligaments of the foot & ankle - Plate: 518 & 519 The plantar calcaneonavicular ligament a.k.a. the spring ligament attaches: sustentaculum tali ⬄ posteroinferior surface of the navicular helps maintain the medial longitudinal arch by supporting the head of the talus if this ligament is stretched, the head of the talus can sink resulting in a flat foot (pes planus) The calcaneocuboid joint - Plate: 515 & 516 the articulation between the calcaneus and the cuboid synovial plane The long plantar ligament - Plate: 518 & 519 attaches: plantar surface of the calcaneus ⬄ cuboid and the bases of the 2nd, 3rd, 4th MTs (to form a tunnel for the tendon of peroneus longus) helps maintain the arches of the foot The transverse tarsal joint - Plate: 515 & 516 a.k.a. the midtarsal joint the talocalcaneonavicular joint and the calcaneocuboid joint are sometimes referred to as the transverse (or midtarsal) joint AVAILABLE MOVEMENTS (AT BOTH JOINTS) inversion eversion it helps increase the inversion/eversion range by allowing abduction and adduction of the forefoot The intertarsal, tarsometatarsal & intermetatarsal joints - Plate: 515, 516, 518 & 519 there are many joints (know that they exist) synovial plane little movement is available at the 2nd tarsometatarsal joint AVAILABLE MOVEMENTS limited due to the tight binding by the ligaments the bases of the 2nd through 5th metatarsals are firmly bound by ligaments The metatarsophalangeal joints - Plate: 515 & 519 the heads of the metatarsals articulate with the bases of the proximal phalanges synovial condyloid AVAILABLE MOVEMENTS flexion, extension, abduction, adduction, circumduction Supporting Ligaments collateral ligaments on either side of the joints the plantar surface of the joint capsules are thickened to form the plantar plates The interphalangeal joints (PIPs and DIPs) - Plate: 515 & 519 the head of one phalanx articulates with the base of the phalanx distal to it synovial hinge AVAILABLE MOVEMENTS flexion, extension Supporting ligaments collateral ligaments The arches of the foot the bones of the foot form arches which act as shock absorbers (the arches distribute the stresses through the bones of the foot) They are the… (1) medial longitudinal arch (2) lateral longitudinal arch (3) transverse arch The arches of the foot The arches of the foot cont Arches are maintained (supported) by: (1) the shape of the interlocking bones (2) the ligaments (3) the fascia (25% of the static, weight-bearing foot) (4) the action of the muscles (the muscles don’t actually do much but when there is a problem with the stability of the arch, the muscles try to compensate) The arches of the foot cont Medial Longitudinal Arch bones: calcaneus, talus, navicular, 3 cuneiforms, metatarsals 1-3 this arch does not normally come in contact with the ground more involved in propulsion than weight bearing The arches of the foot cont Lateral Longitudinal Arch bones: calcaneus, cuboid, metatarsals 4, 5 more involved in weight bearing than propulsion The arches of the foot cont Transverse Arch involves the whole length of the foot the anterior portion: head of the 1st MT to the head of the 5th MT the middle portion: cuneiform #1 to cuboid the posterior portion: navicular to cuboid The plantar fascia (or plantar aponeurosis) - Plate: 523 the thick, central fascia (connective tissue) on the sole of the foot attaches: medial calcaneal tubercle ⬄ proximal phalanx of each toe actually continuous with the fascia of the calf The windlass mechanism of the foot as the toes extend (primarily the 1st), the plantar fascia tightens (because it crosses the MTPs) as it tightens, it pulls the calcaneus anteriorly and elevates the arches putting the foot into a position of supination (supination: plantar flexion, inversion, forefoot adduction) this occurs whether the action is active, passive, weight bearing or non- weight bearing The windlass mechanism of the foot cont Plate: 479 The femur - anterior view The longest and heaviest bone in the human body greater trochanter (widest part of the lower limb) Shaft (roughly triangular in cross-sectional shape) lateral epicondyle lateral condyle patellar surface (a.k.a. trochlear groove) Plate: 479 The femur - anterior view cont. medial condyle medial epicondyle adductor tubercle intertrochanteric line lesser trochanter neck fovea (a.k.a. fovea of head, fovea capitis) head (faces medially, superiorly, anteriorly and articulates with the acetabulum of the pelvis) Plate: 479 The femur - posterior view head fovea neck intertrochanteric crest lesser trochanter gluteal tuberosity linea aspera - a rough ridge with two lips (medial and lateral) on the posterior surface of the femur Plate: 479 The femur - posterior view cont. adductor tubercle medial epicondyle medial condyle intercondylar notch (a.k.a. intercondylar fossa) popliteal fossa (a.k.a popliteal surface) body of the femur greater trochanter Plate: 506 & 509 Popliteus superior/proximal attachment: lateral condyle of the femur inferior/distal attachment: posterior proximal surface of the tibia, superior to the soleal line action: flexion of the knee (very weak) action: medial rotation of the knee (key) The Screw Home Mechanism of the knee when the knee is fully extended, the tibia rotates laterally (due to the medial condyle being longer) which locks the knee into a more stable position – this is the screw home mechanism to flex the knee, the popliteus medially rotates the tibia to ‘unlock’ the knee and allow it to flex therefore popliteus is referred to as the “key to the knee” because it “unlocks” the screw home mechanism Compartments of the leg - Plate: 514 The tibia, fibula, interosseous membrane and the intermuscular septa (fascia) (septum: Latin: something that encloses) divide the leg into compartments which are: (1) anterior compartment (2) lateral compartment (3) superficial posterior compartment (4) deep posterior compartment the muscles in a compartment share the same general function, the same nerve supply and the same blood supply The anterior compartment of the leg - Plates: 514, 511 & 506 Tibialis anterior superior/proximal attachment: anterior, lateral, superior ½ of the tibia, interosseous membrane inferior/distal attachment: base of the 1st MT, 1st (medial) cuneiform (plantar surface) action: dorsiflexion action: inversion The anterior compartment cont. - Plates: 514, 506, 511 & 512 Extensor hallucis longus (EHL) superior/proximal attachment: anterior middle fibula and interosseous membrane inferior/distal attachment: base of the distal phalanx of the 1st toe (dorsal surface) action: extension of MTP, IP of 1st digit action: assists in dorsiflexion, inversion The anterior compartment cont. - Plates: 514, 510, 511 & 506 Extensor digitorum longus (EDL) superior/proximal attachment: proximal ¾ of the anterior fibula, interosseous membrane inferior/distal attachment: middle and distal phalanges of lateral 4 toes (dorsal surface) action: dorsiflexion action: eversion action: extension of MTPs, PIPs, DIPs 2nd - 5th digits The anterior compartment cont. - Plates: 506, 510, 511 & 521 Peroneus tertius superior/proximal attachment: anterior distal fibula inferior/distal attachment: base of the 5th MT (dorsal surface) action: dorsiflexion (weak) action: eversion (weak) Tendon palpation, Tendon sheaths & The retinacula - Plates: 511 & 521 note the tendons: from medial to lateral, you will palpate TA, EHL, EDL note the superior extensor retinaculum and the inferior extensor retinaculum the retinacula prevent the tendons from bowing as the muscles contract retinacula: Latin: hold back (to retain) where there is the possibility of friction between the tendons and the retinacula, there is a tendon sheath which surrounds the tendon connective tissue outer layer for structure and protection with a synovial inner layer for lubrication (as the tendon moves) The lateral compartment of the leg - Plates: 506, 510, 514 & 520 Peroneus longus superior/proximal attachment: lateral proximal 2/3rds of fibula inferior/distal attachment: base of the 1st MT, 1st (medial) cuneiform (plantar surface) passes through the tunnel formed by the extensions of the long plantar ligament action: plantar flexion action: eversion forms a stirrup with tibialis anterior at the base of the 1st MT The lateral compartment cont. - Plates: 506, 510, 514 & 520 Peroneus brevis superior/proximal attachment: lateral distal 2/3rds of fibula inferior/distal attachment: tuberosity of the 5th MT action: plantar flexion action: eversion both tendons pass behind the lateral malleolus note the peroneal retinacula and the associated tendon sheaths The superficial posterior compartment of the leg - Plates: 506, 507 & 514 Gastrocnemius superior/proximal attachment: 2 heads attaching to the medial and lateral femoral condyles inferior/distal attachment: calcaneus (via the achilles tendon) action: plantar flexion action: knee flexion (weak) The superficial posterior compartment cont. - Plates: 506, 508 & 514 Soleus superior/proximal attachment: proximal posterior fibula, soleal line (tibia), middle 1/3rd of medial border of tibia inferior/distal attachment: calcaneus (via the achilles tendon) action: plantar flexion gastrocnemius and soleus together are often called the triceps surae (sura: Latin: calf) The superficial posterior compartment cont. - Plates: 506, 507 & 508 Plantaris superior/proximal attachment: distal lateral supracondylar ridge of the femur inferior/distal attachment: calcaneus (NOT via the achilles tendon) action: plantar flexion (weak) action: knee flexion (weak) a weak muscle but if it ruptures (often with injury to the Achilles), there can be significant pain Loose ends Gastrocnemius & soleus, share a common distal tendon called the Achilles tendon which attaches to the calcaneus note: the fascia of the calf is continuous with the plantar aponeurosis The deep posterior compartment of the leg - Plates: 506, 509 & 514 Tibialis posterior superior/proximal attachment: posterior tibia, interosseous membrane, fibula inferior/distal attachment: navicular tuberosity and surrounding bones (cuneiforms, cuboid, bases of 2nd – 4th MTs) action: plantar flexion action: inversion The deep posterior compartment of the leg - Plates: 506, 509 & 514 Flexor hallucis longus (FHL) superior/proximal attachment: lower 2/3rds of posterior fibula, interosseous membrane inferior/distal attachment: plantar surface of 1st distal phalanx action: 1st MTP, 1st IP flexion action: plantar flexion The deep posterior compartment of the leg - Plates: 506, 509 & 514 Flexor digitorum longus (FDL) superior/proximal attachment: posterior middle tibia inferior/distal attachment: plantar surface of distal phalanges of lateral 4 toes action: PIP/DIP, MTP flexion of 2nd – 5th digits action: plantar flexion Loose ends note that these tendons pass behind the medial malleolus note the flexor retinaculum – this forms a tunnel called the tarsal tunnel (clinically relevant) (possible causes of tarsal tunnel syndrome: prolonged eversion/pronation, chronic tendonitis, direct trauma, RA) note the order of the tendons from anterior to posterior (T, D, H or T, D, an H) The intrinsic foot muscles - Plates: 520 & 521 There is only 1 intrinsic foot muscle in the dorsum of the foot: Extensor digitorum brevis superior/proximal attachment: anterior dorsal surface of the calcaneus inferior/distal attachment: medial distal 4 phalanges action: extension of the medial 4 toes 5th is extended by EDL only extensor hallucis brevis and extensor digitorum brevis are essentially the same muscle Muscles in the sole of the foot - Plate: 523 There are 4 muscular layers in the sole of the foot First Layer (the most superficial) there are 3 muscles all attach proximally to the medial process of the calcaneus and plantar aponeurosis deep to the plantar fascia The first layer of the sole of the foot - Plate: 524 Abductor hallucis superior/proximal attachment: medial process of the calcaneus and plantar aponeurosis inferior/distal attachment: medial side of the base of the proximal phalanx of the 1st toe action: abduction of 1st toe The first layer of the sole of the foot - Plate: 524 Flexor digitorum brevis superior/proximal attachment: medial process of the calcaneus and plantar aponeurosis inferior/distal attachment: both sides of middle phalanges of 2nd – 5th toes note how the tendons split to attach to the sides of the phalanx action: flexion of 2nd – 5th toes The first layer of the sole of the foot - Plate: 524 Abductor digiti minimi superior/proximal attachment: medial process of the calcaneus and plantar aponeurosis inferior/distal attachment: lateral side of the base of the proximal phalanx of the 5th toe action: abduction of the 5th toe The second layer of the sole of the foot - Plate: 525 there are 2 muscles in this layer the tendons of FHL and FDL are also in this layer Quadratus plantae superior/proximal attachment: plantar surface of the calcaneus inferior/distal attachment: posterolateral margin of the FDL tendons action: assists FDL in flexion of the lateral 4 digits action: adjusts the pull of the FDL tendons along the long axis of the digits – note the line of pull of FDL and how it would track medially so quadratus plantae helps to keep the vector more linear The second layer of the sole of the foot - Plate: 454 & 525 Lumbricals (Latin: lumbricus: earthworm) superior/proximal attachment: FDL tendons inferior/distal attachment: extensor expansion, and medial sides of proximal phalanges of the lateral 4 toes action: flexion of the MTP joints and extension the PIPs/DIPs The third layer of the sole of the foot - Plate: 526 there are 3 muscles in the anterior ½ of the foot 2 act on the 1st toe, the other on the 5th Flexor hallucis brevis superior/proximal attachment: plantar surface of cuboid and 3rd cuneiform inferior/distal attachment: both sides of the base of the proximal phalanx of the 1st toe there are 2 sesamoid bones – one adhered to each of the 2 tendons – they protect the tendons from pressure during standing and walking action: flexion of the 1st MTP joint The third layer of the sole of the foot - Plate: 526 Adductor hallucis superior/proximal attachment (oblique head): bases of 2nd – 4th metatarsals superior/proximal attachment (transverse head): plantar ligaments of the MTP joints inferior/distal attachment (both heads): lateral side of the base of the proximal phalanx of the 1st toe action: adducts 1st toe also helps maintain transverse arch The third layer of the sole of the foot - Plate: 526 Flexor digiti minimi brevis superior/proximal attachment: base of the 5th metatarsal inferior/distal attachment: base of the proximal phalanx of the 5th toe action: flexion of the 5th MTP joint The fourth layer of the sole of the foot - Plate: 528 (deepest layer) interossei muscles (DAB, PAD) note: when discussing abduction and adduction of the toes, the ‘midline’ (reference point) is through the 2nd toe The fourth layer of the sole of the foot - Plate: 528 Dorsal interossei superior/proximal attachment: adjacent sides of the metatarsals inferior/distal attachment (1st): medial side of the proximal phalanx of the 2nd toe inferior/distal attachment (2nd – 5th): lateral sides of proximal phalanges 2nd – 4th toes action: abduction of 2nd – 4th MTP joints (DAB) moving the digits away from the 2nd toe The fourth layer of the sole of the foot - Plate: 528 Plantar interossei superior/proximal attachment: bases and medial sides of the 3rd – 5th metatarsals inferior/distal attachment: medial sides of the bases of proximal phalanges 3 - 5 action: adduction of the 3rd – 5th MTP joints (PAD) moving the digits towards the 2nd toe The patella (Latin: small plate) 498 a triangle-shaped sesamoid (a bone embedded in a tendon – usually shaped like a sesame seed) bone in the tendon of the quadriceps (most specifically the rectus femoris muscle) Anterior View Base - the flat superior edge Apex - the more pointed inferior edge The patella cont. - Plate: 498 Posterior View vertical ridge medial articular facet lateral articular facet facets articulate with the patellar surface of the femur and the medial and lateral condyles of the femur (depending on where in the range it is) The knee - Tibiofemoral and Patellofemoral joints Plates: 498, 500 & 502 The knee consists of 3 articulations: 1) the lateral condyle of the tibia articulates with the lateral femoral condyle 1) the medial condyle of the tibia articulates with the medial femoral condyle 1) the patella articulates with the femur Available movements at the knee (tibiofemoral joint) flexion extension internal rotation (limited) external rotation (limited) rotation occurs ONLY when the knee is flexed Tibiofemoral joint cont. Plates: 498, 499 & 500 1) the medial and lateral condyles of the tibia articulate with the medial and lateral femoral condyles 1) synovial 1) modified hinge (because it allows for some rotation) 1) biaxial (some consider it uniaxial) The patellofemoral joint Plate: 498 & 502 1) the medial and lateral facets of the patella articulate with the patellar surface of the femur 1) synovial 1) plane 1) the patella moves down (inferiorly) during flexion and up (superiorly and laterally) during extension The patellofemoral joint cont. Plate: 498, 499 & 500 the lateral femoral condyle projects farther (anteriorly) than the medial femoral condyle this more anterior prominence of the lateral femoral condyle prevents the patella from tracking too far laterally Valgus vs Varus New movement terminology Valgus: (go out) lateral deviation of the distal bone(s) of a joint When the knee is fixed and the tibia (specifically the distal end) has deviated laterally (relative to the knee) a.k.a. knock-knee New movement terminology Varus: (return) medial deviation of the distal bone of a joint When the knee is fixed and the tibia (specifically the distal end) has deviated medially (relative to the knee) a.k.a. bow-leg Ligaments of the knee (Collaterals) - Plate: 500 Lateral collateral ligament (fibular collateral ligament) attaches: lateral epicondyle of the femur ⬄ fibular head checks/restricts varus deviation “pencil-like” (making it easier to palpate) Ligaments of the knee (Collaterals) cont. - Plate: 500 Medial collateral ligament (tibial collateral ligament) attaches: medial epicondyle of the femur ⬄ medial condyle of the tibia checks/restricts valgus deviation it is a flat thickening of the joint capsule the deep fibres of the ligament are attached to the medial meniscus Ligaments of the knee (Cruciates) - Plate: 499 & 500 Anterior cruciate ligament attaches: anterior intercondylar area of the tibia ⬄ posterior and medial side of the lateral femoral condyle slack when the knee is flexed and taut when the knee is in full extension checks anterior translation of the tibia on the femur (or posterior translation of the femur on the tibia) and knee extension Ligaments of the knee (Cruciates) - Plate: 499 & 500 Posterior cruciate ligament attaches: posterior intercondylar area of the tibia ⬄ anterior and lateral side of the medial femoral condyle slack when the knee is extended and taut when the knee is in full flexion checks posterior translation of the tibia on the femur (or anterior translation of the femur on the tibia) and knee flexion KEY POINT Cruciate ligaments are named for where they attach on the tibia. (Ie. The anterior cruciate ligament attaches anteriorly on the tibia.) Ligaments of the knee cont. (Coronary) Medial and lateral coronary ligaments Attach the medial and lateral menisci to their respective tibial plateaus (Not captured well in Netter) Ligaments of the knee cont. (Coronary) Menisci of the knee (Sing. Meniscus) (Greek: crescents) Plates: 498, 499, 500 & 502 C-shaped plates of fibrocartilage attached to the articular surfaces of the tibia the centre is thinner than the outer edges they are slightly mobile and aid in the spreading of synovial fluid during knee movement function as shock absorbers function to deepen the articulation (provide a more stable articulation between the tibia and the femur) the ends of the C-shape are called horns the medial meniscus is attached to the medial collateral ligament (MCL) Ligaments of the knee cont. (Transverse) - Plate: 500 the 2 meniscii are connected anteriorly by the transverse ligament of the knee The pelvis (the hip bones, the sacrum, the coccyx) Means ’basin’ Functions to: protect the internal organs transmit forces from the upper body onto the lower limb absorb forces from lower limb (female pelvis is shorter and wider than the male pelvis for carrying and delivering babies) Plate: 162 & 334 The Sacrum the wedge-shaped bone between the 2 hip bones The Coccyx the tailbone (the remnant of the tail human embryos have until the beginning of the 8th week) The Hip 2 hip bones (a.k.a. innominate (’having no name’), coxal bones, os coxa) each hip bone has 3 regions (separated in newborn (connected with cartilage) but fused in early adulthood (~15-20 yrs)) 1) ilium 2) ischium 3) pubis (os pubis, pubic bone) Plate: 476 The pelvis Ilium (pl. ilia) (yellow) large, superior part (2/3rds of the bone) Ischium (pl. ischia) (blue) posterior, inferior Pubis (pl. pubes) (red) anterior, inferior Plate: 476 & 338 Structures in the lateral view anterior gluteal line inferior gluteal line posterior gluteal line posterior superior iliac spine (PSIS) posterior inferior iliac spine (PIIS) greater sciatic notch converted into the greater sciatic foramen by the sacrospinous ligament (338) Structures passing through the foramen: Piriformis Sciatic nerve Posterior femoral cutaneous nerve Plate: 486 Structures in the lateral view cont. body of the ilium ischial spine lesser sciatic notch body of the ischium ischial tuberosity “sitting bone” ramus of the ischium obturator foramen: ⇨ the junction of the ischium-pubis forms the obturator foramen ⇨ partly covered by connective tissue membrane ⇨ this opening allows nerves and blood vessels to pass through (obturator vessels and nerve) Plate 486: Structures in the lateral view cont. inferior pubic ramus pubic tubercles superior pubic ramus acetabulum the junction of the ilium-ischium-pubis forms the acetabulum this is the place where the thigh bone (head of the femur) articulates with the pelvis anterior inferior iliac spine (AIIS) anterior superior iliac spine (ASIS) iliac crest (runs from the ASIS to PSIS) the iliac tubercle (tuberculum) (~5 cm posterior to ASIS) Plate: 486 Structures in the medial view iliac crest anterior superior iliac spine (ASIS) iliac fossa (also PLATE 337 ) anterior inferior iliac spine (AIIS) iliopubic eminence superior pubic ramus pectineal line (pectin pubis) pubic tubercle inferior pubic ramus Plate: 486 Structures in the medial view cont. obturator foramen ramus of the ischium ischial tuberosity body of the ischium ischial spine greater sciatic notch posterior inferior iliac spine (PIIS) auricular (ear) surface of the ilium (for articulation with the sacrum) posterior superior iliac spine (PSIS) iliac crest Plate: 334 & 337 Structures in the anterior view iliac crest anterior superior iliac spine (ASIS) anterior inferior iliac spine (AIIS) iliopubic eminence superior pubic ramus obturator foramen pubic tubercle inferior pubic ramus ischial tuberosity pubic symphysis aka symphysis pubis Plate: 334 & 337 Structures in the anterior view cont. lesser sciatic notch pectineal line ischial spine greater sciatic notch sacrum ⇨ (each ilium articulates with the sacrum or both ilia articulate with the sacrum) ⇨ (ischiopubic rami – combined form of the ramus of the ischium and the inferior pubic ramus) Plate: 265 The inguinal ligament note the ASIS and the pubic tubercle (attachments of) the inguinal ligament: the boundary between the lower limb and the abdomen surface anatomy – the inguinal region is the depression between the abdomen and the thigh – this is technically referred to as the groin The inguinal ligament The hip (coxafemoral joint) head of the femur articulates with the acetabulum synovial multiaxial ball and socket the head of the femur projects medially, superiorly, and anteriorly the acetabulum projects laterally, inferiorly, and anteriorly Available motions at the hip joint flexion extension medial rotation lateral rotation abduction adduction Motions at the hip cont. Plate: 477 The hip joint articular surface of the acetabulum horseshoe shaped articular cartilage covers the head of the femur and the horseshoe shaped part of the acetabulum (remember that articular cartilage is part of a synovial joint) The hip joint cont. 477 Ligament of the head of the femur (a.k.a. ligamentum teres, round ligament, foveal ligament) connects the head of the femur to the acetabulum Acetabular labrum a fibrocartilagenous lip that attaches to the bony rim of the acetabulum functions to deepen the acetabulum (make the ‘socket’ a deeper socket) The hip joint cont. 477 acetabular fossa in the centre of the acetabulum fossa is occupied by a fat pad covered with synovium acetabular notch a notch between the two ends of the horseshoe passage for blood vessels transverse ligament of the acetabulum connects (closes) the acetabular notch The hip joint cont. 477 Ligaments of the hip all of the capsular ligaments of the hip are coiled or twisted as they pass from the pelvis to the femur (in a neutral position) extension/hyperextension tightens them further making extension part of the close-packed position and a position of stability in an upright posture conversely, full hip flexion with abduction is an unstable position Ligaments of the hip cont. 477 iliofemoral ligament (Y ligament) attaches: AIIS, acetabular rim ⬄ intertrochanteric line of the femur checks extension, abduction, lateral rotation pubofemoral ligament attaches: superior pubic ramus ⬄ iliofemoral ligament checks abduction ischiofemoral ligament attaches: ischial part of the acetabular rim ⬄ femoral neck and medial greater trochanter checks hyperextension Bursa of the hip trochanteric bursa between the gluteus maximus muscle and the (postero-lateral) greater trochanter ischiogluteal bursa overlying the ischial tuberosity Weaver’s bottom (the layman’s term for ischiogluteal bursitis) – people weaving would have to extend one leg forward then the other – the repetitive position changes put excessive pressures on the ischial tuberosity and therefore the bursa iliopectineal bursa (Plate 477) between the iliopsoas muscle and the iliopubic eminence Superficial and deep trochanteric bursa Ischiogluteal bursa The pubic symphysis and supporting ligaments 337 the joint between the 2 pubic bones a.k.a. the symphysis pubis a cartilaginous joint (there is cartilage between the 2 ends) – there is a fibrocartilagenous disc between the 2 bones which acts as a shock absorber limited movement superior pubic ligament inferior pubic ligament Superior and inferior pubic ligaments The sacroiliac joint (a.k.a. the SI joint) & ligaments 337 the joints between ilia and the sacrum (the sacrum is suspended between the ilia) synovial joints (very strong joint – capsule is strong, ligaments are strong etc…) the surfaces are irregular in shape and contour (elevations and depressions) which result in a partial interlocking of the bones limited movement (trade mobility for stability) Anterior and posterior sacroiliac ligaments Vertebropelvic ligaments 337 the pelvis is held together by ligaments these ligaments (and the pubic symphysis) progressively relax during pregnancy to allow passage of the fetus through the birth canal Vertebropelvic ligaments cont. 337 iliolumbar ligament TVP’s L4 & L5 to the posterior iliac crest key stabilizer of L5 limits/checks/restricts lateral flexion sacrotuberous ligament posterior surface of the sacrum/coccyx to the ischial tuberosity stabilizes the SI joint and provides a surface attachment for gluteus maximus sacrospinous ligament lateral sacrum/coccyx to the ischial spine converts the greater sciatic notch into the greater sciatic foramen The fascia of the thigh 484 & 485 fascia: connective tissue that runs throughout the body to provide structure and support (some parts of the body’s fascia are named) the fascia of the thigh is called the fascia lata – it is connective tissue that invests throughout the thigh and surrounds the thigh muscles in a dense tubular sheath The iliotibial band (tract) 484 & 485 iliotibial band the fascia lata thickens laterally – this very strong part of the fascia lata is called the iliotibial band (iliotibial tract) the iliotibial band attaches superiorly to the tubercle of the iliac crest and inferiorly to Gerdy’s tubercle and patella Myology 486 Psoas major (prime mover for hip flexion) superior/proximal attachment: sides of T12 – L4 vertebrae and the associated intervertebral discs inferior/distal attachment: lesser trochanter of the femur action: works with iliacus to flex the hip joint (when the low back is fixed and the femur is moving) action: flexes the lumbar spine (low back) (when the femur is fixed and the low back is moving) Myology cont. 480 & 486 Iliacus superior/proximal attachment: iliac fossa inferior/distal attachment: lesser trochanter action: works with psoas major to flex the hip joint (when the pelvis is fixed and the femur is moving) action: pulls the hip bone anteriorly (anterior pelvic tilt) (when the femur is fixed and the pelvis is moving) “The gluteals” - gluteus maximus, gluteus medius, gluteus minimus 481 484 485 Gluteus maximus superior/proximal attachment: external and posterior surface of the ilium, posterior surface of the sacrum and coccyx, sacrotuberous ligament inferior/distal attachment: ¾ of the fibres attach into the iliotibial band, ¼ of the fibres attach to the gluteal tuberosity action: hip joint extension (Prime mover) action: hip joint lateral rotation action: hip abduction Gluteal muscles cont. 481 485 Gluteus medius (pelvic deltoid) superior/proximal attachment: external ilium (anterior 2/3rds) inferior/distal attachment: lateral surface of the greater trochanter action: hip joint abduction (Prime mover) action: anterior fibres – hip joint flexion & medial rotation action: posterior fibres – hip joint extension & lateral rotation Gluteus medius function cont. Gluteus medius is responsible for pelvic support during weight bearing. Weakness in this muscle results in Trendelenburg gait. Trendelenburg gait Gluteal muscles cont. 481 485 Gluteus minimus superior/proximal attachment: external ilium (deep to gluteus medius) inferior/distal attachment: anterior surface of the greater trochanter action: hip joint abduction action: hip joint flexion action: hip joint medial rotation 481 & 484 Tensor fascia lata (TFL) superior/proximal attachment: outer ASIS inferior/distal attachment: iliotibial band (approximately 1/3rd down the thigh) action: hip joint flexion action: hip joint abduction action: hip joint medial rotation The short hip lateral rotators 480 481 485 493 Piriformis superior/proximal attachment: anterior sacrum traveling through the greater sciatic notch to the… inferior/distal attachment: posteromedial aspect of the greater trochanter action: hip joint lateral rotation (in anatomical position) action: hip joint abduction when the hip is flexed up to approx. 60o action: hip joint medial rotation when the hip is flexed greater than 60o The short hip lateral rotators 480 481 485 493 Gemellus superior superior/proximal attachment: ischial spine inferior/distal attachment: posteromedial aspect of the greater trochanter action: hip joint lateral rotation Obturator internus superior/proximal attachment: inner margin of the obturator foramen inferior/distal attachment: posteromedial aspect of the greater trochanter action: hip joint lateral rotation The short hip lateral rotators 480 481 485 493 Gemellus inferior superior/proximal attachment: ischial tuberosity inferior/distal attachment: posteromedial aspect of the greater trochanter action: hip joint lateral rotation Obturator externus superior/proximal attachment: outer margin of the obturator foramen inferior/distal attachment: posteromedial aspect of the greater trochanter action: hip joint lateral rotation The short hip lateral rotators 480 481 485 493 Quadratus femoris superior/proximal attachment: lateral ischial tuberosity inferior/distal attachment: intertrochanteric crest action: hip joint lateral rotation Bursa of the knee - Plates: 498 & 502 Suprapatellar bursa between the tendon of the quadriceps muscle and the femur connected to the joint capsule the bursa is held in place (and retracted during knee extension) by the articularis genus muscle Bursa of the knee cont. - Plate: 502 Subcutaneous prepatellar bursa between the skin and the anterior part of the patella Layman’s term (for this bursitis) = “housemaid’s knee” Bursa of the knee cont. - Plate: 502 Subcutaneous infrapatellar bursa between the skin and the proximal tibia (in the area of the tibial tuberosity) Layman’s term (for this bursitis) = “clergyman’s knee” or “carpet layer’s knee” Bursa of the knee cont. - Plate: 502 Deep infrapatellar bursa between the patellar ligament and the anterior tibia (superior to the tibial tuberosity) Bursa of the knee cont. - Plates: 497 & 498 Pes anserine bursa between the tendons of the pes anserinus muscles and the medial tibia (pes anserinus muscles: sartorius, gracilis, semitendinosus) looking at the 3 mm. that attach there, they look like a goose foot (pes anserine) Bursa of the knee cont. - Plates: 497 Medial semimembranosus bursa between the tendons of the medial semimembranosus muscles and the medial gastrocnemius Layman’s term (for this bursitis) = “Baker’s cyst” Bursa of the knee cont. - Plates: 497 Bursa deep to the iliotibial band between the iliotibial band and the lateral femoral epicondyle Medical term (for this bursitis) = IT band friction syndrome Layman’s term (for this bursitis) = “runner’s knee” Anterior thigh muscles - Plate: 480, 481, 482, 484 Quadriceps: (quad = 4, ceps comes from cipital = head) Rectus femoris, vastus lateralis, vastus medialis (& VMO), vastus intermedius The prime mover for extension of the knee (All of the above share a common distal attachment at the tibial tuberosity, via the patellar ligament.) Anterior thigh muscles cont. - Plates: 480, 481, 482, 484 Rectus femoris (rectus = straight) (Bipennate) superior/proximal attachment: AIIS and superior to acetabular rim (straight head and reflected head) inferior/distal attachment: tibial tuberosity (via the patellar ligament) action: hip joint flexion action: knee extension this is the only quadricep muscle to cross the hip joint Anterior thigh muscles cont. - Plates: 480, 481, 482, 484 Vastus lateralis (vastus = large) superior/proximal attachment: lateral lip of linea aspera inferior/distal attachment: tibial tuberosity (via the patellar ligament) action: knee joint extension Anterior thigh muscles cont. - Plates: 480, 481, 482, 484 Vastus medialis superior/proximal attachment: medial lip of linea aspera inferior/distal attachment: tibial tuberosity (via the patellar ligament) action: knee joint extension Anterior thigh muscles cont. - Plates: 480, 481, 482, 484 Vastus medialis obliquus (VMO) superior/proximal attachment: medial distal femur, vastus medialis, adductor magnus inferior/distal attachment: medial patella action: knee joint extension action: pulls patella medially (to prevent excessive lateral tracking) VMO Anterior thigh muscles cont. - Plates: 480, 481, 482, 484 Vastus intermedius superior/proximal attachment: proximal 2/3rds of the femur inferior/distal attachment: tibial tuberosity (via the patellar ligament) action: knee joint extension deep to rectus femoris Anterior thigh muscles cont. - Plate: 498 & 502 Articularis genu superior/proximal attachment: anterior distal femur inferior/distal attachment: proximal articular capsule of the knee joint action: pulls the capsule proximally during knee extension to prevent pinching of the capsule Anterior thigh muscles cont. - Plate: 480 & 482 Sartorius (The longest muscle in the body) superior/proximal attachment: ASIS inferior/distal attachment: proximal anteromedial tibia (one of the pes anserinus tendons) action: hip joint flexion action: hip joint abduction action: hip joint lateral rotation action: knee joint flexion action: knee joint medial rotation (when the knee is already flexed) Medial thigh muscles (The adductors) - Plates: 480, 481, 482, 483 & 530 Pectineus superior/proximal attachment: anterior pubic bone (pectineal line) inferior/distal attachment: just inferior to the lesser trochanter action: hip adduction action: hip flexion (weak) Medial thigh muscles (The adductors) - Plates: 480, 481, 482, 483 & 530 Adductor brevis superior/proximal attachment: anterior pubic bone inferior/distal attachment: proximal linea aspera action: hip adduction action: hip flexion (weak) Medial thigh muscles (The adductors) - Plates: 480, 481, 482, 483 & 530 Adductor longus superior/proximal attachment: anterior pubic bone inferior/distal attachment: linea aspera (middle 1/3rd) action: hip adduction action: hip flexion (weak) Medial thigh muscles (The adductors) - Plates: 480, 482, 483 & 530 Gracilis superior/proximal attachment: anterior pubic bone inferior/distal attachment: proximal anteromedial tibia (one of the pes anserinus tendons) action: hip adduction action: knee flexion action: knee medial rotation the only hip adductor that crosses the knee the most medial of the adductors Medial thigh muscles (The adductors) - Plates: 480, 481, 482, 483 & 530 Adductor magnus – anterior fibres superior/proximal attachment: anterior pubic bone inferior/distal attachment: linea aspera action: hip adduction action: hip flexion Medial thigh muscles (The adductors) - Plates: 480, 481, 482, 483 & 530 Adductor magnus – posterior fibres superior/proximal attachment: ischial tuberosity inferior/distal attachment: adductor tubercle action: hip adduction action: hip extension note: in the inferior attachment of adductor magnus (about a hand-width above the adductor tubercle), is an opening called the adductor hiatus which allows for blood vessels to pass through Posterior thigh muscles (The hamstrings) - Plates: 480, 481, 484 & 485 Biceps femoris – long head superior/proximal attachment: ischial tuberosity inferior/distal attachment: fibular head action: hip extension (and lateral rotation) action: knee flexion action: knee lateral rotation Posterior thigh muscles (The hamstrings) - Plates: 480, 481, 484 & 485 Biceps femoris – short head superior/proximal attachment: linea aspera (mid-shaft) inferior/distal attachment: fibular head action: knee flexion action: knee lateral rotation Posterior thigh muscles (The hamstrings) - Plates: 480, 481, 484 & 485 Semitendinosus superior/proximal attachment: ischial tuberosity inferior/distal attachment: proximal anteromedial tibia (one of the pes anserinus tendons) action: hip extension (and medial rotation) action: knee flexion action: knee medial rotation Posterior thigh muscles (The hamstrings) - Plates: 480, 481, 484 & 485 Semimembranosus superior/proximal attachment: ischial tuberosity inferior/distal attachment: posterior aspect of the medial condyle of the tibia action: hip extension (and medial rotation) action: knee flexion action: knee medial rotation Lower limb movement summary Knee flexors: hamstrings, gastrocnemius, popliteus extensors: quadriceps external rotators: biceps femoris internal rotators: semimembranosus, semitendinosus, gracilis Lower limb movement summary Ankle (talocrural joint) dorsiflexors: tibialis anterior, EDL, EHL, peroneus tertius plantarflexors: triceps surae, plantaris, peroneus longus/brevis, tibialis posterior, FHL, FDL Ankle (subtalar joint) inverters: tibialis anterior, tibialis posterior everters: peroneus longus/brevis/tertius, EDL Lower limb movement summary Metatarsophalangeal Joints flexors: FHL, FHB, FDL, FDB, lumbricales extensors: EDL, EDB, EHL, EHB abductors: dorsal interossei adductors: plantar interossei Interphalangeal Joints PIP flexors: FDL, FDB DIP flexors: FDL PIP extensors: EDL, EDB, lumbricales DIP extensors: EDL, lumbricales 1st toe IP flexors: FHL, FHB 1st toe IP extensors: EHB, lumbricales Lower limb movement summary Hip flexors: iliopsoas (psoas major, iliacus), rectus femoris, TFL, pectineus, adductor longus, adductor brevis, adductor magnus (anterior fibres), sartorius extensors: gluteus maximus, hamstrings (except biceps femoris short head), adductor magnus (posterior fibres) abductors: gluteus medius, TFL, gluteus minimus, sartorius Adductors: adductor magnus, pectineus, adductor longus, adductor brevis, gracilis external rotators: Gluteus maximus, piriformis, gemellus superior, gemellus inferior, obturator internus, obturator externus, quadratus femoris, gluteus medius (posterior fibres), sartorius internal rotators: TFL, gluteus medius (anterior fibres), gluteus minimus, (anterior fibres), piriformis (with hip flexed) The Femoral Triangle - Plate: 490 A depression in the superomedial thigh (inferior to the inguinal ligament) observable during hip flexion. Boundaries: superiorly: inguinal ligament medially: adductor longus laterally: sartorius floor (medial to lateral): pectineus, iliopsoas roof: fascia lata contents: femoral a., femoral v., femoral n. The upper limb Relevant Bones: sternum clavicle scapula humerus ulna radius carpals metacarpals phalanges The upper limb cont. Terminology shoulder (scapula, clavicle) (a.k.a. the pectoral girdle, the thoracic girdle) (the junction between the arm and the trunk) arm (humerus) (Latin: brachium) forearm (ulna, radius) wrist (carpals) hand (metacarpals) fingers (phalanges) axial skeleton: the skull, vertebral column, sternum, ribs appendicular skeleton: shoulders, upper limbs, hips, lower limbs The clavicle (Latin: little key) - Plate: 408 first bone in the body to ossify shaped like an ‘S’ (lateral concave anteriorly, medial convex anteriorly) lateral 1/3rd is flattened (this is the most common location for fracture) connects the upper limb to the axial skeleton acromial end (the end that connects to the scapula) sternal end (the end that connects to the manubrium - top of the breast bone) The scapula (Latin: shoulder) - Plate: 409 & 410 Relatively flat, triangular bone sits flat against rib cage from (approximately) the 2nd – 7th ribs (when standing in anatomical position with proper posture) connects the clavicle to the humerus The scapula cont. (anterior view) - Plate: 409 Acromion (the tip of the shoulder) Coracoid process (‘like a raven’s beak’ from Greek: korax (raven), ‘oid’ = like) Glenoid fossa aka glenoid cavity (where the head of the humerus articulates with the scapula) Supraglenoid tubercle The scapula cont. (anterior view) - Plate: 409 Infraglenoid tubercle Lateral border (a.k.a. axillary border) (axilla = armpit) Inferior angle (easily palpated, good place to start for many palpations) Subscapular fossa Medial border (a.k.a vertebral border) Superior angle Suprascapular notch The scapula (posterior view) - Plate: 410 Spine (of the scapula) Supraspinous fossa Infraspinous fossa Root of the spine (the medial end of the spine - not noted in Netter) The scapulothoracic joint (S-T joint) Not a true anatomical joint – it’s a functional joint Scapulothoracic Movements: elevation: a gliding motion with the scapula moving superiorly depression: a gliding motion with the scapula moving inferiorly retraction/adduction: a gliding motion with the scapula moving towards the spine protraction/abduction: a gliding motion with the scapula moving away from the spine rotation: the glenoid fossa is the point of reference upward/lateral rotation: the glenoid fossa moves superiorly (the inferior angle moves laterally) (anterior-posterior axis, frontal plane) downward/medial rotation: the glenoid fossa moves inferiorly (the inferior angle moves medially) The sternoclavicular joint (S-C joint) - Plate: 408 The sternal end of the clavicle articulates with the manubrium saddle synovial superior/inferior glide anterior/posterior glide rotation (M-L axis) scapular depression: sternal end of the clavicle moves superiorly scapular elevation: sternal end of the clavicle moves inferiorly There is an articular disc the disc prevents medial displacement of the clavicle and helps dissipate forces (the S-C joint is the only true articulation between the upper limb and axial skeleton) Ligaments of the sternoclavicular joint - Plate: 408 anterior sternoclavicular ligament posterior sternoclavicular ligament (not shown in Netter) interclavicular ligament these reinforce the capsule costoclavicular ligament - inferior clavicle ⬄ 1st rib The acromioclavicular joint (A-C joint) - Plate: 412 The acromial end of the clavicle articulates with the acromion of the scapula plane synovial ante rior/posterior glide some mild rotation The ligaments of the acromioclavicular joint - Plate: 412 Acromioclavicular ligament clavicle ⬄ acromion coracoacromial ligament coracoid process ⬄ acromion the coracoacromial arch is an arch formed by the coracoid process, the coracoacromial ligament and the acromion (clinically relevant!) coracoclavicular ligament trapezoid ligament conoid ligament coracoid process ⬄ clavicle The Humerus (anterior view) - Plate: 409 head anatomical neck greater tubercle lesser tubercle surgical neck (common fracture site) bicipital groove (a.k.a. intertubercular groove, intertubercular sulcus) deltoid tuberosity lateral supracondylar ridge The Humerus (anterior view) cont - Plate: 409 lateral condyle radial fossa lateral epicondyle capitulum coronoid fossa trochlea medial epicondyle medial condyle medial supracondylar ridge The Humerus (posterior view) - Plate: 410 radial groove aka spiral groove olecranon fossa groove for the ulnar nerve The Glenohumeral (GH) joint - Plate: 412 the glenoid fossa of the scapula articulates with the head of the humerus ball and socket synovial Available movements: abduction/adduction flexion/extension internal/external rotation horizontal abduction/horizontal adduction circumduction scaption The GH joint cont - Plate: 412 glenoid labrum fibrocartilagenous ring that attaches to the glenoid fossa it deepens the joint (the joint is like a golf ball on a golf tee which is unstable) (the glenoid fossa articulates with about 1/3rd of the humeral head) the joint capsule thin and loose weakest inferiorly at the axillary recess there is a weak spot in the capsule anteriorly called the foramen of Weitbrecht (in Netter, it’s the opening indicated as the ‘communication of subtendinous bursa of subscapularis’) The ligaments of the GH joint - Plate: 412 coracohumeral ligament coracoid process ⬄ greater tubercle glenohumeral (capsular) ligaments Bursa of the GH joint - Plate: 412 subacromial bursa between the acromion and the joint capsule subdeltoid bursa between the deltoid muscle and the joint capsule often connected with the subacromial bursa subdeltoid and subacromial bursa are often used interchangeably New movement terminology - Scaption the scapula sits at an angle of approximately 45o relative to the frontal and sagittal planes movement of the arm in this plane is termed scaption there is less tension on the capsule and greater elevation is possible than with pure frontal or sagittal plane elevation neither internal nor external rotation of the humerus is needed to prevent impingement many functional activities occur in this plane Scaption Scapulohumeral rhythm Abduction of the arm involves movement at the glenohumeral (GH) joint, the scapulothoracic (ST) articulation, the acromioclavicular (AC) joint, and the sternoclavicular (SC) joint. During normal abduction range, there is a specific relationship in the amount of movement at the GH joint, compared to the ST articulation. 0 - 15 degrees: no movement of the scapula 15 - 120 degrees: 2:1 ratio (GH:ST) 120 - 180 degrees: 1:1 ratio (GH:ST) Another way to look at it is that between 15 and 120 degrees of abduction, for every 3 degrees of movement, 2 degrees comes from the GH and 1 degree comes from the ST. The biomechanics of abduction - Plate: 412 during abduction of the humerus, the humerus must undergo external rotation (this usually happens around 90o of abduction) this helps the greater tubercle clear the coracoacromial arch (preventing impingement) note how many structures are in a relatively small space Introduction to the spine - Plate: 162 the spine is comprised of several individual bones called vertebrae (sing. vertebra) and is divided into 5 different segments the cervical spine has 7 vertebrae the thoracic spine has 12 vertebrae the lumbar spine has 5 vertebrae the sacrum is considered 1 bone (made of 5 fused vertebrae) the coccyx is considered 1 bone (made of (usually) 4 fused vertebrae) the posterior prominences of the spine are called spinous processes the lateral prominences of the spine are called transverse processes The spine cont. - Plate: 162 & 180 Available Movements flexion extension rotation (left, right) lateral flexion or side bending (left, right) (demonstrate this) The thoracolumbar fascia is extensive fascia in the low back that covers from the 12th rib to the iliac crest. Superficial back muscles - Plate: 180, 413, 409 & 410 Muscles connecting the upper limb to the spine upper/middle/lower trapezius latissimus dorsi rhomboids levator scapula Superficial back muscles - Plate: 180, 413, 409 & 410 Upper trapezius superior attachment: middle 1/3rd of the superior nuchal line, external occipital protuberance (inion) to the C7 SP via the nuchal ligament inferior attachment: lateral clavicle, acromion, superior lip of the spine of the scapula head/neck fixed: action: S-T elevation action: S-T upward rotation scapula fixed: action: head/neck extension (bilaterally contracting) action: head/neck ipsilateral lateral flexion action: head/neck contralateral rotation Superficial back muscles - Plate: 180, 413, 409 & 410 Middle trapezius medial attachment: C7-T5 SPs inferior attachment: superior lip of the spine of the scapula action: S-T retraction Superficial back muscles - Plate: 180, 413, 409 & 410 Lower trapezius medial attachment: T6-T12 SPs inferior attachment: root of the spine of the scapula action: S-T depression (when acting with pectoralis minor) action: S-T upward rotation Superficial back muscles - Plate: 180, 413, 409 & 410 Latissimus dorsi (Latin: widest of the back) medial attachment: SP T6 – iliac crest, lumbar and sacral vertebrae via the thoracolumbar fascia, ribs 9-12, inferior angle of the scapula (this is an inconsistent attachment) lateral attachment: floor of the bicipital groove action: G-H internal rotation action: G-H extension action: G-H adduction Superficial back muscles - Plate: 180, 413, 409 & 410 Rhomboids medial attachment: SP C7-T5 lateral attachment: root of the spine of the scapula to the inferior angle of the scapula action: S-T retraction action: S-T downward rotation action: S-T elevation action: help serratus anterior hold the scapula against the ribs used when forcibly lowering raised upper limbs (i.e. chopping wood) Superficial back muscles - Plate: 180, 413, 409 & 410 Levator scapula $ superior attachment: TVP’s of C1 - C4 inferior attachment: superior angle to the root of the spine of the scapula head/neck fixed: action: S-T elevation action: S-T downward rotation scapula fixed: action: head/neck extension (when bilaterally contracting) action: head/neck ipsilateral lateral flexion action: head/neck ipsilateral rotation Levator scapula Note how it twists from one attachment to the other - this can make it easier to palpate. The muscles of the pectoral region - Plate: 408, 409, 413, 416 & 417 pectoralis major pectoralis minor subclavius serratus anterior The muscles of the pectoral region cont. - Plate: 409 & 413 Pectoralis major 2 divisions: upper fibres (clavicular head) and lower fibres (sternocostal head) medial attachment (upper fibres): medial ½ of the anterior clavicle medial attachment (lower fibres): sternum, anterior costal cartilages of ribs 2-6 lateral attachment (both heads): lateral lip of the bicipital groove action: G-H medial rotation action: G-H adduction action: G-H flexion (from deep extension) action: G-H extension (from deep flexion) action: G-H horizontal adduction The muscles of the pectoral region cont. - Plate: 409 & 416 Pectoralis minor superior attachment: coracoid process inferior attachment: ribs 3-5 action: S-T protraction action: S-T depression (when acting with lower trapezius) action: S-T downward rotation action: if the scapula is fixed, pectoralis minor helps to elevate the ribs with forced inhalation Pectoralis minor Tipping scapula: the inferior angle of the scapula moves posteriorly off of the rib cage (this is likely due to a short pectoralis minor) The muscles of the pectoral region cont. - Plate: 408 & 37 Subclavius medial attachment: 1st rib and its costal cartilage lateral attachment: middle 1/3rd of the inferior surface of the clavicle action: anchors, depresses and draws the clavicle medially serves as a cushion between a fractured clavicle and subclavian structures The muscles of the pectoral region cont. - Plate: 409, 413, 414 & 417 Serratus anterior medial attachment: anterior surface of the medial border of the scapula lateral attachment: lateral surfaces of the upper 8 ribs action: S-T protraction action: S-T upward rotation (lower fibres only) keeps the medial border of the scapula flat against the ribs – if this muscle is weak, a winging scapula can present (the medial border of the scapula moves off the ribcage) Winging scapula: the medial border of the scapula moves posteriorly off of the ribcage (this is likely due to a weak serratus anterior) HOT TIPS (and hot wings ;) Tight pectoralis minor = Tipping scapula Weak serratus anterior = Winging scapula The scapular muscles - Plate: 409, 410, 413, 415, 417 & 418 Rotator cuff Supraspinatus Infraspinatus teres minor Subscapularis deltoids teres major The scapular muscles cont. - Plate: 409, 410 & 413 Deltoid anterior, middle, posterior heads medial attachment (anterior): anterior lateral 1/3rd of the clavicle medial attachment (middle): lateral acromion medial attachment (posterior): spine of the scapula (421) lateral attachment: deltoid tuberosity action (all): G-H abduction action (anterior head): G-H medial rotation, flexion, horizontal adduction action (posterior head): G-H lateral rotation, extension, horizontal abduction The rotator cuff muscles (SItS) Supraspinatus, Infraspinatus, Teres minor, and subscapularis the rotator cuff muscles support/stabilize the G-H joint and help to control its movements the head of the humerus can be separated from the glenoid fossa by 2.5 cm when the muscles are cut – this means the non-contractile elements (capsule, ligaments etc…) don’t stabilize the joint, the muscles do The rotator cuff muscles (SITS) cont. - Plate: 409, 410, 412, 413 & 415 Supraspinatus medial attachment: supraspinous fossa lateral attachment: superior facet of the greater tubercle of the humerus (also the G-H joint capsule) action: abduction/scaption action: stabilizes the G-H joint by ‘tucking’ the head of the humerus up into the glenoid fossa The rotator cuff muscles (SITS) cont. - Plate: 410, 413 & 415 Infraspinatus medial attachment: infraspinous fossa lateral attachment: middle facet of the greater tubercle of the humerus (also the G-H joint capsule) action: G-H external rotation The rotator cuff muscles (SITS) cont. - Plate: 410, 413, 415, 417 & 418 Teres minor medial attachment: lateral middle border of the scapula (between triceps and teres major) lateral attachment: inferior facet of the greater tubercle of the humerus (also the G-H joint capsule) action: G-H external rotation The rotator cuff muscles (SITS) cont. - Plate: 409, 412 & 415 Subscapularis medial attachment: subscapular fossa lateral attachment: lesser tubercle of the humerus (also the G-H joint capsule) action: G-H internal rotation The scapular muscles cont. - Plate: 409, 410, 413, 417 & 418 Teres major (NOT ONE OF THE ROTATOR CUFF MUSCLES) medial attachment: posterior surface of the inferior angle of the scapula lateral attachment: medial lip of the bicipital groove action: G-H internal rotation action: G-H extension action: G-H adduction The forearm bones - Plate: 426 & 429 The Radius the lateral bone in the forearm has a slight bowing and thickens as you travel distally Latin: resembles the spoke of a wheel Landmarks: head neck radial tuberosity interosseous border styloid process dorsal tubercle (a.k.a. Lister’s tubercle) ulnar notch (of the radius) The forearm bones - Plate: 426 & 429 The Ulna the medial bone in the forearm Latin: elbow Landmarks: olecranon trochlear notch coronoid process radial notch ulnar tuberosity interosseous border styloid process head supinator crest The arthrology of the elbow - Plate: 426 & 428 The elbow joint consists of the humeroulnar and humeroradial articulations. humeroulnar: anteriorly, the trochlea of the humerus articulates with the trochlear notch of the ulna posteriorly, the olecranon articulates with the olecranon fossa (in full extension) humeroradial: the capitulum articulates with the head of the radius (the superior surface of the head of the radius is slightly cup shaped - called the fovea) hinge synovial very stable joint flexion & extension Ligaments of the elbow joint - Plate: 428 Collateral ligaments lateral (radial) collateral ligament: lateral epicondyle ⬄ annular ligament of the radius medial (ulnar) collateral ligament: medial epicondyle ⬄ coronoid process, olecranon process Olecranon bursa between the olecranon and the overlying skin The proximal radioulnar joint - Plate: 426, 428 & 429 The head of the radius articulates with the radial notch of the ulna synovial pivot allows for movement of the head of the radius against the ulna (the head rotates within the ring formed by the anular ligament) pronation/supination (used to describe the rotational motions of the forearm) – mainly the radius that moves pronation: palm faces down supination: palm faces up Ligaments of the elbow joint cont. - Plate: 428 annular ligament: a u-shaped ligament that runs from the anterior surface of the radial notch around the head of the radius to the posterior surface of the radial notch – holds the head of the radius in place preschool kids can get a ‘slipped elbow’ from forceful traction of the pronated forearm The distal radioulnar joint - Plate: 429 the head of the ulna articulates with the ulnar notch of the radius pivot synovial allows for movement of the radius around a relatively fixed ulna pronation/supination The distal radioulnar joint cont. - Plate: 445 there is an articular disc that binds the distal radius and ulna together note how the ulna does not directly articulate with the carpal bones palmar and dorsal radioulnar ligaments: distal ulna ⬄ distal radius Note: between the radius and the ulna is an interosseous membrane which helps to stabilize the 2 bones and the proximal and distal radioulnar joints The muscles of the arm - Plate: 409, 421 & 423 Coracobrachialis superior/proximal attachment: coracoid process inferior/distal attachment: middle, medial humerus action: G-H adduction action: G-H flexion (weak) The muscles of the arm - Plate: 409, 421 & 423 Biceps brachii (biceps = 2 heads, brachii = arm) superior/proximal attachment (long head): supraglenoid tubercle the biceps long head travels through the bicipital groove to its proximal attachment – the tendon has a sheath to protect it from the transverse humeral ligament which holds the tendon in place during contraction/movement superior/proximal attachment (short head): coracoid process inferior/distal attachment: radial tuberosity (when the forearm is pronated, the biceps wraps more than ½ way around the radius), bicipital aponeurosis (fascia that runs from the biceps tendon across the cubital fossa and merges with the deep fascia of the anterior forearm (flexors on the medial side) action: G-H flexion action: elbow flexion- Prime mover in supination (weak when the forearm is pronated) The muscles of the arm cont. - Plate: 409, 421 & 423 Brachialis superior/proximal attachment: anterior distal ½ of the humerus inferior/distal attachment: ulnar tuberosity, coronoid process action: elbow flexion (prime mover in pronation) The muscles of the arm cont. - Plate: 410 & 422 Triceps brachii (triceps = 3 heads, brachii = arm) superior/proximal attachment (long head): infraglenoid tubercle superior/proximal attachment (lateral head): posterior proximal humerus (superior to the radial groove) superior/proximal attachment (medial head): posterior distal humerus (inferior to the radial groove) inferior/distal attachment: olecranon process action (long head): G-H extension action (all heads): elbow extension The muscles of the arm cont. - Plate: 440 & 434 Anconeus technically part of the forearm but is functionally related to the triceps so it’s listed here superior/proximal attachment: lateral epicondyle inferior/distal attachment: olecranon process action: elbow extension (assists triceps) Osteology of the hand - Plates: 442, 445 & 446 the carpal bones (8) the metacarpals (5) the phalanges (14) total 27 bones – compare with the foot which has 26 The carpal bones (carpus: Latin - wrist) - Plates: 442, 445 & 446 8 carpal bones (2 rows of 4 bones each) The proximal row (from lateral to medial): scaphoid (sometimes called the navicular) (including its tubercle) (boat shaped (Greek: scaphe) (most commonly fractured) lunate (moon shaped) (most commonly dislocated) triquetrum (pyramid shaped) pisiform (pea-shaped: Latin: pisum (pea) – easily palpable (completely surrounded by tendon - therefore it’s a sesamoid bone) The carpal bones - Plates: 442, 445 & 446 The distal row (from lateral to medial): trapezium (including its tubercle) trapezoid capitate (has a rounded head: Latin: caput (head)) hamate – easily identified by the anterior projection called the hook of the hamate Mnemonics for the carpals Starting with the distal row and moving lateral to medial: TTC Has Seldom Lowered Their Prices TTCH SLTP Starting with the proximal row and moving lateral to medial: Some lovers try positions that they can’t handle SLTP TTCH The carpal tunnel - Plate: 452 there is a natural anterior concavity formed by the carpal bones the flexor retinaculum attaches laterally to the tubercles of the scaphoid and trapezium and medially to the hook of the hamate and pisiform the retinaculum forms a tunnel called the carpal tunnel through which structures pass The metacarpals & phalanges - Plate: 446 5 metacarpals each has a base, a shaft, and a head the head of the 1st metacarpal has sesamoid bones 14 phalanges each has a base, a shaft, and a head The radiocarpal joint - Plate: 445 the distal radius and the articular disc of the distal radioulnar joint articulate with the proximal row of carpal bones (scaphoid, lunate, triquetrum) condyloid (the convex surface of the carpals fit into the concave surface of the distal radius and disc) synovial Movements at the radiocarpal joint flexion extension abduction (radial deviation) adduction (ulnar deviation) circumduction note: pronation/supination does not happen at the radiocarpal joint – try to supinate or pronate while stabilizing your distal radius/ulna Ligaments at the wrist - Plates: 444 & 445 Palmar and dorsal radiocarpal ligaments distal radius ⬄ carpal bones on the palmar (444) and dorsal (445) surfaces The ulnomeniscotriquetral joint - Plate: 445 the ulna articulates with the articular disc which articulates with the triquetrum a functional joint synovial during flexion and extension at the wrist, the disc stays with the radius and ulna and the movement occurs between the disc and the carpals primarily involved with pronation and supination during which the disc moves around the distal end of the ulna The midcarpal joint - Plate: 444 & 445 the proximal row of carpals articulates with the distal row of carpals plane synovial Available movements flexion extension movements of these joints increase the movements at the wrist joint dorsal and palmar intercarpal ligaments The intercarpal joints - Plate: 444 & 445 the articulations between the carpal bones plane synovial interosseous intercarpal ligaments The carpometacarpal joints (CMC) - Plate: 445 & 446 the distal row of carpals articulates with the proximal row of metacarpals 1st Carpometacarpal Joint the trapezium articulates with the base of the 1st metacarpal (which is saddle shaped) saddle synovial Movements of the thumb at the 1st carpometacarpal joint flexion: movement that takes the thumb medially along the coronal plane towards the other fingers extension: movement that takes the thumb laterally along the coronal plane away from the other fingers abduction: movement that takes the thumb along the sagittal plane away from the palm adduction: movement that takes the thumb along the sagittal plane towar

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