Applied Clinical Anatomy Section 1

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Cancellous

(spongy/trabecular bone) spaces contain red bone marrow (myeloid tissue) with elements for blood cell formation, supports body weight but still provides ample support, end of long bones, highly vascular

What are the muscles of the gluteal region

- Gluteus Maximus - Gluteus Medius - Gluteus Minimus - piriformis - Gemelli superior and inferior - Quadratus Femoris

iliofemoral ligament (Y ligament)

-AIIS to posterosuperior acetabulum and labrum -intertrochanteric line -greater trochanter -tightens with extension, internal rotation, lateral fibers with adduction

What forms the sciatic nerve and where does it exit

-Anterior and posterior divisions of L4 and L5 form the lumbosacral trunk, joining the anterior and posterior divisions of spinal nerves S1-S3 -leaves the pelvis through the lateral greater sciatic foramen

What forms the Obturator nerve path and what is supplies

-Anterior divisions of L2, L3, and L4 -pass through obturator foramen to supply medial aspect of the thigh

Iliohypogastric nerve origin, sensory, motor

-L1 anterior division -above pubis, posterolateral buttocks, lowest dermatome of anterior body wall -transversus abdominis and internal oblique

Ilioinguinal nerve origin, sensory, and motor

-L1 anterior division -anterior labial or scrotal region -none

Genitofemoral origin, sensory, and motor

-L1-L2 anterior division -proximal skin of thigh, anterior labial and scrotal area -cremaster

Lateral femoral cutaneous location, sensory, motor

-L2-L3 -crosses and may be compressed at ASIS -s: none in pelvis; lateral proximal thigh -m:NONE

Femoral nerve location, sensory, motor

-L2-L4 -lies between psoas major and iliacus -s: none in pelvis; anteromedial thigh, medial leg and foot (via cutaneous and saphenous nerve) -m: psoas, iliacus, pectineus, rectus femoris, quadriceps, sartorius, articular genu

Obturator origin, sensory, and motor

-L2-L4 anterior division -Inferomedial thigh -external oblique and obturator externus, adductors longus, brevis, magnus, gracilis

Accessory obturator origin, sensory, motor

-L2-L4 anterior division (inconsistent nerve) -none -Psoas

nerve to quadratus femoris origin, sensory, motor

-L4-S1 anterior -s: none -m: quadratus femoris, inferior gemelli

Superior gluteal nerve origin, sensory, motor

-L4-S1 posterior -s: none -m: gluteus medius, gluteus minimus, tensor fascia latae

common fibular (peroneal) nerve origin, sensory, motor

-L4-S2 posterior, descends in groove between biceps femoris and lateral head of gastroc., wrapping around fibular head -s: proximal and distal lateral leg and lateral foot -m: biceps femoris short head, anterior and lateral compartments of leg, extensor digitorum brevis

Tibial nerve origin, sensory, motor

-L4-S3 anterior division descends between heads of gastrocnemius -s:proximal and posterolateral calf, plantar aspect of foot -m: extensive-biceps femurs long head, semitendinosis, semimembranosus, superficial and deep posterior compartments of leg, foot intrinsics

Nerve to obturator internus origin, sensory, motor

-L5-S2 anterior division -s: NONE -m: obturator internus, superior gemelli

inferior gluteal nerve origin, sensory, motor

-L5-S2 posterior -s: none -m: gluteus maximus

Spleen quadrant, function, referral pain

-LUQ -filters RBC and has a role in immune system (problem: rupture due to sport/trauma) -primarily in LUQ radiating posteriorly, Kehr's sign: pain at tip of left shoulder

Lateral femoral cutaneous nerve sensory

-Meralgia paraesthetica: numbness due to lateral femoral cutaneous nerve, compression, -lateral aspect of thigh and anterior aspect of thigh

Somatic pain

-Pain generated from one or more somatic tissues of the spine -This does not include nerve -Common causes of somatic pain are chemical, mechanical, or a combo of the two

Somatic referred pain

-Perceived in a region topographically displaced from the region of the source of pain

What forms the femoral nerve and where does it exit

-Posterior divisions of L2, L3, and L4 -terminates in the femoral triangle by splitting into several branches distal to the inguinal ligament

Spinal nerves S2-C1 give rise to which nerves and function

-Pudendal nerve and lavatory ani (motor and sensory) -S2, 3 and 4 keep it up off the floor

Appendix quadrant, function, referral pain

-RLQ -unknown function, tail off large intestine -pain located in right lower abdominal region, McBurney's Point: 1/3 distance between ASIS and umbilicus (closer to ASIS) rebound tenderness

Gall Bladder quadrant, function, referral pain

-RUQ -receive bile from liver and dump into intestine to break down fatty foods (problem:swollen, inflamed, blockage) -primarily in RUQ radiating posteriorly. Can also reproduce pain in right neck and shoulder region

Pancreas quadrant, function, referral pain

-RUQ -secretes digestive enzymes for carbs, proteins, fat; releases insulin and glucagon into blood (problems: alcohol, fatty foods, gallstones) -pain in middle and upper abdomen

Liver quadrant, function, referral pain

-RUQ and LUQ below diaphragm -filter blood from digestive tract, metabolizes, detoxifies. Liver problems caused by hepatitis, alcoholism, cancer-jaundice (yellow due to bilirubin) -pain in right upper quadrant, right sided lower back pain, right shoulder and neck pain

Posterior femoral cutaneous nerve origin, sensory, motor

-S1-S3 posterior -s: posterior thigh -m: NONE

Nerve to piriformis origin, sensory, motor

-S2 posterior -s: none -m: piriformis muscles

Pudendal nerve origin, sensory, motor

-S2-S4 anterior, exits greater then reenters lesser sciatic foramen -s: perineum via inferior rectal, dorsal nerve to penis/clitoris -m: bulbospongiosus, ischiocavernosus, urethral sphincter, urogenital diaphragm, spincter ani

Nerve to coccygeus origin, sensory, motor

-S3-S4 anterior -s: none -m: coccygeus and levator ani

Nerves of the sacral plexus arising from the anterior division

-Tibial -nerve to obturator internus -nerve to quadratus femoris -pudendal -nerve to coccygeus

Action of erector spinae muscles

-acting bilaterally: all extend vertebral column and head -acting unilaterally: laterally flex vertebral column

Kidney quadrant, function, problems, referral pain

-all 4 quadrants -maintain fluid balance, regulate/filter minerals from blood, filter waste from food, create hormones that help produce RBC, promote bone health, regulate bp -pain referred to lower left pelvic and groin region, left sided lower back pain

Origin of the intermediate layer of the intrinsic back muscles (erector spinae)?

-all have the same origin -iliac crest and posterior sacrum

Insertion and innervation of the deep layer of the intrinsic back

-all insert to spinous process of more superior vertebrae -all innervated by dorsal rami of spinal nerve

Sacroiliac joint

-characteristics of synovial joint as a child -mature adult, becomes modified amphiarthrodial -reciprocal elevations and depressions

femoral head angle of inclination normal values

-child: 135 -adult: 125 -old: 120

Nerves of the sacral plexus arising from the posterior division

-common fibular (peroneal) -superior gluteal -inferior gluteal -nerve to piriformis -posterior femoral cutaneous nerve

Diaphragm function, what innervates it, referral pain

-expand thoracic cavity, compress abdominal cavity -phrenic nerve C3, 4, 5 -referred pain to either shoulder, kehr's sign, sign of ruptured spleen, blood in abdominal cavity irritates diaphragm

Gluteus minimus origin, insertion, innervation, action

-external ilium between anterior and posterior gluteal lines -anterior surface of greater trochanter of femur -superior gluteal nerve (L5 and S1) -abducts, medially rotates thigh, keep pelvis level when opposite leg is raised

Gluteus medius origin, insertion, innervation, action

-external ilium between anterior and posterior gluteal lines -lateral surface of greater trochanter of femur -superior gluteal nerve (L5 and S1) -abducts, medially rotates thigh, keep pelvis level when opposite leg is raised

External oblique origin, insertion, innervation, actions

-external surfaces of 5-12th rib -línea alba, pubic tubercle, anterior half of iliac crest -thoraco-abdominal and subcostal nerves (anterior rami of T7-12 spinal nerves) -compress and support abdominal viscera and flex and rotate trunk (contra lateral rotation)

Spinal nerves L2-L4 give rise to which nerves and where does it innervate

-femoral and obturator nerves -anterior and medial aspects of the thigh

Movements of the hip joint

-flex/extension -ab/adduction -lateral/medial rotation -circumduction

higher angle of femoral head inclination vs lower angle

-high: femur abducts causing coxa valga and genu varus -low: femur adducts causing coxa vara with genu valgus

Longissimus origin, insertion and location

-iliac crest and posterior sacrum -ribs -middle (both ways) or intermediate layer

Iliocostalis origin, insertion and location?

-iliac crest and posterior sacrum -ribs -most superficial and most lateral of intermediate layer

Spinalis origin, insertion and location

-iliac crest and posterior sacrum -spinous process of upper thoracic -most deep and most medial of intermediate layer

Nerves of the lumbar plexus- anterior division

-iliohypogastric -ilioinguinal (2 nerves come from 1 root, L1, 2 i's) -genitofemoral -lateral femoral cutaneous (2 nerves from 1 and 2 lumbar roots, g and l) -obturator -femoral (2 from 3 roots, L 3-5) (I twice get lucky on Friday's)

Gluteus maximus origin, insertion, innervation, action

-ilium posterior to posterior gluteal line, dorsal sacrum and coccyx, sacrotuberous ligament -lateral condyle of tibia or gluteal tuberosity of femur -inferior gluteal nerve (L5, S1, S2) -extend thigh, assist lateral rotation, steadies thigh, assists in rising from seated position

Borders of the femoral triangle

-inguinal ligament (superior) -sartorius (lateral) -adductor longus (medial)

Intrinsic back muscles 4 characteristics

-innervated by dorsal rami of spinal nerves -maintain posture and control movements of the vertebral column -start and end in the spine (true back muscles) -run from pelvis to skull and enclosed by fascia

Transversus abdominis origin, insertion, innervation, actions

-internal surfaces of 7-12th costal cartilages, thoracolumbar fascia, iliac crest, and lateral third of inguinal ligament -línea alba with aponeurosis of internal oblique, pubic crest, and pubis via conjoint tendon -thoraco-abdominal nerves (anterior rami of T7-11), subcostal and first lumbar nerves -compress and supports/stabilizes abdominal viscera

What are the muscles of the minor deep layer of the intrinsic back muscles?

-interspiales -intertransversarii -levator costarum

Organs in the right lower quadrant

-kidney -colon -small intestines -ureter -appendix -bladder

Organs in the left lower quadrant

-kidney -colon -small intestines -ureter -bladder

Nerves of lumbar plexus: posterior division

-lateral femoral cutaneous (L2-L3) -femoral nerve (L2-L4)

Quadratus femoris origin, insertion, innervation, action

-lateral ischial tuberosity -quadrate tubercle on intertrochanteric crest of femur -nerve to quadratus femoris (L5, S1) -laterally rotate thigh, steadies femoral head

Cardiac referred pain

-left sided chest pain -left sided shoulder pain -left sided jam and neck pain -inner aspect of left arm radiating into medial aspect of forearm and hand (5th digit) -left sided mid back pain (posterior -less predictable in women: shortness of breath/fatigue

Organs in the right upper quadrant

-liver -right kidney -colon -pancreas —gall bladder

Organs in the left upper quadrant

-liver -spleen -left kidney -stomach -colon -pancreas

What are the 3 parts of the lumbosacral plexus?

-lumbar portion: anterior rami (T12) L1-L4 -Lumbosacral portion: anterior rami L4, L5 and S1, S2, S3, (S4) -Sacrococcygeal portion (S2-C1)

What is erector spinae and what is it made up of?

-muscles of the intermediate layer of the intrinsic back muscles -spinalis, longissimus, iliocostalis

Piriformis origin, insertion, innervation, action

-origin: anterior surface of sacrum -insertion: greater trochanter of femur -innervation: branches of ventral rami and S1 and S2 -action: laterally rotate extended thigh and abduct flexed thigh, steady femoral head in acetabulum

Splenius capitis

-origin: ligamentum nuchae, spinous process C7-T3 or T4 -insertion: mastoid process, posterolateral aspect of occipital bone -innervation: dorsal rami of C4-C8 -action: extends head (both sides), rotates (same side), laterally flexes (same side) the head

Sternocleidomastoid

-origin: mastoid process -insertion: Sternum and medial portion of clavicle -innervation: spinal accessory nerve -action: side bend head ipsilateral, potatoes contralateral

Splenius Cervicis

-origin: spinous process of T3-T6 -insertion: transverse processes of C1-C3 or C4 -innervation: dorsal rami C4-C8 -action: extends (both sides), rotates (same side), and laterally flexes (same side) the cervical spine

Levator scapulae

-origin: transverse processes of C1-C4 -insertion: superior and medial border of scapula -Innervation: dorsal scapular (C5) and cervical (C3 and C4) nerves -action: elevates and downwardly rotates scapula, sidebands neck and rotates it to the same side

Scalene (anterior, middle, posterior)

-origin: transverse processes of C2-7 -insertion: ant and mid(1st rib), post (2nd rib) -innervation: C3-C8 -action: elevates 1st and 2nd rib, flexes neck (anterior), side bends (all), anterior and middle rotate cervical spine contralateral side

Visceral pain

-pain related to internal organs -poorly localized because innervation is multisegmental

Radicular pain

-pain that radiates from a central source (nerve root) that is accompanied by numbness, reflex changes, motor changes (doesn't have to be all inclusive

Obturator Internus origin, insertion, innervation, action

-pelvic surface of obturator membrane and surrounding bone -trochanteric fossa of femur -nerve obturator internus (L5 and S1) -laterally rotate extended thigh, abduct flexed thigh, steady femoral head

Ischiofemoral ligament

-posteroinferior acetabulum and labrum -posterosuperior femoral neck at greater trochanter -tightens with extension, internal rotation

Ligamentum teres ligament

-primordial ligament of the head of the femur -no stabilizing function in the adult

L2 myotome muscles

-psoas -hip adductors

L3 myotome muscles

-psoas -quadriceps -thigh atrophy

Rectus abdominis origin, insertion, innervation, actions

-pubic symphysis and pubic crest -xiphoid processes and costal cartilages of ribs 5-7 -anterior rami of T7-12 spinal nerves -flexes trunk and compressed abdominal viscera, stabilizes and posterior pelvic tilt

pubofemoral ligament

-pubis to anterior surface of lesser trochanter -tightens with extension, internal rotation, abduction

Multifidus origin, insertion and location

-sacrum, PSIS -spinous process -in the middle of semispinalis and rotatores

Spinal nerves L4-S3 give rise to which nerves and what does it innervate

-sciatic nerves, emerges posterior of the pelvis (motor and sensory), largest and longest nerve in the body -innervates posterior and lateral aspects of lower extremity

What are the muscles of the deep layer of the intrinsic back muscles?

-semispinalis -multifidus -rotatores (brevis and longus)

Pelvic floor actions

-sphinteric -support -stability -sexual -sump-pump (blood and lymphatic fluid out)

What are the muscles of the intermediate layer of the intrinsic back muscles

-spinalis -longissimus -iliocostalis

Functions and actions of the anterolateral abdominal muscles

-strong expandable support for abdominal wall -protect abdominal viscera -compress abdominal contents -maintain or increase Inter-abdominal pressure -oppose diaphragm and produce expiration -move the trunk and maintain posture

Interspinales origin, insertion, innervation and action

-superior surface of spinous process of cervical and lumbar vertebrae -inferior surface of spinous process of vertebrae superior to vertebra of proximal attachment -posterior rami of spinal nerves -extension and rotation of vertebral column

Gemelli superior and inferior origin, insertion, innervation, action

-superior: ischial spine, inferior: ischial tuberosity -trochanteric fossa of femur -superior: nerve obturator internus (L5 and S1) inferior: quadratus femoris nerve (L5 and S1) -laterally rotate extended thigh, abduct flexed thigh, steady femoral head

Hip joint

-synovial ball and socket -stable, less movement than glenohumeral, deep socket

What is the transversospinalis and what is it made up of

-the muscles of the deep layer of the intrinsic back muscles -semispinalis, multifidus, rotatores (brevis and longus)

Internal oblique origin, insertion, innervation, actions

-thorico lumbar fascia, anterior 2/3rds of iliac crest, lateral half of inguinal ligament -inferior borders of 10-12 ribs, línea alba, and pubis via conjoint tendon -thoraco-abdominal nerves (anterior rami of T7-11), subcostal and first lumbar nerve -compress and support abdominal viscera, flex and rotate trunk (ipsiolateral rotation)

The sciatic nerve branches off into what two nerves

-tibial nerve -common fibular (peroneal nerve)

Levatores costarum origin, insertion, innervation, action

-tips of transverse processes of C7 and T1-T11 vertebrae -pass inferolaterally and insert on rib between tubercle and angle -posterior rami of spinal nerves -elevate ribs, assist respiration, assist lateral flexion of vertebral column

Rotatores brevis origin, insertion and location

-transverse process -one spinous process superior -deepest of the deep layer

Rotatores longus origin, insertion and location

-transverse process -one spinous process superior -deepest of the deep layer

Semispinalis origin, insertion and location?

-transverse process of C4-T12 -spinous process of C3-T11 -most superficial layer of transversospinalis

Intertransversarii origin, insertion, innervation, action

-transverse process of cervical and lumbar vertebrae -transverse process of adjacent vertebrae -posterior rami of spinal nerves -bilateral lateral flexion and stabilization of vertebral column

Diaphragm origin, insertion, innervation, actions

-xiphoid process, cartilages of ribs 7-12, anterior surfaces of lumbar vertebrae-right and left crus -central tendon that blends with the anterior longitudinal ligament -phrenic nerve C3-5 -expand thoracic cavity, compress abdominal cavity

Articular cartilage composition

1-7mm thick covering of hyaline cartilage that covers load bearing surfaces of synovial joint, made up of collagen, protein polysaccharides, and water, also has chondrocytes

Pelvic floor layers (1-3)

1. Urogenital triangle 2. Urogenital diaphragm 3. Pelvic diaphragm

Muscles of the sub occipital triangle

1. rectus capitis posterior major 2. rectus capitis posterior minor 3. obliquus capitis superior 4. obliquus capitis inferior

Tendons components

2/3 water, dry weight: collagen, proteoglycans

Ligaments composition

2/3 water, dry weight: collagen, proteoglycans, elastin, glycoproteins

How many bones in the body

206

Innervation of facet joints

3 spinal nerves: the spinal nerve at the level of the facet joint (local articular branch from dorsal ramus) and the spinal nerves above and below (ascending and descending articular branches)

Spinal nerves pairs

31 pairs; 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal

Primary ossification centers of vertebrae

3: 1 at each neural arch, 1 at centrum

Upper cervical ligaments

3: Apical (apex/top) Alar (wings) Transverse (holds dens onto anterior arch)

Cervical facet orientation

45 degrees to the horizontal

Secondary ossification centers of vertebrae

5: superior anular epiphysis, inferior anular epiphysis, one at each transverse process, at the spinous process

Thoracic facet orientation

60 degrees to horizontal and inclined medially 20 degrees

Wolff's Law

A bone grows or remodels in response to forces or demands placed upon it, direction of stresses created by the weight of the body

Trendelenberg gait

A drop of the pelvis on the side opposite of the stance leg, indicating weakness of the hip abductors and gluteus medius and minimus on the side of the stance leg; also may lean towards to weak side

Cranial nerve 6

Abducens -somatic motor -function: turn eye laterally

S1 reflex

Achilles tendon

Visceral sensory

Afferent component of autonomic reflexes and the conductors of pain impulses from internal organs

L5-S1 myotome

Ankle Inversion/Eversion

Disc herniation

Annular fibers are disrupted Starts with prolapse (nucleus to outer fibers of annulus), goes to extrusion (nucleus breaks trough and lies under posterior longitudinal ligament), moves to sequestered (free fragment of nuclear material breaks through PLL and lies free in the spinal canal)

A patient comes to your clinic with complaints. Of pain in the RLQ. What are some possible visceral pain sources?

Appendix and small intestines

force-velocity relationship

As speed of contraction increases, the force it is able to exert decreases

Lumbar vertebrae distinctive characteristics

Body: massive, kidney shaped Vertebral foramen: triangular (smallest diameter) Transverse process: long, slender Articular process: superior facets directed posted, inferior laterally, maxillary process Spinous processes: short, sturdy, thick, broad

Atlas

C1

Rectus capitis posterior minor origin and insertion

C1 posterior tubercle to medial part of inferior nuchal line

Obliquus capitis superior origin and insertion

C1 transverse process to occiput

Axis

C2

Obliquus capitis inferior origin and insertion

C2 spinous process to C1 transverse process

Rectus capitis posterior major origin and insertion

C2 spinous process to lateral part of inferior nuchal line

Amphiarthroses

Cartilaginous joints, that are slightly movable and found at the pubic symphysis

Median plane

Directly down middle of body splits person into right and left halves

C6 myotome

Elbow flexion, wrist extension, pronation

Cranial nerve 7

Facial -somatic motor and sensory -special sensory (taste) -visceral motor -function: motor to muscles of facial expression, taste anterior 2/3 of tongue, general sensation from skin of both aspects of auricle, parasympathetic innervation to salivary glands, lacrimal gland, and glands of nose and palate

Annular lamellar organization

Fibers go in different direction to stabilize movement in different directions- some fibers tighten, others slacken Fibrous outer ring made up of 6-10 circular laminate of fibrocartilage Concentric parallel collagen fibers arranged at 65 degrees

Synarthroses

Fibrous joints, that are immovable and found in the sutures of skull

C8 myotome

Finger and thumb extension and flexion

Cranial nerve 9

Glossopharyngeal -somatic motor, visceral motor, special sensory taste, somatic sensory, visceral sensory -function: motor to assist with swallowing, parasympathetic innervation to parotid gland, tympanic cavity and mastoid cells, carotid body and sinus receptors

L5 myotome

Great toe extension, hip abductors, knee flexion

Cranial nerve 12

Hypoglossal -somatic motor -function: motor to intrinsic and extrinsic muscles of the tongue

What makes up innominate osteology

Ilium, Ischium, pubis

Fryettes law

In the cervical spine side bending is coupled with rotation to the same side Ex. Right side bending produces right rotation Total rotation= 90 degrees Total sidebending= 45 degrees

Rectus sheath

Interlace aponeurosis and raps around rectus abdominis

Orientation from lateral to medial intermediate to deep back muscles

Intermediate: I love spaghetti (iliocostalis, longissimus, spinalis) Deep: Says Mama Ragu (semispinalis, multifidus, rotatores)

Orientation from lateral to medial intermediate to minor deep back muscles

Intermediate: I love spiderman (iliocostalis, longissimus, spinalis) Deep: says MJ recluctantly (semispinalis, multifidus, rotatores) Minor deep: Levitating Intermittently (in the) Inner-city (Levator Costorum, Intertransversarii, Interspinales)

C8-T1 myotome

Intrinsic hand muscles (ventral and dorsal Int)

A patient has pain in the lower back on the left side. What is a question you could ask your patient to differentiate between somatic and visceral pain?

Kidney referral- kidney disease, cancer, UTI, kidney stones. Decreased urination flow/stream, painful urination, unable to urinate

Where does the spinal cord end

L2 level, medullary cone

Trochanter

Large blunt like projection

Muscle fiber orientation of external and internal oblique

Left external oblique connects to rectus sheath helps rotate right internal oblique rotate right

Adduction

Moving toward the median plane

Isometric contraction

Muscle contracts but there is no movement, muscle stays the same length

Ilioinguinal nerve passes through what muscle

Obliques, can get trapped causing pain

Contralateral

Occurring on the opposite side of the body

Cranial nerve 3

Oculomotor, somatic and visceral motor, function: rotates eyeball superiorly, inferiorly, medially

Cranial nerve 2

Optic, special sensory vision, function:vision from retina

two layers of joint capsule

Outer (stratum fibrous) tough fibrous layer that attaches to bone via sharpey fibers. Highly innervated with proprioceptors and pain receptors Inner (stratum synovium) highly vascular, poor innervation, produces synovial fluid (hyaluronic acid)

In the sacrum s2 lines up with

PSIS

If a patient has issues with their gall bladder, then where would the PT suspect pain?

Pain in RUQ radiating posteriorly. Right neck and shoulder region

Lumbar spine function

Protects spinal cord/ nerves Supports body weight Provides rigid and flexible axis for body-pelvic and pectoral girdles Plays important role in posture and locomotion

What are the 4 abdominal quadrants?

Right upper quadrant, left upper quadrant, right lower quadrant, left lower quadrant

Inferior end of dural and arachnoid sacs

S2 or PSIS

C5 myotome

Shoulder abduction, ER, IR, elbow flexion

Special sensory

Smell (olfactory), vision, equilibrium, hearing

Cranial Nerve 1

Special sensory olfaction, function: smell from nasal mucosa of the roof of each nasal cavity

Somatic motor

Stimulate skeletal muscle

Visceral motor

Stimulate smooth muscle, modified cardiac muscle, and glands (sympathetic and parasympathetic)

Diarthroses

Synovial, freely movable and found in the shoulder joint

Vertebral foramen size of opening (biggest to smallest)

T<L<C (diameter widest) End of spinal cord at T before broken out into cada equina at L

C2 dermatome

Temple, forehead, occiput

How do reflexes work

The reflex arc takes the impulse from the sensory neuron to the spinal cord to the motor neuron - no brain involved -afferent to the spinal cord, efferent back to tendon

Somatic sensory

Transmit sensations of touch, pain, temperature, and position from sensory receptors

Cranial nerve 5

Trigeminal -three divisions (ophthalmic, maxillary, mandibular) -somatic sensory and motor -function: sensation to face, motor to muscles of mastication

Cranial nerve 4

Trochlear, somatic motor, function: turns eyeball inferiolaterally

Cranial nerve 10

Vagus -somatic motor, visceral motor, visceral sensory, special sensory taste, somatic sensory -function: motor to constrictor muscles of the pharynx and muscles of the palate, parasympathetic innervation to muscles of trachea, bronchi, digestive tract, cardiac muscle, taste from epiglottis and palate, sensation from auricle, external meatus, and posterior cranial fossa

Cranial nerve 8

Vestibulocochlear -special sensory (equilibrium and hearing) -function: vestibular sensation to position and movement of head, hearing

Labrum

a fibrocartilage disk that attaches to the rim of a ball and socket joint.

nucleus pulposus of intervertebral disc

a spherical shaped gelatinous mass composed of a network of fine collagen fibers imbedded in a mucopolysaccharide gel, receives nutrition from nutrient channels in the vertebral body

T10 dermatome

abdomen (belly button area) and mid-back

T11 dermatome

abdomen and mid back

Frontal plane movement

abduction, adduction, side flexion of trunk, elevation and depression of shoulder, radial and ulnar deviation of the wrist, eversion and inversion of the foot around a sagittal (anterior-posterior) axis

Paresthesia

abnormal sensation in absence of specific stimulation

Labrum function

adds flexibility to the edge of the socket, deepens the socket, serves as an attachment of ligaments and capsule to socket (STABILITY AND FLEXIBILITY)

Myotomes

all musculature derived from a given somite and therefore innervated by the same segmental nerve

Action of the deep layer muscles of the intrinsic back

all rotate contralateral and extend (to some degree)

Sprain

an injury to a ligament or joint capsule, forces that stretch some or all of the ligament fibers beyond their elastic limit, stretching produces a degree of rupture of ligament fibers, can occur at mid-substance and at attachment sites

Valgus

angulation of a distal segment away from the midline of the body (ankles out, knees in) (abducted)

Varus

angulation of a distal segment towards the midline of the body (ankles inward cause knees to go outward) (adducted)

6 main ligaments of the spine (lumbar)

anterior longitudinal ligament: checks ex posterior longitudinal ligament: checks fx Ligamentum flavum: checks fx and maintains disc pressure Interspinous ligament: checks flx Intertransverse ligament: checks lat flx. Supraspinous ligament: checks flx.

Anteversion

anterior or forward torsional relationship between the neck and head of femur and its shaft (pigeon toed)

Lateral rotation

anterior surface away from the median plane (external rotation)

Medial rotation

anterior surface closer to the median plane (internal rotation)

secondary ossification center

appear in the epiphysis, bone growth proceeds toward the diaphysis from each end, during growth proliferation of epiphyseal cartilage cells brings about thickening of this layer, epiphyseal plate allows diaphysis of long bone to increase in length

Synovial fluid function

assists in joint lubrication and provides nutrients to internal joint structures

Synergist

assists or works with another muscle or group of muscles to perform a movement

Gomphosis

attachment of a tooth to its socket (roots) fibrous connections hold tooth in place

posterior (dorsal)

back of body

Flexion

bending of decreasing angle

AA joint motion

biconvex rotation flexion/extension: facets rock no side bending (dens stops ball from going forward)

Condyloid joints

biplane motion, permits flexion extension abduction adduction and axial rotation ex: metacarpophalangeal joints

Saddle joints

biplane motion, permits movement in two different planes, flexion/extension in one plane and abduction/adduction in another plane, has a concave and convex shape ex: carpometocarpal joint of the thumb

Anterior to posterior lumbar vertebrae parts

body--> pedicle--> transverse process--> articular process--> lamina--> spinous process

Osteocytes

bone cells

year 1-2 of bone healing

bone remodels, becomes smooth, normal structure is restored

Central nervous system

brain and spinal cord

Osteoclasts

break down bone

Difference between rotatores brevis and longus

brevis goes up one spinous process and longus goes up 2 spinous processes

Flat bones

broad and thin with a flattened and often curved surface (ex: skull, scapulae, ribs, sternum)

Osteoblasts

build up new bone

S4-5 dermatomes

buttocks

Coccygeal dermatomes

buttocks, area of tailbone

S3 dermatomes

buttocks, genitals

S2 dermatomes

buttocks, genitals, back of thigh and calf

Week 2-6 of bone healing

callus forms (firm mass) that holds the fractured bone together. Ossification begins

endochondral bone formation/primary ossification center

cartilage model develops a periosteum and produces a ring around the bone, cells on inner surface of periosteum differentiate into osteoblasts, primary ossification center forms when blood vessel enters the cartilage model, ossification progresses from diaphysis toward each epiphysis

C 2-3 myotomes

cervical side bend and rotation

Intervertebral joints

classified as symphysis hyaline cartilage endplate IV disc holds vertebrae together Ligaments: ALL and PLL

Deep

close to center of body, deep inside

Superficial

close to skin

Irregular bones

clustered in groups and come in various size and shapes (ex: vertebrae, inner ear)

C5 dermatome

collarbone area, upper shoulders

Third degree ligament injury

complete tear and loss of function/integrity (more than 75%) or (more than 10mm) severe sprain

OA joint movement

convex/concave flexion: chin tuck, joint slides posterior extension: jaw thrust, joint slides anterior some side bending and rotation

One joint muscles

cross one joint, produce movement around 1 joint. ex: soleus (crosses only the ankle)

Two joint muscle

crosses two joints, produce movement around 2 joints. example: gastrocnemius (knee and ankle)

Short bones

cube or box shaped (ex: carpals, tarsals)

Transverse section

cut made in horizontal plane into upper and lower parts

Long bones

cylindrical shape that is longer than it is wide with enlarged ends that articulate with other bones (ex: femur, humerus, radius, ulna, tibia, fibula, metacarpals, metatarsals, phalanges)

Periosteum

dense white fibrous membrane welds to inner bone, anchors muscle to bone and allows tendons to interlace, outer layer is fibrous (strong fascia), inner is loose and contains osteogenic type cells that aid in bone reconstruction, formation and lysis of bone

Two possible sources of paresthesia

dermatome, peripheral nerve distribution

Sesamoid bones

develop in the tendons close to joints for leverage and to protect the tendon (ex: patella)

Oblique section

diagonal cut

Innervation of the muscles of the suboccipital triangle

dorsal ramus of C1 (suboccipital nerve)

Dermatomes

each spinal nerve carries sensory info from a specific region of the body. =area of skin innervated by fibers of a single spinal nerve

elastic cartilage composition

elastic and collagen fibers

C7 myotome

elbow extension, wrist flexion

Groove

elongated depression or furrow

Epicondyle

eminence superior to the condyle

Clinical anatomy

emphasizes relationship between structure and function

Closed chain

end or distal segment is not free (fixed)

open chain

end, or distal segment is free

Sutures

essentially immovable (ex:cranial sutures)

Action of the muscles of the sub occipital triangle

extend head on C1 or rotate c1 on C2

When lower cervical spine extends

facet closes, glides down and back

When lower cervical spine flexes

facet opening, glide up and forward

Pennate muscles

feather like, greater force producing capability

Radiate/flat muscles

fibers fan out from a single attachment ex: gluteus medius, pectorals major/minor

Bipennate

fibers oblique to central tendon on both sides ex: rectus femoris

Symphysis

fibrocartilage uniting two bony surfaces (ex: pubic symphysis, between vertebral bodies)

Joint capsule definition

fibrous tissue surrounding a joint

Origin

fixed or proximal attachment

"-ed" and "-us"

fixed positions (pronated)

Action of the 5 deep cervical spine muscles

flex the neck, stabilize the neck

Sagittal plane movement

flexion, extension, hyperextension, dorsiflexion, plantarflexion around a frontal (media-lateral) axis

Thoracic motion

flexion: facets glide up and forward extension: facets glide down and back side bending (lateral flexion) rotation (R/L)

Anterior (ventral)

front surface of body

Month 6-12 of bone healing

gaps at cortical edges are bridged

Inorganic salts

gives hardness and rigidity of extracellular matrix of bone, phosphate and calcium (85%)

Plane joints

gliding or sliding motion between two flat surfaces ex: AC joint, zygoapophyseal (facet) joints

Fusiform

have fascicles that may be close to parallel in the center or "belly" of the muscle but converge to a tendon at one or both ends

C 1-2 myotomes

head nodding (occipital-Atlantal motion)

Modified hinge joints

hinge type joint with rotation, permits flexion extension and rotation ex: knee

L2-3 myotome

hip adduction

L1-2 (L3) myotome

hip flexion

Organic matrix

hold and maintains, collagen fibers, support and sustain living cells

Fossa

hollow or depressed area

Transverse plane

horizontal planes dividing into upper and lower portions

Synchondroses

hyaline cartilage uniting two bony surfaces (ex: epiphyseal growth plate, rib and sternum -sternocostal joint)

Ligaments of the hip joint

iliofemoral, pubofemoral, ischiofemoral

Intermediate

in between deep and skin

Functional unit

includes the intervertebral disc and 1/2 of the adjacent superior and inferior vertebrae

Notch

indentation at the edge of a bone

Strain

injury to a contractile unit (muscle or tendon)

Labrum components

inner surface is coated with synovium and the outer surface blends to capsule

Central nervous system functions

integrate incoming and outgoing neural signals, control center for higher mental function

structures of synovial joints

joint capsule, joint cavity, synovial membrane, synovial fluid, articular cartilage

L3-4 myotome

knee extension

Tuberosity

large rounded elevation

Line

linear elevation

White matter

long tracts

Types of bones

long, short, irregular, flat, sesamoid

Anesthesia

loss of sensation (partial or full)

T12 dermatome

lower abdomen and mid back

S1 dermatomes

lower back, back of thigh, back and inside of calf, last toe

L2-3 dermatome

lower back, front and inside of thigh

L5 dermatome

lower back, front and outside of calf, top and bottom of foot, first 4 toes

L4 dermatome

lower back, front of thigh and calf, area of knee, inside of ankle

L1 dermatome

lower back, hips, groin

C4 dermatome

lower neck, upper shoulders

Blood supply to vertebral body

lumbar artery branches including nutrient arteries

Synovial fluid composition

made up of plasma proteins and hyaluronic acid (no blood in synovial fluid), color is clear to pale yellow

Spinal nerves components

made up of ventral and dorsal root, has a ventral and dorsal rami

Diaphysis definition and purpose

main shaft-like portion hollow, cylindrical shape and thick compact bone provides for strong support, gives length

week 12-26 of bone healing

mature callus

L5 reflex

medial hamstring and tibialis posterior

Fibrocartilage examples

meniscus, intervertebral disks, labrum

T5-7 dermatome

mid-chest and back

Spinal nerve

mixed motor and sensory

Insertion

mobile or distal attachment

Dorsal rami

motor and sensory to the back

Ventral rami

motor and sensory to the limbs

ventral root

motor neurons

"-ing" and "-ion"

movements or motions (pronating)

Abduction

moving away from the median plane

Quadrate/long

muscle fibers are parallel with 4 equal sides (RA between tendon intersections)

Eccentric contraction

muscle lengthens

Components of muscle architecture

muscle-->fascicle-->muscle fiber-->myofibril-->sarcomere (actin, myosin)

System anatomy

musculoskeletal, neurological, cardiopulmonary, integumentary, etc.

Gray matter

nerve cell bodies and inter-neurons

Innervation

nervous supply to a muscle

Nutritional supply in articular cartilage

no blood or nervous supply, nourishment comes from synovial fluid, blood supplied to deep zone from the bony endplate, nutrients pass into cartilage via diffusion, compression and distraction exchange nutrients (MOVEMENT), lack of compression or prolonged compression can lead to AC degeneration and/or death

Elastic cartilage location

nose and ear

Tear in wall of annulus

nuclear material migrates up, if it goes to far it will herniate or break out

Intervertebral disc parts

nucleus pulposus annulus fibrosus cartilaginous end plates

Ipsilateral

occurring on the same side of the body

bilateral

on both sides

unilateral

on one side

Antagonist

opposite of the agonist (when agonist is contracted, antagonist relaxes)

Unipennate

origin from a large area of bone, fibers oblique to central tendon ex: tibias anterior

Multipennate

origin from a large area of bone, multipennate muscle converge on a common origin ex: deltoid

structural unit of compact bone

osteon or haversian system, unit of compact bone tissue made up of a tapered cylinder with layered, concentric arrangements of calcified matrix and cells around a central canal for nerves and blood vessels

Second degree ligament injury

partial tearing with some loss of function/integrity. (25-75%) or (5-10mm) moderate sprain

Foramen

passage through a bone

L3 reflex

patellar tendon

L4 reflex

patellar tendon

Lumbar spine joints

plane synovial joints (2 superior 2 inferior) which permits gliding and resists rotation (when rotating left, gap on left facets, right facets come together) Zygapophyseal joints (facet joints)

S1 myotome

plantarflexion

Retroversion

posterior or backward torsional relationship between the neck and the head of the femur and its shaft (toe out, "duck walk"

Nerve supply for intermediate layer intrinsic back muscles

posterior rami of spinal nerves

Agonist

prime mover

Red marrow

produces red blood cells

Protuberance

projection of bone

elastic cartilage function

provides a matrix for definition, resists deformation by repeated movements (better reception, allows us to move and breath)

Epiphysis definition and purpose

proximal and distal ends of a long bone Provides space near joints for muscle attachments and gives stability to joints

Muscles of the abdominal wall

rectus abdominis, external oblique, internal oblique, transverse abdominis

What is the group of deep cervical spine muscles

rectus captious anterior, captious lateralis, longus capitus, longus colli, scalene

Metaphysis

region between the epiphyses and diaphysis (in a mature bone)

3 main approaches of anatomy

regional, system, clinical

length-tension relationship

resting length of a muscle and the tension it can produce at that length

Thoracic extension and rib motion

ribs move up and out

Thoracic flexion and rib motion

ribs rotate downward and in

Bones in adult that still contain red marrow

ribs, bodies of vertebrae, ends of the humerus, pelvis, femur

Crest

ridge of bone

Transverse plane movement

rotation, internal, external rotation, horizontal adduction and abduction, pronation and supination around a vertical axis

Condyle

rounded articular area

Malleolus

rounded process

Ligaments function

run from one bone to another, stabilizer of joint complex, guides movement

Tendons function

run muscle to bone or muscle to muscle, transmit tensile force from muscle to bone, dynamic stabilizer of joint complex

SC joint is what type of joint?

saddle joint

Frontal plane movement rotates about which axis

sagittal axis

Lumbar facet orientation

sagittal plane (90 degrees to horizontal) and 45 degrees outward

Dorsal root

sensory

Dorsal root ganglion

sensory nerve cell bodies

Concentric contraction

shortening of muscle

C 3-4 myotomes

shoulder elevation

C6 dermatome

shoulders, outside of arm, thumb

Fusiform and quadrate/long

significantly shorten (50%) and result in large bone movements and speed

Inferior (caudal)

situated near soles of feet

superior (cranial)

situated near the top of the skull

Axial skeleton

skull, vertebral column, ribs and sternum (80 bones)

Syndesmoses

slightly moveable (like the tibiofibular joint), in which fibrous bands connect two bones

Tubercle

small raised eminence

facet

smooth flat area, usually articulates with another bone

functions of articular cartilage

smooth out irregular bony contours, load distribution, resists repetitive loading and shearing forces, low coefficient of friction=superb gliding surface

Bone marrow

soft connective tissue called myeloid, site for production of blood cells, found in medullary cavities of certain long bones and spaces of spongy bone

week 6-12 of bone healing

solid bony ossification occurs across the fracture site (bridge), bone regains strength at this time (normally when the cast is taken off)

Peripheral nervous system

somatic nervous system and autonomic nervous system

First degree ligament injury

some fiber disruption or stretch with little or no loss of function (0-25%) or (0-5mm) mild sprain

function of fibrocartilage

space fillers, increase congruency, shock absorbers, improve weight distribution, decrease point force

Peripheral nerve distribution

specific area of skin innervated by a peripheral nerve

Cranial nerve 11

spinal accessory -somatic motor -function: motor to sternocleidomastod and trapezius muscles

Spinous process

spine like projection

What are the two intrinsic superficial back muscles (splenius group)

splenius capitis and splenius cervicis

Significant difference between splenius capitis and splenius cervicis?

splenius capitis goes to head and splenius cervisis goes to transverse process

Spondolysis vs spondylothesis

spondolysis: fracture spondylothesis: slipping of vertebrae

Anatomical position

standing erect, head eyes and toes directed anteriorly, upper limbs by the sides with palms anteriorly, lower limbs together with feet directed anteriorly

Extension

straightening or increasing angle

Compact/cortical/cortex

superficial layer of bone, bony layers closely packed, strength for weight bearing, allows for rigid attachments of ligament and muscle, thickest in middle of long bone, shaft of bone filled with yellow marrow (fat storage)-medullary cavity

3 layers of intrinsic back muscles

superficial, intermediate, deep

four zones of articular cartilage

superficial, middle, deep, calcified superficial parallel with joint gliding and deep perpendicular with joint gliding

What muscles make up the triceps coxae

superior gemellus, obturator internus, inferior gemellus

Three types of fibrous joints

sutures, syndesmoses, gomphoses

autonomic nervous system

sympathetic (fight or flight) and parasympathetic (return to resting)

2 types of cartilaginous joints

synchondroses and symphyses

Action

the action the muscle performs

Pars interarticularis

the area between the superior and inferior articulations of the vertebrae (lamina and pedicle)

disc protrusion

the disc bulges posteriorly without rupture of the annulus fibrosus, may be confined to one side or bilateral (localized annular bulge and diffuse annular bulge)

Epiphyseal plate

the region between the epiphysis and diaphysis (in a growing bone) cartilage growing plate Epiphyseal line forms=no more growth

Trabeculae

thin beams or branch like threads of bone tissue that supports red bone marrow

Endosteum

thin fibrous membrane that lines the medullary cavity and spaces of spongy bone, formation and lysis of bone

Spine

thorn like process of bone

examples of synovial joints

tibia-femoral, glen-humeral

Regional anatomy

topographical/surface anatomy

Articular disc of distal ulna

transmit forces between radius and ulna

Ball and socket joint

triplanar motion, permits flex/ex/add/ab/IR/ER, more shallow=move movement=less stability ex: glenohumeral joint, hip articulation

Fibrocartilage composition

type 1 and 2 collagen

Hinge joints

uniplanar motion that permits flexion and extension ex: humero-ulnar joint, interphalangeal joints of fingers and toes

Pivot joints

uniplanar rotation, permits pure rotation or spin ex: atlantoaxial joint, proximal radio-ulnar joint

dysesthesia

unpleasant or abnormal sensation

T8-9 dermatome

upper abdomen and mid-back

Appendicular skeleton

upper and lower limbs and their associated proximal partners (126 bones)

C7 dermatome

upper back, back of arm, pointer and middle finger

C8 dermatome

upper back, inside of arm, ring and little finger

T2, 3, 4 dermatome

upper chest and back

T1 dermatome

upper chest and back, armpit, front of arm

C3 dermatome

upper neck, back of head

Movement in transverse rotates about which axis

vertical axis

Longitudinal section

vertical line splits into left and right portions

Coronal (frontal) plane

vertical planes divides front/back portions

Sagittal plane

vertical planes parallel to median plane

Yellow marrow

with age, the red marrow is replaced with adipose tissue and becomes yellow (that can revert if needed)

Week 1-2 of bone healing

wound site filled with blood, ends of fractured bones become necrotic. Blood clot (hematoma) is invaded with macrophages (removal of necrotic tissues) and osteoblasts (produce bone)


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