Applied Clinical Anatomy Section 1
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)