AXIS OF MOVEMENT BONES LIGAMENTS TENDONS

Planes of movement
Frontal plane - move around sagittal (left and right) axis - lateral flexion abduct
adduct
Sagittal plane - move around horizontal (up and down flexion touch toes extension)
axis
Transverse (horizontal plane) - airplane twist move around vertical axis - horizontal
abduction adduction, rotation of whole trunk left right, internal external rotation of
hips and shoulders

Muscle groups relative to joints

shoulder adductors - below joint (frontal plane)
shoulder abductors - above joint (frontal plane)
flexors are in front of joint (sagittal plane)
extensors are behind joint (sagittal plane)
internal rotators are anterior to joint when supine
external rotators are posterior to joint when supine (horizontal plane)

Definitions
all connective tissue - bone ligament cartilage tendon skin fat blood fascia
tendon - muscle insertion
ligament - bone to bone at joints
cartilage - buffers between joints, forms model for bony growth, covers bone ends

Forces on tissue
tension - distractive - pull on tissue
compression - compressive (push together connective tissue)
shear - simultaneous forces at right angles to the connective tissue (hit from side
while bent over)

About Bones
bone - more collagen than elastic 60% water
withstands compression better than tension

intramembranous ossification - mesenchyme ossifies in fetal period (skull)

endochondral - cartilage replaced by bone

Types of Bones
long bones - tubular (humerus phalanges)
short bones - cuboidal only in tarsus and carpus
flat bones - protective (cranium sternum)
sesamoid - patella - develop in tendons - protect tendons from excessive wear
irregular - ex vertebra cranium
condyle - rounded particular area (related to joints)
epicondyle - eminence superior to condyle
crest - ridge (iliac crest)
line - less prominent than crest
facet - smooth flat cartilaginous surface where bones articulate to another bone
(articular facets of vertebra)
spine - sharp pointed slender
process - projecting spine like part (typhoid or spinous process)tuberosity - large
round, roughened (ischial tuberosity)
foramen - passage through a bone
fossa - hollow or depressed area (infraspinous fossa of scapula)
tuberosity - large rounded elevation (ischial tuberosity)
trochanter - larger blunt process (only the greater trochanter of femur)
tubercle - small raised eminence (greater tubercle of humerus)
protuberance - projection of bone (occipital protuberance of cranium)
malleolus - rounded prominence (lateral malleolus of fibula
notch - greater sciatic notch in posterior border of hip bone)

3 cartilage types
white fibrocartilage - intervertebral discs, labrum - little motion, mostly collagen -
meniscus
yellow elastic cartilage - ears epiglottis - mostly elastin, recoils
hyaline articular cartilage - covers bone ends in synovial joints - articular and costal
cartilages - smooth and more glycoproteins

ligaments - more collagen than elastin - resist forces in all directions

tendons - most vulnerable at insertions resist high unidirectional directional force,

susceptible to shear

connective tissues viscoelasticity

elastic - ability to return to original state following deformation of shape/length
viscosity - ability of material to dampen shearing forces
elastic region deforms temporarily, plastic region permanently even after load
removed, worst tissue ruptures avulses or fractures

joints - need stability (braced with capsule ligaments tendons) to have mobility
(synovial fluid cartilage wedges)

2 joint categories

1 synarthroses - fibrous joints and cartilaginous joints - bones directly joined by

connective tissue cartilage or bone ('false') low to moderate movement
fibrous joints (synarthrosis) - suture, gomphosis (peg and socket), syndemosis
(bones joined by a ligament cord or membrane)
cartilaginous joints (synarthrosis) - symphysis (discs or plates - pubic and IV discs)
synchondrosis (parts of bone joined by hyaline growth cartilage (epiphyseal plate in
long bones, 1st sterocostal)

2 diarthroses - synovial - joined through mediation of a capsule with moderate to

maximal movement ('true) cavity capsule ligament
joint capsule formed of fibrous tissue, cavity contains synovial fluid, hyaline
cartilage covers the joint surface

Joint axis movement

1 axis of movement (hinge - finger) (pivot - movement in horizontal plane ring
within ring dens and atlas of C1 C2)
2 axis of movement (condyloid - concave convex slide. metacarpal phalangeal joint
of finger saggital flex/ext and front abd/add)
(saddle - each surface concave/convex in one direction - carpometcarpal joint of
the thumb)
3 axis of movement (plane - slide glide minimal movement between surfaces (like
b/w tarsal bones or carpal bones)
(ball and socket - maximal movement all directions - gleno-humeral and hip joint)

Hilton's law - nerves supplying a joint also supply muscles moving to the joint or
skin covering their attachments

closed kinematic chain - joints interdependent - diesel end of joint linkage (limb) is
fixed, predictable motion
open chain - limb is free, motion in various ways, joints may function independently
or in unison

arthrokinematics - 1 joint surface in relation to another - roll slide or spin -

combining these motions keeps joint surfaces intact and increases ROM
closed pack position - taut congruent joint surfaces - usual at extreme of ROM little
joint play (elbow knee IP extension)
open pack position
loose pack - joint surfaces free to move in relation lax structure

joint play - non voluntary movement of one articular surface on another

osteoarthritis - cartilage becomes less effective as shock absorber and lubricant

degenerative joint disease decreased capture space
VERTEBRAE AND BACK MUSCLES

# vertebrae from cervical to sacral - 7 12 5 5 4

Vertebral body and arch

Transverse and spinous processes - muscle attachments and movement
Articular processes - restriction of movement
Cervical vertebrae – wide body triangular foramen
Thoracic vertebrae - costal facets - spinous process angles downward 'shingles' -
limits T extension
Lumbar vertebrae – short thick processes to hold load of muscles of whole body
sacrum - 5 fused vertebrae
Increased weight - pregnancy obesity - exaggerates lordosis

IV Disks
Intervertebral disks- concentric lamella at right angles - fibrous layer annulus
fibrosus - attached to the bone - nerve supply
Gelatinous central mass - nucleus pulses - through diffusion from bone - no nerve
supply
Pressure can push disk out and pressure nerves in foramen

herniation - tear in wall of annulus - disk doesn't actually 'slip'

Ligaments
posterior long ligament - C2 - sacrum - thinnest in lumbar and vulnerable to hyper
flexion - not visible w/o removing vertebral arch
'taut' - stretched and holding load

anterior long ligament – thickest in lumbar

C7 - vertebral prominence - above that shorter processes - nuchal ligament 'fills' the
space' right in center - many muscles attach to it

Supraspinous ligament - connects tips of spinous processes - connects all spinous

processes one to another up to C7 where nuchal takes over

ligaments flavum - inside vertebral canal between the lamina 'yellow'

C1 no vertebral body - its remnant is the dens - C1 spins around dens

Sympheses - joints b/w discs and bodies - from C2 to S1 (23 total)

Zygapophyseal joints - superior and inferior process of adjacent articular vertebrae

at arch - facet joints - plane synovial joints
bear weight in lumbar and cervical
Osteoarthritis impinges nerves at these facets
C1 and occ condyles - atlanto-occipital joint - mostly flex extend yes
C1-2 atlanto-axis - mostly rotational nodding no

Costovertebral connection at facets superior and transverse to each vertebrae

SI joint - reinforced by A and P ligament - way for bodyweight to transfer from trunk
to hips -taut no functional movement - pregnant hormone relaxes ligaments -
ambulation unstable - widen pelvis

BACK MUSCLES

intrinsic muscle attachments are within the spinal column

Origin - proximal / Insertion - distal

Intrinsic -

superficial - splenius (bandage)

Intermediate - erector spinae - medial - spinalis - more lateral longissimus

Deep - transverospinal

Extrinsic muscles of back - from vertebral column to upper limb

extrinsic back superficial

Upper trap - fibers medial to lateral to post scapular spine and acromion
middle table - from scapular spine to spinous processes - retract scap
lower trap - down from medial spine of scapula

glenoid fossa - golfball on a tee - beyond 90 degrees scapula upward and downward
rotates

synergistic upper trap and lower - elevation and depress to rotate scapula upward
to raise arms - all one nerve

latissimus dorsi (widest of the back) - push out of chair, push down on walker to
hop forward - do pull up - attach to anteriomedial humerus

levator scapulae – raise shoulder blades

Dorsal scapular nerve - from brachial plexus high in tech innervate elevator scapula
- elevation and downward rotation
rhomboid major below minor - also innervated by dorsal scapular nerve - holds
scapula against thoracic wall - retracts and down hardly rotators

extrinsic back intermediate –

serrates posterior superior (inspiration) and inferior (expiration) - proprioceptive
only

intrinsic

superficial splenius captious and crevices

spinalis - from spinous process to spinous process -

rami exit b/w illiicostalus and longissimus (then spinalis most medial)

eccentric vs x movement

deep - transversospinalis - arise from transverse processes of vertebra and pass up

to spinous processes

Rotatores spans 1-2 segments

Multifidus spans 2-4 segments
Semispinalis spans 4-6 segments

semispinalis (capitis, cervicis, thoracic)

mutifidus (most highly developed in lumbar) short triangular

rotators - most developed in thoracic (where most rotation happens)

cervical and lubralsacral enlargement larger than thoracic

spinal cord cross section

gray inner matter - butterfly nerve cell bodies
with outer matter - nerve fibers that carry info CNS
dorsal horn - sensory takes input (trough primary dorsal rami into dorsal horn)
moves to
ventral horn - motor - combine together at spinal nerve - split into dorsal and
ventral rami (both mixed sensory and motor) (ventral much larger)

C1-C7 nerves - exit superior

C8 level spinal nerve - exits inferior (so 8 C nerves only 7 C vertebrae)
all rest down spine exit inferior - below spinal cord have to travel long distance to
exit via caudal equine
more space in L345 for needle insertion without hitting spinal cord once spinal cord
ends (cord tapers off at conus medullar is

spinal cord ends b;/w L1 and L2

3 layers covering spinal cord

dura mater - protective outer - sleeves that exit and cover nerve root
arachnoid - inner spider web
pia mater - covering of spinal cord itself - continues beyond cord down column as

dorsal rami feeds intrisic muscles

trap served by spinal accessory nerve
ventral rami serves extrinsic muscles
ventral root motor
dorsal root sensory