Anatomy, Physiology, Kinesiology

ANATOMY, PHYSIOLOGY, KINESIOLOGY
Prepared By: Floriza P. de Leon, Click to edit Master subtitle style PTRP
Biomechanics
Biomechanics - study of body mechanics, as it relates to the functional and anatomical analysis of biological systems and especially humans
Necessary to study the bodys mechanical characteristics & principles to understand its movements
Manual of Structural
Basic Biomechanical Factors & Concepts
23-2
Biomechanics
Mechanics - study of physical actions of forces Mechanics is divided into

Statics Dynamics
33-3
Biomechanics
Statics - study of systems that are in a constant state of motion, whether at rest with no motion or moving at a constant velocity without acceleration
Statics involves all forces acting on the body being in balance resulting in the body being in equilibrium
43-4
Biomechanics
Dynamics - study of systems in motion with acceleration
A system in acceleration is unbalanced due to unequal forces acting on the body
53-5
Biomechanics
Kinematics & kinetics
Kinematics - description of motion and includes consideration of time, displacement, velocity, acceleration, and space factors of a systems motion Kinetics - study of forces associated with the motion of a body
63-6
Types of machines found in the body
Musculoskeletal system may be thought of as a series of simple machines
Machines - used to increase mechanical advantage Consider mechanical aspect of each component in analysis with respect to components machine-like function
73-7
Machines function in four ways

balance multiple forces enhance force in an attempt to reduce total force needed to overcome a resistance enhance range of motion & speed of movement so that resistance may be moved further or faster than applied force alter resulting direction of the applied force
83-8
Musculoskeletel system arrangement provides for 3 types of machines in producing movement

Levers (most common) Wheel-axles Pulleys
93-9
Levers
Humans move through a system of levers lever - a rigid bar that turns about an axis of rotation or a fulcrum axis - point of rotation about which lever moves Levers cannot be changed, but they can be utilized more efficiently
103-10
Levers
Levers rotate about an axis as a result of force (effort, E) being applied to cause its movement against a resistance or weight In the body bones represent the bars joints are the axes muscles contract to apply force
113-11
Levers
Resistance can vary from maximal to minimal May be only the bones or weight of body segment All lever systems have each of these three components in one of three possible arrangements
123-12
Levers
Three points determine type of lever & for which kind of motion it is best suited Axis (A)- fulcrum - the point of rotation Point (F) of force application (usually muscle insertion) Point (R) of resistance application (center of gravity of lever) or (location of an external resistance)
133-13
Levers
1st class lever axis (A) between force (F) & resistance (R) 2nd class lever resistance (R) between axis (A) & force (F) 3rd class lever force (F) between axis (A) & resistance (R)
143-14
Levers
FAR 1st ARF 2nd AFR 3rd
|
F
Force Arm
||
Resistance Arm
R
| Resistance Arm | | Force Arm

R A
|
F
| |
Force Arm
Resistance Arm
F R 153-15
First-Class Levers
Produce balanced movements when axis is midway between force & resistance (e.g., seesaw postural mm, atlanto-occipital jt.) Produce speed & range of motion when axis is close to force, (triceps in elbow extension) Produce force motion when axis is close to resistance (crowbar)
Basic Biomechanical Factors & Concepts 163-16
First-Class Levers
Head balanced on neck in flexing/extending Agonist & antagonist muscle groups are contracting simultaneously on either side of a joint axis agonist produces force while antagonist supplies resistance
173-17
First-Class Levers
Elbow extension in triceps applying force to olecranon (F) in extending the non-supported forearm (R) at the elbow (A)
183-18
First-Class Levers
Force is applied where muscle inserts in bone, not in belly of muscle Ex. in elbow extension with shoulder fully flexed & arm beside the ear, the triceps applies force to the olecranon of ulna behind the axis of elbow joint As the applied force exceeds the amount of forearm resistance, the elbow extends
193-19
Second-Class Levers
Produces force movements, since a large resistance can be moved by a relatively small force Wheelbarrow Nutcracker Loosening a lug nut Raising the body up on the toes
203-20
Second-Class Levers
Plantar flexion of foot to raise the body up on the toes where ball (A) of the foot serves as the axis as ankle plantar flexors apply force to the calcaneus (F) to lift the resistance of the body at the tibial articulation (R) with the foot Relatively few 2nd class levers in body
213-21
Third-Class Levers
Produce speed & range-of-motion movements Most common in human body Requires a great deal of force to move even a small resistance

Paddling a boat Shoveling - application of lifting force to a shovel handle with lower hand while upper hand on shovel handle serves as axis of rotation
Basic Biomechanical Factors & Concepts 223-22
Third-Class Levers
Biceps brachii in elbow flexion Using the elbow joint (A) as the axis, the biceps brachii applies force at its insertion on radial tuberosity (F) to rotate forearm up, with its center of gravity (R) serving as the point of resistance application
233-23
Third-Class Levers
Brachialis - true 3rd class leverage

pulls on ulna just below elbow pull is direct & true since ulna cannot rotate
Biceps brachii supinates forearm as it flexes so its 3rd class leverage applies to flexion only Other examples
hamstrings contracting to flex leg at knee while in a standing position using iliopsoas to flex thigh at hip
243-24
Factors in use of anatomical levers
Anatomical leverage system can be used to gain a mechanical advantage Improve simple or complex physical movements Some habitually use human levers properly Some develop habits of improperly use human levers
253-25
Torque and length of lever arms
A, If the force arm and resistance arm are equal in length, a force equal to the resistance is required to balance it, B, As the force arm becomes longer, a decreasing amount of force is required to move a relatively larger resistance, C, As the force arm becomes shorter an increasing amount of force is required to more a relatively smaller resistance
Manual of Structural Basic Biomechanical Factors & Concepts 263-26
Human leverage system is built for speed & range of movement at expense of force Short force arms & long resistance arms require great muscular strength to produce movement Ex. biceps & triceps attachments

biceps force arm is 1 to 2 inches triceps force arm less than 1 inch
273-27
Human leverage for sport skills requires several levers
throwing a ball involves levers at shoulder, elbow, & wrist joints
The longer the lever, the more effective it is in imparting velocity
A tennis player can hit a tennis ball harder with a straight-arm drive than with a bent elbow because the lever (including the racket) is longer & moves at a faster speed
283-28
Long levers produce more linear force and thus better performance in some sports such as baseball, hockey, golf, field hockey, etc.
293-29
For quickness, it is desirable to have a short lever arm
baseball catcher brings his hand back to his ear to secure a quick throw sprinter shortens his knee lever through flexion that he almost catches his spikes in his gluteal muscles
303-30
Studying Kinesiology (Cont.)
The forces affecting motion (gravity, muscle tension, external resistance, and friction) are never seen and seldom felt. Kinematics is the science of the motion of bodies in space. Osteokinematics is concerned with movements of bones Arthrokinematics addresses the movements occurring between joint surfaces.
Describe the anatomical position? Identify the cardinal planes and axis.
Planar classification of position and motion (osteokinematics)
Figure 1-2
Identify the position of the hip.
Planar classification of position and motion (osteokinematics)

Frontal plane abduction and adduction Sagittal plane flexion and extension Horizontal plane internal/external rotation pronation/supination Special cases radial/ulnar deviation dorsi-/plantar flexion. Goniometry (Gr. gonia, angle, and metron, measure)
Differentiate arthrokinematics and osteokinematics
Application of Goniometer
Summary Range of Joint Motion (Cont.)
Normal End-Feel
l
When a normal joint is moved passively to the end of its range of motion, resistance to further motion is felt by the examiner The resistance is also called physiological end-feel
What are the types of end feel?
Rotary and Translatory Motion

l
Movements are described as occurring around an axis or a pivot point, identified by mechanical terms as rotary motion, angular motion, or rotation Translatory motion is used to describe movement of a body in which all of its parts move in the same direction with equal velocity
Degrees of freedom
l l
Joints that move in one plane possess one axis and have one degree of freedom If a joint has two axes, the segments can move in two planes, and the joint is said to possess two degrees of freedom motion Ball-and-socket joint such as the hip joints, which permit flexion-extension, abduction-adduction, and transverse rotation, are said to possess three degrees of freedom
Identify the degrees of freedom of the following Elbow Knee Ankle MCP PIP
Kinematic chain
l l
A combination of several joints uniting successive segments constitutes a kinematic chain Distal segments can have higher degrees of freedom than do proximal ones
Open and closed kinematic chains

l
In an open kinematic chain, the distal segment of the chain moves in space whereas in a closed kinematic chain, the distal segment is fixed, and proximal parts move (Steindler,1995) In the upper extremity, open-chain motion occurs when reaching or bringing the hand to the mouth, and closed-chain motion occurs when performing a chin-up
Explain how does a chinup became a closed kinematic chain
Arthrokinematics
l
Arthrokinematics is concerned with the movement of the articular surfaces in relation to the direction of movement of the distal extremity of the bone (osteokinematics)
Ovoid joint surfaces

l
The ovoid articular surfaces of two bones from a convex-concave paired relationship
Sellar joint surfaces

l
Joints have both convex and concave surface on each articulating bone
Movement of joint surfaces

l l l
Rolling or rocking Sliding or gliding Spinning
Convex-Concave Relationships
Convex-concave principles. l Convex joint surfaces move in the opposite direction to the bone segment l Concave articular surfaces moves in the same direction as the bone segment
Close-packed Position
l l l
The ovoid surfaces of joint pairs match each other perfectly in only one position of the joint. This point congruency is called the close-packed position In this position, (1) the maximum area of surface contact occurs, (2) the attachments of the ligaments are farthest apart and under tension, (3) capsular structures are taut, (4) the joint is mechanically compressed and difficult to distract
Open-packed Position
l
In all other position, the ovoid joint surfaces do not fit perfectly but are incongruent and called openpacked, or loose-packed
Close-packed Position
l
The close-packed position usually occurs at one extreme in the range of motion. This is in full extension at the elbow, wrist, hip, and knee; dorsiflexion at the ankle; and flexion at the metacarpophalangeal joints
Accessory Motions
l
In addition to angular motions such as flexion or abduction, joint surfaces can be moved passively a few millimeters in translatory motion. These small motions called accessory movements or joint play
Clinical Applications
l l l
Joint mobilization techniques Normally, ligament and capsular structures limit passive accessory motions in open-packed positions. Has been severed or stretched out, the accessory motion that the ligament controls will be excessive or hypermobile.
Classification of joints
1. Immovable 2. Slightly movable 3. Movable
IMMOVABLE JOINT
SLIGHTLY MOVABLE JOINT

HIP BONE
MOVABLE JOINT
I. Gliding Joint II. Ball and socket Joint III. Hinge Joint IV. Pivot Joint
I. GLIDING JOINT
The first kind of joint is called a gliding joint. Gliding joints are found in our wrists, ankles, and backbone. Gliding joints do what they say: they glide past one another, and help us move those body parts.
Carpals
II. BALL AND SOCKET
Hip joint, Arm joint
III. HINGE JOINT
These joints move up and down in one direction, like a door opening and closing. This type of joint can be found in our fingers, elbows, and knees. Move these joints in your body.
A hinge joint allows extension and retraction of an appendage
IV. PIVOT JOINT
Move your neck from side to side. Can you feel how a pivot joint moves? Joint between 1st and 2nd neck vertebrae. This type of joint lets bones roll over each other, like in our forearms and neck.
Hyoid bone the only jointless bone

A small, U-shaped bone situated centrally in the upper part of the neck, beneath the mandible but above the larynx near the level of the third cervical vertebra.
The hyoid is (uniquely in the vertebrate skeleton) not joined to any other bone but is suspended by the stylohyoid ligaments from the styloid process of each temporal bone at the base of the skull. It is formed from three separate parts the body, and the left and right greater and lesser cornu (horns) which fuse in early adulthood. The function of the hyoid is to provide an anchor point for the muscles of the tongue and for those in the upper part of the front of the neck.
The hyoid bone can be felt by pressing one's finger into the crease where the chin becomes the neck.
Introduction
Muscular system consists of three muscle types: cardiac, smooth, and skeletal Skeletal muscle most abundant tissue in the human body (40-45% of total body weight) Human body has more than 430 pairs of skeletal muscle; most vigorous movement produced by 80 pairs
Muscle Structure
Structural unit of skeletal muscle is the multinucleated muscle cell or fiber (thickness: 10-100 m, length: 1-30 cm Muscle fibers consist of myofibrils (sarcomeres in series: basic contractile unit of muscle) Myofibrils consist of myofilaments (actin and myosin)
MicroscopicMacroscopic Structure of Skeletal Muscle
Muscle Structure (continued)
Composition of sarcomere Z line to Z line ( 1.27-3.6 m in length) Thin filaments (actin: 5 nm in diameter) Thick filaments (myosin: 15 nm in diameter) Myofilaments in parallel with sarcomere Sarcomeres in series within myofibrils
Motor unit Functional unit of muscle contraction Composed of motor neuron and all muscle cells (fibers) innervated by motor neuron Follows all-or-none principle impulse from motor neuron will cause contraction in all muscle fibers it innervates or none
Size Principle

Smallest motor units recruited first Smallest motor units recruited with lower stimulation frequencies Smallest motor units with relatively low levels of tension provide for finer control of movement Larger motor units recruited later with increased frequency of stimulation and increased need for greater tension
Size Principle
Tension is reduced by the reverse process Successive reduction of firing rates Dropping out of larger units first
Motor unit Vary in ratio of muscle fibers/motor neuron Fine control few fibers (e.g., muscles of eye and fingers, as few as 3-6/motor neuron), tetanize at higher frequencies Gross control many fibers (e.g., gastrocnemius, 2000/motor neuron), tetanize at lower frequencies Fibers of motor unit dispersed throughout muscle
Motor Unit
Tonic units smaller, slow twitch, rich in mitochondria, highly capillarized, high aerobic metabolism, low peak tension, long time to peak (60120ms) Phasic units larger, fast twitch, poorly capillarized, rely on anaerobic metabolism, high
Motor unit (continued) Weakest voluntary contraction is a twitch (single contraction of a motor unit) Twitch times for tension to reach maximum varies by muscle and person Twitch times for maximum tension are shorter in the upper extremity muscles (40-50ms) than in the lower extremity muscles (70-80ms)
Shape of Graded Contraction
Shape and time period of voluntary tension curve in building up maximum tension

Shape and time period of voluntary relaxation curve in reducing tension

Due to delay between each MU action potential and maximum twitch tension Related to the size principle of recruitment of motor units Turn-on times 200ms Related to shape of individual muscle twitches Related to the size principle in reverse Due to stored elastic energy of muscle Turn-off times 300ms
Force Production Length-Tension Relationship
Force of contraction in a single fiber determined by overlap of actin and myosin (i.e., structural alterations in sarcomere) (see figure) Force of contraction for whole muscle must account for active (contractile) and passive (series and parallel elastic elements) components
Types of Muscle Contraction

Type of Contraction Concentric Eccentric Isokinetic Definition Work
Force of muscle contraction Positive work; muscle moment resistance and angular velocity of joint in same direction Force of muscle contraction Negative work; muscle moment resistance and angular velocity of joint in opposite direction Force of muscle contraction = Positive work; muscle moment resistance; constant angular and angular velocity of joint in velocity; special case is same direction isometric contraction Force of muscle contraction No mechanical work; resistance; series elastic physiological work component stretch = shortening of contractile element (few to 7% of resting length of muscle)
Isometric
Effect of Muscle Architecture on Contraction

Fusiform muscle Fibers parallel to long axis of muscle Many sarcomeres make up long myofibrils Advantage for length of contraction Example: sartorius muscle Force of contraction along long axis of muscle of force of contraction of all muscle fibers Tends to have smaller physiological cross sectional area (see figure)
Fusiform Fiber Arrangement
Fa = force of contraction of muscle fiber parallel to longitudinal axis of muscle Fa Fa = sum of all muscle fiber contractions parallel to long axis of muscle
Effect of Muscle Architecture on Contraction (continued)
Pennate muscle Fibers arranged obliquely to long axis of muscle (pennation angle) Uni-, bi-, and multi-pennate Advantage for force of contraction Example: rectus femoris (bi-pennate) Tends to have larger physiological cross sectional area
Pennate Fiber Arrangement

Fa = force of contraction of muscle fiber parallel to longitudinal axis of muscle Fa Fm = force of contraction of muscle fiber = pennation angle Fa = (cos )(Fm) Fa = sum of all muscle fiber contractions parallel to long axis of muscle
Fm
Effect of Muscle Architecture on Contraction (continued)
Force of muscle contraction proportional to physiological cross sectional area (PCSA); sum of the cross sectional area of myofibrils Velocity and excursion (working range or amplitude) of muscle is proportional to length of myofiblril
Muscle Fiber Types

Type I Slow-Twitch Oxidative (SO) Speed of contraction Primary source of ATP production Glycolytic enzyme activity Capillaries Myoglobin content Glycogen content Fiber diameter Rate of fatigue Slow Oxidative phosphorylation Low Many High Low Small Slow Type IIA Fast-Twitch Oxidative-Glycolytic (FOG) Fast Oxidative phosphorylation Intermediate Many High Intermediate Intermediate Intermediate Type IIB Fast-Twitch Glycolytic (FG) Fast Anaerobic glycolysis High Few Low High Large Fast
Muscle Fiber Types (continued)
Smaller slow twitch motor units are characterized as tonic units, red in appearance, smaller muscle fibers, fibers rich in mitochondria, highly capillarized, high capacity for aerobic metabolism, and produce low peak tension in a long time to peak (60120ms). Larger fast twitch motor units are characterized as phasic units, white in appearance, larger muscle fibers, less mitochondria, poorly capillarized, rely on anaerobic metabolism, and produce large peak tensions in shorter periods of time (1050ms).
Nerve innervating muscle fiber determines its type; possible to change fiber type by changing innervations of fiber All fibers of motor unit are of same type Fiber type distribution in muscle genetically determined Average population distribution: 50-55% type I 30-35% type IIA 15% type IIB
Fiber composition of muscle relates to function (e.g., soleus posture muscle, high percentage type I) Muscles mixed in fiber type composition Natural selection of athletes at top levels of competition
Electrical Signals of Muscle Fibers
At rest, action potential of muscle fiber -90 mV;caused by concentrations of ions outside and inside fiber (resting state) With sufficient stimulation, potential inside cell raised to 30-40 mV (depolarization); associated with transverse tubular system and sarcoplasmic reticulum; causes contraction of fiber Return to resting state (repolarization) Electrical signals from the motor units (motor unit action potential, muap) can be recorded (EMG) via electrodes
Summary of Function of Cranial Nerves
Figure 13.5b
Cranial Nerve I: Olfactory

Arises from the olfactory epithelium Passes through the cribriform plate of the ethmoid bone Fibers run through the olfactory bulb and terminate in the primary olfactory cortex Functions solely by carrying afferent impulses for the sense of smell
Cranial Nerve I: Olfactory
Figure I from Table 13.2
Cranial Nerve II: Optic

Arises from the retina of the eye Optic nerves pass through the optic canals and converge at the optic chiasm They continue to the thalamus where they synapse From there, the optic radiation fibers run to the visual cortex Functions solely by carrying afferent impulses for vision
Cranial Nerve II: Optic
Figure II Table 13.2
Cranial Nerve III: Oculomotor
Fibers extend from the ventral midbrain, pass through the superior orbital fissure, and go to the extrinsic eye muscles Functions in raising the eyelid, directing the eyeball, constricting the iris, and controlling lens shape The latter 2 functions are parasympathetically controlled Parasympathetic cell bodies are in the ciliary ganglia
Cranial Nerve III: Oculomotor
Figure III from Table 13.2
Cranial Nerve IV: Trochlear
Fibers emerge from the dorsal midbrain and enter the orbits via the superior orbital fissures; innervate the superior oblique muscle Primarily a motor nerve that directs the eyeball
Cranial Nerve IV: Trochlear
Figure IV from Table 13.2
Cranial Nerve V: Trigeminal

Composed of three divisions Ophthalmic (V1) Maxillary (V2) Mandibular (V3) Fibers run from the face to the pons via the superior orbital fissure (V1), the foramen rotundum (V2), and the foramen ovale (V3) Conveys sensory impulses from various areas of the face (V1) and (V2), and supplies motor fibers (V3) for mastication Tic douloureux or trigeminal neuralgia - Most excruciating pain known (?) - Caused by inflammation of nerve - In severe cases, nerve is cut; relieves agony but results in loss of sensation on that side of the face
Cranial Nerve V: Trigeminal
Cranial Nerve VI: Abducens

Fibers leave the inferior pons and enter the orbit via the superior orbital fissure Primarily a motor nerve innervating the lateral rectus muscle (abducts the eye; thus the name abducens)
Cranial Nerve VII: Facial
Fibers leave the pons, travel through the internal acoustic meatus, and emerge through the stylomastoid foramen to the lateral aspect of the face Motor functions include; Facial expression Transmittal of parasympathetic impulses to lacrimal and salivary glands (submandibular and sublingual glands) Sensory function is taste from taste buds of anterior twothirds of the tongue
Cranial Nerve VII: Facial
Figure VII from Table 13.2
Facial Nerve (CN VII)

Bells palsy: paralysis of facial muscles on affected side and loss of taste sensation Caused by herpes simplex I virus Lower eyelid droops Corner of mouth sags Tears drip continuously and eye cannot be completely closed (dry eye may occur) Condition my disappear spontaneously without treatment
Click to edit Master subtitle style
Cranial Nerve VIII: Vestibulocochlear
Fibers arise from the hearing and equilibrium apparatus of the inner ear, pass through the internal acoustic meatus, and enter the brainstem at the pons-medulla border Two divisions cochlear (hearing) and vestibular (balance) Functions are solely sensory equilibrium and hearing
Cranial Nerve VIII: Vestibulocochlear
Figure VIII from Table 13.2
Cranial Nerve IX: Glossopharyngeal
Fibers emerge from the medulla, leave the skull via the jugular foramen, and run to the throat Nerve IX is a mixed nerve with motor and sensory functions Motor innervates part of the tongue and pharynx, and provides motor fibers to the parotid salivary gland Sensory fibers conduct taste and general sensory impulses from the tongue and pharynx
Cranial Nerve IX: Glossopharyngeal
Figure IX from Table 13.2
Cranial Nerve X: Vagus

The only cranial nerve that extends beyond the head and neck Fibers emerge from the medulla via the jugular foramen The vagus is a mixed nerve Most motor fibers are parasympathetic fibers to the heart, lungs, and visceral organs Its sensory function is in taste Paralysis leads to hoarseness Total destruction incompatible with life
Cranial Nerve X: Vagus
Cranial Nerve XI: Accessory
Formed from a cranial root emerging from the medulla and a spinal root arising from the superior region of the spinal cord The spinal root passes upward into the cranium via the foramen magnum The accessory nerve leaves the cranium via the jugular foramen Primarily a motor nerve

Supplies fibers to the larynx, pharynx, and soft palate Innervates the trapezius and sternocleidomastoid, which move the head and neck
Cranial Nerve XI: Accessory
Figure XI from Table 13.2
Cranial Nerve XII: Hypoglossal
Fibers arise from the medulla and exit the skull via the hypoglossal canal Innervates both extrinsic and intrinsic muscles of the tongue, which contribute to swallowing and speech
If damaged, difficulties in speech and swallowing; inability to protrude tongue
Cranial Nerve XII: Hypoglossal
Figure XII from Table 13.2
Surface Anatomy
12312-123
Surface Anatomy of Head
12412-124
Surface Anatomy of the Neck

Thyroid Cartilage Hyoid Bone Cricoid Cartilage Thyroid Gland Sternocleidomastoid Muscle Arteries Veins Trapezius Muscle Vertebral Spines Anterior Triangle Posterior Triangle
12512-125
12612-126
Surface Anatomy of the Trunk

Scapulae Latissimus dorsi muscle erector spinae muscle infraspinatus muscle trapezius muscle teres major muscle posterior axillary fold triangle of auscutation
12712-127
Surface Features of the Chest
12812-128
Surface Features of the Abdomen
12912-129
Surface features of Pelvis
Iliac Crest Anterior Superior Iliac Crest Posterior Superior Spine Pubic Tubercle Pubic Symphysis Mons Pubis Sacrum Coccyx Perineum
13012-130
Surface Anatomy of the Upper Limb
Surface features of the Shoulder Acromioclavicular Joint Acromiun Humerus Greater Tubercle Deltoid Muscle
13112-131
Surface Features of the Armpit apex base axillary lymph nodes anterior wall posterior wall medial wall lateral wall
13212-132

Surface Features of the Arm & Elbow Humerus Biceps brachii muscle Triceps brachii muscle Medial epicondyle Lateral epicondyle Olecron Ulnar nerve Cubital fossa Median cubital vein Brachial Artery Bicipital aponeurosis
13312-133
Surface Features of the Forearm & Wrist Ulna Radius Muscles Radial Artery Pisiform Bone Anatomical Snuffbox Wrist Creases
13412-134
13512-135
Surface Anatomy of the Lower Limb

Gluteus maximus muscle Gluteus medius muscle Gluteal cleft Gluteal fold Ischeal tuberosity Greater trochanter
13612-136

Surface features of the Thigh Sartorius muscle Quadriceps femoris muscle Adductor longus muscle Hamstring muscles Femoral triange
13712-137
Surface Anatomy of the Knee Patella Patellar ligament Medial condyle of femur Medial condyle of thigh Lateral condyle of femur Lateral condyle of thigh Popliteal fossa
13812-138
Surface features of the Leg, Ankle & Foot Tibial tuberosity Tibialis anterior muscle Tibia Peroneus longus muscle Gastrocnemius muscle soleus muscle
13912-139
Surface Features of the Leg, Ankle & Foot

Achilles (Calcaneal) tendon Lateral malleolus of fibula Medial malleolus of tibia Dorsal venous arch Tendons of extensor digitorum longus muscle
14012-140
Shoulder anatomy
Shoulder Complex Bone Anatomy
Clavicle

Sternal end Acromion end Surfaces

Scapula
Acromion end
Sternal end

Costal Dorsal
Borders Angles
1. spine
Scapula
2. acromion 3. superior border 4. supraspinous fossa 5. infraspinous fossa 6. medial (vertebral) border 7. lateral (axillary) border 8. inferior angle 9. superior angle 10. glenoid fossa (lateral angle) 11. coracoid process 12. superior scapular notch 13 subscapular fossa
Humerous

head anatomical neck greater tubercle lesser tubercle greater tubercle lesser tubercle intertubercular sulcus (AKA bicipital groove) deltoid tuberosity
Humerous

Surgical Neck Angle of Inclination
130-150 degrees 30 degrees posteriorly
Angle of Torsion
Shoulder Complex Articulations
Sternoclavicular Joint
Sternal end of clavicle with manubrium/ 1st costal cartilage 3 degree of freedom Articular Disk Ligaments

Capsule Anterior/Posterior Sternoclavicular Ligament Interclavicular Ligament Costoclavicular Ligament
Acromioclavicular Joint

3 degrees of freedom Articular Disk Ligaments
Superior/Inferior Acromioclavicular Ligaments Coracoclavicular

Trapezoid Conoid
Glenohumeral Joint

Configuration 3 degrees of freedom Labrum Ligaments

Capsule Coracohumeral Ligament Glenohumeral Ligaments

Superior Middle Inferior of Weitbrecht Foramen of
Posterior Capsule
Scapulothoracic

Not a joint Movements here very important
Other Shoulder Complex Structures
Axilla

Anterior Border Posterior Border Medial Border Lateral Border
What structure comprises the 4 borders of the axilla?
Shoulder Complex Muscles

Scapular Muscles Click to edit Master subtitle style
Levator Scapulae
O Transverse processes of C1-C4 I Medial border of scapula between superior angle and root of spine of scapula N Nerve root C3-5 F

scapular elevation retraction
Rhomboid Major
Major T2-T5 spinous processes Minor Ligamentum nuchae, C7-T1 spinour processes Major Medial borde of scapula between spine and inferior angle Minor medial border at root of spine of scapula
N Dorsal Scapular
Upper Trapezius
Occiptal protuberance Medial 1/3 of nuchal line Upper part of ligamentum nuchae C7 spinous process Posterior border of lateral 1/3 of clavicle Acromion process
N spinal accessory F

Scapular elevation, retraction Rotation of head to opp. Side Lateral flexion of head to opp. side
Middle Trapezius
Inferior part of ligamentum nuchea T1-T5 spinous processes Medial margin of acromion process Superior lip of spine of scapula
N Spinal accessory F
Scapular retraction
Lower Trapezius
T6-T12 spinous processes Tubercle at apex of root of spine of scapula
N spinal accessory F
Scapular depression, retraction and upward rotation
Serratus Anterior
Outer surfaces and superior border of ribs 1-8 Ventral scapular surface on medial border from superior angle to inferior angle Long Thoracic Scapular protraction, upward rotation Scapular depression (lower fibers) Scapular elevation (upper fibers
Pectoralis Minor
Superior margins and outer surface ribs 3-5 near cartilages Fascia overlying corresponding intercostal muscles Medial border, superior surface of coracoid process Medial Pectoral Scapular depression, downward rotation, protraction
Glenohumeral Muscles
Biceps Brachii
Short head coracoid process Long head supraglenoid tubercle of scapula Radial tuberosity Biceps brachii aponeurosis
N Musculocutaneous F

Shoulder flexion Elbow flexion, forearm supination
Coracobrachialis
Coracoid process Medial surface of midhumerus, opposite to deltoid tuberosity
GH flexion, adduction, Hor. Adduction
Pectoralis Major
Sternal anterior surface of sternum, cartilages of ribs 1-6 or7 Clavicular anterior surface of sternal clavicle crest of humeruss greater tuberosity Sternal medial pectoral Clavicular lateral pectora GH ADD, H. ADD and IR
Fibers twist in themselves
Anterior Deltoid
Anterior border, superior surface of lateral third of clavicle Deltoid tuberosity
N Axillary F

GH H. ADD, flexion IR when in supine position
Middle Deltoid
Lateral margin and superior surface of acromion Deltoid Tuberosity Axillary GH ABD
Posterior Deltoid
Inferior lip of posterior border of spine of scapula Deltoid tuberosity
N Axillary F

GH extension, H. ABD, ER when in prone position
Triceps Brachii
Long Head infraglenoid tubercle Lateral Head lateral and posterior surface of proximal of body of humerus Medial Head distal 2/3 of medial and posterior surfaces of humerus below radial groove Posterior surface of olecranon proess
N Radial F

Shoulder long head Ext and ADD Elbow -- extension
Latissimus Dorsi
Posterior layer of lumbodorsal fascia, then attaching to the T6-T12, lumbar and sacral vertabrae External lip of iliace creast lateral to erector spinae Ribs 9-12 Slip from inferior angle of scapula Intertubercular groove (distal aspect)
N Thoracodorsal F
GH IR, ADD, Ext,
Teres Major (Lats Little Helper)
Dorsal surface of inferior angle Lower 1/3 of scapula lateral border Crest of lesser tuberosity
N Lower Subscapular F
GH IR, ADD, Ext
Rotator Cuff
Suprspinatus
Medial 2/3 supraspinatus fossa Superior portion of greater tuberosity
N Suprascapular F

Intiates shoulder ABD Humeral head stabilization
Infraspinatus
Medial 2/3 infraspinatus fossa Middle portion of greater tuberosity
N Suprascapular F

GH ER Humeral head stabilization
Teres Minor
Upper 2/3 dorsal surface of lateral border of scapula Lowest portion of greater tuberosity Axillary GH ER Humeral head stabilization
I -
Subscapularis
Subscapular Fossa Lesser tuberosity Anterior capsule of GH joint Upper and lower subscapular GH IR Humeral head stabilization
Basic Shoulder Complex Mechanics
Performing Abduction

Initiation Scapulohumeral Ryhthm

First 30 degrees > 30 degrees
Clavicle
Brachial Plexus
Mechanism of Injury (Erbs Palsy)
Erbs Palsy
Deltopectoral Groove
Scapula
Winging of the Scapula
What is the muscle paralyzed which will cause the lateral winging of the scapula?
What do you call a congenital undescended scapula?
Sprengels Deformity
SITS Muscles
What is the primary function of the SITS muscles?
What is the innervation of the SITS muscles?
Elbow Anatomy
Bone Anatomy
Radius
Proximal Radial Head Radial Tuberosity Radial Neck Distal Ulnar Notch Radial styloid process
Bone Anatomy
Ulna
Proximal Olecranon Olecranon Process Coronoid Process Trochlear notch Radial notch Ulnar tuberosity Distal Ulnar Styloid Process
Elbow Articulations

Humeroulnar Joint Humeroradial Joint Proximal Radioulnar Joint Distal Radioulnar Joint
Ligamentous Support
Capsule
anterior
posterior
Ligamentous Support
Medial (Ulnar) Collateral Ligament

Anterior Posterior Oblique
Ligamentous Support
Lateral (Radial) Collateral Ligament
Ligamentous Support
Annular Ligament
Ligamentous Support
Quadrate Ligament
Ligamentous Support
Dorsal and Plamar Radioulnar Ligaments
Ligamentous Support
Interosseous Membrane
Muscles
Biceps Brachii
Short head coracoid process Long head supraglenoid tubercle of scapula Radial tuberosity Biceps brachii aponeurosis

Shoulder flexion Elbow flexion, forearm supination
Brachialis
Distal 2/3 anterior humerus Ulna tuberosity Coronoid process Musculocutaneous Elbow flexion
Triceps Brachii
Long Head infraglenoid tubercle Lateral Head lateral and posterior surface of proximal of body of humerus Medial Head distal 2/3 of medial and posterior surfaces of humerus below radial groove Posterior surface of olecranon proess
N Radial F

Shoulder long head Ext and ADD Elbow -- extension
Anconeus
Posterior lateral humeral epicondyle Lateral side of olecranon process Upper posterior ulnar body Radial Assist with elbow extension
Brachioradialis
Upper 2/3 of lateral humeral supracondylar ridge Lateral radius just proximal to base of styloid process Radial Elbow flexion Supination to midposition Pronation to midposition
Supinator
Lateral humeral epicondyle LCL Annular ligament Lateral upper 2/3 of radius Radial Forearm supination
Extensor Carpi Radialis Longus
Lower 1/3 of lateral supraconsylar ridge Dorsal surface of base of 2nd metacarpal Radial Wrist extension Wrist radial deviation Elbow flexion
Extensor Carpi Radialis Brevis
Lateral epicondyle of humerus Dorsal surface of base of 3rd metacarpal Radial Wrist extension Wrist radial deviation Elbow flexion
Extensor Digitorum Communis
Lateral humeral epicondyle Extensor expansions of digits 2-5 Posterior interosseus nerve (continuation of radial) 2-5 MCP extension 2-5 IP extension
Extensor Carpi Ulnaris
Lateral humeral condyle Posterior base of 5th metacarpal Posterior interosseus Wrist extension Wrist ulnar deviation
Pronator Teres
Medial humeral epicondyle Coronoid process Lateral radius near its center Median Forearm pronation Elbow flexion
Flexor Carpi Radialis
Medial humeral epicondyle Palmar surface at base of 2nd metacarpal Slip to base of 3rd metacarpal Median Wrist flexion Wrist radial deviation Elbow flexion
Palmaris Longus
Medial humeral epicondyle Palmar aponeurosis Wrist flexor retinaculum Median Wrist flexion Elbow flexion
Flexor Carpi Ulnaris
medial epicondyle of humerus olecranon and posterior border of ulna
Pisiform bone, hook of hamate bone, and 5th metacarpal bone Ulnar Wrist flexion Ulnar deviation Elbow flexion
Pronator Quadratus
Distal anterior ulna Distal anterior radius Anterior interosseus (median) Forearm pronation
Cubitus Valgus/Varus
Olecranon Bursitis
Elbow Joint
Cubital Fossa
Radia Head Fracture
Distal Radioulnar Joint
Uniaxial pivot joint that has one degree of freedom Resting position: 10 supination Close packed position: 5 supination Capsular pattern: full ROM with pain at extreme of rotation
Radiocarpal (Wrist) Joint

Biaxial ellipsoid joint Radius articulates with scaphoid and lunate Distal radius is not straight but is angled toward the ulna (15-20), and its posterior margin projects more distally to provide a buttress effect Lunate and triquetrium also articulate with the triangular cartilaginous disc and not the ulna. (the disc extends from the ulnar side of the distal radius and attaches to the ulna at the base of the ulnar styloid process) The disc adds stability to the wrist; creates a close relation between the ulna and carpal bones and binds together the distal
Radiocarpal (Wrist) Joint
With the disc in place, the radius bears 60% of the load and the ulna bears 40%. If the disc is removed, the radius transmits 95% of the axial load and the ulna transmits 5% Therefore, the cartilaginous disc acts as a cushion for the wrist joint and as a major stabilizer of the distal radioulnar joint; the disc can be damage by forced extension and pronation Distal end of radius is concave and the proximal row of carpals is convex Has two degrees of freedom Resting position: neutral with slight ulnar deviation
Intercarpal Joints
Include the joints between the individual bones of the proximal row of carpal bones (scaphoid, lunate, and triquetrium) and the joints between the individual bones of the distal row of carpal bones (trapezium, trapezoid, capitate and hamate). Bound together by small intercarpal ligaments (dorsal, palmar and interosseus), which allow only a slight amount of gliding movement between the bones. Close packed position: extension Resting position: neutral or slight flexion Capsular pattern is none Pisotriquetral joint is considered separately
Midcarpal Joints
Form a compound articulation between the proximal and distal rows of carpal bones with the exception of pisiform On the medial side, the scaphoid, lunate, and triquetrium articulate with capitate and hamate, forming a compound sellar (saddle-shaped joint). On the lateral aspect, the scaphoid articulates with the trapezoid and trapezium, forming another compound sellar joint These articulations are bound together by dorsal and palmar ligaments; however, there are no interosseus ligaments between
Carpometacarpal Joint
Sellar joint that has 3 degrees of freedom (thumb) Plane joint for 2nd to 5th CMC joints Capsular pattern of CMC jt (thumb): abduction is most limited, followed by extension Resting position (thumb): midway between the abduction and adduction and midway between flexion and extension Close packed position (thumb): full opposition Capsular pattern (2-5): equal limitation in all directions Bones of are held together by dorsal and
Intermetacarpal Joints
Have only a small amount of gliding movements between them and do not include the thumb articulation They are bound together by palmar, dorsal and interosseus ligaments
Metacarpophalangeal Joints

Condyloid joints 2nd and 3rd MCP joints tend to be immobile and are the primary stabilizing factor of the hand, whereas the 4th and 5th joints are more mobile. Collateral ligaments of these joints are tight on flexion and relaxed on extension These articulations are also bound by palmar ligaments and deep transverse metacarpal ligaments Has two degrees of freedom 1st CMC has 3 degrees of freedom Close packed position: maximum opposition (thumb); maximum flexion
Interphalangeal Joints
Uniaxial hinge joints with one degree of freedom Close packed position: full extension Resting position: slight flexion Capsular pattern: flexion more limited than extension During flexion, there is some rotation in these joints so that the pulp of the fingers face more fully the pulp of the thumb Cascade sign if the MCP jts and PIP jts of the fingers are flexed, they converge toward the scaphoid tubercle If one or more fingers do not converge, it usually indicates trauma to the digits that
Common Hand Deformities
Swan-neck deformity Involves only the fingers. There is flexion of the MCP and DIP. There is hyperextension of the PIP jt. Result of contracture of intrinsic mm and is often seen in RA Boutonniere deformity Extension of the MCP and DIP and flexion of PIP jt Result of the rupture of the central tendinous slip of the extensor hood Most common after trauma or in RA Ulnar drift
Claw fingers Results from loss of intrinsic mm action and the overaction of the extrinsic (long) extensor mm on the proximal phalanx of the fingers. MCP jts are hyperextended, and the proximal and distal IP jts are flexed. If intrinsic function is lost, the hand is called intrinsic minus hand Normal cupping of the hand is lost, both the longitudinal and transverse arches of the hand disappear. There is intrinsic mm wasting Often caused by a combined median
Ape hand deformity Wasting of the thenar eminence of the hand occurs as a result of the median nerve palsy Thumb falls back in line with the fingers as a result of the pull of the extensor mm Px is unable to oppose or flex the thumb Bishops hand or Benediction hand deformity Wasting of the hypothenar mm of the hand, the interossei mm, and the 2 medial lumbrical mm Occurs because of the ulnar nerve palsy Flexion of the 4th and 5th fingers is the
Z deformity of the thumb Thumb is flexed at the MCP jt and hyperextended at the IP jt. Caused by heredity, or it may be associated with RA Dupuytrens deformity Result of contracture of the palmar fascia There is a fixed flexion of deformity of MCP and PIP jts. Usually seen in ring or little finger. Skin is often adherent to the fascia Affects men more than women and seen in 50-70 year age group
Types of Grip
Power Grip Requires fine control and gives greater flexor asymmetry to the hand Used whenever strength or force is the primary consideration Digits maintain the object against the palm Thumb may or may not be involved, and the extrinsic mm are more important For a power grip to be formed, fingers are flexed and the wrist in ulnar deviation and slightly extended Hook grasp in which all or the second and third fingers are used as
Precision or prehension grip An activity limited mainly to the MCP joints and involves primarily the radial side of the hand Used whenever accuracy and precision are required Radial digits (index and long fingers) provide control by working in concert with the thumb to form a dynamic tripod for precision handling There is pulp to pulp contact between the thumb and fingers, and the thumb opposes the fingers. Intrinsic mm are more important
Wrist and Hand Anatomy

Bone Anatomy

Scapoid Lunate Triquetrium Pisiform Trapeziod Trapezium Capitate Hamate
Wrist Articulations
Radiocarpal Joint

Proximal portion Distal portion Most surface contact found
Articulations
Midcarpal Joint
Articulation between proximal and distal row of carpals Not an uninterupted joint Distal Row

2 degrees of freedom Moves as a fixed unit
Ligament Support
Volar Carpal Ligaments
Volar Radiocarpal Ligament
Three bands
Volar Ulnocarpal Ligament Scapholunate Interosseous Ligament Lunotriquetral Ligament
Ligament Support
Dorsal Carpal Ligaments
Dorsal Radiocarpal Ligament Dorsal Intercarpal Ligament Radial Collateral Ligament Ulnar Collateral Ligament
Triangular Fibrcartilage Complex

Composition Role
Hand
Carpometacarpal (CMC) Joints of 2-5

Composition Carpal Arch

Composition Carpal Arch Ligament Support

Transverse Carpal Ligament Dorsal and Palmar CMC Ligaments Dorsal and Palmar Metacarpal Ligaments Metacarpal Interosseous Ligaments

Composition Carpal Arch Ligament Support
Transverse Carpal Ligament Dorsal and Palmar CMC Ligaments Dorsal and Palmar Metacarpal Ligaments Metacarpal Interosseous Ligaments
Movement of CMC Joints
Metacarpophalangeal (MCP) Joints of 2-5 Fingers
Ligament Support

Capsule Volar Plate Collateral Ligaments Motions
Interphalangeal Joints of 2-5 Fingers

Hinge Joints Motions
Thumb
CMC of Thumb

Saddle Joint Ligament Support

Capsule Intermetacarpal Ligament
MCP of Thumb
Ligament Support
IP Joint of Thumb
Extrinsic Hand Muscles

Extensor Indicis
Dorsal surface lower body of ulna Interosseus membrane Ulnar side of index fingers EDC tendon Radial (posterior interosseus) MCP and IP Ext of 2nd digit
Extensor Pollicis Longus
Posterior 1/3 ulna Interosseus membrane Posterior surface of base of thumb distal phalanx Radial (posterior interosseus) CMC, MCP and IP Ext of 1st digit
Extensor Pollicis Brevis
Dorsal 2/3 of radius Dorsal surface of base of proximal 1st phalanx Radial (posterior interosseus) CMC & MCP Ext of thumb CMC ABD of thumb
Abductor Pollicis Longus
Posterior distal 2/3 of ulna Posterior middle 1/3 of radius Interosseus membrane Radial side of base of 1st metacarpal Radial (posterior interosseus) CMC ABD & Ext of thumb
Flexor Pollicis Longus
Anterior middle of radius Interosseus membrane Palmar surface of base of distal 1st phalanx Median (anterior interosseus) IP Flexion of thumb
Extensor Digiti Minimi
Lateral epicondyle of humerus Extensor expansion of 5th digit Radial (posteior interosseus) MCP and IP extension of 5th digit
Flexor Digitorum Superficialis
Medial epicondyle of humerus Coronoid process Middle anterior radius Four tendons separating into two parts that insert into sides of bases of middle 2-5 phalanxes Median MCP flexion digits 2-5 PIP flexion digits 2-5
Flexor Digitorum Profundus
Anteriomedial surface of ulna Interosseus membrane Four tendons inserting into distal phalanxes of digits 25 Media 2-3 digits Ulna 4-5 digits DIP flexion of 2-5 digits
Intrinsic Hand Muscles

Thenar Eminance
Abductor Pollicis Brevis
Scaphoid tuberosity Trapezium ridge Transverse carpal ligament Lateral base f proximal 1st phalanx Median CMC & MCP ABD of thumb
Flexor Pollicis Brevis
Superficial head trapezium Deep head trapezoid, capitate and palmar ligaments of distal carpal bones Base of prximal 1st phalanx on radial side Extensor expansion Superficial median Deep Ulnar CMC & MCP Flexion of thumb
Opponens Pollicis
Trapezium Transverse Carpal Ligament Radial side of 1st metacarpal shaft Median Opposition
Intrinsic Hand Muscles

Hypothenar Eminence
Abductor Digiti Minimi
Pisiform Ulnar side base of 5th proximal phalanx Ulnar MCP ABD of 5th digit
Opponen Digiti Minimi
Hook of hamate Transverse carpal ligament Ulnar border of entire 5th metacarpal bone Ulnar MCP flexion & rotation of 5th digit
Flexor Digiti Minimi
Hamate bone Transverse carpal ligament Ulnar side of proximal 5th phalanx Ulnar MCP Flexion of 5th digit
Other Intrinsic Hand Muscles

Adductor Pollicis
Oblique Head

Capitate bone Bases of 2-3 metacarpals Proximal 2/3 of palmar surface of 3rd metacarpal
Transverse Head
Ulnar side of base of 1st proximal phalanx Ulnar CMC ADD of thumb
Palmar Interossei
1st ulnar side base of 1st metacarpal bone 2nd ulnar side of 2nd MC bone 3rd radial side of 4th MC bone 4th radia side of 5th MC bone Extensor expansion of 2,4 and 5th digits Ulnar ADD of 1st, 2nd, 4th and 5th digits toward midline of hand
Dorsal Interossei
1st lateral head ulnar side of 1st metacarpal bone 1st medial head radial side of 2nd metacarpal bone 2nd, 3rd, 4th space between metacarpal bones 1st radial side 2nd proximal phalanx 2nd radial side of 3rd 3rd ilnar side of 3rd 4th ulnar side of 4th Ulnar ABD of 2nd, 3rd, and 5th finger from midline
Lumbricales
Tendons of FDP Extensor expansion on dorsal aspect of each digits radial side 1 and 2 median 3 and 4 ulnar MCP flexion 2-5 digits DIP & PIP ext 2-5 digits
Palmaris Brevis
Flexor retinaculum Palmar surface skin on ulnar side of hand Ulnar Wrinkles skin of hand on ulnar side
Biomechanics of Hand
Biomechanics of Finger Flexion
Gliding mechanisms

Retinaculae Ligaments Bursa Digital tendon sheaths A1-A5 C1-C3
Annular Pulleys
Cruciate Ligaments
Function of Pulleys
Biomechanics of Finger Extension
Extensor Hood

EDC tendons DI and PI tendons Lumbricales Central tendon Oblique Retinacular Ligaments Sagittal Bands
Effects on MCP joints Effects on IP Joints
Syndactyly
Polydactyly
Koilonchyia (spoon nails)
Clubbed Nails
Carpal Bones
Anatomic Snuffbox
Tunnel of Guyon
Carpal Tunnel
Dupuytrens Contracture
Trigger Finger
Bouchards Nodes
Heberdens Nodes
Boutonniere Deformity
Swan Neck Deformity
Mallet Finger
Hip Anatomy
Click Prepared By: Floriza P. de Leon, PTRP to edit Master subtitle style
Bony Anatomy
Femur

Femoral Head Femoral Neck Greater Trochanter Lesser Trochanter Intertrochanteric Crest Intertrochanteric Line Gluteal Tuberosity
Frolich, Human Anatomy, Lower
Bony Anatomy
Pelvic Girdle

Acetabulum 3 bones fused together
Ilium

Iliac fossa Iliac Crest ASIS AIIS PSIS PIIS Gluteal Lines Greater Sciatic Notch
Frolich, Human Lateral View Anatomy, Lower
Bony Anatomy
Ilium

Iliac fossa Iliac Crest Iliac Tuberosity ASIS AIIS PSIS PIIS Gluteal Lines
Frolich, Human Medial View Anatomy, Lower
Bony Anatomy

Ilium Ishium

Ramus of ishium Ishial tuberosity Ishial spine Lessor Sciatic Notch
Bony Anatomy

Ilium Ishium Pubis

Superior Ramus of Pubis Inferior Ramus of Pubis Pubic Crest Pubic Tubercle Pectin Symphyseal Surface
Articulations of the Hip and Pelvis
Pubic Symphysis

Interpubic disk Some movement

Pubic Symphysis Sacroiliac Joints

Pubic Symphysis Sacroiliac Joints Hip Joints
Ligamentous and Cartilogenous Structures for the Hip and Pelvic Girdle
Sacroiliac Joint

Sacrotuberous Sacrospinous Function of these two ligaments Iliolumbar Interosseous Sacroiliac
Sacroiliac Joint

Sacrotuberous Sacrospinous Function of these two ligaments Iliolumbar Interosseous Sacroiliac
Sacroiliac Joint

Sacrotuberous Sacrospinous Function of these two ligaments Iliolumbar Interosseous Sacroiliac Dorsal Sacroiliac

Sacroiliac Joint Hip Joint

Capsule Three thickenings of the capsule

Iliofemoral Pubofemoral Ishiofemoral
Ligamentum Teres Inguinal









Hip Muscles
Anterior

Rectus Femoris Sartorius Iliopsoas Muscle Group

Iliacus Psoas Major
Hip Muscles
Anterior

Rectus Femoris Sartorius Iliopsoas Muscle Group

Iliacus Psoas Major
Hip Muscles
Posterior

Semimembranosus Semitendinosus Biceps Femoris Gluteus Maximus
Hip Muscles
Medial

Adductor Brevis Adductor Longus Adductor Magnus Pectineus Gracilus
Hip Muscles
Lateral

Gluteus Medius Gluteus Minimus Tensor Fascia Lata Six Intrinsic External Rotators

Periformis Quadratus Femoris Obturator Internus Obturator Externus Gemellua Superior Gemellus Inferior
Hip Muscles
Lateral

Gluteus Medius Gluteus Minimus Tensor Fascia Lata Six Intrinsic External Rotators

Periformis Quadratus Femoris Obturator Internus Obturator Externus Gemellua Superior Gemellus Inferior
Femoral Triangle
Borders

Superior Lateral Medial Posterior Anterior
Structures
Movements of the Pelvis

Forward and Backward Tilt Left and right Lateral Tilt Left and Right Rotation
Primary Movements of the Pelvis as Performed in a Standing Position

Pelvis Forward Tilt Backward Tilt Lateral Tilt Left Rotation Left
Spinal Joints Hyperextension Slight Flexion Slight Lateral Flexion RT Rotation RT
Hip Joints Slight Flexion Complete Ext. R = ADD L= ABD R = Slight ER L= Slight IR
Movements of the Pelvis Secondary to those of the Spine

Spine Flexion Hyperextension Lateral Flex Left Rotation Left
Pelvis Posterior Tilt Anterior Tilt Lateral Tilt Left Rotation Left
Movements of Pelvis secondary to LE
Moves with LE to supplement the LE ROM for 3 types of motion Movements of the limbs acting in unison Movements when LE is moving in opposite directions Movements of one limb
The Lower Limb

Lower Limb

Skeleton (homologous with upper limb) Muscles--anterior, posterior compartments Nerves--sciatic, femoral Surface anatomy
Upper-Lower Limb Comparison

See Table M&M, Table 8.1
Tibia/fibula
Tibia--big toe side Fibula--little toe side (no pronation/supination)
Ankle
Tarsus--forms ankle joint Calcaneus--forms heel
Foot
Function:
n n
Support weight Act as lever when walking
Tarsals
n
Talus = ankle

Between tibia + fibula Articulates w/both Attachment for Calcaneal tendon Carries talus
Calcaneus = heel
n n
Metatarsals
n
Homologous to metacarpals
Phalanges
n
Smaller, less nimble
Joints of Lower Limb

n
Hip (femur + acetabulum)

n n n
Ball + socket Multiaxial Synovial
Knee (femur + patella)

n n n
Plane Gliding of patella Synovial
Knee (femur + tibia)

n
Hinge Biaxial Synovial
n n
Joints of Lower Limb

n
Proximal Tibia + Fibula

n n n
Plane Gliding Synovial
Distal Tibia + Fibula

n n
Slight give Fibrous
Ankle (Tibia/Fibula + Talus)

n n n
Hinge Uniaxial Synovial
pg
Frolich, Human 218 Anatomy, Lower
Lower Limb Movements
Bending on posterior side is flexion (except hip) Bending on anterior sided is extension (except hip)
Hip Flexion/extension Abduction/adduction Lateral/medial rotation Knee Flexion/extension Ankle Dorsiflexion/plantarflexion Inversion/eversion Toes Flexion/extension
Anterior/Posterior compartments
ANTERIOR POSTERIOR COMPARTMENT COMPARTMENT MOVEMENT MUSCLES NERVES
Extension Quads Shin Femoral n. (lumbar plexus)
Flexion Hamstrings Gastrocs Sciatic n. (sacral plexus)
Thigh movements by compartment
Posterior Thigh
Gluts (gluteal nn.)

Maximusextensor of thigh Medius--pelvic tilt Piriformis syndrome Biceps femoris Semimembranous Semitendinous
Lateral rotators (spinal nn.)
Hamstrings (sciatic n.)

Anterior thigh (femoral n.)
Sartorius (Tailors muscle) Quads (four)
Rectus femoris (crosses hip) 3 vastus mm. (vast--big)
Medial compartment (obturator n.)
Adductor muscles

Gracilis Adductor

Magnus Longus brevis
Leg movements by compartment (in leg all nn a

branches of sciatic)
Anterior Leg (deep fibular n.)
Fibularis (peroneus) longus Extensor digitorum longus Extensor hallicus longus Tibialis anteriorus
Lateral Leg (superficial fibular n.)
Fibularis brevis/longus
Posterior Leg (tibial n.)
Gastrocs and soleus Flexor digitorum longus Flexor hallucus longus
Intrinsics of foot
Sacral plexus (sci nerve)
With leg out to side like quadruped, lumbar-anterior, sacral-posterior makes sense
Lumbar plexus (femoral nerve)
Dermatomes show twisting of leg in development
supply to lower limb
Internal Iliac
n n
Cranial + Caudal Gluteals= gluteals Internal Pudendal = perineum, external genitalia Obturator = adductor muscles
External Iliac
n
Femoral = lower limb
Deep femoral = adductors, hamstrings, quadriceps
Popliteal (continuation of femoral)
Geniculars = knee
Frolich, Human Anterior Tibial = ant. leg muscles, further Anatomy, Lower to feet branches
Surface Anatomy: Posterior Pelvis

Iliac crest Gluteus maximus = cheeks Natal/gluteal cleft = crack Gluteal folds = bottom of cheek
pg 789
pg 792
Surface Anatomy: Anterior Thigh + Leg
Palpate

Patella Condyles of femur Sartorius (lateral) Adductor longus (medial) Inguinal ligament (superior) Femoral a + v, lymph nodes
Femoral Triangle

pg 785
Surface Anatomy: Posterior Leg
Popliteal fossa
Diamond-shape fossa behind knee Biceps femoris (sup-lat) Semitendinosis + semimembranosis (supmed) Gastrocnemius heads (inf) Popliteal a + v
Boundaries

Contents
Frolich, Human pg 793 Lower Anatomy,
Calcaneal (Achilles) tendon
Foot Anatomy
Bone Anatomy
Tarsal Bones
Calcaneus

Sustentaculum Tali Peroneal Tubercle
Cuboid Navicular 3 Cuneiforms 5 metatarsals 5 phalanges (proximal, middle, distal)
Frolich, Human Exception Anatomy, Lower
Division of the Foot

Rearfoot Midfoot Forefoot
Hindfoot (Rearfoot)
Subtalor Joint

Talus and calcaneus articulation Individual Bone Formation
Calcaneus

Calcaneal Tuberosity Sustentaculum Tali Three facets Five functional articulation
Inferior Talus

Midfoot
Composed of

Navicular 3 cuneiforms cuboid
Forefoot
5 MTs
Proximally 1-3 articulate with cuneiforms Proximally 4-5 articulate with cuboid Bases articulate with:
Phalanges
Articulations and Ligamentous Support
Subtalor Joint

Three facets Motions of the Subtalor Joint

Supination Components Pronation Components
WB vs NWB Status of Foot at Subtalor joint
Hindfoot Articulations and Ligamentous Support
Subtalor Joint
Ligamentous Support Intra-articular Ligaments
Interosseous Talocalcaneal Ligamentum Cervis Medial Talocalcaneal Lateral Talocalcaneal
Midfoot Articulations and Ligamentous Support
Six Joints

Talocalcaneonavicular Calcaneocuboid Cuboideonavicular Intercuneiform Cuneocuboid Cuneonavicular Comprised by calcaneocuboid & talonavicular
Transverse Tarsal
Stability Related to subtalor joint

Ligamentous Support
Talocalcaneonavicular Joint

Plantar Calcaneonavicular (Spring Ligament) Talonavicular Bifurcate

Calcaneonavicular Calcaneocuboid
Calcaneocuboid Joint

Bifurcate Ligament
Calcaneocuboid portion
Plantar Calcaneocuboid Long Plantar Ligament
Ligamentous Support
Intercuneiform Joints
Dorsal and Plantar Intercuneifrom Ligaments Plantar and Dorsal Cuneocuboid Ligaments Plantar and Dorsal Cuneonavicular Ligaments
Cuneocuboid
Cuneonavicular Joints
Forefoot Articulations and Ligamentous Support
Tarsometatarsal Joint (Lisfrancs Joint) Intermetatarsal Joint Metatarsalphalangeal Joint (MTP) Interphalangeal Joint

PIP DIP
Forefoot Articulations and Ligamentous Support
Ligamentous Support
Intermetatarsal Joint

Proximal Distal Plantar Fascia Plantar Ligament MCL and LCL
MTP Joints

Interphalangeal Joint

Plantar and dorsal j capsule MCL and LCL
Arches of the Foot

Function Medial Longitudinal Arch Lateral Longitudinal Arch Transverse Arch
Arches of the Foot
Medial Longitudinal Arch

Calcaneus Talus Navicular 1-3 cuneiforms 1-3 MTs Function
Arches of the Foot
Medial Longitudinal Arch continued
Ligament Support

Plantar Calcaneonavicular Long Plantar Lig Deltoid Plantar fascia
Arches of the Foot
Ligament Support

Arches of the Foot
Ligament Support

Arches of the Foot
Ligament Support

Arches of the Foot
Muscular Support
Intrinsic

Abductor Hallucis Flexor Digitorum Brevis Tibialis Posterior Flexor Hallucis Longus Flexor Digitorum Longus Tibialis Anterior Flexor Digitorm Longus
Extrinsic

Arches of the Foot
Muscular Support
Intrinsic

Abductor Hallucis Flexor Digitorum Brevis Tibialis Posterior Flexor Hallucis Longus Flexor Digitorum Longus Tibialis Anterior Flexor Digitorm Longus
Extrinsic

Arches of the Foot
Lateral Longitudinal Arch
Composed of

Calcaneus Cuboid 4-5th MTs Long & Short Plantar Plantar Fascia
Ligament Support

Arches of the Foot
Lateral Longitudinal Arch continued
Muscle Support
Intrinsic
Abductor Digiti Minimi Flexor Digitorum Brevis Peroneus Longus, Brevis & Tertius
Extrinisic
Summary of Arches
Arches of the Foot
Transverse Arch

Formed By: Ligament Support

Intermetatarsal Ligaments Plantar Fascia All intrinsic muscles Extrinisic

Muscle Support

Tibialis Posterior Tibialis Anterior Peroneus Longus
Foot Muscles Plantar Surface
Superficial Layer

Abductor Hallucis Abductor Digiti Minimi Flexor Digitorum Brevis
Middle Layer

Quadratus Plantae Lumbricales
Deep Layer

Flexor Hallucis Brevis Adductor Hallucis
Transverse and Oblique Heads
Flexor Digiti Minimi
Interosseus Layer

Plantar Interossei Dorsal Interossei
Foot Muscles Dorsal Surface
Extensor Digitorum Brevis Extensor Hallucis Brevis
Common Pediatric Foot Deformities
Anatomy/Terminolo gy
3 main sections 1. Hindfoot talus, calcaneus 2. Midfoot navicular, cuboid, cuneiforms 3. Forefoot metatarsals and phalanges
Important joints 1. tibiotalar (ankle) plantar/dorsiflexion 2. talocalcaneal (subtalar) inversion/eversion
Important tendons 1. achilles (post calcaneus) plantar flexion 2. post fibular (navicular/cuneiform) inversion 3. ant fibular (med cuneiform/1st met) dorsiflexion 4. peroneus brevis (5th met) - eversion
Varus/Valgus
Calcaneovalgus foot
Calcaneovalgus foot
ankle joint dorsiflexed, subtalar joint everted classic positional deformity more common in 1st born, LGA, twins 2-10% assoc b/w foot deformity and DDH treatment requires stretching: plantarflex and invert foot excellent prognosis
Congenital Vertical Talus

true congenital deformity 60% assoc w/ some neuro impairment plantarflexed ankle, everted subtalar joint, stiff requires surgical correction (casting is generally ineffective)
Talipes Equinovarus (congenital clubfoot)

A.
General - complicated, multifactorial deformity of primarily genetic origin - 3 basic components (i) ankle joint plantarflexed/equines (ii) subtalar joint inverted/varus (iii) forefoot adducted

B. Incidence - approx 1/1,000 live births - usually sporadic - bilateral deformities occur 50% C. Etiology - unknown - ?defect in development of talus leads to soft tissue changes in joints, or vice versa

D. Diagnosis/Evaluation - distinguish mild/severe forms from other disease - AP/Lat standing or AP/stress dorsiflex lat films E. Treatment Non-surgical - weekly serial manipulation and casting - must follow certain order of correction - success rate 15-80% Surgical - majority do well; calf and foot is smaller
Pes Planus (flatfoot)

A.
General - refers to loss of normal medial long. arch - usually caused by subtalar joint assuming an everted position while weight bearing - generally common in neonates/toddlers
B. Evaluation - painful? - flexible? (hindfoot should invert/dorsiflex approx 10 degrees above neutral - arch develop with non-weight bearing pos?

C. Treatment (i) Flexible/Asymptomatic - no further work up/treatment is necessary! - no studies show flex flatfoot has increased risk for pain as an adult (ii) rigid/painful - must r/o tarsal coalition congenital fusion or failure of seg. b/w 2 or more tarsal bones - usually assoc with peroneal muscle
InToeing
A.
General - common finding in newborns and children - little evidence to show benefit from treatment
InToeing
B. Evaluation - family hx of rotational deformity? - pain? - height/weight normal? - limited hip abduct or leg length discrepancy? - neuro exam C. 3 main causes (i) metatarsus adductus (ii) internal tibial torsion (iii) excessive femoral anteversion
InToeing
(i)
metatarsus adductus - General
normal hindfoot, medially deviated midfoot
diagnosis made if lateral aspect of foot has C shape, rather than straight
InToeing
(i)
metatarsus adductus - Evaluation
should have normal ankle motion
assess flexibility by holding heel in neutral position, abducting forefoot
InToeing
(i)
metatarsus adductus treatment - if flexible, stretching; Q diaper change, 10 sec - if rigid, or if no resolution by 4-8 months, refer to ortho - prognosis is good: 85-90% resolve by 1yr
()
InToeing
(ii) Internal Tibial Torsion usually presents by walking age
knee points forward, while feet point inward
InToeing
(ii) Internal Tibial Torsion Treatment - reassurance! spontaneous resolution in 95% children, usually by 7-8yrs - controversy with splints, casts, surgery
InToeing
(iii) Excessive Femoral Anteversion both knees and feet point inward
presents during early childhood (3-7yrs)
most common cause
InToeing
(iii) Excessive Femoral Anteversion int rotation 70-80 deg ext rotation 10-30 deg

W position
InToeing
(iii) Excessive Femoral Anteversion increase in internal rotation early with gradual decrease
InToeing
(iii) Excessive Femoral Anteversion Treatment - no effective non-surgical treatment - surgical intervention usually indicated if persists after 8-10 yrs and is cosmetically unacceptable or functional gait problems - derotational osteotomy
Anatomy of the spine

The spine is one of the most important parts of your body. Without it, you could not keep yourself upright or even stand up. It gives your body structure and support. It allows you to Click to edit move about freely and to bend Master subtitle style with flexibility. The spine is also designed to protect your spinal cord.
At Birth
The spine of a newborn is C-shaped, with one curve

At About Six Months
As the infant lifts his or her head during the first few months, the neck (cervical) curve and its muscles develop
At About Nine Months
As the infant learns to crawl and stand, the lower back (lumbar) curve and its muscles develop. Strong back muscles help give your child the strength and balance to walk and run.
The spine has three major components: the spinal column (i.e., bones and discs) neural elements (i.e., the spinal cord and nerve roots) supporting structures (e.g., muscles and ligaments)
A. The spinal column

The spinal column consists of individual bones called vertebrae, the building blocks, which provide support for the spine. These vertebrae are connected in the front of the spine by intervertebral discs. The spinal column consists of: seven cervical vertebrae (C1C7) i.e. neck twelve thoracic vertebrae (T1T12) i.e. upper back five lumbar vertebrae (L1L5) i.e. lower back five bones (that are joined, or "fused," together in adults) to form the bony sacrum three to five bones fused together to form the coccyx or tailbone
In general a typical vertebra consists of :

1. 2.
3.
large vertebral body in the front two strong bony areas called pedicles connecting the vertebral body and the posterior arch an arch of bony structures in the back (posterior arch) = (the spinous process).
PEDICL E
BODY
spinous process
transver se process
2 special cervical vertebrea:

1.
Atlas: The atlas is the topmost vertebra The Atlas has no body, and this is due to the fact that the body of the atlas has fused with that of the next vertebra (the Axis) it has no spinous process, is ring-like, and consists of an anterior and a posterior arch and two lateral masses
2.
Axis:
The second cervical vertebra (C2) of the spine is named the axis The most distinctive characteristic of this bone is the strong dens which rises perpendicularly from the upper surface of the body.
B. Neural Elements:
The neural elements consist of the spinal cord and nerve roots. The spinal cord runs from the base of the brain down through the cervical and thoracic spine. Below the L1L2 level the spinal cord ends, as an array of nerve roots continues, looking somewhat like a horse's tail (cauda equina). At each vertebral level of the spine there are a pair of nerve roots. These nerves
The intervertebral discs make up one fourth of the spinal column's length. There are no discs between the Atlas (C1), Axis (C2), and Coccyx. Discs are not vascular and therefore depend on the end plates to diffuse needed nutrients
a tough outer portion and a soft inner core:
Discs are composed of two parts:

The outer portion of the disc (annulus fibrosus) composed of concentric sheets of collagen fibers that seal the gelatinous nucleus and evenly distribute pressure and force imposed on the vertebral column. The inner core (nucleus pulposus) contains a loose network of fibers suspended in a mucoprotein gel.
The outer portion and inner core of the spinal disc fit together like two concentric cylinders and are interconnected by cartilaginous endplates
C. the supporting structures:

1.
Ligaments Fascia Muscles Nerves
1.
1.
1.
Ligaments: Ligaments are rope-like bands of tissue that connect bones together. Most ligaments are lined up to keep joints from bending in the wrong way

The most important ones are:

1.
2. 3.
Anterior and posterior longitudinal ligaments Ligamentum flavum Intervertebral discs
Fascia: Fascia is similar to ligaments, but fascia is more like a sheet than a rope.
v
The most important of which is the thoracolumbar fascia (TLF) which has the following functions:
v
As the spinal muscles work, the TLF pulls tightly the low back, keeping the lumbar spine from bending out of the neutral position. It augments the power generated by spinal muscles.
Muscles:
Because of their location toward the center of the body, and because of their importance in spine stability, these key stabilizers are called "core, paraspinal" muscles
Core muscles help grip and hold the spine. They keep each spinal segment from shifting and sliding as you do your activities
Nerves:
Motor nerves signal the key muscles to grip and hold and to guide and control the spine.
Sensory nerves transmit sensations such as heat, cold, touch, pressure, and pain. They also give us our sense of position
Q. What are the functions of the spinal curves?
Absorbs the shocks of walking on hard surfaces qMore weight can be supported by a curved spine than if it were straight qAdditional space for the viscera is provided by the concavities of the thoracic and pelvic regions. qLastly, the S-curvature protects the vertebral column from breakage
q
What are the functions of the spinal column?
The major functions of the vertebral column are: oProtection of the spinal cord. oProviding stiffening for the body and attachment for the pectoral and pelvic girdle and many other muscles. oProviding motion for the human skeleton. oThe S-curvature enables the vertebral column to absorb the shocks of walking on hard surfaces
Spinal Cord Anatomy
Spinal Cord
Runs through the vertebral canal Extends from foramen magnum to second lumbar vertebra Regions

Cervical Thoracic Lumbar Sacral Coccygeal All are mixed nerves
Gives rise to 31 pairs of spinal nerves
Not uniform in diameter Cervical enlargement: supplies upper limbs Lumbar enlargement: supplies lower limbs Conus medullaris- tapered inferior end
Ends between L1 and L2
Cauda equina - origin of spinal nerves extending inferiorly from conus medullaris.
Meninges
Connective tissue membranes
Dura mater: outermost layer; continuous with epineurium of the spinal nerves Arachnoid mater: thin and wispy Pia mater: bound tightly to surface
Forms the filum terminale
anchors spinal cord to coccyx
Forms the denticulate ligaments that attach the spinal cord to the dura
Spaces
Epidural: external to the dura

Anesthestics injected here Fat-fill
Subdural space: serous fluid Subarachnoid: between pia and arachnoid
Filled with CSF
Cross Section of Spinal Cord
Anterior median fissure and posterior median sulcus
deep clefts partially separating left and right halves
Gray matter: neuron cell bodies, dendrites, axons Divided into horns Posterior (dorsal) horn Anterior (ventral) horn Lateral horn White matter Myelinated axons Divided into three columns (funiculi)

Ventral Dorsal lateral
Each of these divided into sensory or motor tracts
Cross section of Spinal Cord
Commissures: connections between left and right halves Gray with central canal in the center White Roots Spinal nerves arise as rootlets then combine to form dorsal and ventral roots Dorsal and ventral roots merge laterally and form the spinal nerve
Organization of Spinal Cord Gray Matter
Recall, it is divided into horns
Dorsal, lateral (only in thoracic region), and ventral
Dorsal half sensory roots and ganglia Ventral half motor roots Based on the type of neurons/cell bodies located in each horn, it is specialized further into 4 regions

Somatic sensory (SS) - axons of somatic sensory neurons Visceral sensory (VS) - neurons of visceral sensory neur. Visceral motor (VM) - cell bodies of visceral motor neurons Somatic motor (SM) - cell bodies of somatic motor neurons
Gray Matter: Organization
Figure 12.31
White Matter in the Spinal Cord
Divided into three funiculi (columns) posterior, lateral, and anterior
Columns contain 3 different types of fibers (Ascend., Descend., Trans.) Ascending fibers - compose the sensory tracts Descending fibers - compose the motor tracts Commissural (transverse) fibers - connect opposite sides of cord
Fibers run in three directions

White Matter Fiber Tract Generalizations

Pathways decussate (most) Most consist of a chain of two or three neurons Most exhibit somatotopy (precise spatial relationships) All pathways are paired one on each side of the spinal cord
White Matter: Pathway Generalizations
Descending (Motor) Pathways
Descending tracts deliver motor instructions from the brain to the spinal cord Divided into two groups Pyramidal, or corticospinal, tracts Indirect pathways, essentially all others Motor pathways involve two neurons Upper motor neuron (UMN) Lower motor neuron (LMN) aka anterior horn motor neuron (also, final common pathway)
Pyramidal (Corticospinal) Tracts
Originate in the precentral gyrus of brain (aka, primary motor area)
I.e., cell body of the UMN located in precentral gyrus Its axon forms the corticospinal tract Some UMN decussate in pyramids = Lateral corticospinal tracts Others decussate at other levels of s.c. = Anterior corticospinal tracts Exits spinal cord via anterior root Activates skeletal muscles
Pyramidal neuron is the UMN
UMN synapses in the anterior horn with LMN

LMN (anterior horn motor neurons)

Regulates fast and fine (skilled) movements
Corticospinal tracts
Location of UMN cell body in cerebral cortex 2.Decussation of UMN axon in pyramids or at level of exit of LMN 3.Synapse of UMN and LMN occurs in anterior horn of s.c. 4.LMN axon exits via anterior root
1.
Extrapyramidal Motor Tracts

Includes all motor pathways not part of the pyramidal system Upper motor neuron (UMN) originates in nuclei deep in cerebrum (not in cerebral cortex) UMN does not pass through the pyramids! LMN is an anterior horn motor neuron This system includes

Rubrospinal Vestibulospinal Reticulospinal Tectospinal tracts

Axial muscles that maintain balance and posture Muscles controlling coarse movements of the proximal portions of limbs Head, neck, and eye movement
Regulate:

Extrapyramidal Tract
Note: 1. UMN cell body location 2. UMN axon decussates in pons 3. Synapse between UMN and LMN occurs in anterior horn of sc 3. LMN exits via ventral root 4. LMN axon stimulates skeletal muscle
Extrapyramidal (Multineuronal) Pathways

Reticulospinal tracts originates at reticular formation of brain; maintain balance Rubrospinal tracts originate in red nucleus of midbrain; control flexor muscles Tectospinal tracts - originate in superior colliculi and mediate head and eye movements towards visual targets (flash of light)
Main Ascending Pathways
The central processes of first-order neurons branch diffusely as they enter the spinal cord and medulla Some branches take part in spinal cord reflexes Others synapse with second-order neurons in the cord and medullary nuclei
Three Ascending Pathways

The nonspecific and specific ascending pathways send impulses to the sensory cortex
These pathways are responsible for discriminative touch (2 pt. discrimination) and conscious proprioception (body position sense).
The spinocerebellar tracts send impulses to the cerebellum and do not contribute to sensory perception
Nonspecific Ascending Pathway
Include the lateral and anterior spinothalamic tracts Lateral: transmits impulses concerned with pain and temp. to opposite side of brain Anterior: transmits impulses concerned with crude touch and pressure to opposite side of brain 1st order neuron: sensory neuron 2nd order neuron: interneurons of dorsal horn; synapse with 3rd order neuron in thalamus 3rd order neuron: carry impulse from thalamus to postcentral gyrus
Specific and Posterior Spinocerebellar Tracts

Dorsal Column Tract 1. AKA Medial lemniscal pathway 2. Fibers run only in dorsal column 3. Transmit impulses from receptors in skin and joints 4. Detect discriminative touch and body position sense =proprioception 1st O.N.- a sensory neuron synapses with 2nd O.N. in nucleus gracilis and nucleus cuneatus of medulla 2nd O.N.- an interneuron decussate and ascend to thalamus where it synapses with 3rd O.N. 3rd-order (thalamic neurons) transmits impulse to somatosensory cortex (postcentral gyrus) Spinocerebellar Tract Transmit info. about trunk and lower limb muscles and tendons to cerebellum No conscious sensation
Spinal Cord Trauma and Disorders

Severe damage to ventral root results in flaccid paralysis (limp and unresponsive) Skeletal muscles cannot move either voluntarily or involuntarily Without stimulation, muscles atrophy. When only UMN of primary motor cortex is damaged spastic paralysis occurs - muscles affected by persistent spasms and exaggerated tendon reflexes Muscles remain healthy longer but their movements are no longer subject to voluntary control. Muscles commonly become permanently shortened. Transection (cross sectioning) at any level results in total motor and sensory loss in body regions inferior to site of damage. If injury in cervical region, all four limbs affected (quadriplegia) If injury between T1 and L1, only lower limbs affected (paraplegia)
Spinal Cord Trauma and Disorders
Spinal shock - transient period of functional loss that follows the injury

Results in immediate depression of all reflex activity caudal to lesion. Bowel and bladder reflexes stop, blood pressure falls, and all muscles (somatic and visceral) below the injury are paralyzed and insensitive. Neural function usually returns within a few hours following injury If function does not resume within 48 hrs, paralysis is permanent.
Amyotrophic Lateral Sclerosis (aka, Lou Gehrigs disease)
Progressive destruction of anterior horn motor neurons and fibers of the pyramidal tracts Lose ability to speak, swallow, breathe. Death within 5 yrs Cause unknown (90%); others have high glutamate levels
Poliomyelitis

Virus destroys anterior horn motor neurons Victims die from paralysis of respiratory muscles Virus enters body in feces-contaminated water (public swimming pools)

Anatomy, Physiology, Kinesiology

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ANATOMY, PHYSIOLOGY, KINESIOLOGY

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