Download #22 MUSCLES THAT MOVE THE VERTEBRAL COLUMN

Upper & Lower Extremities
Learning Objectives
1. Name & identify the key bones (and bony features) of the upper &
2.
3.
lower extremities?
Name & describe the major joints of the upper & lower extremities?
Identify their functions and supporting structures?
Name & identify the main muscles of the upper & lower extremities
and describe their functions?
THE SHOULDER – Rules of 3
• Comprised of:
– 3 bones
– 3 joints
– 3 groups of muscles
• Represents only attachment
of appendicular skeleton
(arm) to axial skeleton
(trunk).
1. Clavicle
• "S" shaped bone that acts like
a strut (keeps shoulders back
and arms at side)
• Length of clavicle = broadness
of shoulders
• Medial one third is convex
anteriorly (rounded outward)
• Lateral one third is concave
anteriorly (curved inward)
• Functions in force absorption
(Foosh), dissipation of force,
& rotation of the scapula in
abduction
2. Scapula
• 'spade‘ shaped
• thin , flat,
triangular with
3 borders
• NO attachment
to chest wall
• held against
ribs by muscles
3. Humerus:
• typical long bone (shaft and 2
enlarged ends)
• proximal end (head of humerus)
• articulates with the glenoid fossa of
scapula
1. Sternoclavicular joint
• Formed by medial
clavicle and clavicular
notch of the Sternum
• Synovial joint
• Saddle type joint
• Subtle movements
occur about a multi
axial plane.
2. Acromioclavicular joint






Palpable, rounded eminence
on lateral shoulder or "Point
of the shoulder“
Lateral clavicle articulates
with acromion process (spine
of scapula).
Plane type synovial joint
Supported by thick ligaments
Allows for rotational
movements of clavicle on
acromion
Injury of joint referred to as
“shoulder separation"
3. Shoulder (Gleno – humeral) Joint
• Articulation between head of
humerus and glenoid of the
scapula
• Multi-axial, ball & socket type
synovial joint
• Freely movable, but structurally
unstable because very little of
humeral head (1/3rd) is in
contact with fossa at any one
time.
• Glenoid is deepened by a
cartilaginous ring (labrum), and
stabilized by strong ligaments
G-H Joint
3 sets of Movements
1. Flexion / Extension
2. Abduction / Adduction
3. Medial / Lateral Rotation
Scapulo-Humeral Motion
• Movement of the scapula
relative to movement of the
humerus
• 1° of scapular movement for
every 2° of GH movement
• 180° degrees of shoulder
abduction:
– 120° from GH joint
– 60° from ST articulation
• Scapular movement requires
movement of the clavicle
3 Other Paired Movements of the
Shoulder Girdle
(require movements at all 3 joints)
1. Elevation / Depression
2. Protraction / Retraction
3. Cross flexion / Extension
3 Main Groups of
Shoulder Muscles
Posterior Muscles
Anterior Muscles
1. THORAX TO HUMERUS:
1. LATISSIMUS DORSI
2. PECTORALIS MAJOR
Pectoralis Major
• GD: Large, superficial muscle of chest that
forms the anterior wall of axilla
• Functions to power shoulder flexion,
adduction and medial rotation (ie. 'bear
hug“).
Latissimus Dorsi




GD: Large, superficial, broad muscle
of back; Diamond shaped
Forms posterior wall of axilla(armpit)
Arises from lower back and inserts
prox. humerus
Functions:
• Shoulder extension
• Adduction
• Medial rotation
• Composite action: swimming,
paddling
2. THORAX TO SCAPULA/CLAVICLE
1. TRAPEZIUS
2. RHOMBOID MAJOR & MINOR
3. PECTORALIS MINOR
Trapezius:
•
•
GD: Large, superficial, triangular muscle of the
upper back and neck region.
Large number of functions, depending on location & direction:
1. Upper fibers:
• scapular elevation/rotation ("shrug“)
• Neck Side Flexion (unilateral) or Extension (bilateral)
2. Middle fibers:
• scapular retraction
3. Lower fibers:
• pull medial end of scapular spine down.
• (rotates glenoid fossa upward)
• important to facilitate raising the arm over head
Rhomboid Major & Minor


Deep to trapezius
Functions to retract scapula
Pectoralis Minor:
• Positioned deep to
pectoralis major
muscle
• Functionally very
different from pectoralis
major.
• Functions: protraction
of scapula (powers
reach beyond reach)
3. SCAPULA / CLAVICLE TO HUMERUS:
1. DELTOID
2. ROTATOR CUFF (SITS) MUSCLES:
–
–
–
–
SUPRASPINATUS,
INFRASPINATUS
TERES MINOR
SUBSCAPULARIS
Deltoid
• Round muscle on top of
shoulder, provides bulk of
shoulder.
• forms "U" around the shoulder
-3 distinct heads:
– Anterior: shoulder flexion
– Middle: shoulder abduction
– Posterior: shoulder extension
Rotator Cuff
• Intrinsic muscles of shoulder
• Comprised of four separate muscles (SITS)
to originate from scapula to attach to head
of the humerus
1.
2.
3.
4.
Supraspinatus – Abduction of shoulder
Infraspinatus - Lateral rotation of shoulder
Teres minor - Lateral rotation of shoulder
Subscapularis - Medial rotation of shoulder
Supraspinatus
• Action:
– abduction of the
shoulder (esp. first
150)
Infraspinatus
Action: Lateral rotation
Teres Minor
Action: Lateral rotation
Subscapularis
GD: Located on front side of
the scapula
Action: Medial rotation
Biceps Region

Superficial muscles on
the anterior surface of the upper arm

3 MUSCLES
•
•
•
Coracobrachialis
Biceps brachii
Brachialis
Function:
 ELBOW FLEXION
 FOREARM SUPINATION
Triceps Region
 3 HEADED MUSCLE ON
POSTERIOR ARM (BRACHIUM)
 TRICEPS BRACHII
 ALL INVOLVED IN POWERING
ELBOW EXTENSION ALL
Elbow & Forearm
Ulna
 Little finger (ulnar) side
 Part of the elbow joint “proper”.
 Proximal end is shaped like a wrench
(Olecranon Process)
 Distal "head" is small and terminates as the
ulnar styloid process medially.
 Does not contact the carpal bones of the
wrist directly (disc seperates them).
Radius
• Thumb (radial) side of
the forearm
• Articulates directly
with the wrist.
• The proximal end is a
small rounded "head“
• Distal end is larger and
ends as the radial
styloid process
laterally.
ELBOW JOINT
• Hinge type, synovial that allows flexion / extension
 During flexion trochlear
notch of ulna aritulcates
with the trochlear surface of
the humerus
 The radial head glides on
the capitulum
Proximal Radioulnar Joint:
• Joint between proximal
radius and ulna
• Pivot joint
• Radius and ulna are always
side by side proximally
• They cross each other
distally in pronation
• allows for
pronation/supination
MUSCLES OF THE FOREARM
Think in terms of “pairs”
• Posterior
• Anterior
MUSCLES OF THE FOREARM
Think in terms of “pairs”
1.
2.
3.
4.
ANTERIOR vs POSTERIOR
MEDIAL vs. LATERAL EPICONDYLE
FLEXION vs EXTENSION
PRONATION vs SUPINATION
-
Each compartment contains superficial and deep muscles.
All forearm muscles are termed as “extrinsic muscles” of the
hand.
Involved in powering movements of the wrist, thumb and
fingers
-
Movements
•
•
•
ANTERIOR
FLEXION (wrist & fingers)
ULNAR DEVIATION
(adduction)
RADIAL DEVIATION
(abduction)
•
WRIST PRONATION
•
THUMB FLEXION
•
POSTERIOR
EXTENSION (wrist & fingers)
•
ULNAR DEVIATION (adduction)
•
RADIAL DEVIATION (abduction)
•
SUPINATION
•
THUMB EXTENSION
•
THUMB ABDUCTION
Anterior Compartment
Superficial Layer
 5 Muscles:
1.
2.
3.
4.
5.
Pronator Teres
Flexor Carpi Radialis
Palmaris Longus
Flexor Carpi Ulnaris*
Flexor Digitorum
Superficialis
Anterior Compartment
Deep Layer
• 3 Muscles:
1. Flexor digitorum profundus*
2. Flexor pollicis longus
3. Pronator quadratus
Posterior Compartment
Superficial Layer
• 5 Muscles:
1. Extensor Carpi Radialis
Longus
2. Extensor Carpi Radialis Brevis
3. Extensor Digitorum
4. Extensor Digiti Minimi
5. Extensior Carpi Ulnaris
Posterior Compartment - Deep Layer
• 5 Muscles:
1.
2.
3.
4.
5.
Supinator
Abductor Pollicis Longus
Extensor Pollicis Longus
Extensor Pollicis Brevis
Extensor Indicis
Wrist & Hand
“SMALL BUT POWERFULL”
1. Carpal Bones
•
•
•
•
•
There are 8 short bones arranged in two
rows in the proximal aspect of the hand
They allow for mobility of the hand and
opposition which is unique to the human
species
Proximal row from lateral to medial:
Scaphoid, Lunate, Triquetrum and
Pisiform
Distal row from lateral to medial:
Trapezium, Trapezoid, Capitate and
Hamate
She Likes To Play Try To Catch Her
2. Metacarpels
• 5 metacarpals that make up
the palm of the hand.
• Numbered 1 to 5 beginning
with the thumb…the 5th
metacarpal is on the ulnar
side of the hand.
• Consist of a proximal base,
shaft and distal head
• Fingers of the hand
• The thumb has two
phalanges (proximal
and distal)
• The remaining 4 digits
are made up of three
phalanges each
(proximal, middle and
distal)
3. Phalanges
Wrist and Hand
 The wrist joint is comprised of
the distal end of the radius and
the proximal row of bones in the
hands ( carpal bones).
 The ulna is separated from the
carpals by a fibro-cartilagenous
disc and does not contribute to
the wrist joint.
 Condyloid, synovial joint
because of the shape of the
radius and the two carpal bones
the radius directly articulates
with (scaphoid and lunate)
Thumb (1St CMC)
• Saddle type synovial joint
between the trapezium and the
base of the first metacarpal.
• Allows for opposition!
• Movements include Flex/ext,
abd/adduction, & opposition
(which is really a limited type of
rotation)
Metacarpel-phalangeal Joints (MCPs)
• Heads of metacarpels contributes to
the knuckle of the hand..otherwise
known as the Metacarpalphalangeal
joint…or MCP joints
• The MCP’s allow for flexion/extension,
abduction/adduction, with middle
finder used as the point of reference
to describe abduction and adduction
Interphalangeal
Joints (IP’s)
1. Proximal Interphalangeal (PIP) joint
2. Distal Interphalangeal (DIP) joint
(digits 2-5)
• Interphalangeal joints are hinge
joints and allow flexion / extension
Muscles of the Hand - Rule of 3’s:
• 3 Compartments
– THENAR (3)
– HYPOTHENAR (3)
– Central (3)
• 3 Movements
• All are intrinsic muscles of the hand.
• Precision movements, fine motor skills
Thenar Muscles
 Is the fleshy prominence
on the radial (thumb) side
of the palm.
 Comprised of 3 muscles
that act on the thumb.
1. Opponens pollicis
2. Abductor pollicis brevis
3. Flexor pollicis brevis
Hypothaner Muscles
• Is the fleshy prominence
on the lateral side of
hand (ball of the little
finger)
• Comprised of 3 Muscles
1. Opponens digiti minimi
2. Abductor digiti minimi
3. Flexor digiti minimi brevis
Central Compartment
 Muscles between hypo and
thenar eminences.
 Muscles more prominent on
palmer surface.
 Comprised of 3 Muscle groups:
1. Inter-ossei (4 dorsal / 3 palmer)
A: abd / adduction of MCP joints
2. Lumbricals (4)
A: Flex MCP joints with straight fingers
3. Adductor pollicis
A: Adduct thumb
Lower Extremity Functions
• Responsible for stability (posture) and
locomotion.
• Works concentrically:
–
–
–
–
Jumping (hip extension)
Climbing stairs (hip extension)
Rising from sitting to standing (hip extension)
Skating (hip abduction/extension/lat. rotation)
• Muscles of the lower limb have an anti-gravity
function…..ie. they Work eccentrically:
– Descending stairs
– Lowering from standing to sitting
Pelvic region = between iliac
crest and gluteal fold
Thigh = between hip and
knee
Lower Leg = Region below
the knee
Pelvic Girdle:
•
•
•
•
Pelvis: basin (Latin)
Strong , stable joint
Weight bearing
Bones firmly united to
form a basin
• Structured for bipedal
movement (upright
walking)
• Bones form a complete
ring virtually immovable
Innominate (hip)Bone
• Comprised of three bones that
eventually fuse together.
1. Ilium
– The large fan shaped bone that
makes up the proximal portion of
the innominate bone
– protects lower abdominal contents
– provides surface area for
attachment of large powerful
muscles
2. Ischium
– The bone that makes the posterior
and inferior aspect of the
innominate bone
3. Pubis
– Makes up the anterior/inferior
aspect of the innominate bone
Innominate Fusion
• Note: the fusion of
the three bones is
best observed as "Y"
shaped markings
inside the socket of
the hip joint
(Acetabulum)
Anterior View
Greater
trochanter
Head
Neck
Lesser
trochanter
Intertrochanteric
line
Joints of
Pelvic Girdle
Sacroiliac
SACROILIAC JOINT
• The joint between the auricular
surface of the ilium and the
auricular surface of the sacrum.
• The SI joint is partly synovial
(anterior) and partly fibrous
(posterior).
• Allows for some flexion/extension
• Important in walking and in full
forward flexion.
• Supported by very strong anterior
and posterior SACROILIAC
LIGAMENTS .
Symphysis Pubis:
• Is the point where the two
pubic bodies join anteriorly.
• Joined by two very strong
ligaments superior and
inferiorly
• Has a dense
fibrocartilagenous disc in
between which allows
minimal movement
• Softens and loosens in late
pregnancy
THE HIP JOINT
THE HIP JOINT:
• Best example of ball and
socket joint.
• Articulation between the
head of the femur and the
acetabulum of the
innominate bone
• It is one of the most secure,
yet very mobile joints
• It is a synovial and multiaxial joint
ACETABULUM:
• Is an incomplete ring on
the lateral surface of the
innominate bone
• Closed in by the
transverse acetabular
ligament
• ACETABULAR FOSSA
– Deepest part of the
acetabulum
– Does not articulate with the
femur
– LUNATE SURFACE:
• Horseshoe shaped articular
(hyaline) cartilage
• articulates with the head of
the femur
Hip Movements
1. Flexion /Extension
2. Abduction / Adduction
3. Internal / External Rotation
GLUTEUS MAXIMUS
•
Largest muscle of gluteal region
•
Function:
– POWERFUL EXTENSOR OF HIP
– LATERAL ROTATION OF THE EXTENDED HIP
– COMPOSITE MOTION: PUSH-OFF IN SKATING
GLUTEUS MEDIUS & MINIMUS
• Critical stabilizer of pelvis during single leg support
such as walking & running
• Maintains horizontal pelvic alignment during single leg
stance phase
•Inability to stabilize results in “waddling” or
Trendenlenburg gait pattern.
Function:
– INTERNAL HIP ROTATION
– ABDUCTION OF HIP
Piriformis Muscle
(deep gluteal muscle)
• Works in conjunctions with 5 small
muscles collectively referred to as the
“lateral rotators”.
• Analogous to the rotator cuff of the
upper extremity.
1.
2.
3.
4.
5.
SUPERIOR GEMELLUS
INFERIOR GEMELLUS
QUADRATUS FEMORIS
OBTURATOR INTERNUS
OBTURATOR EXTERNUS
Anterior Hip –
Ilio Psoas
This muscle is 2 separate muscles
at its proximal end, the psoas
major and iliacus, which join
distally and have a common
attachment on the femur.
Function:
Flexion of thigh / hip joint
Medial Thigh – “Groin”
region
• 5 MUSCLES
• ALL CROSS THE HIP JOINT
• ONLY ONE--CROSSES THE KNEE GRACILUS
• COMMON FUNCTION IS HIP
ADDUCTION
The Thigh & Knee Region
Anterior Thigh
• Large……Powerful…..Antigravity muscles
• Essential for activities of daily
living:
– Walking, running, jumping
– Sit up/down, up/down stairs
– Sporting activities
• Circulation via femoral artery &
vein
N: All by femoral nerve (L2 – L4)
QUADRICEPS FEMORIS
MUSCLE
• 4 DISTINCT PARTS
• Rectus Femoris: Straight superficial portion that
crosses both hip and knee joints
•
Power hip flexion / knee extension
• The Vasti - medialis/intermedius/lateralis
They surround that shaft of femur and wrap
around thigh from back.
•
Power only knee extension
Quadriceps Tendon
Patella Tendon/Ligament
POSTERIOR THIGH - “HAMSTRINGS”
• GD: 3 MUSCLES, ALL 2-JOINT
• CROSS BOTH HIP AND KNEE
Knee flexion
Hip Extension
• Anatomical Overview
Bones:
- Femur
- Patella
- Tibia
- Fibula
*NOTE: fibula is non weightbearing / non articulating in the knee joint
Patella
• Patella – sesamoid bone
• 1st appears about 7.5 weeks of
gestation
• Shaped like a triangle, being slightly
wider than high
• Constant in both width & height
• Medial border is thicker than lateral
• Large variability in thickness of bone &
articular cartilage
Patellofemoral Joint (PFJ)
• Articulation between the trochlea of
the femur and the posterior surface of
the patella.
• Considered the Centerpiece of the
extensor mechanism.
• Common site of dysfunction
• Structure – well defined!
• Function – many variables!!!
Anatomy of the Tibio / Femoral Joint
“The Knee Joint”
• Synovial (MODIFIED hinge) joint that allows flexion/extension
and some rotation
• Largest and most complex joint in the human body
• Lacks bony stability
• Movements
– Flexion / extension (approx. 135 degrees)
– Medial / lateral rotation
• Only occurs when knee is flexed.
• Max’s out at approx. 45 degrees when knee flexed to 90
degrees.
MEDIAL COLLATERAL LIGAMANT
“MCL”
 Fan shaped
 Attaches to the medial
femoral epicondyle
proximally and medial
surface of the tibia
distally
 Also attached to the
medial meniscus
 Resists valgus force
LATERAL COLLATERAL LIGAMENT
“LCL”
 Cord like ( nearer to back
of joint)
 From lateral epicondyle of
the femur to fibular head
 Easily palpated (can roll
with finger)
 Resists varus force
Cruciate Ligaments
•
Anatomically:
–
–
–
•
Anterior Cruciate Ligament (ACL)
Posterior Cruciate Ligament (PCL)
Inadequate ability to heal after
injury
Functionally:
–
–
1° restraint – tibial translation (TT)
2 ° restraint – int / ext rotation of
tibia on femur.
Meniscus
Medial:
– C shaped, attached to joint
capsule and medial collateral
ligament (MCL)
Lateral:
– O shaped, connected to
popliteus muscle
Functions:
1.
2.
3.
4.
Deepen the tibial surface to increase joint stability.
Spreads out the load bearing force on the joint.
Helps in the control of rotational and gliding motion at
the tibio-femoral joint.
Helps circulate the synovial fluid thru the joint.
Lower leg, Ankle & Foot
Tibia/Fibula
BONES OF THE FOOT
• Analogous to the bones of
the hand but modified for
weight bearing and
locomotion.
• 7 Tarsal bones
• 5 Metatarsals
• 14 Phalanges
ANKLE JOINT
The ankle joint is a synovial joint
comprised of two articulations.
1. Talocrural (true) Ankle joint
2. Subtalar Joint
– Stable in dorsi flexion /
Unstable in planter flexion
– Strong ligaments / weak
muscles
TALOCRURAL JOINT
• True Ankle Joint
• Between the distal end of
the leg bones (tibia and
fibula) and the talus.
• Referred to as a brick and
mortar joint because of its
bony configuration
• The tibia and fibula form a
mortise in which the dome
of the talus fits.
• More stable with eversion
then Inversion!
Ankle Movements
Talocrural Joint:
• Dorsiflexion
• Plantarflexion
SUBTALAR JOINT
• The joint between the
superior aspect of the
calcaneus and the
inferior aspect of the
talus.
Ankle Movements
Subtalar joint:
• Eversion
• inversion
MUSCULAR COMPARTMENTS OF THE
LOWER LEG
• Three compartments
– Anterior
• Dorsiflexors/Toe Extensors
– Lateral
• Everters
– Posterior
• Plantarflexors/Toe flexion
– No Medial compartment
Anterior Compartment
• 3 MUSCLES
1.
2.
3.
Tibialis anterior
Extensor Hallucis longus
Extensor Digitorum
longus
Lateral Compartment
• 2 MUSCLES
– All wrap around lateral malleolus
– ankle eversion
– Support lateral longitudinal arch
Posterior Compartment (superficial)
• 3 MUSCLES
– Common distal
attachment: Achilles
tendon
Posterior Compartment (deep) - TDH
• 3 MUSCLES
– T/D/H
– All wrap around medial malleolus
– Insert into foot, support medial longitudinal
arch
ARCHES OF THE
FOOT
• There are three arches to
the foot
1. Medial Longitudinal
2. Lateral Longitudinal
3. Transverse/Metatarsal
• Combination of dynamic
muscle and static
ligamentous support
• Pes planus / Pes cavus
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