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Study Guide CSUDH Master’s Program Applied Anatomy In Orthotics and Prosthetics General Introduction to Bones of the Skeleton Referring to your text, the articulated and disarticulated skeletons, locate the following bones, and describe their general location. You should be able to recognize them by themselves, as well as articulated (articulated = in position, touching its neighbors) The Axial Skeleton Skull Sternum Vertebrae 7 Cervical 12 thoracic 5 lumbar 5 sacral 5 coccygeal Ribs 7 True ribs 5 False ribs 2 of the false ribs are floating Appendicular skeleton Humerus Radius Ulna Carpals Metacarpals Phalanges Femur Patella Tibia Fibula Tarsals Metatarsals Phalanges Pectoral Girdle Clavicle Scapula Pelvic Girdle Os Coxae (Innominate bone): Ilium Ischium Pubis (Os pubis, pubic bone) 2 MATERIAL FOR THE FIRST PRACTICUM Upper Appendicular Skeleton Pectoral Girdle = Clavicle and Scapula anchored by the manubrium of the sternum Clavicle Sternal end Acromial end Conoid tubercle Scapula Borders Vertebral (medial) Axillary (lateral) Superior Sternum Manubrium Jugular Notch Body Xiphoid Process Ribs Angles Superior angle Inferior angle 7 True Ribs 5 False Ribs 2 Floating Ribs Fossa Supraspinous fossa Infraspinous fossa Subscapular fossa Costal Cartilages Scapular Notch Glenoid cavity Supraglenoid tubercle Coracoid process Acromion process Scapular spine Anatomy of the Vertebrae General Structures of a Single Vertebra: Body Vertebral foramen Has 7 Processes Transverse process (2) Superior and inferior articular processes (4 total) Spinous process (1) Between Adjacent Vertebrae Intervertebral discs Intervertebral foramina (2) 3 Upper Appendage Humerus Head Anatomical Neck Surgical neck Tubercles- greater and lesser Intertubercular groove Deltoid tuberosity Capitulum (lateral condyle) Trochlea (medial condyle) Ulna Olecranon process Semilunar (Trochlear) notch Coronoid process Radial notch Styloid process Radius Head Neck Radial tuberosity Styloid process Ulnar notch Lateral epicondyle Medial epicondyle Olecranon fossa Coronoid fossa Hand Digits (1-5) = fingers Proximal, intermediate, and distal phalanges (phalanx, singular) JOINTS: Interphalangeal Joints (IPJ) are the two distal knuckles on your fingers/toes There are two types of IPJ’s Proximal Interphalangeal Joint (PIPJ) Distal Interphalangeal Joint (DIPJ) Metacarpals (1-5) = bones of the palm JOINTS: Metacarpal Phalangeal Joint (MPJ). These are the larger knuckles at the base of your fingers/toes Carpals (mnemonic: physical therapy, lots of studying, time to come home) Proximal row from lateral to medial: scaphoid (Navicular), lunate, triangular (triquetrum), pisiform Distal row, from lateral to medial Trapezium, trapezoid, capitate, hamate 4 Shoulder Joint (Glenohumeral Joint) Ball and Socket Joint: Humeral head in glenoid cavity Glenoid labrum formed as a fibrocartilagenous ring-like structure which deepens the cavity Ligaments: Glenohumeral ligaments : 3 fibrous bands Radiate laterally and inferiorly from the anterior glenoid labrum to the anatomical neck of humerus Reinforce the anterior part of the articular capsule (and are inside the capsule, not visible from outside.) Coracohumeral ligament From base of coracoid process to anterior aspect of greater tubercle of humerus Transverse humeral ligament (know for National Boards, not on our lab exam) Runs from greater to lesser tubercle of humerus Creates a channel , bridging over the intertubercular groove Site for tendon of long head of biceps brachii Coracoacromial ligament From inferior aspect of acromion to coracoid process Forms an extrinsic protective “arch” overlying the head of humerus, preventing superior displacement of the head Supraspinatus muscle passes under this arch. MUSCLES ABOVE THE WAIST: 5 1. Muscles of the Back N Trapezius O Occipital bone, spines of C7 and all Thoracic vertebrae I A spine and acromion of scapula, lateral side of clavicle Extends head and moves scapula in all ways except protraction: medially/ lateraly rotates, elevates/depresses, retracts scapula N O I A Latissimus dorsi lower 6 thoracic vertebrae, lumbar vertebrae, iliac crest intertubercular groove of humerus Extends, adducts and internally rotates arm N Rhomboideus (major and minor) O spinous process of C7-T5 I A medial border of scapula Retracts and elevates scapula 2. Muscles of the Abdomen N External oblique O I A lower 8 ribs linea alba, pubic crest, iliac crest Flexes trunk and rotates trunk to opposite side N O I A Internal oblique Iliac crest, lumbar fascia, inguinal ligament lower 4 ribs; linea alba; pubic crest Flexes trunk and rotates trunk to opposite side N O I A Rectus abdominis pubic crest and pubic symphysis Costal cartilages of ribs 5-7 and xiphoid process Flexes and rotates trunk N O I A Serratus anterior (“boxer’s muscle”) Ribs 1-8 medial (vertebral) border of scapula Protracts and laterally rotates (glenoid cavity goes up) scapula 3. Muscles of the chest 6 Name O I A Pectoralis major sternum, costal cartilages, clavicle Intertubercular groove of humerus Flexes, adducts and internally rotates arm Name Pectoralis minor O Ribs 3,4,5 I Coracoid process of scapula A Protracts, depresses scapula 4. Muscles of the shoulder Name Supraspinatus (rotator cuff muscle) O supraspinous fossa of scapula I greater tubercle of humerus A Abducts arm 5. Name Infraspinatus (rotator cuff muscle) O infraspinous fossa I greater tubercle of the humerus A Extends and externally rotates arm Name Teres Minor (rotator cuff muscle) O Upper axillary border of scapula I Greater tubercle of humerus A Extends and externally rotates arm Name O I A Teres Major Inferior angle of scapula Intertubercular groove of humerus Extends,adducts and internally rotates arm Name Subscapularis (rotator cuff muscle) O Subscapular fossa I Lesser tubercle of humerus A Internally rotates and adducts arm 5. Muscles of the Arm: Name O I A Deltoid clavicle, acromion and scapular spine deltoid tuberosity of humerus Flexes/Extends, internally/externally rotates, abducts arm Name Biceps brachii (crosses 2 joints) 7 O I A coracoid process, supraglenoid tubercle of scapula radial tuberosity Flexes elbow, supinates forearm (main supinator or forearm) Name Coracobrachialis O Coracoid process of scapula I Middle humerus A Adducts and flexes arm Name O I A Brachialis distal anterior humerus coronoid process of ulna Flexes elbow Name O I A Triceps brachii (crosses 2 joints) axillary border of scapula, posterior humerus olecranon process of the ulna Extends elbow 6. Muscles of the Antecubital Fossa Name Brachioradialis O distal humerus I styloid process of radius A Flexes elbow Name O I A Pronator teres medial epicondyle (humerus), coronoid process (ulna) Middle lateral radius Flexes and pronates forearm 7. Muscles of the Hand Extensors of the Hand (hairy surface of the forearm) Name Extensor digitorum O lateral epicondyle of the humerus I posterior surfaces of distal phalanges of digits 2-5 A Extends fingers and wrist Name O I A Extensor carpi radialis Lateral epicondyle of humerus Base of 2nd and 3d metacarpals, posterior surface Extends and abducts wrist 8 Name O I A Extensor carpi ulnaris lateral epicondyle of humerus Base of 5th metacarpal, posterior surface Extends and adducts wrist Flexors of the hand (smooth surface of the forearm) Name Flexor carpi radialis O medial epicondyle of humerus I base of 2nd and 3d metacarpals, anterior surface A Flexes and abducts wrist Name O I A Flexor carpi ulnaris medial epicondyle of humerus 5th metacarpal, pisiform, hamate Flexes and adducts wrist Name O I A Palmaris longus medial epicondyle of humerus palmar aponeurosis Flexes wrist Name Flexor digitorum superficialis O Medial epicondyle of humerus I Middle phalanges 2-5 A Flexes digits and wrist Name Flexor digitorum profundus O Anterior ulna I Distal phalanges 2-5 A Flexes digits and wrist Retinacula Name Flexor retinaculum Name Extensor retinaculum Thumb muscles Name Name Name Name Flexor pollicis longus Extensor pollicis longus Extensor pollicis brevis Abductor pollicis longus 9 Actions of Muscles SCAPULA Depresses and rotates scapula Rhomboids Trapezius Pectoralis minor Retraction of scapula Rhomboids Trapezius Protraction of scapula Pectoralis minor HEAD Extends head FOREARM Extends elbow Triceps brachii Flexes elbow Brachialis Biceps brachii Brachioradialis Pronator teres Supinates forearm Biceps brachii Supinator Pronates forearm Pronator teres HAND Extends wrist Extensor carpi radialis 10 Trapezius ARM Flexes arm Pectoralis major Coracobrachialis Deltoid Extends arm Latissimus dorsi Teres Major Teres Minor Infraspinatus Deltoid Triceps brachii Abducts arm Supraspinatus Deltoid Adducts arm Latissmus dorsi Teres Major Subscapularis Pectoralis major Coracobrachialis Internally rotates arm Latissmus dorsi Teres Major Subscapularis Pectoralis major Deltoid Externally rotates arm Teres Minor Infraspinatus Deltoid MATERIAL FOR THE SECOND PRACTICUM Lower Appendicular Skeleton Pelvic Girdle = Two Os Coxae joined anteriorly and anchored to the sacrum posteriorly Boney pelvis = two os coxae, sacrum and coccyx Os Coxa (Innominate bone) Acetabulum (latin. Vinegar cup) Acetabular notch (inferior) Acetabular fossa (roughened inferior surface) Lunate surface (smooth superior surface) Obturator foramen 11 Ilium Auricular surface Iliac crest Ala (laterally) Iliac fossa (medially) Spines Anterior superior iliac spine Anterior inferior iliac spine Posterior superior iliac spine Posterior inferior iliac spine Greater sciatic notch Ischium Ischial spine Lesser sciatic notch Ischial tuberosity Pubis (Os pubis; pubic bone) Body Superior ramus Inferior ramus Pubic crest Pubic arch Pubic symphysis (or symphysis pubis) Lower Appendage Femur Head Anatomical neck Surgical neck Greater and lesser trochanter Intertrochanteric crest (posterior) Fovea capitis Linea aspera Gluteal tuberosity Medial condyle Lateral condyle Medial epicondyle (adductor tubercle) Lateral epicondyle Patellar surface 12 Popliteal fossa Tibia Medial malleolus Medial and lateral condyles Intercondylar Eminence Tibial tuberosity Fibular Notch Foot Fibula Head Lateral malleolus Metatarsal bones 1-5 The 5th metatarsal has a styloid process Patella Base Apex Articular facets Tarsal bones Digits 1-5 Proximal, intermediate, and distal phalanges, except hallux Big toe is called the hallux Calcaneus Talus Navicular Cuboid Cuneiforms (3) lateral, intermediate and medial Arches of the foot Longitudinal Transverse 13 Joints of the Appendicular Skeleton: YOU ONLY NEED TO KNOW THE NAMES OF THE LIGAMENTS Knee Joint Hinge joint, but movements are combined with those of gliding, rolling and rotation around a vertical axis. 3 articulations: lateral and medial articulations of femur and tibia; intermediate articulation of patella and femur. Note: Fibula does not articulate with the femur, only with the tibia. Extracapsular ligaments: Patellar ligament Passes from the apex and margins of the patella distally to the tibial tuberosity Joins with the patellar retinacula, aponeurotic expansions of the vastus lateralis and medialis muscles and support the articular capsule laterally. Medial collateral ligament Extends from the medial epicondyle of the femur to the medial condyle of the tibia At its midpoint, its fibers are attached to the medial meniscus, Weaker than the fibular collateral ligament, so more often injured Lateral collateral ligament Extends inferiorly from lateral epicondyle of femur to lateral surface of the fibular head Intracapsular ligaments and menisci: Cruciate ligaments Join proximal tibia with distal femur, crisscrossing in the articular capsule Anterior cruciate ligament (ACL) Weaker of the two cruciates Arises from anterior intercondylar area of tibia, extends posteriorly, superiorly and laterally to attach at the posteromedial side of the femoral lateral condyle. Slack when knee is flexed, taut when fully extended Prevents posterior displacement of femur and hyperextension of knee joint Posterior cruciate ligament (PCL) Arises from posterior intercondylar area of tibia, passes superiorly and anteriorly, attaches to the anterolateral surface of the medial condyle of femur. Taut during flexion, prevents anterior displacement of femur on the tibia Is the main stabilizing factor when weightbearing during flexed knee position (ie. Walking downhill.) Menisci (medial and lateral) Crescent (C-) shaped plates of fibrocartilage located over the medial and lateral tibial condyles Thicker laterally, thinner inside the joint capsule Act like shock absorbers Thicker laterally, taper to thin unattached edges at interior of the joint. 14 Hip Joint Strong, stable multiaxial ball and socket joint Most moveable of all joints Fibrocartilaginous acetabular labrum and travsverse acetabular ligament (which bridges the acetabular notch) hold head in beyond its equator. Ligaments: Iliofemoral ligament Y shaped; Attaches to ant infer iliac spine and acetabular rim proximally and inferior intertrochanteric line distally Prevents hyperextension of the hip during standing Pubofemoral ligament Runs from the superior ramus of the pubis and passes laterally and to the intertrochanteric line (passing deep to the iliofemoral ligament.) Prevents overabduction of the hip joint Ischiofemoral ligament Runs from ischial part of acetabular rim, spirals superolaterally to the neck of femur (best seen from posterior view.) Prevents hyperextension of the hip by screwing the femoral head deeper into the acetabulum Ligament of the head of the femur (know for National Boards, not on our lab exam) Weak, little importance in strengthening hip joint Runs from the transverse acetabular ligament and attaches to the pit ( fovea capitis) of head. 15 MUSCLES BELOW THE WAIST: 8. Trunk Muscles (Note: movement of the “Hip Joint” and movement of the “thigh” mean the same thing, e.g. hip extension = thigh extension) Name O I A Gluteus maximus Iliac crest, sacrum gluteal tuberosity of femur Extends and externally rotates thigh (main extensor of thigh) Name O I A Gluteus medius Iliac fossa greater trochanter of the femur Abducts and internally rotates thigh (controls pelvic tilt at midstance) Name O I A Tensor fasciae latae iliac crest and anterior superior iliac spine iliotibial tract Flexes, abducts and internally rotates thigh Name Piriformis O Sacrum I Greater trochanter of femur A Externally rotates thigh Name Sciatic nerve Name Psoas major Iliacus (together = iliopsoas) O lumbar vert, transverse process Iliac fossa I lesser trochanter of the femur lesser trochanter of the femur A Flexes thigh (main flexor of thigh) Flexes thigh (main flexor of thigh) NOTE: Hip extensors and hip flexors stabilize the pelvis during locomotion. 9. Anterior Muscles of Thigh Quadriceps femoris = Group name (composed of 4 muscles; controls knee flexion) Name Rectus femoris O anterior inferior iliac spine (AIIS) I tibial tuberosity A Extends leg, flexes thigh Name Vastus lateralis O linea aspera, greater trochanter I tibial tuberosity 16 A Name O I A Name O I A Extends leg Vastus medialis linea aspera tibial tuberosity Extends leg Vastus intermedius (does not flex hip) proximal femur tibial tuberosity Extends leg 10. Posterior Muscles of Thigh 3 muscles called Hamstrings. These are located on posterior thigh. The Actions of All 3 is the same. They decelerate the leg at heel strike. Name Biceps femoris O ischial tuberosity and linea aspera I fibula head A Extends thigh, flexes leg Name O I A Semimembranosus ischial tuberosity medial condyle of tibia Extends thigh, flexes leg Name O I A Semitendinosus ischial tuberosity medial aspect of proximal tibia Extends thigh, flexes leg 11. Thigh Adductors Name O I A Pectineus pubis posterior proximal femur Adducts, flexes thigh Name O I A Adductor Longus Pubis, superior ramus linea aspera Adducts, flexes thigh Name O I A Adductor magnus Ischial tuberosity and pubis, inferior ramus linea aspera of femur Adducts, flexes/extends thigh 17 Name O I A Sartorius anterior superior iliac spine Medial tibia Flexes, abducts and externally rotates thigh; flexes lower leg Name O I A Gracilis pubis Medial proximal tibia Adducts, flexes and internally rotates thigh Name Scarpa’s Triangle 12. Leg Muscles Posterior Leg: Plantarflexors of the foot (except politeus). Triceps Surae (the group name for gastroc and soleus) Name Gastrocnemius O medial and lateral epicondyles of femur I Posterior calcaneus via Achilles tendon A Flexes leg, plantarflexes foot Name O I A Soleus head of fibula and middle of tibia Posterior calcaneus via Achilles tendon Plantarflexes foot Name Plantaris O Lateral epicondyle of femur I Posterior calcaneus via Achilles tendon A Flexes leg, plantarflexes foot Name Popliteus O Later condyle of femur I Proximal tibia A Internally rotates leg Muscles behind the medial malleolus; plantarflexors of foot (Tom, Dick, and Harry: Tom = tibialis posterior; Dick = flexor digitorum longus, Harry = flexor hallucis longus) Name Tibialis posterior O Posterior tibia and fibula I Plantar surface of navicular A Inverts and plantarflexes foot 18 Name Flexor digitorum longus O Posterior tibia I Distal phalanges of 2-5th digits A Flexes 2-5th digits and plantarflexes foot Name Flexor hallucis longus O Posterior fibula I Distal phalanx of 1st digit A Flexes hallux and plantarflexes foot Anterior Compartment of the Leg (PRE-TIBIAL group); dorsiflexors of the foot Name Tibialis anterior (prevents foot slap at heel strike) O lateral condyle and shaft of tibia I Plantar aspect of first metatarsal and medial cuneiform A Dorsiflexes and inverts foot Name Extensor hallucis longus O Shaft of fibula I Distal phalanx of hallux A Extends hallux, dorsiflexes foot Name Extensor digitorum longus O Lateral condyle of tibia, proximal fibula I Distal phalanges of 2-5th digits A Extends digits 2-5, dorsiflexies foot Muscles behind the lateral malleolus (Everters of the foot) Name O I A Peroneus (fibularis) longus (runs post to lat malleolus) head of fibula First metatarsal and medial cuneiform Everts and plantarflexes foot Name Peroneus (fibularis) brevis (runs post to lat malleolus) O Shaft of fibula I 5th metatarsal styloid process A Everts and plantarflexes foot Name O I A Peroneus (fibularis) tertius (runs ant to lat malleolus) Distal fibula shaft 5th metatarsal shaft Everts and dorsiflexes foot 19 THIGH Extension of thigh Gluteus maximus Adductor magnus Biceps femoris Semimembranosus Semitendinosus Flexes thigh Psoas major Tensor fasciae latae Sartorius Rectus femoris LEG Flexes leg Sartorius Biceps femoris Semimembranosus Semitendinosus Gastrocnemius Plantaris Extends leg Rectus femoris Vastus lateralis Vastus medialis Vastus intermedius Internal rotation of leg Popliteus FOOT Plantarflexes foot 20 Pectineus Adductor Longus/ Brevis Adductor magnus Gracilis External rotation Gluteus maximus Piriformis, Gemellus, Obturators Quadratus femoris Sartorius Adductor magnus Internal rotation Gluteus medius Gluteus minimus Tensor fasciae latae Adductor magnus Gracilis Abduction of thigh Gluteus medius Gluteus minimus Tensor fasciae latae Sartorius Adduction of thigh Pectineus Adductor Longus/Brevis Adductor magnus Gracilis KEY TO MUSCLE MODELS IN LAB 1. Teres Major 2. Teres Minor 3. Supraspinatus 4. Infraspinatus 5. Subscapularis 6. (skip) 7. Coracobrachialis 21 8. Deltoid 9. Triceps brachii 10. Biceps brachii 11. Brachialis 12. Brachioradialis 13. Pronator teres 14. Extensor carpi radialis 15. Extensor carpi ulnaris 16. Extensor digitorum 17. Extensor pollicis longus 18. Extensor pollicis brevis 19. Abductor pollicis longus 20. Flexor carpi ulnaris 21. Flexor carpi radialis 22. Palmaris longus 23. Flexor digitorum superficialis 24. Flexor digitorum profundus 25. Gluteus maximus 26. Gluteus medius 27. Piriformis 28. Psoas major (Spine model) 29. Tensor fasciae latae 30. Rectus femoris 31. Vastus lateralis 32. Vastus medialis 33. Vastus intermedius 34. Sartorius 35. Gracilis 36. Pectineus 37. Adductor Longus 22 38. Adductor magnus 39. Scarpa’s Triangle (Prosthetic device) 40. Biceps femoris 41. Semimembranosus 42. Semitendinosus 43. Gastrocnemius 44. Soleus 45. Plantaris (plaster models only) 46. Popliteus 47. Tibilalis posterior 48. Flexor digitorum longus 49. Flexor hallucis longus 50. Tibialis anterior 51. Extensor digitorum longus 52. Extensor hallucis longus 53. Peroneus (fibularis) longus 54. Peroneus (fibularis) brevis 55. Peroneus (fibularis) tertius 23