Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Anatomy & Physiology Module 5 Thorax & Upper Extremities Thorax Chapter 5 Bones • Human rib cage • Boney and cartilaginous structure which surrounds the thoracic cavity • Consists of: • 24 ribs • Sternum • Costal cartilages • 12 thoracic vertebrae Bones • Sternum • 3 regions • Manubrium • Jugular notch - notch located at the superior border • Articular surfaces for the clavicle and first rib • Body • Sternal angle - the point where the manubrium and body meet. The second rib articulates with the sternum at the sternal angle • Xiphoid process • Not always present Bones • Ribs • Humans typically have 24 ribs (12 pairs) • First seven sets of ribs are called "true" ribs. They are directly attached to the sternum through the costal cartilage. • The last five pairs are called "false" ribs. Of those, the first three pairs are connected to the sternum by sharing a common cartilaginous attachment. The last two pairs are considered "floating" and have no attachment to the sternum Joints • Thoracic vertebral Articulations were discussed in module 2. • Sternoclavicular joint • Articulation between the sternal end of the clavicle and the manubrium of the sternum. • Sternocostal joint • Articulation between the costal cartilage and the sternum Posterior Thorax Muscles Origin Insertion Action Serratus posterior superior Spinous processes of C7-T3 Superior margin of 2nd-4th ribs Elevates ribs Serratus posterior inferior Spinous processes of T11-L2 Inferior margin of 8th-12th ribs Lowers ribs The Shoulder Girdle Chapter 13 Bones • Scapula • Vertebral border • Axillary border • Inferior angle • Spine • Acromion • Supraspinous fossa • Infraspinous fossa • Subscapular fossa • Glenoid cavity • Coracoid process Bones • Clavicle - AKA collar bone • Connects the upper limb to the trunk • Articulates with the sternum at the manubrium and the scapula at the acromion Left clavicle: from above (a) and below ( b) Bones • Humerus (proximal) • Head - rounded convex surface that articulates with the glenoid fossa • Anatomical neck - the portion of bone that separates the head from the tubercles • Greater tubercle - place of insertion for 3 shoulder muscles: supraspinatus, infraspinatus, and teres minor • Lesser tubercle - location of attachment for the subscapularis muscle • Body - long shaft of the humerus • Deltoid tuberosity - site of attachment for the deltoid muscle Joints • Glenohumeral • Articulation between the head of the humerus and the glenoid cavity of the scapula • Acromioclavicular • Articulation of the acromial end of the clavicle and the acromion of the scapula • Sternoclavicular • Between the sternal end of the clavicle and the manubrium • Scapulothoracic • A physiologic joint formed between the anterior surface of the scapula and the posterior thoracic rib cage. It has no joint capsule and is musculotendinous in nature Joints • Glenohumeral Connective Tissue • Articular capsule • Acromioclavicular ligament • Coracoclavicular ligament • Coracoacromial ligament • Coracohumeral ligament • Sternoclavicular ligament • Costoclavicular ligament Connective Tissue • Bursae • Subdeltoid • Subacromial • Subcoracoid • Coracobrachialis • Infraspinatus Muscles connecting the scapula to the spine Trapezius Rhomboid major Rhomboid minor Levator scapula Origin Insertion Descending: lateral 1/3 Descending: EOP, of clavicle; transverse: ligmentum nuchae, SP's medial side of acromion C2-C7; transverse: SP's and spine of scapula; T1-T4; ascending: SP's ascending: spine of T5-T12 scapula Action Retraction, superior rotation, elevation and depression of the scapula Median margin of the scapula inferior to the spine Stabilizes, retracts, elevates, and inferiorly rotates the scapula SP's of C7 and T1 Medial border of the scapula at the spine Stabilizes, retracts, elevates, and inferiorly rotates the scapula TP's of C1-C4 Superior angle of the medial border of the scapula Elevates scapula medially, ipsilaterally lateral flexes cervical spine SP's of T2-T5 Muscles connecting the upper limbs to the trunk Origin Insertion Action Pectoralis major Medial 1/2 of clavicle, manubrium, body of sternum, costal cartilages of ribs 1-6 Greater tubercle of humerus Adduction, internal rotation, and flexion of humerus Ribs 3-5 Coracoid process Pulls scapula forward, medial, and downward Assists in respiration Rib 1 Acromial end of the clavicle Draws clavicle downward and forward, elevates first rib Ribs 1-9 Medial margin of the costal surface of the scapula Lowers raised arm, elevates ribs, protracts scapula Pectoralis minor Subclavius Serratus anterior Latissimus dorsi Inferior angle of the scapula, ribs 9-12, SP's Intertubercular groove of T7-T12, thoracolumbar humerus fascia, iliac crest Internal rotation, Adduction, and extension of humerus Rotator cuff muscles Origin Insertion Action Supraspinatus Supraspinous fossa of scapula Greater tubercle of humerus Abduction of arm Infraspinatus Infraspinous fossa of scapula Greater tubercle of humerus External rotation of arm Teres minor Upper 2/3 of lateral margin of scapula Greater tubercle of humerus External rotation and Adduction of arm Subscapularis Subscapular fossa of scapula Lesser tubercle of humerus Internal rotation and extension of arm Muscles of the shoulder joint Origin Insertion Action Deltoid Acromion, crest of the spine of the scapula, lateral 1/3 of clavicle Deltoid tuberosity of humerus Adduction of arm; anterior: flexion, internal rotation; posterior: extension and external rotation Teres major Dorsal surface of the inferior angle of the scapula Lessor tubercle of humerus Internal rotation, adduction, and extension of arm Coracobrachialis Coracoid process of the scapula Upper 1/3 of anterior humerus Flexion, Adduction, and internal rotation of arm Biceps brachii, short head Coracoid process of the scapula Radial tuberosity Flexes elbow, flexes shoulder, supinates forearm Biceps brachii, long head Supraglenoid tubercle of the scapula Radial tuberosity and bicipital aponeurosis Flexes elbow, flexes shoulder, supinates forearm Muscles of the shoulder joint Origin Insertion Action Triceps brachii, long head Infraglenoid tubercle of scapula Olecranon process of ulna Extends shoulder, extends elbow Triceps brachii, Lateral head Posterolateral aspect of proximal humerus Olecranon process Extends elbow Triceps brachii, medial Posteromedial aspect of distal humerus head Olecranon process Extends elbow Kinesiology • Scapulohumeral Rythm - describes the timing of movement at these joints during shoulder elevation • First 30 degrees of shoulder elevation involves a "setting phase": • The movement is largely glenohumeral. • Scapulothoracic movement is small and inconsistent. • After the first 30 degrees of shoulder elevation: • The glenohumeral and scapulothoracic joints move simultaneously. • Overall 2:1 ratio of glenohumeral to scapulothoracic movement. • Scapulohumeral rhythm serves at least two purposes. • It preserves the length-tension relationships of the glenohumeral muscles; the muscles do not shorten as much as they would without the scapula's upward rotation, and so can sustain their force production through a larger portion of the range of motion. • It prevents impingement between the humerus and the acromion. Because of the difference in size between the glenoid fossa and the humeral head, subacromial impingement can occur unless relative movement between the humerus and scapula is limited. Simultaneous movement of the humerus and scapula during shoulder elevation limits relative (arthrokinematic) movement between the two bones. The Elbow Joint and Forearm Chapter 14 Bones • The elbow joint consists of the: • Distal humerus • Proximal radius • Proximal ulna • The forearm consists of the: • Radius • Lateral aspect • Ulna • Medial aspect Bones • Humerus (distal) • Condyles - two distinct rounded medial and lateral structures that articulate with radius • Capitulum - lateral structure that articulates with the medial head of the radius • Trochlea - medial structure that articulates the ulna • Lateral epicondyle • Medial epicondyle • Coronoid fossa • Olecranon fossa Bones • Ulna • Olecranon process • Coronoid process • Trochlear fossa • Ulnar tuberosity • Shaft • Head of the ulna • Styloid process Bones • Radius • Head of the radius • Neck of the radius • Radial tuberosity • Shaft • Styloid process Joints • 3 separate joints • Ulnar-humeral • Hinge joint • Radio-humeral • Gliding joint • Radio-ulnar • Pivot joint Connective Tissue • Radial collateral ligament • Ulnar collateral ligament • Annular ligament • Interosseous membrane Nerves • Median • Musculocutaneous • Ulnar • Radial Superficial flexor muscles Origin Insertion Action Pronator teres Medial epicondyle of humerus, Coronoid process of ulna, common flexor tendon Lateral radius Pronates forearm and weak elbow flexion Flexor carpi radialis Medial epicondyle of humerus Base of 2nd and 3rd meracarpal Flexes and abducts wrist Palmerus longus Medial epicondyle of humerus Palmer aponeurosis Tightens palmer aponeurosis, flexes wrist Flexor carpi ulnaris Medial epicondyle of humerus, posterior aspect of the proximal ulna, olecranon Pisiform, hook of hamate, base of 5th metacarpal Flexes and adducts wrist Flexor digitorum superficialis Medial epicondyle of humerus, middle 1/3 of radius Flexion of MCP and PIP Shafts of middle joints of digits 2-5, flexes phalanges of digits 2-5 wrist Deep flexor muscles Origin Insertion Action Flexor digitorum profundus Posterior and medial aspects of proximal ulna, interosseous membrane Bases of the distal phalanges digits 2-5 Flexes MCP, PIP, DIP of digits 2-5, flexes wrist Flexor pollicis longus Anterior surface of radius and interosseous membrane Distal phalanx of thumb Flexion of CMC, MCP, and IP of first digit Pronator quadratus Brachialis Anterior surface of distal Anterior surface of distal ulna radius Pronates forearm Distal anterior surface of Coronoid process of the Flexion of the elbow joint the humerus ulna to flex the forearm Superficial extensor muscles Origin Insertion Action Brachioradialis Lateral supracondylar ridge of distal humerus Lateral stylus of radius Flexes elbow Extensor carpi radialis longus Lateral supracondylar ridge of distal humerus Dorsal base of 2nd metacarpal bone Weak flexion of elbow, extends and abducts wrist Extensor carpi radialis brevis Lateral epicondyle of humerus Dorsal base of 3rd metacarpal bone Weak flexion of elbow, extends wrist Extensor digitorum Lateral epicondyle of humerus Dorsal digital expansion of digits 2-5 Extend wrist, extend MCP, PIP, and DIP of digits 2-5 Extensor digiti minimi Lateral epicondyle of humerus Dorsal digital extension of digit 5 Extend wrist, extend MCP, PIP, and DIP of digit 5 Extensor carpi ulnaris Lateral epicondyle of humerus Base of 5th metacarpal bone Extends and adducts wrist Anconeus Lateral epicondyle of humerus Lateral side of olecranon and ulna Extends elbow Deep extensor muscles Origin Insertion Action Supinator Lateral epicondyle of humerus, supinator crest and fossa of ulna Lateral 1/3 of proximal radius Supinates forearm Abductor pollicis longus Middle 1/3 of posterior radius, interosseous membrane Base of first metacarpal Abducts thumb Extensor pollicis longus Posterolateral surface of Base of distal phalanx of ulna, interosseous first digit membrane Extends distal phalanx of thumb Extensor indicis joins the extensor Posterolateral surface of digitorum tendon to the ulna, interosseous second digit and insert membrane into the posterior digital expansion Extends the proximal phalanx of second digit The Wrist and Hand Chapter 15 Bones • Wrist • Carpal bones • 8 - scaphoid, lunate, triquetral, pisiform, trapezium, trapezoid, capitate, hamate • Hand • Metacarpals • 5 - numbered from the thumb to the fifth finger • Digits • Phalanges • 14 - 3 per finger and 2 for the thumb Connective Tissue • Retinaculum • Flexor retinaculum • Palmer carpal ligament • Transverse carpal ligament • Extensor retinaculum Nerves • Median • Carpal tunnel syndrome • Ulnar • Tunnel of Guyon • Radial Nerves • Carpal tunnel syndrome • Median nerve becomes pressed or squeezed at the wrist • Symptoms - burning, tingling, itching numbness of the palm of the hand, thumb and 2nd and 3rd digit. Progression can result in weakening and atrophy of the thenar muscles Thenar muscles Origin Insertion Action Abductor pollicis brevis Scaphoid and tapezium, flexor retinaculum Base of proximal phalanx of first digit Abduction of CMC joint of first digit Opponens pollicis Trapezium and flexor retinaculum Shaft of first metacarpal Opposition at CMC joint of first metacarpal Thenar muscles Flexor pollicis brevis Origin Insertion Radius and interosseous Base of the proximal membrane phalanx of the first digit Posterior radius and Extensor pollicis brevis interosseous membrane Action Flexion at CMC and MCP joints of the first digit Base of the proximal phalanx of first digit Abduction at the radiocarpal joint, extension at the CMC and MCP of first digit Adductor pollicis oblique Capitate and base of second and third metacarpals Base of the proximal phalanx of first digit Adduction at CMC, flexion at MCP of first digit Adductor pollicis transverse Palmer surface of third metacarpal Base of proximal phalanx of first digit Adduction at CMC, flexion at MCP of first digit Hypothenar muscles Palmeris brevis Origin Palmer aponeurosis Insertion Action Tightens palmar Skin of the Hypothenar aponeurosis and pulls eminence over the ulnar skin of ulnar side of border hand to the center of the palm Abductor minimi digiti Pisiform Base of 5th proximal phalanx on ulnar side, dorsal digital expansion of 5th digit Flexion of MCP joint, extension in PIP and DIP, and abduction of 5th digit Flexor brevis minimi digiti Hook of hamate and flexor retinaculum Base of the 5th proximal phalanx Flexion at CMC and MCP joint of 5th digit Opponens minimi digiti Hook of hamate and flexor retinaculum Ulnar margin of 5th metacarpal Opposes 5th digit Intermediate muscles of the hand Origin Insertion Action Lumbricales Flexor digitorum profundus tendons Extensor expansion of extensor digitorum of digits 2-5 Flexion at MCP joint, extension at proximal and distal IP joints Interosseous Two heads, adjacent to dorsal and palmar metacarpals Sides of the proximal phalanges to extensor expansion of digits 2-5 Flexion at MCP joint, extension and adduction at proximal and distal interphalangeal joints