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Course Introduction Functional Anatomy OT 319/519 Anatomical Position • Body erect, feet slightly apart, palms forward, and thumbs pointed laterally. • Regardless of the position of the body you are describing, terms of reference describe the body as though it were in anatomical position. • Right and Left always refer to the patient / cadaver, not the side of the observer Planes of Orientation • Sagittal (divides into left & right) • Frontal / Coronal (divides into anterior & posterior) • Transverse / Axial (divides into superior & inferior) • Oblique Terms of Orientation • • • • • • • • Superior (Cephalad) / Inferior (Caudal) Lateral / Medial Superficial / Deep Proximal / Distal Anterior / Posterior Ventral / Dorsal Ipsilateral / Contralateral Prone / Supine Brain Orientation Dorsal Anterior Posterior Ventral Multifidus vs. Splenius Contralateral rotation Ipsilateral rotation Terms to Avoid • • • • • • • Above Below Over Under On top of In front of Behind Terms of Movement • Flexion / Extension • Abduction / Adduction • Internal (Medial) Rotation / External (Lateral) Rotation (extremities) • Pronation / Supination (forearm) • Dorsiflexion / Plantarflexion (Talocrural joint) 2 Common Descriptive Terms • Varus: bent or twisted inward toward the midline of the body. • Valgus: bent or twisted outward or away from the body. • In clinical practice these terms are used to describe the distal portion of the distal bone. Varus or Valgus? Varus or Valgus? Varus or Valgus? Veins, Arteries & Nerves • Veins are vessels that carry blood toward the heart. – We talk about veins as having tributaries. • Arteries are vessels that carry blood away from the heart. – We talk about arteries as having branches. • Nerves can be differentiated from the arteries by their flat shape and the acute angles that their branches make. Nerves • You have 31 pairs of spinal nerves that emerge from the spinal cord (8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal). • Each of these is named according to the order (from superior to inferior) and the region in which they emerge. (Ex. C5, L1, S3) We will refer to these as spinal levels. • Each named peripheral nerve in the body comes from one or more spinal levels. (Ex. Thoracodorsal nerve comes from spinal levels C6, C7, C8) More About Nerves • Some nerves are associated with motor function, while others are associated with sensory function and the remainder are mixed (motor and sensory). • When a nerve is described as an afferent, that means it is carrying information to the central nervous system, thus it is a sensory nerve. • When a nerve is described as an efferent, that means it is carrying information away from the central nervous system, thus it is a motor nerve. Roots, Rami, & Spinal Nerves • Peripheral nerves initially emerge from the spinal cord as ventral and dorsal roots. • By the time the neurons travel through the IV foramen, they have combined to form a spinal nerve. • This nerve then splits into a larger ventral and smaller dorsal ramus. Roots vs. Rami Dorsal roots • Spinal nerve roots emerge directly from the cord. • The roots that emerge anteriorly carry motor commands (efferents) out to the PNS. • The roots that emerge posteriorly carry sensory information (afferents) in to the CNS. Ventral roots Roots vs. Rami • When the roots join they become a spinal nerve. • As you look lateral to that, you will see that the spinal nerve has some branches, these are the ventral and dorsal rami (ramus). • In the rami, there are both sensory and motor fibers. Dorsal Ramus Ventral Ramus The fibers in the circle are associated with the sympathetic nervous system. Dermatomes • For every spinal nerve there is a dermatome. • A dermatome is an area of sensation on the body. • Dermatomes are named for the spinal nerve that provides sensation in that area. • For example, T10 dermatome is from spinal nerve T10. It provides sensation in the area around the trunk at the level of the navel. Dermatomes • Some dermatome landmarks to remember: • C5: lateral shoulder • C6: Thumb • C7: Digit 3 • C8: Digit 5 • T4: nipples • T10: navel • L3: medial knee • L5: lateral knee • S1: lateral foot Palpation • Regardless of your program discipline (OT, PT, PA, CHR) you will be performing some degree of patient evaluation and the more comfortable you are performing an evaluation, the easier it will be on the patient. • Palpation of a patient is often a component of your evaluation. Palpation Applications • Vasomotor changes that would change the temperature of the skin. • Localize sites of specific swelling. • Identify specific anatomic structures and their relationship to one another. • Identify points of tenderness. • Evaluate circulatory status by checking pulses. Lab Practicals • All student and instructor cadavers will be used as well as some models and demonstration specimens. • Radiographs: We are usually asking questions about either bony features or muscle attachments. • Palpations: There will be 6-10 index cards face down on the table and you will draw one. Written on the other side is either a bony feature or muscle which you will have to find on a teaching assistant. Lab Practicals • Cross-Sections: These questions concern the model that is cut into various segments in the transverse plane . • Bonus question: There will be one for each exam, so you can go ahead and allow yourself ONE mistake. Testing Content (What you are expected to know) • Muscle attachments • Muscle actions • Muscle Innervation (Name of the peripheral nerve) • Spinal levels of the relevant nerves • Artery names and their sources • Vein names • Ligaments / Specialized Cartilage Waste Baskets • You will notice two kinds of waste baskets in the lab, gray cans with lids and tan open cans. • The gray cans are to be used exclusively for human tissue. That means no gloves, paper towels, cups, etc. • The tan cans are used for all other waste that is not considered sharp. Superficial & Deep Back Functional Anatomy OT 319 / 519