15
Anatomy (Locomotor) (Subject) / Shoulder and Hip (Lesson)
Advertisement
- Pectoral girdle (joints + ligaments) 1. Bones - Scapulae - Clavicles 2. Joints a) Sternoclavicular joint - between medial end (clavicle) and manubrium (sternum)/1st costal cartilage -> gliding movements - articular surfaces seperates by fibrocartilaginous articular disc - Ligaments: costaclavicular ligaments, sternoclavicular ligaments b) Acromioclavicular joint - between lateral end (clavicles) and acromion (scapulae) --> gliding movements - articular surfaces seperated by fabricartilaginous articular disc - Ligaments: acromioclavicular ligaments, trapezius/deltoid muscle fibers (stability) c) Scapulothoracic joint - special bone-muscle-bone articulation between the costal surface of the scapula, subscapularis muscle, serratus anterior, thoracic wall - movement of the scapula (pro/-retraction, elevation/depression, lat./med. rotation)
- Pelvic girdle (bones + joints) 1. Bones - hip bones - sacrum - coccyx 2. Joints a) Pubic symphysis - articulation between left and right hip bone (secondary cartilaginous joint) - hyaline cartilage + fibrocartilaginous disc b) Sacroiliac joint - articulation between sacrum and auricular surfaces of the ilium (synovial joint) - Ligaments: Interosseous ligaments (posterior), Anterior and superiour sacroiliac ligaments, sacrotuberous ligament (sacrum-ischial tuberosity) + sacrospinous ligament (sacrum-ischial spine)--> prevent backward tilting of sacrum by binding it to the hip bones and counteracting each other
- Glenohumeral joint (bones + stability + joint) 1. Bones - articulation between the head of the humerus and the glenoid fossa of the scapula --> synovial ball and socket joint (multiaxial) --> because if its mobility dislocation (especially anterior dislocation) common 2. Joint - Head of humerus and glenoid fossa covered with hyaline cartilage - Glenoid fossa has a glenoid labrum (ring of fibrocartilage runing around the glenoid cavity) --> deepening for stronger joint - Fibrous capsule forms loose cylindrical sleeve between scapula and humerus --> opening for long head of biceps tendon 3. Stability - Transverse humeral ligament (greater to lesser trochanter) - Glenohumeral ligament (fibrous capsule) - Coracohumeral ligament (coracoid process-anatomical neck humerus) - Coracoacromial ligament (coracoid process-acromion) - Subacromial/Subdeltoid bursa --> main stabiliying factors are rotator cuff muscles
- Rotator cuff muscles (+Innervation) 1. Subscapularis - costal surface of the scapula - attaches to lesser trochanter of humerus - Medial rotator of humerus --> Subscapular nerve 2. Supra- and infraspinatus - dorsal surface of the scapula-attach to the greater tuberosity of the humerus - Abductors and lateral rotators --> Suprascapular nerve 3. Teres minor - dorsal surface of scapula - attach to the greater tuberosity of the humerus - Lateral rotator --> Axillary nerve --> Stabilisation of the glenohumeral joint by pulling the humerus in opposite directions and drawing it inwards the glenoid fossa
- Causes of pain in the shoulder - Inflammation or injury in the shoulder joint itself - Inflammation of supraspinatus tendon or subacromial bursa (tendonitis/bursitis) due to impingement of subacromial space --> caused by bony outgrowths or microtrauma - Pain from other regions (e.g. pleura, peritoneum) --> phrenic nerve which supplies the diaphragm and its pleura/peritoneum has the same spinal cord value of C3-C5 as the skin over the shoulder region --> brain doesn't differentiate the pain
- Iliofemoral joint (Bones + stability + joint) 1. Bones - acetabulum - head of femur 2. Joint - synovial ball and socket joint, multiaxial - head of femur covered with hyaline cartilage (except fovea capitis where the ligamentum teres is) - acetabulum covered with hyaline cartilage (except acetabular fossa - contains a fat pad) - rim of acetabulum is deficient inferiorly (acetabular notch) and closed by the transverse ligament + fibrocartilaginous acetabular labrum (deepening of acetabulum) -fibrous capsule with synovial membrane forms a sleeve around femur and hip joint 3. Stability - Iliofemoral ligament (anteriorly between ilium - intertrachanteric line) - Pubofemoral ligament (anteriorly between pubis - intertrochanteric line) - Ischiofemoral ligament (posteriorly between ischium) --> prevent hyperextension of the hip bone (are taught on extension and relaxed on flexion)
- Diseases/Pain in the hip joint - Avascular necrosis of the head of the femur due to fractures in the neck of the femur (vulnerable blood supply) - Hip dysplasia - Slipped femoral capital epiphysis during adolescent rapid growth period --> fracture through the prox. femoral epiphyseal cartilage caused by shear forces - Degenerative joint disease (osteoarthritis) - hyaline articular cartilage and subchondral bone of mainly the hip joint affected
- Muscles of the shoulder region (+Innervation) 1. Rotator cuff muscles 2. Deltoid (clavicle/acromion/spine - deltoid tuberosity humerus) --> Flexion/Extension, Abduction, Med./Lat. rotation --> Axillary nerve 3. Trapezius (occipital bone/cervical/thoracic vertebrae - clavicle, acromion, spine) --> Extension/Abduction (humerus), movement of the scapula --> Cervical plexus 4. Pectoralis major (clavicle/sternum/costal cartilages - bicipital groover humerus) --> Flexion/Extension, Medial rotation, Adduction) --> Medial and lateral pectoral nerve 5. Pectoralis minor (coracoid process - 3th-5th costae) -->Protraction, Depression (Scapula) --> Medial pectoral nerve 6. Latissimus dorsi (Thoracic vertebrae/ribs/iliac crest - bicipital groove humerus) --> Adduction, Extension, Med. Rotation --> Thoracodorsal nerve 7. Serratus anterior (Adduction) --> Long thoracic nerve 8. Teres Major (lat.border scapula - bicipital groove humerus) --> Adduction, Extension, Medial rotation of humerus) --> Subscapular nerve
- Muscles of the gluteal region (+Innervation) 1. Extensors of the hip - Gluteus maximus (Pelvic girdle - femur+iliotibial tract) --> Extension --> superior gluteal nerve - Hamstring group (Ischial tuberosity - tibia and fibula (posterior)) --> Extension (hip), Flexion (knee) --> Sciatic nerve 2. Flexors of the hip - Iliopsoas - Iliacus (Iliac fossa - lesser trochanter femur) --> Femoral nerve - Psoas major (L1-L5 - lesser trochanter femur) --> both Flexion --> Anterior ramus of lumbar plexus - Rectus femoris (Iliac spine - Quadriceps tendon to tibial tuberosity (anterior)) --> Flexion (hip), Extension (knee) --> Femoral nerve 3. Abductors of the hip - Gluteus medius (Ilium - greate trochanter femur (posterior)) --> Superior gluteal nerve - Gluteus minimus + tensor fascia lata (Ilium - greater trochanter (posterior)) --> Superior gluteal nerve --> prevent the pelvis from dropping on the side of the raised leg when walking 4. Lateral rotators of the hip - Quadratus femoris (Ischial tuberosity - greater trochanter (Posterior)) -->Sciatic nerve - Piriformis (Lat. sacrum - greater trochanter (posterior)) --> Sciatic nerve - Obturator internus (Obturator membrane - greater trochanter (posterior)) --> Sciatic nerve - Inferior + superior Gemelli (Ischial tuberosity +ischial spine - Greater trochanter (posterior)) --> Sciatic nerve --> All stabilise the hip joint (like rotator cuff muscles)
- Anatomical spaces - axilla (borders + contents) - 3D pyramidal shaped region/space between the upper part of the thorax and the arm 1. Borders - Apex - clavicle (anteriorly), scapula (posteriorly), first rib (medially) - Anterior wall - clavicle, subclavius muscle, pectoralis major/minor - posterior wall - scapula, subscapularis, teres major muscles, tendon latissimus dorsi - medial wall - upper ribs, intercostal muscles, serratus anterior muscle - lateral wall - bicipital groove containing long head of biceps tendon - base - deep fascia attaching to the axillary folds 2. Contents - Nerves: Brachial plexus - Artery: axillary artery (continuation of the subclavian artery) - Vein: axillary vein (continuation of basilic vein) - Lymphatics: axillary lymph nodes (pectoral group, apical group, lateral group, central group, subscapular group) - Axillary sheath: encloses the axillary artery, vein and brachial plexus
- Advertisement
- Anatomical spaces - femoral triangle (borders + content) - trangular space anterior to the hip joint 1. Borders - superior border - inguinal ligament - medial border - adductor longus muscle - lateral border - sartorius muscle - Apex - point where sartorius muscle and adductor longus muscle meet - floor - adductor longus, pectineus, iliopsoas - roof - fascia lata (deep fascia) 2. Content - Nerves: femoral nerves (L2/3/4) - Artery: femoral artery - Vein: femoral vein (receiving the profunda femoris and great saphenous veins) - Femoral sheath: encloses the femoral artery, vein, lymphatic vessels
- Innervation of the upper limb 1. Brachial plexus a) Roots - vertral rami of C5-T1 spinal nerves b) Trunks - 3 trunks: Upper (C5/6 roots), Middle (C7 root), Lower (C8/T1 roots) c) Divisions - each trunk divides into an anterior and posterior division --> peripheral nerves derived from the anterior divisions supply anterior (flexor) parts of the upper limb, PN derived from the posterior divisions innervate posterior (extensor) parts of the upper limb d) Cords - Posterior (all posterior division), Lateral (anterior divisions of the upper and middle trunks), Medial (anterior division of lower trunk) --> named with respect to their position relative to the axillary artery e) Branches - Radial and axillary nerve (posterior cord), Musculocutaneous nerve (lateral cord), Ulna nerve (medial cord), Median nerve (lateral and medial cords)
- Brachial plexus - Innervation pattern Branch. Sensory Innervation Muscular innervation 1. Musculocutaneus: skin anterolateral arm Biceps brachii, brachialis, coracobrachialis 2. Axillary: skin lateral shoulder/ Deltoid, Teres minor upper arm 3. Radial: Posterior/lateral forearm, Triceps brachii, brachialis, brachioradialis, wrist, posterior arm Extensor muscles posterior arm and forearm 4. Median: skin lateral 2/3 hand Forearm flexors and tips of digits 1-4. 5. Ulnar: skin palm, medial side Some forearm flexors hand and digits 3-5
- Innervation of the lower limb (Plexuses) 1. Lumbar plexus - ventral rami of spinal nerves L1-4 a) Iliohypogastric (L1) b) Ilioinguinal (L1) c) Genitofemoral (L1/2) d) Lateral femoral cutaneous nerve (L2/3) e) To Iliacus (L2/3) f) Femoral nerve (L2-4) g) Obturator nerve (L2-4) 2. Sacral plexus - Lumbosacral trunk (L4/5), dividing into: a) Superior gluteal nerve (L4-S1) b) Inferior gluteal nerve (L4-S2) c) Sciatic nerve (L4-S3) - Nerve to piriformis
- Clinical examination of Dermatomes/Myotomes 1. Dermatomes - assessed using a pin (cutaneous sensation) 2. Myotomes - assessed by testing the power of the muscle and tendon reflexes 3. Sensory/motor components of single spinal nerves - monosynaptic stretch reflexes (deep tendon reflexes)