6. The Skeletal System – Appendicular Division Review - Kines 262 PDF

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Human Anatomy, , Martini/Timmons/Tallitsch

: The Skeletal System – Appendicular Division ● The Appendicular skeleton is very different in structure and function from the axial skeleton. 1. The axial skeleton provides protection to vital organs and allows movements involved in respiration. 2. The appendicular skeleton is involved in changing your position in the external environment. This includes, but is not limited to: a. b. c. d. e.

Standing Walking Sitting Dressing Driving a car

● The appendicular skeleton consists of the 126 bones of the upper and lower limbs and the girdles that attach these bones to the axial portion of the skeleton. ● Muscles and bones are structurally and physiologically linked. Many features of bones discussed in this chapter and in the previous chapter include the attachment sites for muscles to be discussed in later chapters.

II.

The Pectoral Girdle and the Upper Limb ● The pectoral girdle includes the S-shaped clavicle (collarbone) and the flattened scapula (shoulder blade). Can include the humerus as the third bone. 1. The clavicle articulates with the manubrium of the sternum and is the only direct connection between the axial skeleton and the pectoral girdle. 2. The scapula is attached to the clavicle anteriorly but has no connection to the actual axial skeleton; instead skeletal muscles and ligaments support it.

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The upper limb consists of the brachium (humerus), antebrachium (ulna and radius), wrist (carpals), and hand (metacarpals and phalanges). ● The Pectoral Girdle 1. Movements of the pectoral girdle position the shoulder joint to allow arm movement. a. Because stabilization of the shoulder joint is critical, the scapula and clavicle have extensive surface area for muscle attachment.

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Human Anatomy, , Martini/Timmons/Tallitsch

: The Skeletal System – Appendicular Division 2. The Clavicle a. The clavicle extends laterally from the manubrium beginning just lateral to the jugular notch. This end of the clavicle is called the sternal end or medial end. b. The clavicle sweeps laterally and dorsally in an S-shape until its acromial end or lateral end articulates with the acromion of the scapula.

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o The acromial end is flatter and broader than the sternal end. o Clavicular Fracture Facts: Most common fracture among under 25 year olds Falling on shoulder cause fracture. What portion is fractured. 75% of time? _____________________________ 90% of clavicle fractures- require non-operative treatment. Risk of nonunion is greater where- in the lateral end or distal end. Communited Fracture – bone broken in several pieces • •

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Presentation of a Clavicular Fracture 1. Shoulder Depression – Weight of upper arm – Trapezius compromised 2. Shoulder is pulled medially and forward • Pectoralis major (adductor) 3. Elevation of the proximal fragment of the clavical. due to the sternocleidomastoid- SCM pulling up on it.

3. The Scapula and Pectoral Girdle and Gleno-humeral Joint a. The body of the scapula forms a roughly triangular shape and contains numerous markings for muscle attachment of which are covered in our lab (refer to the lab notes for those landmarks). Separated Shoulder AKA - (acromioclavicular separation, AC joint separation, AC separation) The acromio-clavilar ligament – is stretched or ruptured due to a fall on the tip of the shoulder or due to a FOOSH injury …“fall on an outstretched hand.”

Capsulo-ligamentous Injuries & Shoulder Dislocation / Subluxation: 3 Types of Dislocations: • Posterior (backward)4% – See due to electrocution or seizure or – Strength imbalance – in rotator cuff

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Human Anatomy, , Martini/Timmons/Tallitsch

: The Skeletal System – Appendicular Division •

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Inferior (downward) 1% – Luxatio erecta - hyper abduction of the humerus and your arm is in permanent “above your head position.” ….arm appears to be permanently held upward or behind the head. – See that is forces humeral head against the acromion and humeral head points downward below glenohumeral joint. – Anterior (forward) 95% We see this happen most often because the glenoid area has a shallow fossa anteriorly and tends to slip out of the socket! The type of arm position used most See the axillary artery and nerve compromised in an anterior dislocation.

4. The Upper Limb consists of the brachium (humerus), antebrachium (ulna and radius), wrist (carpals), and hand (metacarpals and phalanges). All from Lab again! Carpal bones (wrist) (see lab notes) the Scaphoid (navicular) –is most commonly broken usually due to a FOOSH injury. Anatomical Snuff Box - borders are as follows……………. Posterior border: extensor pollicis longus. The anterior border: (closest to the edge of the hand) extensor pollicis brevis and the abductor pollicis longus. The proximal border: styloid process of the radius The floor is the trapezium and primarily the scaphoid carpal bones Phalanges: Fingers and Thumb – see lab notes for this The Pelvic Girdle and Lower Limb •

Supports and protects lower viscera reproductive organs developing fetus in females.

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Has larger bones for weight bearing and locomotion.

● The bones of the pelvic girdle and lower limb are much more massive than their homologues of the upper limb. • • •

The pelvic girdle consists of two os coxae bones - also called *Innominate bone – (designating many parts otherwise unnamed) or *Coxal bone The Pelvic girdle is composed of right and left sides and blend the axial and appendicular skeletons.

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Human Anatomy, , Martini/Timmons/Tallitsch

: The Skeletal System – Appendicular Division •

Ilium, Ischium, and Pubic Symphysis

Pelvic Insufficiency Fractures AKA stress fractures in pelvis.

The male and female pelvis contains numerous differences. o Generally the male pelvis is heavier with more prominent markings due to the larger muscles attached to it. o Other differences are the result of adaptations for childbearing. Differences are noted as how the female compares to the male.      

Enlarged pelvic outlet, due to wider ischial spines. Less curvature of the sacrum and coccyx. Wider, more circular pelvic inlet. Broader, lower pelvis. Widely fanning ilia. Pubic angle greater than 100 degrees

o These adaptations are made to support the weight of the fetus and allow easier passage through the pelvic outlet. ● The Lower Limb includes the thigh (femur), kneecap (patella), leg, (tibia and fibula), ankle (tarsals) and foot (metatarsals and phalanges). 1. The Femur is the longest, heaviest bone in the body. It has a proximal epiphysis, shaft, and distal epiphysis.

2. The Patella, or kneecap, is a sesamoid bone in the tendon of the anterior thigh muscles, the quadriceps femoris. Patellofemoral Syndrome (PFS): Quadriceps weakness and quadriceps muscle imbalance may contribute to abnormal patellar tracking. .If the strength of the vastus medialis muscle is inadequate, the usually larger and stronger vastus lateralis muscle will pull sideways (laterally) on the kneecap. Strengthening the vastus medialis to prevent or counter the lateral force of the vastus lateralis is one way of relieving PFPS. 3. The Tibia is the larger, more medial bone of the leg. It has a proximal epiphysis, shaft, and distal epiphysis. 4. The Fibula is the much smaller bone of the lower limb that parallels the tibia.

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Human Anatomy, , Martini/Timmons/Tallitsch

: The Skeletal System – Appendicular Division 5. There are 7 Tarsal Bones in total the talus, calcaneus, cuboid, navicular, and three cuneiform bones. Heel Spurs: an osteophyte that forms from the origin of the long plantar ligament Plantar Fasciitis: AKA Plantar fasciopathy or Jogger's heel Inflammation of the heel & structural deterioration of the plantar fascia of the foot. It is commonly associated with long periods of weight bearing and is much more prevalent in individuals with hyperpronation (flat feet.

6. The Metatarsal Bones and Phalanges see lab notes a. The metatarsal bones (5) articulate with the distal tarsal bones and make up the arches of the foot. b. Generally the metatarsals of the foot are longer than the metacarpals of the hand, and the phalanges of the foot are shorter than the phalanges of the hand. a. Arches of the Foot o The longitudinal arch of the foot is from posterior to anterior and transfers weight between the calcaneus and the toes. o The transverse arch of the foot is produced by the irregularity in the depth of the lateral and medial sides of the longitudinal arch. b. Pes Cavus: High arches and associated with people who supinate their foot and ankle. Pigeon Toe laymans term for it as well. c.

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Pes Planus:_ Pes cavus (in medical terminology, also high instep, high arch, talipes cavus, cavoid foot, and supinated foot type).

d. Hallux Valgus A hallux abducto valgus deformity, commonly called a bunion, is a deformity characterized by lateral deviation of the great toe, often erroneously described as an enlargement of bone or tissue around the joint at the head of the big toe.

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