Functional Anatomy Notes PDF

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FUNCTIONAL ANATOMY Sports Therapy

Anatomy vs Physiology  

Anatomy = the study of the body structure Physiology = the study of the body function

Anatomical Position/Directions The erect position of the body with the face directed forward, the arms the side, and the palms of the hands facing forward, used as a reference in describing the relation of body parts to one another.

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* Palms must be facing up to ensure the radius and ulna are in the correct position*

Planes of the Body The body can be divided into 3 different planes:   

Sagittal – right and left (flexion & extension) Frontal – front and back (abduction & adduction) Transverse – top and bottom (medial & lateral rotation)

Anatomical Definitions

Term Anterior Posterior Medial Lateral Superior Inferior Proximal Distal Superficial Deep Ipsilateral Contralateral Flexion Extension Rotation > Medial/Internal > Lateral/External > Abduction > Adduction Supination Pronation (Ankle Joint) > Plantarflexion > Dorsiflexion (Shoulder Joint) > Horizontal Abduction > Horizontal Adduction Prone Supine Hyperextension (Hand/Feet) > Palmer > Dorsum

Definition Front (ventral) Back (dorsal) Towards the Midline Away from the Midline Above/Top (cranial) Below/Bottom (caudal) Nearer to the point of attachment Further away from the point of attachment Closer to the surface of the skin Further away from the surface of the skin, closer to the bone On the same side On the opposite side Reducing the angle of a joint Increasing the angle of a joint > turning towards the midline of the body > turning away from the midline of the body > taking a limb away from the body > bringing a limb closer to the body Turning palms up Turning palms down > pointing toes to the ground > bringing toes up towards the body > moving arm across the body, at shoulder height, away from the midline. > moving arm across the body, at shoulder height, towards from the midline. Lying face down Lying face up Joint moving past the normal range of extension > Palm surface of the hand/sole of the foot > Back of the hand/top of the foot

Regional Areas of the Body The regional areas are based on regions or divisions of the body and emphasising the relations between various structures (muscles, nerves and arteries etc.) in that region.

The anatomical regions (shown) compartmentalise the human body. Just like on a map, a region refers to a certain area. The body is divided into two major portions: axial and appendicular.

The axial body runs right down the centre (axis) and consists of everything except the limbs, meaning the head, neck, thorax (chest and back), abdomen, and pelvis. The appendicular body consists of appendages, otherwise known as upper and lower extremities (which we call arms and legs).

Bony Landmarks/Prominences Bony Landmarks allow for the navigation around the body and are seen as lumps, bumps and protrusions. These are close to the surface of the skin. They allow therapists to determine a start and end point for muscles, ligaments or tendons.

Dermatomes Dermatomes (skin) is a section of skin supplied by a single spinal nerve. Therapists assess sensation in the areas of dermatomes (what the client feels on the skin e.g. hot or cold). Practitioners may be able to link altered sensation to injuries of the spinal cord nerves.

Myotomes Myotomes is the individual muscle or muscle groups that are innervated by the motor neurons of a single spinal. If a client has injured the spine, it may affect the motor fibres of a single spinal nerve. This would result in the client experiencing difficulty moving the muscle in which the motor fibres innervate.

Endangerment Sites Areas which nerves and blood vessels surface close to the skin and are not well protected by muscle or connective tissue. (Fritz, 2009) e.g. popliteal fossa Other areas that can be referred to as endangerment sites are; fragile bony projections, the kidney area, eyes and the coracoid process. Areas which are contraindicators for massage allow for techniques such as deep pressure. Contraindicators = something that may prevent treatment Site E.g. - Anterior/Posterior Triangle of Neck - Axillary Area - Med/Lat Epicondyles of Humorous - Sternal Notch - Inguinal Triangle - Sciatic Notch

Definitions of Landmarks These are there for the attachment of soft tissue and muscles. Projection Definition Tubercle Small bony projection Tuberosity Larger bony projection Malleoli Extension of tibia and fibula Trochanter Proximal, lateral aspect of the femur Condyles Articular surfaces (2 bones coming together to form a joint) Epicondyles Small bony projection that sits on the medial and lateral sides of a condyle

Bony Landmarks/Prominences Lower Body Prominence - Iliac Crest - ASIS - Pubic Symphysis - Greater Trochanter - PSIS - Ischial Tuberosity - Patella - Adductor Tubercle - Tibial Tuberosity - Head of Fibula - Medial/Lateral Epicondyles of Femur - Medial/Lateral Condyles of Tibia - Tibial Plateau - Anterior Border of the Tibia - Medial/Lateral Malleoli - Tubercle of Navicular - Base of 5th Metatarsal - Metatarsal

Location - bones of the waist - down form iliac crest - genital area - side of hip - base of back (dimples) - on the bum fold - the knee - inside of leg, above to the knee - bone below the knee - outside top of lower leg - large bones of either side of the knee - (triangle), two upper points below the knee - hard flat surface below the knee - sharp edge on the shin - inner and outer ankle bones - inner bone of the middle of the foot - outside bone of the middle of the foot - back and front of toes (knuckles)

Upper Body Prominence Sternoclavicular joint (s/c joint) Clavicle Acromioclavicular joint (a/c joint) Bicipital Groove Greater Tubercle Lesser Tubercle Spine of Scapula Superior Angle of Scapula Inferior Angle of Scapula Medial Border of Scapula Lateral Border of Scapula Coracoid Process Med/Lat Condyles of the Humorous Olecranon Process Body of Sternum Xyphoid Process Radial Styloid Ulnar Styloid Head of Radius Metacarpal Phalangeal Joint Proximal IP Joint Distal IP Joint Occipital Protuberance C7 T12 L4

Location Inner 2 bones of the clavicle Bones across neckline Outer 2 bones of the clavicle Groove in the middle of front & rear deltoid Back of the shoulder bones Front of shoulder bone Sharp bone along the back of scapula Point at top of the scapula Point at bottom of scapula Edge of scapula closest to spine Edge of scapula furthest from spine In 2cm and down 2cm from shoulder Bones on either side of the elbow Tip of the elbow Centre line down chest Point at the bottom of the ribcage Outside wrist bone Inner wrist bone Top of radius, outside below elbow Knuckles 1st joint down from knuckles 2nd joint down from knuckles Protrusion at the back of the cranium Large protrusion at the top of spine In line with the inferior angle of scapula Base of back, in line with ASIS

True Ankle Joint RIGHT LEG Movement Pattern: plantarflexion/dorsiflexion The true ankle joint consists of 3 major bones; Tibia, Fibula and the Talus. Subtalar Joint Further on from that, the inferior distal end of the talus, meets with the superior proximal end of the calcaneus and forms the subtalar joint. This joint allows for inversion and eversion.

Muscle Functions Agonist (prime mover): Cause a specific movement to occur throughout their contraction.

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Antagonist: These muscles oppose a specific movement. This motion, slows it down, and returns a limb to its position.

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Synergist: A muscle (or muscles) which assist a prime mover. E.g. Brachialis weakly assists biceps brachii during elbow flexion Fixator: A muscle (or muscles) which fix a bone in place so there is no unwanted movement. Usually proximal to movement at joint e.g. deltoid during bicep curl. One muscle may serve as all of the above during different movements.

Muscle Contractions Isometric: The joint angle and muscle length do not change during contraction. (Phasic) Isotonic: Gives us the ability to move. There are two types, concentric and eccentric. Concentric: Muscle tension is sufficient to overcome the load, the muscle shortens as it contracts. (Phasic). Origin and insertion come closer together Eccentric: The tension generated is insufficient to overcome the external load on the muscle and the muscle fibres lengthen as they contract. (Phasic). Origin and insertion grow further apart.

Muscle Fibre Arrangement Parallel: Parallel to the force-generating axis, three main categories: strap, fusiform, or fan-shaped. - Rectus Abdominus Strap: Fibres that run longitudinally to the contraction direction. - Sartorius Fusiform: Wider and cylindrically shaped in the centre and taper off at the ends. - Biceps Brachii Pennate: Short fascicles attached obliquely to tendon. - Unipennate: muscles attach to tendon on one side (half a feather). - Bipennate: Tendon in the middle and muscles attach both sides (feather) - Multi-pennate: Lots of tendinous attachments, like overlapping feathers. Convergent: Converge from an extensive origin thinning out into a tendinous attachment. e.g. pectoralis major Circular: Fascicles arranged in concentric rings. Usually found in openings/orifices around the body. - Sphincter muscles

Movement and Power Pennate: Have a large amount of muscles fibres which allows a higher force production but smaller range of motion. Strap & Fusiform: Allows a greater range of movement however the muscles are not strong. Fascicles are in a long parallel arrangement.

Muscles of the Body

The Hip Joint - Formed by ball shaped femoral head and the cup shaped depression of the acetabulum of the innominate bone. Innominate bone is made up of ischium, ilium and pubic bone. - Synovial ball and socket joint, which allows six movements. - Hip joint connects lower limb to the trunk. - Most of the head of femur is within the bony acetabulum, which gives stability to the articulation. - The hip joint is a weight bearing joint.

Hip Joint: Stability - Attached to the margin of the acetabulum is a rim of fibrocartilage called the acetabular labrum. - The acetabular labrum increases the depth of the acetabulum providing increased stability.

Ligaments of the Hip Joint - A ligamentous continuation of this rim, the transverse ligament of the acetabulum, crosses the acetabular notch. When the c shaped gap is spanned by the transverse ligament of the acetabulum a foramen is formed. Vessels and nerves pass through this foreamen. - The femur is tied directly to the acetabulum by the Capitate ligament. Extends from the head of femur to the acetabulum. - Iliofemoral Ligament is a strong triangular ligament located anterior to the hip joint. It is positioned between the A.I.I.S and the intertrochanteric line of the femur. - In standing, when the trunk moves backwards the Iliofemoral ligament becomes taut. - Pubofemoral ligament is a triangular ligament located anterior to the hip joint. - It attaches to the base of the pubic bone and passes inferiorly and laterally, blending into the capsule of the hip joint and the Iliofemoral ligament. - Ischiofemoral ligament extends from the ischium to the femur. - It crosses over the posterior surface of the neck of femur and attaches to the superior portion of the neck to the greater trochanter of the femur.

Muscles of the Hip Pectineus

Origin

Insertion

Action

Pectineal surface of the pubis.

Pectineal line of femur.

Adducts the thigh and flexes the hip.

Gluteus Medius

Dorsal ilium inferior to iliac crest.

Lateral and superior greater trochanter.

Abducts the thigh; medially rotates hip (ant fibres) Laterally rotates hip (post fibres)

Gluteus Maximus

Posterior ilium, sacrum and coccyx.

Iliotibial band, gluteal tuberosity.

Extends the hip.

Psoas Major

Psoas transverse processes of L1 - L5 and bodies and discs of T12 - L5 Iliacus Upper 2/3 of iliac fossa lateral aspect of sacrum. Anterior sacrum, Posterior spine of ilium.

Lesser trochanter.

Flex the torso and thigh.

Greater trochanter.

Lateral rotation of hip.

ASIS and fascia lata.

Iliotibial band.

Helps stabilize and steady the hip and knee joints.

Piriformis

Tensor Fascia Lata

Diagram

Gracilis

Pubic symphysis, inferior ramus of pubis.

Medial surface of tibial shaft.

Flexes the knee, adducts the thigh, helps to medially rotate the tibia.

Adductor Brevis

Inferior pubic ramus.

Medial lip of linea aspera.

Adducts and flexes the thigh and helps to laterally rotate the thigh.

Adductor Longus

Anterior body pubis.

Middle 1/3 of linea aspera.

Adducts and flexes the thigh and helps to laterally rotate the hip joint.

Adductor Magnus

Inferior pubic ramus and inferior ischial tuberosity.

Gluteal tuberosity of femur, medial linea aspera, adductor tubercle.

Adducts, superior fibres also flexes the thigh, extension occurs also.

Sartorius

ASIS

Medial shaft of tibia near the tibial tuberosity

Flexes and laterally rotates the hip joint and flexes the knee.

Knee Joint o o o o

Largest most complex joint in the body. Femur, Tibia, Fibula (patella). Synovial Hinge Joint. Flexion, Extension, Medial and lateral rotation.

Joint Capsule o Joint surrounded by a thick ligamentous sheath composed mainly of muscle tendons. o Cylindrical sleeve passing between femur and tibia. o The capsule is deficient anteriorly where it is replaced by the patella and patella tendon.

Tibio-Femoral Joint o Rounded medial and lateral condyles of the femur. o Flat medial and lateral condyles of the tibia.

Patello-Femoral Joint o Posterior surface of Patella. o Patella surface of the femur.

Ligamentum Patellae o Continuation of the tendon of the quadriceps femoris muscle. o Strong flat band attaching around the apex of the patella and inserting onto the tibial tuberosity.

Medial Collateral Ligament o o o o

Kite shaped. Medial femoral epicondyle and antero-medial tibia. It is broadest at the joint line. Prevents tibia moving laterally relative to the femur.

Lateral Collateral Ligament o Cord like ligament. o Lateral femoral epicondyle and the head of the fibula. o Prevents tibia moving medially relative to the femur.

Posterior Cruciate Ligament o Posterior aspect of the intercondylar area of tibia. o Passes upwards, forwards and medially to the lateral surface of the medial condyle of the femur.

Anterior Cruciate Ligament o Anterior aspect of the intercondylar area of the tibia. o Passes upwards, backwards and laterally to the medial surface of the lateral condyle of the femur.

Menisci o Two discs- medial and lateral. o Attach to the upper surface of the tibia. o Increase the congruence between the femur and the tibia.

Medial Meniscus o Largest of the two, semi-circular in shape. o Posterior portion is broader than anterior portion. o Anterior horn is attached to the anterior part of the intercondylar area of the tibia directly in front of the ACL. o Posterior horn, attaches to the posterior intercondylar area between the PCL posteriorly and the posterior horn of the lateral meniscus anteriorly.

Lateral Meniscus o `o’ shaped o Not attached to lateral ligament

Functions of Menisci 1. 2. 3. 4.

Aid lubrication of joint surfaces Aid nutrition of joint surfaces Act as shock absorbers Spread stress and therefore reduce hyaline cartilage wear 5. Make joint surface more congruent 6. Reduce friction during movement 7. Aid ligaments and capsule to prevent hyperextension 8. Participate in locking mechanism by directing femoral condyles Muscles of the Knee Origin Insertion Action

Diagram

Bicep Femoris

- Long head ischial tuberosity; short head lateral linea aspera

- Head of fibula

- Flexes the knee, rotates the tibia laterally

Semimembranosus

- Ischial tuberosity

- Medial tibial condyle

- Extends the thigh, flexes the knee, rotates the tibia medially, especially when the knee is flexed

Semitendinosus

- Ischial tuberosity

- Medial tibial shaft

- Extends the thigh and flexes the knee

Popliteus

- Anterior popliteal groove on lateral femoral condyle

- Medial shaft Tibia

- Rotates knee medially and flexes the leg on the thigh - Unlocks extended knee joint to initiate flexion

Rectus Femoris

- Straight head ASIS; reflected head groove just above acetabulum

- Base of patella

- Extends the knee

Vastus Intermedius

- Superior 2/3 of anterior and lateral surfaces of femur

- Lateral border of - Extends the knee patella

Vastus Lateralis

- Greater trochanter, lateral lip of linea aspera

- Lateral base and border of patella

- Extends the knee

Vastus Medialis

- Intertrochanteric line, medial lip linea aspera

- Medial base and border of patella

- Extends the knee

Ankle Joint o Synovial Hinge Joint o Allows Planter flexion and Dorsi Flexion. o Joint involves the distal ends of the tibia and fibula proximally and the body of the talus (proximal).

Joint Capsule o o o o

Completely surrounds the joint. Thin and weak ant & post to accommodate the movements plantarflexion and dorsiflexion. Stronger at sides due to ligaments. Attaches above to tibia and fibula and below to talus, post to tibiofibular ligament.

Synovial Membrane o Lines joint capsule o Extends upwards between the tibia and fibula as far up as the interosseous ligament of the inferior tibiofibular joint.

Tibiofibular Articulations o Superior tibiofibular joint. o Articulation between the oval head of the fibula and a similar facet on the posterolateral surface of the lateral tibia condyle. o Fibrous Capsule attaches to the margins of the facets on both the tibia and fibula. o Strengthened by accessory ligaments anteriorly and posteriorly.

Lateral Ligaments 3 different components; o A.T.F.L – strong flat band stretching between ant border of malleolus to neck of talus o P.T.F.L – it arises from the malleolus and passes posteromedially to the posterior aspect of the talus o Calcaneo-fibular – Arises from malleolus, passes downwards and slightly backwards to attach to peroneal tubercle on the calcaneus These are; o Weaker than the medial ligaments o Prevent inversion

Medial Ligaments 4 different components; o A.T.T. – Arises from med malleolus, runs forwards and downwards to attach to medial part of neck of talus o P.T.T. – Thickest part of the deltoid ligament, its fibres run laterally and backwards to the medial side of the talus. o T.N. – Runs forwards and downwards towards the tuberosity of the navicular bone attaching to its upper and medial parts o T.C. – Band descends almost vertically to attach to the whole length of the sustentaculum tali. These are; o Strong fan shaped ligament o Prevents eversion

Muscles of the Origin Insertion Ankle Gastrocnemius - Medial and lateral - calcaneus femoral condyles

Action - Plantar flexor of ankle

Soleus

- Head of Fibula, upper 1/3 fibula, middle tibial shaft