method of study for this section (applied anatomy of the musculoskeletal system) read assigned...
TRANSCRIPT
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Method of Study for This Section(Applied Anatomy of the Musculoskeletal System)
• Read assigned readings of text• Use the Dynamic Human CD-ROM and models and illustrations
of the musculoskeletal system to help review structure of bones, joints, and muscles as necessary. This is the purpose of lab.
• Complete labs conscientiously and study models of articulated skeleton, shoulder, spine, and knee
• Lecture will only provide a selective review of structure, muscles & movements, and movement-related issues
• For exams, review lecture notes and understanding questions in both lecture and labs
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Objectives of Upper Ext Unit
• Explain how anatomical structure affects movement capabilities on upper extremity articulations.
• Identify factors influencing the relative mobility and stability of upper extremity movements
• Identify muscles that are active during specific upper extremity movements
• Describe the biomechanical contributions, specific structures, and movement-related causes of common injuries of the upper extremity.
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Sh Jt & Girdle Ant Musculature
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Sh Jt & Girdle Post Musculature
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Upper Extremity – Chapter 7
Shoulder Girdle Structure:
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Normal Rom of Shoulder girdle
• Sternoclavicular joint– Protraction 15 deg, retraction 15 deg– Elevation 45 deg, depression 15 deg
• Acromioclavicular joint– All directions 20-30 deg
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Muscles and Movement of Shoulder Girdle• Illustrations on next three slides• Trapezius (large, superficial medial and sup to scapulae)
– Upper portion - elevation, upward rotation– Middle portion - adduction, or retraction– Lower portion - depression, upward rotation
• Rhomboids - – elevation, downward rotation, adduction, or retraction
• Serratus anterior (underneath scapulae)– abduction, upward rotation
• Pectoralis minor (underneath pectoralis major)– downward rotation, abduction, or protraction
• Levator Scapulae (underneath upper trapezius)– elevation, downward rotation
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Elevation and Depression
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Upward & Downward Rotation
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Protraction & Retraction
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Shoulder Joint Structure
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Normal ROM of arm movements
• Flexion – (arm at side is 0 deg) 180 deg, hyperextension 60 deg
• Transverse flex (arm in front of chest is 0 deg) – 40 deg, transverse ext 90 deg
• Rotation(arm abducted, elbow bent to 90 deg, arm at right angles to trunk is 0 deg)– Internal 90 deg, external 90 deg
• Abduction 180 deg
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Shoulder Joint Stabilizers
• Stabilizers and rotators - Rotator cuff muscles –– Teres minor - external rotation
– Infraspinatus - external rotation
– Supraspinatus - abduction
– Subscapularis - internal rotation
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Shoulder Joint Primary Movers
• Anterior movers – Anterior deltoid, pectoralis major
• Superior movers - middle deltoid
• Posterior movers - posterior deltoid
• Inferior movers - latissimus dorsi, teres major, lower pectoralis m.
• Force vectors of muscles (see next slide)
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Shoulder Jt Muscles
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Movements of Shoulder Complex
• Every movement of upper extremity involves either stabilizing or accommodating action of the shoulder girdle.– If carrying something in arms, scapular elevators are
involved– Arm elevation – scapular protraction and/or upward
rotation (first 30°,1/5th is scapular movement; then 1/3rd scapular movement after that)
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Shoulder Joint Impingement Syndrome• What is it? Pain from shoulder area resulting from impingement of
structures between humeral head, acromion, and coracromial arch. Three stages:
– Stage I - edema and hemorrhage of subacromial structures
– Stage II - tendon fibrosis and bursal thickening
– Stage III - rotator cuff tears, biceps tendon ruptures, and bone spurs
I: II: III:
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Causes of Sh Jt Impingement• Primary impingement:
– Repeated movements requiring elevated and/or medially rotated humerus, compounded by weak rotator cuff muscles, causing: impingement of long head of biceps, supraspinatus
• Secondary Impingement: – Decreased volume of subacromial space due to glenohumeral
joint instability, and perhaps joint capsular tightness
• Structural abnormalities:– hooked or curved acromion, calcium deposits, bone spurs,
thickened bursa, thickened ligaments
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Shoulder Jt Impingement (3)• Treatment:
– Related to the cause - may involve surgery, rotator cuff strengthening, and flexibility exercises.
– Later, avoid humeral elevation and rotation movements.
– Website for Shoulder Joint Impingement Syndrome
(click on “view eorthopod”, then “shoulder”, then “impingement syndrome”)
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Elbow Joint Structure
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Elbow and Wrist Joint Muscles
• True Flexor - Brachialis• Flexor-Supinator - Biceps brachii• Extensor - Triceps brachii• Wrist flexors (medial epicondyle of humerus)
– Flexor carpi ulnaris and flexor carpi radialis• Wrist extensors (lateral epicondyle of humerus)
– Extensor carpi ulnaris & extensor carpi radialis
• Force vectors of muscles on next slide
KIN 330 Biomechanics
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• Muscles of elbow joint:
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Muscles and Movements of Radioulnar Joint• Elbow Flexion -
– Forearm Supination - Biceps Brachii– Forearm Pronation - Pronator Teres
• Elbow Extension - – Forearm Supination - Supinator– Forearm Pronation -Pronator Quadratus
• Muscle force vectors on next slide• Epicondylitis
– The most common cumulative trauma disorder (CTD), repetitive stress injury (RSI), repetitive motion disorder (RMD), or overuse syndrome (OS) is epicondylitis
– Epicondylitis website (click on “view eorthopod”, then “elbow”, then “medial epicondylitis” or “lateral epicondylitis”
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Normal ROM for forearm and wrist movements
• Forearm– Flexion 150 deg
– Supination 80-90 deg
– Pronation 80-90 deg
• Wrist– Flexion 80 deg
– Extension 70 deg
– Radial flex 20 deg
– Ulnar flex 30 deg
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Radioulnar Jt Muscles
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Bones of Wrist and Hand
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Carpal Tunnel Syndrome• Background
Carpal tunnel includes
median nerve and
9 flexor tendons
( 4 flex dig sup,
4 flex dig prof,
1 fl pol l)
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Carpal Tunnel Syndrome (cont’d)
• Symptoms– Pain in wrist area, or referred proximally or distally– Tingling of thumb, fingers, or palmar side of hand– Loss of control of muscles affected by median nerve blockage
• Causes– Enlargement of tissues within tunnel– Decreased size of tunnel– Extraneous tissue in tunnel
• Treatment– Related to cause
• Website on carpal tunnel syndrome (Click on “view eorthopod”, then “hand”, then “carpal tunnel syndrome”
– KIN 330 Biomechanics
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Review & Homework Problems for Chapter 7
• Review problems:– Torque at shoulder with elbow flexed vs extended
• Fig 7-15, 7-16
– Compressive force at shoulder jt• Fig 7-17, sample problem 1 p 197
– Elbow flexion force• Figure 7-25, sample problem 2 p 206
• Homework – Due Tuesday, March 7– Introductory problems, p 217: # 8,9,10– Additional problem, p 218: #10