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Presentation on theme: "Anatomy."— Presentation transcript:

1 Anatomy


3 Sacral Plexus

4 Dermatomes

5 Dermatomes

6 Reflexes Biceps-C5 Triceps-C7 Patella-L4 Achilles-S1

7 Shoulder

8 MuscleActionNerve Serratus AnteriorScapula protraction, lateral rotation (allows abduction>90) Long Thoracic (C5,C6,C7) Pectoralis MinorScapula protraction, rib elevation Medial Pectoral (C8,T1)

9 MuscleActionNerve TrapeziusScapula: Elevation, Retraction, Depression, Lateral Rotation Spinal Accessory (CN XI) Levator ScapulaeScapula: Elevation, Medial Rotation Dorsal Scapular (C5) Rhomboid (Major and Minor) Scapula: Retraction, Depression, Medial Rotation Dorsal Scapular (C5)

10 MuscleActionNerve Pectoralis MajorArm: Flexion, Adduction, Medial Rotation Medial (C8,T1) and Lateral (C5,C6,C7) Pectoral CoracobrachialisArm: FlexionMusculocutaneous (C5,C6,C7)

11 MuscleActionNerve Latissimus DorsiArm: Extension, Adduction, Medial Rotation Thoracodorsal (C6,C7,C8) Teres MajorArm: Extension, Adduction, Medial Rotation Lower Subscapular (C5,C6)

12 MuscleActionNerve DeltoidArm: Abduction, Flexion, Extension Axillary (C5,C6) SupraspinatusArm: AbductionSuprascapular (C5,C6)

13 MuscleActionNerve SubscapularisArm: Medial RotationUpper and Lower Subscapular (C5,C6)

14 MuscleActionNerve InfraspinatusArm: Lateral RotationSuprascapular (C5,C6) Teres MinorArm: Lateral RotationAxillary (C5,C6)

15 Arm

16 MuscleActionNerve Biceps brachiiArm: Flexion Forearm: Flexion, Supination Musculocutaneous (C5,C6,C7) BrachialisForearm: FlexionMusculocutaneous BrachioradialisForearm: Flexion, Supination Radial (C5,C6,C7,C8,T1)

17 MuscleActionNerve Triceps brachiiForearm: extensionRadial (C5, C6, C7, C8, T1)

18 Forearm

19 MuscleActionNerve Flexor Carpi UlnarisHand: Flexion, AdductionUlnar (C8,T1) Median (C6,C7,C8,T1) Palmaris LongusHand: FlexionMedian Flexor Carpi RadialisHand: Flexion, AbductionMedian Pronator TeresForearm: PronationMedian

20 MuscleActionNerve Flexor Digitorum Superficialis Hand: Flexion Digit: Flexion at MCP, PIP Median (C6,C7,C8,T1)

21 MuscleActionNerve Flexor Digitorum ProfundusHand: Flexion Digit: Flexion at MCP, PIP, DIP Ulnar Anterior Interosseous (branch of median) Flexor Pollicus Longus1 st Digit: Flexion at MCP, Interphalangeal Anterior Interosseous Pronator QuadratusForearm: PronationAnterior Interosseous

22 MuscleActionNerve Extensor Carpi Radialis Longus Hand: Extension, AbductionRadial (C5,C6,C7,C8,T1) Extensor Carpi Radialis Brevis Hand: Extension, AbductionRadial Extensor DigitorumHand: Extension Digit: Extension Radial Extensor Digiti Minimi5 th Digit: ExtensionRadial Extensor Carpi UlnarisHand: Extension, AdductionRadial

23 MuscleActionNerve SupinatorForearm: SupinateRadial (C5,C6,C7,C8,T1) AnconeusStabilizes ElbowRadial Extensor Indicis2 nd Digit: ExtensionRadial Extensor Pollicus Brevis1 st Digit: ExtensionRadial Extensor Pollicus Longus1 st Digit: ExtensionRadial Abductor Pollicus Longus1 st Digit: AbductionRadial

24 Hand

25 MuscleActionNerve Opponens Pollicus1 st Digit: OppositionRecurrent Median Flexor Pollicus Brevis1 st Digit: FlexionRecurrent Median Abductor Pollicus Brevis1 st Digit: AbductionRecurrent Median

26 MuscleActionNerve Opponens Digit Minimi5 th Digit: OppositionUlnar (C8,T1) Flexor Digit Minimi Brevis5 th Digit: FlexionUlnar Abductor Digiti Minimi Brevis 5 th Digit: AbductionUlnar

27 MuscleActionNerve LumbricalsMCP: Flexion PIP/DIP: Extension Medial 2: Ulnar Lateral 2: Median Dorsal InterosseousDigit: Abduction (away from middle finger) Ulnar Palmar InterosseousDigit: Adduction (towards middle finger) Ulnar Adductor Pollicus1 st Digit: AdductionUlnar

28 Hip

29 MuscleActionNerve IliopsoasThigh: FlexionFemoral (L2,L3,L4) PectineusThigh: Flexion, Adduction, Medial Rotation Femoral SartoriusThigh: Flexion, Abduction Leg: Flexion Femoral

30 MuscleActionNerve Gluteus MaximusThigh: Extension, Lateral Rotation Inferior Gluteal Nerve (L4,L5,S1)

31 MuscleActionNerve Gluteus MediusThigh: Abduction, Medial Rotation Superior Gluteal Nerve (L5,S1,S2) Gluteus MinimusThigh: Abduction, Medial Rotation Superior Gluteal Nerve Tensor Fascia LataeThigh: AbductionSuperior Gluteal Nerve

32 MuscleActionNerve PiriformisThigh: Lateral RotationN. to Piriformis (L5,S1,S2) Obturator ExternusThigh: Lateral RotationObturator (L2,L3,L4) Obturator InternusThigh: Lateral RotationN. to Obturator Internus (L5,S1,S2) Superior GemellusThigh: Lateral RotationN. to Obturator Internus Inferior GemellusThigh: Lateral RotationN. to Quadratus Femoris (L4,L5,S1) Quadratus FemorisThigh: Lateral RotationN. to Quadratus Femoris

33 MuscleActionNerve GracilisThigh: Adduction Leg: Flexion Obturator (L2,L3,L4) Adductor LongusThigh: AdductionObturator Adductor BrevisThigh: AdductionObturator Adductor MagnusThigh: AdductionObturator

34 Thigh

35 MuscleActionNerve Rectus FemorisThigh: Flexion Leg: Extension Femoral (L2,L3,L4) Vastus MedialisLeg: ExtensionFemoral Vastus LateralisLeg: ExtensionFemoral Vastus IntermediusLeg: ExtensionFemoral

36 MuscleActionNerve Biceps FemorisThigh: Extension Leg: Flexion, Lateral Rotation Sciatic (L4,L5,S1,S2,S3) SemimembranosusThigh: Extension Leg: Flexion, Medial Rotation Sciatic SemiteninosusThigh: Extension Leg: Flexion, Medial Rotation Sciatic

37 Leg

38 MuscleActionNerve Tibialis AnteriorFoot: Dorsiflexion, InversionDeep Peroneal Extensor Hallucis LongusGreat Toe: ExtensionDeep Peroneal Extensor Digitorum LongusFoot: Dorsiflexion Digits: Extension Deep Peroneal

39 MuscleActionNerve GastrocnemiusLeg: Flexion Foot: Plantarflexion Tibial (S1,S2) SoleusFoot: PlantarflexionTibial PlantarisLeg: Flexion Foot: Plantarflexion Tibial

40 MuscleActionNerve Flexor Digitorum LongusDigit: FlexionTibial Tibialis PosteriorFoot: Inversion, Plantarflexion Tibial Flexor Hallucis LongusFoot: Flexion Great Toe: Flexion Tibial

41 MuscleActionNerve Fibularis LongusFoot: Eversion, Plantarflexion Superficial Peroneal Fibularis BrevisFoot: Eversion, Plantarflexion Superfical Peroneal

42 Foot

43 MuscleActionNerve Extensor Digitorum BrevisDigit 2,3,4: ExtensionDeep Peroneal

44 MuscleActionNerve Abductor HallucisGreat Toe: AbductionMedial Plantar (L4,L5,S1) Flexor Digitorum BrevisDigit: FlexionMedial Plantar Abductor Digiti Minimi5 th Digit: AbductionLateral Plantar (S1,S2)

45 MuscleActionNerve Quadratus PlantaeDigit 2-5: Assist FlexionLateral Plantar (S1,S2) LumbricalsFlex: MTP Extend: PIP and DIP 1 st : Medial Plantar (L4,L4,S1) 2,3,4: Lateral Plantar 2

46 MuscleActionNerve Flexor Hallucis BrevisGreat Toe: Flexion MTPMedial Plantar (L4,L5,S1) Flexor Digiti Minimi5 th Toe: Flexion (MTP+PIP)Lateral Plantar (S1,S2) Adductor HallucisGreat Toe: Adduction (Towards 2 nd Toe) Lateral Plantar 0

47 MuscleActionNerve Plantar InterosseiToes: Adduction (Toward 2 nd Toe)Lateral Plantar (S1,S2) Dorsal InterosseiToes: Abduction (Away from 2 nd Toe) Lateral Plantar

48 Clinical Correlations

49 Winged Scapula- Clinical Correlation Damage to Long Thoracic Nerve Common during radical mastectomy Loss of innervation to Serratus Anterior Results in Winged Scapula Test by having patient push against wall

50 Erb-Duchenne Palsy Injury to Superior Trunk of brachial plexus Traumatic Birth- Shoulder Dystocia Loss of C5 and C6 Dorsal Scapular N. (Levator Scapulae, Rhomboids) N. to subclavius Suprascapular N. (Supraspinatus, Infraspinatus) Upper and Lower Subscapular N. (Subscapularis, Teres Major) Axillary N. (Deltoid, Teres Minor) Loss of abduction Deltoid and supraspinatus Loss of external rotation Infraspinatus and teres minor Imbalances cause arm to be held in adduction and medial rotation Waiter’s Tip

51 Claws Defined by lumbricals Flex MCP, Extend PIP and DIP Loss of function: MCP hyperextension, PIP and DIP flexion Ulnar Nerve: Digits 4 and 5 Median Nerve: Digits 2 and 3 Klumpke’s: Loss of Inferior Trunk of brachial plexus (C8,T1) All intrinsic hand muscles Can Test by asking patient to make a fist Ulnar Claw l Median Claw Klumpke’s Total Claw

52 Radial Nerve Saturday Night Palsy Pass out with arm over chair, Use of crutches… Injury at axilla: loss of triceps, wrist extension (wrist drop), digit extension Mid-Shaft Humeral Fracture Radial nerve injured as passes posteriorly in spiral groove Loss of wrist extension (wrist drop), digit extension Proximal Radial Head Radial nerve injured as passes toward posterior compartment of forearm Loss of digit extension

53 Trendelenburg Sign Weakness of thigh abductors Gluteus Medius and Gluteus Minimus Superior Gluteal Nerve (L5,S1,S2) Test by having patient stand on 1 leg Pelvis sags on contralateral side when standing on affected leg

54 Foot Drop Injury to Common Peroneal N. as wraps around head of fibula Be careful with tight bandages and casting Loss of dorsiflexion (deep peroneal) Compensation with Steppage Gait Loss of sensation on dorsum of foot (superficial peroneal)

55 Club Foot Talipes Equinovarus Associated with spina bifida May require serial casting or orthopaedic surgery

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