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Anatomy.

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

1 Anatomy

2

3 Sacral Plexus

4 Dermatomes

5 Dermatomes http://www.patient.co.uk/diagram/Dermatomes-leg.htm

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

7 Shoulder

8 Scapula protraction, lateral rotation (allows abduction>90)
Muscle Action Nerve Serratus Anterior Scapula protraction, lateral rotation (allows abduction>90) Long Thoracic (C5,C6,C7) Pectoralis Minor Scapula protraction, rib elevation Medial Pectoral (C8,T1)

9 Scapula: Elevation, Retraction, Depression, Lateral Rotation
Muscle Action Nerve Trapezius Scapula: Elevation, Retraction, Depression, Lateral Rotation Spinal Accessory (CN XI) Levator Scapulae Scapula: Elevation, Medial Rotation Dorsal Scapular (C5) Rhomboid (Major and Minor) Scapula: Retraction, Depression, Medial Rotation

10 Arm: Flexion, Adduction, Medial Rotation
Muscle Action Nerve Pectoralis Major Arm: Flexion, Adduction, Medial Rotation Medial (C8,T1) and Lateral (C5,C6,C7) Pectoral Coracobrachialis Arm: Flexion Musculocutaneous (C5,C6,C7)

11 Arm: Extension, Adduction, Medial Rotation Thoracodorsal (C6,C7,C8)
Muscle Action Nerve Latissimus Dorsi Arm: Extension, Adduction, Medial Rotation Thoracodorsal (C6,C7,C8) Teres Major Lower Subscapular (C5,C6)

12 Arm: Abduction, Flexion, Extension Axillary (C5,C6) Supraspinatus
Muscle Action Nerve Deltoid Arm: Abduction, Flexion, Extension Axillary (C5,C6) Supraspinatus Arm: Abduction Suprascapular (C5,C6)

13 Upper and Lower Subscapular (C5,C6)
Muscle Action Nerve Subscapularis Arm: Medial Rotation Upper and Lower Subscapular (C5,C6)

14 Muscle Action Nerve Infraspinatus Arm: Lateral Rotation
Suprascapular (C5,C6) Teres Minor Axillary (C5,C6)

15 Arm

16 Forearm: Flexion, Supination Musculocutaneous (C5,C6,C7)
Muscle Action Nerve Biceps brachii Arm: Flexion Forearm: Flexion, Supination Musculocutaneous (C5,C6,C7) Brachialis Forearm: Flexion Musculocutaneous Brachioradialis Radial (C5,C6,C7,C8,T1)

17 Muscle Action Nerve Triceps brachii Forearm: extension
Radial (C5, C6, C7, C8, T1)

18 Forearm

19 Hand: Flexion, Adduction Ulnar (C8,T1) Median (C6,C7,C8,T1)
Muscle Action Nerve Flexor Carpi Ulnaris Hand: Flexion, Adduction Ulnar (C8,T1) Median (C6,C7,C8,T1) Palmaris Longus Hand: Flexion Median Flexor Carpi Radialis Hand: Flexion, Abduction Pronator Teres Forearm: Pronation

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

21 Flexor Digitorum Profundus Hand: Flexion
Muscle Action Nerve Flexor Digitorum Profundus Hand: Flexion Digit: Flexion at MCP, PIP, DIP Ulnar Anterior Interosseous (branch of median) Flexor Pollicus Longus 1st Digit: Flexion at MCP, Interphalangeal Anterior Interosseous Pronator Quadratus Forearm: Pronation

22 Extensor Carpi Radialis Longus Hand: Extension, Abduction
Muscle Action Nerve Extensor Carpi Radialis Longus Hand: Extension, Abduction Radial (C5,C6,C7,C8,T1) Extensor Carpi Radialis Brevis Radial Extensor Digitorum Hand: Extension Digit: Extension Extensor Digiti Minimi 5th Digit: Extension Extensor Carpi Ulnaris Hand: Extension, Adduction

23 Extensor Pollicus Brevis 1st Digit: Extension Extensor Pollicus Longus
Muscle Action Nerve Supinator Forearm: Supinate Radial (C5,C6,C7,C8,T1) Anconeus Stabilizes Elbow Radial Extensor Indicis 2nd Digit: Extension Extensor Pollicus Brevis 1st Digit: Extension Extensor Pollicus Longus Abductor Pollicus Longus 1st Digit: Abduction

24 Hand

25 Flexor Pollicus Brevis 1st Digit: Flexion Abductor Pollicus Brevis
Muscle Action Nerve Opponens Pollicus 1st Digit: Opposition Recurrent Median Flexor Pollicus Brevis 1st Digit: Flexion Abductor Pollicus Brevis 1st Digit: Abduction

26 Flexor Digit Minimi Brevis 5th Digit: Flexion Ulnar
Muscle Action Nerve Opponens Digit Minimi 5th Digit: Opposition Ulnar (C8,T1) Flexor Digit Minimi Brevis 5th Digit: Flexion Ulnar Abductor Digiti Minimi Brevis 5th Digit: Abduction

27 Digit: Abduction (away from middle finger) Ulnar Palmar Interosseous
Muscle Action Nerve Lumbricals MCP: Flexion PIP/DIP: Extension Medial 2: Ulnar Lateral 2: Median Dorsal Interosseous Digit: Abduction (away from middle finger) Ulnar Palmar Interosseous Digit: Adduction (towards middle finger) Adductor Pollicus 1st Digit: Adduction

28 Hip

29 Thigh: Flexion, Adduction, Medial Rotation Femoral Sartorius
Muscle Action Nerve Iliopsoas Thigh: Flexion Femoral (L2,L3,L4) Pectineus Thigh: Flexion, Adduction, Medial Rotation Femoral Sartorius Thigh: Flexion, Abduction Leg: Flexion

30 Thigh: Extension, Lateral Rotation Inferior Gluteal Nerve (L4,L5,S1)
Muscle Action Nerve Gluteus Maximus Thigh: Extension, Lateral Rotation Inferior Gluteal Nerve (L4,L5,S1)

31 Thigh: Abduction, Medial Rotation Superior Gluteal Nerve (L5,S1,S2)
Muscle Action Nerve Gluteus Medius Thigh: Abduction, Medial Rotation Superior Gluteal Nerve (L5,S1,S2) Gluteus Minimus Superior Gluteal Nerve Tensor Fascia Latae Thigh: Abduction

32 Thigh: Lateral Rotation N. to Piriformis (L5,S1,S2) Obturator Externus
Muscle Action Nerve Piriformis Thigh: Lateral Rotation N. to Piriformis (L5,S1,S2) Obturator Externus Obturator (L2,L3,L4) Obturator Internus N. to Obturator Internus (L5,S1,S2) Superior Gemellus N. to Obturator Internus Inferior Gemellus N. to Quadratus Femoris (L4,L5,S1) Quadratus Femoris N. to Quadratus Femoris

33 Muscle Action Nerve Gracilis Thigh: Adduction Leg: Flexion
Obturator (L2,L3,L4) Adductor Longus Obturator Adductor Brevis Adductor Magnus

34 Thigh

35 Muscle Action Nerve Rectus Femoris Thigh: Flexion Leg: Extension
Femoral (L2,L3,L4) Vastus Medialis Femoral Vastus Lateralis Vastus Intermedius

36 Leg: Flexion, Lateral Rotation Sciatic (L4,L5,S1,S2,S3)
Muscle Action Nerve Biceps Femoris Thigh: Extension Leg: Flexion, Lateral Rotation Sciatic (L4,L5,S1,S2,S3) Semimembranosus Leg: Flexion, Medial Rotation Sciatic Semiteninosus

37 Leg

38 Foot: Dorsiflexion, Inversion Deep Peroneal Extensor Hallucis Longus
Muscle Action Nerve Tibialis Anterior Foot: Dorsiflexion, Inversion Deep Peroneal Extensor Hallucis Longus Great Toe: Extension Extensor Digitorum Longus Foot: Dorsiflexion Digits: Extension

39 Muscle Action Nerve Gastrocnemius Leg: Flexion Foot: Plantarflexion
Tibial (S1,S2) Soleus Tibial Plantaris

40 Flexor Digitorum Longus Digit: Flexion Tibial Tibialis Posterior
Muscle Action Nerve Flexor Digitorum Longus Digit: Flexion Tibial Tibialis Posterior Foot: Inversion, Plantarflexion Flexor Hallucis Longus Foot: Flexion Great Toe: Flexion

41 Foot: Eversion, Plantarflexion Superficial Peroneal Fibularis Brevis
Muscle Action Nerve Fibularis Longus Foot: Eversion, Plantarflexion Superficial Peroneal Fibularis Brevis Superfical Peroneal

42 Foot

43 Extensor Digitorum Brevis Digit 2,3,4: Extension Deep Peroneal
Muscle Action Nerve Extensor Digitorum Brevis Digit 2,3,4: Extension Deep Peroneal

44 Flexor Digitorum Brevis Digit: Flexion Medial Plantar
Muscle Action Nerve Abductor Hallucis Great Toe: Abduction Medial Plantar (L4,L5,S1) Flexor Digitorum Brevis Digit: Flexion Medial Plantar Abductor Digiti Minimi 5th Digit: Abduction Lateral Plantar (S1,S2)

45 Digit 2-5: Assist Flexion Lateral Plantar (S1,S2) Lumbricals Flex: MTP
Muscle Action Nerve Quadratus Plantae Digit 2-5: Assist Flexion Lateral Plantar (S1,S2) Lumbricals Flex: MTP Extend: PIP and DIP 1st: Medial Plantar (L4,L4,S1) 2,3,4: Lateral Plantar

46 Flexor Hallucis Brevis Great Toe: Flexion MTP
Muscle Action Nerve Flexor Hallucis Brevis Great Toe: Flexion MTP Medial Plantar (L4,L5,S1) Flexor Digiti Minimi 5th Toe: Flexion (MTP+PIP) Lateral Plantar (S1,S2) Adductor Hallucis Great Toe: Adduction (Towards 2nd Toe) Lateral Plantar

47 Toes: Adduction (Toward 2nd Toe) Lateral Plantar (S1,S2)
Muscle Action Nerve Plantar Interossei Toes: Adduction (Toward 2nd Toe) Lateral Plantar (S1,S2) Dorsal Interossei Toes: Abduction (Away from 2nd 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 Median Claw Klumpke’s Total Claw Ulnar Claw
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 Median Claw Klumpke’s Total Claw Ulnar Claw

52 Radial Nerve Saturday Night Palsy Mid-Shaft Humeral Fracture
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 Be careful with tight bandages and casting
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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