BLUE SKY SCHOOL OF PROFESSIONAL MASSAGE AND THERAPEUTIC BODYWORK. Musculoskeletal Anatomy & Kinesiology II REVIEW

Transcription

1 BLUE SKY SCHOOL OF PROFESSIONAL MASSAGE AND THERAPEUTIC BODYWORK Musculoskeletal Anatomy & Kinesiology II REVIEW MSAK101-II Session 4 LEARNING OBJECTIVES: By the end of this session, the student will be expected to: 1. Apply all review material. 2. For the muscles of the head, face and jaw, and upper extremity: Identify. List the attachments points. Explain fiber direction. List and explain action(s). Describe in relationship to other musculoskeletal structures. Palpate. 3/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 1

2 Muscle Origin Insertion Action(s) Frontalis Epicranial aponeurosis Fascia and Skin above eyes & nose Draws scalp anteriorly and Elevates eyebrows Occipitalis Occipital bone and mastoid process Epicranial aponeurosis Draws scalp posteriorly Orbicularis Oculi Medial side of the eye Medial side of the eye Closes eye and depresses eyelid Orbicularis Oris Opening of the mouth Skin at the corners of the mouth Closes mouth and Protracts lips Zygomaticus Major Zygomatic bone Skin at the angle of the mouth Elevation and retraction of the angle of the mouth Temporalis Temporal Fossa Coronoid process & ramus of mandible Elevation, retraction and ipsilateral Masseter Zygomatic bone and the Zygomatic arch of the temporal bone External surface of the angle, ramus and coronoid process of the mandible deviation of the mandible Elevation, protraction, and ipsilateral deviation of the mandible Lateral Pterygoid Sphenoid bone Condyle of the mandible Protraction and contralateral deviation of the mandible Medial Pterygoid Sphenoid bone Internal surface of the mandible Elevation, protraction and contralateral Buccinator Maxilla and the mandible Lips deviation of the mandible Compression of the cheeks 3/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 2

3 Muscle Origin Insertion Action(s) Upper Trapezius EOP Clavicle & Acromion process Elevation, Upward rotation of scapula Lateral flexion and extension of neck Middle Trapezius SP s of T1-T5 Acromion and spine of scapula Retraction of scapula Lower Trapezius SP s of T6-T12 Root of spine of scapula Depression, retraction and Upward rotation of scapula Levator Scapulae TP s of C1-C4 Vertebral border of scapula from superior angle to root Rhomboid Minor SP s of C7-T1 Root of spine of scapula Rhomboid Major SP s of T2-T5 Vertebral border of scapula from root of the spine to inferior angle Elevation, Downward rotation of scapula Lateral flexion and extension of neck Retraction, Elevation and Downward rotation of scapula Retraction, Elevation and Downward rotation of scapula Serratus Anterior Outer surface of ribs 1-9 Anterior vertebral border of scapula Protraction, Upward rotation of scapula Pectoralis Minor Anterior ribs 3-5 Coracoid process of scapula Protraction, Depression and Downward rotation of scapula Subclavius Anterior Deltoid Middle Deltoid Posterior Deltoid Coracobrachialis Latissimus Dorsi First rib Lateral third of clavicle Lateral Acromion Spine of scapula Coracoid process of scapula SP s of T7-12, Sacrum, Iliac crest, Ribs 9-12 Clavicle Deltoid tuberosity Deltoid tuberosity Deltoid tuberosity Medial middle third of humerus Medial lip of bicipital groove Depression of clavicle Flexion, adduction, horizontal adduction, internal rotation Abduction to 90 degrees Extension, adduction, horizontal abduction, external rotation Flexion, Adduction, Horizontal adduction Extension, Internal rotation, Adduction, Horizontal abduction. Teres Major Lateral border of scapula Medial lip of bicipital groove Extension, Internal rotation, Adduction, Horizontal abduction Supraspinatus Supraspinous fossa Greater tubercle of humerus Abduction of glenohumeral joint Infraspinatus Infraspinous fossa of scapula. Greater tubercle of humerus Extension, External rotation, Horizontal abduction Teres Minor Lateral border of scapula Greater tubercle of humerus Extension, External rotation, Horizontal abduction Subscapularis Subscapular fossa Lesser tubercle of humerus Internal rotation Pectoralis Major Clavicle, sternum and ribs 1-6 Lateral lip of bicipital groove Adduction, Horizontal adduction, Internal rotation, Flexion 3/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 3

4 Muscle Origin Insertion Action(s) Biceps Brachii Supraglenoid tubercle and Coracoid Radial tuberosity Supination; elbow Flexion; weak arm flexion Brachialis Distal half of the anterior shaft of humerus Coronoid process of ulna Flexion of elbow Triceps Brachii Infraglenoid tubercle, posteriolateral and posteriomedial humerus Olecranon process of ulna. Extension of elbow and extension and adduction of glenohumeral joint Anconeus Lateral epicondyle of humerus Olecranon process Extension of elbow Brachioradialis Lateral supracondylar ridge Styloid process of radius Flexion of elbow in neutral forearm position Supinator Lateral epicondyle and posterior ulna Upper third of radius Supination and Weak flexion of elbow Pronator Teres Medial supracondylar ridge & coronoid Middle of lateral shaft of radius Pronation and Weak flexion of elbow Pronator Quadratus Distal fourth of anterior ulna Distal fourth of anterior radius Pronation of distal radioulnar joint Flexor Carpi Radialis Medial epicondyle of humerus Bases of 2 nd and 3 rd metacarpals Flexion and radial deviation of wrist Flexion of elbow Palmaris Longus Medial epicondyle of humerus Palmer aponeurosis Tenses palmer aponeurosis Flexor Carpi Ulnaris Medial epicondyle of humerus and olecranon process Pisiform, hamate, and anterior base of 5 th metacarpal Flexion of wrist and elbow Ulnar deviation of wrist Flexor Digitorum Superficialis Medial epicondyle of humerus Sides of middle phalanges 2-5 Flexion of fingers 2-5, wrist and elbow Flexor Digitorum Profundus Proximal half of medial & anterior ulna Anterior distal phalanges 2-5 Flexion of fingers 2-5 and wrist Flexor Pollicis Longus Medial epicondyle of humerus, coronoid process Anterior base of distal phalanx of thumb Flexion of the thumb Flexion of wrist Extensor Carpi Radialis Longus Lateral epicondyle of humerus Posterior base of 2 nd metacarpal Extension and radial deviation of wrist Extensor Carpi Radialis Brevis Lateral epicondyle of humerus Base of 3 rd metacarpal Extension of wrist and radial deviation of wrist Extensor Carpi Ulnaris Lateral epicondyle of humerus Base of 5 th metacarpal Extension and ulnar deviation of wrist Extensor Digitorum Lateral epicondyle of humerus Base phalanges of 2-5 Extension at MP joints and Extension of wrist Extensor Pollicis Longus Middle of posterior ulna Base of distal phalanx of thumb Extension of thumb at IP joint Extensor Pollicis Brevis Middle of posterior radius Base of proximal phalanx of thumb Extension of thumb at MP joint 3/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 4

5 Frontalis Occipitalis Temporalis P: Place fingers on the forehead and ask client to raise eyebrows. P: Supine or prone. Locate the superior nuchal line and slide fingers one inch superiorly. P: Supine. Locate the zygomatic arch. Place fingers one inch superior to arch and ask client to clench and relax jaw to feel for contraction. Ask client to widely open mouth to locate the coronoid process. Upper Trapezius P: Prone. Grasp the superficial tissue to feel the upper trapezius fibers. Follow superiorly to occiput and inferiorly to clavicle. Ask client to elevate scapula. Supine. At the head of table and ask client to extend their head slightly. The upper fibers of trapezius feel like 2 bands running up the posterior neck. Middle Trapezius P: Locate the spine of the scapula and slide medially onto the trapezius. Fibers are superficial and thin. Ask client to retract to feel for contraction. Lower Trapezius P: Draw a line from the spine of the scapula to the SP s of T12. Palpate along this line for the edge of lower trap. Ask client to depress their shoulder for further definition. Levator Scapulae P: Prone, Supine or side lying. Palpating through trap, locate superior angle of the scapula. Feel for the ropey texture of the levator insertion. Follow fibers superiorly to the TP s of the cervical spine. Locate upper fibers of trap. Roll anteriorly off trap and press into the tissue of the neck. Ask client to elevate scapula and feel for contraction. 3/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 5

6 Rhomboid Minor P: Prone. Locate medial border of scapula and SP s C7-T5. Palpate through the thin trap. Ask client to retract against resistance. Middle trap and Rhomboids will contract. Rhomboid Major P: Prone. Locate medial border of scapula and SP s C7-T5. Palpate through the thin trap. Ask client to retract against resistance. Middle trap and Rhomboids will contract. Serratus Anterior P: Supine. Place fingers along the side of the ribs between pec major and lats. Ask client to flex their shoulder to reach for the ceiling and ask them to protract the scapula. Feel for serratus to contract. Follow fibers along the ribs to where they dive under the lats. Pectoralis Minor P: Seated with forearm relaxed in the small of their back. Place palpating fingers just inferior to coracoid process and ask client to lift their hand away from the back to produce extension. (Extension accompanies downward rotation, an action of the pec minor) Supine. Abduct client s arm and palpate deep to pec major. To further bring out minor, ask client to take a deep breath which will cause minor to tighten without affecting nearby musculature. Subclavius Deltoid P: Side lying. Support arm in flexed position and pull it anteriorly. This position brings the clavicle and pectoralis major off the ribcage and allows your finger or thumb to curl around the clavicle. Place you thumb and fingers at the center of the clavicle. Slowly curl the thumb and finger around the clavicle and try to pinch the subclavius between them. This can be a difficult muscle to locate. P: Seated. Locate spine of the scapula, acromion, lateral clavicle and deltoid tuberosity. Ask client to circumduct and feel divisions contract. 3/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 6

7 Coracobrachialis P: Supine. Can be difficult to distinguish from the short head of the biceps. Externally rotate and abduct the shoulder to 45 degrees. Locate pectoralis major as it forms the axillary anterior wall. Lay one hand along the medial side of the arm and move your fingers into the axilla. Have your partner adduct against resistance. Isolate the solid edge of the pectoralis major and then slide posteriorly to locate the slender contracting belly of coracobrachialis. Its belly may be visible upon adduction. Latissimus Dorsi P: Prone with arm off side of table. Locate lateral border of scapula. Grasp the thick wad of muscle tissue lateral to border between your fingers and thumb. This is Lats and Teres major. Ask client to medially rotate their arm against resistance. Follow superiorly into the axilla. Inferior attachment is sheet-like and is difficult to palpate. Teres Major P: Prone with arm off side of table. Locate lateral border of scapula. Grasp the thick wad of muscle tissue lateral to border between your fingers and thumb. This is the Lats and Teres major. Ask client to medially rotate their arm against resistance. Follow superiorly into the axilla. Move medially to the lateral border. Teres major lies medial to the lats. Supraspinatus P: Prone. Locate spine of scapula. Slide into the supraspinous fossa. Ask client to abduct their arm to feel the muscle tighten. Infraspinatus P: Prone with the forearm off the side of the table. Locate the spine and borders of the scapula. Palpate in this triangle for infraspinatus. Ask client to externally rotate. Follow laterally until it dives under the deltoid. 3/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 7

8 Teres Minor P: Prone with the arm off the side of the table. Locate lateral border of scapula. Slide laterally onto the surface of teres minor. Ask client to externally rotate or extend to force muscle to contract. Subscapularis Pectoralis Major P: Side lying. Flex the shoulder and pull the arm anteriorly as much as possible allowing for easier access to scapula s anterior surface. Hold the arm with one hand while the thumb of the other locates the lateral border by sinking under the lats. Curl your thumb onto the subscapular fossa. Supine. Cradle the arm in a flexed position and locate the lateral border. Curl your thumb or finger onto the subscapular fossa. Ask client to internally rotated arm to feel for contraction. P: Supine with arm abducted. Locate the medial shaft of clavicle and move inferiorly onto the clavicular fibers. Follow fibers laterally as they attach at the lateral humerus. Locate the lateral border of pectoralis by sinking thumb into the axilla. Ask client to medially rotate shoulder. Note the contraction. Masseter. P: Supine. Locate zygomatic arch and angle of mandible. Place fingers between landmarks and palpate for superficial belly of masseter. Ask client to clench and relax jaw to feel contraction. Lateral Pterygoid P: Supine. Place palpating fingers along the internal surface of the upper teeth until the back molars are reached. Press posteriorly and superiorly against the inside wall of the mouth. Ask client to laterally deviate the mandible to the opposite side to feel for contraction. Medial Pterygoid P: Supine. Place fingers on the angle of the mandible and hook them under onto the internal surface of the mandible. Ask client to elevate the mandible to feel for contraction 3/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 8

9 Biceps Brachii P: Shake hands with your client. Ask client to flex elbow with forearm fully supinated against resistance. Palpate anterior surface of arm and locate belly of the biceps. Follow belly distally to inner elbow then proximally to where it dives beneath the anterior deltoid. Ask client to alternately pronate and supinate forearm against resistance. Brachialis P: Ask client to flex and pronate forearm. Place fingers on either side of distal tendon of biceps and slide medially and laterally half an inch. The edge of the brachialis can be detected by rolling your fingers across its surface. Locate the deltoid tuberosity. Slide distally straight down the lateral side forearm to locate the edge of brachialis. Triceps Brachii P: Bring the arm of a prone client off the side of the table. Palpate the posterior aspect of the arm. Locate the olecranon process and ask client to extend their elbow as you apply resistance at forearm. Slide hand off olecranon process and onto the proximal triceps tendon. For the proximal long head, place one hand on the proximal elbow and ask client to raise their elbow toward the ceiling against your resistance. Locate the triceps belly alone the medial aspect of the arm. It disappears underneath the posterior deltoid toward the infraglenoid tubercle. Anconeus P: Locate the olecranon process, proximal shaft of the ulna and lateral epicondyle of humerus. Lay your index finger along the proximal ulna and the tip of your middle finger on the epicondyle. The V formed by your fingers is the outline of the anconeus. 3/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 9

10 Brachioradialis P: Shake hands with your client and flex the elbow to 90 degrees. With the forearm in the neutral position, ask client to flex their elbow against your resistance. Look for the brachioradialis bulging out on the lateral side of the elbow. Try to pinch its belly between your fingers and follow it distally. Supinator P: Shake hands and flex the elbow to 90. Locate the lateral epicondyle of humerus and proximal shaft of radius. Palpate deep against the radius and ask the client to supinate forearm to feel for contraction. Pronator Teres P: Shake hands and flex the elbow to 90. Locate the distal tendon of biceps. Slide distally off this tendon and ask client to flex or pronate the forearm to feel for the contraction. Pronator Quadratus P: Very deep and difficult to palpate. Flexor Carpi Radialis P: Flex elbow to 90 and supinate forearm. Ask client to abduct wrist and feel for the distal tendon lateral to palmaris longus. Continue palpating proximally. Palmaris Longus P: Ask client to flex the hand at the wrist joint with the fingers fully extended. Feel for the distal tendon in the center of the anterior wrist. Palpate distally into the fascia and proximally toward the medial epicondyle. Flexor Carpi Ulnaris P: Shake hands, flex the elbow and supinate the forearm. Locate the pisiform and slide proximally onto ulnaris. Ask client to adduct against resistance and follow the tendon proximally. 3/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 10

11 Flexor Digitorum Superficialis P: Shake hands and flex elbow to 90 degrees. Palpate between carpi ulnaris and radialis bellies. Passive flexion of the wrist softens the tissue and may allow for easier access. Palpate near the ulnar shaft as the client flex the fingers Flexor Digitorum Profundus P: Shake hands and flex elbow to 90 degrees. Palpate between carpi ulnaris and radialis bellies. Passive flexion of the wrist softens the tissue and may allow for easier access. Palpate near the ulnar shaft as the client flex the fingers. Extensor Carpi Radialis Longus P: Shake hands and flex the elbow to 90 degrees. Locate the brachioradialis. Slide laterally onto radialis fibers. Ask client to abduct deviate against resistance. Follow muscle fibers distally. Longus can be difficult to distinguish from brevis. Extensor Carpi Radialis Brevis P: Shake hands and flex the elbow to 90 degrees. Locate the brachioradialis. Slide laterally onto radialis fibers. Ask client to abduct deviate against resistance. Follow muscle fibers distally. Brevis can be difficult to distinguish from longus. Extensor Carpi Ulnaris P: Shake hands with client and flex elbow to 90 degrees. Locate shaft of ulna and slide laterally onto the belly of extensor carpi ulnaris. Ask client to adduct wrist against resistance. Tendon should be easily palpable just lateral to the styloid process of ulna. Extensor Digitorum P: Shake hands with your client and flex the elbow to 90 degrees. Slide laterally of extensor carpi radialis fibers. Isolate its belly by asking client to extend wrist and fingers against resistance. 3/11 Blue Sky School of Professional Massage and Therapeutic Bodywork 11