Extraocular Muscle Analysis
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- Felicity Matthews
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1 Extraocular Muscle Analysis The goals of this activity are to demonstrate: the attachments of the extraocular muscles to the eyeball how each of the six extraocular muscles moves the eyeball within the orbit the principles of extraocular muscle testing. Materials: 1 styrofoam ball (eyeball) 1 bamboo skewer (axes) 6 different colored pipe cleaners (extraocular muscles) 6 T pins (muscle attachments) 6 labels This is the RIGHT eye. Three holes (colorcoded) run through the eyeball: horizontal axis = blue vertical axis = red anteroposterior (AP) axis = through the pupil
2 Step One: Attach Your Muscles Axes of Movement Stick the skewer through each of the colorcoded holes and convince yourself that two movements are possible around each axis. Axis Possible Movements Horizontal (blue) Elevation Depression Vertical (red) Adduction Abduction Anteroposterior (through pupil) Medial Rotation /Intorsion Lateral Rotation / Extorsion Make a label for each of the six extraocular muscles. Attach one label to each pipe cleaner.
3 Step One: Attach Your Muscles Muscle Attachments Using diagrams (below or in an atlas), attach each of the six extraocular muscles to the eyeball. Wrap each pipe cleaner around a T-pin and push the pin all the way into the styrofoam ball to secure it. Attach Superior & Inferior Rectus: slightly anterior and medial to vertical axis Attach Lateral & Medial Rectus: slightly anterior to horizontal axis Attach Superior & Inferior Oblique: slightly posterior and lateral to vertical axis Twist the 4 rectus muscles together posteromedially to simulate their common attachment to the bony orbit. Twist the 2 oblique muscles together anteromedially to simulate their attachments to the bony orbit.
4 Step One: Attach Your Muscles Muscle Pulls Determine which direction(s) each muscle pulls on the eyeball. (Remember that the muscles are attached medially to the bony orbit.) Using your eyeball model, gently tug on the pipe cleaner muscles to determine their directions of pull. Don t worry about the axes right now. Just look at how the muscles pull the eyeball. Superior Rectus is done for you as an example. This is a fillable pdf form. Muscle Direction(s) of Pull (Which direction(s) does the muscle pull when it shortens? Muscles can have more than one direction of pull.) Superior Rectus Posterior Medial Inferior Rectus Lateral Rectus - Medial Rectus - Superior Oblique Inferior Oblique Completed table on next page!
5 Muscle Pulls (completed chart) Determine which direction(s) each muscle pulls on the eyeball. (Remember that the muscles are attached medially to the bony orbit.) Using your eyeball model, gently tug on the pipe cleaner muscles to determine their directions of pull. Don t worry about the axes right now. Just look at how the muscles pull the eyeball. Muscle Direction of Pull(s) (Which direction(s) does the muscle pull when it shortens? Muscles can have more than one direction of pull.) Superior Rectus Posterior Medial Inferior Rectus Posterior Medial Lateral Rectus Posterior - Medial Rectus Posterior - Superior Oblique Anterior Medial Inferior Oblique Anterior Medial
6 Step Two: Muscle Actions Horizontal Axis Stick the skewer through the hole for the horizontal axis (blue). Gently tug on the pipe cleaner muscles to determine the action of each muscle around that axis. Remember that there are only two movements possible around each axis. This is a fillable pdf form. Muscle Horizontal Axis Action Around Vertical Axis AP Axis Superior Rectus Inferior Rectus Lateral Rectus Medial Rectus Superior Oblique Inferior Oblique Correct answers on next page
7 Step Two: Muscle Actions Vertical Axis Stick the skewer through the vertical axis (red). Gently tug on the pipe cleaner muscles to determine the action of each muscle around that axis. Remember that there are only two movements possible around each axis. This is a fillable pdf form. Muscle Horizontal Axis Action Around Vertical Axis AP Axis Superior Rectus Elevate Inferior Rectus Depress Lateral Rectus no action Medial Rectus no action Superior Oblique Depress Inferior Oblique Elevate Correct answers on next page
8 Step Two: Muscle Actions Anteroposterior Axis Stick the skewer through the anteroposterior axis (through the pupil). Gently tug on the pipe cleaner muscles to determine the action of each muscle around that axis. Remember that there are only two movements possible around each axis. This is a fillable pdf form Muscle Horizontal Axis Action Around Vertical Axis AP Axis Superior Rectus Elevate Adduct Inferior Rectus Depress Adduct Lateral Rectus no action Abduct Medial Rectus no action Adduct Superior Oblique Depress Abduct Inferior Oblique Elevate Abduct Correct answers on next page
9 Muscle Actions (completed chart) Muscle Horizontal Axis Action Around Vertical Axis Superior Rectus Elevate Adduct Inferior Rectus Depress Adduct AP Axis Medial Rotation / Intorsion Lateral Rotation / Extorsion Lateral Rectus no action Abduct no action Medial Rectus no action Adduct no action Superior Oblique Depress Abduct Inferior Oblique Elevate Abduct Medial Rotation / Intorsion Lateral Rotation / Extorsion Each movement of the eyeball can be produced by more than one muscle. All rectus muscles, except for lateral rectus, adduct the eyeball. Muscles attached to the superior eyeball medially rotate; muscles attached to the inferior eyeball laterally rotate.
10 Step Three: Testing Extraocular Muscles (part one) As you ve seen, each movement of the eyeball can be produced by more than one muscle. When testing the function of the extraocular muscles, the goal is to move the eyeball into a position that will isolate the function of one of the muscles in order to assess that muscle/function independently. When the eyeball moves within the orbit, the axes move with it. The pulls of the muscles do not change. Horizontal Axis Superior Oblique Inferior Rectus In the figures above, the horizontal axis moves when the eye is abducted or adducted. The muscles stay in place, however. So, moving the eye changes the relationship of the muscles to the axis.
11 Step Three: Testing Extraocular Muscles (part two) A patient comes to the clinic with limited ability to depress her right eye (look down). To distinguish between a deficiency in the function of superior oblique or inferior rectus, you ask her to look down when her eye is straight ahead, adducted, and abducted. When the eye is straight ahead, both muscles have an effective pull around the horizontal axis and can depress the eyeball. In this position, you cannot distinguish between the function of superior oblique and inferior rectus when the patient looks down. Horizontal Axis Superior Oblique Inferior Rectus When the eye is adducted (right eye looks left), you are isolating the function of superior oblique. (Ask the patient to look left, then down.) inferior rectus is parallel to the axis, making it fairly ineffective around the axis (can t move the eyeball); this inactivates inferior rectus. superior oblique is perpendicular to the horizontal axis and can act to depress the eyeball around the axis. In the adducted position, depression is produced primarily by superior oblique. When the eye is abducted (right eye looks right), you are isolating the function of inferior rectus. (Ask the patient to look right, then down.) superior oblique is now parallel to the horizontal axis and is inactivated. inferior rectus is now perpendicular to the axis and can depress the eyeball around the axis. In the abducted position, depression is produced primarily by inferior rectus.
12 Step Three: Testing Extraocular Muscles (part three) Below is a table listing the starting position and actions used to isolate and test the function of the extraocular muscles. Using the principles outlined on the last page and your model eyeball, figure out why each of these combinations of starting positions and actions work to test each muscle. Muscle Being Tested Starting Position (Eye is in this position to start test.) Movement (Ask patient to move eye this way from the starting position.) Final Position of Eyeball (if muscle is functioning) Superior Rectus Abducted Elevate Up and Out Inferior Rectus Abducted Depress Down and Out Lateral Rectus Neutral Abduct Out Medial Rectus Neutral Adduct In Superior Oblique Adducted Depress Down and In Inferior Oblique Adducted Elevate Up and In End of Activity
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