Anatomy of the Musculoskeletal System

Transcription

1 Anatomy of the Musculoskeletal System Kyle E. Rarey, Ph.D. Department of Anatomy & Cell Biology and Otolaryngology University of Florida College of Medicine Outline of Presentation Vertebral Column Upper Extremities Lower Extremities 1

2 I. Vertebral Column 2

3 3

4 Lumbar vertebrae (Isolated and articulated) Intervertebral Disc Lumbar Disc Herniation: Usually 2 protruding nucleus pulposus lateral to posterior longitudinal ligament resulting in compression of the spinal roots as they fuse to form the spinal nerve. Cauda equina Spinal nerve roots Herniated nucleus pulposus Annulus fibrosus 4

5 Spinal Alignment Abnormalities Scoliosis Kyphosis Scoliosis before and after correction 5

6 Abnormal development of vertebrae Effects of osteoporosis on the vertebral column Dislocation of cervical vertebrae Lumbar spinal stenosis Herniation of nucleus pulposus Disc degeneration treated by graft and spinal fusion. Lateral views 6

7 Lumbar puncture 7

8 Herniation of nucleus pulposus Disc degeneration treated by graft and spinal fusion. Lateral views 8

9 Hangman s fracture II. Upper Extremities 9

10 Clinical Significance Nearly 20 million people are affected by an upper extremity injury or disorder every year in the United States. Over 70 million adults currently suffer from arthritis or some other debilitating chronic joint disorder most commonly involving the arms, hands or fingers Over 25% of all work related injuries involve the upper extremity and nearly 70% of all upper extremity injuries occur to individuals in their working years. Nearly 35% of all acute injuries seen in the emergency rooms involve the upper extremity. Repetitive stress injuries (RSI's) are on the rise and affect about 12 million people each year. Carpal tunnel syndrome (CTS) accounts for the large majority of these reported RSI's. About 50% of all work related injuries are CTS. They have become the leading cause of lost workdays and are costing industry in the United States over $100B per year Muscles of Upper Extremities 10

11 Vasculature of Upper Extremities Major arteries of the arm, forearm, and hand 3rd Part of Axillary 2 nd Part of Axillary Subscapular Anterior humeral circumflex Posterior humeral circumflex 1 st Part of Axillary Subclavian Brachial Superior thoracic Long thoracic Thoracoacromial Circumflex scapular Lateral thoracic Thoracodorsal 11

12 Venous System Overview In both the upper and lower extremities, there are two sets of veins which create a deep and superficial system. The deep system of veins parallels the arterial system; therefore, the veins of the deep system are named similarly to the arteries. Major arteries of the arm, forearm, and hand 12

13 Joints of Upper Extremities Shoulder Joint Acromioclavicular Glenohumeral joint 13

14 Shoulder separation Frontal plane Right Glenohumeral Joint: Frontal Section Acromioclavicular ligament Clavicle Acromion of scapula SUBACROMIAL BURSA ARTICULAR CAPSULE Head of humerus Tendon sheath Tendon of biceps brachii muscle (long head) (c) Frontal section Tendon of supraspinatus muscle GLENOID LABRUM Scapula GLENOID CAVITY Articular cartilage GLENOID LABRUM ARTICULAR CAPSULE: Synovial membrane Fibrous membrane Humerus Rotator Cuff Supraspinatus, infraspinatus and teres minor: along with the subscapularis form the rotator cuff (scapulohumeral muscles forming a circumferential muscular sling about the glenohumeral joint) 14

15 View SUPERIOR Tendon of supraspinatus muscle Tendon of infraspinatus muscle Tendon of subscapularis muscle Tendon of teres minor muscle POSTERIOR (b) Lateral view (opened) ANTERIOR Cuff Tears 1.jpg cuff injuryculprits.jpg i.jpg?w=255&h= gif Shoulder dislocation 15

16 Fracture of olecranon of ulna d2d318f3534b536.jpg cmf0co7ffha/thysrqfsd3i/aaaaaaaaacc/x47rhwd8gio/ s1600/elbow_fracture_1.jpg bones 3.jpg 16

17 hah2_c019f026.png /560x352/Colles'_Fracture.jpg Dinner fork fracture of distal radius jpg Lateral cord Suprascapular Dorsal scapular Nerves of the Upper Extremities Lateral pectoral Upper subscapular Medial pectoral N. To Subclavius C5 C6 Musculocutaneous C7 Brachial plexus Axillary C8 T1 Median Radial Long thoracic Medial cord Upper Trunk Posterior cord Thoracodorsal Lower subscapular Middle Trunk Lower Trunk Ulnar 17

18 Injury to brachial plexus Nerves to shoulder muscles: e.g., Axillary nerve, suprscapular, dorsal scapular, medial pectoral, lateral pectoral, long thoracic, upper and lower supsacuplaris, thoracodorasal, (Spinal accessory) Upper Extremity Nerves C5 C6 C7 C8 T1 Musculocutaneous nerve dominant nerve to anterior compartment elbow flexors Radial nerve dominant nerve to posterior compartments of both arm and forearm Median nerve dominant nerve to anterior compartment muscles of forearm (wrist flexors) and thenar hand muscles Ulnar nerve dominant nerve to muscles of the hand; innervates one and part of another forearm flexor muscles Winging of the scapula 18

19 Carpal tunnel syndrome Nerves Musculocutaneous nerve Axillary nerve (fx of surgical neck) Radial nerve (fx of mid shaft) Median nerve Ulnar nerve (fx of medial epicondyle) Cutaneous nerves Tommy John Procedure Dislocated elbow Dislocated or proximal radio ulnar joint 19

20 Mallet finger Fracture of scaphoid III. Lower Extremities 20

21 21

22 Intraosseous infusion (method of delivering hydration blood, and medications directly into medullary cavity of a bone when peripheral venous access is difficult or impossible) Major arteries of the thigh, leg, and foot 22

23 Pulse for posterior tibial artery Pulse for posterior dorsalis pedis artery 23

24 Gluteal region: position of sciatic nerve Trendelenburg sign/gait Blood supply to head and neck of femur 24

25 Hip replacement Hip with moderate arthritis Hip dislocation 25

26 Medial and lateral menisci Anterior and posterior cruciate ligaments Anterior cruciate Posterior cruciate 26

27 Sagittal MRI of knee showing a tear of the ACL Sagittal MRI of knee showing tear of posterior horn of medial meniscus Knee replacement 27

28 Hyperextension Knee Dislocation RVG 28

29 Ankle joint demonstrated radiographically Fractures of the lateral and medial malleoli 29

30 conditions/tibia shinbone shaft fractures 30

31 31