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
I. Vertebral Column 2
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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
Spinal Alignment Abnormalities Scoliosis Kyphosis Scoliosis before and after correction 5
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
Lumbar puncture 7
Herniation of nucleus pulposus Disc degeneration treated by graft and spinal fusion. Lateral views 8
Hangman s fracture II. Upper Extremities 9
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 http://www.wristiciser.com/downloads/wproplussystem.pdf Muscles of Upper Extremities 10
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
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
Joints of Upper Extremities Shoulder Joint Acromioclavicular Glenohumeral joint 13
Shoulder separation http://www.cksn.ca/files/2014/03/separated-shoulder.jpg http://www.sportsortho.co.uk/data/images/grade%20iii_1_1.jpg 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
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 http://exercisesforrotatorcuff.net/wpcontent/uploads/2009/10/rotator Cuff Tears 1.jpg http://warnockmd.com/wpcontent/uploads/2013/07/rotator cuff injuryculprits.jpg https://stemcelldoc.files.wordpress.com/2009/01/shoulder_mri_cuff i.jpg?w=255&h=202 http://www.aaos.org/news/aaosnow/may09/clinical12 1.gif Shoulder dislocation http://healthfavo.com/wp-content/uploads/2013/07/anterior-dislocated-shoulder-onhealthfavo.jpg 15
Fracture of olecranon of ulna http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/17259.jpg http://www.wheelessonline.com/image4/i1/raddh1.jpg http://images.radiopaedia.org/images/935521/8d33d61a95c5d64 d2d318f3534b536.jpg http://2.bp.blogspot.com/ cmf0co7ffha/thysrqfsd3i/aaaaaaaaacc/x47rhwd8gio/ s1600/elbow_fracture_1.jpg http://po.simplifypr.com/wpcontent/uploads/2013/02/broken bones 3.jpg http://www.healthhype.com/wpcontent/uploads/humerusfraktur_nach_op.jpg 16
http://accesspediatrics.mhmedical.com/data/books/shah2/s hah2_c019f026.png http://medacad.wikispaces.com/file/view/colles'_fracture.jpg/1900 25382/560x352/Colles'_Fracture.jpg Dinner fork fracture of distal radius http://img.medscape.com/pi/emed/ckb/radiology/336139 398406 7418.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
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
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
Mallet finger Fracture of scaphoid III. Lower Extremities 20
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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
Pulse for posterior tibial artery Pulse for posterior dorsalis pedis artery 23
Gluteal region: position of sciatic nerve Trendelenburg sign/gait Blood supply to head and neck of femur 24
Hip replacement Hip with moderate arthritis Hip dislocation 25
Medial and lateral menisci Anterior and posterior cruciate ligaments Anterior cruciate Posterior cruciate http://www.islandorthotics.org/img/services/pcl_injury_visual.jpg 26
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
Hyperextension Knee Dislocation RVG 28
Ankle joint demonstrated radiographically Fractures of the lateral and medial malleoli 29
https://orthoinfo.aaos.org/en/diseases conditions/tibia shinbone shaft fractures 30
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