C7 and T1 spinous processes

C7 =70%

T1 = 30%

What is the location orientation of the inferior angle of the scapula with regard to the vertebra when...

-the patient is vertical (standing or sitting up)

-the patient is prone

the inferior angle of the scapula is at T7 when the patient is standing or sitting up.

it is at T6 when the patient is prone.

where is the medial border of the scapula?

-iliac crests of the pelvis

-umbilicus (belly button)

-bifurcation of the abdominal aorta into the left and right common iliac arteries

What happens if you have a bilateral fracture of the pars interarticularis of any vertebra?

Which part of the spine is this injury most common in?

What is the term for a unilateral fracture of the pars interarticularis?

It will lead to Spondylisthesis (which is associated with the vertebra with the pars fracture translating anteriorly on the vertebra below). 

This is most common in L4 and L5.

A unilateral fracture of the pars interarticularis is called spondylolysis

What type of movement causes the Unhappy Triad injury.

What is injured in this injury (3 parts)

"valgus movement" and "external rotation of the tibia on the femur

an unhappy triad invovles injury of the medial collateral ligament (MCL), anterior cruciate ligament (ACL), and medial meniscus

S1

Remember macarena "S1 reach for the sun"

L1,2,3

Macarena....L1,2,3 lift the knee

L2,3,4

macarena..."L2,3,4 kick the door"

L5

macarena..."L5 Heel jive"

What is affected in a grade 1,2, and 3 shoulder separation?

What surface anatomy is noticeable during a grade 3?

• Grade 1: acromioclavicular (AC) ligament is stretched or partially torn
• Grade 2: AC ligament is completely torn, but coracoclavicular ligaments remain intact
• Grade 3: AC and coracoclavicular ligaments are all completely torn, as is the capsule surrounding the joint. Noticeable surface anatomy at this stage is a depressed shoulder and a raised clavicle (causing a bump on the shoulder

What are the differences of the following osteological features:

-size of vertebral bodies in cervical, thoracic, and lumbar

-spinal canal in ""

-foramina

-spinous process in ""

-transverse process in ""

• vertebral bodies are smallest in cervical, largeer in thoracic, and largetst in lumbar

• spinal canal is largest in cervical 

• Foramina

-cervical = 1 vertebral, 2 transverse
-thoracic = 1 vertebral

-lumbar   = 1 vertebral

• spinous process

-Cervical- slender and often bifid (C2-C6)
-Thoracic- long and fairly thick (most project inferiorly)
-Lumbar- short and blunt (project posteriorly rather than inferiorly)

• Transverse process:

what are the 4 antero-posterior curves of the spine?

• 2 convex anterior: cervical & lumbar lordosis

• 2 convex posterior: thoracic & sacral kyphosis

What is hyperkyphosis?

What is the name of the surface structure it forms? 

What type of injury usually causes this?

It is an exaggertaed thoracic curvature.

This forms Dowger's hump.

This is usually caused by a compression fracture.

What is the normal curve of the spine, which is convex posteriorly, called? 

Convex anteriorly?

convex posteriotly: kyphosis

convex anteriorly: lordosis

What is hyperlordosis?

What abnormal condition usually causes this?

Which patients is this condition most common in?

Exaggerated cervical or lumbar curvature.

This can be caused by pendulous abdomen.

This is most common in demale patients (e.g. pregnancy).  

1. What is the sacral hiatus? 
2. What is its clinical significance?

1. a normally occurring gap at the lower end of the sacrum, exposing the vertebral canal, due to failure of the laminae of the last sacral segment to coalesce. 
2. provides cannular access to the sacral epidural space for administration of anesthetics (e.g. caudal nerve blocks, site of epidural injections). 

• Nucleus pulposis: acts as a biological ball-bearing, which spreads load across the vertebral endplates
• Annulus fibrosis: concentric rings which provide strength and structural rigidity

What effect can long-term use of corticosteroids have on the curvature of the spine?

How does this occur?

Long term use of corticosteroids is the most common reason for compression fractures. 

Long term use of these inhibits osteoblasts (bone-forming), leading to greater osteoclastic activity (bone destruction/reabsorption). 

With regards to spinal function in a patient with scoliosis, explain what occurs in "coupled motion".

How do the mechanisms differ in the different regions on the spine?

Coupled motion is laterl flexion coupled with vertebral rotation of the vertebrae.

In the C1-T4 area, there is normal coupled motion in which lateral flexion and vertebral rotation both occur. In the L5-T8 area, these 2 motions occur in the opposite direction. 

What is a spinal herniation?

What role does the posterior longitudinal ligament (PLL) play in a herniation?

Spinal nuclues material that has broken through all layers of the annulus produces a herniation.

Hernitations occuring posterior could potentially impact the spinal nerve and cause pain. The PLL prevents the herniation from doing this but keeping the nucleus in its place. If further impaction of the nucleus proceeds, the PLL causes the necleus pulposus to bulge to one side (posterolateral). 

What are the functions of the following:

-anterior longitudinal ligament (ALL)

-posterior "" (PLL)

-ligamentum nuchae

-intervertebral disc (IVD) 

• ALL: both permit and resist bending movements
• PLL: both permit and resist bending movement. Maintains the nucleus pulposus in the IVD during a herniation. 
• Ligamentum nuchae: also called nuchal ligament. It serves to support the head without muscular effort
• IVD: attaches each pair of vertebra together (top and bottom) and acts as a shock absorber between the two.

• Annulus fibrosus: part of the IVD. It prevents the nucleus pulposus from herniating out of the IVD. 

• Nucleus pulposus: part of the IVD. It is an inner gel core surrounded by multiple rings of the annulus fibrosis. The gel core allows the IVD to withstand forces of compression and torsion

In which area of the spine is the nucleus pulposus most likely to herniate?

Why this location?

The nucleus pulposus is most likely to herniate posterolaterally in the IVD. 

Herniations usually occur posterolaterally because the anulus fibrosus is relatively thin and is not reinforced by the posterior or anterior longitudinal ligament. This is the path of least resistance, and thus most-prone to herniation. 

A person lifting, while bending forward at the waist and twisting, is most likely to incur what spinal condition? 

Why?

This will most likely cause a disc herniation. 

Why does this occur?

Lifting causes the nucleus pulposus to apply pressure on the annulus fibrosus.

Twisting of the body causes ½ of the annulus fibers to become taut and the other half to become slack – reducing the number of fibers in the annulus by ½ to be able to resist force. 

Bending forward decreaes the compression force capabilities of the IVD (compared to standing upright with a similarly heavy load). 

Thus, the coupling of these movements while bending forward will most likely lead to a disc herniation. 

Identify the following features of the Trapezius back muscle:

-origin and insertion

-function

-innervation

Trapezius

Origin:

-external occiptial protuberance

-ligamentum nuchae

-spinous process of C1-C7

-apponeurosis of T1-T4 spinous processes

-spinous processes of T5-T12

Inerstion:

-lateral one-third of clavicle

-medial side of the acromion

-upper crest and tubercle of the scapular spine

Function:

-retraction, superior rotation, elevation, and depression of the scapula

Innervation:

-Spinal Accessory Nerve (CN XI)

Identify the following features of the Latissimus dorsi back muscle:

-origin and insertion

-function

-innervation

Latissimus dorsi

Origin:

-inferior angle of the scapula

-ribs 9-12

-spinous processes of T7-T12

-thoracolumbar fascia

-posterior one-third of the iliac crest

Insertion:

-Crest of the lesser tuberosity of the humerus and the intertubercular groove

Action:

-extension, addution, and internal rotation of the arm

-aids in respiration

Innervation:

-Thoracodorsal nerve

-Posterior cord of the brachial plexus

Identify the following features of the Rhomboid major back muscle:

-origin and insertion

-function

-innervation

Rhomboid major

Origin:

-T2-T5 spinous processes

Inerstion:

-Medial margin of the scapula "inferior" to the spine

Function:

-stabilization, retraction, elevation, and internal rotation of the scapula

Innervation:

-Dorsal scapular nerve (C4-C5)

Identify the following features of the Rhomboid minor back muscle:

-origin and insertion

-function

-innervation

Rhombooid minor

Origin:

-spinous processes of C7-T1

-inferior ligamentum nuchae

Insertion:

-Medial margin of the scapula inferior to the spine.

Action:

-stabilization, retraction, elevation, and internal rotation of the scapula 

Innervation:

-dorsal scapular nerve C4-C5

Identify the following features of the Levator scapulae back muscle:

-origin and insertion

-function

-innervation

Levator scapulae

Origin:

-transverse process of vertebrae C1-C4

Insertion:

-superior angle to the medial border of the scapula

Action:

-elevates the scapula medially 

-inclines the head ipsilaterally

Innervation:

-dorsal scapular nerve C5

-upper part of muscle receives branches of C3-C4 spinal nerves

• Trapezius allows abduction of humerus by elevation and rotation of scapula

•  For every 2 degrees of humeral abduction the scapula rotates 1 degree

• Clinically – can see impingement syndrome +/or subacromial bursitis with altered scapulo-humeral rhythm

Identify the following for the Sternocleidomastoid muscle (SCM):

-origin

-insertion

-action

-innervation

SCM

Origin:

-sternal head (anterior surface of the manubrium)

-clavicular head (medial third of the clavicle)

Insertion:

-mastoid process

-lateral part of the superior nuchal line

Action:

-inclines the head ipsilaterally and rotates it contralaterally.

Innervation:

-spinal accessory nerve (CNXI)

-sensory supply from C2 & C3

Identify the following features of the Serratus posterior superior back muscle:

-origin and insertion

-function

-innervation

Serratus posterior superior

ORIGIN:

-spinous processes of C7-T3

-ligamentum nuchae

INSERTION:

-superior margin of ribs 2-5

FUNCTION:

-elebation of the ribs

INNERVATION:

-branches of the ventral primary rami of the spinal nerves T1-T4

Identify the following features of the Serratus posterior inferior muscle

-origin and insertion

-function

-innervation

Serratus posterior inferior

ORIGIN:

-spinous processes of the vertebrae T11-L2

-thoracolumbar fascia

INSERTION:

-lateral inferior margins of ribs 8-12

FUNCTION:

-lowers the ribs

INNERVATION:

-spinal nerves T9-T12

Identify the following features of the Levator costae muscle:

-origin and insertion

-action

-innervation

Levator costae

ORIGIN:

-Transverse processes of C7-T11

INSERTION:

-outer posterior surface and angle of the ribs below the vertebrae of origin.

ACTION:

-elevation of the ribs

INNERVATION:

-dorsal primary rami of spinal nerves C7-T11

• Serratus posterior superior
• Serratus posterior inferior
• Levator costae

Which 3 mucles make up the erector spinae?

What is their function?

What is another name for the erector spinae?

• Spinalis
• Longissimus
• Iliocostalis

All three muscles help to keep the spine erect. . 

Erector spinae is also known as Sacrospinalis, or Paraspinal muscles

They also act as lateral flexors of the spine when only one side contracts (unilateral).

These muscles act as extensors of the spine when they contract bilaterally.

Identify the following characteristics of the Spinalis muscle:

-origin

-insertion

-action

-innervation

Spinalis

ORIGIN:

-spinous processes of T10-L3

INSERTION:

-spinous ptocesses of T2-T8 

-base of the skull

ACTION:

-support

-keep the spine erect

-extension and lateral flexion of the spine.

INNERVATION:

-dorsal primary rami of the thoracic nerve and the upper lumbar spinal nerves.

Identify the following characteristics of the Longissimus muscle:

-origin

-insertion

-action

-innervation

Longissimus

ORIGIN:

-sacrum

-iliac crest

-spinous processes of lumbar vertebrae

-transverse processes of lower thoracic vertebrae

INSERTION:

-ribs 2-12

-costal processes of lumbar vertebrae

-transverse processes of thoracic vertebrae

ACTION:

-keep the spine erect

-extension and lateral flexion of the trunk, neck, and head. 

INNERVATION:

-Dorsal primary rami of the spinal nerves C1-S1

Identify the following characteristics of the Iliocostalis muscle:

-origin

-insertion

-action

-innervation

Iliocostalis

ORIGIN:

-sacrum 

-iliac crest

-spinous processes of lumbar vertebrae

INSERTION:

-ribs

-cervical transverse processes

ACTION:

-keeps spine erect

-extends and laterally flexes spine

INNERVATION:

-dorsal branches of the cervical, thoracic, and lumbar nerves

Where is the transversospinal group of muscles in relation to the erector spinae group?

What 3 muscles make up the transversospinal group of muslces?

What is their general insertion and origin?

What is their function?

• The transversospinal group is made up of the Rotatores, Multifidus, and Semispinalis muscles
• They all attach from the transverse processes  (tp) of one vertebra, to the spinous processes (sp) 1-6 levels above
• Rotatores: tp attaches to sp 1-2 levels above
• Multifidus: tp attaches to sp 2-4 levels above
• Semispinalis: tp attaches to sp 4-6 levels above
• Function
• Extends head and spine and lateral flexes spine
• rotates spine
• extends spine

Identify the following characteristics of the Splenius capitis muscle:

-origin

-insertion

-action

-innervation

Splenius capitis

ORIGIN:

-Ligamentum nuchae

-spinous processes of the vertebrae C7-T2

INSERTION:

-mastoid process

-lateral end of the superior nuchal line

ACTION:

-ipsilateral rotation of the head

-extension and lateral flexion of the cervical spine and head

INNERVATION:

-dorsal primary rami of spinal nerves C2-C6

what are the 3 mucles which make up the suboccipital triangle?

What is located inside this triangle?

What is the general function of this muscle group?

• Rectus capitis posterior major
• Obliquus capitis superior
• Obliquus capitis inferior

---------------------

• within the suboccipital triangle is the subocciptial nerve and vertebral artery 

---------------------

• the subocciptial triangle generally functions to assist in extension and rotation of the head

---------------------

• this muscle group is innervated by the suboccipital nerve 

Identify the following characteristics of the Rectus capitis posterior major:

• origin, insertion, action, innervation 

Rectus capitis posterior major

ORIGIN:

posterior tubercle of the axis cervical (C2)

INSERTION:

lateral part of the occipital bone below the inferior nuchal line 

ACTION:

extension and ipsilateral rotation of the head

INNERVATION:

suboccipital nerve and the dorsal primary ramus C1

Identify the following characteristics of the Obliquus capitis superior:

• origin, insertion, action, innervation 

Obliquus capitis superior

ORIGIN:

transverse process of the atlas (C1)

INSERTION:

occipital bone below the superior nuchal line

ACTION:

extensio and ipsilateral rotation of the head

INNERVATION:

-suboccipital nerve

-dorsal primary ramus of C1

Identify the following characteristics of the Obliquus capitis inferior:

• origin, insertion, action, innervation 

Obliquus capitis inferior

ORIGIN:

spnous process of the axis (C2)

INSERTION:

Transverse process of the atlas (C1)

ACTION:

Ipsilateral rotation of the head

INNERVATION:

-suboccipital nerve 

-dorsal primary ramus of C1

• in general, it innervates the mucles which form the suboccipital triangle
• rectus capitis posterior major
• obliquus capitis superior
• obliquus capitis inferior

What are the 4 major internal rotators of the arm?

What are the 2 major external rotators of the arm?

Internal rotators

• pectoralis major
• subscapularis
• latissimus dorsi
• teres major

-------------------------------------

External rotators

• infraspinatus
• teres minor

What are the true ribs, false ribs, and floating ribs?

• True = Ribs 1-7
• False = Ribs 8-10
• Floating = Ribs 11,12

1. What does the head of the rib connect with?
2. What are the posterior attachments of the ribs?
3. What are the anterior attachemtns of the ribs

1. The head of the rib connects with the vertebral body
2. Posterior Attachments: 
1. Rib connects to the transverse processes of the vertebrae
3. Anterior Attachments:
1. True Ribs 1-7: attach to sternum via costal cartilage
2. False Ribs 8-10: attach to shared costal cartilage 
3. Floating ribs 11-12: no anterior connections

Identify the following characteristics of the pectoralis major:

-origin

-insertion

-action

-innervation 

Pectoralis major

ORIGIN:

-clavicle,

-manubrium

-sternum, 

-costal carilages of ribs 1-6

-anterior rectus sheath

INSERTION:

-crest of greater tubercle of the humerus

ACTION:

-adduction, flexion, and internal rotation of the humerus

-assists in respiration when shoulder is fixed

INNERVATION:

-medial and lateral pectoral nerves

-brachial plexus C5-T1

Identify the following characteristics of the pectoralis minor:

-origin

-insertion

-action

-innervation 

Pectoralis minor

ORIGIN:

-ribs 3-5

INSERTION:

-coracoid process of the scapula

ACTION:

-pulls the scapula medially, forwards (protraction), and downwards

-aids in respiration

INNERVATION:

-medial and lateral pectoral nerves

-brachial plexus C8, T1

Identify the following characteristics of the Transversus thoracic muscle:

-origin

-insertion

-action

-innervation 

Transverse thoracic

ORIGIN:

-posterior,deep surface os the sternum

-xiphoid cartilage

INSERTION:

-Inner surface of the costal cartilages 2-6

ACTION:

-depression of the ribs 

-compression of the chest for forced expiration

INNERVATION:

-intercostal nerves

These are paired arteries which stem directly from the descending aorta.

They supply each side of the thoracic cavity with oxygenated blood.

These paired veins drain each side of the posterior thoracic cavity. 

Parts of the intercostal vein drain intot he brachiocephalic vein, azygos vein, and hemiazygos veins

Regarding the vertebral artery:

1. what is it's pathway, and 
2. where does it end
3. what area does it irrigate

1. the vertebral artery bracnhes from the subclavian artery in the thoracic cavity, and passes superiorly thorugh the transverse formaina fo the cervical vertebrae (C6 up through C1). 
2. it ends at the passes through the antlantooccipital ligament and foramen magnum, ending the cranial valut and becoming the basilar artery
3. it supplies oxygenated blood to the brain 

Regarding the thyrocervical trunk:

1. what is it's pathway, and 
2. where does it end
3. what area does it irrigate

1. It is a short, relatively wide branch from the subclavian artery. It branches to form the inferior thyroid artery, the transverse cervical artery, and the suprascapular artery.
2. it is short, and ends where it branches into the 3 arteries mentioned above
3. it will irrigate the territories of the 3 arteries above, so
1. Inferior thyroid artery irrigates:
1. lateral lobe of thyroid gland
2. Transverse cervical artery irrigates:
1. trapezius and surrounding tissues.
3. Suprascaular artery irrigates:
1. shoulder joint, supraspinatus, infraspinatus muscles

The scapular anastomosis is formed by the connection of the

1. suprascapular, 
2. dorsal scapular, and 
3. cirmcumflex scapular arteries. 

1. Where does the subclavian artery originate from?
2. What does it irrigate?
3. What vessels does it branch into (name 5)?

1. Subclavian artery arises from teh aortic arch and brachiocephalic artery
2. it primarily irrigates the upper limb
3. It branches into:
1. vertebral artery
2. internal thoracic artery
3. dorsal scapular artery
4. thyrocervical trunk
5. costocervical trunk

Regarding the internal thoracic artery:

1. where does it originate?
2. identify its branches
3. what territories does it irrigate?

1. it originates from the subclavian artery
2. it branches into the superior epigastric and musculophrenic arteries
3. it irrigates the thoracic wall, mammary gland, and the diaphragm

1. Superior thoracic
2. Thoracoacromial 
3. Lateral thoracic
4. Subscapular
5. Anterior Humeral Circumflex
6. Posterior Humeral Circumflex

Lateral thoracic artery:

1. where does it come from
2. what does it irrigate

1. arises from the axillary artery
2. irrigates the subscapularis, pectoralis major, pectoralis minor muscles, and the breasts

Thoracoacromial artery trunk:

1. where does it come from
2. what are its 4 branches
3. what does it irrigate

1. arises fromt eh Axillary artery
2. branches into the deltoid, pectoral, acromial, and clavicular (DPAC)
3. the 4 branches of the thoracoacromial trunk irrigate the  deltoid, pectoralis mino, pectoralis major, breasts, sternoclavicular joint, and the subclavius muscle. 

Subscapular artery:

1. where does it come from
2. what are its 3 branches
3. what does it irrigate

1. is thel argest branch off the axillary artery
2. it branches intot he cirmcumflex scapular artery, and 2 thoracodorsal arteries
3. the combined 3 branches irrigate the teres major, teres minor, infraspinatus, and latissimus dorsi muscles 

-Cimcumflex scapular artery

-Suprascapular artery

-Dorsal scapular artery

Anterior circumflex humeral artery:

1. where does it come from
2. what does it irrigate

1. arises from the axillary artery
2. irrigates the deltoid muscle and arms muscles near the surgical neck of the humerus

Posterior circumflex humeral artery:

1. where does it come from
2. what does it irrigate

1. arises from the axillary artery
2. irrigates the deltoid muscle and arm muscles near the surgical neck of the humerus

TRUE or FALE

The anterior and posterior circumflex humeral arteries anastomose?

Thoracodorsal artery:

1. where does it come from
2. what does it irrigate

1. the axillary artery branches into the subscapular artery, which fruther branches into 2 thoracodorsal arteries
2. it irrigates the latissimus dorsi muscle 

Serratus anterior

ORIGIN:

ribs 1-9

INSERTION:

medial margin of the costal surface of scapula

ACTION:

-superior external rotation of scapula

-draws scapula internally and forwards

-lowers arms from raised position

-elevation of the ribs

INNERVATION:

-long thoracic nerve

-brachial plexus C5-C7

External abdominal oblique

ORIGIN:

-outer surface of ribs 5-12

INSERTION:

-anterior superior iliac spine

-iliac crest

-anterior layer of rectus sheath & linea alba

-pubic crest and tubercle

ACTION:

-unilateral: bends trunk to same side, rotates trunk to the opposite side

-bilateral: flexes the trunk, straightens the pelvis, active in respiration, maintains abdominal tone

INNERVATION:

-Intercostal nerves T5-T12

-iliohypogastric and ilioinguinal nerves

Pyramidalis musle

ORIGIN:

pubis (anterior)

INSERTION:

Linea alba

ACTION:

Tenses the linea alba

INNERVATION:

Subcostal nerve (12th intercostal nerve)

Transversus abdominis

ORIGIN: 

-costal cartilages 7-12

-deep layer of thoracolumbar fascia

-iliac crest, anterior superior iliac spine

-inguinal ligamnet

INSERTION:

posterior layer of rectus sheath, linea alba, pubis bone

ACTION:

-unilateral: rotatation, flexion, and lateral flexion of the trunk to the same side

-bilateral: expiration, maintains abdominal tone

INNERVATION:

-Intercostal nerves T5-T12

-ioliohypogastric nerve

-ilioinguinal nerve

-genitofemoral nerve

Internal abdominal oblique

ORIGIN

-thoracolumbar fascia

-iliac crest

-anterior superior iliac spine

-inguinal ligament

INSERTION:

-ribs 10-12

-anterior and postior rectus sheath

-linea alba

-junction with cremaster muscle 

ACTION:

-Unilateral: bends & rotates trunk to same side

-Bilateral: flexes trunks, straightens pelvis, expiration, maintains abdominal tone

INNERVATION:

-Intercostal nerves T8-T12

-iliohypogastric nerve

-ilioinguinal nerve

Rectus abdominis

ORIGIN:

Pubis

INSERTION:

-ribs 5-7 costal cartilages

-xiphoid process of sternum

ACTION:

flexes lumbar spine, straightens pelvis, expiration, maintains abdominal tone

INNERVATION:

Intercostal nerves T5-T12

They are the transverse lines between sections of the rectus abdominis.

• Aponeurosis are layers of flat broad tendons
• Anastomosis is the reconnection of two blood vessels that previously branched out

What are the layers of aponeurosis in the upper anterior and posteior rectus sheath (above the arcuate line)?

List from superficial to deep layers

Superficial to deep

• external oblique aponeurosis
• internal oblique aponeurosis
• transversus abdominis aponeurosis

What are the layers of aponeurosis in the loweranterior and posteior rectus sheath (below the arcuate line)?

List from superficial to deep layers

Superficial to deep

• external oblique aponeurosis
• internal oblique aponeurosis
• transversus abdominis apeoneurosis

1. What boundary does the arcuate line identify?
2. What aponeuroses are present in the anterior and posterior layers of the rectus sheath ABOVE the arcuate line
3. What aponeuroses are present in the anterior and posterior layers of the rectus sheath BELOW the arcuate line

1. The arcuate line divides the upper 3/4 of the abdominal wall from the lower 1/4th
2. ABOVE the arcuate line:
1. Anterior  = external and internal oblique aponeuroses
2. Posterior = internal oblique and transversus abdominis aponeuroses
3. BELOW the arcuate line:
1. Anterior = external, internal, and transversus abdominis aponeuroses
2. Posterior = no aponeuroses, only transversalis fascia

1. low back extensors (erector spinae)
2. hip flexors (rectus femoris & psoas major)

1. rectus abdominis
2. hamstrings [semimembranosus, semitendinosus, biceps femoris (long head)]

Video which covers all structure and function:

https://www.youtube.com/watch?v=9j-Mg86KXkk

Picture showing the intercrural fibers:

http://dermatologic.com.ar/c2ff11.png

What are the characteristics of a Umbilical hernia?

• are usually small
• hernation occurs through the umbilical ring
• acquired umbilical hernias occurs most commonly in women and obese people

What are the characteristics of a direct hernia?

• internal opening?
• course?
• external opening?

Direct hernia

• Internal Opening: Hesselbach triangle, occur above the inguinal ligament and MEDIAL to the inferior epigastric artery and vein
• Course: sac is perpendicular to the abdominal wall
• External Opening: superficial inguinal ring

What are the characteristics of an indirect hernia?

• internal opening?
• course?
• external opening?

Indirect hernia

• Internal Opening: deep inguinal ring, above the inguinal ligament and LATERAL to the inferior epigastric artery and vein
• Course: sac passes through the Inguinal canal
• External opening: superficial inguinal ring

Identify these osteological features of the scapula:

http://medchrome.com/wp-content/uploads/2010/02/clavicle.jpg

Identify the following osteological features of the humerus

(more are shown the in picture, but the list below is of Dr. A's ASL)

http://classconnection.s3.amazonaws.com/119/flashcards/1114119/jpg/humerus_large1349643448340-141E293CCDC3476FCE1.jpg

Identify the:

Head

Anatomical neck

(Surgical neck)

Greater tubercle

Intertubercular groove

Lesser tubercle

Deltoid tuberosity

Olecranon fossa

Lateral epicondyle

Medial epicondyle

(Capitulum)

(Trochlea)

Identify the following osteological features of the Radius and ulna

(more are shown the in picture, but the list below is of Dr. A's ASL)

Identify:

• For Radius: identigy the head, radial tuberosity, and radial styloid process
• For Ulna: olecranon, coronoid process, ulnar styloid process

Identify:

• wrist:
• carpal bones: scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate, hook of hamate

http://www2.ma.psu.edu/~pt/carpant.gif

Identify:

• metacarpals (rays I-V)
• proximal phalanx phalanges (digits I-V)
• middle phalanx phalanges (digits II-V)
• distal phalanx phalanges (digits I-V)

http://www.paradoja7.com/hand-bones-anatomy/

Deltoid

• ORIGIN: acromion, scapula, clavicle
• INSERTION: humerus
• ACTION: abduction, flexion, internal rotation, external rotation and extension
• INNERVATION: axillary nerve and brachial plexus (C5-C6)

Coracobrachialis

• ORIGIN:coracoid process of scapula
• INSERTION: humerus
• ACTION: flexion, adduction, internal rotation
• INNERVATION: musculocutaneous, brachial plexus C5-C7

Biceps brachii short head

• ORIGIN: cracoid process of scapula
• INSERTION: Radial tuberosity of humerus
• ACTION: flexion of elbow, supination, abduction and internal rotation of the humerus
• INNERVATION: musculocutaneous nerve and brachial plexus (C5-C6)

Biceps brachii long head

• ORIGIN: scapula
• INSERTION: radial tuberosity
• ACTION: flexion of elbow, supination, abduction and internal rotation of the humerus

Brachialis

• ORIGIN: humerus 
• INSERTION: cornoid process of ulna
• ACTION: flexion of elbow joint to flex the forearm
• INNERVATION: Musculocutaneous nerve, brachial plexus C5-C6, radial nerve C7

Triceps brachii long head

• ORIGIN: scapula
• INSERTION: olecranon process of ulna
• ACTION: extension and adduction of the shoulder joint, extension of the elbow joint
• INNERVATION: Radial nerve C6-C8

Triceps brachii lateral head 

• ORIGIN: humerus
• INSERTION: Olecranon process of the ulna
• ACTION: Extension of the elbow joint to extend the forearm.
• INNERVATION: Radial nerve (C6-C8)

Triceps brachii medial head

• ORIGIN: Humerus
• INSERTION: Olecranon process of ulna
• ACTION: extension of the elbow joint to extend the forearm
• INNERVATION: Radial nerve (C6-C8)

Anconeus muscle

• ORIGIN: lateral epicondyle of humerus
• INSERTION: lateral olecranon of ulna
• ACTION: extension of the forearm
• INNERVATION: Radial nerve

Flexor carpi ulnaris

• ORIGIN: medial epicondyle of humerus, posterior border of proximal ulna, medial border of olecranon
• INSERTION: pisiform, hook of hamate, base of 5th metacarpal bone
• ACTION: flexion of the wrist, adduction of the hand
• NERVE: Ulnar nerve (C7-T1)

Flexor carpi radialis

• ORIGIN: medial epicondyle of humerus
• INSERTION: 2nd and 3rd metacarpal bones
• ACTION: flexion of the wrist, abduction of the hand
• INNERVATION: Median Nerve (C6-C7)

Palmaris lognus

• ORIGIN: Medial epicondyle of humerus
• INSERTION: Palmar aponeurosis
• ACTION: tightens the palmar aponeurosis, wrist flexion, weak flexion of elbow joint
• INNERVATION: Median nerve (C7-C8)

Pronator teres

• ORIGIN: Medial epicondyle of humerus, coronoid process of ulna, common flexor tendon
• INSERTION: lateral radius
• ACTION: Weak elbow flexion, pronation of forearm
• INNERVATION: Median nerve (C6-C7)

Flexor digitorum superficialis

• ORIGIN: humeroulnar head, medial epicondyle of humerus, radial head
• INSERTION: middle phalanges of digits 2-5
• ACTION: weak elbow flexion, wrist flexion, flexion of metacarpophalangeal and proximal interphalangeal joints of digits 2-5
• INNERVATION: Median Nerve (C8-T1)

Flexor digitorum profundus

• ORIGIN: ulna, interosseous membrane
• INSERTION: distal phalanges of digits 2-5
• ACTION: wrist flexion, flexion of of all finger joints in digits 2-5
• INNERVATION: Median and Ulnar nerve

Flexor pollicis longus

• ORIGIN: interosseous membrane, radius
• INSERTION: distal phalanx of thumb
• ACTION: wrist abduction, flexion of all thumb joints.
• INNERVATION: Median nerve

Pronator quadratus

• ORIGIN: distal ulna
• INSERTION: distal radius
• ACTION: forearm pronation, stabilization of distal radioulnar joint
• INNERVATION: anterior interosseous nerve from median nerve

Brachioradialis

• ORIGIN: humerus
• INSERTION: stloid process of radius
• ACTION: elbow flexion, supination and pronation of forearm
• INNERVATION: Radial nerve (C5-C6)

Extensor carpi ulnaris

• ORIGIN: humerus and ulna
• INSERTION: 5th metacarpal bone
• ACTION: wrist extension and adduction
• INNERVATION: Deep radial nerve (C7-C8)

Extensor carpi radialis longus

• ORIGIN: lateral humerus
• INSERTION: Dorsal 2nd metacarpal
• ACTION: weak elbow flexion, wrist extension  and abduction.
• INNERVATION: Radial Nerve C6-C7

Extensor carpi radialis brevis

• ORIGIN: humerus
• INSERTION: 3rd metacarpal
• ACTION: weak elbow flexion, wrist extension/abduction
• INNERVATION: Deep radial nerve (C7-C8)

Extensor digitorum

• ORIGIN: lateral humerus
• INSERTION: digits 2-5
• ACTION: wrist extension, extension of all joints associated with digits 2-5, abduction of the fingers
• INNERVATION: Deep radial nerve C7-C8

Extensor indicis

• ORIGIN: ulna, interosseous membrane
• INSERTION: tendons join extensor digitorum tendo to index finger (digit #2)
• ACTION: wrist extension, extension of all joints of index finger
• INNERVATION: Deep radial nerve C7-C8)

Extensor digiti minimi

• ORIGIN: lateral humerus
• INSERTION: extensor digitorum tendon to 5th digit
• ACTION: wrist extension, ulnar abduction of wrist, abduction and extension of all joints of 5th digit 
• INNERVATION: Deep radial nerve (C7-C8)

Supinator arm muscle

• ORIGIN: ulna, lateral humerus, radial collateral ligament and annular ligament of the radius
• INSERTION: proximal radiu
• ACTION: forearm supination at radioulnar joints.
• INNERVATION: Deep radial nerve (C6-C7)

Abductor pollicis longus

• ORIGIN: Radius, ulna, interosseous membrane
• INSERTION: 1st metacarpal bone
• ACTION: abduction of radiocarpal joint, abduction of 1st digit carpometacarpal joint
• INNERVATION: deep branch of radial nerve

Extensor pollicis brevis

• ORIGIN: distal radius, interosseous membrane
• INSERTION: thumb proximal phalanx
• ACTION: radiocarpal joint abduction, thumb extension
• INNERVATION: Deep radial nerve

Extensor pollicis longus

• ORIGIN: ulna, interosseous membrane
• INSERTION: thumb distal phalanx
• ACTION: wrist extension and radial abduction, adduction and extension of thumb
• INNERVATION: deep radial nerve (C7-C8)

Palmar aponeurosis

• ORIGIN: from the Palmaris longus inferior to the flexor retinaculum
• INSERTION: base of each digit
• ACTION: tightens palm
• INNERVATION: Median nerve (C7-C8)

Abductor pollicis brevis

• ORIGIN: Scaphoid and tapezium bones, flexor retinaculum
• INSERTION: proximal thumb
• ACTION: thumb abduction at the carpometacarpal join
• INNERVATION: Recurrent branch of median nerve

Flexor pollicis brevis

• ORIGIN: flexor retinaculum, capitate and trapezium bones
• INSERTION: proximial thumb
• ACTION: thumb flexion
• INNERVATION: recurrent branch of median nerve, ulnar nerve

Opponens pollicis

• ORIGIN: trapezium, flexor retinaculum
• INSERTION: 1st metacarpal bone
• ACTION: thumb opposition
• INNERVATION: recurrent branch of median nerve

Abductor digiti minimi

• ORIGIN: pisiform bone
• INSERTION: pinky finger
• ACTION: flexion, extension, abduction of pinky finger
• INNERVATION: deep branch of ulnar nerve (C8-T1)

Flexor digiti minimi

• ORIGIN: hamate hook, flexor retinaculum
• INSERTION: pinky finger 
• ACTION: pinky flexion
• INNERVATION: deep branch of ulnar nerve

Opponens digiti minimi

• ORIGIN: hamate hook, flexor retinaculum
• INSERTION: pinky finger
• ACTION: pinky opposition
• INNERVATION: deep branch of ulnar nerve

Palmaris brevis

• ORIGIN: palmar aponeurosis overlaying the hypothenar eminence
• INSERTION: skin of hypothenar eminence
• ACTION: tightens palmar aponeurosis, pulls medial skin of palm laterally
• INNERVATION: superficial branch of the ulnar nerve

Adductor pollicis oblique

• ORIGIN: capitate bone, 2nd and 3rd metacarpals
• INSERTION: thumb
• ACTION: thumb adduction and flexion
• INNERVATION: deep branch of ulnar nerve

Adductor pollicis transverse

• ORIGIN: 3rd metacarpal
• INSERTION: thumb
• ACTION: thumb adduction and flexion
• INNERVATION: deep branch of ulnar nerve

Lumbircals of hand 

• ORIGIN: tendon of flexor digitorum profundus
• INSERTION: digits 2-5
• ACTION: flexion/extenion of digits 2-5
• INNERVATION: palmar digital nerve from median nerve C8-T1

Palmar interossei

• ORIGIN: metacarpals 1-2, 4-5 
• INSERTION: 1-2, 4-5 proximal phalanges
• ACTION: flexion, extension, adduction of digits 2,4,5
• INNERVATION: deep branch ulnar nerve (C8, T1). 

Dorsal interossei

• ORIGIN: metacarpals of digits 1-5
• INSERTION:proximal phalanx of digits1-5
• ACTION: flexion, extension, abduction of digits 1-5
• INNERVATION: deep branch of ulnar nerve

Heart to hand

• right brachiocephalic trunk
• brachiocephalic artery
• subclavian artery
• axillary artery
• brachial artery
• bifurcation into radial and ulnar arteries
• radial artery > retinaculum > bifurcates into deep and superficial palmar arch

• common carotid artery
• internal thoracic artery
• costocervical trunk
• posterior intercostal arteries
• deep cervical artery
• vertebral
• thyrocervical trunk
• suprascapular artery
• transverse cervical artery
• ascending cervical artery
• inferior thyroid artery

Thoracoacromial artery trunk branches into:

• deltod: deltoid, subclavius, pectoralis major and minor
• pectoral: pectoral and serratus anterior muscles, breast glands and tissues
• acromial: acromial muscles, deltoid
• clavicular: subclavius muscle

subscapular artery branches into 3 arteries 

• 2 thoracodorsal arteris
• irrigate latissimus dorsi
• 1 circumflex scapular artery
• teres major and minor, infraspinatos

heart > Right brachiocephalic vein > R subclavian > R axillary > R brachial > bifurcates into radial and ulnar veins

• Radial vein > deep palmar venous arch
• Ulnar vein > deep palmar venous arch

Venous branches off the Axillary vein

• Cephalic
• Thoracoacromial: drains pectoral and deltoid
• Lateral thoracic: pectoralis major, serratus anterior
• Thoracoepigastric: lateral superficial aspect of trunk
• Posterior circumflex humeral
• Subscapular: scapula, latissimus dorsi
• Anterior circumflex humeral: humerus bone, shoulder joint

Venous branches of the basilic vein:

• Basilic: superficial medial hand, forearm.
• Median cubital (branches off basilic): drains superficial hand and forearm

1. What are the nerve roots of the brachial plexus?
2. What vetebral levels contribute to the brachial plexus?

1. C5-C8, T1
2. Corresponding vertebral levels
1. C5 root: 4-5th cervical vertebrae
2. C6 root: 5-6th cervical vertebrae
3. C7 root: 6-7th cervical vertebrae
4. C8 root: 7th cervical & 1st thoracic
5. T1 root: 1-2 thoracic vertebrae

My mother usually always right

• musculocutaneous nerve
• median
• ulnar
• axillary
• radial

Identify the following for the Musculocutaneous nerve:

• nerve root(s)
• cord
• brachial plexus branche(s)
• innervated muscle(s)

Musculocutaneous nerve

• NERVE ROOTS(S): C5,C6,C7
• CORD: lateral cord only
• BRANCH: musculocutaneous
• MUSCLE(S):  anterior elbow flexors, coracobrachialis, anterior cutaneous to lateral border of forearm

Identify the following for the Median nerve:

• nerve root(s)
• cord
• brachial plexus branche(s)
• innervated muscle(s)

Median nerve

• NERVE ROOT: C6,C7,C8,T1
• CORD: lateral and medial 
• BRANCH: Median nerve
• MUSCLE: thenar pad muscle to thumb, most anterior forearm, anterior wrist and finger flexors, cutaneous to most of palm.

Identify the following for the Ulnar nerve:

• nerve root(s)
• cord
• brachial plexus branche(s)
• innervated muscle(s)

Ulnar nerve

• NERVE ROOT: C8,T1 (possibly C7)
• CORD: medial cord
• BRANCH: Ulnar
• MUSCLE: 2 medial forearm muscles, wrist and finger flexors, hypothenar pad (pinky side), movement of 5th digit, cutaneous along medial part of hand

Identify the following for the Axillary nerve:

• nerve root(s)
• cord
• brachial plexus branche(s)
• innervated muscle(s)

Axillary nerve

• NERVE ROOT: C5,C6
• CORD: posterior cord
• BRANCH: Axillary nerve
• MUSCLE: deltoid, teres minor, cutaneous over deltoid area

Identify the following for the Radial nerve:

• nerve root(s)
• cord
• brachial plexus branche(s)
• innervated muscle(s)

Radial nerve

• NERVE ROOT: C5-C8,T1
• CORD: posterior cord
• BRANCH: Radial nerve
• MUSCLE: posterior forearm and hand extensors; cutaneous to posterior arm, posterior forearm, and medial lateral part of hand

wrist is flaccid to extension (limp wrist)

fingers are in autoflexed position

• Cause: disc herniation, spinal joint degeneration
• Location: ventral root, lower cervical spine
• Sign and Symptoms: 
• dermatomal pain and/or paresthesia
• traceable to a single spinal cord segment

Paralyses to:

– Biceps brachii, brachialis, coracobrachialis

   deltoid, pect. Maj,

– Pronated forearm.

Paralysis to:

• all of flexor digitorum profundus.
• finger muscles innervated by ulnar nerve and median nerve. 

Understand the terms for movements of hte lower limbs and its parts.

http://drawingbooks.org/lutz1/source/images/000078.png

Tibia 

http://teachmeanatomy.info/wp-content/uploads/Anterior-Surface-of-the-Tibia-Bone-Landmarks-Anatomy.png?95ac22

http://legacy.owensboro.kctcs.edu/gcaplan/anat/notes/tibia-and-fibula-left-tibia-fibula-medicalpages.jpg

Fibula

http://media-3.web.britannica.com/eb-media/05/99105-004-A031C53B.jpg

Patella

http://aboutjoints.com/physicianinfo/topics/anatomyknee/kneeimages/kneefigure2.17.gif

Ankle and Foot

http://starkmandown.files.wordpress.com/2011/12/ankle-anatomy-e1324670821914.jpg?w=531&h=570

• In the knee — the patella (within the quadriceps tendon).
• In the hand — two sesamoid bones are commonly found in the distal portions of the first metacarpal bone (within the tendons ofadductor pollicis and flexor pollicis brevis). There is also commonly a sesamoid bone in distal portions of the second metacarpal bone.
• In the wrist - The pisiform of the wrist is a sesamoid bone (within the tendon of flexor carpi ulnaris).^[3]
• In the foot - the first metatarsal bone usually has two sesamoid bones at its connection to the big toe 

piriformis

gemellus superior

gemellus inferior

quadratus femor

obterator externus 

obterator internus

Gluteus maximus

• ORIGIN: fascia of gluteus medius, iliium, fascia of erector spinae, sacrum, coccyx, sacrotuberal ligament
• INSERTION: iliotibial tract, fasciae latae muscles, femur
• ACTION: femur extension from flexed position, lateral stabilization of hip and knee joints, external rotation of femur
• INNERVATION: inferior gluteal nerve (L5-S2)

Gluteus medius

• ORIGIN: Ilium 
• INSERTION: greater trochanter of femunrs
• ACTION: Abduction of hip and stabilization of pelvis, flexion and internal rotation, extension and external rotation. 
• INNERVATION: superior gluteal nerve (L4-S1)

semimembranosus

semitendinosus

biceps femoris long head 

an openign in the distal tendon of the adductor magnus

the femoral artery and vein pass through into the popliteal fossa

• gracilis
• adductors
  • adductor longus
  • adductor brevis
  • adductor magnus