Vetrebral Centers of 

Ossification

• first notechord (becomes vertebral centrum) body
• later neural arch 

Anatomical Vertebral Features

• vertebral body and vertebral arch
• pedicles and lamina
• transverse and spinous process
• articular process

Uncinate Process

• forms a lip on the superfical, lateral surface of cervical vertebrae
• limits rotation

Transverse Foreamen 

• one on each side of cervical vertabrae
• vertebral artery runs through
• C3-C6

Bifid Spinous Process

• Forked Spinous process
• C3-C6

Costal Facets

• provide articulation for ribs on thoractic vertebrae
• located on vertebral bodies and on transverse processes

Sacrum

• 5 fused sacral vertebrae 
• median, intermediate and lateral sacral crests

Vertebral Discs

• consists of inner nucleus pulposus that is surrounded by anulus fibrosus
• provides flexibility, shock resistance
• nucleus pulposus is more liquid like and the anulus is more solid 

Anterior Longitudinal Ligament

• broad ligament that runs across the ventral surface and prevents hyperextension

Posterior Longitudinal Ligament

• small ligament on dorsal side of vertebral collumn 
• prevents hyperflexion
• has lots of pain receptors
• assists in redirecting herniation of pulposus
• inside the vertebral foreamen on posterior side of body  

Nunchal Ligament

• sheet like ligament that extends from the occipital protruberance to C1-C7 spinous processes
• limits flexion and serves as attachment point for intrinsic back muscles
• also supraspinous and interspinous ligaments

Ligamenta Flava

• Links togethering vertebral lamina
• forms continuous roof over vertebral canal
• can also be seen in between vertebrae on the back of vertebral disks in its linking
• Lamina of vertebrae are posterior to transverse processes

Kyphosis

• primary curvature of the spine
• thoracic and sacralcocxygeal curve this way

Lordosis

• secondary curvature
• cervical and lumbar vertabrae curve in this fasion 

The Radius is homologous to what?

• tibia

The Fibula is homologous to what?

• the ulna in the wrist

Base of Sacrum

• the top of the sacrum

Apex of Sacrum and Coccyx

• They are the bottom, smaller point of each bone 

Zygapophysial Joint

• synovial joint between superior and inferior articular processes of two vertebrae
• guides and limits vertebrae motion

Supraspinous Ligament

• Runs along the top of the nunchal ligament and on the ends of the spinous processes
• Interspinous ligament runs in between the spinous processes

Multifidus muscle

• muscle that fills up the grooves on either side of the spinous processes from axis to sacrum 
• very thin, deep muscle
• stabilizes joints at each segment level

Splenius Cervicis

• transverse process of cervical vertebrae to spinous process of the lumbar vertebrae
• back of the neck  muscle
• extension of cervicle spine and rotation and lateral flexion

Splenius Capitis 

• broad strap like muscle on back of the neck
• base of skull to vertebrae down to T4
• head flexion and lateral rotation and flexion of the spine

Elbow and Knee Orientation

Clavicle

Scapula

• posterior side divided into supra and infraspinous fossa by the spine of the scapula
• anterior concave surface is suprascapular fossa
• most lateral landmark is acromion and right behind it is the longer corocoid process

Clavicular Fracture

• most frequent bone broken in newborns (22%),top 5 in kids (7%) and top ten in adults (3%)
• medial segment of clavicle projects superiorly 
• upper limb depressed, adducted and medially rotated -caused by action of muscles on scapula

Why do Clavicular Fractures

Present Similarly?

• muscles act on upper limb w/o connection to axial skeleton
• medial fragment displaced upward by sternocleidomastoid
• weight of upper limb, aduction by pectoralis major and latismus dorsi
• medial rotation by doris, pec, teres major,subscapularis
• medial rotator are bigger then lateral 

Humerus 

• head(proximal), lateral margin is greater tubercle (3 muscles attatch) 
• lesser tubercle is anterior (subscalpularis 
• intertubercular groove(passage of bicep brach.)
• anatomical and surgical neck

Most common Humerus 

Fracture

• most common fracture is at the surgical neck
• it is usually an impact fracture
• an impact fracture is when one fragment is driven into the spongy bone of the other fragment 

Humerus Greater Tubercle 

Fracture

• limb is pulled into medial rotation 
• this happens to old people who fall on acromion 
• happens to young people who fall on hand when arm abducted 
• the axillary, radial, median and ulnar never run near the head

Sternoclavicular Joint

• connects medial end of clavicle to manubrium of sternum 
• articular surface covered in fibrocartilage and intra-articular disk
• tough capsule and several ligaments give joint great strength 

Acromioclavicular Joint

• connects clavicle to acromion of scapula
• covered in fibrocartilage
• loose capsule and weak joint
• acromioclavicular ligament
• corococlavicular ligament maintains joint integrity 

Glenohumeral Joint 

• Ball and socket joint
• connecting glenoid fossa to humeral head
• The glenoid labrum deepens the shallow fossa
• loose capsule pierced by long head of biceps 
• glenohumeral and coracohumeral
• coracoarmial archs limits superior displacement

Shoulder Seperation 

• dislocation of AC join;more severe if coracoclavicular ligament is torn
• direct, forceful impact to shoulder or from fall on outstretched arm
• presents w/ prominence on shoulder where clavicle extends above acromion 

Shoulder Dislocation

• dislocation of gelnohumeral joint (typically head displaced inferior
• usually caused by excessive extension and lateral rotation of humerous
• glenohumeral ligaments weaker inferiorly
• presents with saging arm and a prominant intact AC joint

Superior Posterior Axioappendicular

• Trapezius
• Latissimus Dorsi 

Trapezius 

Latissimus Dorsi

Origin: T6-T12, lumbar vert, Posterior  pelvis

Insertion: Intertubercular grove

Action: Extends, adducts, meddially rotates humerus

Inervation:Thoracodorsal Nerve

Deep Posterior Axioappendicular

Muscle

• attach scapula to axial skelaton
• Levator Scapulae
• Rhomboid Major and minor

Levator Scapulae

Origin: C1-C4 vertabrae

Insertion: Superior medial border of Scapula

Action: Elevates Scapula and helps depress glenoid

Inervation:Dorsal Scapular Nerve

Rhomboid Major and Minor

Origin: C7-T5

Insertion: MEdial Border of Scapula 

-minor is superior to Major

Action: Rotates and helps rotate scapula

Inervation: Dorsal Scapular Nerve

Pectoralis Major

Pectoralis Minor

Subclavius

Serratus Anterior

Deltoid 

Teres Major

Atrophy of Deltoid

• caused by damage to axillary nerve that runs inferior to head of humerus and wraps around surgical neck
• can be hurt in dislocation or frature of glenohumeral joint
• causes shoulder to apear flat

Supraspinatus

Infraspinatus

Teres Minor

Subscapularis

Rotator Cuff Injury

Conus Medularis

• topped lower end of spinal chord
• around L1-L2
• from here spinal nerves continue to branch out

Filum Terminales

• pia mater that projects downward from the spinal chord
• connects conus medularis to back of coccyx
• filament 

Ventral Vs Dorsal Horn 

• ventral horn thicker portion of grey mater 
• dorsal horn thinner protion
• together the resemble an H

Trabeculae 

• small tissue/ligaments
• connect the arachnoid to the pia mater
• traverse the subarachnoid space

Leptomeninges

• term used to described the combined pia and arachnoid mater

Lumbar Cistern 

• enlargement of subarachnoid space around L2
• contains terminal filuma and caude equina
• site for lumbar puncture 

Denticulate ligament 

• one each side of spinal chord
• attach to arachnoid ad dura mater
• teeth like apearance
• stability of spinal chord against motion within vertebral column

Efferent Pathway

• motor 
• ventral root

Afferent Pathway

• sensory 
• dorsal root 

Segmental Medullary Artery

• branch of cervical part of vertebral artery
• go through intervertebral foreamen 

Meningic Veins

• 3 along the anterior 
• 3 along the posterior
• 1 artery on each side

Internal Vertebral

Venous Plexus

• lie w/ in epidermal space
•  plexus is valveless
• important in metastisis

Brachial Plexus

 Spinal Nerves

• C5-C7
• T1
• sometimes can include C4 or T2

Musculocutaneous Nerve

• from lateral chord of brachial plexus
• inervates anterior compartment of the arm
• biceps brachii, chorocobrachialis, brachialis

Median Nerve

• from lateral and medial chords of brachial plexus
• inervates most anterior forearm muscles and the thenar hand muscles

Ulnar Nerve

• from medial chord
• 1 and a half of anterior forearm muscles and most muscles of the hand

Axillary Nerve

• from posterior chord
• innervates deltoid and teres minor

Radial Nerve

• posterior chord of brachial plexus
• innervates posterior compartments of arm and forearm(extensors)

Infraclavicular Segment of

Brachial Plexus

• chords and terminal nerves along with ther branchs

Dorsal Scalpular Nerve

• direct branch from C5
• inervates major and minor romboid muscles
• levator scalpular nerve?

Long Thoracic Nerve

• from C5-C6-C7 nerves
• innervates serratus anterior muscle
• runs through axilla

Supra Scalpular Nerve

• from upper trunk (C5-C6)
• innervaes infraspinatus and supraspinatus muscles

Medial Pectoral Nerve

• Medial Chord (C8-T1)
• innervates pectoralis minor and major
• runs along backside of major and then penetrates minor

Lateral Pectoral Nerve

• Lateral Trunk  (C5-C6-C7)
• Pectoralis Major

Thoracodorsal Nerve

• C6-C7-C8 (posterior Chord)
• innervates Latissimus Dorsi

Lower Subscalpular Nerve

• posterior chord (C6)
• teres major and subscaplularis

Upper Subscalpular Nerve

• Posterior chord (C5)
• subscalpularis muscle

Medial and Lateral Supracondylar

Ridges

• on distal end of humerus
• widening of humeral shaft above epicondyles of humerus

Erb-Duchenne Palsy

• damage to C5 and C6 spinal roots(upper plexus)
• effects axillary, suprascalplar and musculocutaneous nerve
• patients present with waiters tip
• adducted shoulder(deltoid,supra.)
• medially rotated (inf, teres minor
• pronated hand(biceps)
• loss of sensation along lateral part of upper limb
• increase in angle btw back and shoulder
• excessive stretching of neck during birth

Klumpke Paralysis

• injury to C8 and T1
• all intrinsic muscles of hand inv by C8 and T1
• interossi, hypothaner and lumbricals
• presents as claw hand from ulnar nerve damage
• loss of sensation to medial forarm and digits 4and5
• when limb is sudenly pulled upwar
• rarer then superior plexus injury

Medial epicondyle

• distal end of humerus
• provides attachment for flexors of forearm
• ulnar nerve passes around

Lateral Epicondyle

• distal end of humerus
• provides attachment for extensors of forearm

Trochlea

• distal end of humerus
• spool shaped part of humeral articular surface
• contacts trochlear notch of ulna
• has coronoid process and radial notch and trochlear notch

Capitulum

• rounded articular surface of humerus that articulates w/ radial head

Radial Tuberosity

• distal to neck (radius)
• distal attachment for biceps brachaii

Colles Fracture

• most common distal radius fracture
• distan end of radius displaced dorsally for a dinner fork appearance
• ulnar styloid experiences an avulsion fracture
• often occur in elderly

Radial Head Subluxation

• partial dislocation of proximal radial head
• strong ligaments dont attach to radius because it would restrict supination
• common in children under 5

Anterior Forearm Compartment

Muscles

• flexor carpi radialis
• palmaris longus
• flexor carpi ulnaris
• flexor digitorum superficialis
• flexor policis longus
• flexor digitorum profundus
• pronator quadrates
• pronator teres

Flexor Carpi Radialis

O: medial epicondyle 

I:radial side of wrist

A:flexes and abducts wrist

In: Median Nerve

Palmaris Longus

O: medial epicondyle

I:Palmar aponeurosis

A:Wrist flexor

In:Median Nerve

Flexor Carpi Ulnaris

O:Medial epicondyle

I: wrist on ulnar side

A:flexes and adducts wrist

In:ulnar nerve

Flexor Digitorum Superficialis

(Arm)

O: Medial epicondyle and radial shaft

I:middle phalanges

A:flexes wrist and fingers

In: median nerve

Flexor Policis

O:radial shaft

I:distal phalanx of thumb

A:flexes all joints it crosses

only muscle for distal thumb joint

In: median nerve

Flexor Digitorum Profundis

O:radial and ulanr shafts

I: four tendons go to distal phalanges

A:flexes all joints it crosses

only muscle for distal phalanges

In:Medial and Ulnar Nerve

Pronator Quadratus

Extensor Carpi Radialis

Longus and Brevis

O:Proximal radius

I: metacarpels

A: extends and abducts wrist

In:Radial Nerve

Extensor Carpi Ulnaris

O: lateral epicondyle

I:5th metacarpal

A:extends and adducts wrist

In:radial nerve

Extensor Digitorum

(Arm)

O: lateral epicondyle

I: into extensor expansion

A: extends fingers

In: radial nerve

Extensor Digiti Minimi 

(Arm)

O: lateral epicondyle

I:5th digit

A:extends the digit

In: radial nerve

Extensor Pollicus Longus and Brevis

O:ulnar shat

I: longus is distal phalanx and breves proximal phalanx of thumb

A:extension of thumb

In: radial nerve

Abductor policis

O: radial and ulnar shaft

I: most proximal pollicis

A:primary abductor

In: radial nerve

Axon Hillock

• part between body and axon
• where it is determined if neuron fires or not
• can be effected by hormones, neurotransmitters and secondary messenges 
• also acts as tight junction

Epineurium

• outer covering of a nerve that covers multiple neuron bundles
• nerve sheath 

Perineurium

• firboblast like cells w/ tight junctions
• this provides blood to nerve barrier
• covers collection of reticular fibers (collagen III)(endoneurium) that hold nerve fibers in place

Synaptic Terminal

• contain extensive neurotubles (microtubles)
• can be chemical or electrical synapses
• electrical dont use neurotransmitters, just gap junctions (faster)(bi-derectional)
• chemical has volume amplification
• also en passant synapse

En Passant Synapse

• adrenal medulla
• have neuron and synapse releases vesicles
• directly into blood stream to signal as endocrine 

Axodendritic Synapse

Axosomatic Synapse

Axo-axonal Synapse

• attatchment of axon to a dendrite (axoden)
• attachment directly to neuron body(axoso)
• attachment to another axon(axoaxon(
• axoaxonal are usually inhibitory in the message proliferation

White Ramus Communicans

• path for sympathetic preganglionic axons into ganglion
• only at T1-L3 levels
• sympathetic deals with fight, flight and fuck

Grey Ramus Communicans

• passage of postganglionic axons
• leave unmylinated (dirty)
• at all vertebral levels

Splanchic Nerve

• goes around and attaches to pre-ganglion out in front of spinal chord

Enteric NS

• completely autonomous
• same number of nerves as other nervous system
• controls gut motility
• chemoreceptors and stretch receptors
• mynteric plexus

Mynteric Plexus

• enteric nervous system
• controls mixing and parastalsis
• parastalsis is squeezing and relaxing

Some Lovers Try Positions

That They Cant Handle

• later to medial bottom row then top row
• scaphoid, lunate, triquetrium, Pisiform
• trapezium, trapezoid, capitate, hamate

Radiocarpal Wrist Joint

• condyloid synovial joint
• btw raidus and scaphoid, lunate, triquitreum
• flexion-extension, abduction-adduction and cricumduction

Thumb Carpometacarpal joint

• saddle joint unlike normal plane joints of other carpometacarpal joints
• highly mobile. allows for felxion-extension, abduction-adduction and circumduction

Flexor Retinaculumn 

• roof of carpal tunnel
• attachs to pissiform and hamate  on one side and trapezium and scaphoid on other
• median nerve and 9 tendons of flexor compartment run through

Carpal Tunnel Syndrome

• inflamation of tendons that pass through the carpal tunnel
• puts pressure on median nerve
• cutting of flexor retinaculumn can elivate pressure
• median nerve does sensory for 3 and 1/2 lateral digits and innervates 2 and 1/2 thenar muscles and 2 lumbricals

Thenar Group

• abductor pollicis brevis
• flexor pollicis brevis 
• opponens pollicis
• all except for deep head of flexor pollicis brevis innervated by median nerve

Hypothenar Group

• act on 5th digit
• inervated by ulnar nerve
• abductor digit minimi
• flexor digiti minimi brevis
• opponens digiti minimi

Adductor Pollicis 

• transverse and oblique head
• attaches to proximal phalanx of thumb 
• invervated by ulnar nerve
• most distal thumb muscle

Lumbricals

(Hand)

• four small worm like muscles on digit 2-5
• attach to extensor expansion on digits
• 1st two median nerve second two ulnar
• flex at metacarpophalangeal joint and extend at interphalangeal joint

Interossei

(Hand)

• four dorsal abduct (DAB) fingers 
• three palmar adduct (PAD) fingers
• metacarpals to proximal phalanx

Sensory Nerve suply of hand

red: ulnar blue:radial grey: median

[image]

         dorsal                                      palmar

Nerve Assesment Hand

Motor

• radial nerve: extend thumb to make thumbs up
• median nerve flex thumb and index to make ok sign
• unlar nerve: cross index and and ring to check interosi

Gluteus Maximus

O: Ilium, Sacrum, coccyx and sacrotuberous ligament

I: iliotibial tract and gluteal tubercle of femur

largest and heaviest muscle in body

A: extensor of thight (during runing and stair climbing, and lateral rotation

IN: inferior gluteal nerve (L5/S1-S2)

Gluteus Medius and Minimus

Piriformis

Obturator Internus

Superior and inferior Gemelli

IN: obturator int, sup gemellus ( nerve to obturator internus)(l5,s1)

inferior gemellus (nerve to quadratus femoris (*L5, S1)

known collectivly as triceps coxae

Quadratus Femoris

Tensor Fasciae Latae

Neurovasculature emerging

Superior to piriformis

• superior gluteal nerve and artery

Neurovasculature Emerging 

Inferior to piriformis

• inferior gluteal nerve and artery
• sciatic nerve (union of common fibial and tibial nerve)
• posterior cutaneous nerve of the thigh
• pudendal nerve, internala pudendal artery and vein 

Piriformis Syndrome

• overexertion or hypertrophy of piriformis can result in compression of sciactic nerve, causing pain in the buttock and posterior thigh and muscle weakness
• stretching and anti-infamatories used as conservative treatment, surgery recomended as last resort
• more come in 12% of people whose common fibular nerve pierces piriformis

Varicose Veins

• great and small saphenous veins
• lower limb veins have valves that are shaped like cups that catch blood stopping back flow
• varicose veins caused by valves becomeing lax allowing back flow and distal veins becoming engorged
• often seen in pregnancy when enlarged utures compressed common iliac veins

Deep vein thrombosis

• formation of blood clot(thrombosis) in deep vein, often lower leg
• caused by venous stagnation, often during elongated period of rest
• can travel to heart and block pulmonary trunk

Cloquet's Node

• most superior of deep inguinal nodes or most inferior of external iliac nodes
• sampled to test for metastisis traveling proximal from lower leg
• lymphatic system

Hip bone Avulsion Fractures

• muscle tendon pulls away from attachment, removing bone in process
• most common at illiac spines and ischial tuberosity
• most common in teenage athletes due to loads upon secondary ossification sites before growth plates seal

Hip Joint

• head of femur into acetabulum
• illiofemoral ligament(strongest in body)
• pubofemoral and ischialfemoral ligaments
• spiral course of ligaments allow for tightening and relaxation in every direction
• ligamentum teres in femur(round ligament)

Pectineus

O: Superior Pubic ramus

I: post femoral shaft below lesser trochanter

A: adducts, flexes and medially rotates thigh

In: femoral nerve and possibly the obturator nerve

Iliopsoas

formed by union of psoas major and iliacus musc

O: psoas major: centra and ventral transverse process of T12-L5 vert

Iliacus: iliac fossa on anterior ilium

I: combined tendon onto lesser trochanter of femur

A: primary and strongest thigh flexor

In:psoas major-lumbar ventral rami

illiacus: femoral nerve

Sartorius

Quadriceps femoris

Articularis Genu

• small derivative of V. intermedius of the quadricep muscle
• inserts on the knee joint synovium
• may be involved in stabilizing patella during knee extension

Adductor Longus

Adductor Brevis

Gracilis

Adductor Magnus

Obturator Externus

O: external surface of obturator membrane

I: trochanteric fossa of femur 

A:laterally rotates thigh and stabilizes femoral head

IN: posterior division of obturator nerve

Semitendinosus

O: ischial tuberosity

I: pes anserinus

A: extends thigh and flexes leg

IN: Tibial division of sciatic n(L5-S2)

half its length made up of long, cord like tendon

Semimembranosus

O: ischial tuberosity

I: posterior medial condyle of tibia

A: extends thigh and flexes leg

IN: tibial division of sciatic n (L5-S2)

named after broad flat tendon of proximal attachment

Biceps femoris

Tibialis Anterior

Extensor Digitorum Longus

Extensor Hallucis Longus

Fibularis Longus

Fibularis Brevis

Gastrocnemius

Soleus

Plantaris

Popliteus

Flexor Hallucis Longus

Flexor Digitorum Longus

Tibialis posterior

Abductor Hallucis

Flexor Digitorum Brevis

(Leg)

Abductor Digiti Minimi

(Leg)

Quadratus plantae

Lumbrical muscles 

(Leg)

Flexor hallucis BRevis

Adductor hallucis

Flexor digiti minimi brevis

(Leg)

Toe DAB and PAD

• three plantar interosseous and four dorsal interosseus 
• 2nd digit forms axis (has 2 dorsal on it)

Extensor digitorum and Hallucis Brevis

Femur

• longest and heaviest bone in the body(25% of body weight)
• articulates w/ tibia via femoral condyles

Normal Adult human Neck-Shaft Angle

(NSA)

• for femur -124-135degrees
• less active urban populations tned to have higher angle and the older you get the lower the angle
• coxa vara-NSA too small
• Coxa velga-NSA to large

Contents of Femoral Triangle

• Nerve (Femoral nerve)
• Artery (femoral artery)
• Vein (femoral vien)
• Lymphatics

External Ligaments of Knee

• tibial collateral ligament- weaker of two, medial femoral epicondyle to tibial medial shaft, midpoint fibers insert into medial meniscus
• fibular lateral ligament-stronger of two on lateral side

Internal Knee Ligaments

• ACL runs from anterior intercondlye(tibia) to lateral femoral condyl 
• limits hyperextension and weaker of two
• PCL anterior intercondyle fossa(tibia) to emdial femoral condyle and limits hyperextension

Lateral Ankle Ligament

• anterior talofibular 
• posterior talofiular
• calcaneofibular

Medial Ligament of Ankle

• anterior and posterior tibiotalar
• tibionavicualr and tibiocalcaneal