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Human Anatomy & Human Anatomy & PhysiologyPhysiology

Lower ExtremityLower ExtremityUpper ExtremityUpper ExtremityHead, Neck, Face, & SkullHead, Neck, Face, & SkullAbdomen, Thorax, and Spine Abdomen, Thorax, and Spine

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Types of BonesTypes of Bones

BoneBone-- specialized type of dense connective specialized type of dense connective tissue consisting of bone cells that are fixed tissue consisting of bone cells that are fixed in a matrix. The outer surface is compact in a matrix. The outer surface is compact bone and the inner surface is more porous bone and the inner surface is more porous tissue, tissue, calcellouscalcellous bonebone–– Bone Bone fxnfxn-- body support , organ protection, body support , organ protection,

mvmtmvmt, calcium reservation, and formation of , calcium reservation, and formation of blood cells (blood cells (hematopoesishematopoesis))

FlatFlatIrregularIrregularLong/shortLong/short

Gross StructuresGross Structures

DiaphysisDiaphysis-- the main shaft of the bonethe main shaft of the boneEpihysisEpihysis-- is located at the end of a long is located at the end of a long bone. Bulbous in shape, providing space for bone. Bulbous in shape, providing space for muscle attachment. Composed of muscle attachment. Composed of cancellouscancellousbone giving it a spongy appearancebone giving it a spongy appearancePeriosteumPeriosteum-- a dense, white fibrous a dense, white fibrous membrane, covers the long bones except at membrane, covers the long bones except at the joint surface the joint surface

Tissue PropertiesTissue Properties

Yield Point or Elastic LimitYield Point or Elastic Limit–– When loads exceed the yield When loads exceed the yield piontpiont, the , the

response of the structure is plastic, in response of the structure is plastic, in which when the load is removed, some which when the load is removed, some amount of the deformation will remain. amount of the deformation will remain. LoaadsLoaads exceeding the ultimate failure exceeding the ultimate failure point results in fracture (point results in fracture (fxfx).).

Types of ForcesTypes of Forces

Axial ForceAxial Force-- force acted along the axis of a force acted along the axis of a structurestructureCompression ForceCompression Force-- axial loading that produces a axial loading that produces a squeezing or crushing effectsqueezing or crushing effectTensile ForceTensile Force-- tension or axial loading in the tension or axial loading in the direction opposite that of compressiondirection opposite that of compressionShear ForceShear Force-- Acts parallel or tangent to a plane Acts parallel or tangent to a plane passing thru the objectpassing thru the objectMechanical StressMechanical Stress-- A force divided by the surface A force divided by the surface area over which the force is appliedarea over which the force is applied–– If the force is concentrated over a small area, the If the force is concentrated over a small area, the

mechanical force is relatively high. Itmechanical force is relatively high. It’’s a high magnitude s a high magnitude of stress, rather than a high magnitude of force, that of stress, rather than a high magnitude of force, that tends to result in injury to biological tissuestends to result in injury to biological tissues

StrainStrain-- the amount of deformation an the amount of deformation an object undergoes in response to object undergoes in response to applied force (muscles)applied force (muscles)–– Injury to biological tissues can result from Injury to biological tissues can result from

a single traumatic force of relatively large a single traumatic force of relatively large magnitude, or from repeated force of a magnitude, or from repeated force of a smaller magnitude. Acute trauma is smaller magnitude. Acute trauma is termed termed ““macrotraumamacrotrauma..”” Chronic injury is Chronic injury is termed termed ““microtraumamicrotrauma..””

Grades of StrainsGrades of Strains

Grade IGrade I–– Local pain, increased tension of the muscle, Local pain, increased tension of the muscle,

minor loss of muscle strength, mild swelling, minor loss of muscle strength, mild swelling, echymosisechymosis, localized tenderness, localized tenderness

Grade IIGrade II–– Same as above but moderate Same as above but moderate s/ss/s and impaired and impaired

muscle muscle fxnfxn

Grade IIIGrade III–– Has Has s/ss/s that are severe, loss of muscle that are severe, loss of muscle fxnfxn, and , and

palpated defect in musclepalpated defect in muscle

Soft Tissue TraumaSoft Tissue Trauma–– Contractile tissue are those structures that are Contractile tissue are those structures that are

part of the muscle, its tendon, or its boney part of the muscle, its tendon, or its boney insertioninsertion

–– StrainStrain-- a stretch, rip or tear in the muscle or a stretch, rip or tear in the muscle or adjacent tissue such as the fascia or muscle adjacent tissue such as the fascia or muscle tendontendon

–– SprainSprain-- a stretching or tearing of the fibrous a stretching or tearing of the fibrous connective tissue known as a ligamentconnective tissue known as a ligament

–– HematomaHematoma-- a blood tumor, formed by the a blood tumor, formed by the localization of blood into a clot, which becomes localization of blood into a clot, which becomes encapsulated by connective tissue membranesencapsulated by connective tissue membranes

Skin InjuriesSkin Injuries

A break in the continuity of the soft A break in the continuity of the soft part of the body structures caused by part of the body structures caused by trauma to the tissue.trauma to the tissue.Composed of two layers: Epidermis Composed of two layers: Epidermis and dermisand dermis

Wound ClassificationsWound Classifications

Friction BlisterFriction Blister-- Cont rubbing over the surface of the skin Cont rubbing over the surface of the skin causes a collection of fluid below or within the epidermal layercauses a collection of fluid below or within the epidermal layercalled a blister.called a blister.AbrasionAbrasion-- skin is scraped against a rough surface. The skin is scraped against a rough surface. The epidermis and dermis are worn away, exposing numerous epidermis and dermis are worn away, exposing numerous blood capillariesblood capillariesBruiseBruise-- when a blow compressed or crushes the skin surface when a blow compressed or crushes the skin surface and produces bleeding under the skinand produces bleeding under the skinLacerationLaceration-- a wound in which the skin has been irregularly a wound in which the skin has been irregularly torntornSkin avulsionSkin avulsion-- skin that is torn by the same mechanism as a skin that is torn by the same mechanism as a laceration to the extent that the tissue is ripped off from its laceration to the extent that the tissue is ripped off from its sourcesourceIncisionIncision-- a wound in which the skin has been sharply cuta wound in which the skin has been sharply cutPuncture WoundPuncture Wound-- penetration of the skin by a sharp objectpenetration of the skin by a sharp object

Types of MusclesTypes of Muscles

SmoothSmoothHollow organsHollow organs

StriatedStriatedSkeletal MusclesSkeletal Muscles

CardiacCardiacHeartHeart

Skeletal Muscle Skeletal Muscle PropertiesProperties

Within the cell is a Within the cell is a semifluidsemifluid substance called substance called sarcoplasmsarcoplasmMyofibrils are surrounded by the Myofibrils are surrounded by the endomysiumendomysium, fiber , fiber bundles are surrounded by bundles are surrounded by perimysiumperimysium, and the , and the entire muscle is covered by entire muscle is covered by epimysiumepimysiumThe layers are combined within a fibrous tendonThe layers are combined within a fibrous tendonArteries, veins, lymph vessels, and bundles of nerve Arteries, veins, lymph vessels, and bundles of nerve fibers spread into the fibers spread into the perimysiumperimysium..A complex network of capillaries goes through the A complex network of capillaries goes through the endomysiumendomysium coming into direct contact with muscle coming into direct contact with muscle fibers fibers

Types of Muscle FibersTypes of Muscle Fibers

Slow twitchSlow twitch-- dark fibersdark fibers--RedRed–– Usually resistant to fatigueUsually resistant to fatigue--endurance endurance

fibersfibers

Fast TwitchFast Twitch--light fiberslight fibers--WhiteWhite–– Fatigue quicklyFatigue quickly--anaerobic anaerobic activitesactivites

Muscle ClassificationMuscle Classification

FusiformFusiform–– BicepsBiceps

UnipenateUnipenate–– AbdominalsAbdominals

MultipenateMultipenate–– DeltoidDeltoid

Muscle Cramps & SpasmMuscle Cramps & Spasm

A Cramp is a painful involuntary A Cramp is a painful involuntary contraction of a skeletal muscle or contraction of a skeletal muscle or muscle groupmuscle group–– Cramps have been attributed to the lack Cramps have been attributed to the lack

of water or other electrolytes in relation of water or other electrolytes in relation to muscle fatigueto muscle fatigue

A spasm is a reflex A spasm is a reflex rxnrxn caused by caused by trauma of the MS systemtrauma of the MS system

Overexertion Muscle Overexertion Muscle ProblemsProblems

AcuteAcute--Onset Muscle SorenessOnset Muscle Soreness-- occurs occurs immediately following the physical activity immediately following the physical activity which accompanies fatiguewhich accompanies fatigueDelayedDelayed--Onset Muscle Soreness (DOMS)Onset Muscle Soreness (DOMS)--onset of muscle soreness that appears 24 onset of muscle soreness that appears 24 hrs after activityhrs after activity–– Most intense at 48hrs and gradually subsidesMost intense at 48hrs and gradually subsides–– Leads to increased muscle tension, swelling, Leads to increased muscle tension, swelling,

stiffness, and resistance to stretchingstiffness, and resistance to stretching–– Soreness can be prevented if stretching occurs Soreness can be prevented if stretching occurs

prepre--post activitiespost activities

Muscle stiffnessMuscle stiffness–– Does not produce painDoes not produce pain–– Occurs when a group of muscles have Occurs when a group of muscles have

been worked hard for a long period of been worked hard for a long period of timetime

–– Fluids collect in the muscle during and Fluids collect in the muscle during and after activity and are absorbed at a slow after activity and are absorbed at a slow raterate

Muscle GuardingMuscle Guarding–– Following injury, muscles around an injury act to Following injury, muscles around an injury act to

splint the injured area, thus minimizing painsplint the injured area, thus minimizing pain

Muscle CrampsMuscle Cramps–– Problem related to hard conditioningProblem related to hard conditioning–– Most common cramp in tonic, continuous muscle Most common cramp in tonic, continuous muscle

contractioncontraction–– Caused by the bodies depletion of essential Caused by the bodies depletion of essential

electrolyteselectrolytes

Nerve SupplyNerve Supply

Supplied to ligaments, outer aspect of Supplied to ligaments, outer aspect of synovialsynovial membrane, muscles, and membrane, muscles, and jointsjointsMechanoreceptors are Mechanoreceptors are mylinatedmylinated, , whereas nonwhereas non--mylinatedmylinated fibers are pain fibers are pain receptorsreceptors

Types of JointsTypes of Joints

BallBall--nn--SocketSocket-- allows all possible allows all possible mvmtsmvmts(hip)(hip)HingeHinge-- allows only flex and ext (elbow)allows only flex and ext (elbow)PivotPivot-- only allows rotation around an axisonly allows rotation around an axisEllipsoidalEllipsoidal-- convex head and a concave convex head and a concave socket (wrist)socket (wrist)SaddleSaddle-- allows small amounts of gliding allows small amounts of gliding back and forth or sideways (carpals or back and forth or sideways (carpals or tarsalstarsals))

The FootThe Foot

BonesBonesMusclesMusclesLigamentsLigamentsBlood & Nerve Blood & Nerve SupplySupplyFoot BiomechanicsFoot BiomechanicsCommon InjuriesCommon Injuries

The FootThe Foot

The FootThe Foot

26 bones (14 phalanges, 5 26 bones (14 phalanges, 5 metatarsals, 7 metatarsals, 7 tarsalstarsalsTarsalsTarsals: talus, : talus, calcaneuscalcaneus, , navicularnavicular, , cuboidcuboid, 1, 1stst, 2, 2ndnd, & 3, & 3rdrd cuneiformscuneiformsDesigned for strength, flexibility, and Designed for strength, flexibility, and coordinated coordinated mvmtmvmt

Bones of the FootBones of the Foot

Phalanges Phalanges AkaAka ““ToesToes””

Designed to give a Designed to give a wider base of wider base of supportsupport11stst ““toetoe”” halluxhallux: 2 : 2 phalangesphalanges22ndnd thru 5thru 5thth: 3 : 3 phalangesphalanges2 2 SesamoidSesamoid bonesbones–– assist with WBassist with WB–– increase increase mechmech

advantage for flexor advantage for flexor tendonstendons

MetatarsalsMetatarsals

5 bones b/w 5 bones b/w tarsalstarsals and phalangesand phalangesLittle Little mvmtmvmt, ligaments provide , ligaments provide elasticity to foot during WBelasticity to foot during WB QWAQWA11stst metatarsal is largest and strongest metatarsal is largest and strongest and and fxnfxn’’ss as the main body support as the main body support during ambulationduring ambulation

TarsalsTarsals

7 bones: important for support & 7 bones: important for support & locomotionlocomotionCalcaneusCalcaneus-- largestlargestTalusTalus--irregular shaped, most superiorirregular shaped, most superiorNavicularNavicularCuboidCuboid-- lateral aspect of foot, 4lateral aspect of foot, 4thth & 5& 5thth

MetatarsalsMetatarsalsCuneiforms (3)Cuneiforms (3)

ArchesArches

Assist foot in supporting BWAssist foot in supporting BWAbsorbs shockAbsorbs shockGives space for ligaments, blood Gives space for ligaments, blood vessels, and nerves to run on plantar vessels, and nerves to run on plantar surface of the footsurface of the foot

ArchesArches

4 Arches4 Arches

Medial LongitudinalMedial Longitudinal–– main supporting ligament is the plantar main supporting ligament is the plantar

calcanealcalcaneal (spring ligament)(spring ligament)

Stretches and rebounds during AMBStretches and rebounds during AMB

4 Arches4 Arches

Lateral LongitudinalLateral Longitudinal–– Less flexible than the medialLess flexible than the medial–– Runs along the 5Runs along the 5thth metatarsalmetatarsal

4 Arches4 Arches

Anterior Metatarsal ArchAnterior Metatarsal Arch–– Made up of the heads of all 5 metatarsalsMade up of the heads of all 5 metatarsals

4 Arches4 Arches

Transverse ArchTransverse Arch–– Made up of tarsal bonesMade up of tarsal bones–– Gives the shape to the footGives the shape to the foot

DIP, PIP, & IP JointsDIP, PIP, & IP Joints

DIP (distal DIP (distal interphalangealinterphalangeal joint)joint)Found at the distal extremities of the Found at the distal extremities of the proximal and middle phalangesproximal and middle phalangesAllows for Flex/ExtAllows for Flex/ExtCollateral ligaments on medial/lateral Collateral ligaments on medial/lateral

MTP JointMTP Joint

MetatarsalphalangealMetatarsalphalangeal JointJointArticulation b/w metatarsals & Articulation b/w metatarsals & phalangesphalangesAllows for flex/ext, Allows for flex/ext, abdabd/add/addCondyloidCondyloid jointjoint

MusclesMuscles

GasrocnemiusGasrocnemiusSoleusSoleusAnterior Anterior tibialistibialisPeronealPeroneal MusclesMusclesExtensor MusclesExtensor MusclesFlexor MusclesFlexor Muscles

MusclesMuscles

GastrocneimusGastrocneimus–– Inserts on posterior Inserts on posterior

aspect of tibiaaspect of tibia–– Achilles tendon Achilles tendon

attaches to attaches to calcaneuscalcaneus

–– Provides for PF of Provides for PF of foot (standing on foot (standing on toes)toes)

MusclesMuscles

SoleusSoleus–– Runs underneath Runs underneath gastrocsgastrocs–– Aids in PF of footAids in PF of foot

MusclesMuscles

Anterior Anterior TibialisTibialis–– Major DF of foot and Major DF of foot and

great toegreat toe–– Paralysis of this muscle Paralysis of this muscle

results in results in ““drop footdrop foot””–– Can be involved in Ant Can be involved in Ant

Compartment Syndrome Compartment Syndrome which affects the lower which affects the lower legs blood and nerve legs blood and nerve supplysupply

–– Runs the length of the Runs the length of the tibia and also is involved tibia and also is involved in in ““shin splintsshin splints””

MusclesMuscles

PeronealsPeroneals–– Tendons most commonly Tendons most commonly

injured in an inversion spraininjured in an inversion sprain–– Run along the lateral aspect of Run along the lateral aspect of

the lower leg (fibula) around the lower leg (fibula) around the distal portion of the lateral the distal portion of the lateral maleollusmaleollus and insert on the and insert on the lateral aspect of the foot (5lateral aspect of the foot (5thth

MT)MT)–– Tom, Dick, and HarryTom, Dick, and Harry–– Extensive pressure on the Extensive pressure on the

head of the fibula causes head of the fibula causes peronealperoneal palsypalsy……numbness on numbness on the outside of the lower legthe outside of the lower leg

–– Major muscle involved in Major muscle involved in evertingeverting the footthe foot

MusclesMuscles

Extensor MusclesExtensor Muscles–– Run along the dorsal aspect of the foot Run along the dorsal aspect of the foot

and extend the toesand extend the toes–– They insert at the MT, DP and PPThey insert at the MT, DP and PP

MusclesMuscles

Flexor MusclesFlexor Muscles–– Run along the plantar surface of the foot Run along the plantar surface of the foot

and are associated with flexion of the and are associated with flexion of the toestoes

–– Insert on the plantar surface of MT, DP, Insert on the plantar surface of MT, DP, and PPand PP

MusclesMuscles

LigamentsLigaments

Spring LigamentSpring Ligament–– Medial longitudinal archMedial longitudinal arch–– Keeps the shape of the footKeeps the shape of the foot–– Depresses when Depresses when ambamb and reboundsand rebounds–– Maybe outstretched with people who Maybe outstretched with people who

have have ““flat feetflat feet””

LigamentsLigaments

ATF (anterior ATF (anterior talofibulartalofibular ligament)ligament)–– Most commonly injured in an inversion sprainMost commonly injured in an inversion sprain–– AnteriorlyAnteriorly connects the talus and fibula connects the talus and fibula

PTF (posterior PTF (posterior talofibulartalofibular ligament)ligament)–– Another commonly injured ligamentAnother commonly injured ligament–– PosteriorlyPosteriorly connects talus and fibulaconnects talus and fibula

CF (CF (calcaneofibularcalcaneofibular ligament)ligament)–– Commonly injured along with the ATFCommonly injured along with the ATF–– Connects the Connects the calcaneuscalcaneus and the talusand the talus

LigamentsLigaments

Deltoid LigamentDeltoid Ligament–– Fan shapedFan shaped–– Very strong and hard to injureVery strong and hard to injure–– Usually injured with an Usually injured with an eversioneversion sprainsprain–– Runs along the entire medial aspect of Runs along the entire medial aspect of

the medial the medial maleollusmaleollus

Blood & Nerve SupplyBlood & Nerve Supply

Anterior & posterior Anterior & posterior tibialtibial arteriesarteriesTibialTibial NerveNerve--innervates m. of the innervates m. of the back of the leg and back of the leg and plantar aspect of footplantar aspect of footCommon Common PeronealPeronealNerveNerve-- supplies front of supplies front of leg and footleg and foot

Foot BiomechanicsFoot Biomechanics

Phases of WalkingPhases of Walking–– 11stst phase: support phasephase: support phase–– Heel strike to toe offHeel strike to toe off–– 22ndnd phase: swing/recovery phase: swing/recovery –– Immediately after toe off and in position Immediately after toe off and in position

for heel strikefor heel strike


Forefoot Forefoot varusvarus–– Excessive Excessive pronationpronation-- Excessive Excessive pronationpronation during support phase during support phase

can lead to stress can lead to stress fxfx, , plantarfacitisplantarfacitis, , Achilles tendonitisAchilles tendonitis


Forefoot Forefoot valgusvalgus–– Excessive Excessive supinationsupination–– Excessive Excessive supinationsupination at heel strike can at heel strike can

lead to inversion ankle sprains, ITB lead to inversion ankle sprains, ITB syndrome, syndrome, peronealperoneal tendonitistendonitis

Common InjuriesCommon Injuries

Heel BruiseHeel Bruise–– Extremely painfulExtremely painful–– Etiology: sudden stop/go change from Etiology: sudden stop/go change from

horz/verthorz/vert–– S/S: severe pain, unable to WB, warm & S/S: severe pain, unable to WB, warm &

redness redness –– TX: NWB 24hrs, RICE, NSAIDS, DoughnutTX: NWB 24hrs, RICE, NSAIDS, Doughnut

Image 1 - In the painful heel, the fat pad is compressed and pushed up the side of the foot leaving far less protection for the heel bone.


Bruised Instep (top of foot)Bruised Instep (top of foot)–– Etiology: being stepped on or direct Etiology: being stepped on or direct

contactcontact–– S/S: wearing shoes is painfulS/S: wearing shoes is painful–– TX: ICE, pad the affected areaTX: ICE, pad the affected area


Metatarsal Arch Strain (Metatarsal Arch Strain (PesPes CavusCavus & & PesPes PlanusPlanus))–– Etiology: high arch or flat footEtiology: high arch or flat foot–– S/S: pain or cramping in metatarsal S/S: pain or cramping in metatarsal

regionregion–– TxTx: tape or pad to elevate fallen arch: tape or pad to elevate fallen arch


Turf ToeTurf Toe–– Etiology: results from Etiology: results from

artificial playing surfaces artificial playing surfaces and flexible types of and flexible types of footwearfootwear

S/S: S/S: hyperexthyperext of great of great toe causing toe causing jtjt capsule capsule to be torn from the MT to be torn from the MT headheadTxTx: : –– r/or/o fxfx–– StiffStiff--soled shoessoled shoes–– Tape Tape


Stress Stress fxfx’’ss–– Can occur anywhere Can occur anywhere –– Overuse injury or Overuse injury or

repetitive type repetitive type injuryinjury

–– Starts as a Starts as a weakening of an weakening of an area and can area and can progress into a full progress into a full blown blown fxfx

–– TxTx: Rest, Ice, rehab: Rest, Ice, rehab


Inversion SprainInversion Sprain--““rolling an rolling an ankleankle””–– Etiology: landing on Etiology: landing on

someonesomeone’’s foot, s foot, excessive excessive supinationsupinationand IR of footand IR of foot

–– S/S: severe to mod S/S: severe to mod effusion, effusion, echymosisechymosis, , point tender over ATF, point tender over ATF, CF, & PTF ligamentsCF, & PTF ligaments

–– TX: TX: r/or/o fxfx, , cryokineticscryokinetics, , gentle stretching, gentle stretching, AROM, strengtheningAROM, strengthening

The KneeThe Knee

The KneeThe Knee

BonesBonesMenisciMenisciMusclesMusclesLigamentsLigamentsBlood & Nerve SupplyBlood & Nerve SupplyCommon InjuriesCommon Injuries

The KneeThe Knee

Bones:Bones:–– FemurFemur–– TibiaTibia–– FibulaFibula–– PatellaPatella

The KneeThe Knee

FemurFemur–– Largest & strongest bone in the bodyLargest & strongest bone in the body–– Two Two condylescondyles that articulate with the tibiathat articulate with the tibia

The KneeThe Knee

TibiaTibia–– Medial bone second largest in lower legMedial bone second largest in lower leg–– Two plateaus articulate with femoral Two plateaus articulate with femoral condylescondyles

(concavities where the meniscus sit) (concavities where the meniscus sit) –– Most distal end is known as the medial Most distal end is known as the medial malleolusmalleolus

FibulaFibula–– Smaller bone that runs down the lateral aspect Smaller bone that runs down the lateral aspect

of the lower legof the lower leg–– Most distal portion is known as the lateral Most distal portion is known as the lateral

malleolusmalleolus

The KneeThe Knee

PatellaPatella–– Largest Largest sesamoidsesamoid

bone in the bodybone in the body–– Found in the quad Found in the quad

tendontendon–– Tracking of the Tracking of the

patella depends on patella depends on the pull of the the pull of the quads & patellar quads & patellar tendontendon

The KneeThe Knee

MenisciMenisci–– 2 oval fibro2 oval fibro--cartilages that deepen the cartilages that deepen the

articulation b/w the femur and the tibiaarticulation b/w the femur and the tibia–– Acts as a cushion and shock absorber for the Acts as a cushion and shock absorber for the

kneeknee

Menisci Blood SupplyMenisci Blood Supply–– Each menisci divided into 3 Each menisci divided into 3 circumfrentialcircumfrential zones:zones:–– RedRed--red zone=outer 1/3 good red zone=outer 1/3 good blbl. Supply. Supply–– RedRed--white zone=middle 1/3 minimal white zone=middle 1/3 minimal blbl supplysupply–– WhiteWhite--white zone=inner 1/3 is white zone=inner 1/3 is avascularavascular

The KneeThe Knee

Medial MeniscusMedial Meniscus–– C shapedC shaped–– Attached firmly to the medial Attached firmly to the medial articulararticular

facet of the tibia by the coronary facet of the tibia by the coronary ligamentligament

–– PosteriorlyPosteriorly by the fibers of the by the fibers of the semimembranosoussemimembranosous

The KneeThe Knee

Lateral MeniscusLateral Meniscus–– O shaped O shaped –– Attaches loosely to the lateral Attaches loosely to the lateral articulararticular

capsule and capsule and poplitealpopliteal tendontendon–– Transverse ligament joins the anterior Transverse ligament joins the anterior

portions of the medial and lateral menisci portions of the medial and lateral menisci

MusclesMuscles

FlexorsFlexorsExtensorsExtensorsDynamic StabilizersDynamic Stabilizers

Muscles (flexors)Muscles (flexors)

Biceps Biceps FemorisFemoris


SemimembranosousSemimembranosous


SemitendonosousSemitendonosous


GracilisGracilis–– Abducts, flexes, andAbducts, flexes, and

medially rotates the hipmedially rotates the hip


SartoriusSartorius–– Allows you to sit cross leggedAllows you to sit cross legged–– Known as the Known as the ““tailor sitstailor sits”” musclemuscle–– ASIS to the ASIS to the tibialtibial headhead

Muscles (extensors)Muscles (extensors)

QuadricepsQuadriceps–– RectusRectus FemorisFemoris–– VMOVMO–– VastisVastis LateralisLateralis–– VastusVastus IntermediusIntermedius

Muscles (dynamic Muscles (dynamic stabilizer)stabilizer)

IT Band (IT Band (iliotibialiliotibial band)band)

LigamentsLigaments

Stabilizing ligaments of the kneeStabilizing ligaments of the kneeACL (anterior ACL (anterior cruciatecruciate ligament)ligament)–– Attaches below and in front of the tibia, Attaches below and in front of the tibia,

runs runs posteriorlyposteriorly to attach laterally to the to attach laterally to the inner surface of the lateral inner surface of the lateral condylecondyle of the of the femurfemur

–– Comprised of 3 twisted bandsComprised of 3 twisted bands–– Prevents anterior translationPrevents anterior translation–– Stabilizes the tibia against excessive IRStabilizes the tibia against excessive IR

LigamentsLigaments

PCL (posterior PCL (posterior cruciatecruciate ligament)ligament)–– Stronger of the twoStronger of the two–– Primary stabilizer of the kneePrimary stabilizer of the knee–– Crosses back of tibia Crosses back of tibia anteriorlyanteriorly to attach to attach

anterior portion of the lateral surface of anterior portion of the lateral surface of the medial the medial condylecondyle of femurof femur

–– Resists IR of tibia Resists IR of tibia –– Helps prevent hyperextension of knee Helps prevent hyperextension of knee

and femur, sliding forward during WBand femur, sliding forward during WB

LigamentsLigaments

MCL (medial collateral ligament)MCL (medial collateral ligament)–– Attaches above the Attaches above the jtjt line on medial line on medial

epicondyleepicondyle of the femur and below on the of the femur and below on the tibia just below the tibia just below the pespes anserineanserine

–– Prevents knee from Prevents knee from valgusvalgus and ER forcesand ER forces–– Approx the width of three fingersApprox the width of three fingers

LigamentsLigaments

LCL (lateral collateral ligament)LCL (lateral collateral ligament)–– Round fibrous cord shaped like a pencilRound fibrous cord shaped like a pencil–– Attaches to lateral Attaches to lateral epicondyleepicondyle of the of the

femur and to the head of the fibulafemur and to the head of the fibula–– Taut during knee ext, relaxed during knee Taut during knee ext, relaxed during knee

flexflex

BursalBursal SacsSacs

BursaBursa–– Reduces friction b/w Reduces friction b/w

anatomical surfacesanatomical surfaces–– SuprapatellarSuprapatellar, ,

prepatellarprepatellar, , infrapatellarinfrapatellar, , pretibialpretibial, and , and gastrocgastroc


Blood supplyBlood supply–– Main supply is Main supply is PoplitealPopliteal artery which stems from artery which stems from

the Femoral arterythe Femoral artery

Nerve SupplyNerve Supply–– TibialTibial nerve supplies hamstrings and nerve supplies hamstrings and gastrocsgastrocs–– Common Common peronealperoneal innervates short head of innervates short head of

biceps biceps femorisfemoris–– Femoral nerve innervates the quads and Femoral nerve innervates the quads and

sartoriussartorius

QQ--AngleAngle

Measured from ASIS to midMeasured from ASIS to mid--patella patella and from and from TibialTibial Tubercle (TT) thru mid Tubercle (TT) thru mid patellapatellaNorms:Norms:–– Men=10 degreesMen=10 degrees–– Women=20 degreesWomen=20 degrees–– 20< leads to pathological conditions 20< leads to pathological conditions

associated with improper patellar trackingassociated with improper patellar tracking


MCL sprainMCL sprain–– Etiology: Etiology: valgusvalgus stress from a direct blow stress from a direct blow

to the lateral side of the kneeto the lateral side of the knee–– Grades I, II, or IIIGrades I, II, or III–– S/S ranges from slight pain and instability S/S ranges from slight pain and instability

to complete tear and loss of to complete tear and loss of fxnfxn, swelling, , swelling, & altered gait& altered gait

–– TxTx: RICE, : RICE, r/or/o ACL, crutches, isometric ACL, crutches, isometric exercises, immobilizer if necessary exercises, immobilizer if necessary

Grade IGrade I–– Outstretching of fibersOutstretching of fibers–– Little or no swellingLittle or no swelling–– Some stiffness and pt tenderSome stiffness and pt tender–– Full AROM &PROMFull AROM &PROM

Grade IIGrade II–– Partial tearing of fibers and tear of the capsular Partial tearing of fibers and tear of the capsular

ligamentligament–– Minimal laxity with slight swelling Minimal laxity with slight swelling –– ModMod--severe severe jtjt stiffness w/ inability to actively ext kneestiffness w/ inability to actively ext knee

Grade IIIGrade III–– Complete tear of the fibersComplete tear of the fibers–– Complete loss of stabilityComplete loss of stability–– Moderate swellingModerate swelling–– Severe pain followed by dull acheSevere pain followed by dull ache–– ++valgusvalgus test w/ full test w/ full jtjt openingopening


LCL SprainLCL Sprain–– Etiology: Etiology: varusvarus stress, less common than stress, less common than

MCLMCL–– S/S: pain and tenderness over LCL, S/S: pain and tenderness over LCL,

swelling, effusion, some swelling, effusion, some jtjt laxity w/ laxity w/ varusvarusstress teststress test

–– TxTx: similar to MCL: similar to MCL


ACLACL–– Etiology: rotary Etiology: rotary

mechanism, tibia ER and mechanism, tibia ER and knee is in knee is in valgusvalguspositionposition

–– S/S: S/S: ““poppop”” usually felt usually felt or they may state that or they may state that their knee feels like it is their knee feels like it is coming apart, rapid coming apart, rapid swelling, can be swelling, can be extremely painful, loss extremely painful, loss of ROM, cannot full ext of ROM, cannot full ext kneeknee

–– TX: RICE immediately, TX: RICE immediately, SxSx


PCLPCL–– Etiology: knee flexed 90 Etiology: knee flexed 90

degrees, falling w/ full wt degrees, falling w/ full wt on anterior aspect of bent on anterior aspect of bent knee, foot in PF or hard knee, foot in PF or hard blow to the front of bent blow to the front of bent knee (MVA)knee (MVA)

–– S/S: S/S: ““poppop”” felt, tenderness felt, tenderness and little swelling in and little swelling in poplitealpopliteal fossafossa, laxity in , laxity in posterior sag test, + posterior sag test, + posterior drawerposterior drawer

–– TxTx: RICE, non: RICE, non--operative operative grades I & II, 6 wks of grades I & II, 6 wks of immobilization, rehab immobilization, rehab


MeniscalMeniscal Lesions Lesions (tears)(tears)–– Etiology: WB with rotary Etiology: WB with rotary

force, medial is injured force, medial is injured more than lateralmore than lateral

–– S/S: deep aching pain S/S: deep aching pain inside the knee, inside the knee, problems kneeling, problems kneeling, walking up/down stairs, walking up/down stairs, squatting, locking up or squatting, locking up or giving way, slow giving way, slow effusion appears after effusion appears after 4848--72 hrs72 hrs

–– TxTx: RICE, MRI, : RICE, MRI, SxSx


BursitisBursitis–– Etiology: cont Etiology: cont

kneeling, trauma, kneeling, trauma, overuseoveruse

–– S/S: localized pain & S/S: localized pain & swelling, redness swelling, redness and increased tempand increased temp

–– TxTx: RICE, : RICE, compression wraps, compression wraps, NSAIDSNSAIDS


Patellar Patellar SubluxSublux/Dislocations/Dislocations–– Etiology: poor tracking of the patella due Etiology: poor tracking of the patella due

toto--wide pelvis, increase in Q angle, wide pelvis, increase in Q angle, shallow femoral grooves, patella shallow femoral grooves, patella altaalta or or bajabaja, , pronatedpronated feetfeet

–– S/S: loss of knee S/S: loss of knee fxnfxn, pain, swelling, , pain, swelling, patella in abnormal position patella in abnormal position

–– TxTx: possible : possible sxsx, isometric ex, rehab & , isometric ex, rehab & strengthening, immobilizationstrengthening, immobilization


ChondromalaciaChondromalacia–– Etiology: abnormal tracking of patellaEtiology: abnormal tracking of patella–– S/S: Stage IS/S: Stage I--swelling & softening of swelling & softening of articulararticular

cartilage, Stage IIcartilage, Stage II-- fissuring of the softened fissuring of the softened cartilage, Stage IIIcartilage, Stage III-- deformation of the surfaces deformation of the surfaces under the patella caused by under the patella caused by defragmentationdefragmentation, , pain pain w/Ambw/Amb, running, stairs, squatting, swelling , running, stairs, squatting, swelling around kneecap, + patellar grindaround kneecap, + patellar grind

–– TxTx: Avoid irritating : Avoid irritating activitesactivites, isometric ex, , isometric ex, NSAIDS, neoprene sleeve, NSAIDS, neoprene sleeve, orthoticsorthotics, smoothing , smoothing of the surface of the patellaof the surface of the patella


PFSS (PFSS (patellofemoralpatellofemoralstress syndrome)stress syndrome)–– EitologyEitology: tight hams & : tight hams &

gastrocsgastrocs, , thightthight IT IT Band, foot Band, foot pronationpronation, , patella patella altaalta, VMO , VMO weaknessweakness

–– S/S: tender lateral facet, S/S: tender lateral facet, swelling, dull ache in swelling, dull ache in center of the kneecenter of the knee

–– TxTx: strengthening of : strengthening of VMO and vast. lat, VMO and vast. lat, stretch hams, stretch hams, gastrocsgastrocs, , ITB, McConnell tapeITB, McConnell tape


OsgoodOsgood--SchlatterSchlatter’’ssDiseaseDisease–– Etiology: avulsion of the Etiology: avulsion of the

patellar tendon @ the patellar tendon @ the apophysisapophysis of the TTof the TT

–– S/S: repeated irritation, S/S: repeated irritation, swelling, hemorrhage, swelling, hemorrhage, gradual degeneration of gradual degeneration of the the apophysisapophysis

–– TxTx: Decrease stressful : Decrease stressful activities, Ice preactivities, Ice pre--post post activities, isometric ex activities, isometric ex

Hip, Thigh, Groin, PelvisHip, Thigh, Groin, Pelvis

Hip, Thigh, Groin, & PelvisHip, Thigh, Groin, & Pelvis

BonesBonesFemoral TriangleFemoral TriangleMusclesMusclesLigamentsLigamentsBlood & Nerve SupplyBlood & Nerve SupplyCommon InjuriesCommon Injuries

Hip, Thigh, Groin, & Pelvis Hip, Thigh, Groin, & Pelvis

BonesBonesFemurFemur–– Head and neck of the femurHead and neck of the femur–– Greater & lesser Greater & lesser trochanterstrochanters

femurfemur


Pelvis (made up of Pelvis (made up of 3 bones)3 bones)IliumIliumIschiumIschiumPubisPubis


Ball and Socket JointBall and Socket Joint–– Head of femur articulates with the Head of femur articulates with the

acetabulumacetabulum–– One of the most stable joints in the bodyOne of the most stable joints in the body–– If you have stability you give up mobilityIf you have stability you give up mobility–– AcetabularAcetabular ligament deepens the jointligament deepens the joint

Femoral TriangleFemoral Triangle

Inguinal LigamentInguinal LigamentAdductor Adductor LongusLongusSartoriusSartorius

These structures run through it:These structures run through it:--Femoral ArteryFemoral Artery--Femoral NerveFemoral Nerve--Femoral VeinFemoral Vein--Inguinal Lymph NodesInguinal Lymph Nodes

LigamentsLigaments

IliofemoralIliofemoral LigamentLigament–– One of the strongest and largest in bodyOne of the strongest and largest in body–– Also known as the Also known as the ““YY”” ligamentligament

LigamentsLigaments

AcetabularAcetabular LigamentLigament–– Deepens the Deepens the acetabulumacetabulum to create a to create a

deeper socket and making it more stabledeeper socket and making it more stable

Inguinal LigamentInguinal Ligament–– Many times is involved in hernias Many times is involved in hernias –– Part of the femoral trianglePart of the femoral triangle

MusclesMuscles

IliopsoasIliopsoas–– Major hip flexorMajor hip flexor–– Actually is two musclesActually is two muscles

MusclesMuscles

GlutesGlutes–– MaximusMaximus-- Ext & laterally rot hipExt & laterally rot hip–– MediusMedius-- Abducts hipAbducts hip

Anterior fibers: flex & med rot hipAnterior fibers: flex & med rot hipPosterior fibers: ext & lat rot hipPosterior fibers: ext & lat rot hip

–– MinimusMinimus-- abducts & med rot hipabducts & med rot hip

MusclesMuscles

Tensor Fasciae Tensor Fasciae LataeLatae (TFL)(TFL)–– Flexes and Med Rot hipFlexes and Med Rot hip

Blood and Blood and Nerve Nerve SupplySupply

Femoral Artery & Femoral Artery & VeinVeinFemoral NerveFemoral Nerve


Hip bursitisHip bursitisEtiology: repeated Etiology: repeated trauma, overuse injury trauma, overuse injury (from running)(from running)S/S inability to bend , S/S inability to bend , run, pt tender, run, pt tender, swelling, warm, swelling, warm, snapping sensationsnapping sensationTxTx: RICE, ultrasound, : RICE, ultrasound, padding, stretchpadding, stretch


Femoral Stress Fracture Femoral Stress Fracture –– Etiology: Excessive OveruseEtiology: Excessive Overuse–– S/S: Persistent pain in thighS/S: Persistent pain in thigh–– TxTx: NSAIDS, RICE, ROM in pain free range: NSAIDS, RICE, ROM in pain free range

Femoral FractureFemoral Fracture–– Etiology: Excessive blunt traumaEtiology: Excessive blunt trauma–– S/S: deformation and pain over siteS/S: deformation and pain over site–– TxTx: Treat for shock, immobilize, activate EMS: Treat for shock, immobilize, activate EMS


SubluxationSubluxation/dislocation of hip/dislocation of hip–– Etiology: traumatic force along the long Etiology: traumatic force along the long

axis of femur w/ knees bentaxis of femur w/ knees bent–– S/S: flexed, ABD, and IR, head of femur S/S: flexed, ABD, and IR, head of femur

is moved post to is moved post to acetabulumacetabulum. Possible . Possible damage to sciatic nervedamage to sciatic nerve

–– TxTx: Immediate medical attention: Immediate medical attention


LeggLegg--Calve Calve PerthesPerthes DiseaseDisease–– Etiology: disruption of blood circulation to Etiology: disruption of blood circulation to

the head of the femur causing cartilage the head of the femur causing cartilage to become necrotic and flattenedto become necrotic and flattened

–– S/S: pain in groin, limping and referred S/S: pain in groin, limping and referred painpain

–– TxTx: Bed rest and bracing: Bed rest and bracing


Slipped Capita Femoral EpiphysisSlipped Capita Femoral Epiphysis–– Etiology: boys 10Etiology: boys 10--17 who are tall or 17 who are tall or

obese. Hip slips posterior and inferiorobese. Hip slips posterior and inferior–– S/S: hip and knee pain during passive S/S: hip and knee pain during passive

mvmtmvmt as well as limits in ABD, flex, and as well as limits in ABD, flex, and Med RotMed Rot

–– TxTx: Rest & NWB : Rest & NWB

Abdomen, Thorax, & Abdomen, Thorax, & SpineSpine

Abdomen, Thorax, & Abdomen, Thorax, & SpineSpine

BonesBonesMusclesMusclesLigamentsLigamentsBlood and Nerve SupplyBlood and Nerve SupplyCommon InjuriesCommon Injuries

Abdomen & ThoraxAbdomen & Thorax

BonesBones–– Ribs Ribs

11--7 true ribs (7 true ribs (sternalsternal))88--10 are false ribs10 are false ribs1111--12 are floating ribs12 are floating ribs

–– SternumSternumManubriumManubriumBodyBodyXiphoidXiphoid ProcessProcess

Solid OrgansSolid Organs

KidneysKidneysSpleenSpleenLiverLiverPancreasPancreasAdrenal GlandsAdrenal Glands

Hollow OrgansHollow Organs

StomachStomachIntestinesIntestinesGall BladderGall BladderUrinary BladderUrinary Bladder

4 Quadrants 4 Quadrants

Right UpperRight Upper–– LiverLiver

Left UpperLeft Upper–– SpleenSpleen–– StomachStomach

Right LowerRight Lower–– Gall BladderGall Bladder–– AppendixAppendix–– KidneyKidney

Left LowerLeft Lower–– KidneyKidney

Urinary SystemUrinary System

KidneysKidneys–– One on each side of One on each side of

spine, spine, approximately in the approximately in the center of the backcenter of the back

–– Primary Primary FxnFxn: filter : filter metabolic wastes, metabolic wastes, ions or drugs from ions or drugs from blood and excrete in blood and excrete in urineurine


Adrenal Glands (Adrenal Glands (akaaka suprarenal suprarenal glands)glands)–– Located on top of each kidney Located on top of each kidney –– Secrete: epinephrine, Secrete: epinephrine, norepinephrinenorepinephrine, ,

cortisolcortisol, estrogen, , estrogen, aldestronealdestrone, and , and androgen androgen


UretersUreters and Urinary Bladderand Urinary Bladder–– UretersUreters are small tubes that run inferior are small tubes that run inferior

from the bladder. The bladder lies from the bladder. The bladder lies posterior to pubic posterior to pubic symphysissymphysis. In males: . In males: anterior to rectum; in females, anterior to anterior to rectum; in females, anterior to vagina and inferior to uterusvagina and inferior to uterus

Digestive SystemDigestive System

LiverLiver–– Largest internal organ, UR quadLargest internal organ, UR quad–– FxnFxn: absorbs and stores excessive glucose, : absorbs and stores excessive glucose,

process nutrients, detoxifies harmful chemicals, process nutrients, detoxifies harmful chemicals, secretes bilesecretes bile

Bile neutralizes and dilutes stomach acids and aids in Bile neutralizes and dilutes stomach acids and aids in digestion of fat in small intestinedigestion of fat in small intestine

–– HepititisHepititis-- inflammation of the liver caused by inflammation of the liver caused by viral infection or alcohol consumption. If not viral infection or alcohol consumption. If not corrected it can lead to liver cell death and corrected it can lead to liver cell death and cirrhosiscirrhosis


Gall BladderGall Bladder–– Located inferior to surface of the liverLocated inferior to surface of the liver–– FxnFxn: serves as storage reservoir for bile, : serves as storage reservoir for bile,

secretes those stores into secretes those stores into smsm intestineintestine–– Gall StonesGall Stones-- caused by cholesterol caused by cholesterol

secreted by the liver, block the release of secreted by the liver, block the release of bile, must be removed surgically bile, must be removed surgically


PancreasPancreas–– Located between the Located between the

small intestine and the small intestine and the spleenspleen

–– FxnFxn: secretes pancreatic : secretes pancreatic juice, which is critical in juice, which is critical in digestion of fats, digestion of fats, carbscarbs, , and proteins. Secretes and proteins. Secretes insulin and insulin and glucagonglucagon, , which control amt of which control amt of glucose and amino acids glucose and amino acids in blood in blood


StomachStomach–– UL quadUL quad–– Second stage of food break down (first Second stage of food break down (first

stage is in mouth)stage is in mouth)–– Some absorption but mostly in the small Some absorption but mostly in the small

intestineintestine–– Can see stomach ulcers due to an over Can see stomach ulcers due to an over

production of stomach acidsproduction of stomach acids

Lymphatic SystemLymphatic System

SpleenSpleen–– Largest lymph organLargest lymph organ–– FxnFxn: reservoir of red blood cells, : reservoir of red blood cells,

regulates number of RBC, destroys RBC, regulates number of RBC, destroys RBC, produces antibodies, produces produces antibodies, produces lymphocyteslymphocytes

–– Located under diaphragm, left side, Located under diaphragm, left side, behind ribs 9,10, & 11. behind ribs 9,10, & 11.


Small Intestine (3 Small Intestine (3 parts)parts)–– DuodenumDuodenum–– JejunumJejunum–– IleumIleum

Large intestine (3 Large intestine (3 parts)parts)–– CecumCecum–– ColonColon–– RectumRectum


Evaluation of Abdomen & ThoraxEvaluation of Abdomen & Thorax–– Check chest for asymmetry of breathing, Check chest for asymmetry of breathing,

palpate along ribs, palpate along ribs, intercostalintercostal space, space, costacholandralcostacholandral jxnjxn

–– Check URQ, ULQ, LLQ, LRQ clockwiseCheck URQ, ULQ, LLQ, LRQ clockwise–– Feel and look for muscle guardingFeel and look for muscle guarding–– Distinguish b/w guarding and rigidity Distinguish b/w guarding and rigidity –– Listen and feel for bowel sounds (gurgling Listen and feel for bowel sounds (gurgling

of normal liquid)of normal liquid)


Rib Rib FxFx–– Etiology: direct blow, indirect trauma Etiology: direct blow, indirect trauma

(compression of rib cage), or violent muscle (compression of rib cage), or violent muscle contraction. Direct blow is most dangerous contraction. Direct blow is most dangerous b/cb/cof fragments may displace and cut, tear, of fragments may displace and cut, tear, perforate tissue causing a perforate tissue causing a hemothoraxhemothorax or a or a collapsed lung (collapsed lung (pneumothoraxpneumothorax))

–– S/S: severe pain with inhalation/exhalation, S/S: severe pain with inhalation/exhalation, cough, sneeze, laugh etc.cough, sneeze, laugh etc.

–– TxTx: refer for x: refer for x--rayray


Sternum Sternum FxFx–– Etiology: high impact blow to chest which may Etiology: high impact blow to chest which may

cause a contusion to the underlying cardiac cause a contusion to the underlying cardiac musclemuscle

–– S/S: pt. tenderness, pain exacerbated by deep S/S: pt. tenderness, pain exacerbated by deep inspiration and forceful exhalation, signs of inspiration and forceful exhalation, signs of shock, weak or rapid pulse may indicate a more shock, weak or rapid pulse may indicate a more severe injury.severe injury.

–– TxTx: EMS, X: EMS, X--rays, monitor for heart trauma rays, monitor for heart trauma


HemothoraxHemothorax–– Presence of blood in plural cavityPresence of blood in plural cavity–– Hemorrhage can be Hemorrhage can be negneg of rib of rib fxfx, , –– S/S: Pain on breathing, S/S: Pain on breathing, dyspneddyspned, shock, coughing up frothy , shock, coughing up frothy

blood blood PneumothoraxPneumothorax–– Plural cavity fills with air by an opening in the chest. Air filPlural cavity fills with air by an opening in the chest. Air fills the ls the

cavity and collapses the lung, difficulty breathing and anoxiacavity and collapses the lung, difficulty breathing and anoxiaTension Tension PneumothoraxPneumothorax–– When air filled plural cavity displaces lung and heart towards When air filled plural cavity displaces lung and heart towards

opposite lung compressing itopposite lung compressing it–– S/S: SOB, and pain on injured side, absence of breathing, S/S: SOB, and pain on injured side, absence of breathing,

cyanosis, and distension of neck veins, call EMS immediately. cyanosis, and distension of neck veins, call EMS immediately.

All lung injuries require immediate medical attentionAll lung injuries require immediate medical attention----transporttransport


Traumatic Traumatic AsphyixaAsphyixa–– Results from a violent blow to or Results from a violent blow to or

compression of the rib cage that causes compression of the rib cage that causes cessation of breathingcessation of breathing

–– S/S: purple discoloration of trunk and S/S: purple discoloration of trunk and head, conjunctivas of the eyes display head, conjunctivas of the eyes display bright red colorbright red color

–– TxTx: Rescue Breathing immediately, EMS: Rescue Breathing immediately, EMS

SpineSpineCervical Cervical

ThoracicThoracic

LumbarLumbar

SacralSacral

CC--SpineSpine

Cervical spine vertebrae 1Cervical spine vertebrae 1--77Atlas (#1)Atlas (#1)–– Upper surface articulates with Upper surface articulates with occiputocciput and allows and allows

for flex and ext. No body or for flex and ext. No body or spinousspinous processprocess

Axis (#2)Axis (#2)–– Allows the skull and atlas to rotateAllows the skull and atlas to rotate–– Tooth like projection from vertebral body that Tooth like projection from vertebral body that

fits into ring of atlas (fits into ring of atlas (odontoidodontoid process)process)

If this If this fxfx, you die, you die……skull slips off severing SCskull slips off severing SC

CC--SpineSpine

Smallest bodiesSmallest bodiesHorizontal Horizontal positioning of the positioning of the spinousspinous processesprocesses

TT--SpineSpine

Thoracic SpineThoracic Spine12 vertebrae long 12 vertebrae long transverse transverse processes and thin processes and thin spinousspinous processesprocessesRibs articulate with Ribs articulate with 11--1010Little to no Little to no mvmtmvmt

LL--spinespine

Lumbar SpineLumbar Spine5 vertebrae5 vertebraeMajor support of the Major support of the lower backlower backLargest and thickest, Largest and thickest, with large with large spinousspinous and and transverse processestransverse processesMuch less flexion than Much less flexion than extension extension

SacrumSacrum

Fusion of 5 vertebraeFusion of 5 vertebraeFuses with the 2 hip Fuses with the 2 hip bones to make pelvisbones to make pelvisRoots of lumbar and Roots of lumbar and sacral nerves pass sacral nerves pass through the 4 foramina through the 4 foramina lateral to the 5 fused lateral to the 5 fused vertebraevertebraeArticulates with Articulates with iliumilium to to make the sacroiliac make the sacroiliac joint (SI): sitting and joint (SI): sitting and standing puts weight at standing puts weight at these jointsthese joints

CoccyxCoccyx

““TailboneTailbone””4 or more fused 4 or more fused vertebraevertebrae

Curves of the SpineCurves of the Spine

CervicalCervical–– ConvexityConvexity

ThoracicThoracic–– ConcavityConcavity

LumbarLumbar–– ConvexityConvexity

SacralSacral–– ConcavityConcavity

LordosisLordosis

IntervertebralIntervertebral DiscsDiscs

Annulus Fibrosis: Annulus Fibrosis: periphery of disc. periphery of disc. Composed of strong, Composed of strong, fibrous tissuefibrous tissueSemifluidSemifluid Nucleus Nucleus PulposusPulposus: in the center : in the center and compressed under and compressed under pressurepressureBoth act as important Both act as important shock absorbers for the shock absorbers for the spinespine

LigamentousLigamentous StructuresStructures

Anterior Longitudinal ligamentAnterior Longitudinal ligament–– Wide, strong band: extends the full length of Wide, strong band: extends the full length of

anterior surface of the vertebral bodiesanterior surface of the vertebral bodies–– Attaches to both vertebral bodies and discs and Attaches to both vertebral bodies and discs and

resists extensionresists extension

Posterior Longitudinal LigamentPosterior Longitudinal Ligament–– Contained within the vertebral canal and extends Contained within the vertebral canal and extends

full length of posterior aspect of bodies and full length of posterior aspect of bodies and limits flexionlimits flexion

Spinal CordSpinal Cord

Contained within the vertebral canal Contained within the vertebral canal and spinal columnand spinal columnFrom the foramen magnum of cranium From the foramen magnum of cranium to the 1to the 1stst or 2or 2ndnd lumbar vertebraelumbar vertebraeLumbar roots and sacral nerves form a Lumbar roots and sacral nerves form a horselikehorselike tail called tail called ““caudacauda equinaequina””

Spinal and Peripheral Spinal and Peripheral NervesNerves

31 pairs of nerves31 pairs of nerves–– 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygealcoccygeal–– Has a anterior root (motor) and posterior root (sensory)Has a anterior root (motor) and posterior root (sensory)

Each pair has a dermatome (except C1)Each pair has a dermatome (except C1)Specific area of sensation distributionSpecific area of sensation distributionSpinal nerve roots combine to form a network of Spinal nerve roots combine to form a network of nerves known as a nerves known as a ““plexusplexus””–– Cervical (C1Cervical (C1--C4)C4)–– Brachial (C5Brachial (C5--T1)T1)–– Lumbar (L1Lumbar (L1--L4)L4)–– Sacral (L4Sacral (L4--S4)S4)

Cervical Cervical Nerve RootsNerve Roots

Brachial PlexusBrachial Plexus

Lumbar Lumbar PlexusPlexus

Functional AnatomyFunctional Anatomy

Cervical RegionCervical RegionFlexionFlexion–– SCM and scalene groupSCM and scalene group

ExtensionExtension–– Upper trapsUpper traps

Lateral FlexionLateral Flexion–– All muscles on one side contracting unilaterally All muscles on one side contracting unilaterally

RotationRotation–– SCM, SCM, scalenesscalenes, and upper traps contract on , and upper traps contract on

opposite side of rotationopposite side of rotation

Functional AnatomyFunctional Anatomy

TrunkTrunkFlexionFlexion–– Lengthening of the deep and superficial back muscles and Lengthening of the deep and superficial back muscles and

contraction of the abs (contraction of the abs (rectusrectus abdominisabdominis, internal/external , internal/external obliquesobliques), and hip flexors (), and hip flexors (rectusrectus femorisfemoris, TFL, and , TFL, and sartoriussartorius

ExtensionExtension–– Lengthening of the abs and contraction of erector Lengthening of the abs and contraction of erector spinaespinae and and

gluteglute maxmaxRotationRotation–– External/internal External/internal obliquesobliques

Lateral rotationLateral rotation–– QuadratusQuadratus lumborumlumborum, , obliquesobliques, , latissumuslatissumus dorsidorsi, , iliopsoasiliopsoas, and , and

rectusrectus abdominisabdominis on the same side as direction of on the same side as direction of mvmtmvmt


Cervical Fractures/DislocationsCervical Fractures/Dislocations

EitologyEitology: violent flexion and : violent flexion and rotationofrotationof head (pool head (pool diving), axial loading combined with flexion diving), axial loading combined with flexion (football injury), most common in C4, 5, or 6(football injury), most common in C4, 5, or 6S/S: neck point tenderness and restricted S/S: neck point tenderness and restricted mvmtmvmt, , cervical muscle spasm, pain in neck or chest region, cervical muscle spasm, pain in neck or chest region, numbness in trunk/limbs, weakness or paralysis in numbness in trunk/limbs, weakness or paralysis in limbs/trunk, loss of bladder or bowel controllimbs/trunk, loss of bladder or bowel controlTxTx: EMS immediately, do not move, stabilize head : EMS immediately, do not move, stabilize head and neck and neck


Cervical Sprain (whiplash)Cervical Sprain (whiplash)–– Etiology: head turned suddenly or had Etiology: head turned suddenly or had

forced flexion, extension or rotationforced flexion, extension or rotation–– S/S: tenderness over transverse and S/S: tenderness over transverse and

spinousspinous processes, muscle guarding, processes, muscle guarding, localized pain, and restricted localized pain, and restricted mvmtmvmt

–– TxTx: : r/or/o fxfx, or sc injury, or sc injury


Acute Acute TorticollisTorticollis (wry neck or stiff (wry neck or stiff neck)neck)–– Etiology: pain on one side upon Etiology: pain on one side upon

awakeningawakening


Cervical Cervical StenosisStenosis–– Etiology: narrowing of the spinal canal in Etiology: narrowing of the spinal canal in

the Cthe C--spine region that can impinge the spine region that can impinge the sc. Can occur congenitally or changes in sc. Can occur congenitally or changes in the the vertebaevertebae

–– S/S: pain in limbs, numbness and S/S: pain in limbs, numbness and tingling, associated weakness tingling, associated weakness


Brachial Plexus Brachial Plexus NeruaplaxiaNeruaplaxia (burner), most (burner), most common neurological injurycommon neurological injury–– Etiology: stretching or compression results from Etiology: stretching or compression results from

neck forced laterally to the opposite side or neck neck forced laterally to the opposite side or neck extension, compressed and rotated to the extension, compressed and rotated to the affected sideaffected side

–– S/S: burning sensation, numbness, tingling, and S/S: burning sensation, numbness, tingling, and pain extending from the shoulder down to the pain extending from the shoulder down to the hand, with LOF for several minutes hand, with LOF for several minutes


Lumbar sprains/strainsLumbar sprains/strainsSciaticaSciatica–– Etiology: inflammatory Etiology: inflammatory

response of the sciatic response of the sciatic nerve that has nerve that has associated low back associated low back painpain

–– S/S: shooting pain down S/S: shooting pain down nerve root with possible nerve root with possible numbness and tinglingnumbness and tingling

image 1 - The shaded regions indicate where pain may be felt depending on which part of the

spine is involved.

Forearm, Wrist, Hand, & Forearm, Wrist, Hand, & FingersFingers

Forearm, Wrist, Hand & Forearm, Wrist, Hand & Fingers Fingers

BonesBonesMusclesMusclesLigamentsLigamentsBlood & Nerve SupplyBlood & Nerve SupplyCommon InjuriesCommon Injuries

ForearmForearm

RadiusRadius–– Thumb side Thumb side

UlnaUlna–– ““pinkypinky”” sideside

Muscles of Muscles of ForearmForearm

Flexors and Flexors and pronatorspronators–– Found Found anterioralyanterioraly

Extensors and Extensors and supinatorssupinators–– Found Found posterioralyposterioraly

Nerve & Nerve & Blood Blood SupplySupply

Most flexors, Most flexors, median nervemedian nerveMost extensors, Most extensors, radial nerveradial nerveBlood: brachial Blood: brachial artery (radial/artery (radial/ulnarulnar))

Wrist, Hand, Wrist, Hand, and Fingersand Fingers

BonesBonesMusclesMusclesLigamentsLigamentsBlood & nerveBlood & nerveCommon injuriesCommon injuries

Wrist, Hand, & Fingers Wrist, Hand, & Fingers

CarpalsCarpals8 carpal bones8 carpal bones–– Proximal row (Proximal row (ulnarulnar to radial): to radial): pisiformpisiform, ,

triquetraltriquetral, , lunatelunate, , scaphoidscaphoid ((navicularnavicular))–– Distal row (Distal row (ulnarulnar to radial): to radial): hamatehamate, ,

capitatecapitate, , trapizoidtrapizoid (lesser (lesser multangularmultangular), ), trapezium (greater trapezium (greater multangularmultangular))

–– Carpals articulate with the metacarpalsCarpals articulate with the metacarpals

Articulations (joints)Articulations (joints)

RadiocarpalRadiocarpal joints (radius and the joints (radius and the carpalscarpals–– CondyloidCondyloid jointjoint–– Allows for flexion, extension, abduction, Allows for flexion, extension, abduction,

circumductioncircumduction

CarpalsCarpals–– ArthrodialArthrodial (gliding) joint(gliding) joint

Articulations (Articulations (concon’’tt))

Metacarpal jointMetacarpal joint–– CondyloidCondyloid jointjoint–– Allows for flexion, extension, add/Allows for flexion, extension, add/abdabd, ,

and and circumductioncircumduction

ThumbThumb–– Saddle jointSaddle joint-- allows rotationallows rotation–– Movements of thumb are different then Movements of thumb are different then

other fingers other fingers

Articulations (Articulations (concon’’tt))

PhalangealPhalangeal jointsjointsHinge jointHinge jointFlexion and extensionFlexion and extension

LigamentsLigaments

WristWrist–– Collateral Collateral ulnarulnar ligament: tip of ligament: tip of styloidstyloid

process of ulna to process of ulna to pisiformpisiform–– Radial collateral: Radial collateral: styloidstyloid of radius to of radius to

scaphoidscaphoid–– Transverse carpal ligament: crosses Transverse carpal ligament: crosses volarvolar

aspect of carpalsaspect of carpalsRoof of the carpal tunnelRoof of the carpal tunnel

LigamentsLigaments

PhalangesPhalangesCollateral ligamentsCollateral ligaments–– MedialMedial–– laterallateral

Muscles, Blood & Nerve Muscles, Blood & Nerve Supply Supply

FlexorsFlexors–– PalmarPalmar side of handside of hand

ExtensorsExtensors–– Back side of handBack side of hand

NervesNerves–– UlnarUlnar–– MedianMedian–– RadialRadial

ArteriesArteries–– Radial and Radial and UlnarUlnar


Wrist sprainWrist sprain–– Etiology: falling on a Etiology: falling on a hyperextendedhyperextended wristwrist–– S/S: pain, swelling, c/o difficulty in S/S: pain, swelling, c/o difficulty in

moving wrist, tenderness, limited ROMmoving wrist, tenderness, limited ROM–– TxTx: RICE, NSAIDS, splinting if necessary, : RICE, NSAIDS, splinting if necessary,

taping taping


Wrist strain (Wrist strain (tenosynovitistenosynovitis) usually the ) usually the extensor extensor carpicarpi radialisradialis longuslongus or or brevisbrevis–– Etiology: repetitive overuse of the wrist Etiology: repetitive overuse of the wrist

tendons and their sheathstendons and their sheaths–– S/S: c/o pain with use or in passive S/S: c/o pain with use or in passive

stretching of tendonsstretching of tendons–– TxTx: Ice massage, NSAIDS, rest, heat after : Ice massage, NSAIDS, rest, heat after

72 hrs, 72 hrs, PREPRE’’ss


TendonitisTendonitisEtiology: overuseEtiology: overuseS/S: c/o pain on active use or passive S/S: c/o pain on active use or passive stretching of tendonstretching of tendonTxTx: Same as : Same as tenosynovitistenosynovitis


Carpal Tunnel Syndrome: Carpal Tunnel Syndrome: inflammtioninflammtionof tendons causing compression of of tendons causing compression of median nervemedian nerve–– Etiology: repeated wrist flexion, direct Etiology: repeated wrist flexion, direct

traumatrauma–– S/S: sensory and motor deficitsS/S: sensory and motor deficits–– TxTx: Rest, immobilization, NSAIDS, ice : Rest, immobilization, NSAIDS, ice

massage, US massage, US


FracturesFractures–– ScaphoidScaphoid--most commonmost common–– BoxerBoxer’’ss-- FxFx of neck of of neck of

55thth MCMC–– BennettBennett’’ss-- FxFx of base of of base of

11stst MCMC–– SmithSmith’’ss-- falling on falling on

hyperextenedhyperextened wrist, wrist, distal radius distal radius fxfx

–– ColleColle’’ss-- falling on falling on outstretched arm, distal outstretched arm, distal radiusradius

The ElbowThe Elbow

BonesBonesMusclesMusclesLigamentsLigamentsBlood & Nerve SupplyBlood & Nerve SupplyCommon InjuriesCommon Injuries

The ElbowThe Elbow

BonesBonesHumerousHumerous, Radius, Ulna, Radius, Ulna–– 2 articulating 2 articulating condylescondyles-- capitulumcapitulum and and

trochleatrochlea–– Flexion/ExtensionFlexion/Extension-- articulation of the articulation of the

trochleatrochlea and and semilunarsemilunar notch (ulna)notch (ulna)–– Pronation/SupinationPronation/Supination--head of radius and head of radius and

capitulumcapitulum

LigamentsLigaments

UlnarUlnar collateral ligament (medial)collateral ligament (medial)Radial collateral ligament (lateral)Radial collateral ligament (lateral)Annular ligamentAnnular ligament–– Stabilizes articulation of radius and radial Stabilizes articulation of radius and radial

notchnotch–– Attached to anterior and posterior radial Attached to anterior and posterior radial

notch and it covers head and neck of notch and it covers head and neck of radiusradius

MusclesMuscles

Flexion: biceps Flexion: biceps brachiibrachii, , brachialisbrachialis, , brachioradialisbrachioradialisExtension: triceps Extension: triceps brachiibrachiiSupinationSupination: biceps : biceps brachiibrachii and and supinatorsupinatorPronationPronation: : pronatorpronator teresteres and and pronatorpronatorquadratusquadratus

MusclesMuscles

LES (lateral, LES (lateral, extension, extension, supinatorsupinator))–– Ext Ext carpicarpi radrad longlong–– Ext Ext carpicarpi radrad brevisbrevis–– Ext Ext carpicarpi ulnarisulnaris–– SupinatorSupinator

MFP (medial, MFP (medial, flexion, flexion, pronatorpronator))–– Flex Flex carpicarpi radialisradialis–– PalmarisPalmaris–– Flex Flex carpicarpi ulnarisulnaris–– Flex Flex digitorumdigitorum

superficialissuperficialis & & profundusprofundus


BloodBlood–– Brachial and medial arteries: deep within Brachial and medial arteries: deep within

antecubitalantecubital fossafossa–– Veins: front of elbow, Veins: front of elbow, superficalsuperfical and close to and close to

skinskin

NerveNerve–– Roots C5Roots C5--T1T1–– In In cubitalcubital fossafossa, these nerves become the , these nerves become the

musculocutaneousmusculocutaneous, radial and median nerve, radial and median nerve


OlcranonOlcranon bursitis bursitis –– Etiology: blunt trauma to Etiology: blunt trauma to bursalbursal sac sac

superficial to the superficial to the olcranonolcranon processprocess–– S/S: pain and severe spontaneous S/S: pain and severe spontaneous

swelling and point tendernessswelling and point tenderness

Most common injuries due to falling on Most common injuries due to falling on an outstretched arm.an outstretched arm.


Lateral Lateral EpicondylitisEpicondylitis: tennis : tennis elbowelbow–– Etiology: repetitive Etiology: repetitive

trauma to trauma to extersorextersormuscles of the muscles of the lateral lateral epicondyleepicondyle

–– S/S: pain during S/S: pain during and after activity and after activity eventually causing eventually causing weakness in the weakness in the hand and wrist hand and wrist


Medial Medial EpicondylitisEpicondylitis–– Etiology: forceful Etiology: forceful

flexion of wrist and flexion of wrist and extreme extreme valgusvalgustorques of elbowtorques of elbow

–– S/S: pain can be S/S: pain can be centralized or centralized or radiating down arm, radiating down arm, associated associated weakness of wrist weakness of wrist and handand hand


Little League Elbow: 10Little League Elbow: 10--25% of young 25% of young pitchers affectedpitchers affected

–– Etiology: repetitive micro trauma that leads to Etiology: repetitive micro trauma that leads to many disorders of growth in the pitching elbowmany disorders of growth in the pitching elbow

–– S/S: flexion contracture (tightness of anterior S/S: flexion contracture (tightness of anterior joint capsule and weak triceps), locking or joint capsule and weak triceps), locking or catching sensations and decreased ROMcatching sensations and decreased ROM

The Shoulder ComplexThe Shoulder Complex

BonesBonesMusclesMusclesLigamentsLigamentsBlood & Nerve Blood & Nerve SupplySupplyCommon InjuriesCommon Injuries


BonesBones–– ScapulaScapula–– HumerusHumerus–– ClavicleClavicle–– SternumSternum–– RibsRibs


Articulations:Articulations:–– SternoclavicularSternoclavicular (sternum and clavicle) (sternum and clavicle) –– AcromioclavicularAcromioclavicular ((acromionacromion process and process and

clavicle)clavicle)–– GlenohumeralGlenohumeral ((glenoidglenoid fossafossa and humeral and humeral

head)head)–– ScapulothoracicScapulothoracic (scapula and thorax)(scapula and thorax)

LigamentsLigaments

SternoclavciularSternoclavciular-- extremely weak due extremely weak due to boney to boney arrangmentarrangment. Anterior and . Anterior and posterior posterior sternoclavicularsternoclavicular ligament ligament prevents upward translation of the prevents upward translation of the clavicleclavicleAcromioclavicularAcromioclavicular-- Anterior, posterior, Anterior, posterior, inferior, and superior portions join the inferior, and superior portions join the acromionacromion pocesspocess to the clavicleto the clavicle

LigamentsLigaments

GlenohumeralGlenohumeral ligamentsligaments--an anterior an anterior capsule surrounds the joint and is capsule surrounds the joint and is strongly enforced by the superior, strongly enforced by the superior, middle, and inferior GH ligaments.middle, and inferior GH ligaments.

MusclesMuscles

3 Groups3 GroupsGroup 1: Group 1: latissumuslatissumusdorsidorsi and and pecpec majormajorGroup 2: originates Group 2: originates off scapula and off scapula and inserts into the inserts into the humerushumerus; SITTS; SITTS--subscapularissubscapularis, , infraspinatusinfraspinatus, , supraspinatussupraspinatus, and , and teresteres minorminor

MusclesMuscles

Group 3Group 3-- attach axial skeleton attach axial skeleton to the scapulato the scapula……scapular scapular stabilizers: stabilizers: levatorlevator scapula, scapula, trapeziustrapezius, rhomboids, and , rhomboids, and serratusserratus anterior and posterioranterior and posterior

Scapular Rhythm: Scapular Rhythm: mvmtmvmt of the of the scapula relative to the scapula relative to the mvmtmvmt of of the the humerushumerus. First 30 degrees . First 30 degrees is is humerushumerus only, from 30only, from 30--90 90 the scapula moves 1 degree to the scapula moves 1 degree to every 2 degrees of the every 2 degrees of the humerushumerus. At 90 degrees they . At 90 degrees they are =.are =.


Brachial arteryBrachial arteryBrachial PlexusBrachial Plexus


ClavicularClavicular FxFx–– Etiology: fall on outstretched arm, tip of Etiology: fall on outstretched arm, tip of

shoulder or direct impactshoulder or direct impact–– S/S: supports arm of injured side, tilt S/S: supports arm of injured side, tilt

neck towards injured side, deformity, neck towards injured side, deformity, swellingswelling

–– TxTx: immediate referral, X: immediate referral, X--ray, sling and ray, sling and immoblizeimmoblize 66--8 weeks 8 weeks


SternoclavicularSternoclavicular sprainsprain–– Etiology: direct blow Etiology: direct blow

transmitting through transmitting through humerushumerus

–– S/S: grades IS/S: grades I-- little to no little to no pain w/o disability, IIpain w/o disability, II--visual deformity, pain, visual deformity, pain, swelling, point tenderness, swelling, point tenderness, inability to inability to abdabd shoulder or shoulder or bring shoulder across bring shoulder across body, IIIbody, III-- complete complete dislocation with gross dislocation with gross displacement of clavicle at displacement of clavicle at the SC jointthe SC joint

–– TxTx: RICE, refer to MD : RICE, refer to MD


AcromioclavicularAcromioclavicular SprainSprain–– Etiology: direct impact to Etiology: direct impact to

tip of shoulder, upward tip of shoulder, upward force through the long axis force through the long axis of of humerushumerus

–– S/S: grade IS/S: grade I-- PT and PT and discomfort during discomfort during mvmtmvmt, , IIII--displacement of lateral displacement of lateral end of clavicle, and end of clavicle, and inability to completely inability to completely abdabdarm or bring arm across arm or bring arm across chest, IIIchest, III--rupture of AC rupture of AC ligament and CC ligamentligament and CC ligament

–– TxTx: ice and pressure, : ice and pressure, stabilize stabilize jtjt w/ sling, referw/ sling, refer


GH GH SubluxationSubluxation/Dislocation/Dislocation–– Etiology: (Anterior) most common Etiology: (Anterior) most common

is is abdabd, ER, and ext, but also from a , ER, and ext, but also from a direct blow posterior or direct blow posterior or posterolateralposterolateral aspect of shoulder. aspect of shoulder. (Posterior) forced add and IR or fall (Posterior) forced add and IR or fall on extended and IR shoulderon extended and IR shoulder

–– S/S: (Anterior) flattened deltoid, S/S: (Anterior) flattened deltoid, palpation of humeral head at palpation of humeral head at axillaaxilla, , carrying arm in carrying arm in abdabd and ER and ER position. (Posterior) severe pain position. (Posterior) severe pain and disability, arm in add and IR and disability, arm in add and IR with flattened anterior deltoid.with flattened anterior deltoid.

–– TxTx: Immediate immobilization, ice : Immediate immobilization, ice to reduce swelling and to reduce swelling and hemorrhaging, referral to MD, Xhemorrhaging, referral to MD, X--ray to ray to r/or/o associated associated fxfx


Shoulder Impingement Shoulder Impingement SyndromeSyndrome–– Etiology: Mechanical compression Etiology: Mechanical compression

of of supraspinatussupraspinatus, , subacromialsubacromialbursa, or the long head of the bursa, or the long head of the biceps under the biceps under the acromialacromial arch. arch. Caused by repetitive use in Caused by repetitive use in overhead activities.overhead activities.

–– S/S: diffuse pain around S/S: diffuse pain around acromionacromion. . Overhead use increases pain, ER Overhead use increases pain, ER are weaker than IR, tightness on are weaker than IR, tightness on posterior inferior posterior inferior jtjt capsulecapsule

–– TxTx: RICE, strengthen rotator cuff, : RICE, strengthen rotator cuff, strengthen strengthen abdabd, ER, elevators, and , ER, elevators, and upward rotatorsupward rotators

Throwing DynamicsThrowing Dynamics

Cocking Phase: Cocking Phase: shldshld abdabd, ext, and ER. Can , ext, and ER. Can cause ant cause ant shldshld pain as a result of stretching pain as a result of stretching the the pecpec major, origin of ant deltoid, long major, origin of ant deltoid, long head of biceps, and IRhead of biceps, and IRAcceleration Phase: Acceleration Phase: AbdAbd, IR, and forward , IR, and forward flex. Places tension on post and inferior flex. Places tension on post and inferior capsule, while ant capsule is relaxed.capsule, while ant capsule is relaxed.FollowFollow--Through Phase: Add and IR, the Through Phase: Add and IR, the eccentric load places enormous strain on eccentric load places enormous strain on the ER of the rotator cuff and capsulethe ER of the rotator cuff and capsule

Head, Face, Eyes, Ears, Head, Face, Eyes, Ears, Nose and ThroatNose and Throat

HeadHead–– The skull is composed of 22 bones, the mandible The skull is composed of 22 bones, the mandible

is the only bone not joined by suturesis the only bone not joined by suturesMeningesMeninges–– 3 membranes that protect the brain and SC3 membranes that protect the brain and SC

DuramaterDuramater--outermost dense fibrous inelastic sheath outermost dense fibrous inelastic sheath that covers the brainthat covers the brainArachnoidArachnoid-- extremely delicate, attaches to the SC by extremely delicate, attaches to the SC by silksilk--like strandslike strandsSpace b/w Space b/w arachnoidarachnoid and and piapia mater is called mater is called subarachnoidsubarachnoid space. This space contains cerebrospinal space. This space contains cerebrospinal fluidfluidCerebrospinal fluids main Cerebrospinal fluids main fxnfxn is to act as a is to act as a cusioncusion and and absorb shockabsorb shockPiaPia Mater which is thin, delicate, and highly vascularMater which is thin, delicate, and highly vascular

Head, Face, Eyes, Ears, Head, Face, Eyes, Ears, Nose and ThroatNose and Throat


Skull Skull FxFx–– Etiology: blunt traumaEtiology: blunt trauma–– S/S: c/o severe headaches and nausea, possible S/S: c/o severe headaches and nausea, possible

deformity, blood in middle ear or ear canal, deformity, blood in middle ear or ear canal, bleeding from nose, bleeding from nose, ecchymosisecchymosis around eyes around eyes (raccoon eyes), (raccoon eyes), ecchymosisecchymosis behind ears (battle behind ears (battle signs), cerebral spinal fluid may also appear in signs), cerebral spinal fluid may also appear in ear and noseear and nose

–– TxTx: immediate hospitalization: immediate hospitalization


Cerebral Concussions (mild)Cerebral Concussions (mild)–– Etiology: either a direct blow to the head by an object or Etiology: either a direct blow to the head by an object or

moving head meets a fixed objectmoving head meets a fixed object–– S/S: headache, tinnitus, nausea, irritability, confusion, S/S: headache, tinnitus, nausea, irritability, confusion,

dizziness, LOC, dizziness, LOC, anterogradeanterograde/retrograde amnesia, inability /retrograde amnesia, inability to concentrate, blurred vision, photophobia, and sleep to concentrate, blurred vision, photophobia, and sleep disturbancesdisturbances

–– TxTx: If there is any LOC the athlete MUST be removed from : If there is any LOC the athlete MUST be removed from competition. If ATC finds an unconscious athlete, they competition. If ATC finds an unconscious athlete, they must assume a neck/SC injury.must assume a neck/SC injury.

Athlete shouldnAthlete shouldn’’t be permitted to return to play t be permitted to return to play until ALL until ALL postconcussionpostconcussion s/ss/s are resolved are resolved


PostPost--Concussion SyndromeConcussion Syndrome–– Etiology: Etiology: s/ss/s of a concussion that lingerof a concussion that linger–– S/S: c/o persistent headache, impaired memory, S/S: c/o persistent headache, impaired memory,

lack of concentration, anxiety, irritability, lack of concentration, anxiety, irritability, giddiness, fatigue, depression, and visual giddiness, fatigue, depression, and visual disturbances. Symptoms may last for weeks or disturbances. Symptoms may last for weeks or even months before resolving.even months before resolving.

–– TxTx: not to allow athlete to return until all : not to allow athlete to return until all s/ss/s are are no longer present no longer present


Second Impact Syndrome (ages >20)Second Impact Syndrome (ages >20)–– Etiology: occurs Etiology: occurs b/cb/c of rapid swelling and of rapid swelling and

herniationherniation of brain after a 2of brain after a 2ndnd head injury, before head injury, before the 1the 1stst injury had time to healinjury had time to heal

–– S/S: within 15 sec to several min the condition S/S: within 15 sec to several min the condition worsens rapidly. Pupils dilate, loss of eye worsens rapidly. Pupils dilate, loss of eye mvmtmvmt, , LOC leading to coma, and respiratory failureLOC leading to coma, and respiratory failure

22ndnd impact syndrome is a life threatening impact syndrome is a life threatening condition with a mortality rate of 50%condition with a mortality rate of 50%–– TxTx: must be addressed within 5 min by dramatic : must be addressed within 5 min by dramatic

life saving measures life saving measures


Epidural Epidural HematomaHematoma–– Etiology: a blow to the head or skull Etiology: a blow to the head or skull fxfx

can cause tearing of the can cause tearing of the meningealmeningealartery. Blood accumulation and a artery. Blood accumulation and a hematomahematoma occur occur extremlyextremly fastfast

–– S/S: most cases LOC, signs gradually S/S: most cases LOC, signs gradually worsen, worsen, dialationdialation of one pupilof one pupil

–– TxTx: medical emergency: medical emergency


SubduralSubdural HematomaHematoma–– Etiology: results from acceleration/deceleration Etiology: results from acceleration/deceleration

forces that tear vessels that lie b/w the forces that tear vessels that lie b/w the duramaterduramater and brain. Symptoms appear slowly and brain. Symptoms appear slowly b/cb/c the venous structures are affectedthe venous structures are affected

2 types:2 types:Simple Simple subduralsubdural-- collection of blood w/o injury to cerebrumcollection of blood w/o injury to cerebrumComplicated Complicated subduralsubdural-- both blood pooling and injury to the both blood pooling and injury to the cortex increase cortex increase intercerebralintercerebral pressure (50% mortality rate)pressure (50% mortality rate)

–– S/S: simple no LOC, complicated almost always S/S: simple no LOC, complicated almost always LOC and dilation of one pupil, associated LOC and dilation of one pupil, associated headache, dizziness, nausea, or sleepinessheadache, dizziness, nausea, or sleepiness

–– TxTx: immediate medical attention: immediate medical attention


ZygomaticZygomatic Complex Complex FxFx (cheekbone)(cheekbone)–– Etiology: direct blow, 3Etiology: direct blow, 3rdrd most commonmost common–– S/S: deformity, usually nosebleed S/S: deformity, usually nosebleed

((epistaxisepistaxis), seeing double (), seeing double (diplopiadiplopia), ), cheek numbnesscheek numbness


Mandible Mandible FxFx–– Etiology: 2Etiology: 2ndnd most common, direct blowmost common, direct blow–– S/S: possible deformity, loss of normal S/S: possible deformity, loss of normal

occlusion, pain occlusion, pain bittingbitting downdown

DislocationDislocation–– Etiology: direct blow with mouth openEtiology: direct blow with mouth open–– S/S: locked open mouth, jaw S/S: locked open mouth, jaw mvmtmvmt

impossibleimpossible


Nasal Nasal FxFx–– Etiology: most common facial Etiology: most common facial fxfx, frontal , frontal

or lateral blow to noseor lateral blow to nose–– S/S: profuse hemorrhaging, immediate S/S: profuse hemorrhaging, immediate

swelling, deformity, and swelling, deformity, and crepituscrepitus upon upon palpationpalpation

–– TxTx: refer to MD : refer to MD


Orbital Orbital FxFx–– Etiology: direct blow to the eyeball Etiology: direct blow to the eyeball

forcing it forcing it posteriorlyposteriorly–– S/S: S/S: diplopiadiplopia, restricted , restricted mvmtmvmt of eye, of eye,

downward displacement of eye, pain downward displacement of eye, pain swelling, and hemorrhageswelling, and hemorrhage

–– TxTx: refer to MD: refer to MD


Corneal AbrasionCorneal Abrasion–– Etiology: athlete with object in eye will Etiology: athlete with object in eye will

rub eye, in doing so, they will create an rub eye, in doing so, they will create an abrasionabrasion

–– S/S: severe pain, watering of eye, S/S: severe pain, watering of eye, photophobia, spasm of eye lidphotophobia, spasm of eye lid

–– TxTx: sterile rinse, cover, and refer: sterile rinse, cover, and refer

human anatomy & physiology - fisiokinesiterapiahuman anatomy & physiology lower extremity...

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