Kines Exam 4

Label these structures from the Innominate bone

A. Posterior Superior Iliac Spine

B. Posterior Inferior Iliac Spine

C. Greater Sciatic Notch

D. Lesser Sciatic Notch

E. Ischial Tuberosity

F. Superior Pubic Ramus

G. Inferior Pubic Ramus

H. Pubic Body

I. Ischial Spine

J. Acetabulum

K. Anterior Inferior Iliac Spine

L. Anterior Superior Iliac Spine

M. Iliac Spine

N. Obturator Foramen

What structures make up the pelvic girdle?

two innominate bones and sacrum

What 2 joints are within the pelvic girdle? What type of joint are they?

Sacroiliac joint- non-axial diarthrodial (gliding)

Pubic symphysis - amphiarthrodial (fibrocartilage)

What are the differences between male and female pelvises?

Females V.S Men

• Pelvic arch in females is >90 degrees

• men’s width is more narrow

• the pelvic inlet or brim is wider/larger in women

• the surface markings in women are smoother than men

• bones in females are lighter than mens

Ligaments of the Pelvic Girdle and the structures they attach

Iliolumbar ligament- ileum to L5

Inguinal ligament- connects ASIS to pubic tubercle

Anterior Sacroiliac ligament- sacrum to ileum in front

Ligaments of the Pelvic Girdle and the structures they attach

Sacrotuberous ligament- sacrum to ischial tuberosity

Posterior sacroiliac ligament- sacrum to iliac in the back

Sacrospinous- sacrum to ischial spine

Where does the Pelvis tilts when posterior and anterior and what plane of motion?

Posterior- rotates to the back

Anterior- rotates to the front

Sagittal Plane

What are the motions of the Pelvis?

1. Anterior rotation (forward tilt)-rotation in the sagittal plane in which upper part of the pelvis tilted forward

2. Posterior rotation (tilt backward)- rotation in the sagittal plane

3. Left lateral tilt- rotation in the frontal plane in which left hip is lower than right hip

4. Right lateral tilt- rotation in the frontal plane in which right hip is lower than the left hip

5. Left rotation- on the transverse plane in which our trunk turns left

6. Right rotation- on the transverse plane in which our trunk turns right

Why are there more injuries to shoulder than hip

1. the hip has more muscles to stabilize the joint

2. the ligaments in the hip are stronger

3. the acetabulum labrum is deeper for more stability than the glenoid labrum

Label the following

A. 7 true ribs

B. 8-12 ribs false and floating

C. 8-10 false ribs

D. 11-12 floating ribs

E. Thoracic vertebrae

F. Manubrium of Sternum

G. Body of Sternum

H. Sternum

I. Xiphoid process of Sternum

K. Intercostal Cartilage

How many attachments in all for ribs ____ to ____ Left and Right

there are 6 attachments for ribs #1-10

What two joints does the vertebrae attach to the ribs? What kind of joints are they

1. Costovertebral joint- head of rib and vertebral body

2. Costotransverse joint-rib tubercle and transverse process

Diarthrodial, non-axial, synovial

What are the joints of the Sternum?

1. Manubriosternal Joint- manubrium to body of sternum

Amphiarthrodial, Symphysis, fibrous

What is the joints of the Sternum?

1. Xiphisternal- xiphoid process to body of sternum

Amphiarthrodial, Synchondrosis, Cartilaginous

Label this joint of the rib cage?

1. Costochondral Joint- 10 on R. and 10 on L

Amphiarthrodial, Synchondrosis, Cartilaginous

Label this joint of the rib cage

1. Chondrosternal joint

Diarthrodial, non-axial, synovial

Label the joint of the rib cage

1. Interchondral Joint

Diarthrodial, non-axial, synovial

What are the muscles of ventilation? What do they do?

External Intercostals- inspiration

Internal Intercostals- expiration

Diaphragm- relaxes for inhalation and contracts for exhalation innervated by nerve C3- if injured, person stops breathing on their own

What are the trunk flexors? What do they do?

Rectus Abdominis- flexes trunk and lateral flexion

External Oblique- flexes trunk, lateral flexion, and when R contracts for left rotation (vise versa)

Internal Oblique-flexes trunk, lateral flexion, and R and L rotation

Transverse Abdominis and Quadratus Lumborum - stabilizes trunk flexors, KEGAL exercise

Psoas Major- flexes hip and trunk

Psoas Minor

What are the Superficial Spinal Extensors?

1. Spinalis

2. Longissimus

3. Iliocostalis

What are the Deep Spinal Erector muscles?

1. Rotatores

2. Semispinalis

3. Multifidus

What joints make up the shoulder girdle?

AC joint-L and R acromioclavicular joint

SC joint- L and R sternoclavicular joint

GH joint- L and R glenohumeral joint

Scapulothoracic joint

What is the conoid tubercle important?

The conoid tubercle is important because it attaches the clavicle conoid ligament (coracoclavicular ligament) to the coracoid.

Where on the clavicle does it fracture the most? Who is more likely to get cosmetic surgery got a healed clavicle bump?

about 80% of fractures occur in the middle third area

females are more likely to request cosmetic surgery than males

Where on the shoulder do we see pain from injury to biceps brachii?

Supraglenoid tubercle which is near acromion process (long head) and Coracoid process (short head) are origin attachments of the muscle

Where on the humerus is there most likely an injury?

the surgical neck, due to the weakest spot on the humerus

What ligaments make up the sternoclavicular joint?

1. Anterior and Posterior sternoclavicular ligament

2. Costoclavicular ligament

3. Interclavicular ligament

What kind of joint is the sternoclavicular joint?

It is diarthrodial, NON-AXIAL MULTI-DIRECTIONAL- since it doesn’t technically flex, extend, etc. It moves though on all planes, with reference to movement of the arm. up/down, retract/protract, etc.

What kinds of joint is the Acromioclavicular joint?

It is diarthrodial, NON-AXIAL MULTI-DIRECTIONAL- since it doesn’t technically flex, extend, etc. It moves though on all planes, with reference to movement of the arm. up/down, retract/protract, etc.

What ligaments make up the glenohumeral joint ?

1. Acromioclavicular lig.-acromion process and clavicle

2. Coracoacromial lig.- coracoid process and acromion process

3. Coracoclavicular lig.- coracoid process and clavicle

4. Glenohumeral lig.- glenoid cavity with humerus

What is a common injury to the acromioclavicular ligament?

Acromioclavicular sprain

MOI: posteriorly directed force on scapula (FOOSH)

What injury can happen to the glenohumeral joint?

Dislocation

What are the scapulothoracic muscles?

Pectoralis minor, serratus anterior, trapezius, rhomboid major and minor, and levator scapulae and subclavius

What are the Scapulohumeral muscles?

Rotator Cuff muscles (SITS)- Supraspinatus, Infraspinatus, Teres minor, and Subscapularis

Other muscles: Teres major, Teres minor, Deltoid, coracobrachialis, triceps brachii, and biceps brachii

Label the following

A. Supraspinatus- arm abduction

B. Rhomboid major- retracts scapula

C. Trapezius- upper- elevates middle- retract scapula lower- depress scapula

D. Infraspinatus- laterally rotates humerus

E. Teres Minor- lateral rotation of humerus

F. Teres Major- medial rotation of humerus

G. Latissimus Dorsi- adducts arm and medially rotates arm

Label the thoracic and abdominal muscles and functions

A. Pectoralis Major- adducts arm

B. Serratus Anterior- protracts scapula

C. External Oblique- trunk rotation/lateral flexion of trunk

D. Innermost Intercostals- assist in depress the ribs for exhalation

E. Outer Intercostals- elevate the ribs for inhalation

G. Inner Intercostals- depress the ribs for exhalation

H. Abdominus Rectus- trunk flexion

I. Internal Oblique- trunk flexion

Label the ligaments of the shoulder

A. Acromioclavicular ligament

B. Coracoacromial ligament

C. Coracoclavicular ligament

D. Coracoacromial ligament

E. Glenohumeral ligament

Label the following shoulder and arm muscles

A. Deltoid

B. Subscapularis

C. Coracobrachialis

E. Biceps-short head (biceps long head is lateral to that)

Label the shoulder and arm muscles

A. Supraspinatus

B. Infraspinatus

C. Teres Minor

D. Teres Major

E. Triceps Brachii Long head

F. Triceps Brachii Lateral head (underneath is triceps medial head)

G. Deltoid

H. Biceps brachii (long head)

What is a rotator cuff impingement?

it is the injury of a rotator cuff muscle tendon being squeezed/ pinched leading to irritation, inflammation and pain

most common is the supraspinatus tendon

know the OIF and innervation of Scapulothoracic, Scapulohumeral, and Humerothoracic muscles

Got it!

When the arm/elbow is fully extended and we rotate it, what is it called in terms of rotation?, when the arm/elbow is flexed what is it called in terms of rotation?

Fully extended- medial and lateral rotation of shoulder

Flexed- supination and pronation of forearm

What kinds of joint is the elbow joint? What makes it different to the knee joint?

A diarthrodial, synovial hinge-joint

The knee joint is biaxial do to the “screw-home mechanism” which allows the knee to lock by rotating

Why does the Humeroulnar joint never really get injured during a FOOSH injury?

The strong lock of the olecranon process of the ulna and the olecranon fossa of the humerus allows for a strong stable joint, while the distal wrist and shoulder joints are less stable

What kind of joint is the radiocapitellar joint (radiohumeral)?

Non-axial diarthrodial joint (gliding)

What kinds of joint is the Radioulnar joint?

An amphiarthrodial syndesmosis joint with interosseous membrane.

What happens during forearm supination and pronation?

The radius crosses over the ulna, while the ulna stays in place.

What is unique about the elbow ligaments insertions?

They all come together and insert into the elbow joint capsule

Label the ligaments on the elbow

A. Humerus

B. Annular ligament

C. Radial Collateral ligament/ LCL

D. Ulna

E. Radius

Label the elbow ligaments

A. Humerus

B. Ulnar Collateral Ligament/ MCL

C. Joint capsule

D. Annular Ligament'

E. Ulna

F. Radius

What does the LCL/RCL prevent? MCL/UCL? and Annular ligament?

LCL/RCL: prevents varus forces

MCL/UCL: prevents valgus forces and stabilizes humerus

Annular ligament: hold radial head to ulnar notch

Who is Tommy John? What surgery did he get?

Tommy John was the first MLB player who tore his UCL, he then got this surgery which took his palmaris longus tendon and drilled three holes into the humerus and ulna and threaded the tendon to strengthen it

He then was able to make a full recovery and was able to return to the MLB

Know the OIF and innervation of the Elbow Joint crossing shoulder muscles

Biceps Brachii, Coracobrachialis, and Triceps brachii

Know the OIF and innervation of the Elbow Joint crossing only elbow muscles

Brachialis, Brachioradialis, and Anconeus

Know the OIF and innervation of the Elbow Joint controlling supination and pronation muscles

Pronator teres, Pronator quadratus, Biceps brachii and Supinator

What is Scapulohumeral rhythm?

motions of the scapula and glenohumeral joint that are combined with movement of scapula around rib cage

scapula moves when humerus moves

protaction, retraction, elevation and depression

What plane of movement does the glenohumeral joint during horizontal abduction and adduction occur on?

The transverse plane

Know the OIF and innervation of the wrist flexors and extensors

Flexor Carpi Radialis, Flexor Carpi Ulnaris, Palmaris Longus, Extensor Carpi Radialis Brevis, Extensor Carpi Radialis Brevis, Extensor Carpi Ulnaris

What joint is most responsible for wrist pronation and supination?

The distal Radioulnar joint

Label the carpal bones only

A. Trapezoid (toward the right is the Trapezium)

B. Scaphoid

C. Capitate

D. Hamate

E. Lunate

F. Triquetrum (pisiform on top)

What is the Roof, Bottom and Contents inside the Carpal Tunnel?

Roof: flexor retinaculum

Bottom: carpal bones

Contents:

4 tendons of Flexor Digitorum Superficialis

4 tendons of Flexor Digitorum Profundus

1 tendon of Flexor Pollicis Longus

Median Nerve

What is Carpal Tunnel Syndrome? What 2 Occupations and Sports experience this syndrome?

It is the compression of the Median nerve within the Flexor Retinaculum, causing pain, tingling, and numbness in fingers

Occupations: Hairdresser, desk job

Sports: Rock climbing, Tennis

What types of joints are in the wrist, carpometacarpal, metacarpophalangeal, and interphalangeal

All diarthrodial-synovial

Wrist- biaxial: flexion/extension and radial/ulnar deviation thumb: opposition/reposition

CMC- non-axial

MCP- biaxial: flexion/extension and abduction/adduction

IP-uniaxial flexion/extension

What are some anterior ligaments of the wrist?

Transverse Carpal ligament (flexor retinaculum)

Palmar radiocarpal ligament

Palmar ulnocarpal ligament

What are some dorsal ligaments of the wrist?

Dorsal Radiocarpal ligament

Dorsal Ulnocarpal ligament

What are the 3 groups of intrinsic hand muscles

Thenar Eminence

Hypothenar

Intermediate

What muscles are in Thenar Eminence group and their innervation?

1. Abductor pollicis brevis- median

2. flexor pollicis brevis-median

3. opponens pollicis-median

4. adductor pollicis- ulnar

What muscles are in Hypothenar group and their innervation?

1. abductor digiti minimi- ulnar

2. flexor digiti minimi- ulnar

3. opponens digiti minimi- ulnar

What muscles are in the Intermediate group and their innervation?

1. Dorsal interossei- ulnar

2. Palmar interossei- ulnar

3. Lumbricals- two we do not have to know, but they flex and extend phalanges

OIF and innervation of Flexor Digitorum profundus?

O: medial shaft of ulna and interosseous membrane

I: base of distal phalanx 2-5

F: flexions MP joint and DIP

innervation- median

OIF and innervation of flexor digitorum superficialis

O: Medial epicondyle of humerus

I: Intermediate phalanges (2-5)

F: Flexion of phalanges (2-5)

innervation: Median

OIF and innervation of Extensor Digitorum

O: Lateral epicondyle of humerus

I: Middle and Distal Phalanges (2-5)

F: Extension of phalanges (2-5)

innervation: Radial

What is scoliosis? MOI? treatment?

A lateral curvature of the spine >10° (Cobb angle), often with vertebral rotation

MOI: genetics, neuromuscular disorders, adolescent females, postural habits

Treatment: PT for posture, surgical correction

What is Kyphosis? MOI? treatment?

Excessive thoracic flexion (rounded upper back).

MOI: Postural (most common in adolescents), Scheuermann’s disease, Osteoporotic compression fractures, Degenerative disc disease, Trauma

Treatment: Osteoporosis treatment, surgery if deformity, PT for posture

What is Lordosis? MOI? treatment?

Excessive lumbar extension (increased lumbar curve).

MOI: Weak abdominals, Tight hip flexors, Obesity, Pregnancy, Postural habits

Treatment: Stretch hip flexors, Strengthen core + glutes, Weight management, Correct posture, Treat underlying pathology (e.g., spondylolisthesis)

What is Herniated Intervertebral Discs? MOI? treatment?

Nucleus pulposus protrudes through annulus fibrosus → compresses spinal nerve root.

MOI: Flexion + rotation under load (lifting with poor mechanics), Degeneration, heavy lifting

Treatment: NSAIDs, rest, PT, Epidural steroid injections

Surgery (microdiscectomy)

What is Spinal Cord Injuries ? MOI? treatment?

Damage to spinal cord → motor, sensory, autonomic deficits below the level of injury.

MOI: Trauma (MVC, falls, sports), Penetrating injury, Tumor, infection, ischemia

Treatment: Immobilization, High‑dose steroids, Surgical decompression, Rehab, PT/OT, Prevention of complications

Paraplegia vs Quadriplegia

Paraplegia: injury below T1; Affects legs only

Quadriplegia: Injury at or above C5–T1; Affects all four limbs

Sprains/ Strains, Dislocations/Subluxations

Sprains: tear to ligaments

Strains: tear to muscles/tendons

Dislocations: full loss of joint articulation (FOOSH) surgically put back in

Subluxations: partial loss of joint articulation (FOOSH) popped back in easily

Clinically, how can you check the function and sensory of the terminal branches of the brachial

plexus in the upper extremity?

Musculocutaneous Nerve

• Motor: Elbow flexion (biceps)

• Sensory: Lateral forearm

Axillary Nerve

• Motor: Shoulder abduction (deltoid)

• Sensory: Lateral shoulder

Radial Nerve

• Motor: Wrist extension, finger extension, thumbs‑up

• Sensory: Dorsal 1st web space

Median Nerve

• Motor: Thumb opposition, “OK sign”

• Sensory: Palmar digits 1–3 (tip of index finger = pure median)

Ulnar Nerve

• Motor: Finger abduction/adduction (interossei), Froment’s sign

• Sensory: Digit 5 + ulnar half of digit 4

Clinically, how can you check the function of the arterial supply in the upper extremity?

• Radial pulse (lateral wrist)

• Ulnar pulse (medial wrist)

• Brachial pulse (antecubital fossa)

• Capillary refill <2 sec

• Skin temperature & color (cool, pale = poor perfusion)

• Compare BP between arms (>20 mmHg difference = vascular issue)

• Doppler if pulses are weak or absent

• Check for ischemic signs (mottling, delayed healing, trophic changes)

List the Arterial Supply from Heart to Phalanges

1. Heart (left ventricle)

2. Aorta

3. Brachiocephalic

4. Subclavian

5. Axillary

6. Brachial

7. Ulnar/Radial

8. Deep Palmar/Superficial Palmar Arches

9. Digital

The Brachial Plexus “Read The Damn Cadaver Book”

o Roots (C5, C6, C7, C8, T1)

o Trunks (Superior, Middle, Inferior)

o Divisions (3 Anterior, 3 Posterior)

o Cords (Lateral, Medial, Posterior)

o Branches (Musculocutaneous, Ulnar, Radial, Median, Axillary)

draw it out