HCOM Wellness Exam 2

sports physical has 5 goals

1) determine general psychological and physical health of adolescent athlete

2) evaluate for conditions that may be life threatening or debilitating

3) evaluate for conditions that may predispose for injury or illness

4) provide opportunity for discussion of health and lifestyle issues

5) serve as entry point for health care system for adolescents without healthcare or medical home

somatic nervous system

conscious, voluntary

dermis of skin, skeletal muscles, connective tissue

sensory and motor inputs to skin, skeletal muscles for voluntary movement/actions

autonomic nervous system

unconscious, involuntary

glands, cardiac muscle, smooth muscle

sensory and motor inputs for homeostasis with 2 branches of motor systems

sympathetic and parasympathetic

sympathetic nervous system

fight or flight

dilate pupil, slow digestion, increase heart rate

parasympathetic nervous system

rest and digest

constrict pupil, increase digestion, slow heart rate

dendrites

receives and processes electrochemical signals from other neurons

axon

transmits electrical impulses down neuron to axon terminal in order to send chemical messages to other neurons

axon hillock

initiates action potentials

soma

central part of neuron that contains nucleus

axodendritic synapses

synapses of axon and dendrite to pass chemical messages

receptor membrane

specialized part of neuron that detects stimuli

located at distal end of peripheral axon

converts physical/chemical stimuli into electrical signals

peripheral axon process

part of axon that extends from receptor toward cell body

conducts sensory input from periphery to cell body

central axon process

part of axon that extends from cell body into spinal cord or brainstem

sends sensory signal into CNS

soma

cell body of neuron

located in sensory ganglions

sensory ganglia

cluster of sensory neuron cell bodies located just outside spinal cord

contains soma of primary sensory neurons

Guillain-Barre syndrome

autoimmune disorder

demyelinated in PNS

MS

autoimmune disorder

demyelination in CNS

muscular dystrophy

genetic

affect both PNS and CNS

pectoralis major attachment

medial: anterior surface or medial half of clavicle, anterior surface of sternum, superior six costal cartilages, aponeurosis of external oblique

lateral: lateral lip of intertubercular sulcus of humerus

pectoralis major innervation

lateral and medial pectoral nerves

clavicular head (C5-6)

sternocostal head

pectoralis major action

ADducts and medially rotates humerus

draws scapula anteriorly and inferiorly

pectoralis minor attachement

medial: 3rd-5th ribs near their costal cartilages

lateral: medial border and superior surface of coracoid process of scapula

pectoralis minor innervation

medial pectoral nerve (C8, T1)

pectoralis minor action

stabilizes scapula by drawing inferiorly and anteriorly against thoracic wall

subclavius attachment

medial: junction of 1st rib and costal cartilage

lateral: inferior surface of middle third of clavicle

subclavius innervation

subclavian nerve (C5-6)

subclavius action

anchors and depresses clavicle

serratus anterior attachment

medial: external surface of lateral parts of 1st-8th ribs

lateral: anterior surface of medial border of scapula

serratus anterior innervation

long thoracic nerve (C5-7)

serratus anterior action

protracts scapula and holds against thoracic wall

rotates scapula

superficial veins of upper limbs

cephalic vein

basilic vein

median antebrachial vein

deep veins

pectoral lymph nodes

3-5 nodes on medial wall of axilla, lateral thoracic vein and inferior border of pectoralis minor

receive lymph from anterior thoracic wall including most of breast

subscapular lymph nodes

6-7 nodes along posterior axillary fold and subscapular blood vessels

receive lymph from posterior thoracic wall and scapular region

humeral (lateral) lymph nodes

receive nearly all lymph from upper limb except cephalic vein lymphatic vessels

central lymph nodes

all three passes into 3-4 large central nodes, deep to pec minor; then pass to apical nodes

apical lymph nodes

at apex of axilla, medial side of axillary vein and 1st part of axillary artery

receive lymph from all axillary nodes and proximal cephalic vein

pectoral fascia

layer invests pectoralis major and is continuous inferiorly with fascia of anterior abdominal wall

axillary fascia

leaving lateral border of pec major, pectoral fascia becomes axillary fascia which forms floor of axilla

clavipectoral fascia

located deep to pectoral fascia and pec major, layer descends from clavicle; encloses subclavius muscle and then pec minor muscle becoming continuous inferiorly with axillary fascia

deltoid fascia

fascia invests deltoid muscle and is continuous with pec fascia anteriorly and dense infraspinous fascia posteriorly

scapulohumeral muscles fascia

deep fascia also ensheath scapulohumeral muscles that cover scapula and contribute to bulk of shoulder

brachial fascia

sheath of deep fascia that encloses arm like snug sleeve

deltoid attachement

proximal: lateral third of clavicle; acromion and spine of scapula

distal: deltoid tuberosity of humerus

deltoid innervation

axillary nerve (C5-6)

deltoid actions

clavicular part flexes and medially rotates shoulder joint

acromial part ABducts shoulder joint

spinal part extends and laterally rotates shoulder joint

supraspinatus attachments

proximal: supraspinous fossa of scapula

distal: superior facets of greater tubercle of humerus

supraspinatus innervation

suprascapular nerve (C4-6)

supraspinatus action

initiates and assists deltoid in ABduction of shoulder joint and acts with other rotator cuff muscles

infraspinatus attachments

proximal: infraspinous fossa of scapula

distal: facets of greater tubercle of humerus

infraspinatus innervation

suprascapular nerve (C5-6)

infraspinatus actions

laterally rotates shoulder joint and acts with other rotator cuff muscles

teres minor attachments

proximal: middle part of lateral border of scapula

distal: facets of greater tubercle of humerus

teres minor innervation

axillary nerve (C5-6)

teres minor actions

laterally rotates shoulder joint and acts with other rotator cuff muscles

teres major attachments

proximal: inferior part of lateral border of scapula and posterior surface of inferior angle of scapula

distal: medial lip of intertubercular sulcus of humerus

teres major innervation

lower subscapular nerve (C5,6)

teres major actions

ADducts and medially rotates shoulder joint

subscapularis attachments

proximal: subscapular fossa

distal: lesser tubercle of humerus

subscapularis innervation

upper and lower subscapular nerves (C5-7)

subscapularis action

medially rotates and ADducts shoulder joint and acts with other rotator cuff muscles

biceps brachii attachment

proximal: short head → tip of coracoid process of scapula, long head → supraglenoid tubercle of scapula

distal: tuberosity of radius and fascia of forearm via bicipital aponeurosis

biceps brachii innervation

musculocutaneous nerve (C5,6)

biceps brachii actions

supinates forearm, flexes elbow joint, flexes shoulder joint

brachialis attachments

proximal: distal half of anterior surface of humerus

distal: coronoid process and tuberosity of ulna

brachialis innervation

musculocutaneous nerve (C5-6)

brachialis action

flexes elbow joint in all positions

coracobracialis attachment

proximal: tip of coracoid process of scapula

distal: middle third of medial surface of humerus

coracobrachialis innervation

musculocutaneous nerve (C5-7)

coracobrachialis actions

helps flex and ADduct shoulder joint

triceps brachii attachment

proximal: long head → infraglenoid tubercle of scapula, lateral head → posterior surface of humerus, medial head → posterior surface of humerus

distal: proximal end of olecranon of ulna and fascia of forearm

triceps brachii innervation

radial nerve (C6-8)

triceps brachii actions

chief extensor of elbow joint

anconeus attachment

proximal: lateral epicondyle of humerus

distal: lateral surface of olecranon and superior part of posterior surface of ulna

anconeus innnervation

radial nerve (C7-8, T1)

anconeus actions

assists triceps in extending elbow joint, stabilizes elbow, ABducts ulna during pronation

sternoclavicular (SC) joint ligaments

anterior and posterior SC ligament

interclavicular ligament

costoclavicular ligament

acromioclavicular (AC) joint ligaments

AC ligament

coracoacromial ligament → conoid ligament and trapezoid ligament

glenohumeral joint ligaments

GH ligament

coracohumeral ligament

transverse humeral ligament

coracoacromial arch

rotator cuff muscles

supraspinatus, infraspinatus, teres minor and subscapularis muscles

indications for DMFR

somatic dysfunction

muscle hypertonicity

improved circulation, venous and lymphatic flow

patient relaxation

contraindications for DMFR

absolute → lack of consent

relative → fracture/dislocation, acute sprain/strain, osteoporosis/penia, infection locally, malignancy, vascular/neurologic compromise

acute tissue texture changes

skin: warm, moist, red, and inflamed

tissue: swollen and boggy with increased moisture

musculature hypertonic

pain: sharp and localized

chronic tissue texture changes

skin: cool, pale and dry

tissue: thin, smooth, firm with fibrotic quality

musculature: decreased tone, ropy and stiff

pain: dull, achy and diffuse

Pacinian corpuscles

detects rapid, local compression of tissue and transmitted vibrations

Meissner’s corpuscles

sensitive to low-frequency vibrations

Ruffini’s endings

detects heavy, prolonged touch and pressure

Merkel cell

detects steady touch and info about size and texture

A-delta

detects touch and pressure, temp and pain

C free nerve endings

detects tickle, itch and paing

golgi tendon organ

receptors excited by muscle tension

muscle spindle

receptors excited by muscle stretch

astrocytes

most abundant glial cell

maintain blood-brain barrier

regulate extracellular ion and neurotransmitter levels

provide structural support and repair after injury

oligodendrocytes

form myelin sheath around multiple CNS axons

microglia

immune cells of CNS

derived from mesoderm

phagocytose debris and release inflammatory cytokines in injury/inflection

ependymal cells

line ventricles and central canal of spinal cord

produce and circulate CSF via cilia

Schwann cells

form myelin sheath around 1 axon per cell

aid in axonal regeneration after injury

satellite cells

surround neuron cell bodies in ganglia

provide structural and metabolic support

spinothalamic tract (STT)

pain, temperature, and crude touch

posterior column-medial lemniscus system

vibration, proprioception and fine touch

upper motor neuron symptoms

muscle weakness

spacticity

hyperreflexia

positive Babinski

minimal muscle atrophy

no fasciculations