Slide 1

Anatomy Slide 2 http://medchrome.com/basic-science/anatomy/brachial-plexus-and-its-injury/ Slide 3 Sacral Plexus http://www.medicalook.com/human_anatomy/organs/Sacral_nerve_plexus.html Slide 4 Dermatomes http://healthpages.org/anatomy-function/spinal-cord-anatomy/ Slide 5 Dermatomes http://www.patient.co.uk/diagram/Dermatomes-arm.htm http://www.patient.co.uk/diagram/Dermatomes-leg.htm Slide 6 Reflexes Biceps-C5 Triceps-C7 Patella-L4 Achilles-S1 Slide 7 Shoulder Slide 8 MuscleActionNerve Serratus AnteriorScapula protraction, lateral rotation (allows abduction>90) Long Thoracic (C5,C6,C7) Pectoralis MinorScapula protraction, rib elevation Medial Pectoral (C8,T1) http://www.watkinson.co.nz/serratus_anterior.htm http://en.wikipedia.org/wiki/Pectoralis_minor_muscle Slide 9 MuscleActionNerve TrapeziusScapula: Elevation, Retraction, Depression, Lateral Rotation Spinal Accessory (CN XI) Levator ScapulaeScapula: Elevation, Medial Rotation Dorsal Scapular (C5) Rhomboid (Major and Minor) Scapula: Retraction, Depression, Medial Rotation Dorsal Scapular (C5) http://en.wikipedia.org/wiki/Trapezius_musclehttp://en.wikipedia.org/wiki/Levator_scapulae_musclehttp://en.wikipedia.org/wiki/Rhomboid_muscles Slide 10 MuscleActionNerve Pectoralis MajorArm: Flexion, Adduction, Medial Rotation Medial (C8,T1) and Lateral (C5,C6,C7) Pectoral CoracobrachialisArm: FlexionMusculocutaneous (C5,C6,C7) http://en.wikipedia.org/wiki/Pectoralis_major_musclehttp://en.wikipedia.org/wiki/Coracobrachialis_muscle Slide 11 MuscleActionNerve Latissimus DorsiArm: Extension, Adduction, Medial Rotation Thoracodorsal (C6,C7,C8) Teres MajorArm: Extension, Adduction, Medial Rotation Lower Subscapular (C5,C6) http://en.wikipedia.org/wiki/Latissimus_dorsi_musclehttp://www.ncpad.org/exercise/fact_sheet.php?sheet=426&section=2337 Slide 12 MuscleActionNerve DeltoidArm: Abduction, Flexion, Extension Axillary (C5,C6) SupraspinatusArm: AbductionSuprascapular (C5,C6) http://en.wikipedia.org/wiki/Deltoid_muscle http://www.magnetic-therapy-living.com/shoulder-pain-muscles.html Slide 13 MuscleActionNerve SubscapularisArm: Medial RotationUpper and Lower Subscapular (C5,C6) http://www.myweightlifting.com/subscapularis-muscle.html Slide 14 MuscleActionNerve InfraspinatusArm: Lateral RotationSuprascapular (C5,C6) Teres MinorArm: Lateral RotationAxillary (C5,C6) http://www.daviddarling.info/encyclopedia/R/rotator_cuff.html Slide 15 Arm Slide 16 MuscleActionNerve Biceps brachiiArm: Flexion Forearm: Flexion, Supination Musculocutaneous (C5,C6,C7) BrachialisForearm: FlexionMusculocutaneous BrachioradialisForearm: Flexion, Supination Radial (C5,C6,C7,C8,T1) http://en.wikipedia.org/wiki/Biceps http://www.teachpe.com/anatomy/muscles/brachioradialis.php http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/brachialis Slide 17 MuscleActionNerve Triceps brachiiForearm: extensionRadial (C5, C6, C7, C8, T1) http://en.wikipedia.org/wiki/Triceps_brachii_muscle Slide 18 Forearm Slide 19 MuscleActionNerve Flexor Carpi UlnarisHand: Flexion, AdductionUlnar (C8,T1) Median (C6,C7,C8,T1) Palmaris LongusHand: FlexionMedian Flexor Carpi RadialisHand: Flexion, AbductionMedian Pronator TeresForearm: PronationMedian http://en.wikipedia.org/wiki/File:Gray414.png Slide 20 MuscleActionNerve Flexor Digitorum Superficialis Hand: Flexion Digit: Flexion at MCP, PIP Median (C6,C7,C8,T1) http://www.teachpe.com/anatomy/muscles/flexor_digitoum_superficialis.php Slide 21 MuscleActionNerve Flexor Digitorum ProfundusHand: Flexion Digit: Flexion at MCP, PIP, DIP Ulnar Anterior Interosseous (branch of median) Flexor Pollicus Longus1 st Digit: Flexion at MCP, Interphalangeal Anterior Interosseous Pronator QuadratusForearm: PronationAnterior Interosseous http://en.wikipedia.org/wiki/Flexor_digitorum_profundus http://en.wikipedia.org/wiki/Flexor_pollicis_longus http://en.wikipedia.org/wiki/Pronator_quadratus Slide 22 MuscleActionNerve Extensor Carpi Radialis Longus Hand: Extension, AbductionRadial (C5,C6,C7,C8,T1) Extensor Carpi Radialis Brevis Hand: Extension, AbductionRadial Extensor DigitorumHand: Extension Digit: Extension Radial Extensor Digiti Minimi5 th Digit: ExtensionRadial Extensor Carpi UlnarisHand: Extension, AdductionRadial http://www.theodora.com/anatomy/the_muscles_and_fasciae_of_the_forearm.html Slide 23 MuscleActionNerve SupinatorForearm: SupinateRadial (C5,C6,C7,C8,T1) AnconeusStabilizes ElbowRadial Extensor Indicis2 nd Digit: ExtensionRadial Extensor Pollicus Brevis1 st Digit: ExtensionRadial Extensor Pollicus Longus1 st Digit: ExtensionRadial Abductor Pollicus Longus1 st Digit: AbductionRadial http://www.msd.com.mx/msdmexico/account/signin.html?request_url=ebooks/SurgicalExposuresinOrthopaedicsTheAnatomicApproach/sid132202.html Slide 24 Hand Slide 25 MuscleActionNerve Opponens Pollicus1 st Digit: OppositionRecurrent Median Flexor Pollicus Brevis1 st Digit: FlexionRecurrent Median Abductor Pollicus Brevis1 st Digit: AbductionRecurrent Median http://www.humpalphysicaltherapy.com/Injuries-Conditions/Hand/Hand-Anatomy/a~280/article.html Slide 26 MuscleActionNerve Opponens Digit Minimi5 th Digit: OppositionUlnar (C8,T1) Flexor Digit Minimi Brevis5 th Digit: FlexionUlnar Abductor Digiti Minimi Brevis 5 th Digit: AbductionUlnar http://www.humpalphysicaltherapy.com/Injuries-Conditions/Hand/Hand-Anatomy/a~280/article.html Slide 27 MuscleActionNerve LumbricalsMCP: Flexion PIP/DIP: Extension Medial 2: Ulnar Lateral 2: Median Dorsal InterosseousDigit: Abduction (away from middle finger) Ulnar Palmar InterosseousDigit: Adduction (towards middle finger) Ulnar Adductor Pollicus1 st Digit: AdductionUlnar http://ptlocker.com/anatomy.php?mode=view&id=10&sid=a877b1bdef71751e918ff1021561f5df http://www.mindspring.com/~amfatc/id43.html Slide 28 Hip Slide 29 MuscleActionNerve IliopsoasThigh: FlexionFemoral (L2,L3,L4) PectineusThigh: Flexion, Adduction, Medial Rotation Femoral SartoriusThigh: Flexion, Abduction Leg: Flexion Femoral http://en.wikipedia.org/wiki/Sartorius_muscle http://depts.washington.edu/msatlas/201.html http://medical- dictionary.thefreedictionary.com/pectineus Slide 30 MuscleActionNerve Gluteus MaximusThigh: Extension, Lateral Rotation Inferior Gluteal Nerve (L4,L5,S1) http://en.wikipedia.org/wiki/Gluteal_muscles Slide 31 MuscleActionNerve Gluteus MediusThigh: Abduction, Medial Rotation Superior Gluteal Nerve (L5,S1,S2) Gluteus MinimusThigh: Abduction, Medial Rotation Superior Gluteal Nerve Tensor Fascia LataeThigh: AbductionSuperior Gluteal Nerve http://www.mikereinold.com/2008/12/gluteus-medius-evaluation-strengthening.html http://www.sciencephoto.com/media/200355/enlarge Slide 32 MuscleActionNerve PiriformisThigh: Lateral RotationN. to Piriformis (L5,S1,S2) Obturator ExternusThigh: Lateral RotationObturator (L2,L3,L4) Obturator InternusThigh: Lateral RotationN. to Obturator Internus (L5,S1,S2) Superior GemellusThigh: Lateral RotationN. to Obturator Internus Inferior GemellusThigh: Lateral RotationN. to Quadratus Femoris (L4,L5,S1) Quadratus FemorisThigh: Lateral RotationN. to Quadratus Femoris http://en.wikipedia.org/wiki/Lateral_rotator_group Slide 33 MuscleActionNerve GracilisThigh: Adduction Leg: Flexion Obturator (L2,L3,L4) Adductor LongusThigh: AdductionObturator Adductor BrevisThigh: AdductionObturator Adductor MagnusThigh: AdductionObturator http://en.wikipedia.org/wiki/Gracilis_muscle Slide 34 Thigh Slide 35 MuscleActionNerve Rectus FemorisThigh: Flexion Leg: Extension Femoral (L2,L3,L4) Vastus MedialisLeg: ExtensionFemoral Vastus LateralisLeg: ExtensionFemoral Vastus IntermediusLeg: ExtensionFemoral http://www.criticalbench.com/quadricep-muscles.htm Slide 36 MuscleActionNerve Biceps FemorisThigh: Extension Leg: Flexion, Lateral Rotation Sciatic (L4,L5,S1,S2,S3) SemimembranosusThigh: Extension Leg: Flexion, Medial Rotation Sciatic SemiteninosusThigh: Extension Leg: Flexion, Medial Rotation Sciatic http://www.criticalbench.com/hamstring-muscles.htm http://www.exrx.net/Muscles/Hamstrings.html Slide 37 Leg Slide 38 MuscleActionNerve Tibialis AnteriorFoot: Dorsiflexion, InversionDeep Peroneal Extensor Hallucis LongusGreat Toe: ExtensionDeep Peroneal Extensor Digitorum LongusFoot: Dorsiflexion Digits: Extension Deep Peroneal http://www.teachpe.com/anatomy/muscles/extensor_hallucis_longus.php http://www.teachpe.com/anatomy/muscles/extensor_digitorum_longus.php http://depts.washington.edu/msatlas/221.html Slide 39 MuscleActionNerve GastrocnemiusLeg: Flexion Foot: Plantarflexion Tibial (S1,S2) SoleusFoot: PlantarflexionTibial PlantarisLeg: Flexion Foot: Plantarflexion Tibial http://legacy.owensboro.kctcs.edu/gcaplan/songbook/C.%20%20Gary%20the%20Gastrocnemius.htm http://www.myweightlifting.com/soleus-muscle.html Slide 40 MuscleActionNerve Flexor Digitorum LongusDigit: FlexionTibial Tibialis PosteriorFoot: Inversion, Plantarflexion Tibial Flexor Hallucis LongusFoot: Flexion Great Toe: Flexion Tibial http://en.wikipedia.org/wiki/File:Tibialis_posterior.png http://www.teachpe.com/anatomy/muscles/flexor_digitorum_longus.phphttp://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/lower-body/flexor-hallucis-longus Slide 41 MuscleActionNerve Fibularis LongusFoot: Eversion, Plantarflexion Superficial Peroneal Fibularis BrevisFoot: Eversion, Plantarflexion Superfical Peroneal http://www.teachpe.com/anatomy/muscles/peroneus_brevis.php http://professionalmassagetherapist.org/anatomy/anatomy_Results.php Slide 42 Foot Slide 43 MuscleActionNerve Extensor Digitorum BrevisDigit 2,3,4: ExtensionDeep Peroneal http://www.mendmeshop.com/toe/toe-deformities.php Slide 44 MuscleActionNerve Abductor HallucisGreat Toe: AbductionMedial Plantar (L4,L5,S1) Flexor Digitorum BrevisDigit: FlexionMedial Plantar Abductor Digiti Minimi5 th Digit: AbductionLateral Plantar (S1,S2) http://ptlocker.com/anatomy.php?mode=results&sid=e9ba56c63a5434d1623c9d04860f1629&articulation=8 Slide 45 MuscleActionNerve Quadratus PlantaeDigit 2-5: Assist FlexionLateral Plantar (S1,S2) LumbricalsFlex: MTP Extend: PIP and DIP 1 st : Medial Plantar (L4,L4,S1) 2,3,4: Lateral Plantar http://ptlocker.com/anatomy.php?mode=view&id=106&sid=f01e4ab7c6bdf3177462a88becbaa0a 2 Slide 46 MuscleActionNerve Flexor Hallucis BrevisGreat Toe: Flexion MTPMedial Plantar (L4,L5,S1) Flexor Digiti Minimi5 th Toe: Flexion (MTP+PIP)Lateral Plantar (S1,S2) Adductor HallucisGreat Toe: Adduction (Towards 2 nd Toe) Lateral Plantar http://ptlocker.com/anatomy.php?mode=view&id=7&sid=2f6afd50169ba3f0d2894354be7dfd7 0 Slide 47 MuscleActionNerve Plantar InterosseiToes: Adduction (Toward 2 nd Toe)Lateral Plantar (S1,S2) Dorsal InterosseiToes: Abduction (Away from 2 nd Toe) Lateral Plantar http://en.wikipedia.org/wiki/Plantar_interossei_muscles http://en.wikipedia.org/wiki/Dorsal_interossei_of_the_foot Slide 48 Clinical Correlations Slide 49 Winged Scapula- Clinical Correlation Damage to Long Thoracic Nerve Common during radical mastectomy Loss of innervation to Serratus Anterior Results in Winged Scapula Test by having patient push against wall http://muscletesting.com/blog/health/experiments-in-muscle-testing-episode-02-the-problem-with-bicep-curls/attachment/tumblr_lfshdl9sjy1qb8tcvo1_500-2/ Slide 50 Erb-Duchenne Palsy Injury to Superior Trunk of brachial plexus Traumatic Birth- Shoulder Dystocia Loss of C5 and C6 Dorsal Scapular N. (Levator Scapulae, Rhomboids) N. to subclavius Suprascapular N. (Supraspinatus, Infraspinatus) Upper and Lower Subscapular N. (Subscapularis, Teres Major) Axillary N. (Deltoid, Teres Minor) Loss of abduction Deltoid and supraspinatus Loss of external rotation Infraspinatus and teres minor Imbalances cause arm to be held in adduction and medial rotation Waiters Tip http://pediatric-orthopedics.org/orthopedic-conditions-from-birth-to-walking/24-birth-palsies-brachial-plexus-injuries.html Slide 51 Claws Defined by lumbricals Flex MCP, Extend PIP and DIP Loss of function: MCP hyperextension, PIP and DIP flexion Ulnar Nerve: Digits 4 and 5 Median Nerve: Digits 2 and 3 Klumpkes: Loss of Inferior Trunk of brachial plexus (C8,T1) All intrinsic hand muscles Can Test by asking patient to make a fist Ulnar Claw http://www.aafp.org/afp/2009/0501/p793.htm l Median Claw http://stevensadmissions.typepad.com/julia/2011/11/see-one-do-one-teach-one.html Klumpkes Total Claw http://caseconnector.jbjs.org/article.aspx?articleid=33726 Slide 52 Radial Nerve Saturday Night Palsy Pass out with arm over chair, Use of crutches Injury at axilla: loss of triceps, wrist extension (wrist drop), digit extension Mid-Shaft Humeral Fracture Radial nerve injured as passes posteriorly in spiral groove Loss of wrist extension (wrist drop), digit extension Proximal Radial Head Radial nerve injured as passes toward posterior compartment of forearm Loss of digit extension http://diseaseprone.fieldofscience.com/2010/12/saturday-night-palsy.html http://www.samiralgazzar.com/article-448.html Slide 53 Trendelenburg Sign Weakness of thigh abductors Gluteus Medius and Gluteus Minimus Superior Gluteal Nerve (L5,S1,S2) Test by having patient stand on 1 leg Pelvis sags on contralateral side when standing on affected leg http://www.ptonthenet.com/blog/the-inner-unit/gluteus-medius-an-integral-part-of-foot-function-260 Slide 54 Foot Drop Injury to Common Peroneal N. as wraps around head of fibula Be careful with tight bandages and casting Loss of dorsiflexion (deep peroneal) Compensation with Steppage Gait Loss of sensation on dorsum of foot (superficial peroneal) http://www.advancedfootcare.net/footdrop.html http://www.comfortshoe.com/foot-conditions/drop-foot-signs-symptoms-and-treatment/ Slide 55 Club Foot Talipes Equinovarus Associated with spina bifida May require serial casting or orthopaedic surgery http://www.northcoastfootcareblog.com/clubfoot-recurrence-in-rural-native-americans/