Physio anatomy.pdf

THE UNIVERSITY OF MELBOURNE

DEPARTMENT OF PHYSIOTHERAPY Independent Learning Guide Phys@tomy FOR Doctor Doctor of Physiotherapy Physiotherapy

Introduction: Welcome to the Doctor of Physiotherapy Program. Phys@tomy is a self directed learning package that has been developed to facilitate student revision and preparation for entry into the Doctor of Physiotherapy Program at the University of Melbourne. The The mate materi rial al outl outlin ined ed in this this pack packag age e will form form the the basi basis s of the the theo theore reti tica call background in Functional Anatomy that will be in part assumed knowledge and will will be built built upon upon through throughout out the gradua graduate te program program. The The mater material ial will be pres presen ente ted d in a seri series es of modu module les s each each of whic which h will will have have deta detaile iled d lear learni ning ng objectives that are designed to direct and sequence the learning. It is advised that the student complete each module one at a time prior to moving onto the next. It is recommended that the student take approximately 4 hours to complete each module.

Modules: Module 1: Introductory Introductory Osteology Osteology and Arthrology Module Module 2: The Shoul Shoulder der,, Upper Upper Arm and and Elbow Elbow Module Module 3: The Forea Forearm, rm, Wrist Wrist and and Hand Hand Module Module 4: Nerve Nerve and Blood Blood Supply Supply of the Upper Upper Limb Limb Module Module 5: The Pelvis, Pelvis, Hip Hip and and Knee Knee Module Module 6: The Lower Lower Leg and Foot Module Module 7: The Nerve Nerve and and Blood Blood Supply Supply to the Lower Lower Limb Limb Module Module 8: 8: The Head and Neck Module Module 9: The Abdomen Abdomen and Trunk Trunk Module 10: The Heart and Lungs

Learning Objectives Material in: 

bold bold prin print: t: form form the the stru struct ctur ures es that that requ requir ire e iden identi tifi fica cati tion on.. An anatomical atlas or model may be used for this purpose



regula regularr print print:: form form the indepe independ nden entt learn learning ing quest question ions s to be answ answere ered d from the recommended texts and lectures provided



ital it alic ic bl blue ue pr prin int: t: form form th the e qu quiz iz qu que est stio ions ns th that at ar are e aim imin ing g to ex exte tend nd knowledge into application



bold orange orange print: form the the surface anatomy anatomy objectives objectives

REFERENCES Highly recommended recommended resources to guide your completion completion of each module: 

Moore KL (2006) Clinically Orientated Anatomy (5 (5 th ed.) Textbook: Moore Baltimore: Baltimore: Lippincott Lippincott Williams & Wilkins *.



Rohen J, Yokoch Yokochii C, LutjenLutjen-Dre Drecoll coll E (2002) (2002) Color Atlas of Atlas: Rohen

Anatomy : A Photographic Study of the Human Body. Lippincott, Williams & Wilkins* 

Eizenberg N, Briggs C, Barker P & Grkovic I Web based Materials: Eizenberg (2010)An@tomedia CD-ROMs: CD-ROMs: (Available from University Bookshop and

Modules: Module 1: Introductory Introductory Osteology Osteology and Arthrology Module Module 2: The Shoul Shoulder der,, Upper Upper Arm and and Elbow Elbow Module Module 3: The Forea Forearm, rm, Wrist Wrist and and Hand Hand Module Module 4: Nerve Nerve and Blood Blood Supply Supply of the Upper Upper Limb Limb Module Module 5: The Pelvis, Pelvis, Hip Hip and and Knee Knee Module Module 6: The Lower Lower Leg and Foot Module Module 7: The Nerve Nerve and and Blood Blood Supply Supply to the Lower Lower Limb Limb Module Module 8: 8: The Head and Neck Module Module 9: The Abdomen Abdomen and Trunk Trunk Module 10: The Heart and Lungs


bold bold prin print: t: form form the the stru struct ctur ures es that that requ requir ire e iden identi tifi fica cati tion on.. An anatomical atlas or model may be used for this purpose



regula regularr print print:: form form the indepe independ nden entt learn learning ing quest question ions s to be answ answere ered d from the recommended texts and lectures provided



ital it alic ic bl blue ue pr prin int: t: form form th the e qu quiz iz qu que est stio ions ns th that at ar are e aim imin ing g to ex exte tend nd knowledge into application



bold orange orange print: form the the surface anatomy anatomy objectives objectives

REFERENCES Highly recommended recommended resources to guide your completion completion of each module: 

Moore KL (2006) Clinically Orientated Anatomy (5 (5 th ed.) Textbook: Moore Baltimore: Baltimore: Lippincott Lippincott Williams & Wilkins *.



Rohen J, Yokoch Yokochii C, LutjenLutjen-Dre Drecoll coll E (2002) (2002) Color Atlas of Atlas: Rohen

Anatomy : A Photographic Study of the Human Body. Lippincott, Williams & Wilkins* 

Eizenberg N, Briggs C, Barker P & Grkovic I Web based Materials: Eizenberg (2010)An@tomedia CD-ROMs: CD-ROMs: (Available from University Bookshop and

also available also available to all students on the computers in the Department of Physiotherapy computer laboratory ) *

Additional Additional references for anatomy In additi addition on other other resou resource rces s that that would would be approp appropria riate te for compl completi etion on of these these modules are: 

Netter Netter FH (2006) (2006) Atlas of Human Anatomy (4 (4 th ed. (Elsevier) (Elsevier)



Agur Agur A, Dalley Dalley F (eds) (eds) (2005) (2005) Grant's Atlas of Anatomy (12th (12th ed.) Philadelphia : Lippincott Williams & Wilkins



Schuenke Schuenke M, Schulte E, Schumach Schumacher er U (Ross LM & Lamperti Lamperti ED

Anatomy: General anatomy Consulting eds). (2006). Thieme. Atlas of Anatomy: and musculoskeletal system. Stuttgart, Thieme Publisher 

Oatis Oatis CA (2009) (2009) Kinesiology: The mechanics and Pathomechanics of

human movement . 2 nd ed* 

Levangie, Levangie, P. K. and and C. Norkin Norkin (2005). Joint Structure and Function: (4 th ed). Philadelphia, Philadelphia, F.A.Davis. F.A.Davis. A Comprehensive Analysis (4



Neumann, Neumann, D. D. (2002). (2002). Kinesiology of the Musculoskeletal System.

Foundations for Rehabilitation . St. Louis, Mosby 

Bogduk Bogduk (2008) Clinical Anatomy of the Lumbar spine & Sacrum (6th Edn). Churchill Livingstone. Livingstone.


DEPARTMENT OF PHYSIOTHERAPY Independent Learning Guide Phys@natomy FOR Doctor of Physiotherapy (Module 1: Introductory Osteology and Arthrology)

Dr Doà El-Ansary, BAppSc(Phty), PhD Dr Elizabeth Tully, BAppSc(Phty), Dip Ed, PhD

Introduction: Welcome to the Doctor of Physiotherapy Program. Phys@natomy is a self directed learning package that has been developed to facilitate student revision and preparation for entry into the Doctor of Physiotherapy Program at the University of Melbourne. The material outlined in this package will form the basis of the theoretical background in Functional Anatomy that will be in part assumed knowledge and will be built upon throughout the graduate program . The material will be presented in a series of modules each of which will have detailed learning objectives that are designed to direct and sequence the learning. It is advised that the student complete each module one at a time prior to moving onto the next. It is recommended that the student take approximately 4 hours to complete each module.

Modules:

Module 1: Introductory Osteology and Arthrology Module 2: The Shoulder, Upper Arm and Elbow Module 3: The Forearm, Wrist and Hand Module 4: Nerve and Blood Supply of the Upper Limb Module 5: The Hip and Knee Module 6: The Lower Leg and Foot Module 7: The Nerve and Blood Supply to the Lower Limb Module 8: The Head and Neck Module 9: The Trunk Module 10: The Heart and Lungs Learning Objectives Material in: 

bold print: form the structures that require identification. An anatomical atlas or model may be used for this purpose



regular print: form the independent learning questions to be answered from the recommended texts and lectures provided



italic blue print: form the quiz questions that are aiming to extend knowledge into application



bold orange print: form the surface anatomy objectives

University of Melbourne Doctor of Physiotherapy Independent Learning Package in Functional Anatomy Dr Doa El-Ansary and Dr Elisabeth Tully

REFERENCES Highly recommended resources to guide your completion of each module: 

Textbook: Moore KL (2006) Clinically Orientated Anatomy (5 th ed.) Baltimore: Lippincott Williams & Wilkins*.



Atlas: Rohen J, Yokochi C, Lutjen-Drecoll E (2002) Color Atlas of Anatomy : A Photographic Study of the Human Body. Lippincott, Williams & Wilkins*



Web based Materials: Eizenberg N, Briggs C, Barker P & Grkovic I (2010)An@tomedia CD-ROMs: (Available from University Bookshop and also

available to all students on the computers in the Department of Physiotherapy computer laboratory ) *

Additional references for anatomy In addition other resources that would be appropriate for completion of these modules are: 

Netter FH (2006) Atlas of Human Anatomy (4 th ed. (Elsevier)



Agur A, Dalley F (eds) (2005) Grant's Atlas of Anatomy (12th ed.) Philadelphia : Lippincott Williams & Wilkins



Schuenke M, Schulte E, Schumacher U (Ross LM & Lamperti ED Consulting eds). (2006). Thieme. Atlas of Anatomy: General anatomy and

musculoskeletal system. Stuttgart, Thieme Publisher 

Oatis CA (2009) Kinesiology: The mechanics and Pathomechanics of


Levangie, P. K. and C. Norkin (2005). Joint Structure and Function:

A Comprehensive Analysis (4 th ed). Philadelphia, F.A.Davis. 

Neumann, D. (2002). Kinesiology of the Musculoskeletal System.


Bogduk (2008) Clinical Anatomy of the Lumbar spine & Sacrum (6th Edn). Churchill Livingstone.


1. INTRODUCTORY OSTEOLOGY 1.1.

Define the anatomical position

1.2.

Define the following terms of position and direction which are related to the standardised anatomical positions: 1.2.1. median (midsagittal) plane 1.2.2. sagittal plane 1.2.3. coronal (frontal) plane 1.2.4. horizontal (transverse) plane 1.2.5. anterior; posterior (ventral; dorsal) 1.2.6. superior; inferior (rostral/cephalic; caudal) 1.2.7. medial; lateral 1.2.8. proximal; distal 1.2.9. superficial; deep 1.2.10. palmar; dorsal 1.2.11. plantar; dorsal

1.3.

Classify bones according to shape and give an example of each type. 1.3.1. Long 1.3.2. Short(cuboid) 1.3.3. Flat 1.3.4. Irregular 1.3.5. Sesamoid

1.4.

Draw a 1.4.1. 1.4.2. 1.4.3. 1.4.4.

1.5.

Describe and state the functions of bony markings and find an example of each type of marking. 1.5.1. Condyle 1.5.8. Tuberosity 1.5.2. Crest 1.5.9. Trochanter 1.5.3. Epicondyle 1.5.10. Trochlear 1.5.4. Process 1.5.11. Facet 1.5.5. Line 1.5.12. Canal 1.5.6. Lamina 1.5.13. Fissure 1.5.7. Spine 1.5.14. Foramen

typical long bone and Illustrate the following features: diaphysis metaphysis epiphysis articular surfaces


1.5.15. 1.5.16. 1.5.17. 1.5.18. 1.5.19.

Groove Meatus Fossa Notch Sulcus


2. Introductory Arthrology 1.6.

Define a joint or articulation.

1.7.

Describe the general structure and the relative amount of movement available at each of the following types of joints, and give an example:

1.8.

1.9.

1.7.1. fibrocartilaginous 1.7.2. hyaline and fibrocartilaginous 1.7.3. synovial 1.7.4. Classify synovial joints, and give an example, according to: 1.8.1. structure 1.8.2. hinge 1.8.3. pivot 1.8.4. ellipsoid 1.8.5. condyloid 1.8.6. saddle 1.8.7. ball & socket (plane/gliding)

1.8.8. 1.8.9. 1.8.10. 1.8.11.

degrees of freedom uniaxial biaxial multiaxial

1.8.12.

complexity of organisation (shape of articular surfaces, number of mating pairs).

Describe 3 principal axes of motion about synovial joints. 1.9.1. 1.9.2. 1.9.3.


1.10.

Define and demonstrate the following types of movement about synovial joints: 1.10.1. active 1.10.2. passive (physiological; accessory)

1.11.

Define the following terms with respect to the ways in which articular surfaces move in relation to each other 1.11.1. spin 1.11.2. roll 1.11.3. glide

1.12.

Describe the characteristics of the "close-packed" position of a joint.

1.13.

List the anatomical features which can limit movement at a joint.

Quiz Questions 

Discuss the advantages and disadvantages of the types of joint classification schemes.



Define and list the functions of: bursae, discs, ligaments



DEPARTMENT OF PHYSIOTHERAPY Independent Learning Guide PHYS@TOMY FOR Doctor of Physiotherapy (Module 2: Shoulder, Upper Arm and Elbow)


University of Melbourne Doctor of Physiotherapy Independent Learning Package - Anatomy Dr Doa El-Ansary and Dr Elisabeth Tully

Introduction: Welcome to the Doctor of Physiotherapy Program. Phys@tomy is a self directed learning package that has been developed to facilitate student revision and preparation for entry into the Doctor of Physiotherapy Program at the University of Melbourne. The material outlined in this package will form the basis of the theoretical background in Functional Anatomy that will be in part assumed knowledge and will be built upon throughout the graduate program. The material will be presented in a series of modules each of which will have detailed learning objectives that are designed to direct and sequence the learning. It is advised that the student complete each module one at a time prior to moving onto the next. It is recommended that the student take approximately 4 hours to complete each module. Modules: Module 1: Introductory Osteology and Arthrology Module 2: The Shoulder, Upper Arm and Elbow Module 3: The Forearm, Wrist and Hand Module 4: Nerve and Blood Supply of the Upper Limb Module 5: The Hip and Knee Module 6: The Lower Leg and Foot Module 7: The Nerve and Blood Supply to the Lower Limb Module 8: The Head and Neck Module 9: The Trunk Module 10: The Heart and Lungs












University of Melbourne Doctor of Physiotherapy Independent Learning Package in Functional Anatomy Dr Doa El-Ansary and Dr Elizabeth Tully


Textbook: Moore KL (2006) Clinically Orientated Anatomy (5 th ed.) Baltimore: Lippincott Williams & Wilkins *.



Atlas: Rohen J, Yokochi C, Lutjen-Drecoll E (2002) Color Atlas of Anatomy : A Photographic Study of the Human Body. Lippincott, Williams & Wilkins



*

Web based Materials: Eizenberg N, Briggs C, Barker P & Grkovic I (2010) An@tomedia CD-ROMs: (Available from University Bookshop and also

available to all students on the computers in the Department of Physiotherapy computer laboratory ) * Additional references for anatomy In addition other resources that would be appropriate for completion of these modules are: 







Schuenke M, Schulte E, Schumacher U (Ross LM & Lamperti ED Consulting eds). (2006). Thieme. Atlas of Anatomy: General anatomy and musculoskeletal

system. Stuttgart, Thieme Publisher 

Oatis CA (2009) Kinesiology: The mechanics and Pathomechanics of human

movement . 2 nd ed* 



Neumann, D. (2002). Kinesiology of the Musculoskeletal System. Foundations for

Rehabilitation . St. Louis, Mosby 



BONES, JOINTS, MUSCLES OF THE SHOULDER 1.1

Identify and classify the bones of the shoulder girdle; clavicle and scapula.

1.2

On the clavicle identify: (i) (ii) (iii) (iv) (v)

sternal end acromial end impression for the costoclavicular ligament trapezoid line conoid tubercle

1.3

Identify the jugular notch/interclavicular notch between clavicles.

1.4

On the scapula (shown below) identify: (i) (ii) (iii) (iv) (v) (vi) (vii) (viii) (ix) (x)

dorsal surface costal surface superior, inferior, lateral borders superior, inferior, lateral angles spine acromion and coracoid processes subscapular, supraspinous, infraspinous fossae glenoid fossa suprascapular notch supraglenoid and infraglenoid tubercles


1.5 On the humerus identify: (i)

proximal end - head - anatomical and surgical necks - greater and lesser tubercles - bicipital (intertubercular) groove - medial and lateral lips of bicipital groove

(ii)

shaft - medial,lateral and posterior surfaces - (spiral) groove for radial nerve

(iii)

distal end - lateral and medial supracondylar ridges - lateral and medial epicondyles - capitulum - trochlea - olecranon, coronoid and radial fossae


1.6

Identify and classify the joints of the shoulder girdle: (i) glenohumeral (ii) sternoclavicular joint (ii) acromioclavicular joint

1.7

At the acromioclavicular joint identify its: (i) (ii)

articular surfaces joint capsule


(ii) 1.8

coracoclavicular ligament (conoid and trapezoid parts)

Describe the arrangement of bursae in the shoulder region. What is their function?


1.9

Describ Describe e the attachm attachments ents and state state the nerve nerve supply supply of the the follo following wing muscles

        Muscle Origin Insertion Nerve supply Pectoralis Pectoralis major(sternal (sternal head)

Latissimus dorsi

         Muscle Origin Insertion Nerve supply Trapezius

Rhomboid Rhomboid major

Rhomboid Rhomboid minor

Levator scapulae

Pectoralis Pectoralis minor

Serratus Serratus anterior

Subclavius

University of Melbourne Doctor of Physiotherapy Independent Learning Package in Functional Anatomy Dr Doa D oa El-Ansary and Dr Elizabeth Tul ly

       

Muscle

Origin

Pectoralis Pectoralis major(clavicular (clavicular head) Deltoid

Coracobrachialis

Teres major

Teres minor

Subscapularis

Supraspinatus

Infraspinatus

.


Insertion

Action

Functional activity

1.10. 1.10. Name the the muscles muscles labelled labelled 1, 2, & 3 below in figure figure 1

        1

2

3 4

1.11

(a) Name the the structures structures labelled labelled 1- 8 in figure 2a below. (b) Identify and label the component parts of the capsuloligamentous complex on Figure 2b (c) State 3 functions of the glenoid labrum (d) State the functions of the coracohumeral and transverse ligaments


Figure 2a

Figure 2b

1.12. (a) Identify the shoulder muscles shown in figures 3a and 3b below

     


1.13. (a) Identify the muscles labelled 1 - 4 on the figure below (b) State the nerve supply to these muscles

2

3 4

     


Figure A

Figure B

Image: Hansen JT Net   University of Melbourne Doctor of Physiotherapy Independent Learning Package in Functional Anatomy Dr Doa El-Ansary and Dr Elizabeth Tully

1.14 Identify the nerves labelled 1-6 on Figure A, and 1-9 on Figure B, state their root values

THE SCAPULA 1.14. For the healthy shoulder, a Describe the posture of the scapula on the thoracic wall with reference to adjacent bony landmarks b Describe the orientation of the glenoid cavity in the erect position

1.12 (a) Use table form (as shown below) to list all muscles attached to the scapula and their actions Muscle

UR

E.g. Upper trapezius

X

DR

El

Dep

X

(b) Indicate the attachments of these muscles on the diagrams below


Pro

Ret

X

Images: Thieme 2006

1.13. (a) Describe changes in scapulo humeral rhythm during arm elevation (b) State the advantages of upward rotation (c) Name the muscles that are antagonist to scapula upward rotation (d) How may increased thoracic kyphosis affect arm elevation?


1.14 Scapula Movements: Name the movements of the scapula on the diagrams above

THE CLAVICLE 1.15

For the sterno clavicular joint, describe

(a)

shape of the articulating surfaces.

(b)

role of the disc in the joint.

(c)

joint movement ( in terms of rolls, slides and spin) during


the following shoulder girdle movements

(d)



elevation and depression



protraction and retraction



posterior rotation of the clavicle

What is the approximate range of each of these movements of the clavicle?


BONES, JOINTS AND MUSCLES OF THE ELBOW REGION

2.1

On the ulna identify: (i)

proximal end -

(ii)

olecranon and coronoid processes trochlear and radial notches supinator fossa ulnar tuberosity

shaft -

interosseus border surfaces (medial,anterolateral,posterolateral)

(iii) distal end -

2.2

head styloid process

On the radius identify: (i)

proximal end -

(ii)

head neck radial tuberosity

shaft -

interosseus border surface (lateral, anteromedial, posterolateral) impression for pronator teres

(iii) distal end University of Melbourne Doctor of Physiotherapy Independent Learning Package in Functional Anatomy Dr Doa El-Ansary and Dr Elizabeth Tully

-

2.3

styloid process ulnar notch carpal (inferior) articular surface

Classify the elbow joint and identify and describe its: (i) (ii) (iii)

articular joint capsule and synovial membrane ligaments and their specific functions -

medial (ulnar collateral) lateral (radial collateral) anular

(iv) subcutaneous bursae and fat pads


2.4

Identify and classify the radio-ulnar joints: (i) (ii)

2.5

At the proximal radio-ulnar joint identify and describe its: (i) (ii) (iii)

2.6

superior (proximal) inferior (distal)

articular surfaces joint capsule anular ligament and its specific mechanical functions

At the distal radio-ulnar joint identify and describe its:


(i) (ii) (iii)

articular surfaces joint capsule articular disc

2.7

Identify the interosseus membrane (intermediate radio-ulnar joint) and list its functions.

2.8

Define, demonstrate and analyse movements at the elbow joint and the radioulnar joints. Movement

Description

Functional activity

2.9

State the close-packed position of the elbow and radioulnar joints.

2.10

Describe the "carrying angle" of the forearm.


2.11

Identify, describe the attachments and deduce the actions of the following muscles: Muscle

Origin

Insertion

Action

Biceps brachii Brachialis Brachioradialis Triceps brachii Anconeus Pronator teres Pronator quadratus Supinator

2.12

List the factors responsible for maintaining stability at the: (i) (ii) (iii)

elbow joint superior radioulnar joint inferior radioulnar joint


Functional activity

Surface Anatomy 2.13 Demonstrate on a living subject the principle bony features of the shoulder region: (remember consent first)  scapula - acromion - spine-T3 - vertebral border - inferior-T7 - coracoid process: press firmly upwards and laterally into the junction of the middle and lateral thirds of the clavicle  clavicle - sternal end: bulbous - acromial end: flattened  humerus - head - greater tubercle: most lateral part covered by deltoid - deltoid tuberosity - medial and lateral epicondyles - medial and lateral supracondylar ridges 

sternoclavicular joint



acromioclavicular joint


9.25

Observe and palpate the following muscles of the axilla and scapula regions in a relaxed and contracted state (i) (ii) (iii) (iv) (vi) (vii) (viii) (ix)

trapezius serratus anterior latissimus dorsi-posterior axillary fold teres major pectoralis major-anterior fold deltoid infraspinatus tendons of the rotator cuff muscles



Quiz Questions

(1).

The shoulder joint is designed for mobility. Describe the contribution of the following structural features to mobility at the glenohumeral joint.

(2).

(a)

bony design

(b)

bony congruence

(c)

glenoid labrum

(c)

capsule

(d)

capsular ligaments

               

  deltoid as the arm is raised into full elevation via abduction. Use a diagram to

aid you answer.

(i.e. bony architecture, passive structures (ligaments etc.), and dynamic structures (muscles etc.)

(3).

Define the following terms relating to muscle function: (i) (ii)

spurt shunt

Give examples of each of these at the shoulder and the elbow joints.



DEPARTMENT OF PHYSIOTHERAPY PHYS@TOMY FOR Doctor of Physiotherapy 2010 (Module 3: The Forearm, Wrist and Hand)


University of Melbourne Doctor of Physiotherapy Independent Learning Package - Anatomy Dr Doa El-Ansary and Dr Elizabeth Tully

Introduction: Welcome to the Doctor of Physiotherapy Program. Phys@tomy is a self directed learning package that has been developed to facilitate student revision and preparation for entry into the Doctor of Physiotherapy Program at the University of Melbourne. The material outlined in this package will form the basis of the theoretical background in Functional Anatomy that will be in part assumed knowledge and will be built upon throughout the graduate program . The material will be presented in a series of modules each of which will have detailed learning objectives that are designed to direct and sequence the learning. It is advised that the student complete each module one at a time prior to moving onto the next. It is recommended that the student take approximately 4 hours to complete each module.

Modules: Module 1: Introductory Osteology and Arthrology Module 2: The Shoulder, Upper Arm and Elbow Module 3: The Forearm, Wrist and Hand Module 4: Nerve and Blood Supply of the Upper Limb Module 5: The Hip and Knee Module 6: The Lower Leg and Foot Module 7: The Nerve and Blood Supply to the Lower Limb Module 8: The Head and Neck Module 9: The Trunk Module 10: The Heart and Lungs



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University of Melbourne REFERENCES Doctor of Physiotherapy Highly recommended Independent Learning Package resources - Anatomy Dr Doa El-Ansary and Dr Elizabeth Tully 

to guide your completion of each module:

Textbook: Moore KL (2006) Clinically Orientated Anatomy (5 th ed.)

REFERENCES Recommended References for anatomy Any good anatomy textbook /atlas would be appropriate for completion of these modules. In the past many students have found the following anatomy texts to be useful: 

Moore KL (2006) Clinically Orientated Anatomy (5 th ed.) Baltimore: Lippincott Williams & Wilkins.

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Rohen J, Yokochi C, Lutjen-Drecoll E (2002) Color Atlas of Anatomy : A Photographic Study of the Human Body. Lippincott, Williams & Wilkins

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musculoskeletal system. Stuttgart, Thieme Publisher Web based Materials: 

Eizenberg N, Briggs C, Barker P & Grkovic I (2010)An@tomedia CD-ROMs: (Available from University Bookshop and also available to all students on

the computers in the Department of Physiotherapy computer laboratory ) Recommended References for applied anatomy: 


human movement . 2 nd ed 







1.

1.1

THE WRIST JOINT AND JOINTS OF THE HAND

Identify the bony groups in the articulated hand: (i) (ii) (iii) (iv)

8 carpals 5 metacarpals 14 phalanges 2 sesamoid bones (radiographs)


1.2

Identify the individual carpal bones and some features of these carpal bones, on the articulated hand: (i) (ii) (iii) (iv)

scaphoid and its tubercle lunate triqetrium pisiform

) ) proximal row ) )

(v) (vi) (vii) (viii)

trapezium and its tubercle trapezoid capitate hamate and its hook

) ) distal row ) )


1.3

On the metacarpals identify -

1.4

base shaft head

Identify proximal, middle and distal phalanges and on each phalanx identify: -

base shaft head

1.5

Describe the axis of the hand and state the function of the axial line in regard to force transmission.

1.6

Classify the wrist (radiocarpal) joint and describe its: (i) (ii) (iii) (iv)

1.7

articular surfaces joint capsule articular disc ligaments - palmar and dorsal radiocarpal - radial and ulnar collateral

Describe and demonstrate movements at the wrist joint. Movement

Description


Functional activity

1.8

State the close-packed position of the wrist joint.

1.9

Identify, classify, describe and demonstrate the movements at the following joints of the hand:

Movement

Description

Midcarpal Movements:

carpometacarpal of thumb movements:

carpometacarpal of other digits


Functional activity

1.10

State the contributions of midcarpal and radiocarpal joints to movements of the hand.

1.11

Identify, classify and describe certain features of the joints of the fingers: 

(i) (ii)

(iii) (iv)

articular surfaces ligaments and their functions - collateral - palmar - deep transverse metacarpal - extensor aponeurosis movements sesamoid bones of the thumb and their functions 

(i) (ii)

(iii)

articular surfaces ligaments and their functions - collateral - extensor aponeurosis - palmar movements


2.

2.1

MUSCLES OF THE FOREARM AND HAND

Identify, describe the attachments and deduce the action(s) of the muscles of the forearm:    Muscle

Origin

Superficial layer Pronator teres

Flexor carpi radialis

Palmar longus

Flexor digitorum superficialis Flexor carpi ulnaris

Deep layer Flexor digitorum profundus Flexor pollicis longus Pronator quadratus


Insertion

Action

Functional activity

 ateral) group: Muscle

Origin

Superficial layer Brachioradialis

Extensor carpi radialis longus

Extensor carpi radialis brevis Extensor digitorum

Extensor digiti minimi

Extensor carpi ulnaris

Anconeus

Deep layer Supinator

Abductor pollicis longus Extensor pollicis brevis Extensor indicis


Insertion

Action

Functional activity

2.2

Identify the flexor and extensor retincula and state the function(s) of retincula.


2.3

Identify, describe the attachments and deduce the actions of the intrinsic muscles of the hand: Muscle

Origin

flexor pollicis brevis

thenar eminence abductor pollicis brevis opponens pollicis

hypothenar eminence flexor digiti minimi

abductor digiti minimi


Insertion

Action

Functional activity

opponens digiti minimi

Other Intrinsics adductor pollicis

lumbricals

dorsal interossei

palmar interossei


Anterior View Superficial forearm muscles


Anterior View Deep forearm muscles

Posterior View Superficial forearm muscles


Posterior View Deep forearm muscles.

2.4

2.5

2.6

Identify and describe the extent, and describe the function(s) of: (i)

palmar aponeurosis

(ii)

intertendinous connections

(iii)

synovial sheaths

(iv)

extensor aponeurosis

Define the position of function of the hand.

Describe the role of the interossei and lumbricals in producing normal digital sweep.

SURFACE ANATOMY OF THE ARM, FOREARM AND HAND

2.7

Demonstrate on a living subject:       

(i)

ulnar - olecranon process - posterior borders-intervenes between the two functional groups of the muscles of the forearm. - head - styloid process-best felt when the forearm is pronated

(ii)

radius - head - styloid process

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the following muscles and tendons of the arm and forearm:


(i) (ii) (ii)

biceps brachii triceps brachii anconeus - this is a triangular muscle whose angles are formed by the olecranon process, lateral epicondyle, and a point on the posterior border of the ulna about 10cm distal to the olecranon process

(iii) (iv) (v) (vi) (vii)

brachioradialis cubital fossa extensor compartment (group) of the forearm flexor compartment (group) of the forearm tendons of the following muscles on the anterior aspect of the wrist: - flexor carpi radialis - palmaris longus - flexor digitorum superficialis - flexor carpi ulnaris

(ix) extensor carpi radialis longus (x) extensor carpi radialis brevis 

all the carpal bones and some of their features

(i)

hook of hamate - can be felt by deep pressure in the hypothenar eminence, distal to the pisiform and closer to the centre of the palm

(ii)

tubercle of the scaphoid - at the proximal edge of the thenar eminence, adjacent to the distal crease of the wrist

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(i) (ii)

the following muscles and tendons of the hand: tendons of extensor digitorum the "anatomical snuff box" (evident when the thumb is extended) bounded by the tendons of: - extensor pollicis longus - extensor pollicis brevis - abductor pollicis longus

(iii) thenar and hypothenar eminence (iv) 1st dorsal interosseus muscle

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the relative mobility of the metacarpals and list them in decreasing order of mobility.


2.8

Draw a pattern of the hand, and on it draw the palmar creases. Relate the following creases of the hand to the underlying joints on your drawing: (i)

creases of the wrist: - proximal - middle - distal

(ii)

creases of the palm: - longitudinal palmar ("life line") - middle palmar ("destiny line") - proximal transverse ("head line") - distal transverse ("heart line")

(iii)

creases of the digits: - proximal - middle - distal


Quiz Questions 1.

Demonstrate different types of precision and power grips and discuss the differences in terms of: (i) (ii)

the muscles involved the position of the wrist and hand



DEPARTMENT OF PHYSIOTHERAPY Independent Learning Guide PHYS@TOMY FOR Doctor of Physiotherapy (Module 4: The Nerve and Blood Supply of the Upper Limb)



Introduction: Welcome to the Doctor of Physiotherapy Program. Phys@tomy is a self directed learning package that has been developed to facilitate student revision and preparation for entry into the Doctor of Physiotherapy Program at the University of Melbourne. The material outlined in this package will form the basis of the theoretical background in Functional Anatomy that will be in part assumed knowledge and will be built upon throughout the graduate program . The material will be presented in a series of modules each of which will have detailed learning objectives that are designed to direct and sequence the learning. It is advised that the student complete each module one at a time prior to moving onto the next. It is recommended that the student take approximately 4 hours to complete each module. Modules: Module 1: Introductory Osteology and Arthrology Module 2: The Shoulder, Upper Arm and Elbow Module 3: The Forearm, Wrist and Hand Module 4: Nerve and Blood Supply of the Upper Limb Module 5: The Hip and Knee Module 6: The Lower Leg and Foot Module 7: The Nerve and Blood Supply to the Lower Limb Module 8: The Head and Neck Module 9: The Trunk Module 10: The Heart and Lungs



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


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Textbook: Moore KL (2006) Clinically Orientated Anatomy (5 th ed.) Baltimore: Lippincott Williams & Wilkins*.



Atlas: Rohen J, Yokochi C, Lutjen-Drecoll E (2002) Color Atlas of Anatomy : A Photographic Study of the Human Body. Lippincott, Williams & Wilkins*



Web based Materials: Eizenberg N, Briggs C, Barker P & Grkovic I (2010)An@tomedia CD-ROMs: (Available from University Bookshop and also

available to all students on the computers in the Department of Physiotherapy computer laboratory ) * Additional references for anatomy In addition other resources that would be appropriate for completion of these modules are: 








musculoskeletal system. Stuttgart, Thieme Publisher 









NERVE SUPPLY TO THE UPPER LIMB

1.1

Describe the following features of the brachial plexus: (i) (ii) (iii) (iv) (v)

1.2

its formation from ventral rami its trunks its division its cords the position of each of the above in the shoulder region

Identify the following branches of the brachial plexus and state their motor distribution (the muscles each supplies): (i) (ii)

dorsal scapular long thoracic

(iii) (iv) (v) (vi) (vii) (viii)

suprascapular upper subscapular lateral pectoral medial scapular thoracodorsal lower subscapular


1.3

Identify the following sensory branches of the brachial plexus and state the root value and distribution of each: (i) (ii)

1.4

Identify the peripheral nerves of the brachial plexus: (i) (ii) (iii) (iv) (v)

1.5

medial cutaneous nerve of arm medial cutaneous of forearm

axillary (circumflex) radial and its posterior interosseus branch musculocutaneous median and its anterior interosseus branch ulnar

For each of the peripheral nerves listed in 14.4: (i) (ii) (iii) (iv)

state its root value identify its course through the upper limb describe its sensory distribution describe its motor distribution


1.6

Describe the innervation of the following joints: (i) (ii) (iii)

shoulder elbow wrist

and deduce a general rule for nerve supply to joints.


ACTIVITIES AND QUIZ QUESTIONS: 1.

Describe the functional motor loss and deformity resulting from a lesion to the following nerves in the area indicated: (i) (ii) (iii)

2.

radial nerve - in the axilla ulnar nerve - at the medial epicondyle of the humerus median nerve - at the wrist

Complete the following chart to summarise objective 14.5. PERIPHERAL NERVES TO THE UPPER LIMB Peripheral Nerve Medial cutaneous nerve of arm

Nerve Root Value

Medial cutaneous of forearm

Axillary (circumflex

Radial and its posterior interosseus branch Musculocutaneous

Median and its anterior interosseus branch Ulnar


Motor Distribution

Sensory Distribution

3.

Colour in the distribution of the cutaneous nerves on the dorsal and palmar aspects of the hand: Palm


Dorsum

2.

BLOOD SUPPLY TO THE UPPER LIMB

Objectives 2.1Identify: (i) ascending aorta (ii) arch of aorta (iii) descending thoracic aorta (iv) brachiocephalic artery (v) L common carotid artery (vi) L subclavian artery (vii) R common carotid artery (viii) R subclavian artery

) ) branches of aorta ) ) branches of brachiocephalic ) artery

2.2 Briefly state the area of supply of the arteries listed in objective 15.1


2.3 Identify and describe the course and general areas of supply of the arteries of the upper limb: (i) axillary (ii) brachial (iii) profunda brachii (iv) radial (v) ulnar (vi) superficial palmar arch (vii)deep palmar arch



2.4 Palpate the pulses of the upper limb at the following positions: (i) subclavian artery - above medial end of the clavicle (ii) brachial artery - between the heads of biceps brachii (median bicipital furrow) and at the cubital fossa (iii) radial artery - on the antero-lateral aspect of the wrist (iv) mark on the diagrams where you found them.

2.5Describe the arrangement of the veins of the upper limb into a superficial and a deep group and deduce the functional significance of this arrangement. University of Melbourne Doctor of Physiotherapy Independent Learning Package - Anatomy Dr Doa El-Ansary and Dr Elizabeth Tully

2.6 Identify and describe the course opf the deep veins: (i) radial (ii) ulnar (iii) brachial (iv) axillary

2.7

Identify and describe the course of the superficial veins of the upper limb: (i) dorsal venous arch (ii) palmar venous arch (iii) cephalic (iv) basilic (v) median antebrachial (vi) median cubital


2.8 Identify the veins transporting blood from the upper limb to the heart: (i) subclavian (ii) brachiocephalic (iii) superior vena cava


Physio anatomy.pdf

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