Human Anatomy

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Human Anatomy Physiology

• Lower Extremity
• Upper Extremity
• Head, Neck, Face, Skull
• Abdomen, Thorax, and Spine

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Types of Bones

• Bone- specialized type of dense connective tissue
  consisting of bone cells that are fixed in a
  matrix. The outer surface is compact bone and the
  inner surface is more porous tissue, calcellous
  bone
• Bone fxn- body support , organ protection, mvmt,
  calcium reservation, and formation of blood cells
  (hematopoesis)
• Flat
• Irregular
• Long/short

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Gross Structures

• Diaphysis- the main shaft of the bone
• Epihysis- is located at the end of a long bone.
  Bulbous in shape, providing space for muscle
  attachment. Composed of cancellous bone giving it
  a spongy appearance
• Periosteum- a dense, white fibrous membrane,
  covers the long bones except at the joint surface

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Tissue Properties

• Yield Point or Elastic Limit
• When loads exceed the yield piont, the response
  of the structure is plastic, in which when the
  load is removed, some amount of the deformation
  will remain. Loaads exceeding the ultimate
  failure point results in fracture (fx).

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Types of Forces

• Axial Force- force acted along the axis of a
  structure
• Compression Force- axial loading that produces a
  squeezing or crushing effect
• Tensile Force- tension or axial loading in the
  direction opposite that of compression
• Shear Force- Acts parallel or tangent to a plane
  passing thru the object
• Mechanical Stress- A force divided by the surface
  area over which the force is applied
• If the force is concentrated over a small area,
  the mechanical force is relatively high. Its a
  high magnitude of stress, rather than a high
  magnitude of force, that tends to result in
  injury to biological tissues

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• Strain- the amount of deformation an object
  undergoes in response to applied force (muscles)
• Injury to biological tissues can result from a
  single traumatic force of relatively large
  magnitude, or from repeated force of a smaller
  magnitude. Acute trauma is termed macrotrauma.
  Chronic injury is termed microtrauma.

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Grades of Strains

• Grade I
• Local pain, increased tension of the muscle,
  minor loss of muscle strength, mild swelling,
  echymosis, localized tenderness
• Grade II
• Same as above but moderate s/s and impaired
  muscle fxn
• Grade III
• Has s/s that are severe, loss of muscle fxn, and
  palpated defect in muscle

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• Soft Tissue Trauma
• Contractile tissue are those structures that are
  part of the muscle, its tendon, or its boney
  insertion
• Strain- a stretch, rip or tear in the muscle or
  adjacent tissue such as the fascia or muscle
  tendon
• Sprain- a stretching or tearing of the fibrous
  connective tissue known as a ligament
• Hematoma- a blood tumor, formed by the
  localization of blood into a clot, which becomes
  encapsulated by connective tissue membranes

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Skin Injuries

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

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Wound Classifications

• Friction Blister- Cont rubbing over the surface
  of the skin causes a collection of fluid below or
  within the epidermal layer called a blister.
• Abrasion- skin is scraped against a rough
  surface. The epidermis and dermis are worn away,
  exposing numerous blood capillaries
• Bruise- when a blow compressed or crushes the
  skin surface and produces bleeding under the skin
• Laceration- a wound in which the skin has been
  irregularly torn
• Skin avulsion- skin that is torn by the same
  mechanism as a laceration to the extent that the
  tissue is ripped off from its source
• Incision- a wound in which the skin has been
  sharply cut
• Puncture Wound- penetration of the skin by a
  sharp object

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Types of Muscles

• Smooth
• Hollow organs
• Striated
• Skeletal Muscles
• Cardiac
• Heart

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Skeletal Muscle Properties

• Within the cell is a semifluid substance called
  sarcoplasm
• Myofibrils are surrounded by the endomysium,
  fiber bundles are surrounded by perimysium, and
  the entire muscle is covered by epimysium
• The layers are combined within a fibrous tendon
• Arteries, veins, lymph vessels, and bundles of
  nerve fibers spread into the perimysium.
• A complex network of capillaries goes through the
  endomysium coming into direct contact with muscle
  fibers

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Types of Muscle Fibers

• Slow twitch- dark fibers-Red
• Usually resistant to fatigue-endurance fibers
• Fast Twitch-light fibers-White
• Fatigue quickly-anaerobic activites

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Muscle Classification

• Fusiform
• Biceps
• Unipenate
• Abdominals
• Multipenate
• Deltoid

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Muscle Cramps Spasm

• A Cramp is a painful involuntary contraction of a
  skeletal muscle or muscle group
• Cramps have been attributed to the lack of water
  or other electrolytes in relation to muscle
  fatigue
• A spasm is a reflex rxn caused by trauma of the
  MS system

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Overexertion Muscle Problems

• Acute-Onset Muscle Soreness- occurs immediately
  following the physical activity which accompanies
  fatigue
• Delayed-Onset Muscle Soreness (DOMS)- onset of
  muscle soreness that appears 24 hrs after
  activity
• Most intense at 48hrs and gradually subsides
• Leads to increased muscle tension, swelling,
  stiffness, and resistance to stretching
• Soreness can be prevented if stretching occurs
  pre-post activities

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• Muscle stiffness
• Does not produce pain
• Occurs when a group of muscles have been worked
  hard for a long period of time
• Fluids collect in the muscle during and after
  activity and are absorbed at a slow rate

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• Muscle Guarding
• Following injury, muscles around an injury act to
  splint the injured area, thus minimizing pain
• Muscle Cramps
• Problem related to hard conditioning
• Most common cramp in tonic, continuous muscle
  contraction
• Caused by the bodies depletion of essential
  electrolytes

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Nerve Supply

• Supplied to ligaments, outer aspect of synovial
  membrane, muscles, and joints
• Mechanoreceptors are mylinated, whereas
  non-mylinated fibers are pain receptors

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Types of Joints

• Ball-n-Socket- allows all possible mvmts (hip)
• Hinge- allows only flex and ext (elbow)
• Pivot- only allows rotation around an axis
• Ellipsoidal- convex head and a concave socket
  (wrist)
• Saddle- allows small amounts of gliding back and
  forth or sideways (carpals or tarsals)

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The Foot

• Bones
• Muscles
• Ligaments
• Blood Nerve Supply
• Foot Biomechanics
• Common Injuries

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The Foot
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The Foot

• 26 bones (14 phalanges, 5 metatarsals, 7 tarsals
• Tarsals talus, calcaneus, navicular, cuboid,
  1st, 2nd, 3rd cuneiforms
• Designed for strength, flexibility, and
  coordinated mvmt

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Bones of the Foot
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Phalanges Aka Toes

• Designed to give a wider base of support
• 1st toe hallux 2 phalanges
• 2nd thru 5th 3 phalanges
• 2 Sesamoid bones
• assist with WB
• increase mech advantage for flexor tendons

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Metatarsals

• 5 bones b/w tarsals and phalanges
• Little mvmt, ligaments provide elasticity to foot
  during WB QWA
• 1st metatarsal is largest and strongest and fxns
  as the main body support during ambulation

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Tarsals

• 7 bones important for support locomotion
• Calcaneus- largest
• Talus-irregular shaped, most superior
• Navicular
• Cuboid- lateral aspect of foot, 4th 5th
  Metatarsals
• Cuneiforms (3)

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Arches

• Assist foot in supporting BW
• Absorbs shock
• Gives space for ligaments, blood vessels, and
  nerves to run on plantar surface of the foot

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Arches
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4 Arches

• Medial Longitudinal
• main supporting ligament is the plantar
  calcaneal (spring ligament)
• Stretches and rebounds during AMB

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4 Arches

• Lateral Longitudinal
• Less flexible than the medial
• Runs along the 5th metatarsal

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4 Arches

• Anterior Metatarsal Arch
• Made up of the heads of all 5 metatarsals

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4 Arches

• Transverse Arch
• Made up of tarsal bones
• Gives the shape to the foot

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DIP, PIP, IP Joints

• DIP (distal interphalangeal joint)
• Found at the distal extremities of the proximal
  and middle phalanges
• Allows for Flex/Ext
• Collateral ligaments on medial/lateral

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MTP Joint

• Metatarsalphalangeal Joint
• Articulation b/w metatarsals phalanges
• Allows for flex/ext, abd/add
• Condyloid joint

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Muscles

• Gasrocnemius
• Soleus
• Anterior tibialis
• Peroneal Muscles
• Extensor Muscles
• Flexor Muscles

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Muscles

• Gastrocneimus
• Inserts on posterior aspect of tibia
• Achilles tendon attaches to calcaneus
• Provides for PF of foot (standing on toes)

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Muscles

• Soleus
• Runs underneath gastrocs
• Aids in PF of foot

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Muscles

• Anterior Tibialis
• Major DF of foot and great toe
• Paralysis of this muscle results in drop foot
• Can be involved in Ant Compartment Syndrome which
  affects the lower legs blood and nerve supply
• Runs the length of the tibia and also is involved
  in shin splints

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Muscles

• Peroneals
• Tendons most commonly injured in an inversion
  sprain
• Run along the lateral aspect of the lower leg
  (fibula) around the distal portion of the lateral
  maleollus and insert on the lateral aspect of the
  foot (5th MT)
• Tom, Dick, and Harry
• Extensive pressure on the head of the fibula
  causes peroneal palsynumbness on the outside of
  the lower leg
• Major muscle involved in everting the foot

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Muscles

• Extensor Muscles
• Run along the dorsal aspect of the foot and
  extend the toes
• They insert at the MT, DP and PP

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Muscles

• Flexor Muscles
• Run along the plantar surface of the foot and are
  associated with flexion of the toes
• Insert on the plantar surface of MT, DP, and PP

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Muscles
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Ligaments

• Spring Ligament
• Medial longitudinal arch
• Keeps the shape of the foot
• Depresses when amb and rebounds
• Maybe outstretched with people who have flat
  feet

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Ligaments

• ATF (anterior talofibular ligament)
• Most commonly injured in an inversion sprain
• Anteriorly connects the talus and fibula
• PTF (posterior talofibular ligament)
• Another commonly injured ligament
• Posteriorly connects talus and fibula
• CF (calcaneofibular ligament)
• Commonly injured along with the ATF
• Connects the calcaneus and the talus

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Ligaments

• Deltoid Ligament
• Fan shaped
• Very strong and hard to injure
• Usually injured with an eversion sprain
• Runs along the entire medial aspect of the medial
  maleollus

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Blood Nerve Supply

• Anterior posterior tibial arteries
• Tibial Nerve- innervates m. of the back of the
  leg and plantar aspect of foot
• Common Peroneal Nerve- supplies front of leg and
  foot

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Foot Biomechanics

• Phases of Walking
• 1st phase support phase
• Heel strike to toe off
• 2nd phase swing/recovery
• Immediately after toe off and in position for
  heel strike

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Foot Biomechanics

• Forefoot varus
• Excessive pronation
• Excessive pronation during support phase can lead
  to stress fx, plantarfacitis, Achilles tendonitis

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Foot Biomechanics

• Forefoot valgus
• Excessive supination
• Excessive supination at heel strike can lead to
  inversion ankle sprains, ITB syndrome, peroneal
  tendonitis

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Common Injuries

• Heel Bruise
• Extremely painful
• Etiology sudden stop/go change from horz/vert
• S/S severe pain, unable to WB, warm redness
• TX NWB 24hrs, RICE, NSAIDS, Doughnut

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                       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.
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Common Injuries

• Bruised Instep (top of foot)
• Etiology being stepped on or direct contact
• S/S wearing shoes is painful
• TX ICE, pad the affected area

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Common Injuries

• Metatarsal Arch Strain (Pes Cavus Pes Planus)
• Etiology high arch or flat foot
• S/S pain or cramping in metatarsal region
• Tx tape or pad to elevate fallen arch

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Common Injuries

• Turf Toe
• Etiology results from artificial playing
  surfaces and flexible types of footwear
• S/S hyperext of great toe causing jt capsule to
  be torn from the MT head
• Tx
• r/o fx
• Stiff-soled shoes
• Tape

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Common Injuries

• Stress fxs
• Can occur anywhere
• Overuse injury or repetitive type injury
• Starts as a weakening of an area and can progress
  into a full blown fx
• Tx Rest, Ice, rehab

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Common Injuries

• Inversion Sprain-rolling an ankle
• Etiology landing on someones foot, excessive
  supination and IR of foot
• S/S severe to mod effusion, echymosis, point
  tender over ATF, CF, PTF ligaments
• TX r/o fx, cryokinetics, gentle stretching,
  AROM, strengthening

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The Knee
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The Knee

• Bones
• Menisci
• Muscles
• Ligaments
• Blood Nerve Supply
• Common Injuries

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The Knee

• Bones
• Femur
• Tibia
• Fibula
• Patella

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The Knee

• Femur
• Largest strongest bone in the body
• Two condyles that articulate with the tibia

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The Knee

• Tibia
• Medial bone second largest in lower leg
• Two plateaus articulate with femoral condyles
  (concavities where the meniscus sit)
• Most distal end is known as the medial malleolus
• Fibula
• Smaller bone that runs down the lateral aspect
  of the lower leg
• Most distal portion is known as the lateral
  malleolus

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The Knee

• Patella
• Largest sesamoid bone in the body
• Found in the quad tendon
• Tracking of the patella depends on the pull of
  the quads patellar tendon

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The Knee

• Menisci
• 2 oval fibro-cartilages that deepen the
  articulation b/w the femur and the tibia
• Acts as a cushion and shock absorber for the knee
• Menisci Blood Supply
• Each menisci divided into 3 circumfrential zones
• Red-red zoneouter 1/3 good bl. Supply
• Red-white zonemiddle 1/3 minimal bl supply
• White-white zoneinner 1/3 is avascular

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The Knee

• Medial Meniscus
• C shaped
• Attached firmly to the medial articular facet of
  the tibia by the coronary ligament
• Posteriorly by the fibers of the semimembranosous

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The Knee

• Lateral Meniscus
• O shaped
• Attaches loosely to the lateral articular capsule
  and popliteal tendon
• Transverse ligament joins the anterior portions
  of the medial and lateral menisci

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Muscles

• Flexors
• Extensors
• Dynamic Stabilizers

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Muscles (flexors)

• Biceps Femoris

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Muscles (flexors)

• Semimembranosous

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Muscles (flexors)

• Semitendonosous

                                                
            
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Muscles (flexors)

• Gracilis
• Abducts, flexes, and
• medially rotates the hip

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Muscles (flexors)

• Sartorius
• Allows you to sit cross legged
• Known as the tailor sits muscle
• ASIS to the tibial head

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Muscles (extensors)

• Quadriceps
• Rectus Femoris
• VMO
• Vastis Lateralis
• Vastus Intermedius

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Muscles (dynamic stabilizer)

• IT Band (iliotibial band)

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Ligaments

• Stabilizing ligaments of the knee
• ACL (anterior cruciate ligament)
• Attaches below and in front of the tibia, runs
  posteriorly to attach laterally to the inner
  surface of the lateral condyle of the femur
• Comprised of 3 twisted bands
• Prevents anterior translation
• Stabilizes the tibia against excessive IR

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Ligaments

• PCL (posterior cruciate ligament)
• Stronger of the two
• Primary stabilizer of the knee
• Crosses back of tibia anteriorly to attach
  anterior portion of the lateral surface of the
  medial condyle of femur
• Resists IR of tibia
• Helps prevent hyperextension of knee and femur,
  sliding forward during WB

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Ligaments

• MCL (medial collateral ligament)
• Attaches above the jt line on medial epicondyle
  of the femur and below on the tibia just below
  the pes anserine
• Prevents knee from valgus and ER forces
• Approx the width of three fingers

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Ligaments

• LCL (lateral collateral ligament)
• Round fibrous cord shaped like a pencil
• Attaches to lateral epicondyle of the femur and
  to the head of the fibula
• Taut during knee ext, relaxed during knee flex

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Bursal Sacs

• Bursa
• Reduces friction b/w anatomical surfaces
• Suprapatellar, prepatellar, infrapatellar,
  pretibial, and gastroc

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Blood Nerve Supply

• Blood supply
• Main supply is Popliteal artery which stems from
  the Femoral artery
• Nerve Supply
• Tibial nerve supplies hamstrings and gastrocs
• Common peroneal innervates short head of biceps
  femoris
• Femoral nerve innervates the quads and sartorius

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Q-Angle

• Measured from ASIS to mid-patella and from Tibial
  Tubercle (TT) thru mid patella
• Norms
• Men10 degrees
• Women20 degrees
• 20lt leads to pathological conditions associated
  with improper patellar tracking

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Common Injuries

• MCL sprain
• Etiology valgus stress from a direct blow to the
  lateral side of the knee
• Grades I, II, or III
• S/S ranges from slight pain and instability to
  complete tear and loss of fxn, swelling,
  altered gait
• Tx RICE, r/o ACL, crutches, isometric exercises,
  immobilizer if necessary

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• Grade I
• Outstretching of fibers
• Little or no swelling
• Some stiffness and pt tender
• Full AROM PROM
• Grade II
• Partial tearing of fibers and tear of the
  capsular ligament
• Minimal laxity with slight swelling
• Mod-severe jt stiffness w/ inability to actively
  ext knee
• Grade III
• Complete tear of the fibers
• Complete loss of stability
• Moderate swelling
• Severe pain followed by dull ache
• valgus test w/ full jt opening

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Common Injuries

• LCL Sprain
• Etiology varus stress, less common than MCL
• S/S pain and tenderness over LCL, swelling,
  effusion, some jt laxity w/ varus stress test
• Tx similar to MCL

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Common Injuries

• ACL
• Etiology rotary mechanism, tibia ER and knee is
  in valgus position
• S/S pop usually felt or they may state that
  their knee feels like it is coming apart, rapid
  swelling, can be extremely painful, loss of ROM,
  cannot full ext knee
• TX RICE immediately, Sx

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Common Injuries

• PCL
• Etiology knee flexed 90 degrees, falling w/ full
  wt on anterior aspect of bent knee, foot in PF or
  hard blow to the front of bent knee (MVA)
• S/S pop felt, tenderness and little swelling
  in popliteal fossa, laxity in posterior sag test,
  posterior drawer
• Tx RICE, non-operative grades I II, 6 wks of
  immobilization, rehab

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Common Injuries

• Meniscal Lesions (tears)
• Etiology WB with rotary force, medial is injured
  more than lateral
• S/S deep aching pain inside the knee, problems
  kneeling, walking up/down stairs, squatting,
  locking up or giving way, slow effusion appears
  after 48-72 hrs
• Tx RICE, MRI, Sx

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Common Injuries

• Bursitis
• Etiology cont kneeling, trauma, overuse
• S/S localized pain swelling, redness and
  increased temp
• Tx RICE, compression wraps, NSAIDS

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Common Injuries

• Patellar Sublux/Dislocations
• Etiology poor tracking of the patella due
  to-wide pelvis, increase in Q angle, shallow
  femoral grooves, patella alta or baja, pronated
  feet
• S/S loss of knee fxn, pain, swelling, patella in
  abnormal position
• Tx possible sx, isometric ex, rehab
  strengthening, immobilization

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Common Injuries

• Chondromalacia
• Etiology abnormal tracking of patella
• S/S Stage I-swelling softening of articular
  cartilage, Stage II- fissuring of the softened
  cartilage, Stage III- deformation of the surfaces
  under the patella caused by defragmentation, pain
  w/Amb, running, stairs, squatting, swelling
  around kneecap, patellar grind
• Tx Avoid irritating activites, isometric ex,
  NSAIDS, neoprene sleeve, orthotics, smoothing of
  the surface of the patella

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Common Injuries

• PFSS (patellofemoral stress syndrome)
• Eitology tight hams gastrocs, thight IT Band,
  foot pronation, patella alta, VMO weakness
• S/S tender lateral facet, swelling, dull ache in
  center of the knee
• Tx strengthening of VMO and vast. lat, stretch
  hams, gastrocs, ITB, McConnell tape

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Common Injuries

• Osgood-Schlatters Disease
• Etiology avulsion of the patellar tendon _at_ the
  apophysis of the TT
• S/S repeated irritation, swelling, hemorrhage,
  gradual degeneration of the apophysis
• Tx Decrease stressful activities, Ice pre-post
  activities, isometric ex

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

• Bones
• Femoral Triangle
• Muscles
• Ligaments
• Blood Nerve Supply
• Common Injuries

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Hip, Thigh, Groin, Pelvis

• Bones
• Femur
• Head and neck of the femur
• Greater lesser trochanters

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• femur

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Hip, Thigh, Groin, Pelvis

• Pelvis (made up of 3 bones)
• Ilium
• Ischium
• Pubis

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Hip, Thigh, Groin, Pelvis

• Ball and Socket Joint
• Head of femur articulates with the acetabulum
• One of the most stable joints in the body
• If you have stability you give up mobility
• Acetabular ligament deepens the joint

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Femoral Triangle

• Inguinal Ligament
• Adductor Longus
• Sartorius
• These structures run through it
• -Femoral Artery
• -Femoral Nerve
• -Femoral Vein
• -Inguinal Lymph Nodes

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Ligaments

• Iliofemoral Ligament
• One of the strongest and largest in body
• Also known as the Y ligament

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Ligaments

• Acetabular Ligament
• Deepens the acetabulum to create a deeper socket
  and making it more stable
• Inguinal Ligament
• Many times is involved in hernias
• Part of the femoral triangle

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Muscles

• Iliopsoas
• Major hip flexor
• Actually is two muscles

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Muscles

• Glutes
• Maximus- Ext laterally rot hip
• Medius- Abducts hip
• Anterior fibers flex med rot hip
• Posterior fibers ext lat rot hip
• Minimus- abducts med rot hip

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Muscles

• Tensor Fasciae Latae (TFL)
• Flexes and Med Rot hip

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Blood and Nerve Supply

• Femoral Artery Vein
• Femoral Nerve

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Common Injuries

• Hip bursitis
• Etiology repeated trauma, overuse injury (from
  running)
• S/S inability to bend , run, pt tender, swelling,
  warm, snapping sensation
• Tx RICE, ultrasound, padding, stretch

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Common Injuries

• Femoral Stress Fracture
• Etiology Excessive Overuse
• S/S Persistent pain in thigh
• Tx NSAIDS, RICE, ROM in pain free range
• Femoral Fracture
• Etiology Excessive blunt trauma
• S/S deformation and pain over site
• Tx Treat for shock, immobilize, activate EMS

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Common Injuries

• Subluxation/dislocation of hip
• Etiology traumatic force along the long axis of
  femur w/ knees bent
• S/S flexed, ABD, and IR, head of femur is moved
  post to acetabulum. Possible damage to sciatic
  nerve
• Tx Immediate medical attention

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Common Injuries

• Legg-Calve Perthes Disease
• Etiology disruption of blood circulation to the
  head of the femur causing cartilage to become
  necrotic and flattened
• S/S pain in groin, limping and referred pain
• Tx Bed rest and bracing

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Common Injuries

• Slipped Capita Femoral Epiphysis
• Etiology boys 10-17 who are tall or obese. Hip
  slips posterior and inferior
• S/S hip and knee pain during passive mvmt as
  well as limits in ABD, flex, and Med Rot
• Tx Rest NWB

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Abdomen, Thorax, Spine
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Abdomen, Thorax, Spine

• Bones
• Muscles
• Ligaments
• Blood and Nerve Supply
• Common Injuries

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Abdomen Thorax

• Bones
• Ribs
• 1-7 true ribs (sternal)
• 8-10 are false ribs
• 11-12 are floating ribs
• Sternum
• Manubrium
• Body
• Xiphoid Process

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Solid Organs

• Kidneys
• Spleen
• Liver
• Pancreas
• Adrenal Glands

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Hollow Organs

• Stomach
• Intestines
• Gall Bladder
• Urinary Bladder

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4 Quadrants

• Right Upper
• Liver

• Left Upper
• Spleen
• Stomach

• Right Lower
• Gall Bladder
• Appendix
• Kidney

• Left Lower
• Kidney

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Urinary System

• Kidneys
• One on each side of spine, approximately in the
  center of the back
• Primary Fxn filter metabolic wastes, ions or
  drugs from blood and excrete in urine

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Urinary System

• Adrenal Glands (aka suprarenal glands)
• Located on top of each kidney
• Secrete epinephrine, norepinephrine, cortisol,
  estrogen, aldestrone, and androgen

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Urinary System

• Ureters and Urinary Bladder
• Ureters are small tubes that run inferior from
  the bladder. The bladder lies posterior to pubic
  symphysis. In males anterior to rectum in
  females, anterior to vagina and inferior to uterus

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Digestive System

• Liver
• Largest internal organ, UR quad
• Fxn absorbs and stores excessive glucose,
  process nutrients, detoxifies harmful chemicals,
  secretes bile
• Bile neutralizes and dilutes stomach acids and
  aids in digestion of fat in small intestine
• Hepititis- inflammation of the liver caused by
  viral infection or alcohol consumption. If not
  corrected it can lead to liver cell death and
  cirrhosis

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Digestive System

• Gall Bladder
• Located inferior to surface of the liver
• Fxn serves as storage reservoir for bile,
  secretes those stores into sm intestine
• Gall Stones- caused by cholesterol secreted by
  the liver, block the release of bile, must be
  removed surgically

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Digestive System

• Pancreas
• Located between the small intestine and the
  spleen
• Fxn secretes pancreatic juice, which is critical
  in digestion of fats, carbs, and proteins.
  Secretes insulin and glucagon, which control amt
  of glucose and amino acids in blood

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Digestive System

• Stomach
• UL quad
• Second stage of food break down (first stage is
  in mouth)
• Some absorption but mostly in the small intestine
• Can see stomach ulcers due to an over production
  of stomach acids

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Lymphatic System

• Spleen
• Largest lymph organ
• Fxn reservoir of red blood cells, regulates
  number of RBC, destroys RBC, produces antibodies,
  produces lymphocytes
• Located under diaphragm, left side, behind ribs
  9,10, 11.

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Digestive System

• Small Intestine (3 parts)
• Duodenum
• Jejunum
• Ileum
• Large intestine (3 parts)
• Cecum
• Colon
• Rectum

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Common Injuries

• Evaluation of Abdomen Thorax
• Check chest for asymmetry of breathing, palpate
  along ribs, intercostal space, costacholandral
  jxn
• Check URQ, ULQ, LLQ, LRQ clockwise
• Feel and look for muscle guarding
• Distinguish b/w guarding and rigidity
• Listen and feel for bowel sounds (gurgling of
  normal liquid)

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Common Injuries

• Rib Fx
• Etiology direct blow, indirect trauma
  (compression of rib cage), or violent muscle
  contraction. Direct blow is most dangerous b/c of
  fragments may displace and cut, tear, perforate
  tissue causing a hemothorax or a collapsed lung
  (pneumothorax)
• S/S severe pain with inhalation/exhalation,
  cough, sneeze, laugh etc.
• Tx refer for x-ray

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Common Injuries

• Sternum Fx
• Etiology high impact blow to chest which may
  cause a contusion to the underlying cardiac
  muscle
• S/S pt. tenderness, pain exacerbated by deep
  inspiration and forceful exhalation, signs of
  shock, weak or rapid pulse may indicate a more
  severe injury.
• Tx EMS, X-rays, monitor for heart trauma

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Common Injuries

• Hemothorax
• Presence of blood in plural cavity
• Hemorrhage can be neg of rib fx,
• S/S Pain on breathing, dyspned, shock, coughing
  up frothy blood
• Pneumothorax
• Plural cavity fills with air by an opening in the
  chest. Air fills the cavity and collapses the
  lung, difficulty breathing and anoxia
• Tension Pneumothorax
• When air filled plural cavity displaces lung and
  heart towards opposite lung compressing it
• S/S SOB, and pain on injured side, absence of
  breathing, cyanosis, and distension of neck
  veins, call EMS immediately.
• All lung injuries require immediate medical
  attention--transport

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Common Injuries

• Traumatic Asphyixa
• Results from a violent blow to or compression of
  the rib cage that causes cessation of breathing
• S/S purple discoloration of trunk and head,
  conjunctivas of the eyes display bright red color
• Tx Rescue Breathing immediately, EMS

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Spine

• Cervical
• Thoracic
• Lumbar
• Sacral

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C-Spine

• Cervical spine vertebrae 1-7
• Atlas (1)
• Upper surface articulates with occiput and allows
  for flex and ext. No body or spinous process
• Axis (2)
• Allows the skull and atlas to rotate
• Tooth like projection from vertebral body that
  fits into ring of atlas (odontoid process)
• If this fx, you dieskull slips off severing SC

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C-Spine

• Smallest bodies
• Horizontal positioning of the spinous processes

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T-Spine

• Thoracic Spine
• 12 vertebrae long transverse processes and thin
  spinous processes
• Ribs articulate with 1-10
• Little to no mvmt

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L-spine

• Lumbar Spine
• 5 vertebrae
• Major support of the lower back
• Largest and thickest, with large spinous and
  transverse processes
• Much less flexion than extension

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Sacrum

• Fusion of 5 vertebrae
• Fuses with the 2 hip bones to make pelvis
• Roots of lumbar and sacral nerves pass through
  the 4 foramina lateral to the 5 fused vertebrae
• Articulates with ilium to make the sacroiliac
  joint (SI) sitting and standing puts weight at
  these joints

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Coccyx

• Tailbone
• 4 or more fused vertebrae

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Curves of the Spine

• Cervical
• Convexity
• Thoracic
• Concavity
• Lumbar
• Convexity
• Sacral
• Concavity

         
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Lordosis
                     1 - Lordosis
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Intervertebral Discs

• Annulus Fibrosis periphery of disc. Composed of
  strong, fibrous tissue
• Semifluid Nucleus Pulposus in the center and
  compressed under pressure
• Both act as important shock absorbers for the
  spine

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Ligamentous Structures

• Anterior Longitudinal ligament
• Wide, strong band extends the full length of
  anterior surface of the vertebral bodies
• Attaches to both vertebral bodies and discs and
  resists extension
• Posterior Longitudinal Ligament
• Contained within the vertebral canal and extends
  full length of posterior aspect of bodies and
  limits flexion

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Spinal Cord

• Contained within the vertebral canal and spinal
  column
• From the foramen magnum of cranium to the 1st or
  2nd lumbar vertebrae
• Lumbar roots and sacral nerves form a horselike
  tail called cauda equina

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Spinal and Peripheral Nerves

• 31 pairs of nerves
• 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and
  1 coccygeal
• Has a anterior root (motor) and posterior root
  (sensory)
• Each pair has a dermatome (except C1)
• Specific area of sensation distribution
• Spinal nerve roots combine to form a network of
  nerves known as a plexus
• Cervical (C1-C4)
• Brachial (C5-T1)
• Lumbar (L1-L4)
• Sacral (L4-S4)

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Cervical Nerve Roots
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Brachial Plexus
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Lumbar Plexus
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Functional Anatomy

• Cervical Region
• Flexion
• SCM and scalene group
• Extension
• Upper traps
• Lateral Flexion
• All muscles on one side contracting unilaterally
• Rotation
• SCM, scalenes, and upper traps contract on
  opposite side of rotation

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Functional Anatomy

• Trunk
• Flexion
• Lengthening of the deep and superficial back
  muscles and contraction of the abs (rectus
  abdominis, internal/external obliques), and hip
  flexors (rectus femoris, TFL, and sartorius
• Extension
• Lengthening of the abs and contraction of erector
  spinae and glute max
• Rotation
• External/internal obliques
• Lateral rotation
• Quadratus lumborum, obliques, latissumus dorsi,
  iliopsoas, and rectus abdominis on the same side
  as direction of mvmt

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Common Injuries

• Cervical Fractures/Dislocations
• Eitology violent flexion and rotationof head
  (pool diving), axial loading combined with
  flexion (football injury), most common in C4, 5,
  or 6
• S/S neck point tenderness and restricted mvmt,
  cervical muscle spasm, pain in neck or chest
  region, numbness in trunk/limbs, weakness or
  paralysis in limbs/trunk, loss of bladder or
  bowel control
• Tx EMS immediately, do not move, stabilize head
  and neck

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Common Injuries

• Cervical Sprain (whiplash)
• Etiology head turned suddenly or had forced
  flexion, extension or rotation
• S/S tenderness over transverse and spinous
  processes, muscle guarding, localized pain, and
  restricted mvmt
• Tx r/o fx, or sc injury

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Common Injuries

• Acute Torticollis (wry neck or stiff neck)
• Etiology pain on one side upon awakening

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Common Injuries

• Cervical Stenosis
• Etiology narrowing of the spinal canal in the
  C-spine region that can impinge the sc. Can occur
  congenitally or changes in the vertebae
• S/S pain in limbs, numbness and tingling,
  associated weakness

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Common Injuries

• Brachial Plexus Neruaplaxia (burner), most common
  neurological injury
• Etiology stretching or compression results from
  neck forced laterally to the opposite side or
  neck extension, compressed and rotated to the
  affected side
• S/S burning sensation, numbness, tingling, and
  pain extending from the shoulder down to the
  hand, with LOF for several minutes

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Common Injuries

• Lumbar sprains/strains
• Sciatica
• Etiology inflammatory response of the sciatic
  nerve that has associated low back pain
• S/S shooting pain down nerve root with possible
  numbness and tingling

image 1 - The shaded regions indicate where
pain may be felt depending on which part of the
spine is involved.
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Forearm, Wrist, Hand, Fingers
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Forearm, Wrist, Hand Fingers

• Bones
• Muscles
• Ligaments
• Blood Nerve Supply
• Common Injuries

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Forearm

• Radius
• Thumb side
• Ulna
• pinky side

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Muscles of Forearm

• Flexors and pronators
• Found anterioraly
• Extensors and supinators
• Found posterioraly

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Nerve Blood Supply

• Most flexors, median nerve
• Most extensors, radial nerve
• Blood brachial artery (radial/ulnar)

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Wrist, Hand, and Fingers

• Bones
• Muscles
• Ligaments
• Blood nerve
• Common injuries

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Wrist, Hand, Fingers

• Carpals
• 8 carpal bones
• Proximal row (ulnar to radial) pisiform,
  triquetral, lunate, scaphoid (navicular)
• Distal row (ulnar to radial) hamate, capitate,
  trapizoid (lesser multangular), trapezium
  (greater multangular)
• Carpals articulate with the metacarpals

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Articulations (joints)

• Radiocarpal joints (radius and the carpals
• Condyloid joint
• Allows for flexion, extension, abduction,
  circumduction
• Carpals
• Arthrodial (gliding) joint

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Articulations (cont)

• Metacarpal joint
• Condyloid joint
• Allows for flexion, extension, add/abd, and
  circumduction
• Thumb
• Saddle joint- allows rotation
• Movements of thumb are different then other
  fingers

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Articulations (cont)

• Phalangeal joints
• Hinge joint
• Flexion and extension

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Ligaments

• Wrist
• Collateral ulnar ligament tip of styloid process
  of ulna to pisiform
• Radial collateral styloid of radius to scaphoid
• Transverse carpal ligament crosses volar aspect
  of carpals
• Roof of the carpal tunnel

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Ligaments

• Phalanges
• Collateral ligaments
• Medial
• lateral

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Muscles, Blood Nerve Supply

• Flexors
• Palmar side of hand
• Extensors
• Back side of hand
• Nerves
• Ulnar
• Median
• Radial
• Arteries
• Radial and Ulnar

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Common Injuries

• Wrist sprain
• Etiology falling on a hyperextended wrist
• S/S pain, swelling, c/o difficulty in moving
  wrist, tenderness, limited ROM
• Tx RICE, NSAIDS, splinting if necessary, taping

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Common Injuries

• Wrist strain (tenosynovitis) usually the extensor
  carpi radialis longus or brevis
• Etiology repetitive overuse of the wrist tendons
  and their sheaths
• S/S c/o pain with use or in passive stretching
  of tendons
• Tx Ice massage, NSAIDS, rest, heat after 72 hrs,
  PREs

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Common Injuries

• Tendonitis
• Etiology overuse
• S/S c/o pain on active use or passive stretching
  of tendon
• Tx Same as tenosynovitis

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Common Injuries

• Carpal Tunnel Syndrome inflammtion of tendons
  causing compression of median nerve
• Etiology repeated wrist flexion, direct trauma
• S/S sensory and motor deficits
• Tx Rest, immobilization, NSAIDS, ice massage, US

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Common Injuries

• Fractures
• Scaphoid-most common
• Boxers- Fx of neck of 5th MC
• Bennetts- Fx of base of 1st MC
• Smiths- falling on hyperextened wrist, distal
  radius fx
• Colles- falling on outstretched arm, distal
  radius

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The Elbow

• Bones
• Muscles
• Ligaments
• Blood Nerve Supply
• Common Injuries

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The Elbow

• Bones
• Humerous, Radius, Ulna
• 2 articulating condyles- capitulum and trochlea
• Flexion/Extension- articulation of the trochlea
  and semilunar notch (ulna)
• Pronation/Supination-head of radius and capitulum
  

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Ligaments

• Ulnar collateral ligament (medial)
• Radial collateral ligament (lateral)
• Annular ligament
• Stabilizes articulation of radius and radial
  notch
• Attached to anterior and posterior radial notch
  and it covers head and neck of radius

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Muscles

• Flexion biceps brachii, brachialis,
  brachioradialis
• Extension triceps brachii
• Supination biceps brachii and supinator
• Pronation pronator teres and pronator quadratus

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Muscles

• LES (lateral, extension, supinator)
• Ext carpi rad long
• Ext carpi rad brevis
• Ext carpi ulnaris
• Supinator

• MFP (medial, flexion, pronator)
• Flex carpi radialis
• Palmaris
• Flex carpi ulnaris
• Flex digitorum superficialis profundus

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Blood Nerve Supply

• Blood
• Brachial and medial arteries deep within
  antecubital fossa
• Veins front of elbow, superfical and close to
  skin
• Nerve
• Roots C5-T1
• In cubital fossa, these nerves become the
  musculocutaneous, radial and median nerve

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Common Injuries

• Olcranon bursitis
• Etiology blunt trauma to bursal sac superficial
  to the olcranon process
• S/S pain and severe spontaneous swelling and
  point tenderness
• Most common injuries due to falling on an
  outstretched arm.

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Common Injuries

• Lateral Epicondylitis tennis elbow
• Etiology repetitive trauma to extersor muscles
  of the lateral epicondyle
• S/S pain during and after activity eventually
  causing weakness in the hand and wrist

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Common Injuries

• Medial Epicondylitis
• Etiology forceful flexion of wrist and extreme
  valgus torques of elbow
• S/S pain can be centralized or radiating down
  arm, associated weakness of wrist and hand

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Common Injuries

• Little League Elbow 10-25 of young pitchers
  affected
• Etiology repetitive micro trauma that leads to
  many disorders of growth in the pitching elbow
• S/S flexion contracture (tightness of anterior
  joint capsule and weak triceps), locking or
  catching sensations and decreased ROM

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The Shoulder Complex

• Bones
• Muscles
• Ligaments
• Blood Nerve Supply
• Common Injuries

237
The Shoulder Complex

• Bones
• Scapula
• Humerus
• Clavicle
• Sternum
• Ribs

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The Shoulder Complex

• Articulations
• Sternoclavicular (sternum and clavicle)
• Acromioclavicular (acromion process and clavicle)
• Glenohumeral (glenoid fossa and humeral head)
• Scapulothoracic (scapula and thorax)

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Ligaments

• Sternoclavciular- extremely weak due to boney
  arrangment. Anterior and posterior
  sternoclavicular ligament prevents upward
  translation of the clavicle
• Acromioclavicular- Anterior, posterior, inferior,
  and superior portions join the acromion pocess to
  the clavicle

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Ligaments

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

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Muscles

• 3 Groups
• Group 1 latissumus dorsi and pec major
• Group 2 originates off scapula and inserts into
  the humerus SITTS-subscapularis, infraspinatus,
  supraspinatus, and teres minor

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Muscles

• Group 3- attach axial skeleton to the
  scapulascapular stabilizers levator scapula,
  trapezius, rhomboids, and serratus anterior and
  posterior
• Scapular Rhythm mvmt of the scapula relative to
  the mvmt of the humerus. First 30 degrees is
  humerus only, from 30-90 the scapula moves 1
  degree to every 2 degrees of the humerus. At 90
  degrees they are .

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Blood Nerve Supply

• Brachial artery
• Brachial Plexus

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Common Injuries

• Clavicular Fx
• Etiology fall on outstretched arm, tip of
  shoulder or direct impact
• S/S supports arm of injured side, tilt neck
  towards injured side, deformity, swelling
• Tx immediate referral, X-ray, sling and
  immoblize 6-8 weeks

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Common Injuries

• Sternoclavicular sprain
• Etiology direct blow transmitting through
  humerus
• S/S grades I- little to no pain w/o disability,
  II- visual deformity, pain, swelling, point
  tenderness, inability to abd shoulder or bring
  shoulder across body, III- complete dislocation
  with gross displacement of clavicle at the SC
  joint
• Tx RICE, refer to MD

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Common Injuries

• Acromioclavicular Sprain
• Etiology direct impact to tip of shoulder,
  upward force through the long axis of humerus
• S/S grade I- PT and discomfort during mvmt,
  II-displacement of lateral end of clavicle, and
  inability to completely abd arm or bring arm
  across chest, III-rupture of AC ligament and CC
  ligament
• Tx ice and pressure, stabilize jt w/ sling, refer

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Common Injuries

• GH Subluxation/Dislocation
• Etiology (Anterior) most common is abd, ER, and
  ext, but also from a direct blow posterior or
  posterolateral aspect of shoulder. (Posterior)
  forced add and IR or fall on extended and IR
  shoulder
• S/S (Anterior) flattened deltoid, palpation of
  humeral head at axilla, carrying arm in abd and
  ER position. (Posterior) severe pain and
  disability, arm in add and IR with flattened
  anterior deltoid.
• Tx Immediate immobilization, ice to reduce
  swelling and hemorrhaging, referral to MD, X-ray
  to r/o associated fx

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Common Injuries

• Shoulder Impingement Syndrome
• Etiology Mechanical compression of
  supraspinatus, subacromial bursa, or the long
  head of the biceps under the acromial arch.
  Caused by repetitive use in overhead activities.
• S/S diffuse pain around acromion. Overhead use
  increases pain, ER are weaker than IR, tightness
  on posterior inferior jt capsule
• Tx RICE, strengthen rotator cuff, strengthen
  abd, ER, elevators, and upward rotators

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Throwing Dynamics

• Cocking Phase shld abd, ext, and ER. Can cause
  ant shld pain as a result of stretching the pec
  major, origin of ant deltoid, long head of
  biceps, and IR
• Acceleration Phase Abd, IR, and forward flex.
  Places tension on post and inferior capsule,
  while ant capsule is relaxed.
• Follow-Through Phase Add and IR, the eccentric
  load places enormous strain on the ER of the
  rotator cuff and capsule

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Head, Face, Eyes, Ears, Nose and Throat

• Head
• The skull is composed of 22 bones, the mandible
  is the only bone not joined by sutures
• Meninges
• 3 membranes that protect the brain and SC
• Duramater-outermost dense fibrous inelastic
  sheath that covers the brain
• Arachnoid- extremely delicate, attaches to the SC
  by silk-like strands
• Space b/w arachnoid and pia mater is called
  subarachnoid space. This space contains
  cerebrospinal fluid
• Cerebrospinal fluids main fxn is to act as a
  cusion and absorb shock
• Pia Mater which is thin, delicate, and highly
  vascular

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Head, Face, Eyes, Ears, Nose and Throat
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Head, Face, Eyes, Ears, Nose and Throat
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Common Injuries

• Skull Fx
• Etiology blunt trauma
• S/S c/o severe headaches and nausea, possible
  deformity, blood in middle ear or ear canal,
  bleeding from nose, ecchymosis around eyes
  (raccoon eyes), ecchymosis behind ears (battle
  signs), cerebral spinal fluid may also appear in
  ear and nose
• Tx immediate hospitalization

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Common Injuries

• Cerebral Concussions (mild)
• Etiology either a direct blow to th