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Ortho A&P 2


Fascicles combine into: muscle body
Slow twitch (type I) muscle Oxidative; Aerobic; Endurance
Fast twitch (type II) muscle Glycolytic (ATP system); Anaerobic; Speed/ Strength
Muscle Action: stimulus in neuron: carried down axon to neuromuscular junction
At NMJ: ACTH released from pre-synaptic vesicles & diffuses across synapse to receptor on muscle
Muscle Action: binding at receptor triggers: depolarization, releasing Ca
Muscle Action: Calcium binds: troponin
Muscle Action: troponin is bound; then: Actin-myosin cross bridges form; muscle contracts
Tendon: Attaches mx to bone; transfers mx action to bone; enclosed within a tendon sheath
Ligament: Attaches bone to bone; provides stability to the joint
Dorsal Wrist Compartment I APL & EPB
Dorsal Wrist Compartment II ECRL, ECRB
Dorsal Wrist Compartment III EPL
Dorsal Wrist Compartment IV extensor digitorum comunis (four tendons) & extensor indicis (EDC, EI)
Dorsal Wrist Compartment V extensor digiti minimi (EDM)
Dorsal Wrist Compartment VI extensor carpi ulnaris (ECU)
Median nerve: Motor Wrist flexors, thumb opposition
Median nerve: Sensory Volar thumb, radial 2 ½ digits
Ulna nerve: Motor Intrinsics, Adductor Pollicis
Ulna nerve: Sensory Ulnar 1 ½ digits volar & dorsal
Radial nerve: Motor Wrist extensors, APL, EPB
Radial nerve: Sensory Dorsal thumb & radial half of hand
Vertebral Disk contains: central nucleus pulposus; peripheral annulus fibrosis
Anterior Mxs: Abdominal & Psoas
Posterior Mxs: Superficial: Erector Spinae, Iliocostal, longissimus & spinalis
Posterior Mxs: Middle: Multifida
Posterior Mxs: Deep: Intersegmental
Anterior & posterior muscles alternate to: control trunk movement
Sensory Dermatomes: Lumbar & sacral n. innervate: lower extremities
LS Spine Exam: motor: L1: Hip flexion
LS Spine Exam: motor: L2: Hip adductors
LS Spine Exam: motor: L3: Knee extension
LS Spine Exam: motor: L4: Ankle dorsiflexion
LS Spine Exam: motor: L5: Hallicus Longus extension
LS Spine Exam: motor: S1: Hallicus Longus flexion
LS Spine Exam: sensory: L1: Upper outer thigh
LS Spine Exam: sensory: L2: Mid anterior thigh
LS Spine Exam: sensory: L3: Below patella
LS Spine Exam: sensory: L4: Medial ankle
LS Spine Exam: sensory: L5: First web space
LS Spine Exam: sensory: S1: Lateral ankle
LS Spine Exam: DTRs: Knee: L2,3,4
LS Spine Exam: DTRs: Ankle: S1
Cartilage is nourished and maintained by: hydrostatic transfer of joint fluid (no vascular network); need ROM with joint loading
Mx decrease w/age strength dec 15% / decade (50-70 yo); mass dec 40% by 80 yo
MS H&P: AMPLE = Allergies, meds, Past Hx , Last meal, Events of trauma; PE
Strength 0/5 No movement
Strength 1/5 Trace movement, fasciculations
Strength 2/5 FROM without gravity
Strength 3/5 FROM against gravity but no resistance
Strength 4/5 FROM against gravity and mild resistance
Strength 5/5 FROM: Full Resist; Normal ROM
Resisted ROM: Neck Flex/Extend: level: C1-2
Resisted ROM: Neck Lateral Flexion: level: C3
Resisted ROM: Shoulder Shrug: level: C4, CN XI
Resisted ROM: Shoulder Abduction: level: C5
Resisted ROM: Elbow Flex-Wrist Extend: level: C6
Resisted ROM: Elbow Extend: level: C7
Resisted ROM: Hand Grip: level: C8
Resisted ROM: Abduction of Fingers: level: T1
Resisted ROM: Opposition of Fingers/Pincer: level/mx: Interosseous muscles
Resisted ROM: Hip flexion: level: L1-L3
Resisted ROM: Knee extension / Ankle dorsiflexion: level: L4
Resisted ROM: Great toe extension: level: L5
Resisted ROM: Ankle plantar flexion: level: S1
Pulses : normal = 2+
Gait categories Normal, Unsteady, Cautious, Antalgic, Use of assisted devices
Open chain exercise: Distal end of limb is free, isolates mx (i.e., seated leg extension, biceps curl)
Closed chain exercise: Distal end is fixed, recruits accessory muscles (e.g., push-ups, squats)
ROM: Hand CMC flex: 0-15; CMC ext: 0-30; MCP: 0-90; PIP: 0-100; DIP: 0-70
ROM: Elbow Flexion: 0-150; Pronation/supination: 0-80
ROM: Wrist Extension: 0-60; Flexion: 0-70; Ulnar deviation: 0-30; Radial deviation: 0-20
ROM: Hip Flexion: 0-100; Ext: 0-30; Abd: 0-40; Add: 0-20; IR: 0-40; ER: 0-70
ROM: Knee Flex: 0-140
ROM: Ankle Dorsiflexion: 0-20; Plantar flexion: 0-40; Inversion: 0-30; Eversion: 0-20
ROM: Cervical Spine Flexion: 0-45; Extension: 0-45; Lateral flexion: 0-45; Rotation: 0-80
ROM: Thoracolumbar Spine Flexion: 0-90; Extension: 0-30; Lateral flexion: 0-30; Rotation: 0-30
Axillary nerve innervates: C5-C6. Motor: deltoid, teres minor, triceps). Sensory: shoulder joint, inferior deltoid
Musculocutaneous nerve innervates: C5-C7. Motor: coracobrachialis, biceps, bracialis. Sensory: radial side of forearm-
Radial nerve innervates: C5-T1. Motor: triceps, hand extensors. Sensory: dorsal hand
Created by: Abarnard