Anakines Midterm X Finals GL PTRP

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Midterms
MODULE 1 (PART 1) : INTRODUCTION TO GROSS ANATOMY

Anatomy ➢ the science of the structure and function of the body
➢ the study of the macroscopic structure and function of the body
Clinical Anatomy
as it relates to the practice of medicine and other health sciences
➢ the study of the minimal amount of anatomy consistent with the
Basic Anatomy understanding of the overall structure and function of the body
➢ overview = brief understanding
TERMS RELATED TO POSITION
➢ Standing Erect
➢ Upper limbs by the sides
Anatomical Position
➢ Face and palms of the hands
directed forward
1. Median Sagittal or Sagittal Plane

Cardinal Planes of the Body 2. Frontal or Coronal Plane
3. Horizontal or Transverse Plane
TAKE NOTE: ➢ every plane rotates around an axis
➢ also known as median sagittal plane or (YZ plane)
Sagittal Plane ➢ x - axis
➢ divides the body into equal right and left of the sides
➢ it is a vertical sagittal plane parallel and in close porximity to the
Paramedian median plane (wala sa gitna pero malapit)
➢ it does not divide the body into equal right and left
➢ also known as coronal plane or (XY plane)
Frontal Plane ➢ z – axis
➢ divides the body into equal front and back parts
➢ also known as horizontal plane (XZ plane)
Transverse ➢ y – axis
➢ divides the body into upper and lower parts
Sagittal Plane Paramedian Frontal Plane Transverse Plane
TERMS OF DIRECTION
TERMS DEFINITIONS EXAMPLES
Right ➢ towards the body’s right side ➢ the right hand
Left ➢ towards the body’s left side ➢ the left hand
➢ the forehead is superior to the eyes.
Superior ➢ upper or above
➢ the head is superior to the neck
➢ the nose is inferior to the eyes
Inferior ➢ lower or below
➢ the foot is inferior to the ankle
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Kenneth Santos | Patrick Aquino BSPT 1-A
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Anterior ➢ towards the front of the body ➢ the teeth are anterior to the throat
Posterior ➢ towards the back of the body ➢ the brain is posterior to the eyes
Dorsal ➢ towards the back ➢ the spine is dorsal to the breastbone.
➢ the navel is ventral to the spine.
Ventral ➢ towards the belly ➢ the eyes are ventral to the brain.
➢ the nose is ventral to the brain.
➢ the shoulder is proximal to the elbow
Proximal ➢ closer to a point of attachment
➢ the elbow is proximal to the hand
➢ the hand is distal to the wrist
Distal ➢ farther from a point of attachment
➢ the elbow is distal to the shoulder
➢ the nipple it lateral to the sternum
Lateral ➢ away from the midline of the body
➢ the radius is lateral to the ulna
➢ the nose bridge is medial to the eyes.

➢ towards the middle or midline of
Medial ➢ the ulna is on the medial side of the
the body
forearm
Superficial ➢ towards or on the surface ➢ the skin is superficial to the muscle

Deep ➢ away from surface ➢ the lungs are deep to the ribs
➢ internal carotid artery found inside the
Internal
➢ the relative distance of a structure cranial cavity.
from the center of an organ ➢ external carotid artery found outside the
External
cranial cavity.
Ipsilateral ➢ same side of the body ➢ the left hand and left foot are ipsilateral
➢ the left biceps brachii and right rectus
Contralateral ➢ opposite side of the body
femoris are contralateral.
Supine ➢ lying on back
Prone ➢ lying face downward
➢ no body part is more superior than the head

➢ no body part is more inferior than the feet
TAKE NOTE THAT:
➢ no body part is more lateral than the digital
➢ no body part is more proximal than the shoulders
TERMS RELATED TO MOVEMENT

➢ a movement that decreases the angle between two body parts
Flexion
➢ when the limb is towards the anterior
➢ a movement that increases the angle between two body parts.

Extension
➢ when the limb is towards the posterior
Hyperextension ➢ more than the normal extension

➢ the backward bending and contracting of your hand or foot.
Dorsiflexion ➢ the movement of the foot toward the shin, as when walking on the
heels
➢ a movement in which the top of your foot points away from your leg.
Plantarflexion ➢ the movement of the foot toward the plantar surface, as when
standing on the toes
Abduction ➢ the movement away from the body

Adduction ➢ the movement towards the body
Rotation ➢ the turning of a structure around its long axis.
➢ the rotation of the forearm so that the palm faces superiorly if the
Supination
elbow is flexed to 90 degrees.
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➢ the rotation of the forearm so that the palm faces inferiorly if the elbow
Pronation
is flexed to 90 degrees.
Eversion ➢ it is the turning of foot so that the plantar surface faces laterally
➢ it is the turning of foot so that the plantar surface of the foot faces
Inversion
medially
Radial Deviation ➢ the movement of the wrist towards the radius. (towards the thumb)
Ulnar Deviation ➢ the movement of the wrist towards the ulna. (towards the pinky finger)
BASIC STRUCTURE OF SKIN

• Epidermis
• Dermis (superficial fascia/ ➢ two (2) layers of skin:
subcutaneous tissue)
➢ layer of the skin that are visible in the eyes
Epidermis ➢ a stratified epithelium whose cells become flattened as they mature
and rise to the surface.
• Stratum Corneum
• Stratum Lucidum
➢ five (5) layers of the epidermis (superficial to deep):
• Stratum Granulosum
➢ Mnemonics = COLUGo Sa BAtok
• Stratum Spinosum
• Stratum Basale
➢ also known as “horny layer”

Stratum Corneum ➢ most superficial layer or the outermost layer
➢ it composed of 25 or more layers of dead keratinocytes (dead cells)
➢ derived from the word “lucid,” it means clear.

Stratum Lucidum ➢ it is present only in areas with fixed skin (palms, fingertips, sole of the
foot)
➢ derived from the word “granules,” it means grains

Stratum Granulosum ➢ more layers of keratinocytes
➢ it is the layer where apoptosis takes place
➢ it is the process of programmed cell death

Apoptosis
➢ it’s a normal process of cell death
➢ also known as spiny layer

Stratum Spinosum
➢ it is largely responsible for the strength and flexibility of the skin
➢ the deepest layer of the epidermis.

Stratum Basale ➢ also known as Stratum Germinativum
➢ single row of cuboidal or columnar keratinocytes.
➢ is composed of dense connective tissue

Dermis
➢ very thick layer
It is said that the dermis in women are thinner compared to men
• Hair follicles
• Smooth muscle
• Glands
➢ dermis is consisting of:
• Blood vessels
• Lymphatic vessels
• Nerves
• Nails
• Hair follicles
➢ the appendages of the skin:
• Sebaceous (oil) glands
• Sweat glands
➢ these are keratinized (hard) plates on the dorsal surfaces of the tips of
Nails
the fingers and toes.
Parts of Nails ➢ nail root, nail folds, and nail bed
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➢ hairs grow out of follicles, which are invaginations of the epidermis into
Hair the dermis
➢ covers most of the surface of the body
Parts of Hair ➢ hair bulbs and hair shaft
Fascia ➢ they lie between the skin and the underlying muscles and bones
Two (2) types of fasciae of the 1. Superficial Fascia or Subcutaneous Tissue
body: 2. Deep Fascia
➢ it is the subcutaneous tissue that just directly beneath of dermis
Superficial Fascia ➢ it contains loose areolar and adipose tissue.
➢ fatty layer
Adipose ➢ it is commonly known as body fat
➢ this is the membranous layer of connective tissue
Deep Fascia ➢ it acts as a base for the superficial fascia and as an enclosure for
muscle groups.
OVERVIEW: MUSCLE
• Skeletal muscle
• Smooth muscle ➢ two (2) layers of skin:
• Cardiac muscle
➢ these muscles are attached to the movable parts of the skeleton
➢ cell shape: long, cylindrical
➢ it is striated and multinucleated (it contains multiple peripheral
Skeletal Muscle
nucleus)
➢ it is not autorhythmic, thus, it moves under conscious control or
voluntary control.
Function of Skeletal Muscle: ➢ it is simply for body movements
➢ is found in the walls of hollow organs, such as the stomach and uterus,
and tubes, such as blood vessels and the ducts of certain glands
Smooth Muscle ➢ cell shape: spindle-shaped
➢ it is non striated and uninucleate (it contains single central nucleus)
➢ it is under unconscious control or involuntary control
➢ it compresses organs, ducts, tubes, and so on, to promote different

Function of Smooth Muscle
physiological events: peristalsis (movement of food forward)
➢ is found only in the heart.

➢ cell shape: branched
Cardiac Muscle
➢ it is striated and uninucleate (it contains single central nucleus)
➢ the contractions of it provides the major force for moving blood

Function of Cardiac Muscle
through the circulatory system
Intercalated disks ➢ it is a special feature of cardiac muscle that contains desmosomes
Desmosomes ➢ they hold the fibers together during contraction
Parts of Muscle: ➢ origin, insertion, belly, and tendon

➢ attachment of a muscle on a more stable bone
Origin
➢ a part of muscle that has a least movement
➢ attachment of a muscle on a more moveable bone
Insertion
➢ most movement occurs in insertion attachment of a muscle
Belly ➢ the widest and fleshy part of muscle; bulk
Tendon ➢ a connective tissue that connects muscle to bone
Aponeurosis ➢ a thin but strong sheet of fibrous tissue attaching flattened muscle
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➢ the central part of the deep fascia of the palm which is a highly
Palmar Aponeurosis
specialized thickened structure with little mobility
Raphe ➢ interdigitation (interlocks) of the tendinous ends of fibers of flat muscles
CHARACTERISTICS OF SKELETAL MUSCLE FIBER TYPES

Slow-Twitch Fast-Twitch Oxidative
Fast-Twitch Glycolytic (FG)
Oxidative (SO) Glycolytic (FOG)
(Type IIb)
(Type I) (Types IIa)
Fiber Diameter Smallest Intermediate Largest
Myoglobin Content High High Low
Mitochondria Many Many Few
High anaerobic
High aerobic
Metabolism capacity; intermediate Highest anaerobic capacity
capacity
aerobic capacity
Fatigue Resistance High Intermediate Low
Myosin Head Activity Slow Fast Fast
Glycogen Concentration Low High High

Maintenance of
posture and Endurance activities in Rapid, intense movements of
Functions performs endurance-trained short duration (sprinting)
endurance muscles *more power*
activities
TERMS (TABLE ABOVE)
Myoglobin ➢ a red colored pigment protein that binds oxygen in muscles
➢ the powerhouse of the cell.

Mitochondria
➢ it produces ATP (Adenosine triphosphate)
Myosin Head Activity ➢ acts in muscle contraction
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➢ it is the capability to perform movements or exercise in prolong

Endurance
periods of time (example: running)
Aerobic ➢ it requires air
Anaerobic ➢ it does not require air
OVERVIEW: JOINTS
➢ site where two or more bones come together whether or not
Joints movement occurs between them
➢ these are the axis of the human body (points of rotation)
• Fibrous Joints
• Cartilaginous Joints ➢ different types of joints:
• Synovial Joints
➢ these are bones that held together by collagen fibers
Fibrous Joints ➢ these are joints that has no to little movement (example: sutures in the
skull)
Sutures ➢ these are small fibrous joints between two (2) big skull bones
➢ these are bones that held together by fibrocartilage or hyaline

Cartilaginous Joints cartilage
➢ it has a little movement
➢ these are joints that have synovial cavities; allows free movement
Synovial Joints
➢ these are freely moveable (example: knee, hips)
➢ is a cord or band of connective tissue uniting two structures

➢ commonly found in association with joints
Ligament
➢ it limits excessive movement
➢ example: ACL: Anterior Cruciate Ligament
➢ is a lubricating device consisting of a closed fibrous sac lined with a

delicate smooth membrane
➢ it prevents or decrease friction between tissues
Bursae
➢ it also protects the surface
➢ found wherever tendons rub against bones, ligaments, or other
tendons
Bursitis ➢ the inflammation of bursa
Synovial Sheath ➢ is a tubular bursa that surrounds a tendon
OVERVIEW: BLOOD VESSELS
• Artery
• Vein ➢ blood vessels:
• Capillary
➢ it takes the blood away from the heart

Artery ➢ it delivers blood to the rest of the body
➢ carries the oxygenated blood from the heart
➢ it takes the blood towards the heart

Vein
➢ carries the deoxygenated blood from the tissues back to the heart.
➢ it is smallest blood vessel connecting smallest arteries (arterioles) and

Capillary veins (venule)
➢ responsible for gas, nutrient and waste exchange
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OVERVIEW: LYMPHATIC SYSTEM
➢ it is a natural drainage of our body

Lymphatic System ➢ it maintains fluid levels in our body tissues by removing all fluids that
leak out of our blood vessels
• Lymphatic tissues
• Lymphatic vessels ➢ the lymphatic system is consisting of:
• Lymph
Lymphatic Tissues ➢ these are cells and organs that make up the lymphatic system
Examples of Lymphatic
➢ thymus, lymph nodes, spleen, lymphatic nodules
Tissues:
➢ these are tubes that assist the cardiovascular system in the removal
Lymphatic Vessels of tissue fluid from the tissue spaces of the body; the vessels then return
the fluid to the blood
Lymph ➢ a tissue fluid once it has entered a lymphatic vessel
OVERVIEW: NERVOUS SYSTEM
Nervous System ➢ it is the control system of the body

• Central Nervous System
➢ two (2) major divisions of the nervous system:
• Peripheral Nervous System
Central Nervous System ➢ it consists of the brain and spinal cord
➢ it consists of the spinal and cranial nerves and their associated

Peripheral Nervous System
ganglia
Somatic Nervous System

➢ functional division of the nervous system:
Autonomic Nervous System
➢ it controls voluntary activities (examples: eating, moving the arms,
Somatic Nervous System
chewing)
➢ it controls involuntary activities (examples: pumping of the heart,

Autonomic Nervous System
digesting of food)
MEMBRANES
➢ lining of organs or passages that communicate with the surface of the
Mucous Membrane body
➢ these are moist, inner lining of some organs of body cavities
➢ line the cavities of the trunk and are reflected onto the mobile viscera
Serous Membrane
lying within these cavities
• Parietal Layer
➢ two (2) layers of serous membrane:
• Visceral Layer
➢ lining the wall of cavity.
Parietal Layer
➢ outer
➢ it covers the viscera (organ)
Visceral Layer
➢ inner
OVERVIEW: BONE
➢ is a living tissue capable of changing its structure as the result of the

Bone
stresses to which is subjected
➢ supports surrounding tissues
Primary Functions of Bone: ➢ protects vital organs and soft tissues
➢ provides levers for muscles to pull on
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➢ manufactures blood cells

➢ stores mineral salts
➢ these are bones found in the mid y-axis (longitudinal axis of the body)
Axial Skeleton ➢ refers to the skull, hyoid, vertebrae, ribs, sternum
➢ there are 80 axial skeleton bones
➢ refers to the upper extremities or arms and lower extremities or legs

Appendicular Skeleton
➢ there are 126 appendicular skeleton bones
MODULE 1 (PART 2) : KINEMATICS

Kinesiology ➢ study of human motion
➢ is the application of the principles of mechanics to the living
Biomechanics
human body
➢ the application of kinesiology to environments of the health care
Clinical Kinesiology
professional
➢ to understand movement and the forces acting on the human

body
Purpose of Studying Kinesiology:
➢ to learn how to manipulate these forces to prevent injury, restore
function, provide optimal human performance
1. Gravity
2. Muscle tension
➢ forces acting on motion (GF ME):
3. External resistance
4. Friction
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KINESIOLOGY TERMINOLOGY
Movement ➢ essence of kinesiology
➢ concentrated on the forces that produces or resist the movement (GF

Kinetics ME)
➢ quantitative
➢ deals with types of motion or movement

Kinematics ➢ without regard for the forces that produce that motion
➢ qualitative
Osteokinematics
➢ two (2) subtopics of kinematics:
Arthrokinematics
➢ “osteo” means bones
Osteokinematics ➢ concerns the movement of the bony partners or segment that make
up a joint
➢ “arthro” means joint.

Arthrokinematics ➢ focuses specifically on the minute movements occurring within the
joint and between the joint surfaces
Anatomical Position ➢ reference position of the body in a static, or nonmoving, position.
➢ Standing Erect
Anatomical Position ➢ Upper limbs by the sides
universally described as: ➢ Face and palms of the hands directed forward
➢ Fingers are extended
Frontal/ Coronal
Transverse ➢ the cardinal planes:
Sagittal
X (medial-lateral)
Y (vertical) ➢ the axes of motion:
Z (anterior-posterior)
➢ also known as coronal plane (XY plane)

Frontal Plane ➢ z-axis
➢ this plane divides the body into front and back parts.
➢ abduction and adduction (hip, shoulder, digits)
Motions that occur with the ➢ ulnar and radial deviation (a type of abduction. adduction at the
frontal plane are: wrist)
➢ lateral flexion or bending (neck, trunk)
➢ also known as horizontal plane (XZ plane)
Transverse Plane ➢ y-axis
➢ divides the body into upper and lower parts
➢ medial and lateral rotation (hip and shoulder)

Motions that occur with the
➢ pronation and supination (forearm)
transverse plane are:
➢ eversion and inversion (foot)
➢ also known as median sagittal plane (YZ plane)

Sagittal Plane ➢ x-axis
➢ it divides the body into equal right and left of the sides
Motions that occur with the ➢ flexion and extension (neck, trunk, elbow, and many others)
sagittal plane are: ➢ dorsiflexion and plantarflexion (ankle)
NAMING MOVEMENT AT JOINTS
Flexion ➢ to anterior
Extension ➢ to posterior
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Hyperextension ➢ extending more than a normal

Dorsiflexion ➢ toes up
Plantarflexion ➢ toes down
Protraction ➢ scapula move forward
➢ scapular retraction (chest out)
Retraction
➢ shoulders back
Abduction ➢ away from the body
Adduction ➢ towards the body
Ulnar deviation ➢ towards the pinky finger
Radial deviation ➢ towards the thumb
Lateral flexion ➢ flexing or bending towards the side
Internal (medial) rotation
➢ rotation of the humerus or the arm
External (lateral0 rotation
➢ palms face down

Pronation
➢ in anatomical position: hands will face backwards
➢ palms face up
Supination
➢ in anatomical position: hands will face forwards
Inversion ➢ the subtalar joint in ankle rotated towards the middle part of the body
Eversion ➢ the subtalar joint in ankle turn towards the lateral side of the body
NAMING MOVEMENT AT JOINTS (SPECIAL CASES)
➢ it is an exemption in the planes since it has its own movement.

Thumb ➢ flexion and extension in frontal plane
➢ abduction and adduction in sagittal plane
Flexion Extension Abduction Adduction

Forearm supination and pronation with elbow flexion (z-axis)
Hip internal rotation and external rotation with hip flexion (z-axis)
CONTINUTATION OF KINEMATICS
➢ the movement of our bony levers through their ranges of motion
➢ produced by muscles
Osteokinematics ➢ movement that occurs between the shafts of two adjacent bones as
the two body segments move with regard to each other
➢ macro view or macro approach
Translatory
➢ types of motions:
Rotary
➢ also known as linear motion
➢ motion occurs along or parallel to and axis
Translatory motion
➢ all points on the moving object travel the: same distance, direction,
velocity, and time
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object travels in a curved path

➢
Curvilinear
example: when tossing a ball to a friend
➢
occurs in a circle around an axis
➢
every point on the object attached to the axis follows the arc of a
➢
Rotary Motion circle
➢ takes place at axis of rotation
➢ example: crack the whip
When an object is closer to the axis, it will move slower.
When an object is farther to the axis, it will move faster.
➢ functional motion involves combination of linear and rotary
movements
Impacts of Translatory and
➢ movements in the human body are not solely linear or rotary
Rotary Motion
➢ walking (linear, but the movements in the body have a rotation for
you to walk)
➢ this is the number of planes within a joint move
➢ maximum: 3 degree of freedom
Degrees of Freedom
➢ example: shoulder (the shoulder can do flexion and extension in
sagittal plane)
can do flexion and extension in sagittal plane
shoulder can do abduction and adduction in frontal plane
Example can do internal and external in transverse plane
therefore, shoulder has a maximum degree of freedom
Joints classification: ➢ uniaxial, biaxial, and triaxial
➢ 1 degree of freedom = 1 axis
REMEMBER: ➢ 2 degrees of freedom = 2 axis
➢ 3 degrees of freedom = 3 axis
Uniaxial ➢ a joint that permits movement around one (1) axis only
Biaxial ➢ a joint that permits movement around two (2) axis
Triaxial ➢ a joint that permits movement around three (3) axis
JOINT CLASSIFICATION BY STRUCTURE AND FUNCTION

STRUCTURE/ PRIMARY
TYPE MOTION EXAMPLE
SHAPE FUNCTION
Stability, shocks
I. Synarthrosis absorption and
Fibrous Very slight movement Tibiofibular articulation
Syndesmosis force
transmission
Stability with a. Pubic symphysis
II. Amphiarthrosis Cartilaginous specific and Limited b. Intervertebral joints
limited mobility c. 1st sternocostal joint
Free moveable
Synovial with
III. Diarthrosis Mobility according to degrees
ligaments
of freedom
Irregular
Contributory Between carpal bones
a. Nonaxial plane Gliding
motion Between tarsal bones
surfaces
Elbow, interphalangeal
Motion in
Hinge Flexion, extension joints of fingers, toes,
b. Uniaxial sagittal plane
knee, and ankle
1 degree of
Supination,
freedom (DOF) Motion in Forearm, subtalar joint of
Pivot pronation, inversion,
transverse plane foot, atlas on axis.
eversion
Motion in Flexion and extension,
Metacarpophalangeal
Condyloid sagittal and abduction and
c. Biaxial joints in hand and foot
frontal planes adduction
2 degrees of
freedom (DOF) Motion in Flexion and extension,
Ellipsoidal sagittal and radial and ulnar Radiocarpal joint at wrist
frontal planes deviation
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Motion in
sagittal and Flexion and extension,
frontal planes abduction and Carpometacarpal joint of
Saddle
with some adduction, opposition thumb
motion in of thumb.
transverse plane
Flexion and extension,
d. Triaxial
Ball and Motion in all abduction and
3 degrees of Shoulder, hip.
socket three planes adduction, rotation
freedom (DOF)
(medial and lateral)
TERMS (TABLE ABOVE)
Fibrous ➢ connected by dense connective tissue consisting mainly of collagen

Cartilaginous ➢ a type of joint where the bones are entirely joined by cartilage
➢ also known as ginglymus
➢ greek: hinge
Hinge
➢ a modified sellar joint with each mating surface ovoid on its right and
left sides
➢ also known as trochoid
➢ greek: wheel shape
Pivot
➢ a freely moveable joint (diarthrosis) that allows only rotary
movement around a single axis.
➢ generally spherical convex surface paired with a shallow concave
Condyloid
surface
➢ somewhat flattened convex surfaced paired with a fairly deep
Ellipsoidal
concave surface
➢ each partner has a convex and concave surface oriented
Saddle
perpendicular to each other: like a rider in a saddle
Ball and socket ➢ a spherical type “ball” paired with a concave cup
CONTINUTATION OF KINEMATICS
➢ valuable clinical measurement used to define the quantity of joint

Clinical Goniometry
motion, either actively or passively.
➢ is an instrument that measures the available range of motion at a
Goniometer
joint
➢ when a normal joint is moved passively to the end of its range of
End feel motion
➢ resistance to further motion is palpates by the examiner
Normal end feels: ➢ soft, firm, and hard
➢ indicates that the examiner did not reach the end feel (usually the
Empty patient is not willing to allow motion to end of range because of
anticipated pain)
➢ occur either at a different place in the range of motion than
Pathologic end feels expected.
➢ have an end feel that is not characteristic of the joint
• Active Range of Motion
➢ two (2) types of range of motion:
• Passive Range of Motion
Active Range of Motion ➢ is carried out by the patient her/himself.
Passive Range of Motion ➢ - is carried out by a physiotherapist
Kinematic Chains ➢ it is uniting successive movements of joints that come side by side
Open kinematic chain (OKC)
➢ two (2) types of kinematic chain:
Closed kinematic chain (CKC)
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➢ distal segment of the chain moves in space.

Open kinematic chain (OCK) ➢ example: bicep curls (it’s the distal segment moves; the shoulder
remains stable)
➢ distal segment is fixed
➢ proximal parts are moving
Closed kinematic chain (CKC)
➢ example: hand plank (the distal segment does not move; the
shoulder and elbows move)
➢ the phenomenal superiority of human joints to man-made joints is
Joint Surface Motion
due not only to the physiologic capacities of biologic joints
➢ low coefficient of friction
The reasons why human joints ➢ presence of sensation and proprioceptive feedback
are not easily to replicate: ➢ dynamic growth responses to wear and use
➢ the mechanical complexities of human joint
➢ concerned with how the two articulating joint surfaces actually
move on each other
Arthrokinematics
➢ not voluntary
➢ vital for normal joint function and mobility
Synarthrodial Joints
Amphiarthrodial Joints ➢ classifications of joint according to structure:
Diarthrodial Joints
➢ the joint that connects bones by fibrous tissue and allows only little or
no movement
Synarthrodial Joints
➢ is type of joint connects bones by tough fibrous tissue
Suture- in the Skull ➢ example: Syndesmosis, gomphosis
Syndesmosis Interosseus ➢ two adjacent bones are linked by a strong membrane or ligaments
Membrane
➢ also known as dental alveolar joint
Gomphosis
➢ articulation of the teeth and the sockets of the maxilla or mandible
➢ these joints provide both stability and mobility.
➢ hallmarked by a cartilaginous structure with combinations of both
Amphiarthrodial Joints fibrous and hyaline (or articular) cartilage and typically have a disc
between the bony partners
➢ example: IV joints, pubic symphysis, 1st sternocostal joint
➢ these joints provide mobility (they are freely-moveable)
➢ the key structural component of diarthrodial joints is that they all
Diarthrodial Joints
have a joint capsule.
➢ they are called as synovial joints
Joint Capsule ➢ an envelope surrounding a synovial joint
Stratum fibrosum
➢ two (2) layers of joint capsule (FOSI):
Stratum synovium
Stratum fibrosum ➢ an outer fibrous layer or membrane
Stratum synovium ➢ an inner synovial layer or membrane
Ovoid and Sellar ➢ joint surfaces are described as:
➢ most synovial joints
Ovoid (egg-shaped)
➢ concave-convex joint relationship
➢ type of synovial joint in which the opposing surfaces are reciprocally
Sellar (saddle)
concave and convex
➢ Cartilage (hyaline, fibrous, elastic)
➢ Ligaments
Other materials found in ➢ Articular discs
synovial joints ➢ Joint capsule
➢ Synovial fluid
➢ Bursae
Basic arthrokinematics joint ➢ Rolling (rocking)
motions: ➢ Sliding (gliding)
13 | P a g e
➢ Spinning
➢ is a rotary, or angular, motion in which each subsequent point on one

Rolling/ Rocking surface contacts a new point on the other surface
➢ example: “rolling” a ball across the floor
➢ is a translatory, or linear, motion

➢ movement of one joint surface is parallel to the plane of the
adjoining joint surface
Sliding/Gliding
➢ example: when a figure skater “glides” across the ice (in sliding or
gliding, one point of reference (the skate blade) contacts new points
Accessory Movements
across the adjacent surface
➢ is a rotary, or angular,
Spinning ➢ motion in which one point of contact on each surface remains in
constant contact with a fixed location on the other surface
Compression ➢ facilitate joint proprioceptors and improve joint stability

➢ assist in synovial fluid circulation within a joint and increase joint
Distraction
mobility
➢ if the bone with the convex joint surface moves on the bone with the
concave surface, the convex joint surface slides in the direction
opposite to the bone segment’s rolling motion
Convex-concave principle
➢ if the bone with the concave surface moves on the convex surface,
the concave articular surface slides in the same direction as the
bone segment’s roll does
Convex ➢ if it’s the ____ bone moves, the glide will be opposite
Concave ➢ if it’s the ____ bone moves, the glide will be the same
➢ the maximum area of surface contact occurs,

➢ the attachments of the ligaments are farthest apart and under
tension
Close-packed position
➢ capsular structures are taut
➢ the joint is mechanically compressed and difficult to distract
(separate)
➢ also known as loose-packed position
➢ ligamentous and capsular structures are slack
Open-packed position ➢ joint surfaces may be distracted several millimeters
➢ allow the necessary motions of spin, roll, and slide typically with an
increase in accessory movements and decreased joint friction
➢ The position at which there is the least congruency and at which the
Resting position capsule and ligaments are loosest or most slack
➢ preferred joint position in joint mobilization
Hypomobile and Hypermobile ➢ clinical applications:
Hypomobile ➢ the movement is less than normal

Hypermobile ➢ the movement is more than the normal
MODULE 1 (PART 3) : KINETICS

➢ deals with forces that produce, stop, or modify motion of either the
Kinetics
body as a whole or the individual body segments
➢ the displacement of a body or one of its segments from one point to
Motion
another
1. Type of motion
2. Location of the motion
Determinants of Motion:
3. Magnitude of the motion
4. Direction of the motion
14 | P a g e
5. Rate of motion or rate of change at which the motion occurs
TYPES OF MOTIONS: ➢ translatory and rotorary
Translatory motion ➢ occurs as a linear displacement
Rotary motion ➢ movement of a rigid segment around an axis
Axis and Plane of motion ➢ location of motion:
➢ magnitude of motion
Distance
➢ how far a force moves a body
Linear Distance ➢ measured in meters or feet
Rotary distance ➢ measured in degree (ROM)
Positive or negative ➢ direction of motion:
RATE OF MOTION
Velocity ➢ is the rate at which a body or segment moves
Translatory motion ➢ measured in meters or feet per second (m/s, ft/s)
Rotary motion ➢ the measurement is degrees per second ( ∘/s)
Acceleration ➢ is the rate at which a change in velocity occurs
Linear ➢ (m/s per second or ft/s per second) (m/s2 or ft/s2)
Rotary ➢ (∘/s per second (∘/s2)
➢ motion occurring around an axis

Torque
➢ force applied in an arc of motion around an axis
FORCES
➢ is the study of forces acting on the body
Kinetics
➢ motion occurs because of these forces
Displacement ➢ is the motion of a body or segment that occurs when force is applied
Force ➢ is a push or a pull that produces displacement

Magnitude and Direction ➢ two (2) dimensions of forces:
Equilibrium ➢ forces are equal
1. Gravity
2. Muscles ➢ types of Forces (4 primary sources of force which affect body
3. Externally applied resistance movement) :
4. Friction
Gravity ➢ the most prevalent force that all structures encounter is _____
➢ is commonly referred to as the “weight” of an object, body, or body

Gravitational force
segment
➢ it produces forces on their bone segments by either active
Muscles contraction or passive stretching.
➢ it forces provides motion of body segments and of the entire body
➢ these devices are numerous and are whatever the muscles must
Externally applied resistances
work against to produce motion.
15 | P a g e
➢ example: exercise pulleys, manual resistance, doors, and windows
➢ is the resistance to movement between two objects that are in

Friction
contact with each other
➢ providing stability if optimum
Friction can be advantageous
➢ retarding motion if excessive
or disadvantageous by:
➢ leading to instability if inadequate
Mass ➢ is the amount of matter contained within an object
Weight ➢ is the force of gravity acting on the object

➢ is the result of force acting at a distance from the point of motion, or
Moment
the axis
Formula for Moment: ➢ distance x force
Translational forces
➢ two (2) types of forces:
Rotary forces
Translational forces ➢ distance is the length of the lever arm
➢ moment arm (or the perpendicular distance from the force vector
Rotary forces
to the joint’s axis of motion)
➢ 1st Law = Inertia
Newton’s Law of Motion: ➢ 2nd Law = Acceleration
➢ 3rd Law = Action-reaction
➢ also known as inertia
Newton’s 1st Law of Motion ➢ if a body is at rest, it will remain at rest, and if a body is in uniform
motion. It will remain in motion, until an outside force act upon it
➢ the property of a body that resists change in motion or equilibrium

Inertia
➢ ΣF = 0
Net force ➢ is the sum of forces acting on a mass
➢ also known as acceleration

➢ the acceleration (a) of a body is proportionate to the magnitude of
the net forces (F) acting on it and inversely proportionate to the mass
Newton’s 2nd Law of Motion
(m) of the body.
➢ greater force is required to move (or stop the motion of) a large mass
than a small one
𝒇
Acceleration ➢ 𝐚 ∝
𝒎
➢ also known as action-reaction
Newton’s 3rd Law of Motion
➢ for every action force there is an equal and opposite reaction force
➢ force exerted by the ground on a body in contact with it (resisting
Ground reaction force (GRF)
our force)
➢ vector forces can be combined when more than one force is
applied to a body or segment.
Resultant vector
➢ the combination of these vectors will result in a new vector =
resultant vector
➢ a simple machine that consists of a rigid bar that rotates around an
Levers
axis, or fulcrum, is a _____
Muscles apply forces that produce movement of the body’s levers
Axis/Fulcrum
Resistance/ Weight ➢ three (3) elements of mechanical levers:
Force/Effort
➢ also known as fulcrum
Axis
➢ joints
➢ also known as weight
Resistance
➢ gravity, dumbbell, ankle weights
16 | P a g e
➢ also known as effort

Force
➢ muscle
➢ the perpendicular distance from the axis to the line of action of the
Resistance arm
resistance.
Force arm ➢ the perpendicular distance from the moving force to the axis
LEVER SYSTEM
LEVER MECHANICAL ADVANTAGE FUNCTION EXAMPLE
I 1 balance, stability AO joint, unilateral stance
II greater than 1 (>1) power standing on ball of the foot
most common in the body,
III. less than 1 (<1) speed
open chain movement
1st class (balance) Example: Altanto-occiptal joint
Fulcrum: AO joint
Force/Effort: Neck extensors
Resistance/Weight: Load of the front of the skull
WFE (weight, fulcrum, and effort)
2nd class (power)

Example: Standing on a ball of toes (tiptoes)
Fulcrum: ball of the foot

Force/Effort: gastrocnemius (calf muscle)
Resistance/Weight: weight of the body
FWE (fulcrum, weight, and effort)
3rd class (speed) Example: brachioradialis with dumbbell

most common
Fulcrum: elbow
Force/Effort: brachioradialis
Resistance/Weight: dumbbell
FEW (fulcrum, effort, and weight)

➢ refers to the ratio between the length of the force arm and the length
Mechanical Advantage
of the resistance arm
Mathematical Expression of
Mechanical Advantage:
17 | P a g e
➢ when that body or segment is not moving, it is in the state of

Static Equilibrium
➢ static equilibrium and acceleration is zero (ΣF = 0)
➢ (when force is applied around an axis), is the product of a force times

Torque the perpendicular distance (d) from its line of action to the axis of
motion (or its potential motion if the object is currently stationary)
Formula for torque: ➢ τ = F ・ d.
➢ force application to the body:
Gravity-free
Gravity-eliminated ➢ when a body part is positioned and supported to move in a plane
Gravity-minimized parallel to the earth, effects of gravity is reduced
➢ great for those with significant weakness
➢ is the theoretical point around which the mass of the object is

balanced
➢ it is around this center that gravity acts
Center of Gravity (COG) ➢ this point is also called the center of mass (COM)
➢ center of gravity of the adult body in the anatomic position = slightly

anterior to the second sacral vertebra
➢ approximately 55% of a person’s height.
SPECIFIC COG
➢ if the center of gravity of a body is disturbed slightly and the body

Stable Equilibrium
tends to return the center of gravity to its former position
➢ if the center of gravity does not return but seeks a new position, the
body falls
Unstable Equilibrium
➢ example: rocking while sitting in a rocking chair, sitting on a narrow-
based stool leans forward
➢ occurs when the center of gravity is displaced, but it remains at the
Neutral Equilibrium same level; that is, it neither falls nor returns to its former position
➢ example: rolling ball or a person who is propelled in awheelchair
1. Height of the center of gravity above the base of support
Factors affecting degree of 2. Size of the base of support
stability: 3. Location of the gravity line within the base of support
4. Weight of the body
➢ the direction of gravity is always going to be a vertically downward
Line of Gravity
pull from the COM toward the center of the earth
➢ T – odontoid process, opistropheus, odontoid peg
➢ A - AO joint
➢ T - cervical
LOG ➢ A - thoracic
➢ T - lumbar
➢ P -hip
➢ A - knee
18 | P a g e
➢ A – ankle
➢ T = through, A = anterior. P = posterior
➢ is the area within the points of contact of the body and any object
Base of Support
the individual relies on for support
LINIC
CLINICAL APPLICATION OF CONCEPTS
➢ they can be single fixed, movable, and anatomic
➢ it provides various resistance forces within a joint’s range of motion
➢ the greatest resistance occurs when the line of the pull of the body
pulley system forms a 90-degree angle with the body segment when
entire force is applied as a rotary component
Pulleys
Fixed pulley ➢ changes direction without providing any mechanical advantage

➢ provides mechanical advantage either increase or decrease
Moveable pulley
forces
➢ change a muscle’s angle of pull and improve torque production of
muscles.
Anatomic pulley
➢ the farther the distance of the muscle to the joints, the greater its
efficiency
Fixed Pulley Moveable Pulley Anatomic Pulley
➢ the greater the perpendicular distance between the muscle’s line of

Leverage factor action and the joint’s center (moment arm distance), the greater the
rotational component produced by the muscle at that joint
The biceps brachii muscle produces the most torque at 90 degrees of elbow flexion.
➢ ______ to the capability of range of motion

➢ can help improve flexibility, which means your periarticular tissues
Stretching
(those around the joint), muscles, and tendons, are able to extend
to the level that you require for daily activities.
➢ when we manipulate the joint itself
Joint Mobilization
➢ the careful use of skilled graded forces to move a joint in a desired
19 | P a g e
direction.
➢ is a function of the applied force per unit area (P = F/A) and is

reported in pounds per square inch (PSI) or kilograms per square
centimeter
Pressure
TERMS RELATED TO MOVEMENT (PICTURE)

FLEXION
Cervical Flexion Wrist Flexion Shoulder Flexion Trunk Flexion Elbow Flexion
Trunk Lateral Cervical Lateral

Flexion Flexion
Hip Flexion Knee Flexion
*away from the *away from the
midline* midline*
20 | P a g e
EXTENSION
Cervical Extension Wrist Extension Shoulder Extension Trunk Extension
Hip Extension Knee Extension Elbow Extension
DORSIFLEXION AND PLANTARFLEXION
Ankle Dorsiflexion Ankle Plantarflexion
ABDUCTION
Shoulder Abduction Hip Abduction Ankle Abduction
ADDUCTION
Shoulder Adduction Hip Adduction Ankle Adduction

21 | P a g e
ROTATION
Shoulder Lateral Rotation Shoulder Medial Rotation

Cervical Rotation
(External Rotation) (Internal Rotation)
Hip Medial Rotation

(rotation of hip and thigh Hip Lateral Rotation Trunk Rotation
towards the medial)
OTHER MOVEMENTS
Supination Sample Movement Pronation Sample Movement Eversion Sample Movement

Forearm Supination Forearm Pronation Ankle Eversion
Inversion Sample Movement

Radial Deviation Ulnar Deviation
Ankle Inversion
22 | P a g e
MODULE 2 (PART 1) : MUSCULAR SYSTEM

“No matter where muscle tissues are in the body, they all share the same feature: CONTRACTION.”
• Body movement
• Maintenance of posture
• Respiration
Major functions of Muscles • Production of body heat
• Communication
• Constriction of organs and vessels
• Heartbeat
➢ most skeletal muscles are attached to bones and are responsible

Body movement
for the majority of body movements
➢ skeletal muscles constantly maintain tone, which keeps us sitting

Maintenance of posture
or standing erect
Respiration ➢ skeletal muscles of the thorax carry breathing movements
➢ when skeletal muscles contract, heat is given off as a by-product
Production of body heat
that is critical for maintaining body temperature
➢ skeletal muscles are involved in all aspect of communication

Communication
including speaking, writing, typing, gesturing, smiling or frowning
➢ the contraction of smooth muscles within the walls of internal

Constriction of organ and vessel
organs and vessels causes those structure to constrict
➢ helps propel and mix food and water in the digestive tract
Constriction ➢ removes materials from organs
➢ regulate blood flow through vessels
➢ the contraction of the cardiac muscle causes the heart to beat,
Heartbeat
propelling blood to all parts of the body
1. Contractility
2. Excitability
➢ four (4) general functional characteristics of muscle (CEEE):
3. Extensibility
4. Elasticity
Contractility ➢ ability to shorten forcefully

Excitability ➢ capacity to respond to stimuli
➢ stretched beyond its normal resting length and is still able to
Extensibility
contract
➢ ability to recoil to its original resting length after it has been
Elasticity
stretched
OVERVIEW: MUSCLE
• Skeletal muscle
• Smooth muscle ➢ two (2) layers of skin:
• Cardiac muscle
➢ these muscles are attached to the movable parts of the skeleton
➢ cell shape: long, cylindrical
➢ it is striated and multinucleated (it contains multiple peripheral
Skeletal Muscle
nucleus)
➢ it is not autorhythmic, thus, it moves under conscious control or
voluntary control.
Function of Skeletal Muscle: ➢ it is simply for body movements
23 | P a g e
➢ is found in the walls of hollow organs, such as the stomach and

uterus, and tubes, such as blood vessels and the ducts of certain
glands
Smooth Muscle
➢ cell shape: spindle-shaped
➢ it is non striated and uninucleate (it contains single central nucleus)
➢ it compresses organs, ducts, tubes, and so on, to promote different
Function of Smooth Muscle
physiological events: peristalsis (movement of food forward)
➢ is found only in the heart.

➢ cell shape: branched
Cardiac Muscle
➢ it is striated and uninucleate (it contains single central nucleus)
➢ the contractions of it provides the major force for moving blood

Function of Cardiac Muscle
through the circulatory system
Intercalated disks ➢ it is a special feature of cardiac muscle that contains desmosomes
Desmosomes ➢ they hold the fibers together during contraction
Parts of Muscle: ➢ origin, insertion, belly, and tendon

➢ attachment of a muscle on a more stable bone
Origin
➢ a part of muscle that has a least movement
➢ attachment of a muscle on a more moveable bone
Insertion
➢ most movement occurs in insertion attachment of a muscle
Belly ➢ the widest and fleshy part of muscle; bulk
Tendon ➢ a connective tissue that connects muscle to bone
Aponeurosis ➢ a thin but strong sheet of fibrous tissue attaching flattened muscle
➢ the central part of the deep fascia of the palm which is a highly
Palmar Aponeurosis
specialized thickened structure with little mobility
➢ interdigitation (interlocks) of the tendinous ends of fibers of flat
Raphe
muscles
24 | P a g e
CHARACTERISTICS OF SKELETAL MUSCLE FIBER TYPES
Slow-Twitch Fast-Twitch Oxidative

Fast-Twitch Glycolytic (FG)
Oxidative (SO) Glycolytic (FOG)
(Type IIb)
(Type I) (Types IIa)
Fiber Diameter Smallest Intermediate Largest
Myoglobin Content High High Low
Mitochondria Many Many Few
High anaerobic
High aerobic
Metabolism capacity; intermediate Highest anaerobic capacity
capacity
aerobic capacity
Fatigue Resistance High Intermediate Low
Myosin Head Activity Slow Fast Fast
Glycogen Concentration Low High High

Maintenance of
posture and Endurance activities in Rapid, intense movements of
Functions performs endurance-trained short duration (sprinting)
endurance muscles *more power*
activities
TERMS (TABLE ABOVE)

Myoglobin ➢ a red colored pigment protein that binds oxygen in muscles
➢ the powerhouse of the cell.

Mitochondria
➢ it produces ATP (Adenosine triphosphate)
Myosin Head Activity ➢ acts in muscle contraction
➢ it is the capability to perform movements or exercise in prolong
Endurance
periods of time (example: running)
Aerobic ➢ it requires air
Anaerobic ➢ it does not require air
MUSCLE PHYSIOLOGY
➢ composed of skeletal muscle cells

➢ associated with small amounts of CT, blood vessels, and nerves.
➢ single, long, cylindrical cell, several nuclei at the periphery of the fiber
Skeletal Muscle Structure
near the plasma membrane.
➢ 1 mm to 4 cm in length
➢ 10 um 100 um in diameter
Fascia ➢ a connective tissue sheet within the body
➢ separates and compartmentalizes individual muscles or group of

Muscular fascia muscles
➢ dense irregular collagenous connective tissue
1. Epimysium
2. Perimysium ➢ three (3) coverings of the muscle:
3. Endomysium
Epimysium ➢ surrounds individual muscle
Perimysium ➢ surrounds muscle fasciculi
Muscle fasciculi ➢ a collection of muscle fiber
25 | P a g e
Endomysium ➢ surrounds muscle fiber

➢ each skeletal muscle is a complete organ consisting of cells called __
Muscle Fibers ➢ these are long, cylindrical cells, each with several nuclei located near
the plasma membrane
Sarcolemma ➢ plasma membranes of muscle fiber

Sarcoplasm ➢ cytoplasm without myofibrils
➢ bundles of protein filaments
Myofibril ➢ is a threadlike structure that extends the length of the muscular fiber
➢ consists of two kinds of myofilaments
1. Actin myofilaments
➢ two (2) kinds of myofilaments:
2. Myosin myofilaments
➢ thin filaments
Actin myofilaments
➢ resemble pearls arranges in two twisted strands
• Fibrous actin (F actin)

➢ two (2) minute strands of pearls twisted together:
• Globular actin (G actin)
Globular actin (G actin) ➢ has an active site in which myosin can bind during muscle contraction
Troponin ➢ blinding site for Ca2+
➢ elongated protein that winds along the groove of actin and lie on top
Tropomyosin of active sites on resting state
➢ covering of active sites
➢ thick filaments
Myosin myofilaments
➢ resemble bundles of minute golf clubs
Head, Rod, and Cross-
➢ myosin myofilament is consisting of:
bridges
➢ during muscle contraction, they quickly bind and release in a
Head
ratcheting fashion, pulling themselves along the actin myofilament
Myosin ATPase ➢ enzyme that promotes breaks down of ATP
➢ functional unit of a muscle

➢ extends from one Z disk to an adjacent Z disk
Sarcomere
➢ during contraction, the sarcomere shortens
➢ portion between two adjacent Z lines
Functional unit ➢ a certain part of a system that is important to do what is mainly does
➢ is a filamentous network of protein forming a disk-like structure for the
attachment of actin myofilament
Z disk
➢ gives the muscle a banded appearance
➢ during contraction, the z disk narrows down
➢ light bands containing actin filaments
I bands ➢ isotropic to polarized light
➢ during contraction, the I band shortens
➢ dark bands contain both actin and myosin filaments

A bands ➢ anisotropic to polarized light
➢ during contraction, nothing happens to the A band
➢ center of each A band
➢ actin and myosin filaments do not overlap
H zone
➢ only myosin is present
➢ during contraction, the H zone disappears
➢ middle of the H zone
M line
➢ helps hold the myosin myofilaments in place
26 | P a g e
➢ attaches to Z disks and extends along myosin myofilaments to the M

line
Titin ➢ one of the largest known proteins
➢ functions as a spring, allowing the sarcomere to stretch and recoil
(passive elasticity)
Sliding Filament Model ➢ actin and myosin filaments length is equal in rested and contracted
(Relaxed Muscle) state
➢ actin moves towards each other
Sliding Filament Model ➢ sarcomere shortens as Z disks move toward each other
(Contracting Muscle) ➢ the H zones and the I bands narrow
➢ A bands do NOT narrow (because length of myosin do not change)
➢ ends of actin overlap at the center of the sarcomere.
Sliding Filament Model ➢ H zone disappears.
(Fully Contracted Muscle) ➢ I band narrows further
➢ A band remains unchanged
PHYSIOLOGY OF SKELETAL MUSCLE FIBERS

➢ these are nerves cells that connect the brain and spinal cord to
Motor neurons
skeletal muscle fibers
Brain/SC → Axons → Muscle Fibers = Contraction!!!
➢ these are polarized – that is, there is an electric charge difference

Plasma membranes
across the membrane
Polarity ➢ to have either a positive or negative charge
➢ charge difference across the plasma membrane of an unstimulated

Resting membrane potential
cell the membrane remains at rest
-70 millivolts (mV) ➢ resting membrane potential (RMP) of nerve
-90 millivolts (mv) ➢ resting membrane potential (RMP) od muscle
➢ is a reversal of the resting membrane potential

➢ the inside of the plasma membrane becomes positively charged
compared with the outside
Action potential
➢ when a cell is stimulated, permeability of plasma membrane changes,
as a result of opening of certain ion channels.
➢ diffusion of ions through channels produces action potential
1. Ligand-gated ion channels
➢ two (2) types of gated ion channels:
2.Voltage-gated ion channels
Ligand ➢ is a molecule that binds a receptor
➢ a protein/glycoprotein that has a receptor site to which a ligand can
Receptor
bind
➢ are channels with gates that open to a ligand binding receptor that
Ligand-gated ion channels
is part of the ion channel
27 | P a g e
• Neurotransmitters
➢ substances that are present to the receptor:
• Acetylcholine
➢ released by motor neurons supplying skeletal muscle
➢ it binds to ligand-gated Na+ channels in the membrane of muscle
Acetylcholine (Ach)
fibers
➢ as a result, the Na+ channels open, allowing Na+ to enter the cell
➢ open and close in response to small voltage changes across the

Voltage-gated ion channels plasma membrane
➢ sodium (Na+), potassium (K), and calcium (Ca+)
➢ also called as PISO

Na+ - K- Pump ➢ moves Na out, moves K in
➢ it only occurs during resting membrane potential (RMP)
Resting Membrane Potential

Depolarization ➢ three (3) main phases of action potential:
Repolarization
➢ there is a transport of three (3) sodium going out, with two (2)
Resting Membrane Potential potassium going in
➢ always in a negative potential
➢ the inside of the cell becomes positively charge brought by the

inflowing positively charged sodium ions
Depolarization
➢ POSI: Na in
➢ predominant ion: sodium
➢ rapid diffusion of potassium ions to the exterior re-establishes resting

Repolarization membrane potential
➢ predominant ion: potassium
All-or-none principle ➢ action potentials either will not occur, or if they do, are all the same
• Subthreshold stimulus
• Threshold stimulus ➢ three (3) types of stimulus:
• Propagate
Subthreshold stimulus ➢ too weak

Threshold stimulus ➢ minimum stimulus strength required
Propagate ➢ spread and promote
➢ also known as synapse

Neuromuscular Junction ➢ each axon branch forms a cluster of enlarges axon terminals that rests
in an invagination of the sarcolemma
Pre-synaptic terminal ➢ contains neurons sending the signal

➢ space or gap between the presynaptic terminal and post-synaptic
Synaptic cleft
neurons or terminals where nerve is transmitted (communication)
➢ contains neurons receiving the message
Post-synaptic membrane
➢ also known as motor end-plate
Synaptic vesicles ➢ they store and release neurotransmitters
ACTION POTENTIAL FOR MUSCLE CONTRACTION
1. An action potential arrives at the presynaptic terminal and causes voltage-gated Ca2+ channels in
the presynaptic membrane to open.
2. Calcium ions enter the presynaptic terminal and initiate the release of the neurotransmitter
acetylcholine (Ach) from synaptic vesicles
3. Ach is released into the synaptic cleft by exocytosis
28 | P a g e
4. Ach diffuses across the synaptic cleft and binds to ligand-gated Na+ channels on the postsynaptic
membrane
5. Ligand-gated Na+ channels open and Na+ enter the postsynaptic cell, causing the postsynaptic
membrane to depolarize - If depolarization passes the threshold, an AP is generated along the post-
synaptic membrane.
6. Ach unbinds from the ligand-gated Na+ channels, which then close
7. The enzyme acetylcholinesterase, which is attached to the postsynaptic membrane, acetylcholine
from the synaptic cleft by breaking it down into acetic acid and choline
8. Choline is symported with Na+ into the presynaptic terminal, where it can be recycled to make Ach,
Acetic acid diffuses away from the synaptic cleft
9. Ach is reformed within the presynaptic terminal using acetic acid generated from metabolism and
from choline recycled from the synaptic cleft. Ach is then taken up by synaptic vesicles
SUMMARY OF SKELETAL MUSCLE CONTRACTION
1. An action potential travels along an axon membrane to neuromuscular junction.
2. Ca2+ channels open and Ca2+ enters the presynaptic terminal

3. Acetylcholine is released from presynaptic vesicles
4. Acetylcholine stimulates Na+ channels on the postsynaptic membrane to open
5. Na+ diffuses into the muscle fiber, initiating an action potential that travels along the sarcolemma and
T tubule membranes
6. Action potentials in the T tubule cause the sarcoplasmic reticulum to release Ca2+
7. On the actin, Ca2+ binds to troponin, which moves tropomyosin and exposes myosin attachment sites
8. ATP molecules are broken down to ADP and P, which releases the energy needed to move the myosin
heads
9. The heads of the myosin myofilaments bend, causing the actin to slide past the myosin. As long as
Ca2+ is present the cycle repeats
CONTINUATION
➢ is the mechanism by which an AP in the sarcolemma causes the
Excitation- Contraction contraction of a muscle fiber
Coupling ➢ begins at the neuromuscular junction with the production of an
action potential in the sarcolemma
Terminal cisternae ➢ dilated end sacs of sarcoplasmic reticulum
➢ stores and releases Ca
➢ actively transports Ca2+ into its lumen.
Sarcoplasmic reticulum
➢ concentration of Ca2+ is approximately 2000 times higher within the
sarcoplasmic reticulum than in sarcoplasm of a resting membrane
➢ NMJ → AP @ sarcolemma → T-tubules → Ca+2 channels @ terminal

Muscle Contraction cisternae opens → sarcoplasm → myofibrils (actin and myosin) →
cross- bridge formation → contraction
1. Exposure of active sites

2. Cross-bridge formation
Breakdown of ATP and Cross-
3. Power stroke
Bridge Movement During
4. Cross-bridge release
Muscle Contraction
5. Breakdown of ATP
6. Recovery stroke
➢ calcium ions are transported into the sarcoplasmic reticulum.

Muscle relaxation ➢ calcium ions diffuse away from troponin and tropomyosin moves,
preventing further cross-bridge formation
29 | P a g e
➢ is the contraction of a muscle in response to a stimulus that causes

an action potential in one or more muscle fibers.
➢ does not last long enough or generate enough tension to perform
Muscle twitch
any work
➢ stimulus > latent period or lag phase > contraction phase > relaxation
phase
• Lag/Latent phase
• Contraction phase ➢ different phases of muscle twitch:
• Relaxation phase
➢ it is the time between the stimulus application to the motor neuron

Lag phase
and the beginning of contraction
Contraction phase ➢ it is the time during which muscle contraction occurs
Relaxation phase ➢ it is the time during which muscle relaxation occurs
Multiple motor unit summation ➢ the force of contraction produced by a muscle is increased in two
Multiple-wave summation ways:
Multiple motor unit summation ➢ increasing the # of muscle fibers contracting
Multiple-wave summation ➢ increasing the force of contraction of the muscle fibers
Stimuli ➢ without there will be no action potential.

➢ a stimulus that is too small in magnitude to produce an action
Subthreshold stimulus
potential in excitable cells
Threshold stimulus ➢ a stimulus that is just strong enough to evoke a response
Grade fashion ➢ can range from weak to strong
AP, CXN ➢ action potential, contraction
Subthreshold stimulus ➢ (-) AP nerve, (-) cxn mm
Threshold stimulus ➢ (+) AP on single motor unit (+) cxn on all mm fiber
Submaximal stimuli ➢ (+) AP on additional motor unit (+) cxn
Maximal stimuli ➢ (+) AP of all motor unit (+) cxn
Supramaximal stimuli ➢ no additional effect

➢ action potential lasts about 1-2 milliseconds
➢ skeletal muscle twitch may last 10 milliseconds up to 100 milliseconds
Multiple-Wave Summation
(1 second)
➢ increased tension resulting from increased frequency of stimulation
Incomplete tetanus ➢ muscle fibers partially relax between contractions
➢ action potentials are produced so rapidly in muscle fibers that no

Complete tetanus
relaxation between them
➢ also known as staircase effect
➢ when a skeletal muscle has been dormant for a long period of time,
initial activation and contraction only generate about ½ the force of
Treppe effect
the later contractions.
➢ muscle tension increases in a graded manner (stairs)
➢ muscle contractions become more efficient
➢ is the constant tension produced by muscles of the body over a long
period of time
Muscle tone ➢ state of partial contraction throughout whole muscle
➢ maintains pressure on abdominal contents
➢ aids digestion
Isometric and Isotonic ➢ types of muscle contraction:
30 | P a g e
Isometric ➢ no change in mm length, but there is increase in tension
Isotonic ➢ constant mm tension, length of mm changes
Concentric and Eccentric ➢ types under isotonic contractions:

➢ tension in the muscle is great enough to overcome the opposing
Concentric
resistance, and the muscle shortens
➢ tension is maintained in a muscle, but the opposing resistance is
Eccentric
great enough to cause the muscle to increase in length
Adenosine triphosphate (ATP) ➢ energy source for muscle contraction

➢ Glycolysis
ATP production ➢ Krebs citric acid cycle
➢ Electron transport
Fatty acids and
➢ alternate sources for energy:
Phosphocreatine
THE NAMING AND ACTIONS OF SKELETAL MUCLES
Origin ➢ more fixed attachment of muscle
Insertion ➢ movable attachment of muscle
Tendons ➢ attach muscle to bone
Aponeurosis ➢ wide flat tendon
Flexors ➢ bend limb at a joint
Extensor ➢ straighten limb at a joint
Abductors ➢ move limb away from midline
Adductors ➢ bring limb toward midline
Rotators ➢ revolve limb around axis
Dorsiflexion ➢ raise the foot
Plantar flexors ➢ lower the foot
Supinators ➢ turn palm upward
Pronators ➢ turn palm downward
Levators ➢ raise a part of the body
Depressors ➢ lower a part of the body
Prime movers or agonists ➢ bring about an action
Antagonist ➢ oppose agonists
Synergists ➢ assist prime movers
MODULE 2 (PART 1) : MUSCULAR SYSTEM
• Supports surrounding tissues

• Protects vital organs and soft tissues
Functions of the Skeletal
• Provides levers for muscles to pull on
System
• Manufactures blood cells
• Stores mineral salts
1. Bones
2. Cartilage ➢ four (4) components of skeletal system:
3. Tendons
31 | P a g e
4. Ligaments
➢ framework”
Skeleton
➢ supporting structure
Leonardo da Vinci ➢ he constructed the first correct illustrations of all bones

➢ connective tissue
➢ environment in which bone develops in fetus
Cartilage
➢ found at ends of bones and joints
➢ contains collagens and proteoglycans
1. Hyaline
2. Fibrocartilage ➢ three (3) types of cartilage:
3. Elastic cartilage
Ligament ➢ attach bones to bones
Tendons ➢ attach muscles to bones
THE GROWTH AND FORMATION OF BONE
➢ a three-month fetal skeleton is completely formed (cartilage)

➢ ossification and growth begin
➢ longitudinal growth continues until:
Introduction
➢ 15 years of age for girls
➢ 16 years of age for boys
➢ bone maturation until 21 years of age
Epiphyseal plate ➢ when it closes, no more growth in height

➢ laying down of new bones
Osteoblasts
➢ embryonic bone cells
Osteocytes ➢ mature osteoblasts
Strain on bone (exercise) ➢ increases bone strength
Osteoclasts ➢ bone reabsorption and remodeling (breakdown of bones)
• Intramembranous
➢ types of ossification:
• Endochondral
➢ dense connective membranes replaced by calcium salts
➢ cranial bones, part of the mandible (lower jaw), and the diaphysis of
Intramembranous the clavicles develop by
➢ begins at the 8th week of embryonic development
➢ completed after 2 years of age
➢ bone develops inside cartilage environment

Endochondral ➢ ossification starts at the 8th week of embryonic development
➢ all other bones of the body develop through
Endocrine system ➢ it acts like nervous system, serves as supervisor
Hormones ➢ chemical messengers
• Calcium storage
• Blood calcium levels ➢ three (3) in maintaining the bone, the endocrine controls the:
• Excretion of excess calcium
Parathyroid hormone ➢ regulates calcium release when calcium level is low
Calcitonin ➢ regulates calcium storage when calcium level is high
32 | P a g e
HISTOLOGY OF THE BONE
Compact and Cancellous ➢ two (2) types of bone:
➢ dense bone with few internal spaces organized into osteons

Compact Bone ➢ forms the diaphysis and covers the spongy bone of the epiphyses
➢ has more matrix and is denser with fewer pores than spongy bone
➢ bone having many small spaces

Cancellous or Spongy Bone ➢ found mainly in the epiphysis
➢ arranged into trabeculae
➢ also known as osteon

Haversian system ➢ provides the blood supply of the bone
➢ it is isolated only in compact bone
Osteon ➢ functional unit of the compact bone
• Haversian Canals
• Lamella
➢ four (4) components of Haversian System:
• Lacunae
• Volkmann’s Canal
➢ also called osteon

Haversian Canals
➢ run parallel to surface
Lamella ➢ concentric rings of bone
➢ cavity containing osteocyte
Lacunae
➢ connected by canaliculi
Canaliculi ➢ lacunae are connected by _____
➢ running horizontally to the haversian (central) canals
Volkmann’s Cana
➢ contains blood vessels to carry oxygen and nutrients
➢ cancellous bone contains _______

➢ function as meshwork of bone
Trabeculae ➢ spongy appearance created by _____
➢ bone marrow fills spaces between ________
➢ are interconnecting rods and veins
• Red Marrow
➢ two (2) types of bone marrow:
• Yellow Marrow
➢ connective tissue in the spaces of the spongy bon or in the medullary

cavity
Red marrow
➢ it is the site of blood cell production
➢ mostly found in the ribs, sternum, vertebrae, and pelvis
Hematopoiesis ➢ formation of blood cells
➢ fat stored within the medullary or in the spaces of the spongy bone
➢ shafts of long bones
Yellow Marrow
➢ extends into the osteons replacing red bone marrow when it
becomes depleted
➢ by weight, mature bone matrix is normally 35% organic and 65%
inorganic material
Bone Matrix
➢ the collagen and mineral components are responsible for the major
functional characteristics of bone
Calcium hydroxyapatite
➢ the most abundant in inorganic material in the bone matrix
Ca10(PO4)6(OH)2
Organic Material ➢ collagen and proteoglycans
Collagen ➢ flexible strength to the matrix

33 | P a g e
Mineral ➢ responsible for compression (weight-bearing strength)
1. Long Bones
2. Short Bones
3. Flat Bones ➢ five (5) classification based on shape:
4. Irregular Bones
5. Sesamoid Bones
➢ length exceeds width

Long bones
➢ most bones of upper and lower extremity
• Diaphysis
• Metaphysis ➢ long bones are consisting of
• Epiphysis
Diaphysis ➢ shaft
Metaphysis ➢ flared portion
Epiphysis ➢ extremity
Periosteum ➢ covering of the bone
Examples of long bones: ➢ clavicle, humerus, radius, ulna, femur, tibia, and fibula
➢ not merely shorter versions of long bones

Short bones ➢ lack a long axis
➢ somewhat irregular in shape
Examples of short bones: ➢ carpal bones of the wrist and tarsal bones of the foot
Tarsal ➢ except for calcaneus (irregular)

Carpals ➢ except for pisiform (sesamoid)
➢ thin bones found wherever need for extension muscle attachment

Flat bones or protection
➢ usually curved
➢ sternum, ribs, scapula, parts of the pelvic bones, and some bones of
Examples of flat bones:
the skull
➢ very irregular in shape
Irregular bones
➢ spongy bone enclosed by thin layers of compact bone
Examples of irregular bones: ➢ vertebrae and ossicles of the ears
➢ small rounded bones

➢ enclosed in tendon and fascial tissue
Sesamoid bones
➢ located adjacent to joints
➢ develop in tendons exposed to excessive friction
Example of sesamoid bone: ➢ kneecap or patella (largest sesamoid bone in the body)
➢ processes: projections from the surface (spine, condyle, tubercle,

trochlea, trochanter, crest, line, head, neck)
Bone Markings
➢ fossae: depressions (suture, foramen, meatus, sinus, sulcus)
➢ functions: muscle attachment, articulation, passageways
206 bones ➢ average adult skeleton
• Paired bone
➢ bones can be categorized as:
• Unpaired bone
➢ two bones of the same type located on the right and left sides of the
Paired bone
body (86)
Unpaired bone ➢ is a bone located on the midline of the body (34)
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GENERAL ANATOMICAL TERMS FOR VARIOUS FEATURES OF BONES

TERMS DESCRIPTION
Body ➢ main part
Head ➢ enlarged (often rounded) end
Neck ➢ constriction between head and body
Margin or border ➢ edge
Angle ➢ bend
Ramus ➢ branch off the body (beyond the angle)
Condyle ➢ smooth, rounded articular surface
Facet ➢ small, flattened articular surface
RIDGES
TERMS DESCRIPTION
Line or linea ➢ low ridge
Crest or crista ➢ prominent ridge
Spine ➢ very high ridge
PROJECTION
TERMS DESCRIPTION
Process ➢ prominent projection
Tubercle ➢ small, rounded bump
Tuberosity or tuber ➢ knob, larger than a tubercle
Trochanter ➢ tuberosity on the proximal femur
Epicondyle ➢ upon a condyle
OPENINGS
TERMS DESCRIPTION
Foramen Hole ➢ hole
Canal or meatus ➢ tunnel
Fissure ➢ cleft
Sinus or labyrinth ➢ cavity
DEPRESSIONS
TERMS DESCRIPTION
Fossa ➢ general term form depression
Notch ➢ depression in the margin of a bone
Groove or sulcus ➢ deeper, narrow depressions
AXIAL SKELETON
1. Skull
2. Auditory ossicles
3. Hyoid bone ➢ the axial skeleton is divided into:
4. Vertebral column
5. Thoracic cage/Rib cage
➢ bones of the head for the skull, or cranium
➢ the bones of the skull, except for the mandible, are not easily
Skull separated from each other
➢ there are 22 skull bones (braincase = 8 bones) (facial bones = 14
bones)
35 | P a g e
Cranium ➢ the skull except the mandible
➢ the top of the skull is called the ____

Calvaria or Skullcap
➢ brain case / cranial vault
paired:
➢ Parietal (2)
➢ Temporal (2)
Braincase (8 bones) (PT FOSE) unpaired:

➢ Frontal (1)
➢ Occipital (1)
➢ Sphenoid (1)
➢ Ethmoid (1)
paired:
➢ Maxilla (2)
➢ Zygomatic (2)
➢ Palatine (2)
➢ Lacrimal (2)
Facial Bones (14 bones) ➢ Nasal (2)
➢ Inferior concha (2)
unpaired:
➢ Mandible (1)
➢ Vomer (1)
PICTURES
POSTERIOR VIEW OF SKULL DESCRIPTION
ANTERIOR VIEW OF SKULL INFERIOR VIEW OF SKULL
CONTINUATION
Nuchal lines ➢ the axial skeleton is divided into:
Sinus ➢ connected hallow cavities in the skull
36 | P a g e
Meninges ➢ layers of membranes that protect the central and nervous system
➢ depression found in the sphenoid bone; where pituitary gland is
Sella turcica
located
Sutures ➢ are seams between the bones of the skull
1. Frontal or Coronal
2. Sagittal
➢ four (4) Cranial Sutures
3. Lambdoid
4. Squamous - (4) Cranial Sutures
Frontal or Coronal suture ➢ frontal bone to parietal bone
Sagittal suture ➢ between 2 parietal bones
Lambdoid suture ➢ occipital bone to parietal bone
Squamous suture ➢ parietal bone to temporal bone
➢ no articulation with other bones

➢ floats in the superior aspect of the neck just below the mandible
Hyoid bone
➢ suspended by ligaments from styloid process
➢ supports the tongue
➢ also known as backbones

Vertebral Column ➢ central axis of the skeleton
➢ there are 26 vertebral column bones
1. Cervical (7)
2. Thoracic (12)
3. Lumbar (5) ➢ twenty-six (26) vertebrae bones:
4. Sacrum (1)
5. Coccyx (1)
➢ possess bifid spinous processes

Cervical
➢ transverse foramen
Bifid ➢ Y-shaped spinous process
Vertebral foramen of cervical ➢ large and triangular
➢ they are considered as atypical, since they do not look like a
C1, C2, and C7
typical look of cervical vertebrae
➢ also known as atlas
C1
➢ very much atypical
➢ also known as axis
C2
➢ presence of the dense of axis
➢ not bifid but prominent; its spinous process is called vertebral

C7 prominens
➢ combo of cervical and thoracic features
➢ possess long, slender spinous processes directed inferiorly

Thoracic ➢ attachment sites for ribs
➢ first 10 thoracic vertebrae (articulates with the ribs)
Vertebral foramen of thoracic ➢ circular shape
Vertebral bodies ➢ heart-shaped
➢ possess heavy and rectangular transverse processes

Lumbar ➢ large thick bodies
➢ stability
Vertebral foramen of lumbar ➢ triangular
37 | P a g e
Vertebral bodies ➢ kidney-shaped

➢ includes the thoracic and sacral
Primary Curve
➢ example: kyphosis (convex posteriorly)
➢ includes the cervical and lumbar
Secondary Curve
➢ example: lordosis (concave posteriorly)
➢ pads of fibrocartilage between the bodies of the adjacent
Intervertebral Disks vertebrae
➢ annulus fibrous and nucleus pulposus
Annulus fibrous ➢ circular exterior; tough
Nucleus pulposus ➢ inner core; soft
➢ also known as tail-bone
Coccyx
➢ easily broken in a fall
➢ also known as rib cage

Thoracic Cage
➢ encloses and protects heart and lungs
1. Sternum
2. Costal cartilages ➢ (3) the thorax or rib cage is made up of
3. Bodies of Thoracic Vertebrae
Sternum ➢ it is the breastbone
➢ are flexible and permit the ribcage to expand during respiration

Costal Cartilages
➢ attached ribs anteriorly to the sternum
1. Manubrium
2. Body or Gladiolus ➢ three (3) parts of the sternum:
3. Xiphoid process
Xiphoid process ➢ attachment for diaphragm and rectus abdominis
➢ also known as angle of louis

Sternal angle ➢ anterior angle formed by the junction of the manubrium and the
body of the sternum
➢ also called costae
Ribs (24)
➢ attach posteriorly to thoracic vertebrae
1. True Ribs (1-7)

2. False Ribs (8-10) ➢ the twelve (12) pairs of ribs:
3. Floating Ribs (11-12)
➢ they articulate with the thoracic vertebrae and attach directly
True Ribs
through their costal cartilages to the sternum
➢ they articulate with the thoracic vertebrae that are joined by a

False Ribs common cartilage to the costal cartilage of the seventh rib,
which in turn is attached to the sternum
➢ they articulate with the thoracic vertebrae but do not attach to

Floating Ribs
the sternum
TABLE
CHARACTERISTICS CERVICAL THORACIC LUMBAR
38 | P a g e
OVERALL STRUCTURE
SIZE small larger largest
one vertebral and

FORAMINA one vertebral one vertebral
two transverse
short, blunt (project
slender, often bifid long, fairly thick (most
SPINOUS PROCESSES posteriorly rather than
(C2- C6) project inferiorly)
inferiorly
TRANSVERSE PROCESSES small fairly large large and blunt
ARTICULAR FACETS FOR RIBS absent present absent
Direction of articular facets
SUPERIOR posterosuperior posterolateral medial
INFERIOR anteroinferior anteromedial lateral
SIZE OF INTERVERTEBRAL thick relative to size thin relative to size of

thickest
DISCS of vertebral bodies vertebral bodies
APPENDICULAR SKELETON
1. Upper Extremities (64)

➢ the axial skeleton is divided into:
2. Lower Extremities (62)
1. Clavicle
➢ the pectoral or shoulder girdle comprises the following:
2. Scapula
➢ it is a triangular bone
Scapula or Shoulder Blade ➢ scapular spine, supraspinous fossa, infraspinous fossa, subscapular
fossa, acromion process, coracoid process.
Acromion process ➢ can be felt at the tip of the shoulder
Coracoid process or
➢ provides attachments for some shoulder and arm muscles
Crow’s beak
➢ extends from the acromion process across the posterior surface of
Spine of Scapula
the scapula
➢ forms the only bony connection between the pectoral girdle and
Clavicle or Collar Bone
the axial skeleton
Lateral end ➢ the ______ of the clavicle articulates with the acromion process
Medial end ➢ the ___ of the clavicle articulates with the manubrium of the sternum
1. Arm
2. Forearm
➢ the upper extremity is consisting of the bones of:
3. Wrist
4. Hand
39 | P a g e
➢ Humeral head
➢ Anatomical neck
➢ Surgical neck
➢ Greater tubercle
Parts of the humerus or upper ➢ Lesser tubercle
arm: ➢ Bicipital groove
➢ Deltoid tuberosity
➢ Capitulum
➢ Trochlea
➢ Medial and Lateral epicondyles
Anatomical neck ➢ immediately distal to head
Surgical neck ➢ common site for fracture or diseases
Capitulum ➢ it is the lateral portion that articulates with the radius
Trochlea ➢ it is the medial portion that articulates with the ulna
1. Ulna (Medial)
➢ (2) the forearm comprises the following:
2. Radius (Lateral)
Ulna ➢ is on the medial side of the forearm, the side with the little finger
➢ Head
➢ Trochlear notch
The ulna consists of the
➢ Olecranon process
following:
➢ Coronoid process
➢ Ulnar tuberosity
Radius ➢ is on the lateral, or thumb side of the forearm
➢ Head
The radius consists of the
➢ Radial notch
following:
➢ Radial tuberosity
1. Carpal bones (8)

2. Metacarpals (5) ➢ (27) the wrist, hand, and fingers are consisting of:
3. Phalanges (14)
Carpal bones ➢ arranged in two rows (proximal and distal)
• Scaphoid
• Lunate ➢ proximal (lateral to medial):
• Triquetrum ➢ Some Lovers Try Positions that they cannot handle
• Pisiform
• Trapezium
• Trapezoid ➢ distal (lateral to medial):
• Capitate ➢ some lovers try positions That They Cannot Handle
• Hamate
Metacarpals ➢ are numbered 1-5

➢ thumb: proximal and distal
Phalanges
➢ fingers: proximal, middle, and distal
1. Pelvic Girdle
2. Leg ➢ three (3) parts of the lower extremities:
3. Foot
Pelvic Girdle ➢ attachment for the lower limbs
Coxal bones ➢ join anteriorly
Sacrum ➢ posteriorly
1. Ilium
2. Ischium ➢ (3) the coxal bones or ossa coxae is a fushion of bones:
3. Pubis
40 | P a g e
Acetabulum ➢ the three coxal bones are joined by the _____ to the femur
Pelvic girdle + Coccyx ➢ pelvis is made up of:
1. True Pelvis
➢ (2) the pelvis is subdivided into:
2. False Pelvis
True pelvis ➢ forms the bony canal through which the child passes during birth
➢ supports abdominal contents and is considered a part of the

False pelvis
abdominal; cavity
COMPARISON OF FEMALE AND MALE PELVIS
41 | P a g e
CONTINUATION
1. Thigh
2. Leg
➢ (4) lower limb is consisting of the bones of the:
3. Ankle
4. Foot
Femur ➢ the longest and strongest bone of the human body
➢ Femoral Head
➢ Femoral Neck
➢ Body or shaft
➢ Greater trochanter
➢ Pectineal line
➢ Gluteal tuberosity
Parts of femur:
➢ Linea aspera
➢ Medial and lateral
➢ condyles
➢ Adductor tubercle
➢ Patella
➢ Patellar groove
➢ largest sesmoid bone
Patella or Knee cap ➢ it is not articulated to any bones
➢ articulated on the fascia
Tibia and Fibula ➢ the lower leg bones:
➢ larger lower leg bone

➢ supports most of the weight
➢ articulates with femur
Tibia o Medial condyle
o Tibial tuberosity
o Anterior crest/Tibial crest
o Medial malleolus
➢ does not articulate with femur but has a small proximal head where
it articulates with the tibia
Fibula
o Head
o Lateral malleolus
1. Tarsal bones (7)

2. Metatarsals (5) ➢ (26) the foot consists of:
3. Phalanges (14)
1. Talus
2. Calcaneus
3. Navicular ➢ (7) tarsal bones:
4. Cuneiforms (3)
5. Cuboid
➢ ankle bone
Talus
➢ articulates with tibia and fibula to form the ankle joint
➢ heel bone
Calcaneus
➢ largest and strongest tarsal bone
Navicular ➢ boat-shaped
1. Medial
2. Intermediate ➢ (3) cuneiforms:
3. Lateral
Cuboid ➢ cube-shaped
42 | P a g e
Metatarsal ➢ are arranged in a similar manner to that of the metacarpal bones
➢ great toe: proximal and distal

Phalanges
➢ toes: proximal, middle, and distal
1. Medial Longitudinal Arch
2. Lateral Longitudinal Arch ➢ (3) major arches of the foot:
3. Transverse Arch
JOINTS
➢ a place where two or more bones come together
Articulation ➢ can be mobile or immobile 4) lower limb is consisting of the bones of
the:
Joints ➢ are classified into three major groups
• Fibrous
➢ (3) classification of joints according to type of material holding bones
• Cartilaginous
together (structure)
• Synovial
➢ are those in which bones are connected by fibrous tissue with no joint
Fibrous joints cavity
➢ little or no movement
➢ held together by dense fibrous connective tissue
Sutures
➢ example: Sutures in the skull
➢ fibrous ligaments
Syndesmoses
➢ example: radio-ulnar syndesmosis
➢ pegs held in place within sockets of fibrous tissue
Gomphoses
➢ example: teeth
➢ unite two bones by means of either hyaline cartilage or
Cartilaginous Joints
fibrocartilage.
➢ joined by hyaline cartilage
Synchondrosis
➢ example: epiphyseal plates
Symphyses ➢ slightly movable, fibrocartilage
Synovial Joints ➢ are capable of considerable movement
• Articular cartilage
➢ they consist of the following:
• Joint cavity
• Fibrous capsule
➢ (2) layers of the joint capsule:
• Synovial membrane
• Plane
• Saddle
• Hinge
➢ types of synovial joints:
• Pivot
• Ball and socket
• Ellipsoid
➢ permits the widest range of movement

➢ movement can occur in all planes
Ball-and-socket ➢ multiaxial, allows 3-degree movement (flexion/extension,
abduction/adduction, circumduction)
➢ example: shoulder and hip
➢ uniaxial
➢ a convex cylinder in one bone applied to a corresponding
Hinge
concavity in the other bone
➢ example: knee and elbow
43 | P a g e
➢ uniaxial
➢ cylindrical bony process that rotated within a ring composed partly
Pivot
of bone and partly ligament
➢ example: PRUJ, DRUJ, rotation of the head
➢ biaxial
➢ oval-shaped condyle fits into elliptical cavity
➢ motion in two planes at right angles
Condyloid (ellipsoidal)
➢ allows two-degree movement (extension/flexion, radial/ulnar
deviation)
➢ example: radius and carpal bones
➢ biaxial
Saddle ➢ consist of two saddle-shaped articulating surface
➢ example: permits opposition of the thumb
➢ multiaxial
➢ consist of two opposed flat surfaces of about the equal size in which
Plane
a slight amount of gliding motion occurs
➢ example: intervertebral joints in spine
• Gliding movements
➢ types of movement:
• Angular movements
➢ Flexion
➢ Extension
➢ Hyperextension
➢ Plantarflexion
Angular movements
➢ Dorsiflexion
➢ Abduction
➢ Adduction
➢ Lateral flexion
➢ Rotation (Internal and External)

➢ Pronation
Circular movement ➢ Supination
➢ Circumduction (combination of Flexion, Extension, Abduction, and
Adduction)
➢ Elevation and depressions

➢ Protraction and retraction
Special Movement ➢ Excursion
➢ Opposition and Reposition
➢ Inversion and Eversion
➢ Fibrocartilage articular disc

➢ Superior joint cavity
Temporomandibular Joint
➢ Inferior joint cavity
➢ Motions: protrusion, retraction, elevation, depression
➢ Glenohumeral joint
➢ Ball and socket joint
➢ Glenoid labrum
➢ Subacromial bursa
Shoulder Joint ➢ Rotator cuff
o Supraspinatus
o Infraspinatus
o Teres minor
o Subscapularis
44 | P a g e
➢ Also known as humero-ulnar joint

➢ Compound hinge joint
Elbow Joint ➢ Humeroradial joint
➢ Proximal radioulnar joint
➢ Olecranon bursa
➢ Also known as coxal joint

➢ Ball and socket joint
Hip Joint
➢ Acetabular labrum
➢ Y Ligament of Bigelow
➢ Modified hinge
➢ Lateral and medial meniscus
➢ ACL - Anterior Cruciate Ligament
Knee Joint
➢ PCL - Posterior Cruciate Ligament
➢ MCL – Medial Cruciate Ligament
➢ LCL – Lateral Cruciate Ligament
Ankle Joint and Arches of the ➢ Modified hinge joint

Foot ➢ Also known as talocrural
➢ Less flexible connective tissues of the joints

Effects of Aging ➢ Joint rigidity
➢ Wear and tea
45 | P a g e
MODULE 3: HEAD, NECK, AND TMJ
1. Skull
2. Auditory ossicles
3. Hyoid bone ➢ the axial skeleton is divided into:
4. Vertebral column
5. Thoracic cage/Rib cage
paired:
➢ Parietal (2)
➢ Temporal (2)
Braincase (8 bones) (PT FOSE) unpaired:

➢ Frontal (1)
➢ Occipital (1)
➢ Sphenoid (1)
➢ Ethmoid (1)
paired:
➢ Maxilla (2)
➢ Zygomatic (2)
➢ Palatine (2)
➢ Lacrimal (2)
Facial Bones (14 bones) ➢ Nasal (2)
➢ Inferior concha (2)
unpaired:
➢ Mandible (1)
➢ Vomer (1)
➢ Malleus (2)
Auditory Ossicles ➢ Incus (2)
➢ Stapes (2)
Hyoid ➢ Hyoid (1)

➢ Cervical vertebrae (7)
Vertebral Column ➢ Thoracic (12)
➢ Lumbar (5)
➢ bones of the head for the skull, or cranium
➢ the bones of the skull, except for the mandible, are not easily
Skull separated from each other
➢ there are 22 skull bones (braincase = 8 bones) (facial bones = 14
bones)
Joints of the skull ➢ fibrous synarthrodial suture

Pterion ➢ thinnest/softest part of the lateral aspect of skull.
➢ the larger, membrane-covered spaces between the developing

skull bones that have not been ossified
Fontanels or Fontanelles
➢ the mesenchyme or cartilage filled spaces (SOFT SPOTS)
➢ it allows the skull to move through the birth canal
Ossification ➢ when the cartilage develops into bones

Anterior fontanel ➢ 18 months
Posterior fontanel ➢ 2 months
Anterolateral fontanels ➢ 3 months
Posterolateral fontanels ➢ 12 months
• Skin
• Connective Tissue ➢ layers of the SCALP
• Aponeurosis (galea
46 | P a g e
aponeurotica)
• Loose Areolar Tissue
• Pericranium
MUSCLES OF THE FACE

MUSCLES MUSCLES
Occipitofrontalis ➢ surprise muscle Zygomaticus minor ➢ smiling w/o teeth
Orbicularis oculi ➢ eye muscles Zygomaticus major ➢ smiling w/ teeth
➢ draws the eyebrow ➢ elevates the angle of

Levator anguli oris
downward and the mouth
Corrugator supercilli medially, producing
the vertical wrinkles ➢ found in the lower
Risorius
of the forehead cheek area
➢ gives off a distaste ➢ depresses the angle

Procerus Depressor anguli oris
facial expression of the mouth
Orbicularis oris ➢ orbits the lips Depressor labii inferioris ➢ inferior to the lips
➢ provides facial
Levator labii superioris ➢ a paired muscle
expression and
alaequi nasi Mentalis located at the tip of
dilation of the mouth
the chin
Nasalis
➢ blowing muscle
Compressor nasi ➢ compresses the nose Buccinator
action
➢ a broad sheet of
muscle fibers
Dilator nares ➢ dilates the nostrils Platysma extending from the
collarbone to the
angle of the jaw.
SOME HEAD LANDMARKS POSTERIOR VIEW OF HEAD LAND MARKS

➢ a midline bony
prominence in the
External occipital occipital bone that
protuberance ligamentum nuchae and
trapezius muscle attach to
its tip
Occipital condyle ➢ below the occiput
➢ gives origin to the

Occipitalis and Trapezius,
Superior nuchal
and insertion to the
line
Sternocleidomastoids and
Splenius capiti
VERTEBRAL LEVELS WITH CORRESPONDING ANATOMIC LANDMARKS
CORRESPONDING ANATOMIC CORRESPONDING ANATOMIC

VERTEBRAE LEVEL VERTEBRAE LEVEL
LANDMARKS LANDMARKS
C3 ➢ hyoid bone T7 ➢ Inferior angle of scapula
C4-5 ➢ thyroid cartilage T10 ➢ tip of xiphoid process

C6 ➢ cricoid cartilage L4 ➢ iliac crest – highest position
47 | P a g e
➢ manubrium/ body of
T4 S2 ➢ posterior super iliac spines
sternum junction
CONTINUATION
➢ 1,500 to 2,000 times per day

Temporomandibular Joint ➢ movement: opening, closing, protrusion, retraction, lateral
deviation of the mandible of the temporal bone.
➢ freely moveable
Synovial joints ➢ concave: mandibular fossa
➢ convex: articular eminence of the temporal bone
Odontoid process ➢ also known as dens

➢ synovial joint between the superior articular process of one
Zygapophyseal/ apophyseal
vertebra and the inferior articular process of the vertebra above
joints
it
MUSCLES OF MASTICATION
➢ Temporalis
Jaw closure ➢ Masseter
➢ Internal/Medial pterygoid
➢ Lateral pterygoid
➢ Digastric
Jaw opening
➢ Mylohyoid
➢ Geniohyoid
Retraction ➢ Temporalis
➢ Lateral pterygoid
Protrusion ➢ Medial pterygoid
➢ Masseter
Lateral excursion ➢ mandibular deviation; side by side movement
➢ Temporalis
Ipsilateral
➢ Masseter
➢ Medial pterygoid
Contralateral
➢ Lateral pterygoid (inferior head)
SUMMARY OF THE MORE IMPORTANT OPENINGS IN THE BASE OF THE SKULL AND THE STRUCTURE THAT PASS
THROUGH THEN
OPENING IN SKULL BONE OF SKULL STRUCTURES TRANSMITTED

Anterior Cranial Fossa
Perforations in cribriform plate Ethmoid Olfactory nerves
Middle Cranial Fossa
Optic canal Lesser wing of sphenoid Optic nerve, ophthalmic artery
Lacrimal, frontal, trochlear,
Between lesser and greater oculomotor, nasociliary, and
Superior orbital fissure
wings of sphenoid abducent nerves; superior
ophthalmic vein
Maxillary division of the trigeminal
Foramen rotundum Greater wing of sphenoid
nerve
Mandibular division of the
Foramen ovale Greater wing of sphenoid trigeminal nerve, lesser petrosal
nerve
Foramen spinosum Greater wing of sphenoid Middle meningeal artery
48 | P a g e
Between petrous part of

Foramen laceru temporal Internal carotid artery
and sphenoid
Posterior Cranial Fossa
Medulla oblongata, spinal part
Foramen magnum Occipital of accessory nerve, and right
and left vertebral arteries
Hypoglossal cana Occipital Hypoglossal nerve
Glossopharyngeal, vagus, and
Between petrous part of
Jugular foramen accessory nerves; sigmoid sinus
temporal
becomes internal jugular vein
Vestibulocochlear and facial
Internal acoustic meat Petrous part of temporal
nerves
BONES OF THE NECK

7 (seven) ➢ there are ___ cervical bones
8 (eight) ➢ there are ___ cervical roots
3 atypical ➢ atlas, axis, C7
Zygapophyseal ➢ the synovial joints between the superior articular process and the
joints/apophyseal joints inferior articular process is also referred to as __________
➢ atlas
C1 ➢ (-) body, pedicle, lamina, spinous process
➢ hook-like structure; contains the dens
➢ axis
C2 ➢ (+) odontoid process/dens
➢ point of rotation
➢ vertebral prominens
➢ spinous process is not bifid
C7
➢ long, slender similar to thoracic vertebra
➢ transitional vertebra to the thoracic
LIGAMENTS
➢ continuation of the ALL, which runs as a band down the anterior
surface of the vertebral column
Anterior atlanto-occipital ➢ the membrane connects the anterior arch of the atlas to the
membrane anterior margin of the foramen magnum.
➢ limits neck extension
➢ between the occiput and the atlas (C1)
➢ similar to the ligamentum flavum and connects the arch posterior
Posterior atlanto-occipital
of the atlas to the posterior margin of the foramen magnum
membrane
➢ limits neck flexion
C1-C2 LIGAMENTS
➢ median placed structure connects the apex of the odontoid

Apical Ligament process to the anterior margin of the foramen magnum
➢ center
➢ these lie one on each side of the apical ligament and connects
Alar Ligament the odontoid process of the medial sides of the occipital condyles
➢ wing-like
49 | P a g e
➢ this ligament consists of a transverse part and vertical part

o cross-like structure; consists of two parts: horizontal
(transverse) and vertical (longitudinal) part
➢ the transverse part is attached on each side to the inner aspect
of the lateral mass of the atlas and bind the odontoid process of
Cruciate Ligament
the anterior arch of the atlas
o it keeps the dens in place, without it, hypermobility will
occur
➢ the vertical part runs form the posterior surface of the body to the
axis to the anterior margin of the foramen magnum
➢ this is an upward continuation of the PL

➢ it is attached above the occipital bone just within the foramen
Membrane Tectoria (Tectorial magnum
Membrane) ➢ it covers the posterior surface of the odontoid process and the
apical and cruciate ligaments
➢ a broad band; the most superficial layer posteriorly
BELOW C2 LIGAMENTS
➢ runs continuous from anterior surface of the vertebral column from

skull to sacrum
ALL (Anterior longitudinal
➢ the ALL is wide and is strongly attached to the from and sides of
ligament)
the vertebral bodies and to the IVD
➢ limits extension; stretched – extension and compressed - flexion
➢ runs continuous band down the posterior surfaces of the vertebral

column form the skull to the sacrum.
PLL ➢ PLL is weak and narrow and is attach to the posterior borders of
the discs
➢ limits flexion; flexes – stretches, extended - slacks
➢ supraspinous ligament: runs between the tips of adjacent spine

Ligamentum nuchae continuation
➢ interspinous: This connects the adjacent spine
➢ run between adjacent transverse processes (connects transverse

p to another)
Intertransverse ligaments ➢ limits lateral flexion; sample: when a person lateral flexes to the
right, the left intertransverse ligaments will limit its movement and
vice versa.
➢ connects the laminae of the adjacent vertebrae.

Ligamentum Flavum
➢ continuation of tectorial membrane
JOINTS OF THE NECK
Intervertebral joint ➢ consists of two adjacent vertebrae with a cushion in between
➢ facets are oriented 45 degrees to the transverse plane/ frontal

plane
Zygapophyseal joints
➢ inferior facets face: anteriorly and inferiorly
➢ superior facets face: posteriorly and superiorly
MUSCLES OF THE NECK

MUSCLES ORIGIN INSERTION NERVE ACTION
Deep fascia over Body of mandible Depresses
Facial nerve
Platysma pectoralis major and angle of mandible and
cervical branch
and deltoid mouth angle of mouth
50 | P a g e
Two muscles
acting together
Mastoid process of
Manubrium sterni Spinal part of extend head and
temporal bone
Sternocleidomastoid and medial third accessory nerve flex neck; one
and occipital
of clavicle and C2 and 3 muscle rotates
bone
head to opposite
side
Digastric
Mastoid process of Intermediate Depresses
Posterior belly Facial nerve
temporal bone tendon is held to mandible or
hyoid by fascial Nerve to elevates hyoid
Anterior belly Body of mandible sling bone
mylohyoid
Body of hyoid Elevates hyoid
Stylohyoid Styloid process Facial nerve
bone bone
Elevates floor of
Body of hyoid
Mylohyoid line of Inferior alveolar mouth and hyoid
Mylohyoid bone and fibrous
body of mandible nerve bone or depresses
raphe
mandible
Elevates hyoid
Inferior mental Body of hyoid
Geniohyoid 1st cervical nerve bone or depresses
spine of mandible bone
mandible
Manubrium sterni Body of hyoid Ansa cervicalis; Depresses hyoid

Sternohyoid
and clavicle bone C1, 2, and 3 bone
Oblique line on
Ansa cervicalis;
Sternothyroid Manubrium sterni lamina of thyroid Depresses larynx
C1, 2, and 3
cartilage
Oblique line on Lower border of Depresses hyoid

Thyrohyoid lamina of thyroid body of hyoid 1st cervical nerve bone or elevates
cartilage bone larynx
Omohyoid
Upper margin of
scapula and
Inferior belly Intermediate
suprascapular
ligament tendon is held to Ansa cervicalis; Depresses hyoid
clavicle and first C1, 2, and 3 bone
Lower border of rib by fascial sling
Superior belly body of hyoid
bone
Elevates 1st rib;
Transverse
laterally flexes and
processes of 3rd,
Scalenus anterior 1st rib C4, 5, and 6 rotates cervical
4th, 5th, and 6th
part of vertebral
cervical vertebrae
column
Elevates 1st rib;
Transverse
laterally flexes and
processes of Anterior rami of
Scalenus medius 1st rib rotates cervical
upper six cervical cervical nerves
part of vertebral
vertebrae
column
Elevates 2nd rib;

Transverse laterally flexes and
Anterior rami of
Scalenus posterior processes of lower 2nd rib rotates cervical
cervical nerves
cervical vertebrae part of vertebral
column
51 | P a g e
TABLE
MUSCLES IPSILATERAL CONTRALATERAL
C0-C1 flexion (head); Head
Rectus capitis Anterior
stabilizer
Head stabilizer and for

Rectus capitis Lateralis Head ipsilateral flexion
proprioceptive feedback
Head ipsilateral flexion and ipsilateral

Longus capitis Head flexion
rotation
Longus colli Head flexion Neck flexion
Neck ipsilateral flexion neck contralateral
SCM Neck flexion
rotation; Extension of head and neck
Neck ipsilateral lateral flexion and
Scalene ant/med/post Neck flexion
ipsilateral rotation
Ant scalene only Neck Rotation Neck Contralateral rotation
TABLE
MUSCLES BILATERAL CONTRACTION UNILATERAL CONTRACTION
Rectus capitis posterior Head extension Head ipsilateral rotation
Splenius capitis and cervicis

Neck extension Head and neck ipsilateral rotation
head
Obliquus capitis superior Head extension
Obliquus capitis superior Head ipsilateral rotation
52 | P a g e
MODULE 4: SHOULDER COMPLEX
➢ twenty (20) muscles

Shoulder complex has: ➢ three (3) articulations
➢ three (3) soft tissue moving surfaces (functional joints)
1. Sternoclavicular (SC) joint

2. Acromioclavicular (AC) joint ➢ three (3) joints of the shoulder complex:
3. Glenohumeral (GH) joint
➢ these are structures that did not pass the criteria to be called a
true joint, but still they help the specific body part to promote
Functional joints
efficient movement and stability.
➢ example: scapulothoracic articulation
➢ permit the greatest mobility of any joint area found in the body.
➢ 16,000 different positions (hand placement)
➢ stabilizes the upper extremity for hand motions
➢ lifts and pushes objects
➢ elevates the body
Basic Function/s of Shoulder
➢ assists with forced respiratory inspirations and expirations
Complex
➢ bears weight when walking with crutches or performing
handstands
➢ mobility > stability
o more mobile than it is stable; that’s why shoulder
dislocations are common
Sternoclavicular joint ➢ only bony attachment of upper extremity (UE) to trunk.
Muscles and ligaments ➢ primary support and stabilizer of the shoulder
Shoulder joint ➢ specifically isolating just the glenohumeral joint
Shoulder complex ➢ all structures which make up the shoulder (totality)
BONES OF THE SHOULDER COMPLEX
• Manubrium
• Clavicle
➢ four (4) bones of the shoulder complex:
• Scapula
• Humerus
➢ connects your upper limbs to the bones along the axis of your
Shoulder Girdle
body
• Manubrium
• Right and left clavicles ➢ shoulder girdle is consisting of:
• Right and left scapulae
Incomplete girdle ➢ does not have bony connection posteriorly

➢ is the most cephalic aspect of the sternum; caudal (opposite of
cephalic, same as inferior)
Manubrium
➢ site at which the left and right clavicles secure the upper
extremities to the axial skeleton (bones in the y-axis)
➢ Clavicular facet
o articulation of the sternum to the clavicle
Parts of Manubrium
➢ Sternal/jugular notch
➢ Facets for attachment of the first ribs
53 | P a g e
➢ s-shaped, like a crank; very narrow

➢ forward convexity at its sternal end to clear the brachial plexus
and UE vascular bundle
➢ forward concavity at the humeral end
Clavicle ➢ lateral strut (rod or bar-shaped) to the scapula and the humerus.
➢ this increases glenohumeral mobility to permit greater motion in
reaching and climbing activities; it adjusts, elevates, depresses,
retracts, and protracts which help in achieving the shoulders’
maximum range of motion
➢ slightly above horizontal plane

Long axis ➢ 20 degrees to frontal plane
➢ sternal end - rounded medial end; Humeral Head – flat lateral end
➢ medial end (SE)
o prominent articulation with manubrium (rounded)
➢ costal facet
o articulation with first rib; depression
Parts of Clavicle
➢ costal tuberosity
o attachment site for costoclavicular ligament; protrusion
➢ acromial end
o lateral end where it articulates with the acromion process
➢ is a flat, triangular-shaped bone
Scapula ➢ three (3) sides and (3) angles
➢ sits against the posterior thorax
➢ three (3) borders = lateral, medial, and superior
Scapula has:
➢ three (3) angles = lateral, inferior, and superior
➢ border closer to the spine

➢ approximately 5 to 6 centimeters (two to
Medial border ➢ three finger-widths) from the thoracic spinous processes
(projections directing posteriorly)
➢ between T2 and T7; some people can reach to T9 (vertebral level)
➢ to provide a place for muscles controlling the glenohumeral joint

to venture from; all 6 rotator cuff muscles from scapula
Dual function: ➢ to provide a stable base from which the glenohumeral joint can
function; the scapula works intimately with the clavicle to provide
more motion in the GH joint.
➢ Inferior angle (T7)

➢ Vertebral border (medial border)
➢ Axillary border (lateral border)
➢ Glenoid fossa (the most lateral aspect of the scapula)
➢ Supraglenoid tubercle (attachment for LH of biceps)
➢ Infraglenoid tubercle (attachment for LH of triceps)
➢ Superior border
➢ Scapular spine (T3)
Parts of Scapula
➢ Supraspinatus fossa
➢ Infraspinatus fossa
➢ Acromion process
➢ Acromioclavicular joint
➢ Acromioclavicular ligament
➢ Coracoid process
➢ Glenoid Labrum
➢ Glenoid fossa
Acromion morphology ➢ flat, curved, hooked and convex (upturn)

Impingement ➢ compression
Coracoid process ➢ also known as crow’s beak
Glenoid Labrum ➢ dense fibrous connective tissue rim that surrounds the glenoid
54 | P a g e
fossa; increase joint congruence (they receive each other well

better); Assist in stress reduction by increasing the area of joint
surface contact; Adds about 50% more surface area to the
depth and curve of the glenoid fossa
➢ refers to the joint surface formed from perfect encasing of two
Congruence
interacting parts
➢ tilted 5° upward relative to the scapula’s vertebral border;

Glenoid fossa teardrop or pear-shaped appearance; Orientation: lateral,
superior, and anterior direction (LAS); (concave)
➢ lies on the posterior ribs

Position of Scapula: ➢ conforms to the upper thorax
➢ does not lie in a pure frontal plane
➢ rotated on its transverse axis
➢ approximately 30° to 45°
➢ glenoid fossa is tilted anterior to the frontal (coronal) plane.
➢ tipped in the sagittal plane ~10° to 20°
➢ superior aspect of the scapula lies more anterior than its inferior
angle
Plane of the Scapula:
➢ is a long bone that runs from the shoulder and scapula (shoulder
Humerus
blade) to the elbow
➢ convex
Head of humerus ➢ 1/3 to ½ sphere
➢ orientation: posterior, medial, superior (PMS)
➢ humeral head is angled at 135° to the long axis of the humeral
Angle of inclination
shaft
➢ angle formed between the proximal and distal articular axis of
Angle of torsion the humerus
➢ this angle is measured at the intersection of two lines
➢ one that evenly bisects the articular surface of the humeral head
Two lines
➢ one being the transepicondylar line distally
Resting position of the humeral head in posterior rotation relative to the distal condyles of the humerus
allows the head to be aligned in the scapular plane while maintaining proper elbow joint alignment; this
relative position of posterior rotation = RETROVERSION
55 | P a g e
Retroverted ➢ the act or process of turning back or regressing

Anteverted ➢ refers as leaning forward
➢ the prominent area of bone at the top of the humerus

➢ a prominence on the upper lateral part of the end of the humerus
Greater tubercle
that serves as the insertion for the supraspinatus, infraspinatus, and
teres minor — compare lesser tubercle
➢ it is more prominent than the greater tubercle

➢ a prominence on the upper anterior part of the end of the
Lesser tubercle
humerus that serves as the insertion for the subscapularis —
compare greater tubercle
➢ is a deep groove on the humerus that separates the greater

Bicipital groove tubercle from the lesser tubercle
(intertubercular groove) ➢ through which the long head (LH) of biceps runs from its proximal
insertion on the supraglenoid tubercle
➢ this is the location of many fractures that require surgery
➢ circumferential area on the proximal humerus
➢ distal to the bicipital groove
Surgical Neck
➢ common site for humeral fractures, especially in the elderly,
when a fall occurs and the individual lands on an outstretched
arm
JOINTS
1. Sternoclavicular joint
2. Acromioclavicular joint
3. Glenohumeral joint ➢ four (4) bones of the shoulder complex:
4. Scapulothoracic joint
(functional joint)
➢ are the result of sternoclavicular and acromioclavicular joint

Scapulothoracic motions
movements
Sternoclavicular joint ➢ is responsible for the majority of the scapula’s movement
➢ provides minimal movement and acts more as a fine tuner of

Acromioclavicular join
scapula motion than a producer of its motion
• Elevation
• Depression
• Protraction
• Retraction
➢ shoulder girdle movements
• Upward Rotation
• Downward Rotation
• Scapular Tilting (Anteriorly-
Posteriorly, Medial-Lateral)
56 | P a g e
SHOULDER GIRDLE MOVEMENTS
a. Elevation b. Depression
c. protraction d. retraction
e. upward rotation d. downward rotation
JOINTS
➢ is the only joint that acts as a strut to connect the upper extremity
directly with the axial skeleton
➢ medial end of the clavicle connects with the manubrium of the
sternum and the medial first rib
Sternoclavicular Joint
➢ saddle joint
➢ it has three (3) degrees of freedom
➢ the superior aspect of the clavicle is not in contact with the
manubrium
• Elevation/Depression
• Protraction/Retraction ➢ three (3) DOF (degrees of freedom)
• Rotation
57 | P a g e
➢ is the only joint that acts as a strut to connect the upper extremity
directly with the axial skeleton; medial end of the clavicle
connects with the manubrium of the sternum and the medial first
rib.
Sternoclavicular Joint o saddle joint
➢ 3 DOF
o elevation/depression = opposite glide(convex)
o protraction/retraction = same glide (concave)
o rotation
➢ the superior aspect of the clavicle is not in contact with the
NOTE:
manubrium.
➢ anteriorly: protraction; posteriorly: retraction; inferior: depression;
Motions of Clavicle:
upward: elevation; rotation
➢ the joint has fibrocartilaginous articular disc wherein it separates
the articular surfaces of the clavicle and the sternum
Sternoclavicular Joint Ligaments
➢ the joint has 3 strong stabilizing ligaments (Anterior SC ligament,
Posterior SC ligament, Superior SC ligament)
Interclavicular ligament ➢ connects 2 clavicles
➢ connects the first rib to the clavicle; clavicle (convex) and

manubrium of the sternum (concave); restricts motion in the
Costoclavicular ligament
clavicle, such as elevation, rotation, medial and lateral
movements
SCM ➢ also provides stabilization in the SC Joint

➢ a ligament attached to the coracoid process of the scapula and
Coracoclavicular ligaments
clavicle; primary support of the AC Joint
➢ helps control the movements of the clavicle
Portions: o conoid - medial
o trapezoid - latera
➢ plane synovial joint

➢ 3 DOF
➢ medial margin of the acromion and the lateral end of the clavicle
o elevation/depression
Acromioclavicular Joint
o abduction/adduction
o UR/DR
➢ lined with fibrocartilage; there is a disk in between the acromion
and the clavicle that adds strength and protection
Ligaments of Acromioclavicular
➢ superior AC ligament and inferior AC ligament
Joint
58 | P a g e
➢ acromioclavicular joint motions are limited by two strong

ligamentous pairs:
TAKE NOTE: o anterior and posterior ligaments of the joint
o located coracoclavicular ligaments
▪ conoid and trapezoid
➢ no bony articulations
➢ false joint/pseudojoint/functional joint
➢ separating the scapula from the thorax are soft tissue structures,
including a large subscapular bursa.
Scapulothoracic Joint
➢ scapula is not directly articulating with other bones, it’s actually
articulating with muscles
➢ essential for the mobility and stability of the upper extremity.
➢ provides a movable base for the humerus.
1. increasing the range of motion of the shoulder to provide greater

reach
2. maintaining favorable length-tension relationships for the deltoid
muscle to function above 90° of glenohumeral elevation to allow
better shoulder joint stability throughout a greater motion
3. providing glenohumeral stability through maintained glenoid and
Functions:
humeral head alignment for work in the overhead position
4. providing for injury prevention through shock absorption of forces
applied to the outstretched arm
5. permitting elevation of the body in activities such as walking with
crutches or performing seated push-ups during transfers by
persons with a disability such as paraplegia.
➢ elevation/depression (10cm/2cm)
Scapulothoracic Joint ➢ protraction/retraction (10cm/5cm)
➢ upward rotation/downward rotation
➢ scapulothoracic motion is a direct result of motion within the

Scapulothoracic Kinematics
acromioclavicular and sternoclavicular joints
➢ shoulder joint
➢ ball-and-socket
➢ 3 DOF | Diarthrodial
Glenohumeral Joint
➢ little bony stability
➢ convex: Humeral head (PMS)
➢ concave: Glenoid fossa (small/shallow) (LAS)
➢ Labrum – gives the socket a lower depression

o From neck of glenoid
o To anatomic neck of humerus
Parts of Glenohumeral Joint:
➢ 10 to 15 mL
➢ Axillary pouch = area of redundancy in the inferior capsule to
allow humeral head mobility during shoulder elevation
➢ ligaments and tendons blend with and reinforce the

glenohumeral joint capsule for added stability
Capsular Reinforcement (GH)
o coracohumeral ligament
o superior, Middle, Inferior GH ligament
➢ coracoid process of the scapula → greater and lesser tubercles

of the humerus
➢ where it forms a tunnel for the tendon of the long head of the
biceps brachii.
➢ most important function is to serve as the primary force against
Coracohumeral Ligament gravity’s downward pull on the joint in a resting position.
➢ may also assist in protection against superior humeral head
translation (slides upward excessively) when the rotator cuff fails
to provide this protection; rotator cuff – is the main support and
protection of the shoulder
➢ limits lateral rotation with the arm resting at the side.
59 | P a g e
➢ capsular ligaments
Superior, Middle, and Inferior GH
➢ from the glenoid and its labrum, form capsular thickenings, and
ligaments
attach to the humeral neck and lesser tubercle
Coracohumeral, superior
➢ support the dependent (hanging down) arm and limit lateral
glenohumeral, and middle
rotation in the lower ranges of abduction
glenohumeral ligaments
➢ forms a hammock-like sling with anterior and posterior bands
around the lower portion of the humeral head and is part of the
Inferior glenohumeral ligament
axillary pouch
➢ main stabilizer of the abducted shoulder
GLENOHUMERAL JOINT LIGAMENTS
POSITION OF JOINT
PROXIMAL DISTAL
LIGAMENT GREATEST JOINT PROTECTIONS
ATTACHMENT ATTACHMENT
PROTECTION PROVIDED
Near supraglenoid Protects against

Superior tubercle anterior Anatomic neck inferior and
With arm at the
glenohumeral to attachment site above the lesser anterior
side
ligament of long head of tubercle displacement with
biceps tendon the arm at the side
Provides anterior
stability from 0°–45°
Anterior glenoid With the arm at
Middle Broad attachment abduction Limits
rim at its middle the side and lower
glenohumeral to anterior aspect anterior translation
and superior levels (up to about
ligament of anatomic neck and lateral
aspects 45°) of abduction
rotation of the
humeral head
All limit inferior
translation of
humeral head.
Anterior fibers limit
anterior humeral
head translation
Forms a hammock- during abduction
Anterior, inferior,
like sling in the and lateral
and posterior Higher levels of
Inferior inferior capsule rotation. Posterior
bands attach to abduction (above
glenohumeral from the anterior- fibers limit posterior
corresponding 45°), with or
ligament inferior and humeral head
areas of anatomic without rotation
posterior-inferior translation during
neck
glenoid abduction and
medial rotation.
Inferior pouch limits
abduction at 90°
and provides AP
stability in
abduction
Two bands (long Protects against

head of the biceps lateral rotation
tendon tunnels with the arm
under): Anterior adducted.
Lateral border of aspect of greater Protects against
Coracohumeral With arm at the
the coracoid tubercle and edge inferior translation
ligament side
process of supraspinatus of the dependent
tendon; second arm and superior
band inserts on translation of a
subscapularis and shoulder with a
lesser tubercle weak rotator cuff
60 | P a g e
DEEP MUSCLES OF THE SHOULDER
Tendon of the LH biceps brachii ➢ intra-articular (inner) and extrasynovial (outer)
LH of triceps brachii ➢ blends with posterior capsule
(S IT S) ➢ tendons of 4 short rotator cuff muscles
➢ anterior acromion → lateral coracoid process

Coracoacromial Arch ➢ osteoligamentous arch
➢ roof of the glenohumeral joint
➢ supraspinatus muscle and tendon,
➢ long head of the biceps tendon
Coracoacromial Arch contains:
➢ subacromial bursa
➢ superior capsule
➢ ~1 centimeter wide
Subacromial space ➢ narrows to approximately half of its normal width as the arm is
elevated
➢ area under the coracoacromial
➢ formed by the neck of the scapula, the acromion process, the
rigid coracoacromial ligament, and the coracoid process
➢ the clinical importance of this area is the propensity for
compression and injury of the soft tissues that lie between the
Supraspinatus outlet rigid structures:
o rotator cuff (especially the supraspinatus)
o tendon of the long head of the biceps brachii
o capsule
o capsular ligaments
o subdeltoid and subacromial bursae
➢ a bursa reduces friction between two structures.

➢ 8 bursae within the shoulder area
Bursae
o subacromial bursa
o subdeltoid bursa
➢ located between the supraspinatus tendon and the

coracoacromial arch; the more abduction, the more space
lessens
Subacromial bursa
➢ protect the supraspinatus tendon and allow for smooth tendon
movement during shoulder motion.
➢ beneath the acromion
➢ continuous with the subacromial bursa and is located between

the deltoid muscle and the supraspinatus tendon and humeral
Subdeltoid bursa
head to reduce friction between these structures.
➢ beneath the deltoids
TABLE (RESTING AND CLOSE-PACKED POSITION)

CLOSE PACKED
RESTING POSTION CAPSULAR PATTERN
POSTION
40° to 55° abduction, 30° lateral rotation,
full abduction, lateral
Glenohumeral Joint horizontal adduction abduction, medial
rotation
(scapular plane) rotation
CONTINUATION
➢ LH of biceps tendon
➢ retained by the coracohumeral ligament and by the transverse
humeral ligament
Bicipital Groove
➢ when the glenohumeral joint is in full lateral rotation, the proximal
and distal attachments of the tendon are in a straight line with
each other,
61 | P a g e
➢ but in all other positions of rotation, the bicipital tendon is bent

around the medial wall of the groove.
➢ wear and tear/Impingement
➢ they found that the early phase of abduction was individually

variable.
Scapulohumeral Rhythm ➢ this early stage of motion was termed the “setting phase.” After
about 30° of abduction, a 2:1 ratio occurred: For every 2° of
glenohumeral motion, 1° occurred at the scapulothoracic joint.
COMPANION MOTIONS OF THE SHOULDER GIRDLE AND GLENOHUMERAL JOINTS

Acromioclavicular
Glenohumeral Motion Scapulothoraic Motion Sternoclavicular Motion
Motion
Traditional View: upward ➢ Elevation ➢ Upward rotation
rotation, elevation, and ➢ Posterior rotation ➢ Horizontal &
protraction ➢ Protraction sagittal plane
rotational
Flexion Tri-planar motion: upward adjustments
rotation, posterior tilting
Medial tilting initially followed
by lateral tilting in higher
ranges of flexion
Traditional View: downward ➢ Depression ➢ Downward

rotation, depression, and ➢ Anterior rotation rotation
retraction ➢ Retraction ➢ Horizontal &
sagittal plane
Extension Tri-planar motion: downward rotational
rotation, anterior tilting adjustments
Reverse of all tri-planar motion
occurring in flexion
Traditional View: upward ➢ Elevation ➢ Upward rotation

rotation, elevation, and ➢ Posterior rotation ➢ Horizontal &
protraction ➢ Retraction sagittal plane
rotational
Abduction Tri-planar motion: upward adjustments
rotation, posterior tilting
Medial tilting initially followed
by lateral tilting in higher
ranges of abduction
Traditional View: downward ➢ Depression ➢ Downward

rotation, depression, and ➢ Anterior rotation rotation
retraction ➢ Protraction ➢ Horizontal &
sagittal plane
Adduction Tri-planar motion: downward rotational
rotation, anterior tilting Lateral adjustments
tilting initially followed by
medial tilting when returning
to anatomic position
Retraction (speculation Undocumented at
Lateral rotation Retraction
at this time) this time
Protraction (speculation Undocumented at

Medial rotation Protraction
Retraction (speculation Undocumented at

Horizontal abduction Retraction
Protraction (speculation Undocumented at

Horizontal adduction Protraction
62 | P a g e
MUSCLE
➢ Serratus anterior
➢ Trapezius
Scapular Stabilizers of the
➢ Rhomboids major and minor
Shoulder Complex
➢ Pectoralis minor
➢ Levator scapula
➢ primary scapular protractor

➢ “saw muscle” or “boxer’s muscle”
➢ lowest five digitations are the strongest portion of the muscle
Serratus Anterior
➢ XXX: medial winging of the scapula (when the inferior angle of the
scapula is directed medially)
➢ protracts and upwardly rotates the scapula
➢ superficial muscle of the neck and upper back
➢ “shawl” muscle
➢ musculus cucullaris”
➢ full abduction with scapular rot: All fibers
Trapezius o mid = retraction
o upper and lower = upward rotation
➢ XXX: lateral winging of the scapula (when the inferior angle of the
scapula is directed laterally)
o elevation is limited to 120 degrees (only by GH)
➢ connect the scapula with the vertebral column

➢ lie under the trapezius
Rhomboid Major and Minor
➢ the more cranial portion is known as rhomboid minor (superior)
➢ the larger, more caudal portion is the rhomboid major (inferior)
➢ XXX: scapula in protracted position

In rhomboids weakness/loss of ➢ scapula positioned farther laterally from the thoracic spinous
function: processes than the normal 6 cm from the thoracic spinous
processes.
➢ elevation and retraction

Movements: ➢ downward rotation, adduction and elevation of the scapula
➢ the medial border becomes prominent (winging)
➢ located anteriorly on the upper chest by the pectoralis major.

➢ XXX: weakness of this muscle results in reduced strength during
Pectoralis Minor
scapular depression and downward rotation of the scapula
against resistance
➢ depression and anterior titling

Movements:
➢ elevation of 2nd to 5th ribs
➢ is an elevator of the scapula, an action it shares with the upper

trapezius and with the rhomboids.
Levator Scapulae ➢ elevation + DR
➢ XXX: reduced ability to elevate and downwardly rotate the
scapula
➢ Rotator Cuff
o provide glenohumeral stability as well as glenohumeral
motion.
Glenohumeral Stabilizing Muscles
➢ Biceps brachii
in the Shoulder
➢ Triceps brachii
➢ Teres major
➢ Coracobrachialis
➢ located above the spine of the scapular @ supraspinous fossa

Supraspinatus ➢ capable of performing the total motion of abduction without the
assistance of the deltoid
63 | P a g e
➢ infraspinatus @ infraspinatus fossa (suprascapular nerve)

➢ teres minor @ lateral border of the scapula (axillary nerve)
Infraspinatus and Teres minor
➢ external rotators of the shoulder
➢ different innervations
➢ located on the anterior scapula.

➢ IR = primary medial rotation function
Subscapularis
➢ but can also flex, extend, adduct, or abduct the glenohumeral
joint (it can abduct alone
Biceps and Triceps ➢ also stabilize the GH joint

Teres Major ➢ IR = medial rotation function (subscapular nerve)
➢ inserts in the medial surface of the humerus, originates from the
Coracobrachialis coracoid process
➢ adduction
➢ have their proximal attachments on the trunk and their distal

Large Muscle Movers of the attachments on the humerus, having little or no attachment to the
Shoulder scapula.
➢ they act on the humerus as primary movers
➢ Deltoid
Large Muscle Movers of the ➢ Latissimus Dorsi
Shoulder ➢ Teres Major
➢ Pectoralis Major
➢ a large, superficial muscle consisting of three parts: anterior,

middle, and posterior.
➢ the muscle covers the glenohumeral joint on all sides except in the
inferior axillary region
➢ comprises 40% of the mass of the scapulohumeral muscles.
Deltoid
➢ deltoid does not rotate the glenohumeral joint into abduction until
the higher levels of abduction motion unless the supraspinatus is
unable to perform its duties.
➢ abduction of GH Joint; anterior – flexion and horizontal adduction;
posterior - extension horizontal abduction
➢ this muscle is the broadest muscle of the low back and the lateral
thoracic region
➢ if the arms are stabilized, as in pushing down on crutch handles or
Latissimus Dorsi
in a seated press down, the distal attachment aids to lift the pelvis.
➢ IR, extension, adduction of the GH Joint, scapular depression and
elevation of pelvis (thoracodorsal nerve)
➢ lies distal to the teres minor on the lateral scapula border

Teres Major ➢ the teres major acts in most pulling activities when the shoulder is
extended or adducted against resistance
➢ large muscle of the chest; very broad (Medial and Lateral
pectoral nerves)
➢ two parts:
Pectoralis Major o Clavicular
o Sternocostal
➢ GH Joint adduction, horizontal adduction, IR; clavicular head –
flexion; sternocostal head - extension
➢ mover of the glenohumeral joint rather than a stabilizer

Coracobrachialis
➢ functions more to induce movement
➢ passive and dynamic stabilization of the glenohumeral joint

➢ passive elements: capsule, ligaments
Functions of Muscles of the
➢ dynamic elements: muscles
Shoulder Complex:
➢ SC and AC joint = rely primarily on passive restraints
➢ GH joint and Scapulothoracic joint = rely on muscles for stability
64 | P a g e
➢ motions at the sternoclavicular and acromioclavicular joints are

limited by strong ligamentous attachments and, to a lesser
degree, by bony configuration.
➢ glenohumeral and scapulothoracic joints have little ligamentous
or bony stability.
➢ normally, there is no contraction of muscles of the shoulder girdle
during relaxed sitting or standing, giving rise to the question of
Passive stabilization
what structures prevent the humerus from subluxation when the
person is upright.
➢ the clavicle and scapula rest on the thorax. The head of the
humerus is maintained in the glenoid fossa by the horizontal
coracohumeral and superior glenohumeral ligaments and by
negative atmospheric pressure (helps keep the humeral head in
place, so that it won’t be dislocated) within the capsule.
➢ low-level continuous activity of the upper trapezius frequently

occurs during sitting and standing, but when attention is called to
Dynamic Stabilization this activity, most subjects can relax the muscle easily.
➢ trapezius activity is probably related to head posture because the
upper fibers are neck extensors as well as scapula elevators
➢ holds the humeral head tightly against the glenoid to prevent

subluxation when carrying a weight in the hand.
➢ primary function is to provide stability to the joint by compressing
the humeral head into the glenoid fossa (they anchor the humeral
head into the fossa)
➢ during elevation, the rotator cuff secures and protects the joint
Rotator Cuff Stabilization
and its surrounding soft tissue structures by not only pulling the
humerus to the glenoid, but it also moves the humeral head into
the lower portion of the glenoid fossa where it is able to sit more
securely against a larger surface of the glenoid, thereby allowing
sufficient space under the coracoacromial arch for the soft tissues
positioned between the arch and glenohumeral joint.
➢ compress the humeral head against the glenoid cavity

➢ preventing subluxation of the glenohumeral joint when the elbow
Biceps Brachii
flexes with a weight in the hand.
➢ mimics the rotator cuff muscles
➢ together, these muscles work to keep the humeral head in place

Deltoid and Rotator Cuff
in the glenoid fossa
➢ subscapularis – medial
Directions of Forces
➢ subscapularis and teres minor – inferior and diagonal
➢ with the lower trapezius and serratus anterior weakness, the UF

TAKE NOTE: overpowers these scapular upward rotators to cause the scapula
to elevate rather that rotate, leading to GH J
➢ force couple is defined in mechanical terms as two forces whose

points of application occur on opposite sides of an axis and in
opposite directions to produce rotation of the body.
➢ upward rotators: UF, LF, and Serratus anterior
Synergistic Muscle Actions
➢ downward rotators: levator scapulae, rhomboids and pectoralis
minor
➢ the rotator cuff and deltoid work together to produce rotation of
the humerus in the glenoid
65 | P a g e
COMPANION MOTIONS OF THE SHOULDER GIRDLE AND GLENOHUMERAL JOINTS
SCAPULAR MOTION SYNERGISTS ANTAGONISTS
Upper trapezius Rhomboids

Upward rotation Lower trapezius Pectoralis minor
Serratus anterior Levator scapulae
Rhomboids Upper trapezius
Downward rotation Pectoralis minor Lower trapezius
Levator scapulae Serratus anterior
Rhomboids Pectoralis minor
Retraction
Trapezius Serratus anterior
Pectoralis minor Rhomboids
Protraction
Serratus anterior Trapezius
Upper trapezius Pectoralis minor
Elevation Rhomboids Lower trapezius
Levator scapulae Lower serratus anterior
Depression Pectoralis minor Upper trapezius
Lower trapezius Rhomboid
Lower serratus anterior Levator scapulae
GLENOHUMERAL MOTION SYNERGISTS ANTAGONISTS
Pectoralis major Latissimus dorsi

Flexion Coracobrachialis Teres major
Biceps brachii Triceps brachii (long head)
Latissimus dorsi Pectoralis major (clavicular head)
Teres major Coracobrachialis
Extension
Triceps brachii (long head) Biceps brachii
Pectoralis major (costosternal
head)
Deltoid Pectoralis major
Supraspinatus Latissimus dorsi
Abduction
Biceps brachii Teres major
Triceps brachii (long head)
Pectoralis major Deltoid
Latissimus dorsi Supraspinatus
Adduction
Teres major Biceps brachii (long head)
Triceps brachii (long head)
Infraspinatus Subscapularis
Teres minor Teres major
Lateral rotation Posterior deltoid Pectoralis major
Latissimus dorsi
Anterior deltoid
66 | P a g e
Subscapularis Infraspinatus
Teres major Teres minor
Medial rotation Pectoralis major Posterior deltoid
Latissimus dorsi
Anterior deltoid
CONTINUATION
➢ trapezius and serratus anterior acting as a force couple at the

scapula.
➢ deltoid and supraspinatus providing the force couple at the
glenohumeral joint.
➢ infraspinatus and teres minor providing lateral rotation.
➢ the contractions of the muscles are concentric except for the
eccentric contraction of the trapezius during scapular protraction
and for the posterior parts of the deltoid, which lengthen during
movement from 0° to 60° and then shorten as elevation continues;
Placing the Hand behind the other muscles shorten, while the trapezius lengthen for eccentric
Head contraction
➢ when the extremity is returned to the side, the motions reverse to
include sternoclavicular depression, protraction, and anterior
rotation along with depression, downward rotation, and
retraction of the scapula with glenohumeral adduction,
extension, and medial rotation
➢ however, the primary muscles controlling this motion are the same
as with elevation. The type of contraction of these muscles’
changes to eccentric to control lowering of the arm against
gravity
➢ shoulder’s motion is adduction-extension, similar to lowering the

Pulling arm after combing hair, but now the motion occurs against an
external resistance.
➢ elbow flexion
➢ sternoclavicular depression and posterior rotation
These joint motions include:
➢ scapular retraction, downward rotation, and depression
➢ glenohumeral adduction, extension, and rotation.
➢ if the hands are placed close together = medial rotation occur

TAKE NOTE:
➢ hands are widely separated, the motion is = lateral rotation
➢ glenohumeral adductors and extensors (latissimus dorsi, pectoralis

major, long head of the triceps brachii, and posterior deltoid)
➢ scapular downward rotators and depressors (pectoralis minor and
rhomboids).
Muscles working include the: ➢ they are all working (shorten) to overcome the resistance.
➢ when the overhead bar is fixed and the person performs a chin-
up to lift the body weight, closed-chain motion occurs.
➢ concentric muscle activity of the muscles providing these joint
motions occurs in pulling on the overhead bar to lift the body up
The joint motions that occur ➢ glenohumeral joint adduction, extension, and medial rotation
during this activity include: ➢ scapular retraction, downward rotation, and depression
➢ at the glenohumeral joint, there are three to five muscles that can
perform each motion.
Functional Deficiency
➢ weakness from an injury or paralysis of an individual muscle will
Applications
cause functional deficits from loss of strength during a motion,
➢ but the arm and hand often can still be placed in desired positions
67 | P a g e
through reliance on other muscles that also perform the motion.

➢ scapular muscles often perform very specific actions; therefore, a
deficiency of a single muscle can seriously compromise use of the
hand and arm
➢ although there is more than one scapular muscle performing any
one scapular motion, these muscles must work in concert
Scapular Dyskinesis together to produce the motion correctly; if one is deficient, the
motion usually does not occur as it should.
➢ abnormal position and pattern of motion of the scapula.
➢ subacromial impingement
➢ glenohumeral instability
May lead to many conditions
➢ Superior Labrum Anterior to Posterior (SLAP) lesions
such as:
➢ example: weakness in the trapezius causes instability of the
scapula
➢ if the spinal accessory nerve is severed during radial neck
Isolated Paralysis of the Trapezius
dissection surgery for complete removal of lymph nodes in people
Muscle
with cancer of the head and neck
➢ destroys scapular stability and its ability to upwardly rotate; since

Paralysis of both trapezius and
upward scapular rotation accounts for 60° of total glenohumeral
serratus anterior
elevation, and the arm cannot be elevated greater than 120°
➢ is crucial for efficient activity of the glenohumeral joint.
➢ the most important scapular stabilization occurs during
Scapular Stability glenohumeral elevation activities when the scapula is also
simultaneously rotating upward and moving anteriorly and
laterally on the thorax as it is providing glenohumeral stability.
➢ serratus anterior
These scapular motions are the
➢ upper trapezius
primary responsibility of the:
➢ lower trapezius
68 | P a g e
MODULE 5: WRIST AND HAND
➢ positions the hand

➢ provides a stable platform from which the hand functions
Wrist
➢ finely tuned hand positioning
➢ global positioning of the hand
➢ predominant part of the body serving many purpose

Hand
➢ contains the palm and fingers, which are both sturdy and mobile
DIGIT
1st Thumb Pollex

Often used to point, and pointing is a
2nd First finger Index/ pointing/ forefinger method of making things clearer
(purpose of an index)
3rd Second finger Middle Finger Longest finger of the hand
It was believed that this finger contained
4th Third finger Ring Finger a “vein of love” that flowed directly to
the heart
5th Fourth finger Pinky/ little finger Smallest finger
The thumb is not called a finger; independent on its own.
1st and 2nd digits ➢ used for dexterous or fine manipulation of objects
3rd, 4th, and 5th digits ➢ provide the hand with gross or strength manipulations (power)
➢ complex, multipurpose organ (it’s small but it can be so strong)

➢ also known to be prehensile organ; it can grasp with forces
Hand
exceeding 100 lb. (445 N or 45 kg) or manipulate a delicate thread
➢ it has the capability to conform around objects
➢ pushing and pulling

➢ locomotion
Hands are used for:
➢ sense organ for touch
➢ expression and non-verbal communication
BONES (WRIST)
29 bones ➢ the wrist and hands together they consist of ______
Ulna ➢ the primary forearm bone for the elbow joint
Radius ➢ the primary forearm bone of the wrist
➢ two (2) proximal carpal bones that interact with radius to form the
Scaphoid + Lunate
wrist joint:
➢ not direct contact with the carpal bones
Distal Ulna ➢ fibrocartilaginous disc separated the ulna from the carpal bones
➢ distal portion of the ulna is an important part of the wrist
• Ulnar styloid process

• Fovea ➢ three (3) parts of distal ulna:
• Pole
➢ is a bony projection easily palpated with the forearm pronated,

Ulnar styloid process
on the ulnar side of the wrist
69 | P a g e
➢ is a depression at the base of this styloid process and provides

Fovea
attachment for the fibrocartilaginous disc
➢ is a concave articular surface allowing ulnar articulation with the

Pole
fibrocartilaginous disc
➢ the dorsal surface has a palpable tubercle that is known as the

Distal Radius
tubercle of the radius/ lister’s tubercle / dorsal tubercle
➢ lies about 1/3 of the wrist’s width from the radial styloid process
➢ has grooved on either side of it that serve as pulley for the:
o extensor pollicis longus tendon on the ulnar side
Lister’s Tubercle
o extensor digitorum and extensor indicis tendons on the
radial side
➢ redirect the pull of the extensor pollicis longus
➢ distal projection on the radial surface of the radius

Radial styloid process
➢ more distal than ulnar styloid process
➢ ulnar and radial styloid process serves as _________ for the ulnar
attachment sites
and radial carpal collateral ligaments, respectively
Ulnar notch or sigmoid notch ➢ point of articulation to form the distal radioulnar joint of the wrist
➢ the distal surface of the radius makes up the proximal joint surface
Distal radius + scaphoid + lunate of the wrist and articulates with the scaphoid and lunate carpal
bones
8 (eight) ➢ number of carpal bones
➢ haves as articulating surface on their: proximal, distal, medial, and

lateral aspects
➢ they have roughened surface on their volar and dorsal sides that
Carpal bones
provide attachment sites for the wrist ligaments
➢ sole exception is the pisiform bone, which has only one
articulation surface
➢ Scaphoid, Lunate, Triquetrum

8 carpal bones ➢ Pisiform
➢ Trapezium, Trapezoid, Capitate, Hamate
➢ also known as Os magnum

➢ it occupies a central position at the wrist (in line with the middle
finger)
Capitate ➢ best approached from the dorsum, where a slight depression
indicates its location
➢ the axis of motion for ulnar and radial deviation goes through this
bone in a dorsopalmar direction
➢ also known as Navicular

➢ palpation: distal to the styloid process of the radius + ulnar
deviation of the wrist causes the bone to become prominent to
the palpating fingers
Scaphoid
➢ most frequently fractured carpal bone
➢ it makes up the floor of the anatomic snuffbox (fovea radialis)
o depression between the tendon extensor of the extensor
pollicis longus and extensor pollicis brevis (borders of AS)
➢ known to be “Greater multangular”

➢ palpation: proximally to the first carpometacarpal (CMC) joint of
Trapezium
the thumb and distal to the identified scaphoid by passively
flexing and extending the thumb to identify the joint margin.
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➢ palpation: capitate is palpated first; lunate is immediately

proximal to the capitate and in line with the distal Lister’s tubercle.
Lunate
Prominent in wrist flexion
➢ most frequently dislocated carpal
➢ also known as “Lesser multangular”

➢ more radial to the trapezium towards the thumb
Trapezoid
➢ palpation: most difficult carpal bone to palpate. It lies distal to the
scaphoid, medial to the trapezium, and lateral to the capitate
➢ also known as “Triangular”

➢ palpation: under the pisiform and best palpated on the dorsal
Triquetrum
wrist with the wrist in radial abduction. It is palpated as a bony
prominence just distal to the ulnar styloid process.
➢ palpation: located by palpating its hook. This protuberance lies at
a 45° angle into the palm from the pisiform. Lay the base of your
thumb’s distal phalanx over the pisiform so the tip of your thumb
Hamate
points toward the first web space between the thumb and index
finger. The tip of your thumb should then be on the hook of the
hamate.
BONES (HAND)
Metacarpals and phalanges ➢ these bones comprise the hand
Phalanges ➢ the make up the digits
➢ are identified numerically, laterally to medially (from the
Metacarpals and digits
anatomical position), one through five
➢ direct articulation with the carpal bones

Metacarpals
➢ each _____ has their own base, body or shaft, and the head
Shaft ➢ has a (palmar concavity)
Head ➢ articulates with the base of proximal phalanx
Tubercle at the medial base of ➢ distal attachment extensor carpi ulnaris ECU (Dorsolateral aspect
5th Metacarpal just distal to the hamate.
Eminence at the base of 2nd
➢ distal attachment for extensor carpi radialis longus ECRL
metacarpal bone (dorsally)
➢ 2 phalanges of the thumb

o Proximal
o Distal
Phalanges ➢ 3 phalanges of the 2nd to 5th digits
o Proximal
o Middle
o Distal
➢ promotes wide mobility of the hand

➢ it has great structural stability in the wrist
➢ allows the hand an extensive degree of function
Wrist Joint ➢ it is ellipsoidal joint (biaxial in nature, thus it has 2 degrees of
freedom
➢ consist of 15 bones, and 17 joints
➢ it also have extensive ligament system
two (2) joints: ➢ two (2) joints: radiocarpal joint and midcarpal joint
➢ biconcave: Distal end of radius

➢ biconvex: Proximal articulating surface of the scaphoid and
Radiocarpal Joint lunate
➢ it has two (2) degrees of freedom (DOF)
➢ motions: flexion, extension, radial deviation, ulnar deviation
71 | P a g e
➢ formed by the proximal and distal carpal rows

➢ the scaphoid articulates with the trapezium, trapezoid, and
capitate
Midcarpal Joint
➢ lunate articulates with the capitate
➢ triquetrum articulates with the hamate.
➢ wrist motions: flexion, extension, and radial and ulnar deviation
➢ the hand has a ______

5 digits
➢ four (fingers) and one (1) thumb
Each digits has: ➢ carpometacarpal joints + metacarpophalangeal joint
Each of the four fingers has: ➢ proximal interphalangeal joint + distal interphalangeal joint
Interphalangeal joint (IP) ➢ the thumb has only one , since it is short
➢ 2 d to 5th digit = DIP and PIP
➢ Thumb = Interphalangeal joint
Interphalangeal joint (IP) ➢ it has one (1) degree of freedom (DOF)
➢ motion: flexion and extension
➢ (+) volar plate mechanism: prevents hyperextension
➢ the hand is made up of _____
o 5 metacarpal
19 bones o 5 proximal phalanges
o 4 middle phalanges
o 5 distal phalanges
➢ it has a concave appearance even when the hand is fully open
Palm of the hand
due to the arches produced by the carpal bones and ligaments
➢ the articulation between the carpals and the metacarpals

Carpometacarpal Joints (CMC) o 2nd – 4th metacarpals + adjacent metacarpals
o distal row or carpals + Metacarpals
2nd and 3rd CMC joint ➢ minimal movement

3rd CMC joint ➢ least mobile (central pillar of the hand)
4th CMC joint ➢ 10 to 15 degrees dorsovolar movement
➢ also known as the first CMC joint
➢ very mobile
➢ connection of the trapezium + base of first metacarpal
Carpometacarpal Joint of Thumb
➢ saddle joint
➢ motions: flexion, extension, abduction, adduction, opposition,
reposition
➢ MCP joints
➢ IP joints
Fingers and thumb
➢ convex: proximal surface
➢ concave: distal surface
➢ it is a condyloid type of joint (biaxial in nature)
➢ it has two (2) degrees of freedom (DOF)
Metacarpophalangeal Joints ➢ flexion, extension, abduction, and adduction
➢ convex: head of metacarpals
➢ concave: base of proximal phalanges
CLASSIFICATION OF LIGAMENTS OF THE WRIST

Extrinsic ligaments ➢ they connect carpal bones to the radius, ulna, or metacarpals
Intrinsic ligaments ➢ they attach between the carpal bones only
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MUSCLE
➢ the hand is a compact, multipurpose organ with

interdependency of structures in which injury to one may affect
many others
Function ➢ the hand possesses both great mobility and great stability and
can shift from one to the other in a fraction of a second.
➢ almost all of the muscles are multiarticular and, therefore, can
have an effect on each joint crossed
➢ The hand has many automatic, neurophysiologic synergies, which

are so strongly linked that a person cannot willfully separate them
NOTE
➢ For example, when making a fist, the wrist extensors contract
forcefully and cannot be voluntarily inhibited
➢ The hand is a wonderful sensory organ that provides us with

tremendous feedback about our environment.
NOTE ➢ For example, each finger tips has about 100 sensory endings and
the fingertips and hands are among the most sensitive parts of the
body
➢ (1) over which joints each muscle passes
➢ (2) the line of action of the muscle and its tendon
In studying the wrist and hand,
➢ (3) the distance of the muscle to the axis of joint motion at various
we should consider:
positions of the joint
➢ (4) the relative length of the muscle
➢ Proximal attachment: Lateral epicondyle

➢ ECRL = lateral supracondylar ridge
➢ @ 15 degrees elbow flexion, line of pull moves anterior (they also
Wrist Extensor
become elbow flexors)
➢ ECRL = good lever arm for elbow flexion @ 90 degrees (often used
to flex the elbow when the brachialis and biceps are paralyzed)
Primary wrist extensors: ➢ ECRL, ECRB, ECU
➢ Proximal attachment: Medial humeral epidondyle

Wrist Flexors ➢ Lies anterior to the elbow axis (not a good elbow flexor compared
to wrist extensors)
Primary muscles involved in wrist

➢ FCR, FCU, Palmaris longus, FDS, FDP, FPL, and APL
flexion:
➢ Palmaris longus and ECRB = centrally located

Radial and ulnar motions ➢ Muscles located on the radial side: radial deviation
➢ Muscles located on the ulnar side: ulnar deviation
73 | P a g e
MUSCLES ACTING ON THE DIGITS
➢ Extrinsic muscles with proximal attachments in the forearm or

Muscles acting on the digits
humerus and distal attachments in the hand
➢ Intrinsic muscles with both proximal and distal attachments

Muscles acting on the digits
existing within the hand
➢ They also affect the wrist when they contract

Extrinsic Muscles ➢ Main function: to provide strength and gross motor control in hand
function
➢ Long finger extensors

➢ Long finger flexors
➢ Thumb muscles
Extrinsic Muscles
o Flexors
o Extensors
o Abductors
➢ Extensor retinaculum
➢ 6 extensor tunnels (Lateral to medial (wrist))
Long Finger Extensors
➢ 9 extensor tendons (surrounded by synovial sheath) → region of
the CMC joint
I. APL + EPB
II. ECRL + ECRB
III. EPL
6 Extensor Tunnels
IV. ED + EI
V. EDM
VI. ECU
ED = only muscle that extends all four fingers.

EDM = extend all the joints of the little finger
6 Extensor Tunnels
EI = main extensor of the index finger at the metacarpophalangeal
joint.
➢ 2 extrinsic flexors on the anterior forearm for digits 2 to 5:

Long Finger Flexors o FDS
o FDP
➢ has a large muscle belly proximally that divides into a superficial

and a deep muscle belly more distally in the forearm
➢ 2 Superficial tendons (Digits 3 and 4)
FDS
➢ 2 Deep tendons (Digits 2 and 5
➢ right before each of these tendons attach, their ends split to insert
on either side of the middle phalanges of their respective digits.
➢ located on the ulnar aspect of the anterior forearm and has one
muscle belly that divides into four tendons
➢ each tendon lies under its respective superficialis tendon in the
FDP hand and digits
➢ until they become more superficial when they each emerge
through the split of their digit’s flexor digitorum superficialis to
attach at the distal phalanges of the finger
➢ Median nerve = 2 and 3 digits

FDP ➢ Ulnar nerve = 4 and 5 digits
➢ DP + FDS = synergist
➢ Flexors, Extensors, Abductors

➢ Flexors (FPL)
Thumb Muscles
➢ Extensors (EPL and EPB)
➢ Abductors (APL)
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➢ Thenar
o APB + FPB + OP
➢ Hypothenar
o ADM + FDM + ODM
Intrinsic muscles of the hand
➢ Deep (Midpalm) Muscle
o 3 palmar interossei
o 4 dorsal interossei
o Adductor pollicis
➢ Is a complex interaction of the three vital movement groups of the
hand:
o intrinsic muscles
o long finger extensors
o Indirectly through their connection to the intrinsics—the
long finger flexors
➢ the purpose of the assembly is to extend the digits in different
Extensor Mechanism
positions of finger flexion
➢ the extensor tendons must cover a longer distance from maximum
extension to full flexion
➢ t
➢ his distance is about 25 mm and can be measured in the normal
subject by placing a string over the dorsum of a finger and
marking the change in length from full extension to end flexion
➢ also known as:
o extensor hood mechanism
o extensor expansion
Extensor Mechanism o apparatus
o aponeurosis
o retinaculum
o dorsal hood or hood
➢ Distal tendons of attachment of the extensor muscles

➢ Lumbricals
The extensor mechanism is made ➢ Interossei
up of a tendinous system ➢ Thenar
composed of the: ➢ Hypothenar muscles
➢ Retinacular system of fasciae and ligaments to retain and stabilize
the tendons and the skin.
➢ the retinacular system influences both the flexors and extensors of

the fingers
➢ the complex fascial and ligamentous parts of the retinacular
Retinacular System
system enclose, compartmentalize, and restrain the joints and
tendons as well as the nerves, blood vessels, and skin
➢ Extensor hood and Flexor pulleys
➢ Power Grip
Types of Grasp
➢ Precision Grip
➢ incorporates the entire hand

➢ used for gross activities to grasp an object rather than to
manipulate it
➢ involves holding an object between the partially flexed fingers
Power Grip and the palm
➢ the thumb usually applies counterpressure to maintain and
stabilize the object within the hand
➢ there is only one power grip in which the thumb is not required to
participate, the hook grip
➢ an object is pinched between the flexor surfaces of one or more

fingers and the opposing thumb
Precision Grip
➢ used when accuracy and refinement of touch are needed to
manipulate or use an object
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➢ optimal wrist position during grip activities is 20° to 35° of extension

Grip Activities with slight ulnar deviation
➢ this is known as the functional position of the wrist
➢ Fingers
Balanced Forces
➢ Thumb (50% of hand function)
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Goodluck Future PTRP! Finals
Pelvis and Hip

Pelvic and Hip Region •Power production during closed
chain functions.
•Trunk ↔pelvis
•Pelvis ↔hip
Pelvic Girdle •(Posterior) Right and left pelvic
bones ↔ sacrum and fifth lumbar
•(Anterior) Left and right hemipelvis
↔ pubis symphysis
Hip Joint •Femoral head ↔ Acetabulum
•Very stable structurally + Very
mobile
•Hip abductor muscles on the weight-
bearing leg must create a force to
counterbalance about 85% of body’s
weight during each step taken.
Pelvis •Latin word, “bowl”/”basin”
•A bridge between the lower
extremities and the entire head, arm,
and trunk complex (HAT).
Functions of the Pelvis
Functions of the Pelvis 1.Providing a stable base for HAT
2.Containing and supporting the
visceral contents
3.Transmitting and absorbing
forces to and from both HAT
superiorly and the lower extremities
inferiorly.
Major role in elevating and lowering the body: •Climbing
•Rising from a chair
•Lifting the limb, as when the foot is
elevated to tie a shoelace.
Hip muscles may function by: •moving the femur on the pelvis
(e.g., flexing the hip to step up onto a
step) (Open Kinematic Chain).
•by moving the pelvis over the
femur (e.g., leaning over to pick up
an object from the floor) (Close
Kinematic Chain).
BONES
Pelvis •Supporting and transferring the
weight of the HAT to the femurs in
standing or to the ischial
tuberosities in sitting.
•Rotating during walking to create a
rhythmic pelvic swing so a smooth
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translation of both the trunk and the

lower extremities occurs.
•Providing a broad area for muscular
attachment.
•2 Innominate bones (R) and (L)
•Ilium
•Ischium
•Pubis
Ilium •“wing/ear”
•Largest, superior
•Iliac crest (L4) highest point of the
pelvis
•Iliac tubercle (L5)
Iliac spines •ASIS
•AIIS
•PSIS
•PIIS
ASIS •ASIS (Origin of Sartorius, Inguinal
Ligament/ paupart’s/ aponeurosis of
external oblique)
•Measurements:
•LLD, Q-angle
•Fulcrum for hip abduction,
adduction
AIIS •AIIS (Origin of rectus
femorisstraight head)
PSIS •PSIS
•S2
•Dimples of Venus
•Measurement:
•Schober’s Test (AS)
Duverney’s Fracture •Fracture of the Iliac wing
Ischium •“fish”
•Posterior
Ischial Tuberosity •Ischial tuberosity

•Ischiogluteal bursa
Ischial tuberosity •“sit bone”

•For weightbearing in sitting
•Origin of hamstrings
Ischiogluteal bursa •Prolonged sitting causes bursitis;
Tailor’s/weaver’s/boatman’s
bottom
Pubis
Pubis •“crotch”
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•Common site of adductor origin

Superior Ramus origin of pectineus
Pubic Tubercle/ Body origin of adductor longus
Inferior Ramus a. Magnus
b. Gracilis
c. Brevis
Obturator foramen a. Lumbar and sacral nerves
b. Blood Vessels
Acetabulum •Triradiate ligament connects ilium,
ischium, pubis (Fused after birth)
•Covered by fibrous cartilage:
acetabular labrum
Orientation of acetabulum: (LIA) Lateral, Inferior, Anterior
Sacrum •Sacral promontory
•Sacral body
Coccyx •“tail bone”
•Painful coccyx “coccygodenia”
•MOI: falling in seated position
Pelvis Inlet (Pelvic Brim) •Carries abdominal organs
•Male: Heart, smaller
•Female: Oval, larger
•Borders:
•Ant: Symphysis pubis
•Post: Sacral promontory
•Lat: Iliopectineal line
Pelvis Outlet •carries reproductive organs
•Borders:
•Ant: Pubic arch
•Post: Coccyx
•Lat: Ischial tuberosity
Pelvic Tilt •(N) ASIS = PSIS
•APT = ASIS < PSIS
•PPT = ASIS > PSIS
Nutation Movement Counter-nutation

Sacral Flexion AKA Sacral Extension
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Smaller Pelvic Inlet Larger

Larger Pelvic Outlet Smaller
Posterior Pelvic Tilt Anterior
Anterior + Inferior Sacral Promontory Posterior + Superior
Posterior + Superior Coccyx Anterior + Inferior
Approximate Pelvic Wing Distract
Distract Ischial Tuberosity Approximate
Sacroiliac
Sacrotuberous Ligaments Restrict
Sacrospinous
LABOR •During labor = Lithotomy position –

Nutation + PPT
Level Structures •ASIS = PSIS

•XXX: Pelvic tilt
•Iliac crest (L) = (R)
•XXX: Pelvic obliquity/list
•Pubic tubercle = Greater trochanter
•XXX: True LLD, coxa vara,
dislocation
Femur •25% of the general height
Neck Shaft Angle •Adult= 125 degrees

•Child= 160 degrees
•Increase = coxa valga (If more than 25

degrees)
•Decrease = coxa vara (If less than 25
degrees)
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Femoral •Bisection of the axis of the femoral neck

Torsion (a line connecting the center of the
femoral head and shaft)
•Line parallel to the tabletop on which the
posterior condyles are resting
• (N) 8-15 degrees
•Increase anteversion (in-toe, patellar
squinting, SPITT, knocked knees) (More
than 15 degrees)
•Decrease Retroversion (out-toe, frog
eyes/ grasshopper, SSETT, bowleg) (Less
than 8 degrees)
Center edge •“Angle of Wiberg”

angle •(N) 20-30 degrees
•↑angle = more stable
•↓angle = less stable
•Aging increases center edge angle
Femoral Head •Covered by hyaline and fibrous cartilage

•Blood supply
•20% obturator artery / ligamentum
teres
•80% Medial circumflex artery
Femoral Neck
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Greater •G. Med/Min

trochanter •Red carpet muscles
•POOSIQ
•(Sup to inf) Piriformis, obturator
internus, obturator externus, superior
gamellus, inferior gamellus, quadratus
femoris
Lesser •Iliopsoas
trochanter
JOINTS
SI Joint •Ligaments: weakened by relaxin, AS
•Movement: Nutation/Counternutation
Sciatic Notch •divided by sacrospinous ligament

•Greater
• a. Piriform is passes through and
divides (if sciatic nerve passes through
piriformis = “fat wallet syndrome”)
•Superior GSF
•Superior gluteal nerve/ artery
•Sciatic nerve
•Inferior GSF
•Inferior gluteal nerve/ artery
•Lesser, closed by
sacro tuberous ligament
Acetabulofemoral Joint / Hip Joint
Hip Joint
Resting Position: 30 degrees flexion, 30 degrees abduction,
slight lateral rotation
Close packed Position: Full extension, medial rotation, and
abduction
Capsular Pattern: Flexion, abduction, medial rotation (but
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in some cases, medial rotation is limited)

Forces on the Hip
Standing: 0.3 times to body weight
Standing on one Limb: 2.4 to 2.6 times the body weight
Walking: 1.3 to 5.8 times the body weight
Walking upstairs: 3 times the body weight
Running: 4.5+ times the body weight
Ligaments of the Hip
Iliofemoral ligament •A.k.a. Y ligament of bigelow
•Strongest ligament of the body
•Restricts: Extension, ER small amount
AD
•This is used if there is weakness of
iliopsoas, jackknife
•Psoatic gait, weak iliopsoas (swing
phase)
•Difference, Backward lurch (Stance,
GMax weakness)
•Psoatic limp –LCPD (FABER swing)
Ischiofemoral ligament •Restrict IR, EXAB small amount of AD
83 | P a g e
Pubofemoral ligament •Restrings AB, EXER
Factors affecting Hip Stability •Architecture/stability

•Ligaments –Y ligament
•Atmospheric pressure is negative,
creates a suction
Dislocation •MC direction of Hip D/L: posterior
•MOI: dashboard injury, FAddIR+
PCL injury
Hip Muscles
Hip Action Prime Movers
Flexion Iliopsoas
Rectus Femoris
•Especially with knee extension
Sartorius
•Especially with hip abduction and lateral
rotation
Pectineus
•Especially with hip adduction
Tensor facia latae
•Especially with hip abduction and
medial rotation
Extension •Gluteus Maximus
•Biceps Femoris
•Semimbranosus
•Semitendinosis
•Abductor magnus (posterior fibers)
Adduction •Adductor longus
•Adductor brevis
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•Adductor magnus
•Gracilis
•Pectineus (also a flexor)
Abduction Gluteus Medius
Gluteus Minimus
Tensor fascia latae (also flexes and
medially rotates)
Lateral Rotation Gluteus maximus
Deep lateral rotators
Sartorius
•Especially with hip flexion and
abduction
Medial Rotation Gluteus minimus, anterior fibers
No muscle acts as a primary mover: all are Gluteus Medius, anterior fibers
secondary movers in medial rotation Tensor fascia latae
•Especially with hip flexion and
abduction
Knee
Bones 1. Femur
2. Tibia
3. Patella
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Femoral Condyle •MC Osteochondritis

dissecans
•MC Osteoarthritis
Medial condyle •Larger

•Longer
•MC = Osteoarthritis
Lateral condyle •More anterior

•MC = Rheumatoid
Arthritis
Intercondylar groove •Increases the moment arm
length for the quadriceps
femoris muscles at
midrange knee flexion
Palpable Bony Features of the Distal Femur: •Medial Epicondyle

•Lateral Epicondyle
•Medial condyle
•Lateral condyle
•Tibiofemoral Joint Line
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Tibia •Tibial plateau (MC LO)

•Media = C-shaped
•Lateral = O-shaped
•Tibial tuberosity
•Attachment for patellar
tendon
•Osgood Schlatter disease
(swelling and irritating of
the tibial tuberosity)
Fibula •Head
•Neck
•Shaft
Palpable Bony Features of the Proximal Tibia and Fibula: •Medial condyle or Plateau
•Lateral condyle or Platea
•Tibial Tuberosity
•Crest of the Tibia
•Fibular Head
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Patella •Sesamoid bone, largest

(smallest: Fabella, back of
the knee)
•Diamond shaped
•Superior pole: Quads
tendon
•Inferior pole: Patellar
tendon
•Increases leverage power
by 35% of quads
Displaced Patella •Alta – High, Camel Sign

(prominence of infrapatellar
bursa)
•Baja – Low, decrease
quads leverage, prone to
stiff knee (arthrogenic knee)
•Parva – Irregularly
Shaped
•Tarda - Small
Palpable Bony Features of the Patella: •Apex (Inferior pole)

•Base
•Anterior Surface
•Posterior surface of lateral
facet
•Posterior surface of medial
facet
•Posterior surface of old
facet
The Patella has several important functions at the knee. 1. Improve the efficiency
According to Heegaard and associates, the patella serves to: and increase torque of the
knee extensor throughout
the knee’s range of motion;
2. Centralize the forces of
the four quadriceps muscles
into one concerted direction
of pull;
3. Provide a smooth gliding
mechanism for the
quadriceps muscle and
tendon to reduce
compression and friction
forces during activities such
88 | P a g e
as deep knee bends;

4. Contribute to the overall
stability of the knee; and
5. Provide bony protection
from direct trauma to the
femoral condyles when the
knee is flexed.
Quadriceps angle/Q-angle •Line from the ASIS to the
center of the patella
•Line from the tibial
tuberosity to the center of
the patella and upwards.
•Men – 10-14 degrees
•Women – 15-23 degrees
•Excessive – GENU
VALGUM “Knock knees”
•Insufficient – GENU
VARUM “Bowleg”
Bauer’s Clinical Prediction Rule for Acute Knee Fracture •Severe joint line
tenderness
•Severe localize swelling
with effusion and
ecchymosis
•Flexion less than 90
degrees
•Inability to bear weight
*The presence of these
signs would indicate that an
x-ray assessment is
warranted.
Tibiofemoral Joint •Modified hinge joint
•2 joints:
•Medial tibiofemoral
(more weightbearing)
•Lateral tibiofemoral
(more synovium)
•(N) position of the knee,
Genu valgus 6 degrees
•OPP: 25 degrees flexion
•CPP: Full extension + ER
•Capsular pattern: Flexion
> Extension
Screw Home Mechanism •Cannot be controlled
(mechanical event)
•Last 20 degrees of
extension (FIR –TER)
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•Tibia ER on femur
(OKC)
•Femur IR on Tibia
(CKC)
•Muscles:
•Unlocks the knee:
popliteus (deepest muscle
of back of knee) FER-TIR
•OKC –Tibial IR
•CKC –Femoral ER
•Locking: None
LIGAMENTS OF THE KNEE
LIGAMENTS OF THE KNEE – CONT’D
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Cruciates •ACL
•PCL
Collaterals •MCL
•LCL
Anterior Cruciates Ligament •SPL from medial tibial
plateau to lateral femoral
condyle
•Slack = 30-60 degrees
•Taut = Extension/IR
•Weakest ligament of knee
•Prevents: anterior
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translation of the tibia on

the femur
•MOI: hyperextension,
rotation
Triad of O’Donoghue •ACL
•MCL
•Medial meniscus
Special Test •Lachman’s test

•Anterior drawer test
Posterior Cruciate Ligament •SAM from lateral tibial
plateau to medial femoral
condyle
•Strongest ligament in the
knee
•Slack: Extension, Taut:
flexion
•Prevents: posterior
translation of tibia on femur
Posterior Cruciate Ligament •MOI: Dashboard,
hyperflexion
•Special test
•Posterior Sag sign
•Godfrey Test
Medial Collateral Ligament •Slack in 90 degrees flexion
•Taut: in extension + ER
•Prevents valgus force/
abduction
•Ossification of MCL:
Pellegrini Steida Disease
•Frog swim’s Swimmers
knee (MCL)
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Lateral Collateral Ligament •Slack in 90 degrees

flexion
•Taut in extension + ER
•Prevents = Varus force/
adduction
Coronary/Meniscal Ligament •Medial meniscus to the

tibia
Patellofemoral Joint •Function:

•Leverage
•Protection
Patellofemoral Joint Loading •Walking = 0.3x BW
•A –Ascending = 2.5x BW
•D –Descending = 3.5x BW
•S –Squats =7x BW
Patellar Loading with activity
Walking: 0.3 times the body weight
Climbing: 2.5 times the body weight
Descending stairs: 3.5 times the body weight
Squatting: 7 times the body weight
MUSCLES
Genu articularis •Pulls the synovial capsule
and bursa superiorly during
knee extension to move
them out of the way of the
joint to prevent the capsule
from being compressed
between the femur and
patella
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Quadriceps •Rectus femoris

•Vastus lateralis
•Vastus medialis
•Vastus intermedius
Hamstrings •Semitendinosus
•Semimembranosus
•Biceps femoris
Other knee flexors •Gastrocnemius

•Plantaris
•Popliteus
Medial rotators of the Pes Anserinus •Sartorius

knee •Gracilis
•Semitendinosus
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Lateral rotators of •Biceps femoris

the knee •Tensor fascia lata
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ANATOMY AND KINESIOLOGY OF THE ANKLE AND FOOT

TOPIC OUTLINE 1. Functions of the Ankle and
Foot
2. Bones of the Ankle and Foot
3. Joints and Ligaments of the
Ankle and Foot
4. Muscles of the Ankle and Foot
5. Arches of the Foot
6. Kinesiology and Biomechanics
of the Ankle and Foot
FUNCTIONS
FUNCTIONS OF THE ANKLE AND FOOT 1.Support of the body’s weight.
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2.Control and stabilization of the

leg on the
planted foot.
3.Adjustments to irregular
surfaces.
4.Compensation for more
proximal segment
malalignment or pathomechanics.
5. Elevation of the body, as in
standing on the toes, climbing, or
jumping.
6. Shock absorption in walking,
running, or
landing from a jump.
7. Operation of machine tools.
8. Substitution for hand
functions in
persons with upper extremity
amputations or
muscle paralysis.
BONES OF THE ANKLE AND FOOT
BONES OF THE ANKLE AND FOOT 1. Tibia
2. Fibula
3. Tarsals
4. Metatarsals
5. Phalanges
TIBIA • Medial bone of the leg
• “Shin bone”
• 90% weight-bearing
• Medial malleolus
FIBULA • Lateral bone of the leg
• Essentially considered as a non-
weightbearing bone (Brunnstrom)
• 10% weight-bearing
(Brunnstrom)
• It takes no part in the
transmission of body
weight (Snell)
• Carries 17% of the axial load
(Magee)
• Lateral malleolus
3 SECTIONS OF THE ANKLE AND FOOT
Hindfoot (Rearfoot) Midfoot Forefoot
❑Calcaneus ❑Navicular ❑Metatarsals
❑Talus ❑Cuboid ❑Phalanges
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❑Medial cuneiform
❑Intermediate cuneiform
❑Lateral cuneiform
JOINTS OF THE ANKLE AND FOOT
Hindfoot (Rearfoot) Midfoot (Midtarsal Joints) Forefoot Joints
Joints
1) Inferior (distal) N) Talocalcaneonavicular 1) Tarsometatarsal joints
tibiofibular joint joint 2) Intermetatarsal joints
2) Talocrural (ankle) 2) Cuneonavicular joint 3) Metatarsophalangeal
joint 3) Cuboideonavicular joint joints
3) Subtalar 4) Intercuneiform joints 4) Interphalangeal joints
(talocalcaneal)
joint
JOINTS OF THE HINDFOOT
Tibiofibular Joint Resting Position: Plantar Flexion
Close Packed position: Maximum
Dorsiflexion
Capsular Pattern: Pain when Joint
is stressed
Talocrural (ankle) Joint Resting Position: 10 degrees
flexion, midway between
inversion and eversion.
Close Packed position: Maximum
dorsiflexion
Capsular Pattern: Plantar flexion,
dorsiflexion
Subtalar Joint Resting Position: Midway
between extremes of range of
motion (ROM)
Close Packed position: Supination
Capsular Pattern: Limited ROM
(Varus, Valgus)
DISTAL TIBIOFIBULAR JOINT • Between fibular notch at the
lower end of tibia and the lower
end of the fibula.
• Fibrous joint
• No capsule
• Ligaments:
• Interosseous ligament
• Anterior tibiofibular ligament
• Posterior tibiofibular ligament
• Inferior transverse ligament
TALOCRURAL JOINT • “Ankle joint” = Ankle mortise
and talus
• Ankle mortise = distal part of
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the tibia + lateral malleolus +

medial malleolus
• Uniaxial
• Modified hinge joint
• Synovial joint
• 1 DOF
• Dorsiflexion and Plantarflexion
• Ligaments:
• Deltoid (medial collateral)
ligament (4)
• Lateral collateral ligaments
(3)
DELTOID (MEDIAL COLLATERAL) LIGAMENT • Superficial (resist talar
abduction)
• Tibionavicular ligament
• Tibiocalcanean ligament
• Posterior tibiotalar ligament
• Deep
• Anterior tibiotalar ligament
• Resists:
• Lateral translation of the talus
• Lateral rotation of the talus
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LATERAL COLLATERAL LIGAMENTS • Anterior talofibular ligament

• Resists inversion of talus
• MC injured (lateral ankle
sprain)
• Posterior talofibular ligament
• Resists ankle DF, adduction
(tilt), medial rotation and medial
translation of the talus
• Calcaneofibular ligament
• Resists maximum inversion at
the ankle and subtalar joints.
• 2nd MC injured (lateral ankle
sprain)
SUBTALAR (TALOCALCANEAL) JOINT • Synovial joint

• Joint axis: 40 to 45 degrees
vertically inclined and 15 to 18
degrees to the sagittal plane
• 3 DOF: gliding and rotation
• Sinus tarsi – sinus between the
talus and calcaneus” and it
contains the interosseus
talocalcaneal ligament
(proprioceptive subtalar center)
• Ligaments:
• Lateral talocalcaneal
ligament
• Medial talocalcaneal ligament
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• Interosseous talocalcaneal
ligament
• Cervical ligament
Open and Closed Kinetic Chain Movement of Pronation and Supination at the
Talocrural and Subtalar Joints
JOINTS OF THE MIDFOOT

Joints of the Midfoot (Midtarsal Joints) Resting Position: Midway
motion (ROM)
Close Packed Position: Supination
Capsular Pattern: Dorsiflexion,
plantar flexion, adduction,
medial rotation
CHOPART JOINT • “Transverse tarsal joints”
• “Midtarsal joints”
• Refers collectively to the
midtarsal joints between the;
• Talus-calcaneus
• Navicular-cuboid
TALOCALCANEONAVICULAR JOINT • Ball and socket joint
• Synovial joint
• 3 DOF: gliding and rotation
• Ligaments:
• Dorsal talonavicular ligament
• Bifurcated ligament
• Plantar calcaneonavicular
(spring) ligament
CUNEONAVICULAR JOINT • Plane synovial joint
• Allows slight gliding and rotation
CUBOIDEONAVICULAR JOINT • Fibrous joint
• Allows slight gliding and rotation
INTERCUNEIFORM JOINTS • Plane synovial joints
• Slight gliding and rotation
CUNEOCUBOID JOINT • Plane synovial joints
• Slight gliding and rotation
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CALCANEOCUBOID JOINT • Saddle shape joint

• Allows gliding with conjunct
rotation
• Ligaments:
• Bifurcated ligaments
• Calcaneocuboid ligament
• Long plantar ligaments
FOREFOOT JOINTS
Tarsometatarsal Joints Resting Position: Midway
motion (ROM)
Close Packed Position: Supination
Capsular Pattern: None
Metatarsophalangeal Joints Resting Position: 10 degrees
extension
Close Packed Position: Full
Extension
Capsular Pattern: Big toe:
extension, flexion / Second to
fifth toe: Variable
Interphalangeal Joints Resting Position: Slight Flexion
Close Packed Position: Full
Extension
Capsular Pattern: Flexion,
extension
TARSOMETATARSAL JOINTS • Taken together, these joints are
referred to as “Lisfranc joint”
• Plane synovial joint
INTERMETATARSAL JOINTS • 4 intermetatarsal joints
• Plane synovial joint
• Allows gliding
METATARSOPHALANGEAL JOINTS • 5 metatarsophalangeal joints
• Condyloid joints
• 2 DOF
• Flexion, extension, abduction
and adduction
INTERPHALANGEAL JOINTS • Synovial hinge joint
• 1 DOF
• Flexion and extension
MUSCLES OF THE LEG, ANKLE AND FOOT
Muscles of the Lateral Fascial Compartment of the Leg
Muscle Origin Insertion Nerve Nerv Action
Supply e
Root
Peroneus Lateral surface Base of 1st Superficia L5; • Plantar flexes foot
longus of shaft of metatarsal and l peroneal S1, 2 at ankle joint
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fibula the medial nerve • Everts foot at

cuneiform subtalar and
transverse tarsal
joints
• Supports lateral
longitudinal and
transverse arches of
foot
Peroneus Lateral surface of fibula Base Superficia L5; • Plantar flexes foot
brevis of shaft of of 5th l peroneal S1, 2 at ankle joint
fibula metatarsal bone nerve • Everts foot at
subtalar and
transverse tarsal
joint
• Supports lateral
longitudinal arch of
foot
Muscles of the Posterior Fascial Compartment of the Leg
Supply e
Root
Superficial Group
Gastrocnemiu Lateral head Via tendo Tibial S1, 2 • Plantar flexes foot
s from lateral calcaneus into nerve at ankle joint
condyle of posterior • Flexes knee joint
femur and surface of
medial head calcaneum
from above
medial condyle
Plantaris Lateral Posterior Tibial S1, 2 • Plantar flexes foot
supracondylar surface of nerve at ankle joint
ridge of femur calcaneum • Flexes knee joint
Soleus Shafts of tibia Via tendo Tibial S1, 2 • Plantar flexor of
and fibula calcaneus into nerve ankle joint
posterior • Provides main
surface of propulsive force in
calcaneum walking and
running
Deep Group
Popliteus Lateral surface Posterior Tibial L4, 5; • Flexes leg at knee
of lateral surface of shaft nerve S1 joint
condyle of of tibia above • Unlocks knee
femur soleal line joint by Lateral
rotation of femur on
tibia and slackens
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ligaments of joint
Flexor Posterior Bases of distal Tibial S2, 3 • Flexes distal
digitorum surface of shaft phalanges of nerve phalanges of lateral
longus of tibia lateral four toes four toes
• Plantar flexes foot
at ankle joint
• Supports medial
and lateral
longitudinal arches
of foot
Flexor Posterior Base of distal Tibial S2, 3 • Flexes distal
hallucis surface of shaft phalanx of big nerve phalanx of big toe
longus of fibula toe • Plantar flexes foot
at ankle joint
• Supports medial
foot
Tibialis Posterior Tuberosity of Tibial L4, 5 • Plantar flexes foot
posterior surface of navicular bone nerve at ankle joint
shafts of tibia and other • Inverts foot at
and fibula and neighboring subtalar and
interosseous bones transverse tarsal
membrane joints
• Supports medial
foot
Muscles of the Anterior Fascial Compartment of the Leg
Supply e
Root
Tibialis Lateral surface Medial Deep L4, 5 • Extends foot at
anterior of shaft of tibia cuneiform and peroneal ankle joint; inverts
st
and base of 1 nerve foot at subtalar and
interosseous metatarsal bone transverse tarsal
membrane joints; holds up
medial longitudinal
arch of foot
Extensor Anterior Extensor Deep L5; • Extends toes •
digitorum surface of shaft expansion of peroneal S1 Extends foot at
longus of fibula lateral four toes nerve ankle joint
Peroneus Anterior of fibula Base Deep L5; • Extends foot at
tertius surface of shaft of 5th peroneal S1 ankle join; everts
of fibula metatarsal bone nerve foot at subtalar and
transverse tarsal
joints
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Extensor Anterior Base of distal Deep L5; • Extends foot at

hallucis surface of shaft phalanx of peroneal S1 ankle joint
longus of fibula great toe nerve • Inverts foot at
subtalar and
transverse tarsal
joints
Extensor Calcaneum By four tendons Deep S1, 2 • Extends toes
digitorum into the peroneal
brevis proximal nerve
phalanx of big
toe and long
extensor
tendons to 2nd,
3rd and 4th toes
Muscle of the Sole of the Foot
Supply e
Root
First Layer
Abductor Medial Base of Medial S2, 3 • Flexes and
hallucis tuberosity of proximal plantar abducts big toe
calcaneum and phalanx of big nerve • Braces medial
flexor toe longitudinal arch
retinaculum
Flexor Medial tubercle Four tendons to Medial S2, 3 • Flexes lateral four
digitorum of calcaneum four lateral plantar toes
brevis toes- inserted nerve • Braces medial and
into borders of lateral longitudinal
middle arches
phalanx;
tendons
perforated by
those of flexor
digitorum
longus
Abductor Medial and Base of Lateral S2, 3 • Flexes and
digiti minimi lateral proximal plantar abducts fifth toe
tubercles of phalanx of fifth nerve • Braces lateral
calcaneum toe longitudinal arch
Second Layer
Quadratus Medial and Tendon of Lateral S2, 3 • Assists flexor
plantae lateral sides of flexor plantar digitorum longus in
calcaneum digitorum nerve flexing lateral four
longus toes
Lumbricals Tendons of Dorsal extensor First S2, 3 • Extends toes at
(4) flexor expansion; lumbrical:
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digitorum bases of medial interphalangeal

longus proximal plantar joints
phalanges of nerve;
lateral four toes remainder
: lateral
plantar
nerve
Flexor See previous
digitorum Table
longus tendon
Flexor See previous
hallucis Table
longus tendon
Third Layer
Flexor Cuboid, lateral Medial tendon Medial S2, 3 • Flexes
hallucis brevis cuneiform, into medial side plantar metatarsophalangea
tibialis of base of nerve l joint of big toe
posterior proximal • Supports medial
insertion phalanx of big longitudinal arch
toe; lateral
tendon into
lateral side of
base of
proximal
phalanx of big
toe
Adductor Oblique head Lateral side of Deep S2, 3 • Flexes
hallucis bases of 2nd, 3rd base of branch metatarsophalangea
and 4th proximal lateral l joint od big toe
metatarsal phalanx of big plantar • Holds together
bones; toe nerve metatarsal bones
transverse head
from plantar
ligaments
Flexor digiti Base of 5th Lateral side of Lateral S2, 3 • Flexes
minimi brevis metatarsal bone base of plantar metatarsophalangea
proximal nerve l joint of little toe
phalanx of little
toe
Fourth Layer
Interossei
Dorsal (4) Adjacent sides Bases of Lateral S2, 3 • Abduction of toes
of metatarsal proximal plantar • Flexes
bones phalanges- first nerve metatarsophalangea
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medial side of l joints

second toe; • Extends
remainder: interphalangeal
lateral sides of joints
second, third
and fourth toes-
also dorsal
extensor
expansion
Plantar (3) Inferior Medial side of Lateral S2, 3 • Adduction of toes
surfaces of 3rd, bases of plantar • Flexes
4th and 5th proximal nerve metatarsophalangea
metatarsal phalanges of l joints
bones lateral three • Extends
toes interphalangeal
joints
Peroneus See previous
longus tendon table
Tibialis See previous
posterior table
tendon
Muscle of the Dorsum of the Foot
Supply e
Root
Extensor Anterior part of By four tendons Deep S1, • Extend toes
digitorum upper surface into the peroneal S2
brevis of the proximal nerve
calcaneum and phalanx of big
from the toe and long
inferior extensor
extensor tendons to 2nd,
retinaculum 3rd and 4th toes
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ARCHES OF THE FOOT

ARCHES OF THE FOOT 1. Medial longitudinal arch
2. Lateral longitudinal arch
3. Transverse arch
MEDIAL LONGITUDINAL ARCH
Bone Ligament Tendon
❑Talus (keystone) ❑Spring ligament (Plantar ❑Tibialis posterior
❑Navicular calcaneonavicular ligament) tendon
❑Calcaneus ❑Proximal attachment:
❑Cuneiforms Sustentaculum tali
❑1st, 2nd, 3rd Metatarsals
High arch – pes cavus
Low arch/flatfoot deformity – pes planus
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LATERAL LONGITUDINAL ARCH

Bone Ligament Tendon
❑Calcaneus ❑Long plantar ligament ❑Peroneus longus
❑Cuboid (keystone) tendon
❑4th and 5th Metatarsals
TRANSVERSE ARCH
Bones Support
❑3 cuneiforms ***Middle cuneiform ❑Intrinsic muscles of the foot
(keystone)
❑Cuboid
❑1st-5th Metatarsal (bases)
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BIOMECHANICS OF THE ANKLE AND FOOT

PLANTAR APONEUROSIS • “Plantar fascia”
• It begins posteriorly on the medial tubercle
of the calcaneus and continues anteriorly to
attach by digitations to the plantar plates and
then, via the plates, to the proximal phalanx
of each toe.
Summary of Tie-Rod and Truss • Tension in the plantar aponeurosis (The tie-rod)
Relations caused by metatarsophalangeal joint extension can
draw the hindfoot and forefoot (the struts) together
to raise the longitudinal arch (supinate the foot).
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• Supination of the weight-bearing foot through

lateral rotation of the leg or by applying a varus
force to the calcaneus will decrease the angle
between the struts (raise the apex of the triangle)
and release tension in the tie-rod (plantar
aponeurosis).
• Flattening of the triangle (pronation of the foot)
in weight-bearing will increase tension in the
plantar aponeurosis (the tie-rod) and limit
metatarsophalangeal joint extension.
Fick angle = out-
toeing position
(N) Adults = 12 – 18
degrees
(N) Child = 5
degrees
Foot Loading During Gait Walking: 1.2 times the body weight
Running: 2 times the body weight
Jumping (from height of 60 cm [2 feet]): 5 times
the body weight
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ANATOMY AND KINESIOLOGY OF THE THORAX AND CHEST WALL

THORAX (CHEST) •Thoracic vertebrae
•Ribs + Intercostal spaces
•Sternum + costal cartilages
FUNCTION 1.Muscle attachment of UE, head, neck and

vertebral column.
2.Protection for the heart, lungs and viscera.
3.Ventilation
STERNUM •Manubrium
•Body of the sternum
•Xiphoid process
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THORACIC VERTEBRAE •12 pairs

•6 articulating surfaces:
•Superior costal facets (on VB)
•Inferior costal facets (on VB)
•Costal facet (on transverse process)
RIBS •True ribs (vertebrosternal) ribs = Ribs 1-7

•False ribs (vertebrochondralribs) = Ribs 8-10
•Floating (vertebral) ribs = Ribs 11-12
ARTICULATIONS OF THE RIB CAGE •Manubriosternal joint (Sternal angle/Angle of

Louis)
•Xiphisternal joint
•Costovertebral joint
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•Costotransverse joint
•Costochondral joint
•Chondrosternal joint
•Interchondral joints
TYPICAL RIBS •Ribs 2-9
ATYPICAL RIBS •Ribs 1, 10, 11, and 12
ACTIONS OF THE RIBS •Pump-handle action = Ribs 1-6
•Bucket-handle action = Ribs 7-10
•Caliper action = Ribs 8-12
PUMP-HANDLE ACTION •Ribs 1-6
•Inspiration:
•Increase AP dimension of chest
•+Elevation of manubrium sternum upward
and forward.
BUCKET-HANDLE ACTION •Mainly on Ribs 7 to 10

•But also, by Ribs 2 to 6 (lesser extent)
•Increase in lateral or transverse dimension
•Inspiration: ribs move upward, backward and
laterally
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CALIPER ACTION •Ribs 8 to 12

•Lateral movement of the ribs
VENTILATORY MUSCLES 1.Increased fatigue resistance and greater

oxidative capacity.
2.Contract rhythmically throughout life rather
than episodically.
3.Workprimarily against the elastic
properties of the lungs and airway resistance
rather than against gravitational forces.
4.Neurological control of these muscles is
both voluntary and involuntary.
5.Actions of these muscles are life sustaining.
CLASSIFICATION OF VENTILATORY 1.Primary muscles of ventilation
MUSCLES 2.Accessory muscles of ventilation
PRIMARY MUSCLES OF VENTILATION 1.Diaphragm
2.Parasternal muscles
3.Scalenes
****No primary muscle for expiration
ACCESSORY MUSCLES OF •Sternocleidomastoid

VENTILATION •Trapezius
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•Pectoralis major
•Pectoralis minor
•Subclavius
•Levatores costarum
•Serratus posterior superior
•Serratus posterior inferior
ACCESSORY MUSCLES OF Abdominal muscles
VENTILATION •Transversus abdominis
•Internal abdominal obliques
•External abdominal obliques
•Rectus abdominis
•Transversus thoracis
SPIROMETRY •A simple method for studying ventilation

•Recording the volume of air into and out of
the lungs.
•Pulmonary Volumes
•Pulmonary Capacities
TIDAL VOLUME •is the volume of air inspired or expired with

each normal breath.
•500mL
INSPIRATORY RESERVE VOLUME •is the extra volume of air that can be inspired
over and above the normal tidal volume when
the person inspires with full force.
•3000 mL
EXPIRATORY RESERVE VOLUME •is the maximum extra volume of air that can
be expired by forceful expiration after the end
of a normal tidal expiration.
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•1100 mL
RESIDUAL VOLUME •is the volume of air remaining in the lungs
after the most forceful expiration.
•1200 mL
INSPIRATORY CAPACITY •equals the tidal volume plus the inspiratory
reserve volume.
•This is the amount of air (about 3500
milliliters) a person can breathe in, beginning
at the normal expiratory level and distending
the lungs to the maximum amount.
FUNCTIONAL RESIDUAL CAPACITY •Equals the expiratory reserve volume plus the
residual volume.
•This is the amount of air that remains in the
lungs at the end of normal expiration (about
2300 milliliters).
VITAL CAPACITY •equals the inspiratory reserve volume plus the
tidal volume plus the expiratory reserve
volume. •This is the maximum amount of air a
person can expel from the lungs after first
filling the lungs to their maximum extent and
then expiring to the maximum extent
(about4600 milliliters).
TOTAL LUNG CAPACITY •is the maximum volume to which the lungs
can be expanded with the greatest possible
effort (about 5800 milliliters)
•it is equal to the vital capacity plus the
residual volume.
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ANATOMY AND KINESIOLOGY OF THE VERTEBRAL COLUMN
FUNCTIONS OF THE VERTEBRAL •Supports the head

COLUMN •Important attachment of muscles and
ligaments
•Ribs attachment
•Encloses and protects the spinal cord
•Mobility and flexibility of the trunk
•Ability to transfer weight the head and body
to the lower extremities
VERTEBRAE
Adults Newborn
Cervical 7 7
Thoracic 12 12
Lumbar 5 5
Sacral 1 5
Coccygeal 1 4
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Characteristics Cervical Thoracic Lumbar

Overall Structure
Size Small Larger Largest

Foramina One vertebral and One vertebral One vertebral
two transverse
Spinous processes Slender, often bifid Long, fairly thick Short, blunt (project
(C2-C6) (most projects posteriorly rather
inferiorly). than inferiorly).
Transverse Small Fairly Large Large and blunt
processes
Articular Facet for Absent Present Absent
Ribs
Direction of articular facets:
Superior Posterosuperior Posterolateral Medial
Inferior Anteroinferior Anteromedial Lateral
Size of Thick relative to size Thin relative to size Thickest
Intervertebral discs of vertebral bodies of vertebral bodies
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PARTS OF A VERTEBRA • Body

• Transverse process
• Spinous process
• Vertebral foramen
• Pedicle: Connects transverse process to
body
• Lamina: Connects the spinous process to
transverse process
• Vertebral arch, zygapophyseal joint, facet
joint: Area between pedicle and lamina
CURVES OF THE SPINE • Primary curve = kyphosis

• Secondary curve = lordosis
• Cervical lordosis = 3-4 months
• Lumbar lordosis = 10-12 months
standing/walking
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FEATURES OF THE VERTEBRA

Cervical Thoracic Lumbar
Vertebral body Small Heart shaped Large/ massive,
Moderate sized kidney shaped
Spinous process Bifid, short Long and inclined Short, Thick, Flat,
downward/ almost quadrilateral
vertical
Transverse process Transverse foramen Costal Facets Conical shape
Vertebral foramen Largest and triangular Smallest and circular Triangular
Facets SAF: SAF: Posterior/ SAF: Medial
Posterior/Superior Lateral IAF: IAF: Lateral
IAF: Anterior/ Anterior/ Medial
Inferior
Angle 45 degrees 60 degrees 90 degrees
IMPORTANT LANDMARKS (CERVICAL • Hyoid: C3
REGION) • Thyroid cartilage: C4-C5
• Cricoid cartilage: C6
IMPORTANT LANDMARKS (THORACIC • T2 = superior angle of scapula
REGION) • T3 = scapular spine
• T7 = inferior angle of scapula
• T10 = Xiphoid process
IMPORTANT LANDMARKS (LUMBAR • L4 – Iliac crest
REGION) • L5 – tubercle of iliac crest
• S2 – Sacroiliac joint and PSIS
Biomechanics Vertebral Spinous IV Discs Foramina Facets

Body process
Flexion Approximates Separates Flattens Open Opens,

(Art) anterosuperior
Pushed movement
(Post)
Extension Separates Approximates Flattens Closes Closes,
(Art) posteroinferior
Pushed
(Post)
Lateral Approximates Flattens Closes Closes (Ipsi)
Flexion (Ipsi) - (Ipsi) (Ipsi) Opens
Separates Pushed Opens (Contra)
(Contra) (Contra) (Contra)
Rotation Rotates (Ipsi) Rotates At its Closes Closes (Ipsi)
(Contra) weakest (Ipsi) Opens
Opens (Contra)
(Contra)
Distraction Separates - - - -
Compression Approximates - - - -
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Shearing Sliding ant, - - - -

post, lat
INTERVERTEBRAL DISCS • 25% of the vertebral height
• Annulus Fibrosus (Outer)
• Contains collagen (elasticity) and protein
(lamellae, angled at 30o)
• Sharpey’s fibers – attached to outside
part of A.F.
• Nucleus Pulposus (Inner)
• Contains collagen, water, and protein
(Proteoglycans, strong affinity with water)
• % of H2O 80-90%, through aging this
amount decreases.
JOINTS • Interbody joints
• Zygapophyseal joints
MOVEMENTS • Flexion
• Extension
• Rotation
Some examples of Forces on the Lumbar (L-3) Intervertebral Disc
Position Newtons Ratio to Standing
Supine in traction (300 N) 100 -0.2
Supine 250 -0.5
Supine arm exercises (20 N) 600 +1.2
Standing at ease 500 1.0
Sitting unsupported 700 +1.4
Sitting in office chair 500 1.0
Cough in standing 700 +1.4
Standing forward bent 40 1000 +2.0
degrees
Lifting 100 N (Knees ext, 1700 +3.4
back flex)
Lifting 100 N (Knee flex, 1900 +3.8
back ext)
• Connects many vertebrae.
• ALL connects that anterior aspect of
vertebral body of many vertebrae
• Taut: extension
• Lax: flexion
• PLL connects the posterior aspect of the
124 | P a g e
INTERSEGMENTAL LIGAMENTS vertebral body of the many vertebrae

• a. Taut: flexion
• b. Lax: extension
• Supraspinous ligament – connects the tip
of spinous process of many vertebrae
• (C7 to sacrum)
• Taut: flexion
• Lax: extension
• Connects individual vertebra
• Ligamentum flavum/flava – connects the
laminae of adjacent vertebrae
INTRASEGMENTAL LIGAMENTS • a. Taut: flexion
• b. Lax: Extension
• Ligamentum nuchae – connects the tip of
spinous process of adjacent vertebrae
• (Occiput to C7)
• Continuation of supraspinous ligament, in
the neck region
• Taut: flexion
• Lax: Extension
• Interspinous ligament – connects the
adjacent spinous processes
• Taut: flexion
• Lax: Extension
• Intertransverse ligament – connects the
adjacent transverse processes
• Taut: lateral flexion contralateral
• Lax: lateral flexion ipsilateral
• Alar ligaments – controls the skull and atlas
rotation over the axis
• Transverse ligament – holds the dens
against the atlas
• Jefferson’s fracture – fracture of C1
OTHER LIGAMENTS • Hangmans fracture – fracture of C2
• Cruciform Ligament – vertical ligament
over the transverse ligament, limits rotation of
skull and atlas.
• Accessory Atlanto-Axial ligament – (AAA
ligament) Functions similar to alar ligaments.
SUPERFICIAL MUSCLES OF THE BACK • Superficial muscles
• Trapezius (Upper, middle, lower), shawl
muscle
• Rhomboids – (Minor, Major)
• Levator Scapulae
• Latissimus Dorsi – broadest muscle “crutch
walking muscle.
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INTERMEDIATE MUSCLES OF THE • Serratus Posterior

BACK • Superior – forced inspiration
• Inferior – forced expiration
MUSCLES OF THE ANTERIOR TRUNK • Pectoralis Major and minor

•Rectus abdominis
•Transversus abdominis
• Obliques
• External oblique
•Internal oblique
126 | P a g e
POSTURE
STATIC POSTURE • The body and its segments are aligned and
maintained in certain positions.
• Standing
• Sitting
• Lying
• Kneeling
ERECT BIPEDAL STANCE VS. QUADRUPEDAL STANCE
Bipedal Stance Quadrupedal Stance
• Allows the use of UE • BW distributed b/w UE and LE.
• Increases the work of the heart • Larger BOS.
• Stress on VC, pelvis and LE
• Reduces stability
• Smaller BOS.
Base of Support (BOS) Defined by an area bounded posteriorly by the
tips of the heels and anteriorly by a line
joining the tips of toes
CENTER OF MASS
Adult Young Child
S2 T12
POSTURAL CONTROL • The ability to maintain stability in the erect
standing posture is a skill that the central
nervous system learns, using information
from passive biomechanical elements, sensory
systems, and muscles.
REACTIVE (COMPENSATORY) • Occur as reactions to external forces that
RESPONSES displace the body’s CoM.
PROACTIVE (ANTICIPATORY) • Responses occur in anticipation of
RESPONSES internally generated destabilizing forces.
• Raising arms to catch a ball
• Bending forward to tie shoes
GOALS OF POSTURAL CONTROL IN 1. To control the body’s orientation in space.
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STANDING POSITION 2. To maintain the body’s CoM over the BoS.

3. To stabilize the head with regard to the
vertical so that the eye gaze is appropriately
oriented.
PERTURBATION • Is any sudden change in conditions that
displaces the body posture away from
equilibrium.
• Two Types of Perturbation
1. Sensory perturbation
2. Mechanical perturbation
SENSORY PERTURBATION • Might be caused by altering visual input,
such as might occur when a person’s eyes are
covered unexpectedly.
MECHANICAL PERTURBATION • Are displacements that involve direct
changes in the relationship of the body’s CoM
to the BoS.
FIXED-SUPPORT SYNERGIES/STRATEGIES
FIXED-SUPPORT STRATEGIES • are patterns of muscle activity in which the
BoS remains fixed during the perturbation and
recovery of equilibrium.
• Two Types of Fixed-Support Strategy:
1. Ankle synergy
2. Hip synergy
ANKLE SYNERGY • Consists of discrete bursts of muscle
activity.
• Either the anterior or posterior aspects of
the body
• Distal-to-proximal pattern
• In response to forward and backward
movements of the support platform,
respectively
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HIP SYNERGY • Consists of discrete bursts of muscle

activity
• Proximal-to-distal pattern of activation.
• May be used primarily in situations in which
change-in-support strategies (stepping or
grasping synergies) are not possible.
Summary of Fixed Support Strategies
Ankle Strategies
Perturbation
Forward translation of support surface (Back-ward motion of the body)
Backward translation of support surface (forward motion of the body)
Muscle Distal to Proximal Response Tibialis Anterior Gastrocnemius
Quadriceps Femoris Hamstrings
Abdominals (Neck flex.) Paraspinals (neck
ext.)
Hip Strategies
Perturbation
Forward translation of support surface (Back-ward motion of the body)
Backward translation of support surface (forward motion of the body)
Muscle Proximal to Distal Response Abdominal Paraspinals
Quadriceps Femoris Hamstring
Tibialis Anterior Gastrocnemius
CHANGE IN SUPPORT STRATEGY
CHANGE IN SUPPORT STRATEGY • The change-in-support strategies include:
1. Stepping Strategy (forward, backward, or
sidewise)
2. Grasping Strategy (using one’s hands to
grab a bar or other fixed support) in response
to shifts in either the BoS or the entire body.
HEAD-STABILIZING STRATEGIES • Occur in anticipation of the initiation of
129 | P a g e
internally generated forces caused by changes

in position from sitting to standing.
• Are used to maintain the head during
dynamic tasks such as walking.
TWO STRATEGIES FOR MAINTAINING 1. Head stabilization in space (HSS)
THE VERTICAL STABILITY OF THE 2. Head stabilization on trunk (HST)
HEAD
HEAD STABILIZATION IN SPACE (HSS) • Is a modification of head position in
anticipation of displacements of the body’s
CoG. • The anticipatory adjustments to head
position are independent of trunk motion.
HEAD STABILIZATION ON TRUNK • Is one in which the head and trunk move as a
(HST) STRATEGY single unit.
KINETICS AND KINEMATICS IN POSTURE
EXTERNAL FORCES ON BODY IN 1. Inertia
STANDING POSTURE 2. Gravity
3. Ground reaction forces
INTERNAL FORCES ON BODY IN 1. Muscle activity
STANDING POSTURE 2. Passive tension in ligaments, tendons, joint
capsules, and other soft tissue structures.
POSTURAL SWAY/SWAY ENVELOPE • the optimal erect standing posture, little or
no acceleration of the body occurs, except that
the body undergoes a constant swaying
motion.
• The extent of the sway envelope for a
normal individual standing with about 4
inches between the feet can be as large as 12°
in the sagittal plane and 16° in the frontal
plane.
OPTIMAL POSTURE
IDEAL STANDING POSTURE • is one in which the body segments are
aligned vertically and the LoG passes through
all joint axes.
• Normal body structure makes such an ideal
posture impossible to achieve, but it is
possible to attain a posture that is close to the
ideal.
OPTIMAL STANDING POSTURE • The LoG is close to, but not through, most
joint axes.
• Therefore, the external gravitational
moments are relatively small and are balanced
by internal moments generated by passive
capsular and ligamentous tension, passive
muscle tension (stiffness), and a small but
continuous amount of muscle activity.
Alignment in the Sagittal Plane in Standing Posture
130 | P a g e
Joints Line of External Passive Active Opposing

Gravity Movement Opposing Forces
Forces
Atlanto-Occipital Anterior Flexion Ligamentum Rectus capitus
Anterior- nuchae and alar posterior major and
to- ligament; the minor, semispinalis
transverse tectorial, capitus and cervicis,
axis for atlantoaxial, and splenius capitis and
flexion and posterior cervicis, and
extension atlanto-occipital inferior and superior
membranes oblique muscles
Cervical Posterior Extension Anterior Anterior scaleni,
longitudinal longus capitis and
ligament, coli
anterior anulus
fibrous fibers,
and
zygapophyseal
joint capsules
Thoracic Anterior Flexion Posterior Ligamentum
longitudinal, flavum, longissimus
supraspinous, thoracis, iliocostalis
and interspinous thoracis, spinalis
ligaments thoracis, and
Zygapophyseal semispinalis
joint capsules thoracis
and posterior
anulus fibrosis
fibers
Lumbar Posterior Extension Anterior Rectus abdomminis
longitudinal and and ecternal and
iliolumbar internal obliques
ligaments, muscles
anterior fibers of
the anulus
fibrous, and
zygapophyseal
joint capsules.
Sacroiliac Joint Anterior Nutation Sacrotuberous, Transversus
sacrospinous, abdominis
iliolumbar, and
anterior
sacroiliac
ligament
Hip Joint Posterior Extension Iliofemoral Iliopsoas
ligament
131 | P a g e
Knee Joint Anterior Extension Posterior joint Hamstring,

capsule gastrocnemius
Ankle Joint Anterior Dorsiflexion Soleus,
gastrocnemius
Alignment of standing Posture: Anterior Aspect

Body Segment Line of Gravity Location Observation
Head Passes through middle of Eye and ears should be level
the forehead, nose and and symmetrical
chin
Neck/Shoulders Right and left angles between
shoulder and neck should be
symmetrical. Clavicles also
should be symmetrical.
Chest Passes through the middle Ribs on each side should be
of the xiphoid process symmetrical
Abdomen/hips Passes through the Right and left waist angles
umbilicus (navel). should be symmetrical
Hips/Pelvis Passes on a line Anterior superior iliac spine
equidistant from the right should be level
and left anterior superior
iliac spines. Passes
through the symphysis
132 | P a g e
pubis
Knees Passes between knees Patella should be symmetrical
equidistant from medial and facing straight ahead
femoral condyles
Ankles/Feet Passes between ankles Malleoli should be
equidistant from the symmetrical, and feet should be
medial malleoli parallel. Toes should not be
curled, overlapping, or deviated
to one side.
Alignment of standing Posture: Posterior Aspect

Body Segment Line of Gravity Location Observation
Head Passes through middle of Head shoulder be straight with
head no lateral tilting. Angles
between shoulder and neck
should be equal.
Arm Arms should hang naturally so
that the palms of the hands are
facing the side of the body.
Shoulders/Spine Passes along vertebral Scapulae should lie flat against
column in a straight line, the rib cage, be equidistant
which should bisect the from the line of gravity, and be
back into two symmetrical separated by about 4 inches in
halves the adult.
Hips/Pelvis Passes through gluteal The posterior superior iliac
133 | P a g e
cleft of buttocks and spines should be level. The

should be equidistant from gluteal folds should be level
posterior superior iliac and symmetrical
spines
Knees Passes between the knees Look to see that the knees are
equidistant from medial level
joints aspects
Ankles/Feet Passes between ankles The heel cords should be
equidistant from the vertical and the malleoli should
medial malleoli be level and symmetrical.
COMMON POSTURAL DEVIATIONS
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Genu Recurvatum Excessive knee extension
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Torticollis “Wry Neck” Titled and twisted neck

Scoliosis Lateral curvature of the spine
137 | P a g e
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EFFECTS OF AGE, GENDER, PREGNANCY, OCCUPATION, AND RECREATION

ON POSTURE
140 | P a g e
141 | P a g e
Gait Analysis
What is Gait? • Gait is defined as the manner or style of
walking.
• It is described as a translatory
progression of the body as a whole,
produced by coordinated, rotatory
movements of body segments
• Locomotion refers to an individual’s
capacity to move from one place to
another
• Gait is discussed and investigated by its
most fundamental unit, the gait cycle. The
gait cycle is also known as a stride.
• One gait cycle is the time from when
the heel of one foot touches the ground to
the time it touches the ground again.
• The gait cycle is divided into two
phases: stance and swing
Major Tasks of Gait 1. Maintenance of support of the head,
arms, and trunk, that is, preventing
collapse of the lower limb
2. Maintenance of upright posture and
balance of the body
3. Control of the foot trajectory to achieve
safe ground clearance and a gentle heel or
toe landing 4. Generation of mechanical
energy to maintain the present forward
velocity or to increase the forward
velocity
5. Absorption of mechanical energy for
shock absorption and stability or to
decrease the forward velocity of the body
142 | P a g e
Walking at various stages of life
Phases of Gait 1. Stance Phase

• defined as the interval in which the
reference foot is in contact with the
ground
• 60% of the gait cycle
2. Swing Phase
• when the foot is not in contact with
the floor/ground
• 40% of the gait cycle
Gait Terminology Systems
STANCE PHASE SWING PHASE
TRADITIONAL RANCHOS LOS TRADITIONAL RANCHOS LOS
TERMINOLOGY AMIGOS (RLA) TERMINOLOGY AMIGOS (RLA)
TERMINOLOGY TERMINOLOGY
HEEL STRIKE INITIAL ACCELERATION INITIAL SWING
RESPONSE
FOOT FLAT LOADING MIDSWING MIDSWING
RESPONSE
MIDSTANCE MIDSTANCE DECELERATION TERMINAL
SWING
HEEL OFF TERMINAL
STANCE
TOE OFF PRE-SWING
Gait Terminologies – STANCE PHASE
Initial contact: Beginning of stance when heel or some
other portion of foot contacts ground.
Component of initial double limb stance.
143 | P a g e
Loading Response: Body weight rapidly loads onto lead limb

from trailing limb. Hip remains stable,
knee flexes to absorb shock, and forefoot
lowers to ground. immediately follows
initial contact and is final component of
initial double limb stance. Ends when
opposite limb lifts from ground for swing.
Mid stance: Trunk progresses from behind to in front
of ankle over single stable limb. First half
of single limb support. Starts when
contralateral foot lifts from ground for
swing.
Terminal stance: Trunk continues forward progression
relative to foot. Heel rises from ground
and limb achieves trailing limb posture.
Second half of single limb support. Ends
with contralateral initial contact.
Pre-swing: Body weight rapidly unloads from
reference limb and reference limb
prepares for swing during this terminal
double limb stance period. Starts with
contralateral initial contact and ends at
ipsilateral limb toe off
Gait Terminologies – SWING PHASE
Initial swing: Starts when reference foot lifts from
ground. Hip, knee, and ankle rapidly flex
for clearance and advancement during this
initial 1/3 of swing.
Midswing: Thigh continues advancing, knee begins
to extend, and ankle achieves neutral
posture during this middle 1/3 of swing.
Terminal swing: During this final 1/3 of swing, knee
achieves maximal extension and ankle
remains at neutral in preparation for heel
first initial contact.
• Ends when foot contacts ground

Double Limb Stance (Double support) • explained in the gait cycle when both
limbs are in contact with the ground at the
same time.
• During gait, body weight is smoothly
transferred from one limb to the next
during two intervals of double limb
stance
• Initial DLS: occurs at the beginning of
the gait cycle as weight transfers onto the
144 | P a g e
outstretched reference limb from the

trailing limb
• Initial contact and loading response
• Sometimes referred to as weight
acceptance
• Terminal DLS: at the end of stance as
body weight transfers from the trailing
reference limb to the lead limb.
• Pre-swing or push off
• In normal gait, it occurs twice during the
gait cycle and represents about 25% of the
cycle.
Single Limb Stance/Support • arising between the two double limb
stance periods, is the portion of the gait
cycle when only one limb supports body
weight.
• combined phases of mid stance and
terminal stance
• this occurs twice during the normal gait
cycle and takes up approximately 30% of
the cycle.
Running • Running includes jogging, slow running,
fast running, and sprinting—each of these
forms of gait falls within the general
category of running.
• Running occurs when the two periods of
double-limb support during walking are
replaced by two “flight” periods— when
both feet are off the ground at the same
time. This is called as the float phase or
double unsupported phase
• COM is lowered throughout the running
cycle, there is no double support phase in
running
• When transitioning from walking to
running, the duration of stance phase for
each limb drops suddenly from 60% to
40% of the cycle.
• causes the Center of Mass (COM) to
move more like a bouncing ball or pogo
stick, using muscle stiffness to provide
elastic energy release to propel the body
forward
145 | P a g e
Gait Cycle
Gait Analysis: Joint Angles on Sagittal Plane

STANCE PHASE (60%)
JOINT HS FF MS HO TO
HIP 20° F 15° F 0° 10-20° 10-20° E
E
KNEE 0° 15° F 5° F 0° 30° F
ANKLE 0° 5° PF 5° DF 0° 20° PF
MTP 25° E 0° 0° 21 E° 55° E
146 | P a g e
SWING PHASE (40%)

JOINT HS FF MS
HIP 20° F 30° F 30° F
KNEE 60° F 30° F 0°
ANKLE 10° PF 0° 0°
Gait Analysis: Horizontal Plane
• Stride: sequence of events between

147 | P a g e
successive heel strikes of the same foot

• Step: sequence of events between
successive heel strikes of the opposite
foot
• Stride length: The distance between
successive heel strikes of the same foot.
Average is 144 cm or 57 inches.
• Step length: The distance between
successive heel strikes of the opposite
foot. Average is 72 cm or 28 inches.
Normal Parameters of Gait • Step or base width: the lateral
distance between the heel centers of two
consecutive foot contacts. Average is 8-
10 cm or 3-4 inches.
• Cadence (step rate): number of steps
per minute. Average is 90-120
steps/minute.
• Walking or gait speed: distance
covered in a given amount of time.
Average is 1.4 m/sec or 3 mph.
• Degree of toe out: represents the angle
of foot placement and may be found by
measuring the angle formed by each
foot’s line of progression and a line
intersecting the center of the heel and
the second toe. Normal angle is about 7
degrees. The degree of toe-out
decreases as the speed of walking
increases.
148 | P a g e
Other Parameter:
LATERAL PELVIC SHIFT (PELVIC LIST) • side-to-side movement of the pelvis
during walking.
• It is necessary to center the weight of
the body over the stance leg for balance
• (N) 2.5 to 5 cm (1 to 2 inches).
• Total side-side displacement is 4 cm
(Neumann, 2010)
VERTICAL PELVIC SHIFT • Vertical pelvic shift keeps the center of
gravity from moving up and down more
than 5 cm (2 inches) during normal
gait.
• the high point occurs during midstance
and the low point during initial contact
PELVIC ROTATION • The rotation decreases the amplitude
of displacement along the path traveled
by the center of gravity and thereby
decreases the center-of gravity dip.
• There is a total of 8° pelvic rotation
with 4° forward on the swing leg and
4° posteriorly on the stance leg.
Muscle Actions During Gait Cycle
149 | P a g e
For functional movement, the minimum

range of motion requirements at each
joint is as follows:
• Pelvis: 5° to 8° lateral tilt (frontal),
3° anterior and posterior tilt in the
(sagittal), and a total of 8° protraction
and retraction in the (transverse).
• Hip: 10° extension to 25°–30°
Range of Motion Requirements of Normal Gait flexion in the sagittal plane; 15°
adduction to 5° abduction in the frontal
plane; and 8° to 14° in the transverse
plane.
• Knee: full extension to 60° flexion
in the sagittal plane; 3° to 8° in the
frontal plane; 10° to 20° in the
transverse plane.
• Ankle and foot: 10° dorsiflexion to
20° plantarflexion in the sagittal plane;
5°–8° inversion and eversion.
Trunk and Upper Extremity Movement • TRUNK
•Trunk leans right 2-3 cm Trunk rotates
a few degrees
• UPPER EXTREMITIES
• Right arm swings back about 24
degrees Left arm swings forward about
6 degrees
• PELVIS
• Pelvis rotates about 4-8 degrees
150 | P a g e
Kinematic Strategies to Optimize Energy Expenditure during Gait

Direction of Action Name of Strategy Action
Vertical Horizontal plane pelvic Reduces the downward
rotation displacement of the center of
mass (CoM)
Vertical Sagittal plane ankle rotation Reduces the downward
displacement of the CoM
Vertical Stance phase knee flexion Reduces the upward
Vertical Frontal plane pelvic rotation Reduces the upward
Side to side Frontal plane hip rotation Reduces the side-to-side
(step width) excursion of the CoM
Observational Analysis
151 | P a g e
• Gait deviations can occur for three reasons:

• they may occur because of pathology or
injury in the specific joint
Abnormal Gait • they may occur as compensations for injury
or pathology in other joints on the same or
ipsilateral side.
• they may occur as compensations for injury
or pathology on the opposite or contralateral
limb
• Antalgic gait
• Anrthrogenic gait
• Ataxic gait
• Contracture gait
• Equinus gait
Common gait abnormalities • Gluteus Maximus gait
• Parkinsonian gait
• Plantar Flexor gait
• Psoatic limp
• Quadriceps avoidance gait
• Scissors gait
• Short leg gait
• Steppage or Drop Foot gait
Antalgic (Painful) Gait • The antalgic or painful gait is self-protective
and is the result of injury to the pelvis, hip,
knee, ankle, or foot.
• The stance phase on the affected leg is
shorter than that on the nonaffected leg,
because the patient attempts to remove weight
from the affected leg as quickly as possible
• If a painful hip is causing the problem, the
patient also shifts the body weight over the
152 | P a g e
painful hip
Arthrogenic Gait • Stiff hip or knee gait
• The arthrogenic gait results from stiffness,
laxity, or deformity, and it may be painful or
pain free.
• If the knee or hip is fused or the knee has
recently been removed from a cylinder cast
• Circumducted gait
• The patient with this gait lifts the entire leg
higher than normal to clear the ground
because of a stiff hip or knee
Ataxic Gait • The gait of a person with cerebellar ataxia

includes a lurch or stagger, and all movements
are exaggerated.
• The feet of an individual with sensory ataxia
slap the ground, because they cannot be felt.
• The patient also watches the feet while
walking. • The resulting gait is irregular,
jerky, and weaving.
Contractures Gait • may exhibit contracture if immobilization
has been prolonged or pathology to the joint
has not been properly cared for
• HIP FLEXION
• results in increased lumbar lordosis and
extension of the trunk combined with knee
flexion to get the foot on the ground
• KNEE FLEXION
• excessive ankle dorsiflexion from late
swing phase to early stance phase on the
uninvolved leg and early heel rise on the
involved side in terminal stance
• PLANTARFLEXION
• results in knee hyperextension (midstance
of affected leg) and forward bending of the
trunk with hip flexion (midstance to terminal
stance of affected leg).
Equinus Gait (Toe Walking) • This childhood gait is seen with talipes
equinovarus (club foot)
• Weight-bearing is primarily on the
dorsolateral or lateral edge of the foot,
depending on the degree of deformity.
• The weight-bearing phase on the affected
limb is decreased, and a limp is present
• The pelvis and femur are laterally rotated to
153 | P a g e
partially compensate for tibial and foot medial

rotation.
Gluteus Maximus Gait • Weak gluteus maximus muscle
• the patient thrusts the thorax posteriorly at
initial contact (heel strike) to maintain hip
extension of the stance leg.
• Backward lurch of the trunk
Gluteus Medius Gait • Trendelenburg gait

• Weak gluteus medius and minimus muscle
• patient exhibits an excessive lateral list in
which the thorax is thrust laterally to keep the
center of gravity over the stance leg
• A positive Trendelenburg sign is also
exhibited the contralateral side droops
because the ipsilateral hip abductors do not
stabilize or prevent the droop
• Bilateral weakness
• Wobbling gait
• Chorus girl swing
• Mae West gait
Hemiplegic or Hemiparetic Gait • Neurogenic or flaccid gait
• hemiplegic or hemiparetic gait swings the
paraplegic leg outward and ahead in a circle
(circumduction) or pushes it ahead
• affected upper limb is carried across the
trunk for balance.
Parkinsonian Gait • The neck, trunk, and knees of a patient with

parkinsonian gait are flexed.
• The gait is characterized by shuffling or
short rapid steps (marche à petits pas) at
times.
• The arms are held stiffly and do not have
their normal associative movement
• Festination – patient may lean forward and
walk progressively faster as though unable to
stop
154 | P a g e
Quadriceps Avoidance Gait • quadriceps muscles have been injured (e.g.,

femoral nerve neuropathy, reflex inhibition,
trauma—3°strain)
• patient compensates in the trunk and lower
leg. Forward flexion of the trunk combined
with strong ankle plantar flexion causes the
knee to extend (hyperextend).
• the patient may use a hand to extend the
knee
Psoatic Limp • seen in patients with conditions affecting the

hip, such as Legg-Calvé-Perthes disease
• patient demonstrates a difficulty in swing-
through, and the limp may be accompanied by
exaggerated trunk and pelvic movement
• Classic manifestations of this limp are
lateral rotation, flexion, and adduction of the
hip
Scissors Gait • This gait is the result of spastic paralysis of

the hip adductor muscles, which causes the
knees to be drawn together so that the legs
can be swung forward only with great effort
• This is seen in spastic paraplegics and may
be referred to as a neurogenic or spastic gait
Short leg Gait • If one leg is shorter than the other or there is
a deformity in one of the bones of the leg, the
patient may demonstrate a lateral shift to the
affected side, and the pelvis tilts down on the
affected side, creating a limp
• The patient may also supinate the foot on the
affected side to try to “lengthen” the limb
155 | P a g e
Steppage or Drop foot gait • weak or paralyzed dorsiflexor muscles,

resulting in a drop foot
• To compensate and avoid dragging the toes
against the ground, the patient lifts the knee
higher than normal
• At initial contact, the foot slaps on the
ground because of loss of control of the
dorsiflexor muscles resulting from injury to
the muscles, their peripheral nerve supply, or
the nerve roots supplying the muscles
Common Compensatory Mechanisms

Compensatory Movement Causes
Genu recurvatum (knee hyperextension) Quadriceps femoris weak or short;
compensated hamstring weakness
Circumduction Increased limb length; abductor muscle
shortening or overuse; stiff hip or knee
Hip hiking Increased limb length; hamstring weakness;
inadequate hip or knee flexion or ankle
dorsiflexion; quadratus lumborum shortening
Vaulting (ground clearance of swinging leg is Functional leg-length discrepancy; vaulting
increased if subject goes up on toes of stance occurs on shorter limb side
period leg)
Excessive trunk back bending (gluteus Hip extensor or flexor muscle weakness
maximus gait)
Excessive trunk forward bending Quadriceps femoris and gluteus maximus
weakness; decreased ankle dorsiflexion
Excessive trunk lateral flexion Gluteus medius weakness; hip pain; unequal
leg length; hip pathology; wide base
156 | P a g e

Anakines Midterm X Finals GL PTRP

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MODULE 1 (PART 1) : INTRODUCTION TO GROSS ANATOMY

TERMS RELATED TO POSITION

1. Median Sagittal or Sagittal Plane

Sagittal Plane Paramedian Frontal Plane Transverse Plane

➢ the nose bridge is medial to the eyes.

Superficial ➢ towards or on the surface ➢ the skin is superficial to the muscle

➢ no body part is more superior than the head

TERMS RELATED TO MOVEMENT

➢ a movement that increases the angle between two body parts.

Hyperextension ➢ more than the normal extension

Abduction ➢ the movement away from the body

BASIC STRUCTURE OF SKIN

➢ also known as “horny layer”

➢ derived from the word “lucid,” it means clear.

➢ derived from the word “granules,” it means grains

➢ it is the process of programmed cell death

➢ also known as spiny layer

➢ the deepest layer of the epidermis.

➢ is composed of dense connective tissue

➢ it compresses organs, ducts, tubes, and so on, to promote different

➢ is found only in the heart.

➢ the contractions of it provides the major force for moving blood

Parts of Muscle: ➢ origin, insertion, belly, and tendon

Tendon ➢ a connective tissue that connects muscle to bone

CHARACTERISTICS OF SKELETAL MUSCLE FIBER TYPES

Fiber Diameter Smallest Intermediate Largest

Myoglobin Content High High Low

Mitochondria Many Many Few

Fatigue Resistance High Intermediate Low

Myosin Head Activity Slow Fast Fast

Glycogen Concentration Low High High

TERMS (TABLE ABOVE)

Myoglobin ➢ a red colored pigment protein that binds oxygen in muscles

➢ the powerhouse of the cell.

➢ it is the capability to perform movements or exercise in prolong

Anaerobic ➢ it does not require air

➢ these are bones that held together by fibrocartilage or hyaline

➢ is a cord or band of connective tissue uniting two structures

➢ is a lubricating device consisting of a closed fibrous sac lined with a

Bursitis ➢ the inflammation of bursa

Synovial Sheath ➢ is a tubular bursa that surrounds a tendon

OVERVIEW: BLOOD VESSELS

➢ it takes the blood away from the heart

➢ it takes the blood towards the heart

➢ it is smallest blood vessel connecting smallest arteries (arterioles) and

OVERVIEW: LYMPHATIC SYSTEM

➢ it is a natural drainage of our body

Lymph ➢ a tissue fluid once it has entered a lymphatic vessel

OVERVIEW: NERVOUS SYSTEM

Nervous System ➢ it is the control system of the body

➢ it consists of the spinal and cranial nerves and their associated

Somatic Nervous System

➢ it controls involuntary activities (examples: pumping of the heart,

➢ is a living tissue capable of changing its structure as the result of the

➢ manufactures blood cells

➢ refers to the upper extremities or arms and lower extremities or legs

MODULE 1 (PART 2) : KINEMATICS

➢ to understand movement and the forces acting on the human

Movement ➢ essence of kinesiology

➢ concentrated on the forces that produces or resist the movement (GF

➢ deals with types of motion or movement