Kin2222 - Anatomical Terms, Planes - Movements 2 2

Anatomical Terms, Planes
& Movements
Dr. Katelyn Wood, PhD
katelyn.wood@uwo.ca
Learning Outcomes
By the end of this lesson you will be able to
• Use common language to discuss/identify anatomical

structures, locations and movements
Anatomical Planes &
Sections
- consists of a person facing forward, feet flat on the
floor, limbs extended and palms facing forward
- sagittal plane --> cuts the body into left and right halves
- median plane --> one that goes right through the nose
and belly button
Anatomical Position + Planes - the median plane of the hand goes through the middle
finger
- the median plane of the foot goes through the second
toe
- frontal plane (coronal plane) divides the body into front
and back
- transverse (axial) plane divides the body into top and
bottom
- a sagittal plane can be seen through a longitudinal section
- transverse plane would create a transverse section
- oblique section --> section taken at an angle
Anatomical Sections
Anatomical Sections
Question: What plane does
the scout line represent?
Coronal Plane (MR, T1W)
Axial Plane (MR, T1W)
image is from front to back

- scout line --> radiologist use this
Anterior-Posterior to pan through the image to view a
Radiograph variety of other images in another
plane
Sagittal Plane (MR, T1W)
Upper Limb Anatomy Tutorial Using an Imaging Platform https://www.mededportal.org/publication/10167/

Anatomical Terms
Superior (rostral)
Anatomical Terms
• Specific terms used to
denote a specific location
in the body Medial Proximal
• Important for establishing Lateral

a common language Distal
amongst a team
• All terms are in reference Posterior

to anatomical position Anterior
Inferior (caudal)
Upper body (head, neck, and trunk)
Term Explanation
Anatomical Terms Cranial
Caudal
Pertaining to, or located toward, the head
Pertaining to, or located toward, the tail
Pertaining to, or located toward, the front

Anterior Synonym: Ventral (used for all animals)
Pertaining to, or located toward, the back

Limbs Posterior Synonym: Dorsal (used for all animals)
Term Explanation Superior Upper or Above
Proximal Close to, or toward, the trunk, or toward the point of origin Inferior Lower or Below
Distal Away from the trunk (toward the end of the limb), or away Axial Pertaining to the axis of a structure
from the point of origin
Transverse Situated at right angles to the long axis of a structure
Radial Pertaining to the radius or the lateral side of the forearm
Longitudinal Parallel to the long axis of a structure
Ulnar Pertaining to the ulna or the medial side of the forearm
Horizontal Parallel to the plane of the horizon
Tibial Pertaining to the tibia or the medial side of the leg
Vertical Perpendicular to the plane of the horizon
Fibular
Pertaining to the fibula or the lateral side of the leg Medial Toward the median plane
(peroneal)
Lateral Away from the median plane
Palmar
Pertaining to the palm of the hand
(volar) Median Situated at the medial plane or midline
Plantar Pertaining to the sole of the foot Peripheral Situated away from the center
Dorsal Pertaining to the back of the hand or top of the foot Superficial Situated near the surface
Deep Situated beneath the surface
External Outer or lateral
Hands & Feet Internal Inner or medial
Term Explanation Apical Pertaining to the top or apex
Pollicis Pertaining to the thumb Basal Pertaining to the bottom or base
Hallicus Pertaining to the great toe Sagittal Situated parallel to the sagittal suture
Coronal Situated parallel to the coronal suture (pertaining to

the crown of the head)
- cranial cavity houses the brain
- the vertebral canal has the spinal cord
- thoracic cavity --> can be further subdivided
Anatomical Cavities
- abdominal and pelvic cavities are divided at the pelvis
- pericardial cavity --> right in the center holds the heart (the area above it called
the mediastinum)
- pleural cavities --> left and right for the lungs
- thoracic cavity is divided from the abdominal cavity by the diaphragm
- subcostal means below the ribs
- Umbilical means around the belly button.
Abdominal Regions - Epigastric means above the stomach

Common Movements
Common Movements Flexion: decreases angle
between bones at a joint
Extension: increases angle
Bending between bones at a joint
Wikimedia Commons
Common Movements Protraction: moving forward
Retraction: moving backward
Protraction/Retraction & Elevation/Depression Elevation: move in a superior direction

Depression: move in an inferior direction
PROTRACTION
scapula
RETRACTION
scapula
Wikimedia Commons
Pronation*: palm/sole rotates downward
Common Movements Supination*: palm/sole rotates upward
Lateral/External Rotation: away from the

Pronation/Supination, Rotations midline, along long axis
pronation/supination only
Medial/Internal Rotation: toward midline,
occurs in the forearm along long axis
ROTATION
internal/external
internal
external
*doesn’t happen @ ankle

Wikimedia Commons
Common Movements Adduction: move toward midline
Abduction: move away from midline
Abduction/Adduction, Circumduction
Circumduction: distal aspect makes a
circle, proximal end fixed
Wikimedia Commons
Finger Adduction: move toward midline
Common Movements Finger Abduction: move away from midline
Hands & Thumb Adduction: align thumb with hand

Abduction: thumb moves anteriorly
Flexion: thumb comes toward midline,
frontal plane
Extension: thumb moves away from
midline, frontal plane
Opposition: bringing toward (oppose)
ADDUCTION ABDUCTION
other digits
FLEXION EXTENSION OPPOSITION ADDUCTION ABDUCTION

Common Movements Eversion: tilt sole away from midline
Inversion: tilt sole toward midline
Feet Dorsiflexion (extension): flex foot superiorly
Plantar Flexion (flexion): flex foot inferiorly
DORSIFLEXION
(extension)
EVERSION INVERSION
PLANTARFLEXION
(flexion)
To Summarize…
• Anatomical Position is the starting place for
describing locations and movements
• It is defined as facing forward, feet on the floor,
limbs straight, palms forward
• Anatomical Planes are used to divide the body into

sections, and are particularly relevant for interpreting
2D clinical scans
• Anatomical terms are precise ways of communication

that create a common language amongst a team
©
Ankle + Foot
katelyn.wood@uwo.ca
Learning Outcomes
By the end of this lesson you will be able to…
• Identify key bony landmarks, and their associated structures on the tibia, fibula,
tarsals, metatarsals and phalanges
• Identify the location, components (bones + ligaments + associated structures) of the

3 joints of the ankle
• Recall muscles which cross the ankle, their primary actions and innervations
• Predict muscle function based upon joints crossed and implications for injury
Lower Limb Overview
The Lower Limb Hip
LOWER LIMB
pelvic bones
femur Thigh
patella Knee
tibia
fibula
tarsal bones
metatarsals
phalanges
Shank/Leg
Ankle
Foot
Tibia + 75 aspect
Inferior
Fibula - medial malleolus

- lateral malleolus
- ankle mortise —> formed by the tibia and
fibula (important for ankle articulation); u-
shaped
Ankle Mortise
anterior view posterior view
I II III
IV
V
Tarsal Bones Phalanges
(distal, middle, proximal)
- form plane joints between them and allow for a little bit of mobility through the foot
- calcaneus —> heel
- talus —> on top of the calcaneus; primary bone that participates in the articulation at the ankle
- anterior to talus = navicular
- lateral to talus = cuboid
- 3 cuneiforms anterior to that: medial, intermediate, and lateral —> anterior are the metatarsals and then
the phalanges Metatarsals
lateral view
Cuneiforms
(medial, intermediate, lateral)
Navicular Cuboid
medial view
Talus
Calcaneus
Distal
Bones of the phalanx

Middle
Foot phalanx
Proximal
phalanx
Cuneiforms
Metatarsal
Cuboid
Calcaneus
Tarsal
bones
Talus Navicular
Upper Limb Radiology Tutorial
https://www.mededportal.org/doi/10.15766/mep_2374-8265.10167
Lateral Ankle
Anterior Posterior
Fibula
Tibia
Talus
Navicular
Lateral Cuneiform
Calcaneus
Base of the 5th Metatarsal Cuboid
Lower Limb Radiology Tutorial –

Surface Anatomy
Joints of the Ankle
Distal Tibiofibular Joint
Joints of the Ankle Talocrural Joint
Subtalar Joint
Distal tibiofibular joint

- articulation at the distal aspect of the tibia and the fibula
- maintain a rigid shape between the tibia and fibula
Talocrural joint
- articulation between the talus and the ankle mortise that is
formed by the tibia and fibula
- allow for dorsi and plantar flexion
Subtalar joint
- joint underneath the talus
key for inversion and eversion
Posterior Leg Lateral
Medial
Interosseous Membrane
Ankle Mortise
Distal Tibiofibular Jt
Medial Malleolus
Lateral Malleolus
Talocrural Joint

Posterior Leg
Anterior Posterior
Fibula
Tibia
Talocrural Joint Talus

Navicular
Subtalar Joint
Calcaneus

Interosseous
Membrane

allows the bones to stay in this arrangement
• Articulation between tibia and fibula

• Tight Tibiofibular Syndesmosis (fibrous jt)
allows bones to stay in really close proximity to each other when the lower limb is loaded
held
together by • Anterior + Posterior Tibiofibular Ligaments
allows for the maintenance of the shape of the ankle mortise
Fibula
Tibia
Anterior
Posterior Tibiofibular
Tibiofibular
Ankle Mortise

High Ankle Sprain
- ligaments of the distal tibiofibular joint are impaired
Distal Tibiofibular Joint - pain upon dorsi flexion —> the talus is a little bit
wider anteriorly and is going to spread out the ankle
mortise; if the mortise is spread you put stress on the
• Tearing of anterior/posterior ligaments
- caused by a lateral rotation of the foot —> lateral
tib-fib lig malleolus is broken off (one image) and the fibula
which helps to stabilize against rotation has been
• May occur alongside fibular damaged (the other picture)
fracture
• Pain upon dorsiflexion
• Due to talus spreading the
ankle mortise
• Typically caused by lateral
rotation of foot
Crural Joint *talus is wider anteriorly
• Articulation between Ankle Mortise (tibia + fibula) and Talus

• Permits dorsi- and plantar flexion
Crural Joint
Calcaneonavicular
Ligaments “spring ligament”
Deltoid
ligament
Posterior talofibular Anterior talofibular
- lateral side = the green
- medial side = the blue
- deltoid ligament —> looks like a triangle
- calcaneonavicular ligament —> spring ligament; exists on
the medial aspect just inferior to the deltoid ligament
Calcaneofibular
Ankle Inversion Sprain Grade 1 = Stretching or slight tearing with
mild tenderness, swelling & stiffness
Grade 2 = Incomplete tear with moderate
Anterior pain, swelling & bruising
talofibular Grade 3 = Complete tear of ligaments with
ligament severe swelling, bruising + instability
- common
- ankle is being brought into inversion and that stressing
out some ligaments on the lateral aspect of the ankle;
causes separation of the crural joint
- ATL = anterior
- ACL = posterior side
medial
- sprains are damage to ligaments
- avulsion of the bone can also occur: if ligaments are
talus
strong but the bone is weak, it can tear off part of the
bone
Anterior
calcaneofibular lateral
ligament
Lateral view Posterior view
Subtalar Joint- below the talus
• Articulation between the

Talus + Calcaneus +
Navicular
• Anterior =
talocalcanealnavicular
complex
• Posterior = talocalcaneal jt
• Permits: inversion/eversion
- inside of the joint, dividing the anterior and posterior compartments is the
interosseous talocalcaneal ligament
Subtalar Joint Medial
Talocalcaneal lig
Ligaments
Cervical lig
(Ant. Talocalcaneal)
Lateral Talocalcaneal lig

Muscle Summary
• Anterior • Deep Posterior
• Tibialis Anterior • Tibialis Posterior
• Extensor Digitorum • Flexor Digitorum
Longus Longus
• Extensor Hallucis • Flexor Hallucis
Longus Longus
• Lateral • Superficial Posterior

• Peroneus (fibularis) • Gastrocs
Longus • Soleus
• Peroneus (fibularis) • Plantaris
Brevis
• Popliteus
Shank Muscles Acting on the Foot
Flexors Extensors
Tibialis Tibialis Posterior Tibialis Anterior
Flexor Digitorum Extensor Digitorum
Digitorum
Longus Longus
Flexor Hallucis Extensor Hallucis
Hallucis
Longus Longus
Lat + Med superficial posterior compartment
Gastrocnemii
Achilles ---
Plantaris
Soleus
lateral compartment that
provides eversion
Peroneus Brevis
Peroneal ---
Peroneus Longus
Attachment Summary
Extensor Hallucis Extensor Digitorum
Flexor Digitorum
Longus Longus
Longus
Flexor Hallucis
Longus
Peroneus
Peroneus Brevis Longus
Tibialis Anterior
Tibialis Posterior
Tibialis
Digitorum
Hallucis
Peroneal
Achilles Achilles
Base of the 5 th Avulsion
• Can occur alongside an inversion
sprain
• Peroneus (fibularis) brevis resists the
movement, and can pull the base of
the 5th metatarsal bone off
• Common in tennis
• Signs/Symptoms:
• Pain on lateral aspect, significant swelling
- peroneus brevis muscle attaches at the base of the 5th metatarsal
- foot goes into inversion and peroneal muscles try and combat that
- peroneus brevis pulls strongly on the edge of the bone where it’s attached and can
pull it off entirely
- clinical assessment —> push on the bump on the lateral aspect of the foot and it
would cause pain if fractured
To Summarize…
• 3 primary joints exist at the ankle, each allowing for a different motion
• Distal tibiofibular: limited movement (syndesmosis)
• Crural: dorsi/plantar flexion
• Sub-Talar: ankle inversion/eversion
• 11 ligaments hold these 3 joints together – they are named based on the
bones they connect!:
• Anterior/posterior tibiofibular
• Anterior/posterior talofibular, calcaneofibular, calcaneonavicular & deltoid
• Interosseous talocalcaneal, medial/lateral talocalcaneal, cervical
• Nearly all muscles of the shank cross the ankle, and thus act upon it!
• There are intrinsic foot muscles, but we aren’t going to talk about them
©
katelyn.wood@uwo.ca
Autonomic Nervous System
katelyn.wood@uwo.ca
Consider the Following
• When you sit down, your blood pressure drops
• Your heart pumps, even while you’re sleeping
• When you’re too hot, you start sweating
Do you have control over these processes?

Do you consciously know this is happening?
What system does?
Learning Outcomes
• Define the term “Homeostasis” and explain its importance to bodily function
• Describe the role the ANS plays in regulating homeostasis
• Compare/contrast the somatic and autonomic NS in terms of physical anatomy
• Compare/contrast the SNS and PSNS divisions in terms of physical anatomy + function
• Hypothesize the influence of the SNS or PSNS (and their inhibition) on various vital
signs or bodily processes including HR, BP, RR, pupil constriction and digestion
Homeostasis
The ANS maintains Homeostasis
• Greek: Homeostasis = steady/stable
• = maintaining a relatively stable internal state despite external changes
• Allows for ideal bodily conditions

• Dynamic process requiring:
• Monitoring (to detect changes)
• Integration (to understand the larger picture)
• Response (to restore stability)
ex. if you are starting to sweat when it

gets too hot out, that's your body a constant balance of
attempting to adapt to a higher external
temperature than it would like. If it didn't, How? forces throughout your
body to try and maintain
this internal state
your internal temperature would rise and
that would be problematic
• Lives in the hypothalamus
• Interprets and integrates a variety of signals

• Dull aching visceral pain (stomachache, kidney stones, heart attack)
• Stretch receptors (stomach/intestines, blood vessels, heart muscle)
• Chemoreceptors (carotid sinus) check the concentration of
oxygen and carbon dioxide in
the blood
• Sends autonomic motor signals to adjust tone of
could be speeding up the pace of the heart, or increase the
• Cardiac muscle contractile force (inotropy)
• Smooth muscle vasoconstriction or dilation of blood vessels
• Glands distributing hormones
The ANS at work
when you stretch out these arteries, you get an
increased firing, and that's that green series of lines. But
Standing Up when you decrease pressure, you get a decreased firing
rate. Cardiovascular control in the brainstem then
integrates all of this information
Stand up
Visceral Receptors Afferent (sensory) Cardiovasc Control in

Lower Limbs Syst. Arteries
(carotid sinus + aortic arch) Pathways the brainstem
Gravity causes AP frequency Integrate info in

BP Detect BP
blood to pool (sensory response) brainstem
Efferent (motor) Pathway
Heart + Blood Vessels SNS PSNS

activity activity
Negative Feedback
if you want to increase blood pressure, you want things to kind of
get excited. This overall will cause an increase in blood BP
pressure. So this will impact the heart, causing it to beat faster
and stronger, and it will impact blood vessels, causing them to
vasoconstrict
Nervous System Divisions
Central Nervous System
Peripheral Nervous System

sensory motor
Somatic Autonomic Autonomic Somatic

(body) (viscera, interoceptors) (visceral motor) (skeletal muscle,
voluntary control)
Sympathetic Parasympathetic SLUDD:

(fight, flight, fright) (rest, relaxation, rumination salivation, lacrimation,
urination, defecation
or SLUDD) and digestion
somatic means it's the voluntary system that you have control
over. So this is a single motor neuron leaving through the ventral motor
horn through the ventral root and out to the spinal nerve, and
then either the anterior or posterior rami.
Somatic vs Autonomic
- It's a myelinated nerve fiber and this is going to go and interact
with skeletal muscle. The neurotransmitter once you reach
skeletal muscle is acetylcholine
autonomic systems --> e two neurons that travel from the spinal
cord to the effector organ. We term these preganglionic and
postganglionic because they exist on either side of an autonomic
Motor Systems ganglion. At the ganglion, the neurotransmitters acetylcholine,
but at the effector organ, which could include a gland, cardiac
muscle or smooth muscle. The neurotransmitter could be any
one of acetylcholine, epinephrine, or norepinephrine
Somatic
Autonomic
motor
Motor Systems
Somatic Autonomic
# of neurons 11 2 (pre
2 (pre&&postganglionic)
postganglionic)
Neurotransmitter ACh
ACh ACh, E,Eoror
ACh, NENE
Yes Pre – yes

Pre --> Yes
Myelination? Yes Post --> No
Post - no
Skeletal Muscle Smooth
Smooth+ +Cardiac Muscle
Cardiac Muscle
Effectors Skeletal Muscle Glands Glands
Most organs have SNS & PSNS input
but one is usually more dominant*
Heart:
• SNS = speed up HR (tachycardia), + contraction force (positive inotropy)
• PNS* = slow HR (bradycardia), - contraction force (negative inotropy)
GI:
• SNS = relaxation of system, re-routing of blood to MSK
• PNS* = increase digestion
Some organs have only 1 type of
ANS input
SNS only:
• Sweat glands
• Visceral arterioles (contraction only)
• Radial muscle of the iris (pupil dilation)
PNS only:
• Iris sphincter (pupil constriction)
miosis mydriasis
This varied innervation impacts what drugs do
For example:
Sympatholytic (stops sympathetic innervation) drugs will:
• Decrease HR, decrease inotropy
• Increase digestion
• Cause bronchoconstriction
Sympathomimetic (mimics sympathetic innervation) drugs will:

• Increase HR, increase inotropy
• Decrease digestion
• Cause bronchodilation
*sexual simulation is a special circumstance requiring both PSNS

(excitation/erection) and SNS (orgasm/ejaculation) activity
drugs which impair the function of the PSNS or SNS can impair fertility
Parasympathetic NS
• Rest, Relax, Ruminate + SLUDD

• Cranio-Sacral origins
• Signals to:
• Ganglia next to or within target
organs
• Vagus N (CN X) is the most important
• 75% of PNS control
- pre-ganglionic neuron is very long and post ganglionic neuron is
very short
Posterior horn Posterior root
Parasympathetic NS Posterior root

ganglion
Posterior ramus
of spinal nerve
1. Pre-ganglionic PSNS signals travel Sacral spinal

nerve
through anterior root, into spinal Anterior horn
Spinal cord Anterior root Anterior ramus
of spinal nerve
nerve and out through peripheral (sacral segment)
nerves to reach effector organ

2. Synapse with post-ganglionic
neuron is at ganglion within, or
very near-by effector 2
Urinary bladder
1 preganglionic N
with 1 target
Key: Visceral effector
Parasympathetic preganglionic neuron
Parasympathetic postganglionic neuron
Sympathetic NS
• Fight, Flight and Fright
• Thoracolumbar origins T1 to L4
• Signals to:
• Sympathetic chain
• Next to spinal cord
• information travels up and down
• Collateral Ganglia (T + L regions)
• Adrenal gland (secrete NT into blood)
• Beyond NT release of NE and E, it
travels in your blood stream too
(like a hormone)
- all the ganglia are close to the spinal cord
- short pre-ganglionic neuron, long post ganglionic neuron
Beyond neurotransmitter release, you can also get release of norepinephrine and epinephrine into
the bloodstream. And that's actually what's going to affect your lungs. So that's what's going to
cause the bronchodilation at your lungs. So that's an error in the diagram here. So you don't
actually cause direct bronchodilation via sympathetic nerves synapsing in the bronchioles.
Posterior root Posterior ramus of
Posterior
Sympathetic NS root
ganglion
spinal nerve
Anterior ramus of spinal
nerve
3
1. Pre-ganglionic SNS signals travel
through anterior root, into spinal
nerve and through the white
ramus communicans into
sympathetic chain Spinal
nerve
1 Sympathetic
2. Signals travel up and down chain trunk ganglion
as required (especially in cervical Anterior root
Gray ramus To somatic vessels and
and sacral regions) + branch communicans glands
4
3. Synapses occur at the level where 2
the post-ganglionic nerve exits
via the gray ramus communicans White ramus
Prevertebral communicans
(unmyelinated)
ganglion
(celiac ganglion)
4. SNS to viscera synapses @
collateral ganglia
1 preganglionic N Preganglionic neuron

with multiple targets Postganglionic to somatic vessels and glands
Anterior view
Postganglionic to gut tube vessels
PSNS vs SNS neuron anatomy Did you know…
Epinepherine = Adrenaline
Think Adrenaline rush for SNS!
Short Preganglionic Adrenergic Receptors:

NT = NE
ACh
Spinal cord
SNS
PSNS Nicotinic Receptors:

NT = ACh
Muscarinic Receptors:
NT = ACh
ACh
Spinal cord Unmyelinated post ganglionic
Long Preganglionic
PSNS vs SNS neuron anatomy
Consequences of Structure
• In SNS, short pre-ganglionic neuron allows you to turn everything on

at once
• 1 pre-ganglionic neuron synapses with many post-ganglionic neurons that
innervate everything
BUT…
• Just because 1 part of the parasympathetic system is active doesn’t

mean another one is… why?
• The ganglion is right inside the organ, so you can have really specific control
Receptor Summary
• Cholinergic
• Stimulated by Acetylcholine
• Subtypes:
• Nicotinic (autonomic ganglia + muscles)
• Muscarinic (PSNS effector synapse)
• Adrenergic
• Stimulated by Epinephrine or Norepinephrine
• SNS effector synapse
• Subtypes:
• Alpha ( ) – primarily cause constriction
• Beta ( ) – primarily inhibits constriction (except in the heart)
Ex. beta-blockers. These are drugs that are going to block the beta subtype of
adrenergic receptors. So, by contrast, beta-agonists will encourage the activity at
those sites, those sympathetic effector synapse
SNS vs PSNS Neurons
SNS PSNS
ganglionic
Myelination? Thin
Thin Thin
Thin
Pre-
Axon Length Short

Short Long
Long
Receptor + NT Nicotinic, ACh

Nicotinic, ACh Nicotinic,
Nicotinic, ACh
ACh
Ganglion/Synapse Sympathetic chain,

sympathetic chain,collateral
collateral
ganglia or or
adrenal gland @ target
@ targetorgan
organ
Location ganglia adrenal gland
ganglionic
Myelination? None
None None
None
Post-
Axon Length Long

Long Short
Short
Receptor + NT Adrenergic,
Adrenergic, NE,NE
or or
E E Muscarinic,
Muscarinic, ACh
ACh
# of effector targets Many
Many One
One
Referred Pain
• Sensory branch of Autonomic NS
• Visceral pain is never experienced at the site of the damage

• Dull aching pain
• Sympathetic pain fibers enter the spinal cord alongside somatic pain
fibers… and your body can’t tell the difference
• For example, heart sympathetic pain fibers come into the spinal
cord at the same level as somatic nerves of the arm
• That’s why a classic heart attack symptom is pain radiating down
the arm
To Summarize…
• 3 neural pathways to know and distinguish between:
• Somatic motor vs Autonomic (sympathetic & parasympathetic)
• The ANS maintains homeostasis by differentially activating SNS + PSNS

• SNS = everything at once
• Flight, Fight or Fright
• PSNS = specific effector control
• Rest, Relaxation, Ruminate + SLUDD
• Receptor types and NT differ at each synapse location

• Implications for administering drugs + interpreting vital signs
©
katelyn.wood@uwo.ca
Arm
katelyn.wood@uwo.ca
Learning Outcomes
• Identify key bony landmarks, and their associated structures on the humerus
• Predict functional implications of humeral injury
• Identify and recall the innervation of muscles in the arm
• Predict muscle function based upon joints crossed

Upper Limb Overview
The Upper Limb
Shoulder
UPPER LIMB
Arm
scapula
clavicle
Elbow
humerus
radius
ulna Forearm
carpal bones
Wrist
metacarpals
phalanges Hand
Head Greater tubercle
The Humerus
- head is going to articulate in the
Anatomical
neck
glenohumeral joint Surgical neck
- has 2 necks:
1. anatomical neck —> epiphysial Intertubercular
plate of the long bone
2. surgical neck (common to see
sulcus (groove)
broken) Lesser tubercle Radial groove
where deltoid muscles attaches Posterior:
- body (shaft) —> Deltoid tuberosity where the radial
Anatomic Neck identify the greater nerve is going
tubercle, lesser to run
(epiphysial Plate) tubercle, and in
between them the Body (shaft)
intertubercular sulcus
and this is where the
long head of the biceps
is going to run
- long head of biceps:
contained within a posterior
sheath, a tendon sheath - also part of
and is going to run elbow joint
between the 2 tubercles Olecranon fossa
Medial epicondyle
Surgical Neck Capitulum Trochlea Lateral epicondyle

- Capitulum and trochlea articulate at the
elbow
Muscles of the Arm
- arm split into 2 compartments:
1. flexor compartment —> innervated by the
musculocutaneous nerve
Arm Compartments 2. posterior compartment —> innervated by the

radial nerve
- muscles within these compartments share a
common function
- anterior side = flexors
- posterior = extensors
posterior
Posterior (extensors)
Radial N
Anterior (flexors)
Musculocutaneous N
anterior
Flexors (anterior)
Extensors (posterior) Arm L
Arm Flexors
Biceps Brachii
• Supination: Long Head
• Biceps Short Head Coracobrachialis
• Shoulder Flexion:
• Coracobrachialis
• Elbow Flexion: aponeurosis
• Brachialis* tendon
• Minor = bicipital aponeurosis Brachialis*
- arm flexors are going to flex either the shoulder or the elbow
- Biceps (two heads) Brachii (arm)
- has 2 heads:
• Nerves: Musculocutaneous (& Radial*) 1. long head —> crosses the glenohumeral joint (long tendon)
2. short head —> attaches to the coracoid process (short tendon)
- bicep itself attaches distal to the elbow
• Pierces coracobrachialis - tendon attaches on the radius and an aponeurosis that crosses over to protect
the cubital fossa and attach on the ulnar side
- tendinous attachment going to do supination
- aponeurosis going to do weak forearm flexion or elbow flexion
- coracobrachialis = primary shoulder flexor
- brachialis = primary elbow flexor
- all these muscles are innervated by musculocutaneous except for brachialis
(innervated by radial nerve)
- musculocutaneous actually pierces corabrachialis
Rupture of Long Head of Biceps
• Long-head of biceps
• “Popeye Sign”
• Generally not surgically

repaired
• minimal weakness in upper
limb due to action of
brachialis
- either tendon has been torn or avulsed, or a pull off of the superglenoid tubercle in the glenohumeral joint
- will be repaired cosmetically (if you are worried about your appearance), otherwise it will be left alone and overtime
the muscle itself will atrophy because it’s not being loaded
Musculocutaneous N
• Course:
• In front of humerus,
• Pierces coracobrachialis
• Can be injured in shoulder

dislocation
• Loss of shoulder flexion,
forearm supination + elbow
flexion coracobrachialis,
because those are the primary functions of
biceps brachii, and brachialis
inferior to the humeral head

Arm Extensors Lateral Head
• Arm Extension
• Long Head
the only one that crosses the shoulder joint
• Forearm Extension
• Triceps (Long, Lateral Long
+ Medial heads) Head
• Nerve: Radial Medial

Head
Humeral Shaft Fracture
• Population:
• Young people, high-
energy trauma
• Older people,
osteopenia
• Risks: - radial nerve courses behind the humerus in

• Radial N Palsy the radial groove
- can be impaired or injured in a humerus
shaft break = radial nerve palsy
• What symptoms would - symptoms seen:
- reduced wrist extension and radial deviation
you expect? —> depends where the fracture occurs and
• Reduced wrist extension where along it’s course the nerve is impaired
+ radial deviation - innervation to the arm extensors have
probably come off —> they won’t be impaired
• Reduced elbow flexion but everything distal might
(brachialis) - radial nerve innervates the whole of the
posterior upper limb = wrist extension would
be impaired
- reduced elbow flexion since brachialis is
innervated by the radial nerve
Anterior
Coracoid
process of
Head of humerus scapula
Humerus
Radial nerve
Media
Later
l
al
Radial groove of humerus

Glenoid of
scapula
Acromion of scapula
Upper Limb Radiology Tutorial –

Posterior
Radial N
in the arm
• Course:
• behind humerus,
• under lateral head of
triceps
• along radial groove
continues down into the forearm
Cadaveric Specimens
Arm
To Summarize…
• Flexors = Biceps, Brachialis + Coracobrachialis
• Extensors = Triceps
• When considering function, think about joints crossed!
• Muscles of the arm are innervated by:

• Musculocutaneous N: flexors (anterior)
• Radial N (posterior + brachialis)
• Radial N. Palsy is possible with humeral shaft break

©
katelyn.wood@uwo.ca
The Axial Skeleton
katelyn.wood@uwo.ca
Learning Outcomes
By the end of this lesson
Identify bones and key landmarks of the skull
Compare/Contrast vertebrae from different spinal levels in terms of features
Identify key ligaments of the spine
Understand a variety of clinical considerations throughout the spine

AXIAL
The Skeleton skull

mandible
sternum
ribs (costa)
Functions vertebrae
cervical (7)
thoracic (12)
Support and framework lumbar (5)
sacrum + coccyx
Leverage for movement
Protection of vital organs
Storage of minerals
Production of blood cells
APPENDICULAR
The Skull
The Skull
Neurocranium Viscerocranium (Facial)
Bones Bones
Frontal Ethmoid
Occipital Inferior Nasal Concha
Parietal Lacrimal
Sphenoid Zygomatic
Temporal Vomer
Mandible
Maxilla
Nasal
Palatine
The Skull Frontal bone
Neurocranium
Parietal bone
Sphenoid bone
Temporal
bone
Occipital
bone
Neurocranium Bones
Frontal
Occipital
Parietal
Sphenoid
Temporal
Neurocranium
Parietal bone
internal auditory meatus

--> part of the ear canal
occipital condyles --> Sphenoid bone

articulate with the
vertebra to allow you to Temporal
nod up and down bone Sella Turcica
sella turcica is part of the
Internal Auditory
sphenoid bone; means Meatus
saddle
sphenoid bone is where

the pituitary gland sits
Occipital
bone
Neurocranium Bones
Occipital Condyles
Frontal
Occipital
Parietal
Sphenoid
Temporal
The Skull
Neurocranium
Parietal bone
Temporal
bone
Occipital
bone
Neurocranium Bones
Occipital Condyles Foramen
Frontal Magnum
Occipital
Parietal
Sphenoid
Temporal
Neurocranium
Parietal bone
Sphenoid bone
- skull cap (calvaria)
sphenoid bone Sella Turcica

- lesser wing --> more superior
portion of the bone
- greater wing
Temporal
bone
Internal Auditory
Meatus
Lesser Wing
Occipital Greater Wing

bone
Neurocranium Bones
Foramen Magnum
Frontal
Occipital
Parietal
Sphenoid
Temporal
Sutures
(a) superior view (b) lateral view
Frontal bone
Coronal suture
Sagittal suture
Parietal
bones
Labdoid suture
Squamoid suture
Occipital bone
Temporal bone
Fontanelles
The Skull Ethmoid bone
Viscerocranium
Lacrimal bone
Nasal
bone
Viscerocranium
(Facial) Bones
Ethmoid Zygomatic
Inferior Nasal Concha
bone
Lacrimal
Zygomatic
Vomer
Mandible
Maxilla Maxilla bone
Nasal
Palatine Mandible
Viscerocranium
Nasal
bone
Viscerocranium
(Facial) Bones Inferior
Ethmoid
Nasal
Concha
Lacrimal
Vomer
Zygomatic
bone
Vomer Palatine bone
Mandible
Maxilla bone
Maxilla
Nasal
Mandible
Palatine
The Skull
Viscerocranium
Viscerocranium
(Facial) Bones
Ethmoid
Vomer
Lacrimal bone
Zygomatic
Palatine bone
Vomer Inferior Nasal
Mandible Concha
Maxilla
Nasal Maxilla bone
Mandible
Palatine
The Skull Nasal bone
Viscerocranium
Zygomatic
Lacrimal bone bone
Vomer
Ethmoid bone bone
Viscerocranium
(Facial) Bones
Ethmoid
Inferior Nasal
Lacrimal
Concha
Zygomatic
Vomer
Mandible
Maxilla
Nasal Maxilla bone
Mandible
Palatine
The Spine
+ Vertebrae
SUPERIOR
The Spine
1
2
3
4 Cervical
5
6
7
vertebrae (7)
1
2
3
24 Vertebrae 4
5
7 Cervical 6
7
8
Thoracic
12 Thoracic 9 vertebrae (12)
5 Lumbar 10
11
1 Sacrum 12
1
5 fused vertebrae 2
1 Coccyx 3 Lumbar
4 vertebrae (5)
5
Sacrum (1)
Intervertebral
disc Coccyx (1)
Curvatures of the Spine
Abnormal Curves of the Spine
(A) Scoliosis (B) Kyphosis (C) Lordosis

Surface Anatomy
General Vertebral
Anatomy
Body
(body)
Pedicle
(arm)
Transverse Pr.
Lamina (elbow)
(forearm)
Spine
(hands)
General Vertebral
Anatomy Superior Superior
Vertebral Articular
Notch Facet
Intervertebral foramen
Spinal nerve
Cervical Spine
7 vertebra
Lordosis
Key Features:
Bifid spinous pr.
Transverse Foramen
C1 (Atlas)
No body or spine
C2 (Axis)
Dens
anterior
Cervical Spine
Typical Vertebrae (7)
lateral
superior
anterior
Cervical Spine
Atlas (C1)
lateral
superior
anterior
Cervical Spine
Axis (C2)
lateral
superior
Vertebral Artery
Cervical Spine Manipulation
Risk of Vertebral Artery Dissection, or Stroke (dislodged thrombus)
superior view
vertebral
artery
Thoracic Spine
Kyphosis
12 vertebra
Key Features:
Heart-shaped bodies
Costal facets
Thoracic Spine anterior
lateral
superior
Lumbar Spine
Lordosis
5 vertebra
Key Features:
Squat, thick bodies
Lumbar Spine anterior
lateral
superior
Normal Osteoporotic
Osteoporosis
Imbalance between bone
formation (osteoblast) +
breakdown (osteoclast)
activity
Symptoms:
Back pain
Compression Fractures
Cervical Thoracic Lumbar
Sacrum + Coccyx
Kyphosis
5 Fused vertebra
Key Features:
Promontory
Auricular surface
Sacral canal + hiatus
Coccyx (3-5 fused vertebrae)
lateral
Sacrum + Coccyx
posterior anterior
Vertebral Comparison
Size Body Shape Spinous Pr. Special Features
Cervical Small -- bifid Transverse foramen
Costal facets and

Thoracic Medium Heart-shaped Giraffe
articular facets
Lumbar Large Concave edges Moose --
None Posterior No IVD with C2,

Atlas Small
(anterior arch) tubercle atlanto-occipital jt
Medial Atlanto-Axial jt,

Axis Small Dens bifid
2 lateral atlant-axial jts
promontory, auricular
Sacrum Large 5 fused
surface
Coccyx Small 2-3 fused minimal

Ligaments of
the Spine
Longitudinal Ligaments
Anterior
Anterior of vertebral bodies
Broad fibrous band
Occipital bone to sacrum
Posterior
Posterior of vertebral bodies
Narrow fibrous band
Within vertebral canal
Supraspinous Ligament
On top of spinous processes
Interspinous Ligament
Between Spinous Processes
Ligamentum Flavum
Between Lamina Processes
Joints of the Spine
Joints of the Spine
Atlanto-Occipital Jt
Lateral Atlantoaxial Jt
*medial jt not seen here
Zygapophyseal Jt
Intervertebral Jt
*Costovertebral Jts
Atlanto-Occipital Joints
Synovial joints between superior
articular facets of atlas + occipital
condyles of skull
Allow for nodding (flexion/extension)
Atlanto-Axial Joints
2 lateral (LAJ)
1 medial (MAJ) joint between atlas and axis
Similar to zygapophyseal joints
Facilitates pivoting of the head
Transverse
Ligament of
Atlas
superior
Torn transverse ligament Fracture of Dens
Zygapophyseal (Facet)
Joints
Plane, synovial joints between
articular processes of adjacent
vertebrae
Stabilize column
Innervation: dorsal rami

Joints
vertebrae
Stabilize column
Innervation: dorsal rami Inferior Articular Pr.
Superior Articular Pr.

Intervertebral Joints
Fibrocartilaginous Joints
Between Vertebral Bodies +

Intervertebral Discs
Not between C1 & C2

C1 has no body
Intervertebral Disc
Outer part = Annulus Fibrosis

Thick Fibrous Ring
Inner part = Nucleus Pulposus

Gelatinous centre
Avascular
Shock absorption, maintain spinal alignment L2
Named for vertebrae above + below L2-3 Disc
L3
Disc Herniation
Costovertebral/Costotransverse
Joints
Thoracic Cage
Thoracic Cage
Composed of
12 Ribs (X2)
Costal Cartilage
Sternum
Manubrium
Body
Xyphoid Process
Thoracic Vertebrae (T1-T12)
Designed to protect vital organs

Suprasternal notch
The Sternum Clavicular notch
Manubrium
Sternal angle
Facet for
Costal Cartilage Body
Xyphoid
Anterior view
process
Rib Anatomy
Neck Head Superior facet

Articular Facet for
Transverse Process Inferior facet
Tubercle
Costal angle
Costal groove Body
(c) Posterior view

The axial skeleton consists of the skull, vertebral column and ribs
The spinal cord is protected by running through the vertebral foramen
Vertebral shape and features change throughout the vertebral column to

support a variety of functions
Joints of the vertebral column are supported by a variety of ligaments that

traverse the length of the column
You have 12 pairs of ribs: 7 true, 3 false, 2 floating

©
katelyn.wood@uwo.ca
Spine + Back
katelyn.wood@uwo.ca
Learning Outcomes
• Review bones of the spine, thoracic cage + pelvis
• Identify muscles of the deep back, separating them into key groupings and recall
their innervation and actions
Bone Review
true rib, ribs 1-7, that's
going to have a direct
Thoracic Cage connection to the

sternum via its own piece
of costal cartilage
False ribs, ribs 8- 10

have an articulation with
a common piece of
Composed of costal cartilage
• 12 Ribs (X2) floating ribs, 11 and 12,
• Sternum don't articulate with

costal cartilage
• Manubrium
• Body
• Xyphoid Process
• Costal Cartilage unites ribs with the sternum, and based on that union,
we label the ribs as being true, false or floating
• Thoracic Vertebrae (T1-T12) posterior aspect

contains all the things that are important for you to maintain life. heart,
your lungs, and a few other organs
Joints two main joints:
1. costovertebral —> an articulation between the vertebral body and
the head of the rib
2. costotransverse —> an articulation between the costal tubercle and
the transverse process
- ribs articulate with the vertebra at the

posterior aspect of the thoracic cage
- articulations are important
- everytime you breath the rib cage moves —>
on of the points where articulation occurs
SUPERIOR
The Spine
1
2
3
4 Cervical
5
6
7
vertebrae (7)
1
2
3
• 24 Vertebrae 4
5
• 7 Cervical 6
7
Thoracic
• 12 Thoracic 8
9 vertebrae (12)
• 5 Lumbar 10
11
• 1 Sacrum 12
1
• 5 fused vertebrae 2
• 1 Coccyx 3 Lumbar
4 vertebrae (5)
5
Sacrum (1)
Intervertebral
disc Coccyx (1)
vertebra out of our body
General Vertebral - bring hands together in front

- hands become the spine
- forearms equivalent to lamina
- pedicles formed from the arms
Anatomy
- elbow in between represents the transverse process
- body = vertebral body
Body
(body)
Pedicle
(arm)
Lamina Transverse Pr.

(elbow)
(forearm)
Spine
(hands)
Sacrum + Coccyx
• 5 Fused vertebra
• Key Features:
• Promontory
• Auricular surface
• Sacral canal + hiatus
• Coccyx (3-5 fused vertebrae)
- continuation of the spinal column
- promontory on the anterior aspect
- auricular surface on the lateral aspect which is going to articulate with the ilium
of the pelvis
- the sacral canal and hiatus through which spinal nerves are going to travel
- coccyx is the most inferior portion
- auricular surface going to match up with the sacrum
- acetabulum —> a primary articulation site for the hip anterior view
- pubic tubercle which exists anteriorly, left and right sides come together to
form the pubic symphysis
The Os Coxae
- anterior superior iliac spine —> pointy bit at the front of the hips; anterior
inferior iliac spine just below
- Posteriorly, we have our posterior
superior iliac spine and our posterior inferior iliac spine
- ischial spine = important obstetrical landmark
- ischial tuberosity —> bony part of the pelvis that you sit on
lateral view
Iliac Crest Auricular
Surface
PSIS
ASIS
Pubic
PIIS Tubercle
AIIS Acetabulum
Ischial
Spine
Obturator
Foramen Fossae:
- Gluteal
- Iliac
Ischial Tuberosity medial view
Bones of the Pelvic Girdle
- vertical column ends in the sacrum which forms
the sacroiliac joint with the os coxae on either side
- Anteriorly the os coxae come together to form
the pubic symphysis or symphysis pubis
Sacrum
Os Coxae
Sacroiliac
Joint
Pubic
anterior view Symphysis posterior view
Spinal Nerves
Spinal Cord
- spinal nerves need to exit the

spinal cord to get to where they're
going in the body
- spinal cord going down the
vertebral foramen of a cervical
vertebra
- this is cervical because it has a
bifid spinous process, and it has a
transverse foramen for the vertebral
artery
- the spinal nerves are going to exit
Dorsal rami through the intervertebral foramen,
and it's formed from adjacent
vertebra
Rami communicantes Ventral Rami
(to sympathetic chain)
Spinal Cord
Sensory
- first they come off the spinal cord —> roots
Dorsal Root Ganglion
- on the dorsal root, there is a dorsal root
ganglion which houses the cell body for sensory
neurons
- they come together to form the spinal nerve
Dorsal Root
- going to exit through the intervertebral foramen Dorsal Horn
- splits again to form the dorsal rami and the
ventral rami
- ventral rami innervates nearly everything in the
Dorsal Rami
body
- then go on to form peripheral nerves via
plexuses
- dorsal rami innervates specific things
- sensory information comes from pseudounipolar
sensory neurons comes through the dorsal root
- motor information travels through multipolar
motor neurons and going to exit the spinal cord
through the ventral root
Ventral Horn
Ventral Rami
Spinal Nerve
Motor
Ventral Root
Spinal Nerve
Posterior Rami
• Sensory from and motor to:
• Zygapophyseal Joints
• Muscles of the Deep Back
in situ
- the roots coming off of the spinal cord form the spinal
nerve as it exits through the intervertebral canal
- splits to form both the anterior and posterior ramus
- posterior ramus (rami) —> going to carry sensory
information from and motor information to the
zygapophyseal joint
- zygapophyseal joint —> occurs between vertebra
throughout the spinal column as well as muscles of the
deep back
Spinal Nerve
anterior ramus carries
more information than
Spinal cord
the posterior ramus
which innervates two
things Anterior (ventral)
root
Posterior (dorsal) root
External jugular vein
Posterior (dorsal) ramus
Anterior (ventral) ramus
Cervical vertebra
Larynx
ANTERIOR
Deep Back Muscles
Deep Back Muscles
• Superficial
• Erector Spinae “I Like Standing
• Iliocostalis
• Longissimus
• Spinalis
• Splenius Cervicis + Capitus
Cervicus refers to the neck, and capitus refers to the head.
• Deep
• Transverso-Spinal Group
• Semispinalis
• Rotatores
• Multifidus
• Nerve: posterior rami of spinal n.

Erector Spinous Group
Iliocostalis, Longissimus, Spinalis
Action: extend vertebral column and

head; laterally flex column
Nerve: posterior
rami of spinal n.
- iliocostalis, it's most lateral followed by
longissiums, and spinalis
- spinalis next to the spine
- primary action —> extend the vertebral
column and head and laterally flex the
column when both sides of the body are
working independently
“I like standing”
Splenius Cervicis,
- Cervicus —> its job is to laterally flex the
neck, particularly when it’s working
separate from then other side
Splenius Capitis - if you contract the left splenius cervicus,

the head is going to flex to the left side
- Capitis —> focuses on rotating and

extending the head, so it's going to attach
right in at the base of the skull
Action: - an action of a muscle is fully dependent

upon the joints that it crosses
• Cervicis: Laterally flex neck
• Capitis: Rotate + extend head
Nerve: posterior
rami of spinal n.
Transverso-Spinalis Group Rotatores
Semispinalis
Capitis
Semispinalis Capitis, Multifidus, Rotatores
Actions:
• SC = Head + Neck Extension
• M = Vertebral Extension + Stabilization
• R = Vertebral Extension + Stabilization + Rotation
- semispinalis capitus in blue, and that's going to be responsible for head and neck
extension —> starts right up there on the base of the skull and is going to extend through
the thoracic spine
- Multifidus is responsible for vertebral extension and stabilization —> runs almost the full
length of the vertebral column; attaches between the spinous process and transverse
processes, a few vertebra down and allows it to do that stabilization and extension,
particularly when the left and right sides are working together
- Rotatores —> deepest muscle; also does vertebral extension and stabilization, but it also
Multifidus
does a little bit of rotation; attaching adjacent vertebra you can get better rotation.;
Sometimes this is referred to as the "Christmas
tree muscle". And this is because you get this zigzag pattern of the muscle extending down
the thoracic spine
Nerve: posterior
rami of spinal n.
Deep Back Muscle Summary
• Erector Spinae • Splenius Capitis
• Iliocostalis • Splenius Cervicis
• Longissimus
• Spinalis
• Transverso-Spinals
• Rotatores
• Multifidus
• Semispinalis Capitis
Cadaveric
Specimens Semispinalis capitis Splenius capitis
Splenius cervicis
Spinalis
Longissimus
Iliocostalis
Multifidus
To Summarize…
• Bony Anatomy
• Thoracic Cage = 24 Ribs, 12 Vertebrae, Sternum, Costal Cartilage
• Spine = 24 Vertebrae + Sacrum + Coccyx
• Pelvis = Os Coxae + Sacrum
• When considering function, think about how joints

are crossed!
• Deep muscles are innervated by the dorsal rami and include:

• Erector-Spinae Muscles
• Splenius Cervicis, Splenius Capitus
• Transverso-Spinalis Group
©
katelyn.wood@uwo.ca
Bones
katelyn.wood@uwo.ca
Learning Outcomes
• Provide a basic overview of the appendicular and axial skeleton
• Describe 5 classifications of bone shape, relating them to bone function
• Define the structure/function of common bony landmarks
• Understand the microscopic structure of bone (including cell types and features)
• Define and recognize the 6 common fracture types

Appendicular vs
Axial Skeleton
AXIAL
The Skeleton skull

mandible
sternum
ribs (costa)
Functions vertebrae
cervical (7)
thoracic (12)
Leverage for movement sacrum + coccyx

Storage of minerals
APPENDICULAR
The Skeleton Shoulder
APPENDICULAR
Elbow Upper Limb
Wrist
Hip
Lower Limb Knee
Ankle
The Skeleton
Arm
APPENDICULAR
Upper Limb
- arm doesn't equal upper limb Forearm
- it only equals the region between the shoulder and elbow
- leg just means the region between the knee and ankle
Hand
Thigh
Lower Limb
Shank/Leg
Foot
“radius’ are rad!”
The Skeleton
APPENDICULAR
- radical is lateral in anatomical position
UPPER LIMB
- carpals are small bones in the base of the hand and
scapula
make up part of the wrist joint (8 in total --> 2 rows of 4) clavicle
- "some lovers try positions that they cannot handle" -->
represents the 2 rows of 4 moving lateral to medial and
humerus
then proximal to distal radius
- scaphoid, lunate, triquetrum, pisiform, trapezium,
trapezoid, capitate, and hamate LOWER LIMB ulna
- tibia on medial side
pelvic bones carpal bones
- fibula on the lateral side
- calcaneus = heel femur metacarpals
- talus makes up part of the ankle joint phalanges
- navicular anterior to talus patella
- cuboid is on the lateral side
- 3 cuneiforms
tibia
fibula Carpals
Tarsals
tarsal bones
metatarsals
phalanges
“Some lovers try positions

that they cannot handle”
Sesamoid - Patella
Bone Classifications Short - Carpals Irregular - Scapula
Long - Humerus
CLASSIFICATION STRUCTURE -- FUNCTION EXAMPLE
tubular
tubular in-->shape
in shape provides–strength,
provide strength,
structure and mobility in limbs humerus, femur, tibia, ulna
Long humerus, femur, tibia, ulna
structure and mobility in limbs
cuboidal in shape
cuboidal in shape –support
--> provide provide support
and stability and
with limited
Short movement carpal
carpalbones, tarsal
bones, tarsal bones bones
stability with limited movement
Flat – Protection or broad surfaces of
flat --> protection or broad surfaces of muscle attachment
skullskull
(parietal, frontal), pelvis, Flat - Sternum
Flat (parietal, frontal), pelvis, sternum
muscle attachment sternum
oddly shaped
oddly shaped – various
--> various function --> function (nerve
nerve protection, skeletal Facialfacial
bones, scapula, hyoid,
Irregular muscle attachment
bones, scapula, hyoid, vetebra
protection, skeletal muscle attachment vetebra
Develop in tendons where they cross long
Sesamoid bones
develop--
in protect
tendons where tendons from
they cross long boneswear and
--> protect Patellapatella
tendons from wear and tear
tear
Shape Predicts Movement + Function!!!

Boney Landmarks
Attachments
PROJECTIONS THAT ARE THE SITE OF MUSCLE/LIGAMENT ATTACHMENT

TUBEROSITY Large rounded elevation
CREST ridge of bone
TROCHANTER large blunt elevation
LINE linear elevation, sometimes called a ridge
TUBERCLE small raised eminence
EPICONDYLE eminence superior or adjacent to a condyle
SPINE thorn-like process
PROCESS projection or outgrowth of tissue
Boney Landmarks
Joints
SURFACES THAT FORM JOINTS

HEAD large, round articular end
smooth flat area, usually covered with cartilage, where a bone
FACET
articulates with another
CONDYLE rounded, knuckle-like articular area
Boney Landmarks
Depressions/Openings
DEPRESSIONS AND OPENINGS

FORAMEN passage through bone, hole
GROOVE elongated depression
FISSURE groove, natural division
NOTCH indentation in the edge of a bone
FOSSA hollow or depressed area
MEATUS natural body opening or canal
SINUS sac or cavity
Surface Anatomy
Knowledge Check-in
Palpate the following structures on yourself
• Acromion & Coracoid Process • Costal Margin

• Spine of Scapula • Iliac Crest
• Olecranon Process • Greater Trochanter of Femur
• Epicondyles of Humerus • Ischial Tuberosity
• Styloid Process of Ulna • Epicondyles of Femur
• Styloid Process of Radius • Patella
• Pisiform and Scaphoid • Tibial Tuberosity
• Metacarpals • Head of Fibula
• Manubrium • Medial and Lateral Malleoli
- Von Hochstetter triangle --> a region in the gluteal region were you can provide an
Landmarking
injection and not be worried about hitting nerves
- need to identify the iliac crest and the anterior superior iliac spine and then the
region in between the fingers is a safe spot for an injection
Bone Structure
Bone Development - all bones start as a cartilaginous Closure of epiphyseal plates
mold
- cartilage becomes mineralized
- then blood vessels come in and
start to form bone at ossification
Did you know… centers
Damage to the epiphyseal plates - the center of the long bone is called
the diaphysis and the ends are
can affect further bone growth! called epiphysis
- the region in between them is
called the epiphyseal plate
- epiphyseal plate is important because here

new bone is generated from and it's a
cartilaginous plate
- if it's damaged before bones are fully done
developing = impairments in kids growth
6 weeks gestation Birth 20 years of age
Bone Development - the epiphyseal plate will fuse together and you stop growing together
- we call in a line at this point because it is no longer a cartilage that is helping you develop new bone
Epiphyseal
Plate
Epiphyseal
Line
femur of a 3-year-old adult femur

Bone Cells
- bone cells start off as periosteum
mesenchymal stem cells
- the osteoprogenitor cells will then devlop into
osteoblasts
- osteoblasts are going to secrete extracellular
which is what actually creates the bone
- once secreted the extracellular matrix, they'll
differentiate to become these osteocytes
- osteocytes maintain the bone structure
- osteocytes have projections coming off of them
called canaliculi
- canaliculi --> allows communication between
multiple osteocytes so that the bone tissue itself
knows what's going on throughout it
(maintains bone tissue)

Bone Types
trabecular bone is interior
to the cortical bone
• Cortical (compact) Bone

• Exterior of bone
• Covered in periosteum the outer layer of bone
• Trabecular (spongy, cancellous) Bone

• Interior of bone
• Occasionally replaced by medullary cavity
• Contains bone marrow
Trabecular Bone
(spongy/cancellous)
- trabecular bone is going to be primarily in the ends of

the bone or on the exterior in general
- osteoblasts --> pinkish cells lining the cavitives;
they're creating bone and laying it down and are going
to differentiate once the extracellular matrix has been
secreted into these osteocytes
- osteoclasts --> going to break down bone; derived
from the white blood cell lineage
degrade bone
derived from
WBC lineage
create bone
occurs when osteoclasts
Osteoporosis
have gone a little crazy
and taken out too much
bone
- problem in aging and in
genetic females
SEM 30x SEM 30x

(A) Normal bone (B) Osteoporotic bone
Compact Bone
(cortical)
- exists on the exterior of a bone

- covered in periosteum
- have a blood vessel called the haverisan canal
and you have a ring of osteoblasts around the
haversian canal
- start to lay down extracellular matrix in
concentric rings
- starts interiorly and moves exteriorly over time
as new bone is created
- get differentiation of osteoblasts into osteocytes
forming these connections throughout the rings
- rings called lamellae
- the whole circle is called an osteon
- osteon is restricted ti a certain diameter that can
be supplied by this one haversian canal
Compact Bone
(cortical)
- have a layer of osteoblasts in the cambium layer

so that can lay down new bone
- this layer is going to be highly vascularized and is
critical for repair after fracture
- because of that layer of osteoblasts, it can create
new cortical (compact) bone on the surface of
bones after fracture
- stratum fibrosum --> the periosteum and it's
anchored into the compact bone via fibers called
"sharpy fibers"
anchor to bone
highly vascularized
also contains osteogenic cells
Fractures
Fractures
Fracture Description Prevalence
Bone fragments in 3+ Common in aged individuals with more brittle
Comminuted
pieces bones
Common in porous bones (e.g. osteoporotic)
Compression Bone is crushed
subjected to extreme trauma
Epiphysis separates from “Salter-Harris” Fracture, occurs in
Epiphyseal diaphysis along epiphyseal preadolescence prior to closure of the
plate epiphyseal plates
Broken bone portion is
Depressed Typical skull fracture
pressed inward
Ragged break due to
Spiral Common sports fracture or in toddlers
excessive twisting forces
Incomplete break; one
Green stick Common in children
side broken, one side bent
comminuted
depressed
compressed
spiral
epiphyseal
green stick
Fractures
simple --> injure just the bone
compound --> bone pierces the skin
Aging + Exercise
Aging
• From birth to adolescence: bone production > absorption
• In middle age (after menopause), women experience
greater bone loss than men due to decreased estrogens
• In old age: bone production < absorption
• Aging typically results in:

1. Loss of Bone Mass
• Demineralization ( calcium)
2. Increased Brittleness
• Decrease protein synthesis ( collagen)
Charles Jr. et al (2004) Johns Hopkins APL Technical Digest 25 (3) 187-200 (2004)
Exercise
• Bone tissue can alter its strength in response to strain it experiences
• High impact intermittent strains > lower-impact constant strains for bone deposition
• Without mechanical stress, bone does not remodel normally because resorption occurs more
quickly than formation
• Especially important in adolescents and for healing
• Special Populations
• Weakened Bones:
• Bedridden individuals or those in a cast (fracture) Astronauts subjected to microgravity
• Strengthened Bones:
• Athletes have thicker and stronger bones
To Summarize…
• The skeleton is divided into axial and appendicular components
• There are 5 classifications of bone shape

• Remember: structure predicts function!
• Boney Landmarks can represent sites of attachment, joints or depressions/openings
• Bone is exists in two forms: cortical and traebecular

• Its microstructure is formed from osteoblasts and osteoclasts, the balance of
which is important for maintaining appropriate bone density
• Bone density can be manipulated by strain experienced + aging
• There are 6 x 2 ways to classify fractures

©
katelyn.wood@uwo.ca
The Brachial Plexus
katelyn.wood@uwo.ca
Learning Outcomes
• Understand the structure and role of the brachial plexus in upper limb innervation
• Be able to draw and label a brachial plexus diagram
• Hypothesize clinical implications of lesions at various sites throughout the plexus

The Brachial Plexus
come together and combine in a
variety of ways to form peripheral
The Brachial Plexus nerves
• Anterior Rami from C5-T1 join together

• Clinically important for diagnosing upper limb injury and
disease
• 5 portions:
Roots
• _______________
Trunks
• _______________
Divisions
• _______________
Cords
• _______________
Branches
• _______________
the artery coming through the axilla, or the armpit, Roots C4
you'll see that there are three nerves circling around
it, just medial to the glenohumeral joint or the C5-T1
shoulder -- those are the cords
Trunks C5
Brachial Plexus
- 5 peripheral nerves; axillary, radial,
musculocutaneous, median, and ulnar U, M, L
Divisions C6
Ant/Post
Spinal Nerves (anterior rami)
Cords C7
Roots --> C5 to T1. The root that
REALLY THIRSTY, Lat, Med, Post C8
comes out between C7 and T1 is
actually called C8 (very special nerve - DRINK COLD BEER
the only one in the whole spinal cord
T1
named differently from a vertebra)
- nerves of the cervical column come Branches
out above their named vertebra.
Whereas everywhere else in the PERIPHERAL NERVES
vertebal column, the named nerve, so
T1 and lower, come out below the
named vertebra.
Axillary
teres minor, deltoid (C5-C6)
Trunks: 3 trunks --> upper, middle and

lower and is followed by 2 divisions
Radial
posterior compartments (C5-T1)
Divisions --> anterior and posterior

division and they combine to form
Musculocutaneous
arm flexors (C5-7)
cords
“Really Thirsty, Median
Cords: lateral, medial, and posterior
forearm flexors (C5-T1)
Drink
and ColdforBeer”
are named their position
around the axillary artery
Ulnar
t two of these radial and axial are in the posterior side of the arm and upper limb,
whereas musculocutaneous, median and ulnar supply the anterior aspect of the
upper limb.
Median is always in the middle, musculocutaneous is always on top and ulnar is
always on the bottom C5
Brachial Plexus C6
Spinal Nerves (anterior rami) C7

U
C8
• Separation of flexor & extensor nerves @ M
divisions level T1
lateral medial
L
• Extensors to the back
• Flexors to the front posterior
posterior rami innervate far less in the body Axillary Artery Roots: C5 – T1
C5 and C6 come together to form the upper trunk
C7 continues on its own
C8 and T1 comes together to form the lower trunk
each trunk is going to divide into an anterior and a posterior
Trunks: Upper, Middle, Lower
division (allows to separate the flexor nerves from the extensor
axillary
nerves
If you want to flex your elbow that requires muscles on the Divisions: Anterior & Posterior
anterior aspect of your upper limb. By contrast, extending your
elbow requires muscles on the post your aspect of your upper musculocutaneous
limb (allows for division --> extensors go to the back and flexors
fo to the front) --> forms 3 cords: lateral, medial, and posterior radial Cords: Medial, Lateral, Posterior
the divisions from the upper and middle anterior divisions are
going to come together to form the lateral cord, the lower
anterior division stays on its own median Branches: Radial, Axial,
all three posterior divisions come together to form the posterior
Musculocutaneous, Median,
cord
ulnar
Roots Trunks Divisions Cords Branches
Anterior/posterior
C4 Musculocutaneous
Lateral
C5
Upper
C5
C6
C6
Middle Axillary
C7 Median
Posterior
C7 Radial
C8
Lower
T1
T1 Medial Ulnar
T2
Lat. Pectoral
Musculocutaneous
Suprascapular
C5
these 9
peripheral C6
nerves go
on to supply
muscles Axillary
either in the C7 Thoracodorsal Median
pectoral
region, Radial
superficial
back, or the C8
upper limb
Upper & Lower
Subscapular
T1
Med. Pectoral Ulnar
Long Thoracic Med Cutaneous Forearm

Med Cutaneous Arm
Lat. Pectoral
Musculocutaneous
Suprascapular
C5
axillary and the
upper and lower
red --> subscapular nerves
upper trunk C6 only have fibers
from C5 and C6.
blue -->
Axillary
middle trunk Median
C7 Thoracodorsal
green -->
lower trunk Radial
C8
Upper & Lower

Subscapular
T1
Med. Pectoral Ulnar

Med Cutaneous Arm
Brachial Plexus
Spinal Nerves (anterior rami) Superior trunk
Lateral pectoral C5
C6
C7
Suprascapular
C8
Medial pectoral T1
Upper subscapular
Lateral cord Middle trunk
Musculocutaneous Inferior trunk
Posterior cord
Axillary
Medial cord
Radial
Long thoracic
Median Lower
subscapular
Ulnar
Thoracodorsal
Brachial Plexus
Extensor
Compartment
Nerves
- on the posterior aspect of the upper limb
and that's axillary and radial
- Axillary only innervates, two muscles deltoid
and teres minor
- Deltoid, teres minor those are the only two
nerves, only two muscles, innervated by the
axillary nerve.
- radial does everything on the extensor side
of the upper limb
Flexor
Compartment
Nerves
- musculocutaneous only
innervates muscles in the arm -->
coracobrachialis, biceps brachii
and brachialis are the only three
muscles innervated by
musculocutaneous.
- in the forearm --> innervation

split between median and ulnar
Nerve Muscles Innervated
Musculocutaneous Anterior Muscles of arm
Nerves + Axillary
(sensory: lat. Cut N forearm)
Deltoid, Teres –, Triceps Long head
Muscles Radial
Median
Posterior Compartment of Arm
Most Anterior Muscles of Forearm
(not FCU, FDP -- ulnar)
Ulnar Some forearm, Anterior hand
Long Thoracic Serratus Anterior
Suprascapular Supraspinatus, Infraspinatus
Lateral Pectoral Pectoralis +
Medial Pectoral Pectoralis +, Pectorals -
Med. Cut Arm (sensory: med aspect of arm)
Med. Cut. Forearm (sensory: med aspect of forearm)
Thoracodorsal Latissimus Dorsi
Lower Subscapular Subscapularis, Teres +
Upper Subscapular Subscapularis
Plexus & Peripheral C3
Nerves C4
T2
- these nerves are multi segmental, meaning that C5 T3
information from multiple roots recombined throughout
the plexus to form a single nerve T4
- , the radial nerve is formed from everything from C5 all
C6 T2 T5 Radial
the way to T1
- only going to see radial innervation on the posterior
aspect of the upper limb Lateral
- Do sensory tests to figure out what's going on: C5 Medial
antebrachial brachial
if you can have or you can perceive sensation in all of T1
the dermatomes present on the left, but you seem to be cutaneous cutaneous
lacking innervation or sensation over the radial nerve
area, that's how you would know that the radial nerve
Medial
has been impaired and not the root Radial antebrachial
cutaneous
C6
C7
C8
dermatomes cutaneous
Brachial Plexus Injury
Erb-Duchenne Palsy (C5/6)
• Excess angle between neck + shoulder

• Result: stretching of the top roots
(usually C5/C6)
• Outcome: waiter’s tip
• Musculocutaneous + Axillary N
impaired
• Paralysis of: deltoid, biceps +
brachialis
• Limb medial rotation + adduction,
extended elbow, pronated
forearm
Klumpke Paralysis (C8-T1)
• Excess angle between arm and body, usually

overhead
• Result: stretching of the lower roots (C8/T1)
• Outcome:
• Poor Ulnar N Function
• Arm and hand movement
• Loss of sensation to lateral,
distal hand
baby or fetus' arm exiting through the
vagina and the pulling on that arm can
extend it to a great angle from the body.
This is a fairly rare birth complication, and
actually usually resolves within about six
months without surgery
Lat. Pectoral
Musculocutaneous
Suprascapular
C5
C6
Axillary
C7 Thoracodorsal Median
Radial
C8
Upper & Lower

Subscapular
T1
Med. Pectoral Ulnar
Long Thoracic
Med Cutaneous Arm
Med Cutaneous Forearm
To Summarize…
• The brachial plexus provides sensory +
motor innervation to the upper limb
• 5 spinal nerves intermingle to create
multisegmental peripheral nerves
• radial, axillary, musculocutaneous, ulnar
median
• Being able to pair nerves with muscles and eventually understanding

function allows you to predict functional implications of injury
©
katelyn.wood@uwo.ca
Cardiac Cycle
+ ECG
katelyn.wood@uwo.ca
Learning Outcomes
• Draw the pathways of blood flow and electrical conduction through the heart
• Understand how heart rate is regulated by pacemaker cells and the ANS
• Explain how an Electrocardiogram (ECG) works
• Draw a simple, labelled diagram of an ECG tracing, matching segments of the

ECG to heart function
• Label and identify phases of the cardiac cycle, and explain key events occurring in
each
• Recall principles of autonomic control of the heart

Heart Review
The Heart
• 2 halves based entirely on
• Right = thinner walls the distance that
they need to pump
• Left = thicker walls blood
top bottom
• 4 Chambers (2 atria, 2 ventricles)

• 4 Valves 2 atrioventicular and 2 semilunar
• Communicates with:
• The lungs (pulmonary)
• The body (systemic)
• Itself (coronary)
Vessels create a
closed loop!
- arteries that transition to arterioles, into capillaries then venules, veins and sinuses and
back to the heart
- allows nutrients, oxygen, waste products, all kinds of things to move throughout the
body and be delivered to the sites that need Arterioles
Arteries delivering and taken away from those that
no longer need it
Veins/
Capillaries
Sinuses
Venules
9. Capillaries of head
and upper limbs
Blood Flow
through the Heart 8.
4. Pulmonary 10. 4. Pulmonary
capillaries of right capillaries of
lung left lung
3. 6. 5.
5.
Right side = deoxygenated 1.
Left side = oxygenated
starting off witht eh blood entering the
right atrium, and then making its way
back to the right atrium via the superior
and inferior vena cava 2. 7.
Key: 10.
Oxygen-rich blood
Oxygen-poor blood
9. Capillaries of trunk
and lower limbs
Great Vessels
connection points between the heart and the body, as
well as the heart and the lungs
Cardiac Muscle +
Contraction
Anatomy of Cardiac Muscle transverse
http://www.histologyguide.com/slideview/MH-070-heart/09-slide-2.html?x=0&y=0&z=-1&page=1
• Striated, involuntary muscle found in the heart
wall
• Cardiomyocytes contain the same contractile

filaments as skeletal muscle (sarcomere) arranged
differently
slightly
longitudinal
• Cells are joined end-to-end and are connected
via “intercalated discs” allows for easy electrical signal propagation
across the cardiac muscle
• Nuclei are centrally located, sometimes there

are 2 their shape also is sometimes branched, as opposed to
just a long single kind of rectangular-ovoid shape
the picture
- cell on the left is depolarized and that
signal is going to transfer to the other cells
via intercalated discs, to tell them that they
Anatomy of Cardiac Muscle need to depolarize and contract as well
• 2 types of cardiomyocytes:
1. Pacemaker
could contract on
• Auto-rhythmic cells (“automaticity”) their own
• Spontaneously contract
• SA node, some fibers in AV node, bundle of His, Purkinje fibers
2. Non-pacemaker cells
• Bulk of the heart
• Basic contractile myocytes
• Depolarization is induced by adjacent cells depolarizing
• The heart can further be divided into two syncytia: the atrial
syncytium and ventricular syncytium – this will allow for the atria
to contract prior to ventricular contraction
• Syncytium = network of cardiomyocytes connected via intercalated discs
- calcium channels are going to close and
the potassium is going to continue to leak
out of the cell and allows the cell to finish
repolarizing
Action Potentials
- results in a refactory period
- phases 0 to 3 --> cell can't be re-excited
during this period and limits the firing rate
- prolonged depolarization and
repolarization cycle that cells to fire in a very
specific way and allows overall the heart to
Neuronal vs Cardiomyocytes contract in a very specific way
• Neuronal = Rapid depolarization (1ms) red line top right graph

• Depolarization caused by fast sodium channels
• Cardiomyocytes (200-400ms)depolarization is much slower

• Pacemaker Cells = slow response
• Myocytes = faster response
• Depolarization caused by sodium + calcium
- pacemaker cells with autorhythmicity feature have a slower
repsonse whereas cardiomyocytes (non-pacemaker cells) have
• Refractory period a slightly faster response
- depolarization is causedcaused by both sodium (Na+) and
• Phases 0-3 calcium (Ca2+) --> what changes the shape

- when the cell depolarizes, sodium channels open and sodium
rushes in
• Can’t be re-excited - salt on the outside potassium (K+) on the inside, the potassium
channels open
• Limits firing rate - in cardiomyocytes, calcium channels open and that allows
calcium to come in from the exterior of the cell to the interior
- calcium and potassium are positively charged and this
Physiol Rev. 2005 Oct;85(4):1205-53 stabilizes the membrane potential across the cardiomyocytes
Conduction System in the Heart
- the signal is transferred to the
atrioventricular node
- the SA node is going to depolarize faster,
this is going to drive the speed at which the
atrioventricular node will depolarize
SA Node = pacemaker
• Origin of cardiac impulse
• Rate of depolarization is greatest
here – which means it drives
everything else
only connection point between the atria syncytium and the
- delays the signal that is
originally sent by the SA node AV Node ventricular syncytium --> this is how the signal gets through
on its way to the ventricles

- squishing at the top part of the
heart from the atria
• Located at the center of the heart, in
- a slight delay as the signal is
transferred through this system
the floor of the right atrium, between
and then a depolarization
starting at the apex of the heart the atria and ventricles
(base of the ventricles), allowing
blood to be squeezed up and • Electrically connects atria and
out of the great vessels
- due to the slowing, the atria
can fully empty their blood into
ventricles via Bundle of His
- as soon as a cell enters that refractory period, it can't be
restimulated even if it has its own autorhythmicity feature
the ventricles before they
contract
• Slows the signal from the SA node
- if it's already been depolarized recently, it's not going to
depolarize again until it resets
• Allows for atrial blood to empty
- from the SA node, the signal transmitted throughout the atria and down to the AV
- SA node depolarizes and then induces depolarization in
adjacent cells
node into ventricles -andthistheis going to travel down the left bundle branch
right bundle branch ti get all the way down to
- anterior, middle and posterior internodal bundles going up across the right atrium and the base of the ventricles; the contraction of the
- this happens at a rate that is faster than what any other to the AV node ventricles starts from the bottom and moves up
naturally depolarizing cell or autorhythmic properties could - an inter atrial bundle heading over to the left atrium; allows for coordinated
depolarize at, it wins, and it drives the entire system contraction of the atria
Electrocardiogram
(ECG)
ECG is the clinical test used to measure changes in electrical signal across
cardiomyocytes
- as they depolarize, they're going to send electrical currents across the body
and we can measure
- electrical impulses are picked up by electrodes
How does the ECG work?

- the change in voltage is measured as a difference between the two
electrodes
- when the signal is moving towards the positive electrode, you get positive
deflection, moving away from the positive electrode you get a negative
https://makezine.com/product-review/boards/maxim-hsensor/
deflection
• As cardiomyocytes depolarize/repolarize,
electrical currents pass across the body
• Electrical impulse picked up by electrodes
• voltage measured as a difference between 2 electrodes
• Toward +ve = +ve deflection, Away from +ve = -ve deflection
• Multiple lead arrangements = many signals and
characteristic patterns
- we put leads/electrodes all
over the chest in different
configurations and measure
the signal and results in the
https://litfl.com/ecg-lead-positioning/
characteristic patterns seen in

ECG
-
Sassi et al 2017
P-wave: Atrial Depolarization
QRS: Ventricular Depolarization
The ECG Recording T-wave: Ventricular Repolarization
http://www.bem.fi/book/06/fi/0607.gif Atrial Contraction

Ventricular Contraction
- P wave, QRS complex T wave

- we can measure a variety of
interval or segments between
these key parts
- they reason why they exist in
variations in the duration of these
segments or intervals, or even in
the amplitude of the signal is
what's interpreted by clinicians who
are reading an ECG
- ventricles have a greater amount
of mass that's being depolarized,
their signal is stronger than the
atrial contraction
- P-wave is going to correspond to
heart image atrial depolarization
- sinus node is depolarizing and then the atrial muscle, Av node, common bundle, bundle branchea, - QRS complex corresponds to
prukinje fibers, ventricular muscle ventricular depolarization
- all of those signlas sum together creating characteristics ECG recording - T-wave corresponds to ventricular
depolarization
- atrial repolarization happens
around the same time as the QRS
complex, but because the signal is
stronger, it basically wipes it out
The Cardiac Cycle
The Cardiac Cycle
• Sequence of events that occur
and repeat with every heart beat
• Systole = ventricular contraction
• Diastole = ventricular relaxation
• 7 Phases
• Recordings:
• Aortic Pressure (AP)
• Left Ventricular Pressure (LVP)
• Left Arterial Pressure (LAP)
• Left Ventricular Volume (LV)
• ECG
•
- aortic pressure is always slightly higher than the ventricular pressure, except at a
Heart Sounds certain couple points
- arterial pressure is generally lower than the ventricular pressure except at a
couple points
Basic Principles:
• Conduction Contraction Flow
• Blood flows from higher to lower pressure
• Contraction increases pressure
• Relaxation/emptying decreases pressure
• Valves open/close based on pressure gradients

• Atria are always filling (no valves in vena cava or pulmonary veins)
- send signal, the signal causes contraction, contraction cause blood
• Heart Sounds are caused by closing valves to move

- blood flows always from higher to lower pressure
- contraction of the heart is going to increase pressure
• S1 = mitral valve (left AV valve) - relaxation and emptying of the chambers decreases pressure
- valves open and close based on pressure gradients
• S2 = semilunar valve (aortic) - atria are always filling
- no valves in the vena cava or the pulmonary veins
- blood is constantly flowing into the atria and nothing is going to stop
that
- heart sounds are caused by closing valves
The Cardiac Cycle - 1
- contraction of the atria
- atria contract as an increase in pressure in the atrium
- ventricle in diastole --> left ventricle end diastolic volume
- contraction of the atria is going to push last little bit of blood into the
Atrial Systole ventricles before they contract = increased pressure in the atria in
comparison to the ventricles
- when ventricle pressure begins to exceed atrial pressure, the AV
valve closes = heart sound
- electrical activity precedes contraction
• Atria Contract - conduction preceeds contraction, preceeds blood flow

- events slightly offset because it takes a little bit of time for the signal to
get there and cause a contraction
• Ventricles in Diastole
• LVEDV = left ventricle end diastolic
volume
• Pushes last bit of blood into
ventricles
• Increased pressure in ventricles
closes AV-Valve
• Heart Sound S1 (mitral valve)
• *electrical activity precedes

contraction – QRS complex starts
(ventricular depolarization)
- the volume of blood in the ventricles is not
changing
Isovolumetric Contraction - green line = horizontal
- atria have relaxed and ventricles begun to contract
- red line crossed over the yellow line --> is has
higher pressure = AV valve closed and moving up
towards the pressure that exists in the aorta
• Atria relax
- when it exceeds it at the end of this phase, that's
going to push the aortic valve open
• Ventricles contract (systole)

• No blood is ejected =
isovolumentric

contraction – QRS complex
starts
Rapid Ejection
• Aortic + Pulmonary Valves

open
• Blood rushes into aorta +
pulmonary trunk
• Volume falls in ventricles
rapidly
• Pressure in ventricles continues
to increase - pressure in the ventricles is higher than that of the aorta
- blood is going to be pushed from the ventricles out through
the aorta
- the volume in the ventricles is going to start to fall rapidly
- pressure is going to be increasing in the ventricles because
we're squishing them
Reduced Ejection finished contracting in
the ventricles
• Pressure begins to decrease in

aorta as the last bit of blood
leaves the ventricles
• Pressure in atria continues to
rise as atria passively fill with
blood
• T-wave = ventricular
repolarization - they're just finishing
their contraction
- electrical signal
precedes contraction
and starting to
repolarize here
The Cardiac Cycle - 5 - semilunar valves are going to close because the
pressure and ventricles is lower now than the
Isovolumetric Relaxation pressure of the aorta --> closing causes heart
sound S2
- ventricles have entered diastole, they're relaxing
causing their pressure to fall
• Semilunar valves close

• Heart sound S2
• Ventricles enter diastole
• AV valves are still closed thus
volume of blood in ventricles
doesn’t change = isovolumetric
relaxation
• LVESV = Left Ventricle End
Systolic Volume
Rapid Filling
• Pressure in atria exceed

pressure in ventricles and AV
valves open
• Blood dumps into ventricles
from atria “rapidly filling” them
• Atrial volume + pressure drops
• Ventricular volume + pressure
rises
Reduced Filling
• Blood passively flows into heart

from vena cava + pulmonary
arteries
• AV valves are open, so it flows
directly into ventricles
• Ventricular volume (and
pressure) slowly rises - the AV vales are open and the
blood will just rush through the
atria right into the ventricles
- the pressure and the volume
slowly rises in both the atria
• P-wave starts = atrial and the ventricles because it's
in continuous space at this time
contraction triggered
https://www.youtube.com/watch?v=IS9TD9fHFv0
Heart Rate Control
Autonomic Control
Pacemaker Firing Frequency determines HR
however, it’s modulated by:
Parasympathetic Innervation
• Dominant innervation
• Via Vagus N (CN X)
• Heart Rate (bradycardia)
• Contraction Force (negative inotropy)
• Receptors: - dominant form of autonomic

• Cholinergic - Nicotinic (ACh) @ ganglia innervention and comes via the
vagus nerve, which is cranial
Parasympathetic NS
• Cholinergic - Muscarinic (ACh) @ heart nerve X
- vagus nerve is going to cause a
decrease in heart rate which
return bradycardia and a
decrease in the contraction force
which is negative iontropy
Autonomic Control
however, it’s modulated by: - less prevalent than the parasympetic control
- cholinergic receptors respond to acetylcholine
- adrenergic receptors respond to epinephrine or
norepinephrine
Sympathetic Innervation - Beta 1 receptors which are a form of adrenergic
• Via sympathetic Chain

receptor in the heart cause contraction, everywhere
else they cause relaxation
- drugs can influence the heart by modulating both
• Heart Rate (tachycardia) the SNS or PSNS influence on the heart
• Contraction Force (positive inotropy)
• Receptors:
• Cholinergic - Nicotinic (ACh) @ ganglia
• Adrenergic – Adrenergic (E or NE) @ heart
• Beta 1 in the heart causes contraction, elsewhere it Sympathetic NS
causes relaxation
Drugs can be used to modify SNS + PSNS influence

To Summarize…
• Conduction of electrical impulses through the heart is coordinated
by pacemaker and conductive cells to induce contraction of
non-pacemaker cardiac muscle
• 2 syncytia – atrial + ventricular which are separate from each other
• Contraction = SA node Atria + AV node Ventricles
• Electrical activity of the heart during the cardiac cycle can be viewed through an
ECG
• Changes to the ECG waves and intervals indicates an issue with the electrical activity of
the heart
• Cardiac Cycle = series of events with every heartbeat
• Synchronization of ECG, Contraction, pressure, blood flow + sounds
• Heart is under autonomic control (primarily PSNS)
©
katelyn.wood@uwo.ca
Cartilage
katelyn.wood@uwo.ca
Learning Outcomes
• Describe and differentiate between the 3 types of cartilage
• Recall the composition of hyaline cartilage
• Explain what happens during joint loading and how nutrient exchange is
accomplished in hyaline cartilage
• Describe implications for injury

Cartilage
Cartilage Types
Hyaline/Articular Cartilage
• Most abundant, yet weakest
• Smooth surface flexibility and support @ joints,
• E.g. articular cartilage, nose, bronchi, epiphyseal plate Hyaline Elastic Fibro
synovial joints
Elastic Cartilage
• Specialized tissue with elastic fibres
• Provide strength + elasticity to maintain shape of structures
• E.g. epiglottis and outer ear, eustachian tubes
Fibrocartilage
• Shock absorber, very durable; lots of collagen
• Support + join structures, strongest type
• E.g. menisci, intervertebral disc, symphysis pubis
A dense viscoelastic connective tissue covering the articulating ends of

bones within synovial joints
It is a metabolically active tissue that has:

• No blood supply
• No lymph channels
• No neurological supply
Injury or repair --> in order to sense an injury or pain, you need nerves.
Hyaline cartilage doesn't have them, so it is difficult to know if the cartilage
has been damaged. In order to repair structure, you need blood supply to
remove waste products and bring in new nutrients but the hyaline
cartilage doesn't have blood supply
Function
• Distributes mechanical load over a wider area to decrease

stress/pressure on joint surfaces
Pressure = Force / Area
• Reduce friction to minimize wear and allow relatively free movement

of the opposing joint surfaces
If you increase the area through which a force is acting, you decrease the pressure thus
decreasing the amount of force and damage that could occur
Composition
Cells (<10% of total volume) Extracellular Matrix

• Chondrocytes • Interstitial Fluid:
• Manufacture, secrete, • Water: 60-80% by weight
organize and maintain ECM • Lipids
• Dissolved electrolytes
• Collagen
• Proteoglycans
Extracellular Matrix (ECM)
• Interstitial Fluid:
• Water: 60-80% by weight
• Lipids
• Collagen
• Proteoglycans
- Articular surface is what contacts the joint
3 zones:
Hyaline/Articular Cartilage - the superficial zone is meant to distribute

the force
- the middle zone has the most fluid
- the deep zone connects the cartilage to
the bone
Distribute Force
Fluid Storage
Bony Connection
in synovial joints there is a joint capsule. We have a synovial membrane and fluid which
load
is produced by this novo membrane called synovial fluid. A joint exists within a fluid filled
sac. Water exists in the extracellular matrix (blue middle zone). When we put a load
through the joint, we end up having pressure and the cartilage squishes and then it will
Cartilage Loading rebound. The water is squished out into the synovial fluid and then sucked back in like a
sponge (nutrient exchange)
compression forces the interstitial fluid out of the cartilage and into the joint capsule.
When the load is removed, fluid flows back into the cartilage when it expands. And
cartilage is avascular.
• Compression forces interstitial
fluid out of the cartilage into the
joint capsule
• When the load is removed, fluid Joint Capsule

flows back into the cartilage,
which expands
Synovial Membrane
• Cartilage is avascular – this is + Fluid
how nutrient exchange is
accomplished!
H20 H20
• What happens in injury? H20
Cartilage Injury
Arthritis
Osteoarthritis (OA) Rheumatoid Arthritis (RA)

• Joint cartilage is gradually lost • Inflammation of joint linings (synovial
• “wear & tear” membrane) + cartilage
• Most common type of arthritis and • Autoimmune disease

cause of hip- and knee- • Eventually, as cartilage degrades,
replacements fibrous tissue joins exposed bone
ends, making them immovable
• Can be unilateral
• Typically bilateral
Damage at joints to articular cartilage.

Osteoarthritis --> Unilateral --> If you mess up one knee, it’s just going to present on that one side
Rheumatoid arthritis --> could become a problem at small joints like your fingers as they will end up locked in a position --> global/systemic issue = bilateral
joint infection
Cartilage Injury
Arthritis
rheumatoid arthritis - Bone erosion will
potentially cause fusion
osteoarthritis is preventable in some
cases --> the trick is you have to have
proper joint mechanics
ex. if someone has a musculoskeletal
injury and are rehabilitating, it is
important their joints are moving
normally and the pressure being put
through them is normal and is what to be
expected at that joint.
- if not, then they are going to get
hotspots and breakdown of cartilage
Because cartilage is not innervated you

don't know there's a problem until it's too
late
when the cartilage wears thin, the bones
start to be damaged and that's when you
feel the pain
To Summarize…
• Hyaline/Articular Cartilage is well-suited to:
• Bear weight and transfer load
• Reduce friction during joint motion
• REMEMBER: no blood, lymph or neural supply

• Nutrition of cartilage is dependent upon exchange of materials through inflow
and outflow of interstitial fluid
• Healing is difficult, and damage is hard to detect early on
• Injury can alter joint mechanics

• Increases pressure points, leading to more damage
©
katelyn.wood@uwo.ca
CNS Overview
katelyn.wood@uwo.ca
Learning Outcomes
• Define common neuroanatomy terms including “fissure”, “sulcus” and “gyrus”
• Correctly identify major landmarks, components and functions of the brain and
spinal cord
• Describe where CSF is produced
• Observe the spinal cord in situ, identifying the level (and clinical significance) of
conus medullaris
• Identify the 3 meninges of the CNS
• Compare/contrast epidural vs spinal needle placement

- sensory information comes in from the
periphery to reach the CNS
- motor information comes from the CNS and
Nervous System Divisions goes out to the periphery

sensory motor

voluntary control)
Sympathetic Parasympathetic
(fight, flight, fright) (rest, relaxation, rumination
or SLUDD)
White & Gray Matter
The Brain
The Brain Cerebral
hemisphere
Diencephalon
Cerebellum
Lateral view
Brainstem:
Midbrain
Pons - neurons start in the cortex - neurons

are going to project via axons, down
Medulla oblongata through the white matter tracts within
the brain, and then through the
brainstem and even into the spinal cord
to get down to the periphery
- the diencephalon include the
Spinal cord hypothalamus and the thalamus
Sagittal section, medial view
The Brain
• Two large cerebral hemispheres overlie the brainstem
• Hemispheres divided by the longitudinal fissure
• Communicate via the corpus callosum
- connected by white fiber tracts called the corpus callosum
- the white fiber tract is a bundle of axons
Corpus Callosum
https://www.neuroscientificallychallenged.com/glossary/medial-longitudinal-fissure Sagittal section, medial view

Neuro Terms
Gyrus
Fissure
Sulcus
Fissure = Deep Groove
Sulcus = Shallow Groove
Gyrus = Ridge Cerebral cortex
the surface of the cortex is grooved, Cerebral white matter

and that's primarily to increase
surface area so you can get more
gray matter in there
Lobes of the Brain Central Sulcus
Central sulcus
Postcentral gyrus
Precentral gyrus
POSTERIOR
ANTERIOR
Lateral (Sylvian) Fissure
you have to take off part of the
Lobes of the Brain frontal and temporal lobes to

get into the insula
Frontal lobe
POSTERIOR
ANTERIOR
Parietal lobe Insula
Occipital
lobe Temporal
lobe (cut)
Pons
Cerebellum Medulla oblongata
Spinal cord
Frontal Lobe
• Behaviour & Emotional Control Pre-Central Gyrus
• Personality Central Sulcus
• Problem Solving (reasoning &
judgement)
• Voluntary Motor Activity

• Pre-Central gyrus
• Broca’s Area Broca’s Area
• If damaged, difficulty producing

language
Parietal Lobe
• Integrates sensory information
• Processing and perception of: Post-Central Gyrus
• Touch
• Pain Wernicke’s Area
• Proprioception
• Post-Central Gyrus
• Sensory reception (touch)
• Perception of Language
• Wernicke’s Area
• If damaged, difficulty
understanding speech
Temporal Lobe
• Auditory Information Processing
• Processes Language
• Semantics and Naming
• Processes Smell
Divided off from the frontal Lateral Fissure
and parietal lobes from (sylvian)
the lateral fissure
Occipital Lobe
• Receives and processes visual
Parieto-occipital
information sulcus
separated off the parietal lobe by
the parieto-occipital sulcus
Thalamus
Diencephalon Hypothalamus
• Thalamus
• Gatekeeper for sensory
information
• Hypothalamus
• Maintain homeostasis
• Pituitary Gland
Pituitary gland
• Secrete hormones
sensory information originating in the periphery comes

through the thalamus before being funneled off to the
right part of the brain
Inferior
Brainstem
• Midbrain
• Connect brainstem to cortex
• Pons
• Connect cerebrum to cerebellum +
medulla
• Transmit sensory information to brain
from periphery
• Medulla Oblongata Midbrain

• Continuous with Spinal Cord Pons
• Pyramid (center) Medulla oblongata
• Olive (lateral)
Cerebellum
• Coordination of voluntary
movement
• Controls balance and
equilibrium
• Integrates proposed movement

with current body position
• Monitors and makes
adjustments to correct motor
plan
Fourth Ventricle
4th ventricle contains cerebrospinal
fluid Cerebellum
Cerebrum
Diencephalon:
Thalamus
Hypothalamus
Brain stem:
Midbrain
Cerebellum
Pons
Medulla oblongata
Spinal cord
The Spinal Cord
Spinal Cord in Situ
L1-L2
- the spinal cord ends at the conus medullaris (cone shaped piece).
- L1-L2 spinal nerves just continue
- the length of the spinal nerves get longer as you proceed inferiorly through the spinal
cord (this is due to embryology and growing)
- when you start off the spinal cord is the full length of the vertebral column but as you
grow, the bones outspace the spinal column
- the collection of spinal nerves beyond the conus medullaris is called cauda equina
(horse tail)
Motor information starts in
the brain and sensory
Did you know…
information comes in from
Spinal Cord the periphery and goes up
to the brain
White matter is “white”
because of myelin on axons
White Matter:
Periphery
Longitudinal Tracts of Axons
Sensory (to brain)
Motor (from Brain) Sensory
Gray Matter:
Central “H” Motor
Contains:
Neuron Cell Bodies
Glial Cell Bodies
Dorsal Horn = SENSORY
Ventral Horn = MOTOR
- synapses between neurons starting in the brain, and then neurons are going to start in the spinal
cord to go out to the periphery
- glial cells support neurons
Cerebrospinal Fluid +
Meninges
Lateral ventricles
Ventricles Interventricular
foramen
Third ventricle
• Large fluid (CSF) filled cavities
Cerebral Aqueduct
in the brain Fourth
• Produce CSF which surrounds ventricle
brain and spinal cord within
Central canal
the subarachnoid space Lateral ventricles
• 3 parts:
• Lateral ventricle (X2): anterior, Interventricular
foramen
inferior and posterior horns
• 3rd ventricle: interventricular Third ventricle
foramen, cerebral aquaduct
• 4th ventricle: continuous with Cerebral Aqueduct
central canal of SC Fourth ventricle
the interventricular foramen are what connects the lateral
ventricles to the third ventricle. Central canal
https://en.wikipedia.org/wiki/Third_ventricle
Blue – Lateral Ventricles Lateral ventricles

Cyan - Interventricular Foramina
Yellow - Third ventricle
Red - Cerebral Aqueduct connects 3rd and
Pink – fourth ventricle 4th
Green - continuous with the central canal
hole in the middle for

inter-thalamic
adhesion (the left
and right thalamus
are connected
through the hole)
Dura mater
- thickest of the meninges
Brain/Spinal Cord - on the most exterior layer

Arachnoid mater
- much thinner
Meninges - white and whispy
Pia mater
- thinnest of the meninges
- will go into the sulci of the brain
Thick Exterior - as if it has been spray painted on Thin Interior
- meninges provide tether points for them throughout the skull
- the arachnoid/subarachnoid space is filled with cerebrospinal fluid for
cushioning
Brain/Spinal Cord
- above the dura mater, there is the epidural space (arterial blood)
- some of the arteries (blood supply) to the brain are going to run on top of the
dura mater
- in the subdural space there is venous blood
Meninges
- also contains dural sinuses, whcih are the veins of the brain
- the subarachenoid space is where the cerebrospinal fluid is
- cerebrospinal fluid is produced in the ventricles
• Supportive framework for

vasculature
• Protect CNS from mechanical
damage
• Alongside CSF
Epidural Subdural Sub Arachnoid

space (A) space (V) space (CSF)
- thick exterior meninge
- endosteal layer --> right against the bone
- meningeal layers --> right against the brain
- where those 2 layers separate --> dural sinus
Brain – Dura Mater - flax cerebri --> dural fold or septa that separates the left and right hemispheres
- tentorium cerebelli --> separates the cerebrum from the cerebellum
- diaphragma sellae --> going to go over the della turcica
- the hole in the center is where the pituitary gland is going to go through
• Dural Sinuses = separation between endosteal + meningeal layers,

• Dural folds/septa (2 layers of meningeal dura)
• Falx cerebri
• Tentorium cerebelli & Falx cerebelli
• Diaphragma sellae
- outside of blood vessels, blood is
pretty toxic to cells. So that is
problematic and will create damage
- an epidural hematoma or a bleed
Extracerebral Hemorrhages above the dura is going to be arterial

blood.
- subdural hematoma --> below the dura
- subarachnoid hemorrhage --> above
• Between skull + brain the arachnoid mater will have venous
blood because that's where the veins
run or the sinuses. And sometimes we
• Increased intracranial pressure + blood = damage have blood vessels, right in the sub
arachnoid space, particularly at the
base of the brain
Spinal Cord Meninges
pia = red
arachnoid = green
dura = blue
Epidural Space
Arachnoid Mater
Dura Mater
Denticulate Ligament
Subarachnoid
Space
Pia Mater
View
Transverse
plane
Dura mater and
arachnoid mater
Spinous process Spinal cord

of vertebra
Pia mater
Subarachnoid space
Epidural space
Posterior (dorsal)
root of spinal nerve Superior articular
facet of vertebra
Denticulate Posterior (dorsal)

ligament ramus of spinal nerve
Anterior (ventral)
Spinal nerve
root of spinal
nerve Anterior (ventral)
Transverse ramus of spinal nerve
foramen
Vertebral artery in
Body of vertebra transverse foramen
ANTERIOR
(b) Transverse section of the spinal cord within a cervical vertebra
- inserting a needle into the lumbar region to access the
spinal cord, either to sample cerebrospinal fluid (lumbar
puncture) or provide analgesia (epidural)
- below the level of conus medullaris, around L1-L2,
Lumbar Puncture +
either going to be sampling from or injecting nearby the
lumbar cistern, which is an outpouching sort of area in
the subarachnoid space, which is going to be filled with
the cerebrospinal fluid
- we do it below the level of the conus medullaris, is
Epidurals
- dura mater and arachnoid mater (blue
we're then working with just spinal nerves floating
around the subarachnoid space (going to dodge the
needles coming in)
- epidural space -> fat filled and contains lots of blood

and green)
- pia mater is going to be right on top of the vessels
spinal nerves
- subarachnoid space is going to be filled Epidural
with the cerebral spinal fluid around that
area
- needle 2 = lumbar puncture --> going to Lumbar
go and collect cerebrospinal fluid (spinal
anesthesia would occur here) Puncture
- needle 1 = epidural --> going into epidural
space and not actually going to puncture
the dura (anesthesiologist will insert a
needle in between the spine of the
vertebral column at a bit of an angle and
feel for the dura with the tip of the needle,
once they feel the dura, they're going to
back off a bit and that's when they inject
the anesthetic)
To Summarize…
• The CNS is composed of the Brain and Spinal Cord
• Unmyelinated cell bodies, neuroglia + ganglia = grey matter
• Myelinated axons + tracts = white matter
• The Brain is divided into:
• Cerebrum: 4 lobes
• Cerebellum
• Diencephalon: Thalamus, Hypothalamus + Pituitary
• Brainstem: Midbrain, Pons + Medulla
• Ventricles produce CSF
• 3 Meningeal Layers surround the CNS:
• Dura Mater, Arachnoid Mater, Pia Mater
©
katelyn.wood@uwo.ca
Muscle Compartments
katelyn.wood@uwo.ca
Learning Outcomes
• Understand that muscles are grouped into compartments, which are outlined by thick
fibrous sheaths
• Describe the features shared amongst muscles within a compartment

Compartments
the shank has 4 compartments:
Limb Compartments
- fascia layer around the whole muscle—>
brown
- interosseous membrane between the tibia
and fibula —> green fascia
• Compartments define groups of muscles

within the limbs
• Separated by fibrous sheaths which are

difficult to stretch
• Muscles within a compartment typically

act synergistically on a joint
• Each compartment is supplied by it’s own

neurovascular bundle
- they’re going to have a common nerve and blood supply
Upper Limb Anterior View
L Upper Limb
Compartments
Arm
Forearm
- muscles in the front of the arm are
going to cause flexion and muscles
Upper Limb Compartments on the back of the arm are going to

cause extension
Arm Forearm L
Flexors (anterior)
Extensors (posterior)
Upper Limb Compartments
Arm Forearm L
Radial N
Anterior (flexors)
Musculocutaneous N
- innervation between the arm and forearm
- in the armMedian N
—> just musculocutaneous
Ulnar N
- in the forearm —> split between median and ulnar
- median = middle —> goes down the middle of the forearm and
supply everything form the middle out to the lateral aspect (thumb
side)
- ulnar —> supply everything on the medial aspect (pinkie side)
Arm Forearm L
- the division between flexor and extensor nerves occurs at the
divisions level of the trunks
- go on to form cords and then the branches
- the branches innervate the compartments C5
- musculocutaneous innervates the anterior compartment of the
Brachial Plexus arm

- median and ulnar innervate the anterior compartment of the
forearm
- axillary only innervates two things: deltoid and teres minor (up in
C6
the shoulder)
Spinal Nerves (anterior rami) - radial —> going to do everything on a posterior aspect of the C7
upper limb
C8
• Separation of flexor & extensor nerves @
divisions level T1
• Flexors to the front

Roots: C5 – T1
axillary
Divisions: Anterior & Posterior
musculocutaneous
radial
Cords: Medial, Lateral, Posterior
median Branches: Musculocutaneous,

Axial, Radial, Median, Ulnar
ulnar
Extensor
Compartment
Nerves
Flexor
Compartment
Nerves
- median and ulnar tracks right through the are to
get to the forearm whereas musculocutaneous
stops
- median is more lateral than ulnar
- muscles that are more lateral in the forearm are
going to be innervated by median
Extensors (anterior)
Flexors (posterior)
Lower Limb Compartments
Thigh Leg
Compartment Syndrome
• Fibrous sheaths surrounding Ant.
compartments don’t stretch
Lat.
• If damage + swelling occur,
pressure can build up Deep Post.
• Common sites: Shank & Forearm

- if damage and swelling occurs, pressure can build up because there
is nowhere for it to go Superficial Post.
- commonly see this in the shank and forearm
- clinical implication of having facial compartments
- pain is a sign of
trauma, Trauma/
increasing blood Pain Blood
• Acutely this is a surgical flow again
Flow
- if you don’t - pain that increases with
emergency: break the cycle, passive movement of the joint
then you keep on distal to the affected area
• Major early sign is pain getting more
blood flow to the
- when trauma occurs, there is
an increase blood flow to the
• Increasing with passive area and more
swelling,
area, relevant for an acute case
- leads to swelling and bleeding,
movement of joint distal pressure, and
pain
leading to increased pressure
since the tendonous sheaths
to the affected area can’t stretch
- decreased blood and nerve Swelling/
nerve
• Ortho or Trauma consult supply
supply because as the pressure
increases everything in the
Bleeding
compartment gets squished
• May also occur with chronic

over use (not emergent) Increased
- for example: having compartment syndrome in the shank if you start moving your ankle Pressure
around, that's going to start causing problems and this is because many muscles that live in the shank
cross the ankle. And so that's going to irritate them, especially if they're already being squished an example due to chronic overuse: if you start running and your increase your distance or your duration
because rapidly and you don't give your body enough time to adjust. So this is something that happens
of the compartment syndrome chronically and it's not emergent in that case usually it just requires taking some time off and then
building up to a level where you can maintain that intensity
Fasciotomy
- surgery that is performed to release the pressure inside of the

compartments
- they would take either a medial approach or a lateral approach and
cut through the fascia and relieve some of the pressure
To Summarize…
within the limbs
• Muscles within a compartment typically act
synergistically on a joint
• Tight facial “sleeves” can have clinical
implications for injury (compartment
syndrome)
©
katelyn.wood@uwo.ca
Elbow
katelyn.wood@uwo.ca
Learning Outcomes
• Identify key bony landmarks on the humerus, ulna and radius as they pertain to the
elbow
• Identify the location, components (bones + ligaments) and actions of the 3 joints of
the elbow
• Identify muscles which cross the elbow, their primary actions and innervation
Upper Limb Overview
The Upper Limb
Shoulder
UPPER LIMB
Arm
scapula
clavicle
Elbow
humerus
radius
ulna Forearm
carpal bones
Wrist
metacarpals
phalanges Hand
The Humerus
- humerus, distally has a few key landmarks that pertain to

the elbow
- capitulum —> rounded shape on the lateral aspect
- trochlea —> medial aspect (looks like spinning top on its
side)
- olecranon fossa —> posteriorly
Olecranon fossa
Medial epicondyle
Capitulum
Trochlea
Lateral epicondyle
going to fit the olecranon fossa
on the posterior aspect of the
The Radius & Ulna humerus

Olecranon
anterior view Trochlear posterior view

ulna
Notch
going to
Radial Radial Notch articulate at the
Head elbow
fits into the radial
notch on the ulna Radial Notch
articulating
the radius,
Radial Tuberosity coronoid
process, and
ulnar
tuberosity
Coronoid
Process
Ulnar Tuberosity
Bones of
the Elbow Medial epicondyle
Lateral
epicondyle
Capitulum Trochlear
Notch
Trochlea
Radial Notch Radial Head
Olecranon
Coronoid
Process
Radial
Tuberosity

Joints of the Elbow
Joints of the Elbow
Humeroradial
humeroradial + humeroulnar = cubital joint

Cubital Joint
• flexion
Proximal Radioulnar
• supination
articulation between the radius
and ulna allowing for
supination and pronation Humeroulnar
- capitellum of the humerus articulates with the
head of the radius Humerus
- trochlea of the humerus articulates with the
coronoid process of the ulnar
Olecranon fossa of humerus

Radiocapitellar Ulnotrochlear joint
joint
Medial
Olecranon of ulna
Lateral
Capitellum of
humerus Trochlea of humerus
Head of radius
Coronoid process of ulna
Neck of radius
Radial tuberosity
Proximal radioulnar
Radius joint
Ulna

superior view
Ligaments of the Elbow

anterior view
lateral view
- elbow hinge joint and synovial
- joint capsule lined by synovial membrane,
filled with synovial fluid
- different ligaments:
1. annular ligament of the radius; encircles
the head of the radius and keep it pinned
up to the radial notch on the ulna —>
important for the proximal radioulnar joint
2. collateral ligaments —> radial or lateral
(orange), and the other is medial or ulnarmedial view
(green)
Cubital + Proximal
Radioulnar Joints
b c
Elbow Dislocation
Cubital Joint
the radius has come off of the

capitulum, and the ulna has
come off of the trochlea and both
have been slipped posteriorly
would have to be reduced by a

physician or an athletic trainer/
therapist
Radial Head
Subluxation
• Arm is jerked upwards with forearm pronated
• Annular ligament can tear loose from

attachment on radial neck, radius dislocates
• Annular ligament can become entrapped

between radius + humerus
painful when radial head moves back into its place, the annular ligament is in the way and gets pinched
• Supination + elbow flexion returns radius to

normal position
- similar to dislocation but bones usually go back into their original positions
- common for young children to experience this
- pull to the arm could result in a radial head dislocation (ex. child holding an adult’s
hand and is trying to pull away; kid swinging holding the adult’s hands - radial head
subluxation)
Upper Limb Radiology Tutorial - https://www.mededportal.org/doi/10.15766/mep_2374-8265.10167
What joint is circled?
The Cubital Fossa
Cubital Fossa
Bicipital tendon Epicondyles
Radial N
Median N
Brachial A
Cubital Veins
Brachioradialis
Pronator Teres
Bicipital aponeurosis
- triangular shaped region on the anterior aspect of the

• Bicipital tendon reflex location elbow
- bounded by 3 things:
1. epicondyles of the humerus (a line between them)
• Bicipital aponeurosis protects 2. brachioradialis
3. pronator teres
Brachial A - these 3 are a key transition zone from the arm to the
forearm for a variety of neurovasculature
- laterally —> radial nerve —> pokes forwards, goes in front
• Key location for phlebotomy of the lateral epicondyle and goes back around to the
posterior aspect of the forearm
- medially —> median nerve —> bicipital tendon crosses
here and the brachial artery and other is covered by the
bicipital aponeurosis —> site to perform tendon reflex, site
of cubital veins and good site for phlebotomy
Muscles Acting on the
Elbow
Muscles Acting on the Elbow
• Arm Flexors: • Arm Extensors
• Biceps • Triceps
• Brachialis
• Forearm Flexors: • Forearm Extensors

• Brachioradialis • Supinator
• Pronator Teres • Extensor Carpi Radialis Longus
• Flexor Carpi Radialis • Extensor Carpi Radialis Brevis
• Palmaris Longus • Extensor Digitorum
• Flexor Carpi Ulnaris • Extensor Digiti minimi
• Flexor Digitorum Superficialis • Extensor Carpi Radialis
To Summarize…
• 3 joints exist within the elbow:
• Ulnotrochlear, Radiocapitellar, Proximal Radioulnar
• Flexion occurs at the ulnotrochlear & radiocapitellar joints

• Supination occurs at the proximal radioulnar joint
• The cubital fossa is a region through which nerves and vessels

travel from the arm to the forearm
• 4 groups of muscles act on the elbow

• Arm Flexors, Arm Extensors, Forearm Flexors, Forearm Extensors
©
katelyn.wood@uwo.ca
Forearm
katelyn.wood@uwo.ca
Learning Outcomes
• Identify key bony landmarks, and their associated structures on the radius & ulna
• Identify and recall the innervation of muscles in the forearm

Upper Limb Overview
The Upper Limb
Shoulder
UPPER LIMB
Arm
“radius’ are rad!” scapula

clavicle
Elbow
radius are on the thumb side
humerus
radius
ulna Forearm
carpal bones
Wrist
metacarpals
phalanges Hand
The Radius Radial Neck
Head
articulates at the
elbow
Radial Tuberosity
key muscle attachment
Interosseous
Boarder
- butting up against the ulna and

has an interosseous membrane
that binds the two together
Styloid Process
down at the wrist

Distal Radial Fracture
Colle’s Fracture
• Mechanism = FOOSH:
Fall On Outstretched
Hand
• Dinner fork deformity
- the weight is going through the kind of dorsal
aspect of the forearm, the tip of the radius, the
styloid process, is going to be bent = fracture =.
dinner fork deformity —> the angle that the
hand joins the forearm at the wrist resembles a
dinner fork
Radial Notch
The Ulna Trochlear

Notch
Radial Notch
Olecranon
- more medial bone in the forearm Ulnar Tuberosity
- trochlear notch —> important at the elbow
Coronoid
- radial notch —> where the radius is going to Process
articulate at the proximal radioulnar joint
- olecranon —> pointy part of the elbow on the
posterior aspect
coronoid process —> on the anterior aspect
- those key features form the “C-shape” that
allows to have a really tight hinge joint that’s
stable at the elbow Interosseous
- ulnar tuberosity —> key site for muscle
Interosseous Boarder
attachment Boarder
interosseous boarder —> where the interosseous
membrane is going to join the ulna and the radius
- also has styloid process at its distal aspect
Head of
Ulna Styloid Process

The Forearm
• Supination:
radius & ulna
are parallel
(anatomical
position)
- radius + ulna articulated = forearm
- bound together by the interosseous membrane
that allows them to stay in close proximity through
• Pronation: whatever movements they complete
- special movement —> supination and pronation
radius & ulna - in anatomical position the forearm is supinated
and the radius and ulna are parallel to each other
are crossed - in pronation, the radius and ulna are crossed
- ulna is staying fixed and the radius pronating
overtop of the ulna
Pronation Supination
Radius
Ulna
Supination/Pronation
• Supination:
radius & ulna
are parallel
(anatomical
position)
• Pronation:
radius & ulna
are crossed

https://www.mededportal.org/doi/10.15766/mep_2374-8265.10167 Pronation Neutral Supination
Manus (Hand) Overview (Anterior-Posterior Radiograph)
Distal
Bones + Joints phalanx
Middle
of the Hand phalanx
DIP
Proximal
Joints: phalanx PIP
• CMC = Carpal Metacarpal MCP

• MCP = Metacarpal Phalangeal
• PIP = Proximal Interphalangeal Metacarpal
• DIP = Distal Interphalangeal CMC

Carpal
bones

Radius Ulna
Muscles of the Forearm
anterior view
Forearm Compartments
posterior
Radial N
Anterior (flexors)
Median N
Ulnar N
anterior
Flexors (anterior)
Extensors (posterior) Forearm L
“Pass, Fail, Pass, Fail”
Forearm Flexors Medial Epicondyle
Brachioradialis‡
Superficial Layer
Pronator Teres
• Pronation: Pronator Teres Palmaris Longus
• Abduct Hand: Flexor Carpi Radialis

Flexor Carpi
• Flex Hand: Palmaris Longus Radialis
Flexor Carpi
• Adduct Hand: Flexor Carpi Ulnaris* Ulnaris*
- pronator teres —> pronation of the forearm
- flexor capri radialis —> to abduct the hand; on the flexor side, it
attaches to the carpal bones and is on the radial side
• Flex Elbow: Brachioradialis‡ - palmaris longus —> flexing the hand; inserts into the palmar
aponeurosis —> a thick piece of fascia in the palm of the hand
- flexor carpi ulnaris —> adduct the hand; flexor compartment, carpi -
attaches to the carpals and ulnar side
- orientation of the 4 muscles going lateral to medial “ pass fail pass
• Nerves: fail”
- start on the medial epicondyle and doing to go down and attach into
• Median the hand itself
- brachioradialis —> flex the elbow
• *Ulnar, ‡Radial - median is going to do most of the muscles except for the 2
highlighted anterior view
- ulnar nerve is going to innervate the flexor carpi ulnaris
- radial nerve innervates the brachioradialis
Flexor Dig.
Forearm Flexors Text

Profundus*
Middle + Deep Layers
• PIP Flexion: Flexor Digitorum Pronator

Superficialis Quadratus
Flexor Dig.
• DIP Flexion: Flexor Digitorum Superficialis
Profundus*
• Forearm Pronation: Pronator

Quadratus
anterior view
• Nerves:
• Median Flexor
Retinaculum
• *Ulnar
Forearm Flexors
Medial epicondyle of
humerus
Medial epicondyle Pronator teres
of humerus
Palmaris longus
Flexor carpi radialis
Supinator
- carpi muscles are going
to attach to the carpals
Flexor digitorum superficialis
- Digitorum muscles are
going to go into the digits or
the fingers Flexor carpi ulnaris
Pronator Flexor pollicis longus
quadratus
Pronator quadratus
Flexor digitorum Flexor retinaculum
profundus (cut)
Palmar aponeurosis
Flexor digitorum
superficialis (cut)
- does nothing in the arm
- tracks right on through and then moves in
front of the medial epicondyle
Median N - either goes under or through pronator teres

where it can be squished
- then travels between the flexor digitorum
profundus and superficialis muscle bellies
- 2 muscle bellies —> sandwich the median
In the forearm nerve and pops out right in the middle of the
wrist
• Course:
• In front of medial epicondyle
• Under or through pronator teres
• Between flexor digitorum
profundus and superficialis
- median nerve squished by
pronator teres resulting in weak
• Pronator teres syndrome: wrist flexion
- median nerve supplies a lot of
• weak wrist flexion wrist flexors
• no IP flexion @ thumb - no interphalangeal flexion at the
thumb because the median nerve is
responsible for innervating the
• *no innervation in arm! thenar muscles —> intrinsic

muscles that innervate the thumb
Ulnar N
In the forearm - travels behind the medial epicondyle
- funny bone
- hangs out on the medial aspect of the
forearm
• Course:
• Posterior to medial
epicondyle
• *no innervation in arm!

Supinator
Lateral
Epicondyle
Forearm Extensors Extensor
Carpi Radialis
• Supination: Supinator (L + B)
• Abduct Hand: Extensor Carpi Extensor

Radialis - all innervated by the radial nerve
- supinator —> supinates the
Digitorum
forearm
- extensor compartment —>
• Extend Digits @ MCP Jt attaches to the carpals and on the Extensor
radial side Digiti Minimi
• Extensor Digitorum - extensor digiti minimi —> extends
to the pinky
• Extensor Digiti Minimi - all of these muscles come off the
lateral epicondyle
- flexors come off the medial
epicondyle
• Adduct Hand: Extensor Carpi Extensor
Carpi Ulnaris
Ulnaris
• Nerve: Radial
- extensor retinaculum —> pins down all of the tendons on the posterior Extensor
aspect of the wrist to keep them tight despite their movements Retinaculum posterior view
Lateral epicondyle
Forearm Extensors of humerus
Brachioradialis
- part of flexor
Extensor carpi compartment —>
radialis longus flexes elbow
- innervated by radial
Extensor
carpi
radialis brevis
Extensor
digitoru
m
Extensor
carpi ulnaris
Extensor
digiti
minimi
Golfer’s Elbow
Epicondylitis
• Inflammation of
tendons at either
medial or lateral
epicondyle
- golfer’s elbow = medial
epicondyle
- tennis elbow - lateral epicondyle
Tennis Elbow
Extensor Carpi
Forearm Extensors Radialis (L + B)
Outcropping Muscles*
*Abductor Pollicis
• Abduct Thumb @ CMC: *Abductor Longus
Pollicis Longus - interact with the thumb
- to abduct the thumb at the carpometacarpal
joint —> use the abductor pollicis longus
- pollicis refers to the thumb and longest (long *Extensor
• Extend @ MCP, CMC Jts tendon)
- there is going to be a extensor pollicis brevis
Pollicis Longus
• *Extensor Pollicis Longus (+IP jt) - for extending the thumb at the
*Extensor
metacarpalphalangeal or carpometacarpal joint,
• *Extensor Pollicis Brevis uses the extensor pollicis muscles Pollicis Brevis
- extensor indices —> extends to the index finger
- all the muscles are innervated by the radial
Extensor Indicis
• Extend 2nd Digit: Extensor Indicis
• Nerve: Radial
posterior view
Forearm Extensors
Ulna
Abductor pollicis
longus - intrinsic muscle in the hand Radius
Extensor pollicis
Extensor pollicis longus brevis
Extensor indicis
- travels behind the humerus, in the radial
groove
Radial N - slips in front of the lateral epicondyle and

back into the posterior compartment
- splits to form 2 nerves:
1. posterior interosseous nerve —> provides
deep motor to the area and can pierce
in the forearm through supinator
2. Superfic ial branch —> sensory information
in the forearm and hand
• Course:
• In front of lateral
epicondyle, then back into
posterior compartment
• Splits to form
• Posterior interosseous N -
deep motor (can pierce
supinator)
• Superficial branch (sensory)
To Summarize…
• Radius & Ulna are the bones of the forearm
• Bound together by interosseous membrane
• Movement = pronation/supination @ radioulnar joints
• Flexors = 3 layers, primarily medial epicondyle

• Extensors = 2 layers + outcropping muscles, primarily lateral epicondyle
• Muscles of the forearm are innervated by:

• Median & Ulnar Ns: flexors (anterior)
• Radial N (posterior + brachioradialis)
• Flexor + Extensor retinaculum hold tendons in place

©
katelyn.wood@uwo.ca
Hand
katelyn.wood@uwo.ca
Learning Outcomes
• Identify key bony landmarks, and their associated structures on the carpals,
metacarpals and phalanges
• Identify key attachment points of muscles of the forearm, acting upon the hand
• Identify and recall the innervation of intrinsic muscles in the hand

Upper Limb Overview
The Upper Limb
Shoulder
UPPER LIMB
Arm
scapula
clavicle
Elbow
humerus
radius
ulna Forearm
carpal bones
Wrist
metacarpals
phalanges Hand
- label from 1 to 5 starting at the thumb
- phalanges have 3 components —> proximal, middle and distal except for in the thumb —> Pinkie
only proximal and distal IV III
V II
Bones of the Hand “digiti minimi”
Thumb
“Some Lovers Try Positions Phalanges I
(distal, middle, proximal) “pollicus”
That They Cannot Handle”
- 8 carpal
Hamate bones
Capitate
Pisiform
Trapezoid Metacarpals
Triquetrum Trapezium
Carpals
Lunate
Scaphoid
palmar view
Distal
Middle
of the Hand phalanx
DIP
Proximal
Joints: phalanx PIP


Carpal
bones Carpal

Radius Uln
- on the thumb side and is most proximal row of bones;
right up against the radius
- if you extend your thumb as far as you can laterally, you
can see a divot between your outcropping muscle
Scaphoid Fracture tendons —> anatomical snuff box

- blood supply to the scaphoid is through the distal aspect
- fracture in the piddle part can compromise the proximal
segment
- no reunion of the
• Most common carpal middle bones =

nonunion accompanied
by vascular necrosis —>
bone fracture the bone doesn’t have
blood supply so it dies
• Tenderness in anatomical
snuff box
• Blood supply is via distal
aspect, thus fracture can
compromise proximal
segment
• Consequence = nonunion
+ avascular necrosis ulna radius
Radial artery
Forearm Muscles
Acting on the Hand
Forearm Muscles Acting on the Hand
Flexors Extensors
attach to Flexor Carpi Ulnaris Extensor Carpi Ulnaris
Carpi the
carpals Flexor Carpi Radialis Extensor Carpi Radialis
Extensor Digitorum
Flexor Digitorum
Digitorum Extensor Digiti Minimi
attach to Superficialis/Profundus
the digits Extensor Indicis
Abductor Pollicus Longus
Outcropping --- Extensor Pollicus Longus
thumb Extensor Pollicus Brevis
Specials Palmaris Longus ---
Carpi Muscles
Flexion/Extension, Lateral & Medial Deviation of Wrist
• Extensor Carpi Radialis (L & B)

• Extensor Carpi Ulnaris - to perform any of these actions you need to engage 2 of
the muscles
• Flexor Carpi Radialis

• Flexor Carpi Ulnaris
• *Palmaris Longus
- special muscle
- flexor
- inserts into the palmar aponeurosis —> thick piece of fascia on the palmer side of the hand
- it doesn’t go through or underneath the flexor retinaculum
Digitorum Muscles
Flexion/Extension of Phalanges
- first 3
• Extensor Indicis
are on
the
posterior • Extensor Digiti Minimi
aspect Text
(yellow)
• Extensor Digitorum palmar view dorsal view
• Flexor Digitorum Superficialis

• Flexor Digitorum Profundus
- how the purple and green enter and connect the phalanges —> dorsally, there are extensors and they are going to go into the dorsal
hood. Anteriorly, there are going to have the digitorum or the flexor muscles. the green muscle is going to go all the way up to the tip of
the finger = the profundus muscle and superficialis muscle in purple —> going to split in half like a snakes tongue to allow the
profundus through
- extensors are on top and the digitorum profundus and superficialis tendons on the bottom
- all encased in a synovial sheath —> provide protection and reduce the friction of the tendons sliding over the bones and muscles
*all encased in a synovial sheath!

Outcropping Muscles
Extension + Abduction of Thumb
Abductor Pollicis
• Abductor Pollicis Longus Longus
• Extensor Pollicis Longus Extensor Pollicis

Longus
• Extensor Pollicis Brevis Extensor Pollicis
- emember abductor pollicis brevis —> intrinsic hand muscle Brevis
- “brevis sandwich” —> brevis is in the middle and the longus
muscles on either side
posterior view
Carpi
Digitorum
Outcropping Attachment Summary
dorsal view palmar view
Extensor carpi Extensor carpi

radialis brevis radialis longus
Extensor
carpi ulnaris Abductor Flexor carpi
pollicis longus ulnaris
Flexor carpi
Extensor radialis
pollicis brevis
Extensor
pollicis longus
Flexor digitorum
Extensor
superficialis
digitorum
Extensor Flexor digitorum

Extensor indicis profundus
digiti minimi
Intrinsic Muscles
of the Hand
Intrinsic Muscles of the Hand
- lumbricals —> cause flexion at the metacarpophalangeal
joint, yet extend the interphalangeal joints though they are
Lumbricals opposing actions; one happens on the flexor side and the palmar view
other on the extensor side - start on the palmar
side and are going to
attach into the dorsal
• Action: Flex MCP Jts, Extend IP hood on the backside

of the fingers, just like
Joints extensor digitorum
• Attaches into dorsal hood – like ED

MCP - they cross over the
• Nerve: 1 & 2 = Median, 3 & 4 = metacarpophalangeal
joint and that causes
Ulnar flexion when they
contract
1 and 2 are
innervated by
- lumbricals attaching to the median
dorsal hood labeled from lateral to medial
- dorsal hood —> network of 3 and 4 are
fascia and tendons on the - when you pull on that interconnected piece of fascia, it will extend your distal innervated by ulnar
posterior aspect of the digits interphalangeal joints (DIPs) and proximal interphalangeal joints (PIPs)
Dorsal Interossei (4) palmar view
• Action: Abduct digits from

midline
• Nerve: Ulnar
- midline = middle finger (digit 3)
- innervated by ulnar
- D = dorsal
• 4 DAB - A,B = abduct
Palmar Interossei (3) palmar view
• Action: Adduct digits to midline

• Nerve: Ulnar - innervated by the ulnar nerve
- none on the middle finger because it is
the midline and can’t really bring it towards
itself
- 3 PAD = 3 palmar adduction
• 3 PAD
Lumbricals + Interossei
palmar views
Lumbricals
Palmar Interossei
Dorsal Interossei
How do the thumb and

pinky move?
they have their own series of muscles called thenar and
hypothenar muscles
superficial deep
Thenar & Hypothenar Groups palmar view
Thenar muscles
Hypothenar muscles
- allows you to do flexion, extension,
abduction, adduction, and opposition of
thumb and pinkie
- innervation of thenar group —> median and
ulnar
- innervation of the hypothenar group —>
ulnar
- median is going to do the most of the
innervation in the thenar group —> if you
impair the median, you can’t move the thumb
around very well = symptom of carpal tunnel
syndrome
Nerves:
• Thenar: Median & Ulnar
• Hypothenar: Ulnar
To Summarize…
To Summarize…
• Bones of the hand include carpals (8), metacarpals (5) and
phalanges (distal, middle and proximal)
• Joints include: Carpal, CMC, MCP, PIP and DIP
• Several muscles live in the forearm, but act on the hand. Their
tendons are held in place by the flexor/extensor retinaculum
• Useful for larger, more powerful movements
• 4 muscle groups are intrinsic to the hand

• Useful for smaller, more intricate movements
©
katelyn.wood@uwo.ca
Heart Anatomy
katelyn.wood@uwo.ca
Learning Outcomes
• Define borders and contents of thoracic compartments
• Identify and label anatomical components of the heart and pericardium
• Describe how blood flows through the heart
• Differentiate between pulmonary, systemic and coronary circulation

• Identify which arteries can be implicated in a heart attack
The Thorax
Thoracic Cage
Composed of
• 12 Ribs (X2)
• Sternum
• Manubrium
• Body
• Xyphoid Process
• Costal Cartilagejoins the ribs to the sternum
• Thoracic Vertebrae (T1-T12)

Superior Mediastinum
Middle Mediastinum
Thoracic Compartments Anterior Mediastinum
- middle mediastinum contains the heart = right in the center
Posterior Mediastinum
- pleural cavities contain the lungs
- superior mediastinum —> superior to the middle mediastinum for L + R Pleural Cavities
the heart
Middle
mediastinum
Anterior Superior Lateral

Mediastinum Middle Mediastinum

Anterior Mediastinum
Thoracic Inlet
• Manubrium to 1st rib to T1
• Sternal Angle to T4 Base - sternal angle —> where the manumbrium and the body of the sternum come together—> to posterior
to the base of T4
Diaphragm
• Central tendon continuous
with fibrous pericardium
Contents:
• Sup. Vena Cava
• Brachiocephalic Veins
• Arch of Aorta + branches
• Brachiocephalic A
• Left Common Carotid
• Left Subclavian
• Trachea windpipe, leading to your lungs
• Esophagus tube that delivers food to your
stomach
Middle Mediastinum
Contents:
• Heart
• Pericardium
• Fibrous
• Serous
• (visceral/parietal)
• Great Vessel Roots
• Superior Vena Cava
• Ascending Aorta
• Pulmonary Trunk
when they come off of the heart or enter into it are
in the middle mediastinum
Contents:
• Descending Thoracic Aorta
• Esophagus
• Vagus Nerve
• Sympathetic Trunk
- once the aorta comes off of the heart, it arches
up through the superior mediastinum and then
comes right back down through the posterior
mediastinum behind the heart
- vagus nerve does a lot of innervation
(innovation) in the thorax and abdomen
- and sympathetic trunk
Contents:
• Connective Tissue seen in adults
• Thymus Gland- seen in children and young people
but, goes away after puberty
Pleural Cavities
Contents:
• Lungs
• Pleura
the connection point between

Hilum: the heart and lungs
• Pulmonary Arteries
• Pulmonary Veins
• Primary Bronchi
The Heart +
Pericardium
- need to supply blood to the heart as it is a
muscle
- the diffusion distance is too great between
blood that exists in the atria and the
The Heart ventricles to actually penetrate into the

muscle and supply it
- the heart has its own blood supply called
coronary blood supply
• 2 halves
• Right = thinner walls
• Left = thicker walls
• 4 Chambers (2 atria, 2 ventricles) - the right has thinner walls because
• 4 Valves
it’s only pumping blood out to the lungs
= short distance, not need to pump
hard
- the left has thicker walls because it is
sending blood out to the rest of the
body and has to pump blood further
with more pressure
- atria are superior to ventricles
- 4 valves —> helps control blood flow
• The lungs (pulmonary) through the heart
- 2 atrioventricular valves —> going to allow

• The body (systemic) blood to travelventricles
from the atrium to the
• Itself (coronary) - 2 semilunar valves —> going to allow blood

to travel from the ventricles out into
- the heart can communicate with the lungs for pulmonary
circulation circulation (whether it’s pulmonary to the
- the body for systemic circulation lungs or systemic to the body)
- coronary arteries —> going to supply the heart muscle
itself
right atrium —> going to receive deoxygenated blood from - when you see a pocket of fat in the
the body body, there are arteries, veins, or
nerves running through there
right ventricle —> going to collect blood from the atrium and
The Heart then allow it to travel out to the lungs
left atrium —> going to receive blood from the lungs

- the blood is then going to move into the left ventricle and
Chambers then pumped out to the rest of the body
- interventricular sulcus —> groove on the anterior side of

the heart between the left and right ventricles; fat-filled
- cardiac apex —> between the left and right ventricles
L. Atrium
R. Atrium R. Atrium
L. Ventricle
anterior view Interventricular

Sulcus
posterior view
R. Ventricle
Cardiac Apex
- blood first enters form the body via the superior and inferior vena cava
and also the cardiac sinus
- blood coming in to the right atrium is going to come in through one of
those three sources
- it's going to move into the ventricle and then go out towards the lungs, via
The Heart the pulmonary trunk and arteries

- the pulmonary trunk is the singular vessels coming off the right ventricle
- divides into two form the left and right pulmonary artery
- blood comes back to the heart via pulmonary veins (left adn right set and
Great Vessels feeds into the left atrium)
Aortic Arch
Pulmonary Trunk
+ Arteries Superior
Vena Cava
Superior Pulmonary Veins
Vena Cava
Cardiac Sinus
Inferior
Vena Cava
Inferior
- the one instance in the body where the
Vena Cava anterior view oxygenation of the blood traveling in vessels is
flipped
- blood traveling away from the heart travels via
arteries, whereas blood traveling to the heart posterior view
comes in veins
- aortic arch —> goign to allow blood to leave
the left ventricle and enter into systemic
circulation to feed the body
Atria
• Right = Entrance for superior +
inferior vena cava + coronary sinus +
anterior cardiac veins
anterior
• Left = Entrance for Pulmonary
Veins
• First part of heart to contract,

pushing blood into ventricles via
Atrioventricular Valves
- the main job is to collect blood from either from the body in terms of the right atrium and
the lungs in terms of the left atrium
- the first part of the heart to contract and this is going to push the last little bit of blood into
the ventricles to help prime them before blood is sent out of the heart.
- Blood travels from the atria to the ventricles via the atrioventricular valves
posterior
- fossa ovale is in the right side of the heart
- the valve of the fossa ovale is in the left side of the heart
- a remnant from fetal circulation
- when you are a fetus you are not actually using your lungs right side
Atria
- a hole that forms in the interatrial septum allows blood to get from
the right side of the heart into the left side of the heart and bypass
the lungs
- pectinate muscle —> big part of atria and allows them to contract
- atria has a smooth wall and a muscular side to the wall
- smooth wall derived from vasculature during development and the
muscle there is what allows it to contract
• Key Landmarks:
- terminal crest —> on the right side of the heart is just the border
between the smooth wall and the muscular wall
• Fossa Ovale + valve within interatrial Right Atrioventricular

(AV) valve
septum (remnant of fetal circulation) Fossa Ovale
• auricle = “ear-like” protrusion on

anterior surface, formed from
pectinate muscle
left side
• Pectinate muscle is important for

contraction Valve of Fossa Ovale
• Posterior wall is smooth, derived

from embryonic vasculature
Left AV Valve
Ventricles
• Second part of heart to contract
• Right = sends blood to lungs via anterior

pulmonary trunk
• Pulmonary semilunar valve
• Pulmonary circulation
• Left = sends blood to body via aorta

• Aortic semilunar valve
• Systemic circulation
posterior
- interventricular septum —> a thick muscular division between
the left and right ventricles; important for coordinated contraction
as there are neural fibers that actually run right down the septum
Ventricles - ligamentum arteriosum —> provides a shunt for blood to get

from the right ventricle into the systemic circulation, again
bypassing the lungs
- Trabeculae carnae is the muscle that exists in ventricles; a bit
stronger than the atria
- cordae tendonae —> tether these valves to prevent backflow;
attach into these little muscular structures called papillary muscles
• Key Landmarks: within the ventricles
• Interventricular septum = important

for coordinated contraction
• Ligamentum arteriosum between anterior
aorta + pulmonary trunk is a remnant
of fetal circulation
• Trabeculae carnae muscle is

left side
important for contraction

• Papillary muscles are anchor points
for cordae tendonae of AV valves
- 4 valves in total
- atrioventricular (AV) valves —> allows blood to move from the atrium anterior
into the ventricle
Valves
• 2 Atrioventricular (AV) Valves
• Atrium Ventricle
• Right = Tricuspid superior view
• Left = Bicuspid/Mitral
• Chordae Tendineae prevent backflow posterior
• 2 Semilunar Valves
• Ventricle Aorta/Pulmonary Trunk
• Aortic – location of coronary arteries
• Pulmonary
• Cusp shape holds blood, preventing
backflow
- AV valves more anteriorly
- semilunar valves have 3 cusps
- aortic semilunar valve —> blood is
going to pool in there once the heart is
Semilunar Valves
Valve Shape stopped contracting for a moment

allowing reight and left coronary arteries
to fill
- AV valves shaped oppositely and
they’re tethered on their midline by
chordae tendonae
posterior
AV Valves
Semilunar Valves
Valve Mechanics
- when blood pushes through the cusps, it
forces them open
- the chordae tendonae will pull taut on the
valve when blood flow is increased or
pressure is increased in the ventricles
- this will stop them from opening up again
and allowing blood back into the atrium
semilunar valves
- will fill with blood
- cause them to drape back down into each
other
- when the heart contracts, new blood is
pushed through the aorta and that’s going to
push through the valve and allow that blood to
be transmitted to the rest of the body
- settling of blood into the semilunar valves is
important, particularly in the aortic valve as
that’s what allows the coronary arteries to refill
AV Valves
Brachiocephalic Trunk
Great Vessels L Common Carotid
L Subclavian
Systemic Circulation
• Aorta (from Left Ventricle)

• Ascending aorta —> leaving the left ventricle
• Coronary arteries - sends blood up kind of in a “U”

shape
• Arch
- goes first though the ascending
artery, which allows for the
branches of the coronary arteries
• Brachiocephalic Trunk to come off
- brachiocephalic trunk is going to
• L Common Carotid divide to become the right
common carotid and right
• L Subclavian subclavian
• Descending
• Thoracic + Abdominal Branches
• Superior + Inferior Vena Cava

• Drain into Right Atrium
bringing back blood from the body
Great Vessels
Pulmonary Circulation - blood is going to leave the heart through the right
ventricle via the pulmonary trunk
- divides into the left and right pulmonary arteries
- Blood is then going to return to the heart via the
pulmonary veins
Arteries
• Pulmonary Trunk
• Left + Right Pulmonary Arteries
• Contains deoxygenated blood
going to lungs
Veins
• L & R Pulmonary Veins
• Contains oxygenated blood from
lungs
Great Vessels
and upper limbs
Blood Flow
lung left lung
3. 6. 5.
5.
- blood us going to start by coming into the right atrium via superior vena
cava, inferior vena cava, cardiac sinus and anterior cardiac veins
- moves through the right atrioventricular valve into the right ventricle
- heads out the pulmonary semilunar valve to reach the pulmonary trunk,
which divides to become the pulmonary arteries 2. 7.
- blood is going to travel through pulmonary capillaries and back to the
heart by pulmonary veins Key: 10.
- going to enter into the left atrium, and then travel through the left atrial
ventricular valve (mitral valve) to reach the left ventricle
- going to exit the heart through the aortic semilunar valve, through the
Oxygen-rich blood
aorta to reach systemic circulation
- going to head up into capillaries of the head, neck and upper limbs, but Oxygen-poor blood
also travel through the trunk via the descending aorta to reach the the rest 9. Capillaries of trunk
of the body (thorax, abdomen, pelvis, and lower limbs) and lower limbs
- comes back to the heart, into the superior and inferior vena cava
Heart Failure
• Heart muscle doesn’t pump as
well as it should =
oxygen/nutrient delivery
• Shortness of breath, fatigue,
coughing
Left sided: Right sided:
• L ventricle impaired = systemic • typically caused by left side
circulation impaired impairment
• Muscle too weak • fluid backs up through lungs, and
• Ventricle doesn’t refill eventually venous system
- blood isn’t being sent out to the body in a sufficient
fashion
- ductus arteriosus —> a temporary
structure that allows blood traveling
via the pulmonary trunk to mix in with
blood that is coming in, through or
Fetal Circulation coming out through the aorta to get

out to the rest of the body
- mixing of deoxygenated blood that

has come in from the systemic
circulation via the superior vena
1. Oxygenated fetal blood from the placenta passes to cava, and oxygenated blood, which
is coming into the heart via the
the fetus via the umbilical vein umbilical vein —> aorta = purple
- allows blood to travel throughout
the body and head back out to the
placenta to become oxygenated
2. Blood bypasses the liver (via the ductus venosus) and again
enters the inferior vena cava.
3. Blood entering the right atrium from the IVC bypasses

- the descending aorta is going to
right ventricle (lungs not yet functional) to enter the give rise to the internal iliac
arteries
left atrium via the oval foramen. - common iliac comes off and
then splits to form internal iliac on
both sides, and then the umbilical
arteries come off of those internal
4. Blood from the SVC enters right atrium, passes to the iliac arteries and head out to the
right ventricle, and moves into the pulmonary trunk placenta
where it enters the aorta via the ductus arteriosus
5. Partially oxygenated blood in the aorta returns to the

placenta via the paired umbilical arteries that arise
from the internal iliac arteries.
- peri means around
- cardium means heart
- heart pushes pushes down into the pericardium and wraps around it
- it is a layer that is continuous along the surface of the heart and
Pericardium
along the exterior surface of the pericardium
- the space contains serous fluid which allows for lubrication
- sack contains some fluid
- the fluid is separate from the heart
- fibrous pericardium is on the outside and is a tough outer layer —>
the tope edge of it fuses into the great vessels
• 3-layered sac in which the heart resides

the aorta, the superior vena cava, the
pulmonary trunk, everything coming out
of the superior aspect of the heart, this
• Fibrous Pericardium (outer, toughest layer)

pericardium or pericardial layer is going
to fuse into
Continuous with
• Serous Pericardium - the fibrous pericardium is going to go
up and attach to the great vessels Great Vessels
• Parietal (outer layer) - the serous pericardium is going to
actually reflect at that point to kind of
form that pocket in which the serous
• Visceral (inner layer) fluid will exist
- the visceral layer is sometimes referred
• Epicardium to as the epicardium (layer right on top
of the heart)
- the base of the pericardium is
continuous with the central tendon of the
diaphragm
- the middle mediastinum being its own Reflection @
region within the thorax and this helps
define the bounds of it Great Vessels
- everything inside the pericardium is
part of the middle mediastinum
Continuous with
Central Tendon of Diaphragm
Coronary Circulation
Coronary Arteries = 1st branch of
Aorta
- blood is pushed out from the left ventricle into
systemic circulation during systole (contraction of
the heart)
- When the heart relaxes, and that pressure is
removed, it starts to flow backwards down the
ascending aorta
Backflow of blood
- collects in the cusps of the aortic valve
- cusps fill up with blood, and that allows them to
Blood Flow during closes valve and
kind of inflate in size and join up with each other and Ventricular Systole causes filling of
seal off
- Two of these cusps contain the coronary arteries coronary arteries
left and right, which are going to go on to supply the
myocardium or the heart muscle itself
to to
myocardium myocardium
Valve Open Valve Closed

Coronary Circulation Anterior Interventricular/
Left Anterior Descending
• Arteries
• Right Coronary Artery
• Right Marginal R Marginal
Diagonal
• Posterior Interventricular
• Branches to SA and AV nodes (hard to see)
• Left Coronary Artery: Circumflex
• Anterior Interventricular/Left Anterior Descending

• Diagonal (anastomoses with posterior IV)
• Circumflex - these arteries are going around the heart (like a crown)
- marginal means edge (right edge of the heart)
L Marginal
- posterior interventricular artery —> posterior side of the heart
• Left Marginal between the ventricles
- some branches to the sinoatrial and atrioventricular nodes (hard to
see) —> important for the contraction of the heart
- left anterior descending —> going to travel in the interventricular
sulcus on the anterior aspect of the heart
- anastomosis is important for collateral blood supply
- circumflex means around in a circular motion —> going around the
Post Interventricular
left side of the heart and going to give rise to the left marginal artery
Great Cardiac
Coronary Circulation Anterior Cardiac
• Veins
• Coronary Sinus (within coronary groove – posterior) Small Cardiac
• Great Cardiac Vein - the primary collecting area for venous blood
in the heart is the coronary sinus Middle Cardiac
• Left Posterior Ventricular Vein - on the posterior aspect of the heart just
inferior to the atria
• Left Marginal Vein - going to collect blood from the heart itself
- greater cardiac vein = the interventricular
sulcus
• Middle Cardiac Vein - left posterior ventricular vein = on the
posterior aspect of the heart between the
• Small Cardiac Vein ventricles
- small cardiac vein = pairs up with the right Coronary Sinus
• Anterior Cardiac Veins marginal artery

- anterior cardiac veins = going to drain
directly into the right atrium
- the coronary sinus drains into the right
atrium and the anterior cardiac veins also L Marginal
drain into the right atrium
Where does the coronary sinus drain into?

L. Posterior Ventricular
Middle Cardiac
Heart Attack/Myocardial Infarction - athlerosclerotic plaques limit the amount of blood that can flow
through; fully obstructed = can’t get blood through = heart attack
- heart attack means that blood can’t get to the muscle and the
• Disruption to coronary blood flow heart will still keep pumping, but muscle is being damaged
- cardiac arrest means the heart stops pumping
- transient disruption in blood flow could be angina
• Commonly caused by atherosclerosis, a narrowing of the

lumen due to plaque deposits on the vessel wall
• Risk Factors:
• Smoking, BP, cholesterol, obesity,
diabetes, exercise, stress
• Age, family + medical hx, heritage
• a number of coronary arteries and

depending on where along the artery,
you could get a blockage or a
• Angina = temporary disruption rupture, that will determine exactly
what area of muscle is impaired
• Location + extent of damage depends

upon location of damaged vessel
To Summarize…
• Thorax can be divided into 6 cavities:
• Superior, Middle, Anterior + Posterior Mediastinum and Pleura
• Heart is a muscular pump at the center of pulmonary (to lungs) and
systemic (to body) circulation
• 2 Halves (right + left)
• 4 Valves (2 AV, 2 semilunar)
• Foramen Ovale + Ligamentum Arteriosum are remnant fetal

structures, once responsible for bypassing the lungs
• Heart itself exists within the pericardium, a 2-layered sac
• Circulation to the heart is termed “coronary” circulation
• Disruption = heart attack
Brachiocephalic trunk
To Summarize… Left subclavian artery
Left common carotid artery
Arch of aorta
Superior vena cava
Ligamentum arteriosum
Ascending aorta Left pulmonary artery
Right pulmonary Left pulmonary veins

veins
Pulmonary trunk
Right auricle of right atrium Left auricle of left atrium
Right atrium
Coronary sulcus Left ventricle
Anterior interventricular
Right ventricle
sulcus
To Summarize… Brachiocephalic trunk
Aortic arch Superior vena cava
posterior view
Right pulmonary arteries
Left pulmonary artery
Left pulmonary veins Right pulmonary veins
Left atrium Right atrium
Coronary sinus Inferior vena cava

(in the coronary sulcus)
Right ventricle
Left ventricle
Posterior interventricular
sulcus
©
katelyn.wood@uwo.ca
Hip + Pelvis
katelyn.wood@uwo.ca
Learning Outcomes
• Compare/Contrast features of the upper and lower limb
• Outline blood supply of the lower limb
• Identify the location and components (bones + ligaments) of the 3 joints of the
pelvis
• Understand clinical implications of femoral head fracture or dislocation
• Identify muscles which cross the hip, their primary actions and innervation
Lower Limb Overview
- upper limb’s main goal
is grasping and the
lower limb’s main goal is
weight bearing (gait)
- upper limb is smaller =
smaller bones
- lower limb is bigger =
larger bones
- the joints of the upper
limb have a specific
pattern of mobility and
stability and change as
you move throughout
the upper limb; this
pattern is not conserved
when you get to the
lower limb
Flexion, Extension + Limb Formation
- upper limb flexion is always to the anterior

- lower limb flexion of the knee occurs towards the
posterior
- due to embryological development
- at 8 weeks, we see limb rotation
- arms and legs grow out as little buds and grow out
laterally
- then start angling anteriorly and get a bend in them
for the elbows and knees ~ 8 wks gestation
- at 8 weeks they start to rotate
- arm is going to supinate
- lower limb is going to pronate
L2
Lumbosacral FEMORAL NERVE
Plexus extensors of knee

L2-L4
L5
Terminal Branches
OBTURATOR NERVE
S1
- lumbosacral plexus is the analogous structure ti the adductors of hip (flexor)
brachial plexus
- termed lumbosacral because all of the anterior rami that L2-L4
recombined to form peripheral nerves come off of the lumbar
and sacral regions inguinal ligament
- extends from L2 to S4
- key vertebra is L5 and S1 SCIATIC NERVE S4
- S1 is the start of the sacrum
- sciatic nerve = everything in the posterior compartment
(tibial & fibular nerves)
- sciatic nerve is the tibial and fibular nerves together in a L4-S3
common sheath
- moves through the thigh as the sciatic nerve and then split
around the politeal fossa to become the tibial and fibular
nerves
TIBIAL NERVE
flexors of knee, plantar flexors &
There is a separation of intrinsic flexors of foot
anterior flexor and posterior L4-S3
obturator
extensor divisions; flexor to foramen
FIBULAR NERVE
the back of the limb, extensor
(common peroneal)
to the front Dorsiflexors, extensors & evertors of foot
L4-S2
Arterial Supply
- the blood starts off in the abdominal aorta
- will bifurcate to form the left and right common iliac arteries
- will bifurcate (split in two) again to become the internal and
external iliac artery
- internal iliac artery —> supply the musculature and viscera of
the pelvis
- external iliac —> supply the lower limb
- once passed under the inguinal ligament, the external iliac
artery becomes the femoral artery and a branch off of there
called the deep artery of the thigh
- deep artery of the thigh —> going to supply all the deep
musculature right next to the femur
- femoral artery going to go through the adductor canal
- hole called the adductor hiatus becomes popliteal artery on
the back of the knee
- popliteal bifuricates and forms anterior tibial artery —> sneaks
through the interosseous membrane coming back to the
anterior aspect of the lower limb (shank) and becomes the
dorsal petal artery on the top of the foot
- other branch off popliteal is hte posterior tibial artery
- runs along the interosseous membrane = medial plantar
artery and supply the bottom of the foot
- gives off a branch called fibular artery —> supplys the lateral
aspect of the shank
Deep Veins To heart
(same names as arteries)
Venous Supply
- superficial veins have different names
- deep veins start off with the posterior tibial veins and
venules and then become the popliteal vein as it goes
through the posterior aspect of the knee
- turns into the femoral vein and drain into the external
iliac vein
- deep veins are responsible for returning blood
Deep veins return Superficial

during exercise
- veins are floppy in nature; they collapse when there
isn't anything inside
blood during Veins - muscles will squeeze the veins and push blood
along
- veins have valves in them --> it stops retrograde or
exercise flow in the opposite direction or away from the heart
- called the muscle pump --> going to help bring blood
back to the heart
Popliteal V.
Superficial veins
From leg
return blood @
Muscle contractions
rest Lesser Saphenous V. squeeze deep veins;
- superficial veins begin off with the dorsal venous plexus which
is on the dorsum (top of the foot)
- can again go through the lesser saphenous vein and can drain
into the popliteal vein but can also continue through the thigh as
Valves force blood
the great saphenous vein
- superficial veins return blood at rest
return to heart
- on top of the fascia lata, they have to go through a hiatus up Dorsal Venous Plexus
underneath the inguinal ligament
Fascia of the Lower Limb
Fascia Lata
Continuous with inguinal ligament, inferior
abdominal wall
Encloses thigh muscles - facial sleeve
- covers the whole leg
Thickened @ iliotibial (IT) tract - IT is on the lateral
aspect of the thigh
- continuous with the
deep fascia of the
shank
Deep Fascia of the Shank
“Crural Fascia”
Divides Shank into 3 compartments:
Anterior, lateral, posterior
The Lower Limb Hip
LOWER LIMB
pelvic bones
femur Thigh
patella Knee
tibia
fibula
tarsal bones
metatarsals
phalanges
Shank/Leg
Ankle
Foot
fovea
- the place where the
ligament of the head of the
Femur femur attaches

- ligament holds the head of
the femur in the socket and
also contains an artery
- round articular surface

- joins the pelvis creating hip
joint

posterolateral view
The Os Coxae
- hands on the hips = ilium
- ischium = the bony part of the pelvis that
• 3 Bones which fuse you sit on; bony prominence underneath the
glutes
at the acetabulum - pubis is at the anterior aspect
- pubic bone = pubis
• Ilium - acetabulum —> area in which the 3 bones
come together and form the socket for the
• Ischium hip joint
- on the posterior aspect, it is going to join
• Pubis up with the sacrum to form the actual pelvis
- pelvis itself is tilted forward
- in anatomical position, the pubis is inferior
to the sacrum
• Other Terms:
• Innominate bone
• Hemipelvis
- greater and lesser sciatic notch --> important passage of nerves and vessels out of - also called hemipelvis
the pelvis and into the gluteal region
- gluteal fossa --> more posterior anterior view
- iliac fossa --> more anterior
The Os Coxae
- auricular means ear --> auricular surface is ear
shaped; this is the area where the sacrum is
going to articulate with the os coxae
- obturator foramen --> hole right at the inferior
aspect of the os coxae
lateral view
Surface
PSIS
ASIS
Pubic
PIIS Tubercle
AIIS Acetabulum
Greater Sciatic
Notch
Ischial
Spine
- acetabulum = socket for the hip joint
Lesser - pubic tubercle = bony prominence and the
anterior aspect of the os coxae (going to
Sciatic Notch join up with the other half to form the pubic
Fossae:
Obturator symphysis)
- Gluteal
-ischial spine = important obstetrical
Foramen landmark
- ischial tuberosity
- Iliac
- "you sit on your ish"
The Acetabulum - lateral view of the acetabulum
- fusing of the ischium, ilium, and
pubis
- labrum of the hip similar to the
labrum at the shoulder
- lunate surface —> area covered by
articular cartilage within the
acetabulum
- ligament of the head of the femur
attaches to the fovea on the femur
Sacrum
Os Coxae
Femur

Surface Anatomy
Pelvic radiograph Lumbar Spine
Ilium
Sacrum
Femur Coccyx
Superior Pubic Ramus
Pubis
Obturator Foramen
Ischium
Inferior Pubic Ramus

Pelvic radiograph
Iliac Crest
superiorly
- sacroiliac joint (SI) where
the ilium and sacrum join SI Joint
together
Anterior Superior
Iliac Spine (ASIS)
Anterior Inferior
Ischial Spine
Iliac Spine (AIIS)
Acetabulum
Pubic Symphysis

femur Posterior Proximal Femur
- shaft —> long part of the bone
- fovea —> where the ligament of the Acetabulum
head of the femur attaches
hip replacement Neck

- going to replace both the acetabulum Fovea for Head
and the head of the femur
Hip Replacement ligament
of head Greater
of femur trochanter
of femur
Lesser
Ischial tuberosity trochanter of
femur
Shaft of femur

https://www.mededportal.org/doi/10.15766/mep_2374-8265.9466 Medial Lateral
Joints of the Pelvis
Ligaments of the Pelvis
Sacrospinous = sacrum to ischial spine
Sacrotuberous = sacrum to ischial tuberosity
Sacroiliac = SI Joint
Greater Sciatic Foramen
Lesser Sciatic Foramen
- sacroiliac --> going to hold the sacroiliac (SI) joint together
- sacrotuberous ligament --> going to extend from the sacrum to
the ischial tuberosity
- sacrospinous ligament --> runs from the sacrum to the ischial
spine
- the greater and lesser sciatic foramen are formed from the
ligaments, and the greater and lesser sciatic notches on the os
coxae
- all these strutures exist bilaterally
posterior view
anterior view
anterior view
medial view
medial view
superior view
superior view
anterior view
Sacroiliac (SI)
3 joints of the pelvis:

1. Sacroiliac joint —> between the acrum
and the ilium
2. hip joint —> between the head of the
femur and the acetabulum
3. pubic symphysis —> between the two
pubic (pubis) bones at the anterior aspect of
the pelvis
Hip
Pubic Symphysis
Sacroiliac Joint
anterior view
• Sacrum + Ilium
• Bilateral, synovial joint
• Relatively immobile
due to strong
ligaments
• Anterior/Posterior
Sacroiliac
Pubic Symphysis
anterior view
• L + R Pubic Rami
• Cartilaginous Joint
• Symphysis
• Hyaline Cartilage on
ends of bones,
fibrocartilage disc in-
between
during pregnancy and
parturition (birth), these joints
can become slightly more
mobile
Open Book Fracture
• Separation of Pubic
Symphysis
• Normal = 4-5mm
• Pregnancy = 8-9mm
• 2 main causes:
• Diastasis symphysis pubis
(during child birth)
• Traumatic Injury
• Complications:
• Infection & hemorrhage
substantial blood loss in the pelvic
cavity
Lower Limb Radiology Tutorial – https://www.mededportal.org/doi/10.15766/mep_2374-8265.9466
Hip Joint
anterior view
• Femoral Head +
Acetabulum
• Bilateral, Synovial
Joint
• Ball & Socket Joint
• Highly mobile
• Less than shoulder
Hip Joint
Ligaments
- iliofemoral joint —> going from

the ilium to the femur
- pubofemoral —> going from the
pubis to the femur
- ischiofemoral —> going from the
ischium to the femur
Iliofemoral
Pubofemoral
Ischiofemoral
Intracapsular Structures
Acetabular Labrum
• Thickening of fibrocartilage
around the acetabulum
• Deepens the socket for better
contact with the femoral head
Ligament of Head of the

Femur
• Contains obturator A branches
- obturator artery branches important for
providing vasculature to the head of the femur ;
attaches in on the fovea
transverse ligament of the acatabulum —>

thickening on the inferior aspect of the
acatabulum that helps reinforce that position
Hip Joint
Summary
Joint
capsule
Acetabular
Labrum
Acetabular Fovea
fossa
Obturator Greater
Membrane Lig. of trochanter
head of
femur
Lesser
trochanter
Hip Bursae - helps cushion ligaments and skin that
crossover bone
• Trochanteric
• Separates glutes from
greater trochanter
helps prevent the rubbing between the gluteal muscles and the bone
- greater trochanter on the lateral aspect of the femur
• Ischiogluteal
• Separates gluteus
maximus from ischial
tuberosity
- exists on the inferior aspect of the ischial tuberosity
• Iliopsoas
• Separates iliopsoas from https://www.sciencedirect.com/book/9781416031970/the-sports-medicine-resource-manual
hip joint capsule - if there is a change in diet rapidly (ex. suddenly malnourished)
the bursae can change size
- one way to notice is if it becomes painful to sit; no longer have
cushioning of a fluid filled sac underneath the ischial tuberosity
Hip Fracture vs Dislocation
Fracture
- iliopsoas, one of the
muscles crossing the hip,
pulls on the greater
trochanter of the femur
and turns the femur into
external rotation
dislocation Posterior
- posterior; the traction of
Pull of iliopsoas the adductor group causes dislocation
on lesser internal rotation causes
trochanter of traction of
femur = the adductor
external group =
rotation internal
foreshortened foreshortened rotation
external rotation internal rotation
FRACTURE DISLOCATION
FOOT DROP
Hip Dislocation - seen when someone has a car
Why?
accident
Foot Drop - their hips are flexed and knees hit
the dash
- pushes the femur out of the socket
posteriorly
• Characterized by an inability the nerve is the
sciatic nerve
to dorsiflex and reduced

eversion
• Foot hangs, plantar flexed
and slightly inverted when
raised off of the ground Posterior dislocation
in hip flexion
• High steps are required for the picture
- the head of the femur has
walking and the foot “clops” translocated posteriorly out of
the acatabulum and is
on the ground femur pushong up against a nerve;
generally occurs when the hip
- the sciatic nerve isn’t firing; it controls the muscles sciatic nerve is in flexion
blood supply to the head of the femur comes through two
arteries
- foveal artery —> branch of obturator
- branches from the lateral circumflex femoral artery —>
Femoral Neck Fracture branch off of the femoral artery itself

- fracture at the neck can tear the arteries resulting in
avascular necrosis
Obturator A
Epiphyseal Plate
- obturator artery has a bit of blood supply

in it, going through the ligament of the
Femoral A head of the femur but if you lose that
Fracture to Femoral Neck vascular supply from the femoral artery,
Avascular necrosis the head of the femur can be in trouble
Hip
Muscles Acting on the Hip
• Gluteals • Iliopsoas
• Gluteus Maximus • Iliacus
• Gluteus Medius • Psoas
• Gluteus Minimus
• Tensor Fascia Latae • Thigh
• Flexors
• Deep Rotators • Quadriceps Femoris, Sartorius
• Obturator Externus • Hamstrings
• Obturator Internus • Biceps Femoris,
Semimembranosus,
• Gemelli Semitendinosus
• Piriformis • Hip Adductors
• Quadratus Femoris • Pectineus, Adductor Longus,
Adductor Brevis, Adductor
Magnus, Gracilis
Gluteal Compartments Hip Adductors
(within thigh)
Iliopsoas
Gluteals
Deep Rotators
Iliopsoas
• Composed of both Iliacus + Psoas
• Innervation: Femoral N Psoas
• Function: Hip Flexion

Iliacus
they cross over the anterior
aspect of the joint
flexion
of hip
Gluteus
Medius
Gluteals *
Gluteus Maximus
Tensor
Fascia Latae
• Function
• *Hip Extension, Lateral Rotation
• Hip Abduction, Medial Rotation Hip
- on the posterior aspect of the hip
*Extension abduction
Gluteus Maximus
- largest and most superficial of the of hip
• Innervation gluteal muscles
- responsible for extension of the hip
and lateral rotation of the thigh
• Inferior Gluteal N* - innervated by the inferior gluteal
nerve
• Superior Gluteal N
deep to the gluteus maximus --> gluteus medius and minimus *Lateral Gluteus
- both are responsible for hip abduction and medial rotation of the thigh
Rotation Minimus
- with every muscle, the actions they can perform depends solely on
how it acts on the joint --> how it crosses it and how it attaches to the
bone on either side
- the tenor fascia latae,
tensor fascia latae gluteus medius and gluteus
- to tense the fascia latae; joined into the fascial sleeve that covers the outside minimus are innervated by
the superior gluteal nerve
of the lower limb
Medial
Rotation
Obturator Externus
Deep Rotators
- lateral rotation of the hip and hip Hip adduction
abduction
• Function: Lateral Rotation of Hip

• Hip Abduction
• Obturator externus = Adduction Piriformis
include piriformis, the gemelles, obturator internus, quadratus, femoris,
and obturator externus Gemelli
• Innervation Innervation differs across all of these muscles Obturator
• N to piriformis Internus
• N to Obturator Internus Quadratus

Femoris
• N to Quadratus Femoris
• Obturator N
Lateral
Rotation Hip abduction
Gluteal Region Nerves
• Sciatic N
(Inferior to Piriformis)
• Hamstrings Piriformis
- size of thumb and innervates hamstrings and
other things in the lower limb - triangular shaped
- the most superior of
• Superior Gluteal N the deep rotators
(Superior to Piriformis)
innervates • Gluteus Medius + Minimus
• Tensor Fascia Latae
• Inferior Gluteal N
innervates • Gluteus Maximus
- much smaller than the sciatic
nerve
- greater and lesser sciatic foramen are
formed by the ligaments of the pelvis, and
notches, the greater and lesser sciatic notch
Neurovascular Pathways on the os coxae

inferior
1. Superior Gluteal N
2. Inferior
superior
Gluteal N + Sciatic N

3. Pudendal N innervates perineum
Obturator Foramen
4. Obturator N
Femoral Triangle
5. Femoral N
6. Femoral A & V
medial view of the pelvis
To Summarize…
• 3 joints exist within the pelvic girdle:
• Sacroiliac, Pubic Symphysis and Hip
• Movement of the lower limb originates at

the Hip
• 4 groups of muscles act on the hip joint:

• Gluteals, Iliopsoas, Thigh & Deep Rotators
• You should be able to identify all 12 muscles we spoke about
today, and understand their innervation + function
©
katelyn.wood@uwo.ca
Intro to Neuro
katelyn.wood@uwo.ca
Learning Outcomes
• Correctly label both sensory and motor neurons
• Compare/Contrast cells of the central and peripheral nervous systems
• Describe the process of neuronal transmission and saltatory conduction
• Describe how demyelinating diseases affect the CNS and PNS
• Describe what happens to transmit a signal across a synaptic cleft via

neurotransmitters
• Differentiate between the Central and Peripheral Nervous Systems

Nervous System
Function + Cells
Nervous System Function
Enables the body to react to continuous change in its internal and external
environments
Controls and integrates bodily activity
Neurons & Neuroglia = 2 specialized cells in the nervous system

Neurons = sensory + motor they either provide information about sensation or transmit motor information to the body
Neuroglia = Schwann cells (and others) supportive cells
Nonexcitable cells supporting, insulating and nourishing neurons

For every neuron, there are 5
neuroglia to support it
Cells of the Nervous System

Neurons Neuroglia
• Transmit information • Nonneuronal, nonexcitable cells
• Myelinated cells transmit signals • 5X as abundant as neurons
faster • Support cells for neurons:
• Types: • Supporting, insulating & nourishing
• Multipolar motor neuron
• Pseudounipolar sensory neurons
• CNS: oligodendroglia, astrocytes,
ependymal cells & microglia
• PNS: satellite cells, Schwann cells
where you are going to see
where all of the pieces of synaps (could be with other
information are summed together. neuron or with an end organ)
Neuron Structure If threshold is reached, then you

get action potential
Trigger zone
Axon terminal
(Axon Hillock)
Multipolar Motor Neuron acting like a wire
helps with faster
connecting the cell
conduction
body to the
Cell body periphery. Signal is Myelin sheath
transmitted down
integrate all of the signals together and decide
whether or not the neuron is going to send an action Axon
potential
Node of Ranvier
Dendrites
Collect the information. They synapse with
number of other things, typically other
neurons (let's the cell know whether or not
there's a signal to be transmitted
Found in: ANS + Skeletal Muscle Control
Did you know…
Neuron Structure A collection of cell bodies is

called a “ganglia”
Pseudounipolar Sensory Neuron Dendrites

- going in the opposite direction because
Cell body Node of
sensory neurons carry information from the Myelin Ranvier
periphery to the brain
- take signals form the receptor organ and sheath Trigger
transmit them to the CNS (the brain)
zone
(via dorsal horn of SC)

- the dendrites are connected directly into an
axon instead of a cell body
Receptor Organ
- trigger zone --> sum the information the
dendrites collect to decide whether or not an
action potential is worth sending (the
CNS
peripheral process)
- the central process is the one between the
cell body and brain
- sensory neurons are found in sensory
signaling
- cell body on sensory neurons is in the
center because they usually come from
Central process
ganglia that exists in the periphery
Peripheral process
Axon terminal
Found in: Sensory Signaling
- a degenerating oligodendrocyte will influence multiple neurons, and that's going to have a much more
widespread influence than a degenerating Schwann cell
Neuroglia - the structures of these cells mirror each other (slightly different)
- location of nucleus is different because Schwann cells exist as a single myelin wrapping, the nucleus of it
exists as part of the myelin sheath
- have separate cell body for an oligodendrocyte and the nucleus is within the cell body
- nodes of Ranvier --> piece of unmyelinated axon that exists throughout the neuron and important for
Myelination conduction
CNS - Oligodendrocyte PNS – Schwann Cell

• Forms several myelin sheaths • Forms one myelin sheath
• Myelinates sections of several axons • Myelinates one section of an axon
Schwann cell
Node of
Node of Ranvier
Ranvier
Nucleus Myelin
Myelin sheath
Oligodendrocyte sheath
Axon Axon
Nucleus
Neuroglia Myelinated Axon Unmyelinated Axons
Myelination
- unmyelinated axons --> one supportive cell that is
lightly wrapped around several axons adn not going to
provide the same amount of insulation that it would if it
was a myelinated cell
Schwann cell Schwann cell
Node of Ranvier
Myelin sheath
Unmyelinated
Myelinated axon
axons
Peripheral vs Central Neuropathy
CNS: Multiple Sclerosis PNS: Guillain-Barré Syndrome
• Slow progression
• Progression over days to weeks
• Onset between ages 20-50
• Afflicts any age (more common <40)
• Life expectancy decreases 7-14 years, no
cure but remission can occur • 80-90% recover within 2-4 weeks
• Oligodendrocytes won’t repair themselves • Schwann cells can dedifferentiate, proliferate
• Secondary demyelination due to high ratio of and remyelinate bare axons over time
Schwann cells can repair themselves
axons myelinated by a single oligodendrocyte
Signal Propagation +
Depolarization Na+Cl-
Electrical signal propagation is caused by progressive

depolarization of the cell
Resting membrane potential = -80mV
K+
- the resting membrane potential will change throughout the cell in a progressive
manner
- plasma membrane outside separates the interior of the cell from the exterior of the cell
- outside is more positive and inside is more negative
- outside there is lots of sodium and sodium is a positively charged ion
- inside there is lots of potassium
- starts at the trigger zone (axon hillock) and the dendrites are
going to collect all of the information about a change in the
polarization
Na+Cl-
- sodium rushes into the cell, the voltage gated channels -->
called depolarization (flip the polarization = inside of the cell
become more positive)
- at the same time potassium is going to start to flow out of the
cell (rebalancing the polarization of the cell --> repolarization)
K+
Depolarization

It starts at the “trigger zone” where multiple stimuli
(received through dendrites) can sum to initiate an
“action potential”
a) Resting membrane potential @ -80mV
b) Na+ rushes in via voltage gated channels = depolarization
c) K+ flows out of cell = repolarization
d) Na+/K+ exchange pump restores balance of ions
- in myelinated fiber, depolarization jumps from one Node of Ranvier to another
- in unmyelinated fiber, you have to depolarize every single part of the axon in sequence
(takes longer)
- myelinated fibers move at a speed of 3 to about 120 meters per second
Signal Propagation + - unmyelinated fibers take longer to move --> 0.5 to 2 meters per second
Depolarization
Conduction Velocity depends upon:
Larger fiber diameter = faster conduction velocity
Myelination = faster conduction velocity (saltatory conduction)
Myelinated Fiber Unmyelinated Fiber
3-120 m/s 0.5-2.0 m/s

Neuronal Synapse
• Once a synaptic cleft is reached, neurotransmitters must be released to
continue signal transmission from one neuron to another neuron or
effector organ
- encounter a neuronal synapse
Neuronal Synapse
1. Impulse arrives at end bulb
2. Voltage gated Ca2+ channels
open, Ca2+ flows into cell
3. Increased [Ca2+] causes
neurotransmitter release
4. Neurotransmitters cross
synaptic cleft to bind
receptors on postsynaptic
membrane
5. Voltage gated channels open,
allowing Na+ to enter cell
6. Post synaptic cells depolarizes
7. Nerve impulse initiated
Neuronal Structure Review
Structure Function
Axon conduct electrical impulses
conduct electrical impulses
Dendrite receive input signals

receive input signals
Area where electrical activity is summer prior to

Trigger Zone area where electrical activity is summer prior to transmission
transmission
end of neuron, synapses with target
Axon terminal end of neuron, synapses with target neuron/structure
neuron/structure
Nucleus contains genetic
contains genetic information of cell information of cell
contains nucleus, protein synthesis, AP

Cell Body (soma) contains nucleus, protein synthesis, AP generated here
generated here
spaces between myelin (for saltatory
Node of Ranvier spaces between myelin (for saltatory conduction)
conduction)
formed from schwann cells, increases rate of
Myelin Sheath formed from schwann cells, increases rate of transmission
transmission
Nervous System
Structure
Nervous System Structure
Anatomical/Structural Functional
• Central Nervous System • Autonomic Nervous System
• Brain • Viscera
• Spinal Cord (involuntary smooth muscle)
• Glands
• Peripheral Nervous System
• Everything else • Somatic Nervous System
• Everything else
PNS:
- the
CNS vs PNS
information as soon as it leaves the spinal cord out
CNS:
Brain
Cranial
nerves
through the spinal nerve, to get to muscles, that is the
peripheral nervous system
- then sensory information originates in the peripheral
Spinal
nervous system will come in and synapse in a ganglia. cord Spinal
- the cell body there of the pseudounipolar sensory nerves
neuron and is going to come in and synapse in the
central nervous system in the spinal cord
Sensory Ganglia
receptor (in skin)
Gray matter Dorsal root

Axon
Dorsal horn terminal Cell body
Dorsal root ganglion
Dorsal Afferent axon Enteric

Ventral
plexuses
Ventral horn
Central Cell body
Spinal nerve
Efferent in small
Axon
canal White axon
Ventral root terminals intestine
matter
Effector (in muscle)

Sensory
receptors
in skin
CNS vs PNS
CNS vs PNS
- motor cells, the cell body will be actually in the spinal cord.
- the cell body is part of the central nervous system, but the
axon is going to exit via the spinal nerve, and that's gonna be
part of the peripheral nervous system
- in the sensory neurons, the cell body is in those ganglia,
which are in the periphery. But the axon terminals come into
the spinal cord to synapse. So those would be central

sensory motor

voluntary control)
or SLUDD)
White & Gray Matter
White & Gray Matter
White matter
Gray matter
(c) Transverse section of spinal cord (d) Frontal section of brain

To Summarize…
• There are two types of cells in the nervous system:
• Neurons = multipolar motor neuron + pseudounipolar sensory neuron
• Neuroglia = Oligodendrocytes (CNS) + Schwann Cells (PNS)
• Neural signal propagation occurs because of progressive cell

depolarization + neurotransmitter release at the synaptic cleft
• The nervous system can be divided in two ways:

• Anatomically/Structurally = Central + Peripheral Nervous Systems
• Functionally = Somatic + Autonomic Nervous Systems
©
katelyn.wood@uwo.ca
Joints
katelyn.wood@uwo.ca
Learning Outcomes
• Identify 3 joint classifications and describe their movement capabilities
• Recall and provide examples of 6 kinds of synovial joints, and describe the type of
movement they permit
• Describe factors contributing to joint stability/ROM

Joint Classifications
Joints
Classification
• 3 classifications:
• Fibrous Found in the skull
• Cartilaginous pubic symphysis
• Synovial most common joint
(ex. finger joint)
- three examples of this are sutures in the skull, the
syndesmosis, which actually is the same thing as
Joints your inferior tibiofibular ligament -- so right at the

base above your ankle, you've got a ligament there
that's a syndesmosis. And gomphosis, which is the
type of joint that keeps your teeth in their socket.
Fibrous
• Articulating Bones connected by fibrous tissue

• Limited movement
• Depends upon length of fibers
Joints
Cartilaginous
• Articulating bones united by hyaline or fibrocartilage

• Primary = Synchrondroses
• Early life bone development
• Secondary = Symphyses
• Strong, slightly moveable joints, united by fibrocartilage
Joints
Synovial
• Articular surfaces = hyaline cartilage
• Free movement between articulating bones
• Joint capsule lined by synovial membrane contains synovial fluid
• Reinforced by ligaments + special structural elements

fluid made by the synovial membrane
• discs, menisci
these capsules are reinforced by ligaments, and
sometimes they even have some special
• 6 joint classes
structural elements to them (discs or menisci)
two articulating bones, that really smooth
cartilage to help with joint mechanics, your
synovial cavity and your fibrous membrane there
to form the articular capsule
Synovial Joints shoulder or
hip
base of your wrist

thumb Saddle Ball and Socket Condyloid
radial head humerus, ulna carpals and

next to the articulatiing at tarsals
ulna in the Pivot Hinge the elbow, or Plane
elbow knee
- stability and range of motion are always at odds with
Joints
each other. in order to gain one, you basically have to
give up the other.
examples of the 1st primary factor
1. glenoid fossa, which is a flat spot on the scapula,
where the humeral head articulates to create a
shoulder joint, the glenoid fossa shaped like a saucer,
Stability vs Range of Motion (ROM) whereas the humeral head is like a ball. And so if you
try and balance a ball and a saucer, you'll notice pretty
quickly, there's not a lot of stability there. But you have
a lot of range of motion. To contrast this, if you look at
1. Shape and arrangement of articulating surfaces the trochlear notch on the ulna, and how that fits over
the humerus, that creates a much more stable elbow
• E.g. glenoid fossa (scapula) vs. trochlear notch (ulna) joint
• Extra structures? (menisci, discs) - if you have more ligaments and tighter ligaments, you
have more stability
- muscle tone example.
2. Ligaments crossing the joint joint like the shoulder, the tone of the surrounding
muscles is integral to the stability of that joint. So if you
• More + tighter ligaments = more stability have an injury to the rotator cuff muscles which hold
the humeral head in that glenoid fossa, you're going to
have a problem with stability
3. Tone of Surrounding Muscles

• Think about atrophy, aging and injury
Stability Range of Motion
Ball & Socket Joints
Shoulder + Hip
• Multi-Axial, synovial joint

• High mobility, low stability
• Labrum (band of fibrocartilage)

improves joint contacts
the glenoid fossa was quite flat, like a saucer.

What this does is it builds up an area around it
to turn into more of a bowl shape to improve
joint contacts. The same thing happens at the
hip. Though the acetabulum of the hip is much
deeper than the glenoid fossa
Shoulder + Hip
Hinge Joints
Elbow + Knee
• Uniaxial joint*
• More stability, less range of motion
• Simple joint = Elbow

• Complex joint = Knee
- this is a uniaxial joint for the most part, meaning that you only
get movement in a single axis.
- elbow will flex and extend at the humeroulnar joint
- knee has a bit of rotation --> more stability and less range of
motion
- elbow only has one kind of degree of motion and the knee has
more *usually
Hinge Joints
Elbow + Knee
elbow --> ulna

wrapping the base of
the humerus creating
solid joint contacts and
a lot of stability
knee --> not the same
interlocking piece. You
have the tibial plateau,
and the femoral
condyles sitting on top
and is aided by the
menisci and intra
articular structures to
improve bony contacts
Synovial Joints Tendons/
Muscles
Are made from 5 structures Bursae
Bones
Intra-Articular
Structures
menisci, the
Ligaments discs or a
+ Capsule labrum
Joint Injury Did you know…
Damage to muscle tendons is called
a strain?
Sprains
• Ligaments are connective tissue structures which bind bones together

• Non contractile tissue can't actually actively contract back to the shape they want to be in
• Damage occurs when forces exerted exceed their strength
• Bones do not dislocate, but ligaments are torn
• Grade 1) Stretching or slight ligament tearing with mild tenderness, swelling & stiffness
• Grade 2) Incomplete tear with moderate pain, swelling & bruising
• Grade 3) Complete tear of ligaments with severe swelling, bruising + instability
• Treatment: PRICE
• protection, rest, ice, compression, elevation
Intra-Articular Structures
Primary ones, the medial collateral ligament and the
lateral collateral ligament
• Extracapsular Ligaments
• Reinforce capsule
• Intracapsular Ligaments
• Within a joint, but excluded from
synovial cavity
• Articular Discs
• Absorb shock
• Better fit between bony surfaces
• Distribute weight Tibial Plateau (knee)
• Labrum
• Common in Ball& Socket Joints
• Fibrocartilaginous lip extending from the
edge of a joint to deepen the socket +
- a lot of friction between 2 surfaces (bones + tendons, noes + ligaments, bones + skin) you will find
a bursa --> helps protect the structures from each other
Joint Injury - tendon sheath provides a channel that has got some cushioning so the tendon doesn't undergo
much wear and tear
Bursitis
• Bursas are fluid filled sacs that reduce friction

between moving parts
• Also includes tendon sheaths
• Fibrous capsule lined with synovial fluid
• sometimes continuous with synovial joint capsules
• Chronic inflammation of a bursa = bursitis
typically caused by:
• Irritation from repeated excessive exertion of a joint
• Trauma
• Acute Chronic Infection
• Rheumatoid Arthritis
To Summarize…
Fibrous Cartilaginous Synovial
Tight, very limited Somemovement,
Some movement,
Tight, very limited Freemovement
Free movement
Function movement allowgrowth
allow growth forfor
between bones
movement new bone between bones
new bone
Stability Most
Most Middle
Middle Least
Least
Smaller fibres
Smaller fibres = less Primary and secondary
= less
Features? 1° and 2° classes
classes
Joint
Jointcapsule
capsule
movement
movement
Both
Bothhyaline
hyaline & &
Cartilage? No!
NO!Fibres
Fibres fibrocartilage Hyaline
Hyaline
fibrocartilage
Suture, 6 6classes:
classes: pivot,
pivot,
1°Primary epiphysial
Epiphysial plate
Suture, gomphosis,
gomphosis, plate plane,
plane, hinge,
hinge,
Example 2° Intervertebral condyloid, saddle,
syndesmosis
syndesmosis Secondary condyloid, saddle,
disc
intervertebral disc ball & socket
ball & socket
To Summarize…
• Stability vs ROM at a joint is dictated by:
1. Shape and arrangement of articulating surfaces
2. Ligaments crossing the joint
3. Tone of surrounding muscles

©
katelyn.wood@uwo.ca
Knee
katelyn.wood@uwo.ca
Learning Outcomes
• Identify key bony landmarks on the femur, patella, tibia and fibula associated with
the knee
• Identify the location, components (bones + ligaments + intra-articular structures)

and actions of the 3 joints of the knee
• Identify muscles which cross the knee, their primary actions and innervation
• Explain how morphology & spatial alignment of anatomical structures contribute to

stability and mobility of the knee
Lower Limb Overview
The Lower Limb Hip
LOWER LIMB
pelvic bones
femur Thigh
patella Knee
tibia
fibula
tarsal bones
metatarsals
phalanges
Shank/Leg
Ankle
Foot
- primary function of the bones is to allow the weight of the body and the thigh to be transferred through to the shank and ankle
- major necessity when it comes to propulsion or locomotion
- there is contact between the femur and tibia but no contact between the femur and fibula
- fibula exists on the lateral aspect of the shank and is going to prevent rotation in the case since the two bones, the fibula and tibia, don’t participate in pronation and
supination
Bones of
- patella —> on the anterior aspect of the knee increase the force production that the quadriceps femoris muscles are capable of by increasing the moment arm that they are
acting on the knee joint at
- lateral and medial tibial condyles form the tibial plateau —> which is one surface articulating within the knee
- tibial tuberosity —> the attachment point for the quadriceps femoris via the patellar ligament
- intercondylar eminence —> posterior; key attachment point for ligaments
the Knee
• Femur = transmits
force from pelvis
through the knee
• Tibia = weight
bearing in the shank
• Fibula = rotational
stability
• Patella = increases
force production
(moment arm) at
joint
Surface Anatomy
Anterior Posterior
Joints of the Knee
Lateral
Joints of the Knee

Femorotibial + Patellofemoral = Knee Joint
Femorotibial Jt Patellofemoral jt
Transverse
- femorotibial joint
- patellofeoral joint —> the joint between the
femur and patella and the proximal or superior
tibiofibular joint
- the femorotibial and patellofemoral form the
knee joint —> they share a joint capsule and
the proximal or superior tibiofibular joint is not
part of the knee proper
Proximal/Superior
Tibiofibular jt
Anterior Posterior
Knee Function
Transition Zone Standing & Locomotion
- popliteal fossa —> allows neurovascular structures to move
- the knee itself if more mobile than the elbow despite it being a
from the thigh into the shank and this is one the posterior
hinge joint
aspect of the knee
• Connects Thigh to Shank • Stability vs Mobility

Lateral Knee
Femur
Quadriceps tendon
Lateral condyle of femur
Patellofemoral Jt
- the quadriceps tendon that's going

to insert onto
the patella and continue down to
insert on the tibial tuberosity via the Patella
patellar ligament
- There's the
patellofemoral joint existing between Femorotibial Jt
the femur and the patella and the
femoral tibial joint existing
between the femoral condyles and
Patellar ligament
the tibial plateau
Fibula Tibia
Posterior Anterior
The Femorotibial Joint
3 Factors Contribute to Joint Stability/Mobility

• E.g. glenoid fossa (scapula) vs. trochlear notch (ulna)
• Extra structures? (menisci, discs, labrum)

• More + tighter ligaments = more stability

• atrophy, aging and injury
Stability Mobility
Bony Contacts
• Low stability, based on
bones alone
• Small area of contact =
High force transmission Femoral condyle
• What really happens?

• MENISCI!!
- the tibial plateau is like a saucer
- the femoral condyle is like a ball
- low stability since there is a circular object on top of a flat object
- small area of contact between the bones which means high amount of force transmission
through a small area could lead to an injury
- menisci —> intrarticular wedge-like structure to add more support and stability through the
bony contacts; provides additional cushioning so that when you load the joint, the menisci
can spread out the area of contact and reduce the pinpoint forces that would generally
Tibial Plateau
cause damage
- they're made of a dense form of cartilage that's not going to
break down easily and absorb some shock
- particularly important when you load the joint
Menisci - prevents wear and tear on the knee

- the menisci themselves can become damaged
- if the fibrocartilaginous structures can be damaged over time
—> throws off the kinematics of the joint and can lead to
progressive injury if not treated properly
• Deepen + stabilize articulating surfaces

• Fibrocartilage shock absorbers Superior View, Tibial Plateau
• Protects underlying hyaline cartilage + bone Left Knee
Medial
Meniscus
Lateral Meniscus
Normal Meniscus Repaired Meniscus
https://www.howardluksmd.com/orthopedic-social-media/what-is-the-function-of-a-meniscus/
1 2
Anterior View
1 2
Number 1
- normal knee
- even joint space across the
whole joint
- right knee
Number 2
- left knee
- seven years post a subtotal
meniscectomy and the loss of
the joint line on the medial side
lead to taking the meniscus out
and the bones are contacting
with each other
Anterior View
Provide mediolateral
Ligaments of the Knee stabilization
Collateral
- collateral ligaments provide mediolateral

stabilization; exists on the medial and
lateral aspect (MCL and LCL)
- the medial collateral ligament is
attached to the medial meniscus, there's
no space between them
- the lateral collateral ligament is
separated from the lateral meniscus
Named based on
Ligaments of the Knee tibial attachment
Cruciate
- cruciate ligaments exist on the
midline of the joint; cruciate
means crossed
- the anterior ligament attaches
on the anterior aspect of the
tibia
- the posterior ligament attaches
tibia
- crossed in a medial-lateral
formation but also crossed in an
anterior-posterior orientation
- patellar ligament reflected
inferiorly

Named based on
Cruciate
- starts on the anterior aspect of the
tibia and moves to the posterior aspect
of the femur
- The bone that moves though is just
Anterior Cruciate Lig (ACL) based on whether or not the foot is
planted or the foot is free
Foot Planted:
• Prevent femur moving
posteriorly on tibia
Foot Free:
• Prevents Tibia from moving
anteriorly under femur
Lateral
Named based on
Cruciate - begins on the posterior aspect of the tibia and attaches
to the anterior part of the femur
Posterior Cruciate Lig (PCL)

Foot Planted:
• Prevents femur from
moving anterior on tibia
Foot Free:
• Prevents tibia from
moving posterior under
Lateral femur
Named based on
Cruciate “right knee”
- anterior cruciate in front
posterior cruciate behind
- crossing of these
ligaments, both in the
frontal plane and the
sagittal plane
- ex. right knee —> start
off with the right leg being
the anterior cruciate
ligament, and the left leg
being the posterior
cruciate ligament
PCL ACL
Named based on
- anteriorly ACL is in
front and laterally ACL
is on the lateral side
ACL
PCL
Lateral Anterior
PCL Rupture ACL Rupture
Hyperextension Rotation of
of knee knee
- a tearing of the MCL, the medial collateral
- if we get a rotation of the knee, ligament, the ACL, the anterior cruciate
- damage here is going to be caused by anything that forcibly where the foot rotates medially
moves the tibia posteriorly on the femur, so we can see a ligament and the medial meniscus because
and the thigh rotates laterally, it's attached to the MCL
hyper extension of the knee here, or a blow to the tibia that's going to tighten that
ligament and can cause a rupture
- also see it ruptured with a blow
Blow to tibial to the lateral femur
up- blow to the lateral femur is also
tuberosity going to stress out the medial
collateral ligament —> unhappy
triad
force
Blow to
lateral femur Stretch
Tibial Plateau
MCL is adhered to MM LCL is free from LM

Knee Joint Capsule + Synovial
Membrane - knee joint —> synovial joint
- lined by synovial membrane
- the anterior and posterior cruciates to be intercapsular
- it’s going to be inside the joint capsule but extra-synovial
- the synvoial membrane goes outside of the anterior and
posterior cruciate ligaments
Which ones cross the knee?
Thigh Musculature
Muscles Crossing the Knee
Anterior Compartment: Medial Compartment:
• Rectus Femoris • Gracilis
• Vastus Lateralis
• Vastus Intermedius
• Vastus Medialis Shank:
• Sartorius • Gastrocnemii
• Plantaris
Posterior Compartment: Other:

• Biceps Femoris • Popliteus
• Semi-Membranosus
• Semi-Tendinosus
Movements?
The Knee Flexes, Extends + Rotates
- flexion and extension = bending and straightening

- medial rotation of the leg with the knee joint flexed and a lateral
rotation as well —> important because it allows the knee to be a
little bit more mobile when moving and going through locomotion
Moore’s Clinically Oriented Anatomy

Walking
What
is Energy
about Intensive
Standing?
walking = energy intensive
standing = less energy intensive
despite the knee being fairly
unstable joint
What about Standing?
“Screw Home” Mechanism
• Knee locks into place
when standing
• Promotes stability +
efficiency
lock
• Medial Meniscus
surface is larger, thus
medial femoral
condyle moves further
• = femur internally - allows you to stand for a long period of time
- the medial meniscus surface is larger, and thus the medial femoral condyle can move further
rotates - medial side is larger and that means a greater translation of the medial femoral condyle
- when you stand and lock the knee, there is a rotation and the femur internally rotates —> screw home mechanism —> allows femur to
achieve a position on the knee where it’s locked into place
- to come out of this you need to laterally rotate
Popliteus
Attachments
• Lateral Femoral Condyle
• Posterior Tibia
Action: Unlocks the knee
- unlocking of the knee is achieved by the popliteus

Nerve: Tibial N muscle
- triangular muscle
- It starts on the lateral aspect of the femur and
attaches to the medial aspect of the tibia
- it's going to unlock the knee primarily by causing
rotation of the tibia and the femur in
opposing directions
The Patellofemoral
Joint
Patellofemoral Joint Lateral
Transverse
- exists between the femur and patella

- patella is primarily there to improve or
increase the moment are that the
quadriceps act at
Patella
• Largest Sesamoid Bone
Axis of
rotation
Force from Quads

• Extends moment arm of quads
= increases torque/force
produced when moving the
shank
- exists within a tendon
Force
- quadriceps tendon inserts into the patella, and then it
Medial Collateral Ligament
continues at the as the patellar ligament to the tibial tuberosity
- The base of the patella is actually superior and the apex is Patellar Ligament
Force w Patella
inferior
- you get an extension further away from the joint line of where
the rotation or torque force has the potential to act
Lateral Collateral Ligament
The patella moves superiorly in
extension
patellar tendon
patellar tendon
patella patella
patellar lig. patellar lig.
translocation superiorly
occurs whenever you extend
the knee
flexion extension
Patellar Dislocation
• Tendency to dislocate
patella laterally
• Due to pull of vastus lateralis
(generally bigger than
medialis) up
• Resisted by:
• Vastus medialis
• High lateral femoral condyle
- generally this is reduced —> you extend your knee because you take the
force off of it, and that allows it generally to slip back into position
- have to be careful —> the underside of the patella can become chipped,
and that can cause problems long term
Knee Bursae
• Fluid filled
sacs
important for
cushioning
and reducing
friction
- provide protection to the tendons and skin that are
crossing over bony elements
- subpatellar bursa —> protect the patella from the
femur
- prepatellar bursa —> going to protect skin from the
anterior aspect of the knee that is going to move over
top of the patella every time the knee bends
- infrapatellar bursa —> both a superficial and a deep
bursa here that are going to cushion the patellar
ligament
To Summarize…
• 3 joints exist within the knee:
• Femorotibial + Patellofemoral = knee
• Superior/proximal Tibiofibular Joint (rotational stability)
• Many key ligaments (cruciates + collaterals) support the knee
• Movements = flexion, extension + rotation
• 5 groups of muscles act on the knee

• Anterior Thigh, Posterior Thigh, Medial Thigh, Shank + Popliteus
• Walking = energy intensive as many structures act together to

promote knee stability. The “Screw-home” mechanism allows standing
to be far less intensive
©
katelyn.wood@uwo.ca
Lung + Pleura
Anatomy
katelyn.wood@uwo.ca
Learning Outcomes
• Understand the composition of the lungs
• Describe the location of the lungs within the thoracic cavity
• Label hilum structures, lobes and fissures of the lungs
• Describe the structure and function of pleura

- divided into 6 compartments
Middle Mediastinum
L + R Pleural Cavities
Middle
mediastinum

- the transition zone between the middle
mediastinum and the pleura is the hilum
Pleural Cavities
- transition zone --> where we see the entrance
or exit of pulmonary arteries and veins, primary
bronchi and bronchial arteries
Contents:
• Lungs
• Pleura
Hilum:
• Pulmonary Veins
• Primary Bronchi
• Bronchial Arteries
Airway branching
branches # of tubes
Trachea 1
Copyright © 2017 by John Wiley & Sons, Inc. All rights reserved.
Main bronchi 1
Lobar and segmental

Bronchial Tree
bronchi
Conducting zone Lobar = 2–3
Segmental = 10
Bronchioles and terminal

11–16
bronchioles
Divisions
- to get from the external

environment down deep into
your lungs, air needs to traverse Respiratory
through a variety of tubes that 17–19
progressively become smaller as bronchioles
we move from your trachea
down towards the alveoli
Respiratory zone
- for gas exchange to occur, you
need to get to an area where you Alveolar ducts 20–22
have a single cell of alveoli
juxtaposed with a single cell of a
capillary
Alveolar sacs 23
- subdivide these tubes coming
off of the trachea progressively
as we get further and further
away (b) Airway branching
The Lungs
Trachea
Lungs in Situ
- kind of wrap around the front of the heart a little bit (bottom left picture)
Right lung Left lung
- left lungs has 2 lobes and the right lung has 3
- trachea moves right down the midline held open by C-shaped cartilages
where the cartilage is open on the posterior aspect
- trachea divides at the carina to form the main bronchus on both the left
and right sides
- main bronchus is then going to divide to form the lobar bronchi with one
of them heading to each of the lobes of the lungs Carina
- on the right side --> superior, middle, and inferior
- on the left side --> superior and inferior
Right main bronchus
Right lobar bronchi

Right segmental
bronchus
Right bronchiole
- then divides into segmental bronchi

- they correspond with the bronchopulmonary
segments
- then gets into the bronchioles and terminal
bronchioles before it goes down into the Anterior view of bronchial tree in lungs
respiratory zone
Copyright © 2017 by John Wiley & Sons, Inc. All rights
reserved.
What is the lung made of?
• Space between 2 adjacent
alveoli = Interalveolar Septum
• Contents:
• pulmonary capillaries (gas
exchange)
• Interstitium (fibroblasts for
elastic tissue production +
macrophages for protection)
- between alveoli there is a space referred to as the interalveolar septum
- contains pulmonary capillaries important for gas exchange via pulmonary circulation
- a space referred to as the interstitium --> contains fibroblasts which make the elastic tissue that
lungs are primarily composed of as well as macrophages
- macrophages --> part of the immune system and are there for protection
Netter’s Essential Histology by Ovalle and Nahirney 2008

- it's there to supply the tissues themselves
- the lungs are a form of tissue in your body, it needs a blood supply and its right
special feature is gas exchange and that's why it has the pulmonary circulation
Lungs
- the heart has tissue that needs blood supply and that's what the coronary
system is for but its special is contraction
- muscles --> they get systemic blood flow but their special feature is contraction
as well
• Each lung has 3 surfaces:

• Costal surface (against the ribs) Lateral aspect
• Diaphragmatic surface (against the diaphragm) Inferior aspect
• Mediastinal surface (against the mediastinum) going towards the
midline
left
• Apex = top of lung
• Root/Hilum = mediastinal surface
a region of transition from structures within the middle mediastinum out towards the lungs and
back again
• Separated into lobes by fissures
• Connected to the heart via pulmonary (gas

exchange) + bronchial (systemic) circulation
- gas exchange, which allows you to oxygenate your blood and remove carbon dioxide
- bronchial circulation --> part of systemic circulation; very similar to the coronary circulation of the heart
apex
- the presence of the two fissures together
are going to form the three lobes: superior,
middle, and inferior
Right Lung
superior lobe
Lateral View
anterior border
horizontal fissure
costal surface
middle lobe
inferior lobe
oblique fissure
base
inferior border
apex
only 2 lobes: superior and inferior

- lingula --> a little piece of the superior lobe
Left Lung
that actually wraps around the front of the
heart and looks a little bit like a tongue
Lateral View
superior lobe
anterior border oblique fissure
costal surface
inferior lobe
lingula
inferior border
- place of transition --> where tubes and
vessels are going to transition from the
mediastinum out into the lungs
Hilum Structures
• Bronchi (air) lumen is a term for the inside of the hole
• Have cartilaginous rings surrounding lumen

• Pulmonary Arteries (deoxygenated blood)
• Anterior to bronchi, thicker walled than veins
• Pulmonary Veins (oxygenated blood)
• Inferior
• Lymphatics lungs have some lymphatic drainage and bronchial arteries
supply to the lung
• Bronchial Arteries (systemic circulation)tissue itself Number of divisions
depends upon location
• Pulmonary Ligament (pleural reflection) of X-section
apex
R. Hilum
branches of right
pulmonary a.
superior lobe
superior lobar bronchus
mediastinal surface
Root of the Lung
oblique fissure
anterior border
inferior and middle lobar
bronchi (common origin)
hilium
branches of right
horizontal fissure pulmonary vv.
inferior lobe
cardiac impression costal surface, vertebral

part
pulmonary ligament
middle lobe
diaphragmatic base
surface Pulmonary lig
inferior border Double layer of pleura
transitioning from visceral to
parietal
Pleura
Pleural Cavities
• Pleura are 2-layered sacs
surrounding the lungs
• Visceral = next to lung
• Parietal = next to thoracic wall
- the visceral layer is next to the lung and is adhered to it

- parietal layer is next to the ribs
- similar to the way that the pericardium is formed around the heart
- visceral pleura (purple) then the parietal pleura (red) --> ex. like blowing
up a balloon with a little bit of air and sticking your fist inside it -->
represents the continuous nature of the pleura between both the parietal
and visceral layers
- the lungs would be the fist
- the hilum would be the wrist
- the area inferior to the wrist formed of that transition zone between
visceral and parietal pleura would be where the pulmonary ligament was
Pleural Cavities
• Costal = ribs
• Diaphragmatic = diaphragm
• Mediastinal = heart/mediastinum
• Cervical = neck
- name the pleura based on which surface it's against

- looking at a lung from a cadaveric specimen, the lungs appear shiny
and smooth because the visceral pleura is still on there
- cervical pleura is at the apex
- costal pleura next to the ribs
- diaphragmatic pleura is at the base of the lung
Figure 4.30C – Clinically Oriented Anatomy (Moore et al)

- lungs don't fill the entire space
- there is a gap between the 2 layers of parietal and visceral pleura
- key more maintaining a pressure difference which we capitalize on in
order to be able to breathe
Lungs within Pleura - lungs are ending a bit short of pleura --> it's important so that the lungs
have space to move within the pleura when you breath and that we can
alter the pressures of the intrapleural space to allow breathing to occur
Figure 4.31B-D – Clinically Oriented Anatomy (Moore et al)

Pleural Reflections + Recesses
• 2 clinically significant recesses within
the pleura:
• Costomediastinal
• Costodiaphragmatic
• Potential areas where

What muscles
fluid can collect
- the 2 clinically significant recesses within the pleura are are these?
potential areas where fluid can collect intercostals -->
- one space between the costa (anterior) chest wall and the external, internal and
mediastinum --> costomediastinal recess innermost
- costodiaphragmatic recess --> inferior between the ribs and
the diaphragm
- if you have a pleural effusion, or an accumulation of fluid
within the pleural or intrapleural space and you are seated, fluid
can collect in the extra space between the lung and pleura
To Summarize…
• Lung consists of alveoli + interstitium
• 2 lungs, divided into lobes by fissures
• Left lung = 2 lobes
• Right lung = 3 lobes
• Pleural cavities exist to the right and left of the mediastinum
• Contain lungs + pleura
• Pleura = 2 layered sac, in which the lungs are situated
• Visceral layer = next to lung; parietal layer = next to chest wall
• Space between pleural layers = intrapleural space
• Opening in pleura at the hilum of the lung
• A key passageway for neurovasculature + pulmonary structures into the lungs
©
katelyn.wood@uwo.ca
Breathing + Gas
Exchange
katelyn.wood@uwo.ca
Learning Outcomes
• List the thoracic muscles which contribute to inspiration/expiration
• Describe how changes in thoracic cage volume and intrapleural pressure allow for
lung inflation/deflation
• Describe how a pneumothorax occurs

Thoracic MSK Review
Bony Anatomy
• Thoracic Cage
• Sternum, ribs, costal
cartilage, thoracic vertebrae
- going to form a bony shell within which the lungs reside
• Costotransverse +
Costovertebral Joints
• Articulation @ posterior
aspect between ribs +
vertebrae
ribs join to the sternum on the anterior aspect via costal
cartilage, but also join to the vertebrae on the posterior aspect
via two joints
1. costotransverse joint --> an articulation between the costal
tubercle and the transverse process of a thoracic vertebra
2. costovertebral joint --> consists of an articulation between
the head of the rib and the vertebral body
Thoracic Muscles
• External Intercostals
• Elevates ribs (inspiration)
• Superolateral to Inferomedial
• “hands in your pockets”
these are on the most exterior aspect of the thoracic cage
• Internal + Innermost Intercostals

• Depresses ribs (forced expiration)
opposite direction • Superomedial to Inferolateral
• “grab your collarbones”

internal to the external intercostals
interior aspect --> innermost intercostals
• Diaphragm
• Contraction lowers domes
when you contract the diaphragm, it lowers and it will increase the volume
of the thoracic cavity --> important for inspiration
Mechanics of Breathing
Pressure Changes Respiration
Sternum:
• Breathing is all about pressure Exhalation
changes Inhalation
• Dependant upon the volume of
Diaphragm:
the thoracic cage
• Increasing volume = inspiration Exhalation
• Decreasing volume = expiration Inhalation
- coloured in diagram is in
expiration, grayed out is
inspiration
- ribs are a fixed shape

- almost like they swing outwards Copyright © 2017 by John Wiley & Sons, Inc. All rights reserved.
a little bit (like the handle on a

bucket) when you inspire
- at the same time, you contract Changes in size of thoracic cavity
your diaphragm and the domes during inhalation and exhalation
lowers and increases the volume
of the thoracic cage
Fundamental Mechanics
• Lungs are under tension (interstitium is primarily elastic)
• Naturally want to collapse
• Stuck to visceral pleura
• Alveolar Pressure = atmospheric pressure
• Pleura has parietal & visceral layers creating a sac

• Intrapleural pressure = ~4mmHg below atmosphere
• When the thoracic cage expands (muscle contraction), so does the

parietal pleura decreasing the intrapleural pressure
• The lungs follow suit, decreasing the alveolar pressure
• Air flows in
- black = trachea
Air
- lungs outlined with visceral pleura
- 2nd blue outline = parietal pleura (exists inside the
Pressure = A
rib cage; chest wall is stuck to the layer of parietal
pleura)
- diaphragm (red) --> the pressure inside the lungs,
specifically the alveoli, is equivalent to the
atmospheric pressure (pressure in the space around
you)
- pressure in the intrapleural space is about 4
millimeters of mercury less than that of the lung (the
atmospheric pressure) --> A - 4
- creates oppositional force to the lung wanting to
contract and helps it to stay open
when you breath in --> ribcage expands pulling on
the parietal layer of pleura
- diaphragm drops
- pressure in intrapleural space is going to decrease
causing the lungs to expand
- drops the pressure in the lungs and allows air from lower
A
the periphery to flow in
when you breath out --> chest wall moves back in
and increases the pressures and the lungs will
collapse in
A-4
lower
- clinical circumstance where air exists in the thorax where it shouldn't be
- when the pleural membrane is punctured, the pressure inside the intrapleural space
Pneumothorax
changes
- no longer get the opposition between the intrapleural space and the lungs which are
wanting to contract
- lungs are no longer under the tension and they collapse inward as they want to do
- when the membrane is punctured, air is allowed to move in and out of the intrapleural
space
• Puncture to pleural membrane causes air (pneumo) in pleural

space
Essentials of Clinical Examination Handbook. Ed. 8. Shi et al. Thieme 2018
• Intrapleural pressure = atmospheric pressure

• Doesn’t change with thoracic cage expansion
• Lung is no longer under tension + collapses
• If blood is involved called a hemothorax

- when the thoracic cage expands, it pulls on the parietal layer and air is sucked in through whatever hole exists
and there is no change in pressure that would allow the lung to reinflate
treatment options --> resealing the hole and getting the lung to expand
- it can be dangerous because if the pressure in the intrapleural space doesn't return to normal, it can shift the
position of organs in the thorax
Air Pressure = A
Pneumothorax
- black = trachea
- green = lungs
- blue = pleural membranes
- yellow = costal area (ribcage)
- red = diaphragm
- pressure inside the alveoli is the same as atmospheric pressure under normal
conditions
- pressure inside the intrapleural space is 4 millimeters of mercury less than that,
creating an oppositional force that helps to keep the lungs open
- if you disrupt a pleural membrane, you're going to disrupt the pressures
in a pneumothorax:
- air can flow in
- now the pressure inside the intrapleural space is the same as it is inside the
A
lungs
- no longer have oppositional force
- the lung which wants to recoil under normal conditions can do so but/and it
collapses
AA - 4
Gas Exchange
Pulmonary vs Bronchial Circulation
From aorta or
intercostal As)
Pulmonary Bronchial (systemic)

lungs superpower --> lungs oxygenate blood systemic circulation that supplies the lung tissue; ordinary form of circulation
that every cell in the body needs
Gilroy A, MacPherson B, Johnson A et al., ed. Atlas of Anatomy. 4th Edition. Thieme; 2020
A = arteries
V = veins

- high flow means we can get a lot of blood through the lungs
- low pressure because they're right next to the heart
- low resistance means it's easy for the blood to flow through
System Origin Location Features Goal

move down from the
A: center of
bronchopulmonary
deoxygenated High flow, low
segment Oxygenate
Pulmonary blood from the pressure, low
V: outside of blood
right ventricle resistance
out to the lungs
bronchopulmonary
segment
A: center of
oxygenated bronchopulmonary
Bronchial High pressure, Perfuse
blood from the segment
(systemic) high resistance lung tissue
left ventricle V: drains into
out to the lungs
pulmonary vein
- high pressure because coming off of the systemic system, which needs to travel to the whole
body they're going to be under high pressure leaving the aorta
- high resistance results from them being conventional arteries and that is there to oppose the
high pressure that's present in them
Bronchial Artery
Vasculature of the drains via pulmonary vein
Pulmonary
Artery
Trachiobronchial Tree respiratory
- the blood is going to return via the bronchiole
pulmonary veins
• Arteries in Centre of
- the veins now are on the periphery
- blood comes in down the center of the
bronchopulmonary segment and returns via
the periphery
Bronchopulmonary
segment Pulmonary
Vein
Capillary bed
on Alveolus
- alveoli appear on the respiratory bronchiole and leads all the way down
through the alveolar ducts into the alveolar sacs and all these pockets of
alveoli is where gas exchange is going to occur
• Veins in the - arteries from both the bronchial and pulmonary circulation travel down the
center of the bronchopulmonary segment
- bronchopulmonary segments refer to a tertiary segment of the bronchi and
periphery the lung tissue it supplies
- bronchial artery is going to drain via a pulmonary vein
alveoli
- pulmonary artery also traveling down the center of the bronchopulmonary
segment
- going to go on to form a capillary bed on top of the alveoli through which
gas exchange will occur Gilroy A, MacPherson B, Johnson A et al., ed. Atlas of Anatomy. 4th Edition. Thieme; 2020
Gas Exchange outside air
• Goal = oxygenate blood +

remove carbon dioxide
• Diffusion of oxygen + carbon

dioxide between alveoli +
pulmonary capillaries
O2 CO2
- occurs via passive diffusion of the 2 gasese between the
alveoli of the lungs and the pulmonary capillaries carrying
blood
- when you breath in, oxygen moves into the alveoli and then
diffuses across the membrane to get into the capillary
- at the same time, carbon dioxide present in the capillary is BLOOD CO2 O2 BLOOD
going to move into the alveoli and be breathed out
Pulmonary Circulation
- the bottom part that type I pneumocyte of the Netter’s Essential Histology by Ovalle and Nahirney 2008
alveolus, interfacing with a capillary, where we
see an RBC, or a red blood cell existing on the
top left
- These two sets of cells kind of abut each
Gas Exchange other, and they will fuse in this instance, which
is very specific to cases where you have
diffusion occurring
- going to see gas passing through three zones
in order for exchange to happen
- going to see our pulmonary capillary, this
fused basement membrane of the two cells,
• Goal = oxygenate blood + and then our alveoli.
- Oxygen is going to move from the alveoli of
remove carbon dioxide the lungs, up through these two other areas to
reach the blood
- carbon dioxide is going to move in the
opposite directiom

• Gas has to pass through 3 - movement through the zones

has implications for physiology
zones: - if for some reason the
movement is imparied, either by
swelling, a thickening in the
Pulmonary Capillary membrane, or a resistance to
that passive diffusion, gas
O2 Fused Basement Membrane CO2 exchange is going to be impaired
Alveoli
Ventilation vs Perfusion
• Gas exchange depends upon the relationship
between ventilation (air in alveoli) + perfusion (blood
flow through capillaries) gas exchange is dependent upon an interface between alveoli and a capillary
- need to make sure that the two aspects are well matched so that there's enough air to contain oxygen to diffuse into the blood that's passing by
- mismatches between the two can actually be problematic
- Va = ventilation in the alveoli, Q = cardiac output
VA/Q = alveolar ventilation/ cardiac output

- alveolar ventilation (air coming into the alveoli), cardiac output determines the amount of blood flowing through the capillaries
• Shunt = adequate perfusion, but no ventilation

• Causes: pulmonary edema, asthma, COPD, pneumothorax,
gas trapping -- adequate perfusion, blood is flowing through the capillary, but don't have ventilation
blood is flowing pas, but there is no oxygen and no air for it to interface with to allow diffusion to
occur
• Dead Space = adequate ventilation, but no perfusion

• Causes: hemorrhage, dehydration, pulmonary embolism
- a lot of air in the alveoli but blood isn't flowing through the capillaries
- preventing the blood from getting to the capillaries
- you've got the air but you don't have the blood to put it into
alveolar flooding --> the type I pneumocytes Essentials of Clinical Examination Handbook. Ed. 8. Shi et al. Thieme 2018
are really tightly adhered to each other and
are resistant to fluid moving into the alveoli; if
Pulmonary Edema the pressure in the interstitium becomes too

great, you can get leaking of fluid into the
alveoli
- becomes super problematic for gas
exchange, because the gases simply can't
diffuse that far or through the fluid
• Usually secondary to heart failure

• Blood not effectively pumped from L ventricle leads
to back up in pulmonary veins + lungs
• Swelling, and eventual leaking of pulmonary capillaries = Fluid

accumulation + increased pressure in interstitium
• Increases pressure around alveoli + respiratory bronchioles, which may lead
to collapse + shunting because air becomes trapped
• Diffusion (and thus oxygenation) becomes more difficult
• Fluid may leak into the pleural cavity (pulmonary effusion) or

mediastinum - when heart failure occurs, blood is not effectively pumped from
the left ventricle leading to a backup in the pulmonary veins and
lungs
- when you are not exhanging the air, you're not creating that
• Alveolar flooding is possible (very problematic) pressure gradient that you need for oxygen or new oxygen to be
present and carbon dioxide to be taken away
- pulmonary effusion and results into circumstances similar to a
pneumothorax or can also lead into the mediastinum
To Summarize…
• Breathing depends upon changes in pressure within the thoracic cavity
• Lungs always want to collapse, but are held open by the intrapleural pressure
• Thoracic cage expansion intrapleural pressure decrease lungs expand
• When pressure drops within the lung tissue, air is inspired
• Pneumothorax = disruption in pleura loss of pressure differential + lung
collapse
• Diffusive gas exchange occurs between alveoli + pulmonary capillaries

• Goal = Remove CO2 from body, Add O2 to blood
• Mismatch between perfusion and ventilation causes problems
• Shunt = perfusion, ventilation
• Dead space = ventilation, perfusion
• Lungs receive both systemic circulation (bronchial A) + pulmonary

circulation (pulmonary A)
©
katelyn.wood@uwo.ca
Muscle Basics
katelyn.wood@uwo.ca
Learning Outcomes
• Understand the structure of muscle from whole organ to sub-cellular components
• Describe how neural signals reach the muscle
• Describe how muscle contraction occurs via the sliding filament theory
• Explain the role of calcium in muscle contraction

Muscle Types
3 types of muscle
Skeletal Cardiac Smooth
• Found in skeletal muscles • Found in the heart • Found in viscera + blood
• Striated vessels + skin
• Striated (myosin + actin)
allow for contraction
• Involuntary control • Not striated your brain controls

• Voluntary control when it contracts, but
you don't really know
does its own thing and
you get to decide when it contracts and when it doesn't
• Autorhythmicity has cells that will • Involuntary control about it
• Multi-nucleated cause contraction
more than one nucleus
for a given cell
• Single nucleus • Single nucleus
Functions of Muscle Tissue
1. Produce body movements
• Attached to bone via tendons
2. Stabilizing body positions
3. Producing heat (thermogenesis)

when you shiver your muscles contract and relax radidly, and that causes
heat to be produced
4. Storing + moving substances in the body

• Sphincters, peristalsis, blood vessel tone
Properties of Muscle Tissue - autorhythmicity in the heart allows the
heart to contract at a regular interval and
pump blood
- chemical signals --> when neurons send
signals down and release
1. Electrical Excitability neurotransmitter at a synaptic cleft; if the
synaptic cleft is joining up with a muscle
• Able to respond to stimuli cell, those chemical signals are going to
cross and tell the muscle to contract
• Electrical signals = autorhythmicity in the heart

• Chemical signals = action potential signals received at
neuromuscular cleft
2. Contractility
Attached to bone via tendons. Cells physically contract to generate
force
- if you stretch a muscle,
3. Elasticity it's going to rebound back
to its original shape
Returns to original length after contraction and extension - when you contract a
muscle and then relax it
again, it's going to go back
4. Extensibility to its original resting state
Can stretch, within limits, without being damaged

Greatest in smooth muscle (think food in stomach) & heart (blood
in chambers)
Muscle Organization Periosteum: lines
surface of bone
Did you know… Tendon

Blood vessels + nerves are
carried in connective tissue
- periosteum --> where a tendon is going to
attach; fuses right into the periosteum and get a
strong connection with the bone
- fascicles = a bundle of myofibers

Epimysium: encases muscle
- myofibers are muscles cells
- group all the muscle cells to form a fascicle
- all the fascicles come together to form a
muscle
Fascicle: bundle of myofibres
- epimysium --> outside of a muscle and
encases the muscle; epi means on top of
- perimysium --> encases fascicles; peri means

around
Perimysium: encases fascicle
- endomysium --> covers an individual myofiber
or muscle cell; endo means inside of
- tendons connect muscles to bones

Endomysium: covers myofibre
- tendons are just connective tissue continuing
on without muscle cells in between
Myofibre: muscle cell
- encased in a layer of endomysium
- inside of myofiber there are several myofibrils and consist of repeating units of
sacromeres
- myofibrils are bundles of thick and thin filaments (actin and myosin); densely packed
together
Myofibre = Muscle Cell
Myofibre
Myofibril: repeating
units of sarcomeres
Thick & Thin

filaments
Endomysium
The Sarcomere = contractile unit
- the interaction between actin and
myosin allows muscles to contract
- Z-line --> where two sets of actin fibers

are going to join together
I-Band M-Line
- M-line --> where two sets of myosin H-Band Thick Filament (Myosin)
fibers are going to join together
- I-band --> the region within the

myofibril where only actin is present
- H-band --> a region where only myosin

is present
- A-band --> the full length of where

myosin is, but can be overlapping with
actin
- when the muscle contracts, myosin is

going to slide over actin
- the sizes of the bands are going to
change but A-band is always going to
be the same width
- H-band and I-band are going to get
smaller because you start overlapping
actin and myosin
A-Band
Z-Disk/Line
Thin Filament (Actin)
Thin + Thick Filaments
Actin (thin filament)

Myosin (thick filament) - series of balls that wrap around each other in a double helix
- formed of two pieces - have myosin binding sites
- they wrap around each other to form the tail - covered in a protein called tropomyosin
- two myosin heads - tropomyosin is attached to another sub-unit called troponin which needs to be interacted with to
- two binding sites --> a site for the actin where they're going to grab onto the actin and physically pull cause it to roll off of the binding sites to allow myosin to bind to actin
it along and a site for ATP - the presence here of troponin and tropomyosin that allow you to have control over when myosin
- ATP = energy molecule used by the body is going to be able to bind to actin
- ATP will bind and allow the myosin heads to physically move - If those sites were available all the time, myosin would always be grabbing on to actin and you
would have constant contraction (gives fine control over when contraction is going to happen)
Muscle Contraction
Muscles pull Bones
• Muscles are attached
to bones via tendons
• Tendons are a
continuation of the
same fascial layers
that encase the
muscle
- when you contract a muscle, it pulls on a bone
- muscles can't push, only pull
- if you want to perform opposing actions at a joint --> one set
of muscles is going to contract to flex and another set is going
to contract to extend
- to get a contraction, you need to send a motor signal from the
brain to the muscle
- upper and lower motor neuron is at play
Brain - travels from the brain (or the brain stem), through the spinal cord
and then out into the periphery
- these are multipolar motor neurons
- one neuron starting in the brain, traveling down the spinal cord
and synapsing in the grey matter
Brain Stem - then a second neuron carrying the signal from the spinal cord out
to the muscle you want to effect
Upper Motor Neuron

Motor Signals (UMN)
Spinal Cord
Lower Motor Neuron

(LMN)
Muscle
(a) Single Motor Unit
Motor Neurons
Motor
• Signals travel from Brain to Muscle neuron
via 2 neurons, which synapse in the Neuromuscular junctions
spinal cord
• Innervation is contralateral (b) Two Motor Units
• E.g. signals originating on the right
side of the brain, innervate the left
side of the body
• 1 motor unit = motor neuron + all
the fibers it innervates Motor
neurons
- motor information is contralateral
- important clinically —> ex if you have a stroke on the left side of the brain, the right side of the body is going to be impaired
- one motor neuron impacts several muscle fibers and connect at neuromuscular junctions —> synaptic cleft,
- sends the signal all the way down, releases neurotransmitters, crosses the cleft and impact the muscle cells
- two motor units innervate different muscle fibers, those muscle fibers are interspersed with each other within a single muscle
Principle of Orderly Recruitment
Henneman Size Principle
• The recruitment of motor units within a
muscle proceeds from small motor units to
large motor units
• Low force contractions = small motor units
recruited
• force = larger motor units recruited
• Force production = Motor Unit Size + Firing

Frequency- motor units- wearecanrecruited
control how much force is produce by activating more or fewer motor units
from smallest (1) to the largest (5) and they’re derecruited in the opposite order
- allows you to perform really fine dexterous movements because small motor units are active
- larer motor units perform large force actions —> less dexteriors and start recruiting the entire muscle at once
- when you recruit a motor unit, you need more motor units
- the original one stays on and becomes summative
Skeletal Fiber Types
• All muscles contain a
combination of all fiber types,
but their proportions vary
• Can train specific fiber types!
Fatigue
Type Name Force
Rate
Type I Slow Oxidative Slow Low
Type IIa Fast Oxidative-Glycolytic Med Med
Type IIx Fast Glycolytic Fast High
- how myosin and actin interact with each
other to produce contraction
- myosin binds ATP and actin and then
undergoes a conformational change (changes
The Sliding Filament Theory

shape around the hinge region), allows it to
bend and pull on actin
- causes actin filaments to slide over myosin
and creates shortening effect
- the 2 sets of actin bind together and when
you contract, it’s going to move inwards
towards the H-band
• Muscle contraction is a repetitive cycle of cross-bridge - I-bands are going to get smaller
- A-bands are going to stay the same
formation (actin/myosin binding)

• Occurs in the presence of elevated calcium (Ca2+) and requires ATP
• Requires conformational change in myosin protein around the hinge
region
• Causes actin filaments to ‘slide’

over myosin thick filaments,
creating a shortening effect
• Z-Disks move closer together
2. Power Stroke
3. Rigor State
1. Bound State
1. bound state —> myosin has bound to actin

4. Relaxed State
and is stuck there
2. power stroke —> release inorganic phosphate
from myosin and that causes a structural
transformation (the myosin bends at the hinge
region adn it physically pulls actin along
3. rigor state —> gotten rid of inorganic
phosphate, myosin been contracted and now it’s 5. Binding State
stuck to actin and in that position
4. relaxed state —> when ATP binds
- ADP is bound to myosin
- release inorganic phosphate
- moves to a contracted state
Bound State
- released inorganic phosphate
- myosin head is bent at the hinge section
- slid actin forward
Pi
Power Stroke
rigor state
- bound to ADP
- myosin already contracted and just stuck there
Rigor State
- when ATP binds, myosin is going to release from actin and is
going to get ready to be able to bind again
-myosin has completely dissociated from actin
- what stops the two from sliding apart is that there are a whole
bunch of myosin heads trying to interact with actin and the timing
of them is slightly offset
- there’s always some piece of myosin grabbing actin during a
contraction
Rigor State
once ATP is bound here = relaxed state
- dissociated from actin
Relaxed State
binding state
- ready to bind to actin again
- hydrolyze the ATP to ADP
ATP
Binding State
ATP + 2+
Ca cause muscle contraction
ATP
• Necessary for myosin to bind actin & for power stroke
CALCIUM
• Binding sites on actin are usually covered by tropomyosin Tropomyosin
• When calcium binds to the troponin complex,
tropomyosin rolls away
- move from having ADP to ATP to release actin and get
• Contraction can occur ready to rebind it again
Actin
- conversion of ATP into ADP that allows you to bind the
actin
- hydrolyzation that allows to bend the myosin at the hinge
and for the power stroke to occur
Troponin Complex
- sacroplasmic reticulum —> organelle that holds
all the calcium
- calcium is required for muscle contraction to
Calcium Release bind with the tropronin compex which is going to

remove tropomyosin from binding sites
- if you gather up all the calcium —> stops
muscle contraction
- the signal of depolarization, the flipping of the
polarity of the membrane, is going to travel down
the t-tubules
- on the t-tubule membrane there is a volted
• Stored intracellularly in the sarcoplasmic reticulum gated channel and it mechanically opens a
channel on the sacroplasmic reticulum
• Sequestering calcium stops muscle contraction

- when signal travels down the t-tubule there is a
receptor that is holding the plug and will
physically unplug the sarcoplasmic reticulum
channel and calcium flows out rapidly
• When the muscle cell is depolarized, the signal travels down t-tubules
• Voltage sensitive receptor on the t-tubule membrane mechanically
opens a channel on the SR
• Calcium flows out, down its concentration gradient
http://www.sci.sdsu.edu/movies/actin_myosin_gif.html.
To Summarize…
• Muscle type (skeletal, cardiac, smooth) and shape predict function
• Motor neurons carry signals from the brain to muscle
• 3 Skeletal Muscle Fiber types that are differentially recruited
• Sarcomeres are the fundamental contractile unit of muscle cells

• Contains thin (actin) + thick (myosin) fibers, which form cross-bridges via the
sliding filament theory
• ATP + Calcium are required for contraction
• Sustained force requires repetitive cross-bridge cycles
©
katelyn.wood@uwo.ca
Muscle Force
Production, Injury & Aging
katelyn.wood@uwo.ca
Learning Outcomes
• Describe 3 types of muscle contractions and give an example of each
• Understand factors which determine muscle force generation
• Understand injuries that can occur within muscles, and implications for function
• Explain the influence of aging on muscle structure and function

Review
Last Module:
1. 3 types of muscle
• Skeletal, Cardiac + Smooth
2. Muscle Organization
• Layers of connective tissue surrounding muscle cells
• Think + thin filaments make up sarcomeres fundamental unit of contraction within the
muscle
- tendons are
just a continuation of the connective tissue in the absence of muscle cells
3. Muscle Function + Properties

• 3 fibre types (I, IIa, IIx) slow oxidative, to fast glycolytic
- These types of fibers
have different capabilities in terms of force production, how quickly they fatigue and their distribution
throughout muscle cells
Last Module:
4. Contraction
• Requires ATP + Ca2+
• Sliding Filament Theory
5. Motor Unit = Motor neuron +

innervated myofibrils
• Each muscle contains
multiple motor units
- ATP is necessary for myosin to bind to actin and to undergo the power stroke
- calcium is required for the myosin binding sites on actin to be revealed
- you can spend time recruiting just maybe one or two units, depending upon how
much force you want to generate
Force Production
Factors Influencing Force Generation
1. Force-Length 2. Force-Velocity 3. Moment Arm at 4. Physiological

Relationship Relationship which the Muscle is Cross-Sectional
Acting Area
# of fibers or sarcomeres engaged + how they’re acting on the joint = how forces are generated
- more fibers or sacromeres engaged = greater force
- the way they interact with the joint are going to determine exactly what that force is like
# of fibers/sarcomeres engaged + how they’re acting on the joint

depending on the angle of
the joint and the length of
1. Force-Length Relationship the muscle, you are going

to be able to produce more
or less force
• Sliding filament sarcomere structure has implications for muscle

force production
• When a muscle is maximally activated, the isometric force that is

produced is dependent upon muscle length - isometric means that the muscle is not actually
changing length
- the proximity of myosin to actin and the number of sites on actin that myosin can bind will determine the amount of force that can be produced
- this changes as a function of the length of the muscle
- when a muscle is maximally activated (when you contract it as hard as you can), the isometric force that’s produced is dependent upon muscle length
1. Force-Length Relationship
Z M Z 2
1 3
Force
Length
1. Ascending Limb: sarcomere shortened, mechanism for reduced force unknown

- when the muscle is really short
- huge overlap between myosin and actin
- don’t really know why this occurs; hypothesis —> could be a misalignment of the myosin heads and the binding site on actin
- when you muscle is super super short, you can’t generate a lot of force

2. Plateau: optimal overlap of actin/myosin = maximal cross bridges = maximal force
- plateau region —> optimal overlap of actin and myosin
- every myosin head can engage with a binding site on actin
- you get maximal cross bridges and maximal force
- occurs somewhere around 90 degrees of the joint in the arm

3. Descending Limb: as length increases, fewer actin sites overlap myosin
- as you start to lengthen, there are fewer sites overlapping between myosin and actin
- get less and less force production
One more thing…
Passive Muscle Stretch Matters
• Degree of muscle activation (#
of active sarcomeres)
determines force produced
but…
• Just stretching a muscle will

generate a “passive force” at
longer muscle lengths as - the number of active
sacromeres determines force
connective tissue (e.g. produce
perimesium) attempts to recoil - more active fibers = more
force
- when you stretch out the connective tissue, it starts to kind of
resist that stretching and when able, will recoil (purple line)
• Called “parallel elastic Fig 1. Active and passive force length curves
component” - when you add active force of muscle and the passive force of the connective tissue together, you’re
able to produce a little bit more force at greater muscle lengths —> red line; important for biomechanics
2. Force-Velocity Relationship
• Force produced by muscle depends upon the velocity of
the contraction
- negative force = muscle lengthening
- positive force = muscle contracting
- isometric = not moving
Isometric: High force,
- high amount of force, zero velocity —> trying to lift something that’s too heavy off the
ground
velocity = 0
- concentric —> able to actually contract the muscle; you are stronger than the object
that you are trying to lift and are able to lift it up
- as velocity increase, the force decreases
- cross bridges can only go so fast
Concentric: velocity = force
- eccentric contractions —> poorly understood in terms of the force that they are able to
produce; you are ableCross
to produce bridges canto only
a lot of force resist it;go
yourso fast amount of force,
maximal
but you’re resisting then not actually kind of moving the force
Eccentric: poorly understood

muscle lengthening muscle shortening
Types of Muscle Contractions
Torque =
3. Moment arm at Force X Moment Arm
which a muscle is axis at the orange circle
- the line of action of a force is the red line and it
changes based on muscle shape
variety of different shapes of muscles throughout
acting the body

- allows muscles inherently to pull at different
angles
- it also changes based on the degree of flexion
that a joint is in
• Moment arm = perpendicular distance

from an axis to the line of action of a
force
• Changes depending upon angle of
insertion - rotation doesn’t necessarily happen but it’s a
force about the tendency for that rotation,
equals the amount of force that’s produced by
• Muscle shape the muscle times the moment arm
- we can assume that muscle force is kind of
• Degree of Flexion
capped, it can only produce so much force, but
we can change the angle at which it acts
- lever arm —> bone changing the moment arm
- muscle is pulling on that bone at a certain angle - the moment arm is perpendicular distance
- moment arm is the right angle between the axis of rotation (orange from an axis to the line of action of a force
circle)
- the angle at which the muscle is pulling
- when you change that angle, you change the moment arm and torque,
which is the tendency for an object to want to rotate
3. Moment arm at 1
2
which a muscle is - the muscle pulling at less of an angle = shorter moment arm
3
acting - pulling at a greater angle = greater moment arm

- rotation is going to be around the elbow
- as you start to lengthen or
shorten the muscle, so shorten, then lengthen, the moment arm, that yellow line is
going to change
4
5
- yellow line: moment arm of different lengths
- if you pull with
exactly the same amount of force through your arm flexors there, you're going to
produce different
amounts of force, because torque is equal to the force produced by the muscle times
the moment arm
- greatest around 90 degrees
1 2 3 4 5
Biceps Brachii
Brachialis
3. Moment arm at Brachioradialis

Avg Weighted
which a muscle is
acting *alters angle of insertion
- biceps brachii,
brachialis, and brachioradialis.
- their moment arms are slightly
different because they attach at
different places in the arm and forearm
- means that there is a different Biceps Brachii
amount of torque being produced Brachialis
based on the angle of the elbow
Brachioradialis
- moment arm can also be changed by
Sum Moment
Torque (N/cm)
the girth of muscle
- if you see hypertrophy (kind of a
bulking of the muscle) because you
are getting stronger, that’s going to
change the moment arm because you
have more muscle activated
- see more strength because you’re
changing the moment arm at which
these muscles are acting on the joint
Angle (deg)
Muscle Shape + Pennation Anatomical Cross-Sectional Area
4. Physiologic Cross-
Sectional Area (PCSA)
• Muscle strength is directly

proportional to the cross-sectional
area of a muscle 1:1 ratio
• Reflection of the number of

functioning sarcomeres, working in
parallel with each other
• Increases with pennation angle

- pennation —> the angle at which muscle fibers all connect in
blue —> diameter of the muscle
together into the tendon
- as we change the pennation, the orientation of
- multiple pennations in some muscles like the deltoid whereas a
the fibers (red lines), we can increase the
single pennation in muscles like flexor pollicis longus
amount of force that’s produced
- flexor pollicis longus —> flexes you thumb, whereas the deltoid
A = unipennate muscle
moves the shoulder
B = bipennate
- deltoid is going to be able to produce more force because of the
C = multipennate
way the fibers are arranged

area of a muscle


- if you have a larger physiological cross-sectional area
that is going to allow you to produce more force with the
same amount of activation
- more cross-sectional area, specifically physiological Force = PCSA * muscle activation
cross-sectional area, more force.

Acting Area

Muscle Injury, Aging &
Exercise
Strain
Grade 2 - partial tear —>
it’ll still contract and kind
of dance under the skin,
but not actually going to
be able to contract and
Tendon/Muscle Injury change the joint angle
• Grading:
• Grade 1 = Over-stretching
• Grade 2 = Partial Tear
• Grade 3 = Complete Tear
• Symptoms:
• Swelling/bruising or redness - force depends on
• Pain at rest muscle fibers are highly innervated the muscle actually
being able to transmit
• Inability to use muscle, or weakness the force to bone; if
the muscle is cut in
half, you’re no longer
• First Aid: Protection, Rest, Ice, Compression, able to transmit that
force all the way
Elevation (PRICE) through to bone
- if still under 30, you are still reaching your peak - in the aged person, more of those
- over 30 starting to decline already kind of white areas, so we can see the bone
- muscle mass is gradually replaced by fibrous connective tissue and adipose (fat) which is those white circles outlined in black,
Aging + Muscle but within the

muscle itself, that darkish gray area, you see
more white splotches, and that's fat and
connective tissue.
• Progressive muscle loss with aging, from 30

onwards
• Muscle mass replaced by fibrous connective

tissue + adipose - causes of decreased abilityof ofwhich
muscles to contract an aging are many, one
is decreased
voluntary neural control of the muscle, so you can lose motor neurons and
you can get decreased sensory
feedback
• Causes: - slower nerve conduction speeds
- takes longer to be able to initiate a contraction
• Decreased voluntary neural control of muscle

(motor neuron loss + decreased sensory
feedback)
• Slower nerve conduction speed
• Muscle fibre loss (particularly type II = more
oxidative metabolism, less force) type II muscle fibers —> more
oxidative fibers and they are
the ones that produce a lot of
force
• Overall: less power & strength - you are able to do less

ballistic high force movements
= smaller muscles and less
strength
Exercise + Muscle
• Exercise is effective to improve muscle mass at any age!
• Aerobic + Strength-based activities are effective at both slowing,

and even reversing age-related muscular decline
• Benefits:
since you are stressing the bone
• Increased bone density —> when youremodels
stress the bone it
• Increased motor neuron firing rate

• Hypertrophy of muscle fibers ( size)
To Summarize…
• 3 types of muscle contraction: concentric, isometric, eccentric
• Muscle force generation is determined by # of actin/myosin fibers
binding + how they act on the joint:
• Force-length relationship
• Force-velocity relationship
• Moment arm that a muscle acts at
• Physiological Cross-sectional area of muscle
• Muscle Strength & Size decrease in age

• Exercise improves muscle force and function
©
katelyn.wood@uwo.ca
The Peripheral
Nervous System
katelyn.wood@uwo.ca
Learning Outcomes
• Describe how motor information exits the spinal cord to reach the periphery
• Describe how sensory information enters the spinal cord to reach the CNS
Nervous System
Structure
Brain and spinal cord

everything else
sensory motor

voluntary control)
there is a sensory component of information coming in from the

periphery to the central nervous system, and a motor component Sympathetic Parasympathetic
exiting
Each of these aspects has two divisions, a somatic component (fight, flight, fright) (rest, relaxation, rumination
that you are cognitively aware of, or have control over, and an or SLUDD)
autonomic component that's either automatically interpreted or
sent out without your knowledge
Spinal Cord
• Two enlarged areas with a greater number
of neurons for limb innervation:
1) Cervical Enlargement:
• Cervical plexus
• Brachial plexus
2) Lumbar Enlargement:
• Lumbar plexus
• Sacral plexus
• Ends at ~ L1/L2 at Conus Medullaris

• Remaining structure of nerves is termed
the Cauda Equina (Horse’s tail)
plexuses --> combinations of anterior rami of spinal nerves that are going
to go on to become multi segmental peripheral nerves
a synapse between two neurons is going to
occur in gray matter Did you know…
Spinal Cord glial cells support neurons

sensory information comes through the
dorsal horn (posterior aspect)
motor information leaves through the ventral
White Matter: horn (anterior aspect)
Periphery
Sensory (to brain)
Gray Matter:
Contains:
Neuron Cell Bodies
Glial Cell Bodies
Spinal Cord
Intervertebral foramen --> spinal nerves will exit

Spinal Cord
Sensory information Dorsal Root Ganglion
comes back into and
motor information Dorsal Root
goes out through the Dorsal Horn
front. (parallel Dorsal Rami
structures)
ventral and dorsal
roots come together
to form a spinal
nerve and then split Ventral Horn
again to form rami
Ventral Rami
Root --> Nerve -->

Ramo Spinal Nerve
Ventral (front) and Did you know…

Dorsal (back) Ventral Root Dorsal = Posterior
Ventral = Anterior
Spinal Cord
Sensory Pathway
Dorsal Root
Dorsal Horn
Dorsal Rami
Ventral Horn
Ventral Rami
information is coming in to the

spinal cord. Information is going to Spinal Nerve
in pseudounipolar sensory neurons,
come in through either the dorsal the cell body is in the middle of the
or ventral rami, travel through the axon (dorsal root ganglion --> the
spinal nerve and go through the Ventral Root collection of sensory nerve cell bodies
dorsal root to reach the dorsal horn that exist in the dorsal root
Spinal Cord
Motor Pathway
Dorsal Root
Dorsal Horn
Dorsal Rami
Ventral Horn
Ventral Rami
motor information is exiting the

spinal cord. Starts in the ventral horn Spinal Nerve
of the spinal cord and then it's going
to proceed out through the ventral
route, the spinal nerve and then split Ventral Root
to the dorsal and ventral rami
Spinal Cord
Dorsal Root
Dorsal Horn
Dorsal Rami
Ventral Horn
Ventral Rami
Spinal Nerve
the spinal nerve and rami contain both

Ventral Root
sensory and motor
Spinal Cord
Structure Contents
Ventral Root Motorneurons
Motor Neurons
Dorsal Root Sensory
Sensory neurons
Neurons
Dorsal Root Ganglion Cell
Cellbody
Bodyof
ofsensory
Sensoryneurons
Neurons
Spinal Nerve Sensory motor neurons
Sensory + Motor Neurons (goes
(goes through
through intervertebral
intervertebralforamen)
foramen
Ventral Rami Sensory motor neurons
Sensory + Motor Neurons ++ autonomics
Autonomics (most
(mostnamed
namednerves)
nerves)
Dorsal Rami Sensory ++ Motor
motor Neurons
neurons -–to
todeep
deepback
back&&Z-joints
Z-joints(smaller
(smallerbranches)
branches)
in pseudounipolar sensory neurons, the cell body is in the middle of the axon
The dorsal rami also contain sensory motor information, but these only travel to the deep back
muscles and zygapophyseal joints
Spinal Cord
- Spinal nerve comes out and divides
into anterior and posterior ramus
- posterior ramus is only going to do
those deep back muscles as well as
some sensory over that area
- the zygapophyseal joints, which are
part of the spinal column, your
anterior rami are going to supply
everything else
Thoracic Region
Plexus & Peripheral
Nerves Brachial Plexus
• Anterior Rami merge with other anterior

rami from other spinal levels to form a
network called a “plexus”
• Multisegmental peripheral nerves emerge

from the other side of the plexus
• Cervical, Brachial, Lumbar & Sacral
an individual nerve is going to have information

from a variety of spinal segments
radial nerve --> going to contain information from
five different segments, C5-T1
Dermatomes vs C3
Cutaneous Maps C4
T2
C5 T3
- radial nerve contains information from C5 all
the way to T1
T4
- there is a difference between the fibers that go T5
from the 5 segments and combine to form the C6 T2 Radial
radial nerve
- C5 information gets split up a whole bunch of
times to form a variety of different peripheral Lateral Medial
nerves, you end up with 2 different maps: C5
1. map of dermatomes --> tell you which patches T1
of skin are innervated by which spinal level cutaneous cutaneous
2. cutaneous map --> show you which patches of
skin are innervated by each nerve Medial
ex. doing tests to find out what is happening with antebrachial
a nerve lesion Radial
- if the radial nerve patches don't have
cutaneous
sensation, but you can get sensation in anything
C6
from you know, C5 to T1. That could mean that C7
your lesion is peripheral and just affecting the C8
radial nerve and not all of the C5 fibers
the nerves entering the spinal cord at the posterior aspect are going
to be sensory in nature. These two routes come together and form
the spinal nerve and this is going to split to form both the posterior or
dorsal ramus which innervates the deep muscles of the back and
To Summarize then the anterior ramus which is going to go on to innervate

everything else
Spinous process of vertebra
Epidural space
Deep muscles of back
(contains fat and blood vessels)
Spinal cord


Anterior (ventral) ramus ganglion
Spinal Nerve
Anterior (ventral) root

Denticulate ligament
Subarachnoid space
(contains CSF)
Rami communicantes
- Above the dura, at the posterior
Dura mater and arachnoid aspect, we have the epidural space
mater and this contains fat and blood vessels
- the dura mater and the arachnoid mater, which are Sympathetic ganglion on - subarachnoid space contains
meninges of the spinal cord and brain sympathetic trunk cerebrospinal fluid --> The nerves that
- a denticulate ligament which is part of the arachnoid Body of vertebra emerged then are going to form the anterior
mater, which helps to stabilize the spinal cord in the canal. ventral route and this is going to be motor
(this is the subarachnoid space around the spinal cord and information exiting the spinal cord
that's going to be filled with cerebrospinal fluid)
To Summarize SUPERIOR
Denticulate ligament Spinal nerve
Pedicle of vertebra
(cut)

Dura mater and

arachnoid mater
(b) Anterior view and oblique section of spinal cord

To Summarize…
• The PNS contains both
• Motor information travelling from the spinal cord
to the periphery via the anterior (ventral) root
• Sensory information travelling from the
periphery to the spinal cord via the posterior
(dorsal) root
• Information travelling via the ventral rami creates

peripheral nerves
• Plexuses form when spinal nerves of various
levels combine
©
katelyn.wood@uwo.ca
The Respiratory
System
katelyn.wood@uwo.ca
Learning Outcomes
• Describe the pathway air takes to travel from the atmosphere to enter your lungs
to faciliate gas exchange
• Differentiate between the conducting and respiratory zones in terms of structures

and function
The Respiratory
System
The Respiratory System
Series of passages conducting air from environment to alveoli
to facilitate gas exchange
has 2 components:
1. all the tubes that air needs
to travel through to get from
the mouth down into the
lungs
2. lungs themselves is where

gas exchange occurs
Structural Divisions:
• Upper = Nose & Pharynx
• Lower = Larynx, Trachea, Bronchioles, Alveoli
Functional Divisions:
• Conducting = Nasal Cavities Terminal
Bronchioles
• Cleanse, warm and humidify air
• Respiratory = Respiratory Bronchioles
Alveoli
• Gas Exchange
- divided a couple of ways: https://www.lung.ca/lung-health/lung-info/respiratory-system
1. Structural division --> between the upper and lower segments
2. Functional division --> conducting and respiratory airways
The Conducting Zone
Nose Terminal Bronchioles
The Conducting Zone Nasal cavity
Naso
Oro Pharynx
Laryngo
Larynx
Trachea
Bronchi
- conducting zone --> everything from the nose to the
terminal bronchioles
- nasal cavity --> where air goes in
- pharynx has 3 portions:
1. nasopharynx
2. oropharynx
3. laryngopharynx
- larynx and trachea will subdivide to form the bronchi
and eventually the terminal bronchi
Nasal Cavity Cribriform plate
• Mucous Linings
• Olfactory Mucosa (smell – CN I,
olfactory N; on cribriform plate)
• Respiratory Mucosa (cleaning)
Inferior
meatus
• Bony Protrusions = Conchae Hard palate
• Increases surface area
• Covered in epithelium + Highly vascular
• Superior + middle = ethmoid bone - primary area through which air can get into the respiratory system
- starts at the nostril (nares)
•
bounded by:
Inferior conchae is a bone - superiorly = cribriform plate --> part of the skull through which the olfactory nerve travels
- olfactory nerve --> responsible for the sense of smell
• Meatus = space under conchae - inferiorly = hard palate --> roof of the mouth (soft part = soft palate)
- entirety of the nasal cavity is lined by mucus
serves 2 purpose:
1. superior aspect --> olfactory mucosa --> where the olfactory nerve and cranial nerve I is going to embed it
fibers to pick up on smell
2. respiratory mucosa --> everything else within the nose or nasal cavity and it's purpose is cleaning
Nasopharynx
Oropharynx nasal cavity
Pharynx Laryngopharynx
uvula
with conchae
• Connects Nasal Cavity with Larynx

• Made of skeletal muscle, lined with
mucous membrane
• Three sections:
• Nasopharynx = air only hard palate
• Oropharynx = air + food
• Larygopharynx = divides air + food esophagus
• Bottom = esophagus + larynx
pharynx has 3 parts:
1. nasopharynx --> air only
2. oropharynx --> back of the mouth going to contain both air and food hyoid bone
3. laryngopharynx --> divides air and food
- pharynx connects the nasal cavity with the larynx --> air travels through to get to lungs
larynx
- larynx anteriorly headed to the lungs --> has air
- esophagus is posterior --> where all the food goes to get to the stomach
- uvula at the end of the soft palate
- hyoid bone --> at the base of the mouth --> key attachment point for muscles as you transition from your mouth into your neck
hyoid
thyroid epiglottis
Larynx
cuneiform
• Functions:
• Prevent food from entering
trachea
• Permit passage of air corniculate
• Produce vocalization
• 9 Cartilages (mostly hyaline) Tracheal

Cartilage
• Thyroid
• Cricoid arytenoid
• Epiglottis (elastic cartilage)
• 2x Arytenoid (anchor vocal cords) cricoid
- where the vocal cords live
• 2x Cuneiform - mostly formed of hyaline cartilage
- 3 unpair pieces of cartilage
• 2x Corniculate 1. thyroid --> looks like a shield on the anterior aspect

2. cricoid --> looks like a signet ring with the thick part at the back
3. epiglottis --> an ovoid shaped piece that is going to cover up the trachea and prevent food from getting into
it; formed from elastic cartilage
- 3 paired pieces of cartilage
1. arytenoid --> posterior aspect; anchors the vocal cords
2. cuneiform --> inferior aspect
3. corniculate --> superior aspect; tips of the arytenoid cartilages
- the larynx starts off at the hyoid bone and ends at the tracheal cartilage
Glottis Rima Glottidis
Speech Production (opening)
Vocal fold
• Vocal Ligaments/fold (cords)
superior view
• Arytenoid to Thyroid
• Intrinsic laryngeal muscles
control tension and length of - vocal cords are covered in mucosa
cords ( tension = pitch) - the muscles pull on the arytenoid cartilages and
that changes the shape of the vocal folds
- increase in tension = higher pitch Vestibular fold
- decrease in tension = lower pitch
• Vestibular Fold
• Superior to vocal folds
• No role in voice production
• Important for holding pressure
within lungs (e.g. valsalva)
- ex. if you want to hold your breath or perform a valsalva maneuver, the vestibular folds will come into play
- the whole area is referred to as the glottis and the hole passing through is referred to as the rima glottidis HIGH and LOW pitch
Trachea + Bronchial Tree
• Held open by “c”-shaped cartilages
• Divides into Primary bronchi @ carina

• Left = longer, more horizontal
• Right = shorter, more vertical, wider
• Secondary (Lobar)
http://license.umn.edu/technologies/20180250_central-airway-stent-removal-device
- trachea subdivides to form the bronchial tree

- the opening is at the posterior aspect
• Left = 2 the number of lobes that
- carina = the black star
• Right = 3 exist in each lung - ex. if you are choking on a foreign body then
it will end up in the right bronchi as it is a bit
wider and more vertical
- brochopulmonary segment consists of a
• Tertiary (Segmental)
segmental bronchus and all the vessels are
going to go with it
- this is important clinically because if you
• Bronchopulmonary Segments need to perform a lung resection, you can

actually just remove a full bronchopulmonary
segment and not impact the rest of the lung,
(segmental bronchus + vessels) because each bronchopulmonary segment
much like groupings, or compartments of
muscles, is supplied by its own neurovascular
bundle
The Respiratory Zone
Respiratory Bronchi Alveoli
Alveolar duct
- the transition into the respiratory zone
= getting the capability to have gas
exchange occur Respiratory bronchiole
- from the tertiary bronchiole it is going to
move into respiratory bronchioles
- alveoli --> little air sacs in which gas Alveoli
exchange is actually going to occur
- the respiratory bronchioles are going to
go down and form alveolar ducts, which
are going to have alveolar sacs on the
end of them --> clustering of alveoli Tertiary
- air needs to get all the way down to this
zone before gas exchange can occur
- clear passage through the tubes is
bronchiole
needed to interface with the capillary
network
Alveolar sac
TYPE I PNEUMOCYTES
- interface with the pulmonary capillaries to Histology An Essential Textbook, 1st ed. Lowrie Jr. Thieme 2020
allow for gas exchange within the pulmonary
circulation
Alveoli Structure TYPE II PNEUMOCYTES

- the pulmonary surfactant allows the alveoli
to remain popped open even when pressure
drops in the lung
- at some point the pressure gets quite low in
• Two Cell Types:

the alveoli, but you want them to stay open
instead of collapsing
• Type I Pneumocyte Junquiera’s Basic Histology, 14th Ed, Mescher, 2016
• Long and flat shaped

• Make up walls of alveoli +
interface with pulmonary
capillaries
• Type II Pneumocyte
• Cuboidal
• Secrete surfactant to reduce
surface tension
• Allows alveoli to remain
popped open
A = Alveolus; I = Type I Pneumocyte
II = Type II Pneumocyte; C = Capillary
Airway branching
branches # of tubes
Trachea 1
Main bronchi 1
Lobar and segmental

Bronchial Tree
bronchi
Segmental = 10

11–16
bronchioles
Divisions
Respiratory
17–19
bronchioles
Respiratory zone
Alveolar ducts 20–22
Alveolar sacs 23
(b) Airway branching

To Summarize…
• Respiratory system consists of 2 zones:
• Conducting (passage of air + moistening & cleaning)
• Mouth/Nose Terminal Bronchi
• Respiratory (gas exchange)
• Respiratory Bronchi Alveoli
• Bronchial tree progressively divides into smaller and smaller tubes as

you progress from the nose to the alveoli
• Gas Exchange occurs via alveoli

• 2 main cell types:
• Type I Pneumocyte = diffusion
• Type II Pneumocyte = pulmonary surfactant
©
katelyn.wood@uwo.ca
Shank (leg)
katelyn.wood@uwo.ca
Learning Outcomes
• Identify key bony landmarks, and their associated structures on the tibia and fibula
• Identify and recall the innervation of muscles in the shank
• Define the boarders and contents of the popliteal fossa
• State the function of retinacula and identify their locations

Lower Limb Overview
The Lower Limb Hip
LOWER LIMB
pelvic bones
femur Thigh
patella Knee
tibia
fibula
tarsal bones
metatarsals
phalanges
Shank/Leg
Ankle
Foot
Tibia +
Fibula
- joined by the interosseous membrane —> a thick
fibrous sheath that connects the two bones together
and maintains the orientation = important for stability
of the shank
- tibia bears most of the weight
- fibula provide rotational stability
- on the superior aspect of the tibia —> lateral and
medial conondyles and between them, intercondylar
eminence —> important for ligament attachment
- inferiorly —> medial malleolus on the tibia
- anteriorly —> tibial tuberosity —> insertion point for
the patellar ligament, which is a continuation of the
patellar tendon coming from the quadriceps muscles
- ankle mortise (green line) —> important for
articulation at the ankle

Posterior Leg Tibial Plateau
medial and
lateral condyles Lateral Condyle
articulate at the
knee, not the
fibula
Medial Condyle Superior Tibiofibular Jt
Head of Fibula
Ankle Mortise
Inferior Tibiofibular Jt
Medial Malleolus
Lateral Malleolus
Popliteal Fossa
Popliteal Fossa
• Boarders:
• Semimembranosus
• Biceps femoris
• Gastrocnemii - diamond shaped at the
back of the knee
- key passageway for
neurovasculature moving
• Main Contents: from the thigh into the
shank
• Popliteal Artery
• Popliteal Vein
• Sciatic N
• Tibial N
• Fibular/Peroneal N
- neurovascular reaches the popliteal fossa, through travelling through the subsartorial canal and
through the adductor hiatus to reach the specific point in the leg
- key boundaries:
- first, semimembranosis and biceps femoris form the superior borders of the popliteal fossa, the
gastrocnemii muscles of the shank (form the inferior borders passing through the popliteal artery
and vein and the sciatic nerve)
- at this location the sciatic nerve splits to form the tibial nerve and the fibular or peroneal nerve
Popliteal Fossa
Semimembranosus Biceps Femoris
Popliteal artery Sciatic nerve

- the words in black form the 4 (deeper)
borders of the popliteal fossa
- popliteal artery —> generally a bit
deeper
- the popliteal vein and the sciatic
Common Peroneal
nerve
sciatic nerve
Popliteal vein (fibular) nerve
- splits to form the common
peroneal or fibular nerve and the
tibial nerve Tibial nerve
- the lesser saphenous vein can
drain into the popliteal vein at this
location Medial gastrocnemius Lateral gastrocnemius
Lesser saphenous v.
Muscles of the Shank
Shank Compartments
anterior
4 compartments:
Anterior (dorsiflexors) 1. anterior —> responsible for
Deep Peroneal N dorsiflexion and innervated by
the deep peroneal nerve
(comes out at the popliteal
fossa and slip around the
lateral aspect of the knee)
Lateral (evertors) 2. lateral —> evertors; allow the
Superficial Peroneal foot to move into eversion and
(fibular) N innervated by the superficial
peroneal nerve
3 and 4. posterior —>
innervated by the tibial nerve
Deep Posterior and cause plantar flexion (2
(plantar flexors) different compartments
because the type of fascia that
Tibial N outlines them is slightly
different)
Superficial Posterior
(plantar flexors) posterior
Tibial N
Shank R
Anterior
Compartment - consists of 3 muscles:
1. tibialis anterior —> cross the ankle, attach
to tarsal bones and allows you to dorsiflex
ankle
• Ankle Dorsiflexion 2. extensor digitorum longus
3. extensor hallucis longus
- 2 and 3 allows to extend the toes; innervation
is the deep peroneal nerve
- hallucis = great toe (big toe)
• Innervation: Deep Peroneal
(fibular) N
Dorsiflexion
Lateral
Compartment
• Ankle Eversion
• Innervation: Superficial
Peroneal (fibular) N
- exists on the lateral aspect of the ankle = ankle eversion

- fibularis longus (peroneus longus) —> starts at the head of the fibula and Eversion of
the tendon wraps around the bottom of the foot and attaches over at the
base of the big toe; allowing eversion and provide support to the arches o ankle
the bottom of the foot
- fibularis brevis —> deep; stops at the base of the fifth metatarsal
Base of the 5th

metatarsal
Peroneal (Fibular)
N
head of fibula
Deep Branch
Superficial
Branch
• Deep Branch = Anterior
• Superficial Branch = Lateral
- the peroneal branch is going to wrap around the fibular head and then
split to form both the deep and the superficial branches
lateral
malleolus
Superficial *
Posterior Knee
Flexion
Compartment * ‡
• Plantar Flexion *
• *knee flexion - tricep surae —> triceps = 3 heads;
they use the same attachment —>
• ‡ unlock knee calcaaneus or “achilles” tendon
- plantaris —> tiny muscle that
crosses over the knee (you figure out
it’s there when it ruptures the tendon
• Innervation: Tibial N
- posteriorly
Plantarflexion
- superficial group —> muscles are responsible primarily for plantar of ankle
flexion; a couple of them cross the knee so they can also do knee flexion
- popliteus is used to unlock the knee
- gastrocnemeii, lateral and medial heads —> both cross the knee and
provide knee flexion; also insert onto the calcaneus (heel bone) via a
common tendon with soleus
- soleus —> doesn’t cross the knee, it’s only going to do plantar flexion
- plantar flexion —> pushing toes into the ground
Triceps Surae = Gastrocs + Soleus

Deep Posterior - innervation is against the tibial nerve
- parts: the tibialis posterior, flexor
digitorum longus and flexor hallucis *
Compartment longus
- posterior
- have flexor retinaculum —> tendons
and neurovascular structures are going
to cross in the same order every time ‡
(the gateway of the foot)
• Plantar Flexion
• *Inversion
• ‡ Digit Flexion Post. ‡
FDL Tib A Post.
TP Tib N
• Innervation: Tibial N Plantarflexio

n of ankle
FHL
Gateway to the Foot

“Tom, Dick, and not Harry”
Tibial N
- it is going to innervate both of the posterior
compartments: superficial and deep
- it’s going to course around the medial
malleolus and is going to the foot
Muscle Summary
Longus Longus
Longus Longus

Longus • Soleus
Brevis
• Popliteus
Cadaveric Specimens
To Summarize…
are crossed!
• Muscles of the shank are innervated by:

• Anterior: Deep Peroneal (Fibular) N
• Lateral: Superficial Peroneal (Fibular) N
• Posterior: Tibial N
• The Popliteal Fossa represents a transition zone from the thigh to the
shank – it’s a continuation of the adductor hiatus!
• Retinacula are thick fibrous bands which hold tendons in place when the
cross the ankle (or wrist!)
©
katelyn.wood@uwo.ca
Shoulder
katelyn.wood@uwo.ca
Learning Outcomes
• Outline blood supply of the upper limb
• Identify the location and components (bones + ligaments + intra-articular

structures) of the 4 joints of the shoulder
• Differentiate between a shoulder separation & dislocation
• Identify muscles which cross the shoulder, their primary actions and innervation
Upper Limb Overview
right side of the body —> blood supply of the upper limb begins at the brachiocephalic trunk
- brachiocephalic leads into the right subclavian artery (same on both sides)
left side of the body —> blood supply to the upper limb begins at the left subclavian artery
- three vessels coming off of the arch of the aorta

- starting off at the brachiocephalic trunk, then subclavian artery, followed by the axillary artery, and this is
going right through where the brachial plexus is, and it’s going to become the brachial artery on the
anterior aspect of the arm
- divides into two pieces; the ulnar artery and radial artery
- when it reaches the hand, 2 arches form:
1. superficial palmar arch —> goes from ulnar to radial
Arterial
2. deep palmar arch —> goes from radial to ulnar
- creates anastomosis —> two vessels supplying the saem area
Anastomosis
Supply Radial A Ulnar A Radial A Ulnar A
Deep Palmar Arch Superficial Palmar Arch

Palmar Arches
Cubital Fossa to subclavian v
to brachial v
superficial side
- start by draining the superficial
deep side
palmar venous arch, which is going to
- start by draining the palmar digital veins
travel through the median basilic vein,
Venous Supply
and then the deep palmar venous arch

the median antibrachial vein and the
- going to drain through the ulnar vein, the
cephalic vein
radial vein, and the interosseous vein
- small vein across the elbow call the
- going to drain then into the brachial vein,
median cubital vein; goes right across
which meets up with the basilic vein to
the cubital fossa
ultimately drain into the axillary vein and
- drains into the brachial vein via the
the the subclavian vein
basilic vein
- the subclavian vein goes to join the
- cubital fossa —> triangular shaped
jugular vein, and that’s going to drain into
region at the anterior aspect of the
the superior vena cava into your heart
elbow; important for phlebotomy
(drawing blood)
Superficial Deep
The Upper Limb
- upper limb extends from the shoulder all
the way down through the hand
3 joints: Shoulder
1. shoulder
2. elbow
3. wrist UPPER LIMB
divided into 3 regions:
1. arm Arm
2. forearm
3. hand scapula
clavicle
Elbow
humerus
radius
ulna Forearm
carpal bones
Wrist
metacarpals
phalanges Hand
- triangular shaped and has a superior fossae —> that’s where the
border, lateral border and medial border muscles are going to set
Fossae:
- Subscapular
Scapula
the process on superior
- Supraspinous
- Infraspinous
the anterior border
aspect Scapular
Coracoid Superior Acromion
Notch the process at the
Boarder posterior aspect of the
scapula
Supraspinous fossa —> above the
spine
Spine
Glenoid
Medial Fossa
Boarder Supraglenoid
tubercle
key muscle
attachment
Lateral point
Boarder inraspinous fossa —> right

below the spine
the spine of the scapula and the

subcapular foasa —> pinched
glenoid fossa —> important for
between the scapula and ribcage
articulation at the shoulder or the
(sub = under)
glenohumeral joint
anterior view posterior view lateral view
Clavicle Sternal
Articular
Surface
Which end is lateral? superior view

Shaft
- “S” shaped bone

- exists at the anterior aspect of the
thorax
- extends right from the manubrium of
the sternum all the way out to the inferior view
shoulder; articulates at the scapula
there Acromial
- the middle of the clavicle —> the
shaft Articular
- concave end —> articulates with the
sternum
Surface
- convex end —> articulates with the
acromion of the scapula
- tubercle —> the attachment site of Costoclavicular Lig.
the costoclavicular ligament
-acromial articular surface is lateral Attachment
because that’s on the scapula
Bones of the Pectoral Girdle
clavicle clavicle
acromion
acromion
coracoid
process
glenoid spine of
fossa the
scapula
sternum

Acromial end of clavicle
Acromion of scapula
Coracoid process of scapula
Sternal end of clavicle

Lateral
Medial
Head of Superior border of scapula
humerus
Spine of scapula
Lateral border of
scapula
Medial border of
scapula
Joints of the Shoulder
Sternoclavicular Joint
Ant. Sternoclavicular Lig. Costoclavicular Lig.
1st rib
Inter-clavicular lig.
clavicle
- joint between the clavicle and the sternum

- the first rib, manubrium, part of the sternum
and clavicle
- anterior sternoclavicular ligament helps
secure the head of the clavicle into the
sternum
- costoclavicular ligament —> joins the
clavicle to the first rib manubrium
- interclavicular ligament —> between the two anterior view
clavicles which holds them together
Acromioclavicular Joint
Acromioclavicular Lig
clavicle
acromion
Coracoacromial Lig
Coracoclavicular lig
humeral
head - exists between the acromion and the clavicle
key ligaments:
- coracoacromial ligaments
- acromioclavicular ligament
- coracoclavicular ligament
coracoid process
anterior view
Grade 1 —> stretching of the acromioclavicular ligament
Shoulder Separation Grade 2 —> rupture the acromioclavicular ligament and stretch the
coracoclavicular ligament
Grade 3 —> tear both of them; referred to as a springboard clavicle,
because without these ligaments intact, the clavicle will springboard up
at the end and protrude
Acromioclavicular + Sternoclavicular Joints
Grade 1 Grade 2 Grade 3

Stretching of AC lig. Rupture of AC lig Rupture of AC +
Stretching of CC lig CC ligs
- the articulation between the head of the humerus and the glenoid fossa of the scapula
- ball and socket joint —> high mobility and low stability
factors that interplay between joint mobility and stability
- one factor —> bony contacts; the glenoid fossa is shallow and the head of the humerus is round like a ball
- number of other features at the glenohumeral joint which allow it to maintain its integrity
Glenohumeral Joint
- glenohumeral ligaments are critical fr glenohumeral joint stability —> thickenings of the joint capsule which surround the glenohumeral joint
- Being a synovial joint this is going to have a joint capsule lined by a synovial membrane and filled with synovial fluid for lubrication and protection
- Thickenings in this joint capsule are these glenohumeral ligaments
- The long head of the biceps also crosses the glenohumeral joint to attach at the supraglenoid tubercle
- the tendon is going in the intertubercular sulcus
- It's traveling right over the superior aspect of the humeral head to attach it the superior aspect of the glenoid fossa
coracoid process clavicle acromion
Joint Capsule
(synovial
membrane)
glenoid
fossa
humeral
head
scapular
spine
Tendon of Biceps Brachii
Long Head anterior view posterior view Glenohumeral Ligs
Glenohumeral Joint
Glenohumeral Ligaments long head of
Coracohumeral lig. biceps
Thickenings of the
joint capsule, lateral view
primarily anteriorly,
superiorly and
inferiorly Superior glenoid fossa
glenohumeral lig.
- the long head of the biceps there in purple as it
crosses right over the superior aspect of the humeral Middle
head
humeral head (cut)
to attach to the supraglenoid tubercle glenohumeral lig.
Inferior
glenohumeral lig.
posterior view
acromion
long head of
Glenoid Labrum biceps tendon
coracoid
• Thickening of
fibrocartilage around glenoid labrum
the glenoid fossa
• Deepens the socket for
glenoid fossa
better contact with the
humeral head
joint capsule
• May be torn with
dislocations
- important intra articular structure at the shoulder
- labrum only exists in ball and socket joints, and they provide a method for
deepening the fossa or the socket
- it can be torn with dislocations
- building up the edge of that saucer and giving you a better contact region between
the humeral head and the glenoid fossa
- a coronal cut through the shoulder so you can see that it protrudes out from the lateral view
glenoid fossa as an extension on all sides
Shoulder Dislocation
Glenohumeral Joint
- shoulder separation occurs at the acromioclavicular and
sternoclavicular joints only
- that is the bones move out of position relative to each other
- If that same type of movement occurs at the glenohumeral joint,
it's a dislocation
- two of the most common are inferiorly and superiorly, slash
anteriorly
- deltopectoral space —> the space between the deltoid and the
pectoral muscle; some nerves coursing through this area, brachial
plexus, and 2 nerves in particular are going to transverse through
this space
- these are axillary because this is going to be going up to
innervate teres minor in the deltoid and musculocutaneous
1. Axillary
CLINICAL TESTING NERVES AT RISK
APPEARANCE 2. Musculocutaneous
Scapulothoracic Joint Subscapularis
Scapulothoracic Joint
Not a “real” joint
Allows for
acromion
movement between
the scapula +
humeral
thoracic cage, which head
is critical for arm

abduction coracoid process
- the scapula on lateral side and the thorax on the medial side
- subscapularis, a muscle on the interior of the scapula Serratus Anterior
- serratus anterior which is right against the ribcage, but attaches
also to the scapula
clavicle
superior view
Scapulohumeral Rhythm
• Arm abduction requires

movement @ 2 joints:
• < 30° abduction, just
glenohumeral (GH) jt
• > 30°= GH jt +
scapulothoracic (ST) jt
• 2° : 1°, GH to ST
- talks about the movement that occurs between the scapula, the
humerus and the thorax
- arm abduction requires movement at 2 joints:
1. abduction at the glenohumeral joint can only get you about 30
degrees of movement on its own
2. beyond that, involve the scapulothoracic joint movement here
occurs at a two to one ratio —> for every two degrees, you move the
glenohumeral joint, the scapulothoracic joint is going to move one
degree

The Axilla
The Axilla
• Fat-filled space
• Provides passageway for
blood vessels and nerves
• Contains axillary lymph
nodes
- provides passageway for blood vessels and
nerves to move from your thorax into your upper
limb
- cone-shaped area
- thinner at the top than at the bottom
- going to allow for the transmission of nerves of the brachial plexus,
arteries and veins
The Axilla - critical area and highly protected by fat

- general location —> pinned between the thorax and upper limb
Nerves – Brachial Plexus Arteries - Axillary Veins - Axillary

Saturday Night Palsy
Radial Nerve Compression
• brachial plexus nerve

compression leading to
wrist drop and sensory
loss on posterior arm
What nerve is compressed?

- It leads to wrist drop, so you can't extend your
wrist and a loss of sensation on the posterior aspect
of the whole of the upper limb
- the radial nerve is what innervates
everything on the posterior aspect of the upper limb
and so compromised function in those areas
indicates radial nerve compression
Shoulder
Muscles Acting on the Shoulder
• Superficial Layer (extrinsic back) • Deep Layer (Rotator Cuff)
• Trapezius • Supraspinatus
• Latissimus dorsi • Infraspinatus
• Rhomboids (+/-) • Teres Minor
• Teres Major • Subscapularis
• Pectoral • Brachium
• Serratus Anterior • Deltoid
• Pectoralis Major • Long head of Biceps*
• Pectoralis Minor • Long head of Triceps*
Superficial Layer (extrinsic back)
trapezius
• Trapezius
• Accessory N (CN XI)
• Scapular Elevation,
Depression + retraction
latissimus
• Latissimus dorsi dorsi
• Thoracodorsal N
• Extend, adduct + medially
rotate humerus
- Cranial nerve XI —> comes off the brain and is the 11th one and acts similarly to a
spinal nerve
- trapezius —> elevates, depress, and retracts the scapula depending on which fibers
are activated
rhomboids
• Rhomboids
exist between the scapula
and spine
• Dorsal Scapular N teres +

• Retract scapula, rotate
glenoid cavity inferiorly
- retracts scapula, pulls it backwards towards
the spine and rotate the glenoid cavity inferiorly
• Teres Major
• Lower Subscapular N
• Adduct + Medially rotate
Arm
Deep Layer (rotator cuff) greater tubercle
• Supraspinatus above the spine,

posterior
• Suprascapular N Supraspinatus
• Initiate & assist with arm
abduction
Infraspinatus
• Infraspinatus below the spine of the
scapula, posterior
• Suprascapular N
• Laterally rotate arm
- consists of four muscles which are integral to glenohumeral joint stability

- tendons of these muscles are going to extend out around the humeral head and pull it into the glenoid fossa
greater tubercle
POSTERIOR VIEW
Deep Layer (rotator cuff)

• Teres Minorinnervated
along with deltoid, the only other muscle
by the axillary nerve, posterior
• Axillary N
Teres Minor
• Subscapularis anterior aspect
• Upper & Lower

Subscapular Ns
• Medially rotate arm
lesser tubercle Subscapularis
ANTERIOR VIEW
Rotator Cuff LATERAL VIEW
SUPERIOR VIEW
(deltoid removed)
“SITS” supraspinatus
infraspinatus
teres minor
ANTERIOR VIEW POSTERIOR VIEW

Pectoralis Major
Pectoral Pectoralis
Minor
• Pectoralis Major
• Lat. + Med Pectoral Ns
• Arm Flexion + Adduction
• Pectoralis Minor
• Medial Pectoral N
• Scapular Protraction
• Serratus Anterior
same root word as Serratus
serrated —> jagged edge
- finger like projections that • Long Thoracic N Anterior
are going to attach on the
ribs and the muscle starts
on the medial border of the • Rotate + Protract Scapula - pec major attaches to the humerus so it acts on
scapula the arm and pec minor attaches to the scapula so it
- pinned right between the
scapula and thoracic cage acts on the scapula
Winged Scapula
- pectoral muscles
• Intact pectoralis minor
pulls coracoid forward
• Inactive serratus
anterior allows medial
boarder of the scapula
to move backwards
leads to winging up of the scapula off of
the posterior aspect of the thorax
• What nerve?
• Long Thoracic
We’ll cover Biceps + Triceps in the next module!
Deltoid
• Axillary N
ABDUCTION 90°
• Flexion
• Extension
• Abduction
- wraps around the whole shoulder
- responsible for giving the shoulder a
round shape
- does flexion, extension, and abduction up
to 90 degrees
- the brachial muscles that are going to
cross the shoulder or the glenohumeral
joint

Shoulder Joint Movements
Range: 0-15° Range: 15°-90° Range: 90°-160° Range: 160°-180°

Muscle:supraspinaturs
Supraspinatus muscle deltoid innervated
Muscle: Deltoid Muscle: trapezius
Trapezius innervated by serratusAnterior
Muscle: Serratus anterior
Nerve: Suprascapular the
innervated by by the axillary
Nerve: Axillary the accessory
Nerve: Accessory nerve, innervated by
Nerve: Long Thoracic the long
subscapular nerve nerve cranial
(Cranial Nervenerve
XI)XI thoracic
Abduction of the upper limb at the shoulder joint involves four different muscles, supplied by
four different nerves, to achieve the full range of motion from 0°-180°

Cadaveric
Specimens
Pectoral Region
Cadaveric Specimens
Rotator Cuff
teres major not a rotator
cuff muscle
Cadaveric
Specimens
Superficial Back
To Summarize…
• 4 joints exist within the shoulder girdle:
• Acromioclavicular, Sternoclavicular, Glenohumeral + Scapulothoracic
• The Glenohumeral + Scapulothoracic joints are responsible for

arm abduction
• The axilla (armpit) is a region through which nerves and vessels

travel to reach the upper limb. It is a key site for injury
• 4 groups of muscles act on the glenohumeral joint:

• Superficial (back), Deep (rotator cuff), Pectoral & Brachium
• You should be able to identify all 12 muscles we spoke about today, and
understand their innervation + function
©
katelyn.wood@uwo.ca
Thigh
katelyn.wood@uwo.ca
Learning Outcomes
• Identify key bony landmarks, and their associated structures on the femur
• Predict functional implications of femoral injury
• Identify and recall the innervation of muscles in the thigh
• Define the borders and contents of the femoral triangle

Lower Limb Overview
The Lower Limb Hip
LOWER LIMB
pelvic bones
femur Thigh
patella Knee
tibia
fibula
tarsal bones
metatarsals
phalanges
Shank/Leg
Ankle
Foot
Femur
Proximal End
the head and fovea —> where the ligament to the head of
the femur attaches
- the neck is the common site for fracture

Femur
Distal End
articular cartilage —> articulates at the

knee
lateral and medial condyles —> condyle
means knuckle; rounded bony
protrusions at the distal end
- superior to the condyles there are the
lateral and medial epicondyles —> small
bumps above the condyles important for
muscle attachment
- intercondylar notch —> posterior
aspect
- patellar surface —> anterior aspect
Articular Cartilage

Femur

Posterior Proximal Femur
Acetabulum
Neck
Fovea for Head
ligament
of head Greater
of femur trochanter
of femur
Lesser
femur
Shaft of femur

Muscles of the Thigh
Thigh Compartments extension and flexion
are regards to the
knee
- thigh only has one
bone traversing
anterior through it —> femur
Anterior (extensors)
Femoral N
Medial (adductors)
Obturator N
Posterior (Flexors)
posterior
Sciatic N (tibial)
Thigh R
Anterior *
Compartment “Quadriceps
Femoris”
flexion *
of hip
• *Hip Flexion + Knee Extension
• Innervation: Femoral N
for muscle to cause these movements, it
needs to cross the joint
muscles that cross the hip:
- Sartorius —> aka tailor’s muscle allows you
to performs both hip flexion and knee
extension
- Rectus femoris —> the center of the thigh;
rectus means straight up and down; it also
crosses the hip producing hip flexion
- Vastus intermedius —> deep to rectus
femoris; intermedius means middle
—> vastus medialis and vastus lateralis
patellar tendon extension
those 4 muscles make up the quadriceps
femoris —> quadriceps meaning four muscle
bellies and femoris meaning of the thigh
of knee
- all of these muscles are going to attach to
the patella via the patellar tendon
- patella is going to attach to the tibial
patella
tuberosity via the patellar ligament
- tendons join muscles to bones and
ligaments join bone to bone
- innervated by the femoral nerve —> course
out of the pelvis just below or deep to the
patellar ligament
inguinal ligament and then sprays out —>
comes through the femoral triangle and
splays out to go and innervate all of the
tibial tuberosity
muscles
Medial
hip
Compartment flexion
Pectineus
• Hip Adduction, Flexion +

hip
Medial Rotation adduction
*
• Innervation: Obturator N
• *½ Adductor Magnus = tibial N
- primarily responsible for hip adduction —> bringing it towards the midline, flexion, and
medial rotation
- the first muscle is the pectineous
- next is the adductor longus
- then gracilis —> it is the smallest and the most medial
- adductor brevis is deep to pectineus and adductor longus
- brevis and longus refer to the tendon length
- adductor magnus —> has two parts to it
1. adductor component
2. hamstring component
- the hamstring component of adductor magnus is innervated by the tibial nerve, and
that makes sense because the tibial nerve, which is part of sciatic, is what innervates the
hamstring compartment
Medial
- the adductor magnus has a hole in it on the inferior aspect —> the adapter hiatus Rotation
Posterior
Compartment extension
of hip
• “Hamstrings”
• Knee Flexion
• Hip Extension
• Innervation: Sciatic N
• Tibial muscles on the medial aspect
- semitendinosis —> most superficially; more superficial and a little bit
rounder in shape
- deep to it is the semimembranosus and is a bit flatter like a membrane
- laterally there is the biceps femoris and has 2 heads: flexion
1. long head —> more superficial; lateral
2. short head —> more deep; lateral of
- quadriceps femoris on the front as part of the knee extensors
- the sciatic nerve is composed of the tibial and the fibular or peroneal knee
branches, and is basically two separate nerves sharing a common
sheath Medial
- when they're within that common sheath, we call it the sciatic nerve
- the sciatic nerve coming out of the pelvis coming out of that greater Rotation
sciatic foramen, and then it's going to traverse through the gluteal
region and then come down and innervate the posterior aspect of the
thigh
Pes Anserine 3 muscles:
Goose’s Foot tripod muscles • Sartorius

• Gracilis
• Semitendinosis
• Common Insertion on
- these muscles are all two joint muscles
- they cross both the hip and the knee
- they originate on the 3 different bones of the os
Medial Tibial Condyle
coxae —> the ilium, ischium, and pubis
Muscle Summary
• Anterior Thigh • Medial Thigh
• Sartorius • Gracilis
• Pectineus • Adductor Brevis
• Rectus Femoris • Adductor Longus
• Lateralis • Adductor Magnus
• Medialis
• Intermedius
• Posterior Thigh
• Semi-Tendinosis
• Semi-Membranosis
• Biceps Femoris
Cadaveric Specimens
Neurovascular
Pathways
Femoral Obturator Sciatic
Nerve Summary
Femoral Triangle
• Contents:
• Femoral N
• Femoral Sheath
• Femoral A & V
• Borders:
• Sartorius
• Inguinal Ligament
• Adductor Longus
- important region for neurovascular supply on the anterior aspect of the thigh
- contain femoral nerve —> comes out just deep to the inguinal ligament and then sprays out to innervate
the whole anterior compartment of the thigh
- femoral sheath which has the femoral artery and vein in it
- The borders are sartorius, the inguinal ligament and adductor longus = triangular shape
- this is just deep to the fascia lata and so the saphenous opening of the fascia lata is superior to this or
more superficial rather, and this is where the great saphenous vein is going to be able to return blood from
those superficial veins back into the femoral vein
Neurovascular Pathways
2. Inferior Gluteal N + Sciatic N

3. Pudendal N
Obturator Foramen
covered generally by the obturator
4. Obturator N membrane, and this is the way that
the obturator nerve gets
out of the pelvis
Femoral Triangle
5. Femoral N
6. Femoral A & V
Subsartorial Canal +
Adductor Hiatus
Subsartorial Canal also referred to as the adductor
canal
• Extends from the femoral triangle

between the anterior and medial
compartments
the vessels are going to transverse to reach the adductor hiatus
Adductor Hiatus
• Hole in hamstring portion of adductor
magnus
• Provides passage for femoral vessels

from anterior thigh to popliteal fossa
To Summarize…
• When considering function, think about how joints are crossed!
• Muscles of the thigh are innervated by:
• Femoral: Anterior Compartment
• Obturator: Medial Compartment
• Sciatic (Tibial): Posterior Compartment
• The femoral triangle represents a transition zone from the pelvis to

the lower limb
• The subsartorial canal + adductor hiatus allow femoral vessels to enter

the popliteal fossa (posterior knee)
©
katelyn.wood@uwo.ca
Thoracic Wall +
Abdominals
katelyn.wood@uwo.ca
Learning Outcomes
• Review spinal nerves
• Identify muscles of the thoracic + abdominal walls along with their actions +
innervations
• Describe how these muscles contribute to active and passive respiration

Spinal Nerves
Spinal Cord
- spinal nerves are the nerves that are exiting out of your spinal cord
and they're going to carry both motor and sensory information
- Motor information comes from your brain out to your muscles
- Sensory information comes in from the periphery to your brain
- spinal nerves are going to exit through the intervertebral foramen
which is formed by the superior
and inferior vertebral notches on adjacent vertebra
Dorsal rami

Spinal Nerve
Posterior Rami
Anterior Rami
everywhere else
• In thorax = intercostal Nerve
- when the spinal nerve exits out through the intervertebral foramen, it's going to split to form the anterior
and posterior ramus
- posterior ramus —> going to provide sensory information from and motor information to the zygapophyseal
joints in the spine and muscles of the deep back
- anterior ramus —> provide sensory information from and motor to basically everything else
- in the thorax = intercostal nerve
- anterior rami is now the intercostal nerve in the thorax, and this is because there's no plexus here
- not actually going to see a recombining of these interior rami to form peripheral nerves —> they stay on
their own and become the intercostal nerve
Intercostal Nerves
“VAN”
• Superior to Inferior:
• Vein, Artery, Nerve
• Travels in costal groove
(inferior to rib) for
protection
• Provides segmental
innervation throughout
the thorax
- intercostal nerves run from posterior to anterior then and they are going to run alongside the intercostal artery and the intercostal vein
- run just inferior to each rib along with the vein, artery and nerve
- intercostal van trucking right through underneath each of the ribs
- the costal groove —> for protection
- they are protected from bone or by bone on the exterior aspect
- These nerves are then going to provide segmental innervation throughout the thorax —> striped banding pattern that happens across the chest
and the back
- anterior rami just continue straight out of the spinal cord, become the intercostal nerve and then wrap all the way around to the anterior aspect of
the body
Thoracic Muscles
Intercostal Muscles
- increasing the volume contained within the chest cavity
• External
- fibers run in a superiolateral to inferomedial direction
- hands in your pocket —> the direction that your forearm is
traveling is the same direction as the external intercostal muscle
fibers

- when you're relaxed, when you inspire, you activate your external intercostal muscles
- when you want to expire, you just relax
- tension that's built up across those muscle fibers is going to pull the ribs back down
• Internal + Innermost
- when you need to need to force expiration (ex. when working out) and need to breath out
faster than you can just by relaxing
- going to depress the ribs and they run in the opposite direction
- grabbing your collarbones —> opposite position

• Superomedial to Inferolateral
• Innervation: Intercostal N
- another word for ribs is costa
- inter means in between the muscles exists in layers and are
important for respiration
Diaphragm
• Central Tendon
• 3 openings
• Caval opening (vena cava)
• Esophageal hiatus
• Aortic hiatus
• “I ate 10 eggs at 12”
• Innervation = Phrenic N. - separates the thoracic cavity from the abdominal cavity
- tendon is in the center
- allows it to lower itself or lower the domes of the diaphragm
- when you contract, the diaphragm is pulled inferiorly decreasing the pressure in the thoracic cavity and increase the pressure in the abdominal cavity —> change in
volume
- 3 openings:
1. Caval opening —> the inferior vena cava passes; exists within the central tendon; important because veins, like the inferior vena cava, can be squished and you
want blood to get back to the heart
2. Esophageal hiatus —> where the esophagus passes; exists in the muscles of the diaphragm because the esophagus is muscular in nature
3. Aortic hiatus —> the descending portion of the aorta passes; exists between the diaphragm and spinal column; aorta is resistant to squishing and has a rigid
backstop at the back
- occur at three different spinal levels —> T8, T10, and T12
Thoracic Muscle Summary
• Intercostal Muscles
• External
• Internal
• Innermost
• Diaphragm cavity
- separates the thoracic
from the abdonimal
cavity
Slide 13
- muscles innervated by the anterior rami of the thoracic spinal nerves

- external and internal oblique correspond to the same directions in the thorax
- Rectus abdominus runs up and down very similarly to rectus femoris
- transversus means across; moves in a medial-lateral direction
- all of the muscles when they contract are going to compress the abdomen increasing the
amount of abdominal pressure; important for things such as urination, defecation, and partuition
(childbirth)
- External oblique, internal oblique and rectus abdominus are going to flex the vertebral column
(ex. sit-ups are going to activate these muscles)
- because they're on an angle, external and internal obliques are going to rotate the vertebral
column and assist with lateral bending when acting on their own
- left side is acting in the absence of right side
Slide 14
Abdominal Muscles - inguinal ligament —> formed from layers of the abdominal wall and important landmark for
reproductive organs; extends from your anterior superior iliac spine, to your pubic symphysis;
going to divide the abdominal region from the lower limb
- linea alba —> running right down the center of the abdomen from the xyphoid process to the
pubic symphysis; it isn't adhering of the fascia layers of all of these abdominal muscles
- linea semilunaris —> lateral aspects; Semi lunaris means "half moon”; the area where the
external and internal oblique muscles attach onto their aponeurosis
- external oblique aponeurosis —> a broad fascial tendon-like structure that the external oblique
is going to attach into on the anterior aspect of the abdomen
- internal oblique aponeurosis —> as the internal oblique aponeurosis approaches rectus
abdominus, it splits into an anterior and posterior compartment to form a sheath around rectus
abdominus
- arcuate line —> important for a surgical landmark
- transversalis fascia —> a thin fascial layer that runs in behind the abdominal muscles.
Innervation: Anterior Rami
Abdominal Muscles
External Oblique Internal Oblique Rectus Abdominus Transversus Abdominus
Compress Abdomen
actions
Flex vertebral column

Rotate Vertebral Column + Lateral Bending
Abdominal Muscles
linea alba
external oblique
aponeurosis
internal oblique
aponeurosis/ internal oblique
rectus sheath aponeurosis/
linea (anterior) rectus sheath
semilunaris
(posterior)
transversalis
inguinal fascia
ligament
arcuate line
Compress Abdomen
actions

Rotate Vertebral Column + Lateral bending
Anterior Body Wall
- a complete rectus
sheath —> anterior and posterior
Above Arcuate Line layers
- external oblique and
it's aponeurosis, and then the
- below arcuate line, difference of rectus sheath internal oblique and it's
- external oblique aponeurosis and then our aponeurosis is going to split and
internal oblique aponeurosis right deep —> form that sheath
doesn’t split and only goes on the anterior side of - Deep to that then we have our
rectus abdominus transversus abdominus, and it's
- aponeurosis is going to aponeurosis, which really just
travel with the internal oblique aponeurosis and fuses in with the internal oblique
that leaves just transveraslis fascia behind the aponeurosis, posterior layer
rectus abdominus - transversalis fascia —>
separate the anterior body wall
from the abdominal cavity
Below Arcuate Line
Abdominal Muscle Summary
• External Oblique
• Internal Oblique
• Rectus Abdominus
• Transversus Abdominus
linea alba
Diastasis Recti
Separation of Fascia at Linea Alba
linea alba fusing of all those layers of fascia together
• Increases with abdominal straining
• Common during or following pregnancy especially with:

• Carrying larger babies or multiples (twins/triplets)
• Mom is of a smaller stature
• Age 35+
linea alba
• Also sometimes seen with newborns
• Treatment:
• stop all abdominal exercise during pregnancy – it can
worsen the condition
• Post pregnancy -- exercise & physiotherapy can
improve function.
• Sometimes surgery is needed
- muscles for breathing exist in both the thoracic and
abdominal walls
- the diaphragm are going to change the dimensions of the
Muscles for Breathing thoracic cage
• Lungs are under tension

• Anything that changes the volume of your thoracic cage
will contribute to breathing
• Inspiration (increase volume):

• Diaphragm, External Intercostals
• Active Expiration (decrease volume):

Cadaveric
Specimens
- tendinous insertions between
rectus abdominis —> 6 pack
appearance
- external oblique then inserting
into the linea semilunaris
Cadaveric Specimens
Cadaveric Specimens
To Summarize…
• Thoracic + Abdominal Muscles are innervated by anterior rami
• In the thorax, it’s called the intercostal nerve
• Thoracic Muscles:
• External, Internal + Innermost Intercostals
• Abdominal Muscles:
• External + Internal Obliques, Rectus + Transversus Abdominus
• Muscle Function is based upon angle of insertion + joints

crossed
• Breathing is based on changes in thoracic cage volume
• Arcuate Line is a facial division within the abdomen

©
katelyn.wood@uwo.ca
Vessel Anatomy
katelyn.wood@uwo.ca
Learning Outcomes
• Compare and contrast the three vessel types within the body identifying major
characteristics and functions of each
• Review major vasculature throughout the body

Vessel Anatomy
- full closed loop circuit through which blood is going to run
3 types of vessels
Arteries Capillaries Veins
• Blood travelling away from • Between arteries and • Blood travelling towards
heart veins the heart
• High pressure = Thick walls • Exist in networks • Low Pressure = Thin walls
sustain the pressure - they are on the other side of the circuit
• Larger arteries = Elastic • Single cell thick • Contain valves when

helps promote blood
• conduction + propulsion below the heart flow back to the
blood pushed through them, expand, and contract back down to help push the blood
further down the artery • Diffusion happens here! heart
• Smaller arteries = Muscular - blood can get very close to whatever’s on the
other side of the capillary —> nutrients, oxygen
- they are floppy in shape and don’t
• vascular tone waste products, carbon dioxide —> all that can
really hold their shape and can be
compressed easily
diffuse very easily across the membranes
can be contracted and can change the pressure that exists
throughout the system
Other Vessel Terms sphincters —> muscular band or ring that can constrict
- resistance vessels —> this is where you can put a brake
• Arteriole: on the system; if you don’t need blood supply to a certain
area, arterioles will contract and help redirect blood flow
• Small artery that regulates blood flow to capillary networks to areas that need it more
- they can also dilate/expand allowing for more blood flow
• Contains sphincters – “resistance vessels” to reach an area
• vasoconstriction + vasodilation
artery, arteriole, capillary
• Venules: - exists between capillaries and veins

- diffusion can occur in capillaries and
• Drain capillary blood but smallest ones are also a site for diffusion venules; as they get slightly bigger, it doesn’t
occur anymore
• Highly distensible – “capacitance vessels” - too thick and diffusion can’t occur across
the distance
- highly distensible —> hold a lot of blood
• Venous Sinus:
• Drains venous blood back to the heart or other veins + exist in 2 locations:
• Dural Venous Sinus in the brain, formed by dura mater
ex. the knee and the brain
• Coronary Sinus in the heart - the blood vessels that travel around your
knee or are at the base of your brain exist
• Anastomoses: in an anastomosis
- when you're bending your knee, for
• Union of 2 or more arterial branches supplying the same area instance, you don't cut off all the blood
supply to your shank, because there's
• Collateral blood supply to preserve blood supply to important areas another pathway it can take to get there
• E.g. Around the knee, base of the brain (Circle of Willis) - same thing exists at the base of your
brain to help ensure that blood is always
able to reach the cortex
Vessels create a
closed loop!
- the center of the closed loop is the heart
Arteries Arterioles
- give off arteries —> become arterioles
- then capillaries, venules, veins or sinuses and then back to the heart
Veins/
Capillaries
Sinuses
Venules
- deep veins of the lower limb —> muscle pump —> muscles contract and
squish veins and pushes the blood back to the heart
Varicose Veins
- once blood gets past the valve it can’t flow back down
- varicose veins —> occurs when the valves are unable to close properly,
instead of getting a unidirectional flow, there is a retrograde flow
- dilated and twisted appearance of veins throughout the body
- occur in the superficial veins of the limbs
• Valves promote unidirectional flow

back toward the heart inthe
veins that exist below
level of the heart
• Develop when valves are unable to

close properly = retrograde flow
• Typically in superficial veins (limbs)
• Within anal canal = hemorrhoids
• Bleeding esophageal varices = life
threatening (liver disease)
• Causes: congenital, mechanical

(pregnancy, prolonged standing),
aging
• Tx: elastic stockings, occlusion or

removal
Vasculature Review
- blood supply to the upper limb begins at teh brachiocephalic trunk on
Anastomosis the right side of the body and the left subclavian artery on the left side of
- two vessels supplying the same area the body
- very important - the right side of the body brachiocephalic leads into the right subclavian
- wrist and hand are very mobile and so artery
- only 3 vessels coming off of the arch of the aorta
sometimes a specific route of blood could be cut
staring from the braciocephalic trunk
off and this prevents that from happening by - subclavian artery followed by the axillary artery and going to go through
providing collateral blood supply where the brachial plexus is
- then it's going to become the brachial artery on the anterior aspect of
the arm
Arterial - then it is going to divide into 2 pieces --> ulnar artery and radial artery
- once it reaches the hand, 2 arches form
Anastomosis

Palmar Arches goes from radial to ulnar goes from ulnar to radial
to brachial v
superficial side
- start by draining the superficial palmer venous arch which
Venous Supply
is going to travel through the median basilic vein, the

median antibrachial vein, and the cephalic vein
- small vein right across the elbow called the median cubital
vein --> goes right across the cubital fossa
- drain into the brachial vein via the basilic vein
- cubital fossa --> triangular shaped region at the anterior
aspect of the elbow --> important area for phlebotomy
Deep side
- start by draining the palmer digital vein and then the deep
palmar venous arch
- going to drain though the ulnar vein, radial vein, and the
interosseous vein
- these are going to drain then into the brachial vein which
meets up with the basilic vein to ultimately drain into the
axillary vein and then the subclavian vein
- subclavian vein goes on to join the jugular vein, and that's
going to drain into your superior vena cava into the heart
Superficial Deep
Arterial Supply
- blood will start out off in the abdominal aorta
- it will bifurcate to form the left and right common iliac arteries
- this will bifurcate again or split in two, to become the internal iliac artery and the
- internal iliac is going to supply musculature and viscera of the pelvis
- external iliac is going to supply the lower limb
- once passed under the inguinal ligament, the artery, the external iliac artery,
becomes the femoral artery
- branch off of there termed the deep artery of the thigh --> going to supply all the deep
- femoral artery is going to go through the adductor canal and through the hole called
the abductor hiatus to become the popliteal artery on the back of the knee
- going to get a bifurcation and going to form the anterior tibial artery which sneaks
through the interosseous membrane coming back to the anterior aspect of the lower
limb or shank
- then becomes the dorsal pedal artery on the top of the foot
- other branch off popliteal is the posterior tibial artery
- going to run along the interosseous membrane, becoming the medial plantar artery
to go on and supply the bottom of the foot and give off a branch called the fibular
artery that's going to supply the lateral aspect of the shank
Deep Veins To heart
Venous Supply
- muscles will squeeze the veins and push the blood along 2 routes of venous supply that return blood
- veins have valves in them --> feel these in superficial veins from the lower limb
- it stops retrograde or flow in the opposite direction or away from the heart -deep veins (blue) have the same name as the
- muscle pump --> going to help bring blood back to the heart
arteries
- superficial veins begin off with the dorsal venous plexus which is on the dorsum or
the top of the foot - superficial vein (green) have different names
- they can go through the lesser saphenous vein and can drain into the popliteal vein - deep veins start off with the posterior tibial
veins and venules and then become the
popliteal vein as it goes through the posterior
Deep veins return Superficial aspect of the knee
- turns that into the femoral vein and drain into
blood during Veins the external iliac vein
- deep veins are responsible for returning
blood during exercise
exercise - muscles contract and squish the veins
- veins are floppy in nature
Popliteal V.
Superficial veins
From leg
return blood @
Muscle contractions
superficial veins return blood at rest
and they're on top of the fascia lata Valves force blood
- have to go through a hiatus up
underneath the inguinal ligament return to heart
Dorsal Venous Plexus
To Summarize…
• Vessels form a closed loop throughout the body
centered around the heart to transport blood
• Heart Arteries Arterioles Capillaries
Venules Veins Heart
• Artery = Away from Heart
• Vein = Towards Heart
• Other Vessel Terms:
• Sinus: similar to vein (Cardiac Sinus, Dural Sinus)
• Anastamosis: 2 arteries providing collateral supply
• Reviewed Key Vasculature of Upper + Lower
Limbs
©
katelyn.wood@uwo.ca
Wrist
katelyn.wood@uwo.ca
Learning Outcomes
• Identify key bony landmarks, and their associated structures on the radius, ulna and
carpal bones
• Identify the location and components (bones + ligaments + associated structures) of

the 2 joints of the wrist
• Identify muscles which cross the wrist, their primary actions and innervations
• Predict implications of carpal tunnel syndrome on sensation and movement

Upper Limb Overview
The Upper Limb
Shoulder
UPPER LIMB
Arm
scapula
clavicle
Elbow
humerus
radius
ulna Forearm
carpal bones
Wrist
metacarpals
phalanges Hand
Right Forearm!
The Ulna + Radius

Distal Aspect
- radius is thicker at the distal end than

the ulna since it is going to do the
articulation at the wrist
- ulna articulates with the radius and an
interarticular disc, not actually the
Ulnar carpals
Notch
Head of
Carpal Articulation Surface Ulna Styloid Process Styloid Process
on the radius of Ulna of Radius
IV III
II
V
Carpal Bones Phalanges
“Some Lovers Try Positions

I
- pisiform looks
like a pea —>
small round and
circular
-triquetrum —>
begins with tri
Hamate (3rd from the
pneumonic)
- trapezoid and
Capitate trapezium —>
Pisiform alphabetical order
Carpals
Lunate - hamate —>
Scaphoid has a hook on it
palmar view
Bones of
the Wrist Triquetrum
- styloid process of the radius and

the ulna on the medial and lateral
sides of your wrist Lunate
- ulnar notch where your ulna is
going to articulate with the radius
at the distal radioulnar joint
- radioulnar joint —> primarily for Styloid
supination and pronation flexion Process of
Ulna
Scaphoid
Ulnar Notch
Styloid Process
of Radius
posterior view
Joints of the Wrist
- radius on the thumb side, and wider at the
distal aspect than ulnas palmar view
- radiocarpal joint —> articulation between the
radius and the carpals
- just the radius that comes into contact with the
carpals
- distal radioulnar joint —> pronation and
supination in the forearm, along with the
proximal radioulnar joint
Radiocarpal
Joint
Carpal
bones Ulna
Radius Distal Radioulnar Jt

Ligaments of the Wrist 75
radial collateral ligament —> ligament on the

radial side of the wrist
ulnar collateral ligament —> by extension
radioulnar ligament —> exists both dorsally
and palmer aspect
radiocarpal ligament —> exists on the dorsal
and palmer aspects; help bind the radius to
the carpals for it to articulate at the wrist
radiocarpal joint —> flexion and extension
Radiocarpal Ligaments
(dorsal / palmar)
Ulnar Collateral Lig

Radial Collateral Lig
Radioulnar Lig
(dorsal / palmar)
dorsal aspect palmar aspect

Radioulnar Ligs
Joints of the Wrist

supination
Distal Radioulnar Joint
Interosseous
Membrane
• Articulation between
radius + ulna
• Contains an articular disc semipronation
• Pronation/supination
articular disc —> cushions bones; extends over the
inferior portion of the ulna as well
Ulna
Radius
Radioulnar joint pronation

Joints of the Wrist
Radiocarpal Joint
radius + scaphoid, lunate Lunate
Triquetrum
Scaphoid
and triquetrum + articular
disc from radioulnar joint
• *ulna doesn’t participate!
Radiocarpal Ulnocarpal Disc

from distal
radioulnar joint
Wrist
Muscles Acting on the Wrist
• Palmaris Longus • Extensor Carpi Radialis (L + B)
• Flexor Carpi Radialis • Extensor Digitorum
• Flexor Digitorum Superficialis • Extensor Carpi Ulnaris
• Flexor Digitorum Profundus • Abductor Pollicis Longus
• Extensor Pollicis Longus
• Extensor Pollicis Brevis
• Forearm Pronators: • Forearm Supinators:

• Pronator Teres • Biceps
• Pronator Quadratus • Supinator
Movement @ the Wrist
Condyloid – Flexion/Extension, Abduction/Adduction
• Primarily caused by “carpi” muscles of forearm

The Carpal Tunnel
Carpal Bones “Some Lovers Try Positions
Hamate
Capitate
Pisiform
Trapezoid
Lunate Scaphoid
palmar view
flip
& flex
Carpal Tunnel
• Floor: Carpal Bones
• Roof: Flexor Retinaculum
• Contents: Median N, Carpal Tunnel
flexor digitorum tendons
Flexor Digitorum S & P
Radial A
Flexor Retinaculum
Median N Ulnar
A&N Median N
(Axial Plane, MR, T1W)
Carpal Tunnel
Trapezium Trapezoid Capitate
Hamate
First
metacarpal
Hand Muscles
(hypothenar)
Median
Nerve Ulnar nerve
Hand Muscles Ulnar
(thenar) Flexor retinaculum
artery
Carpal Tunnel Syndrome Thenar
Median nerve
Compression of Median N muscles

Muscular
• Thenar muscle weakness branch of
median nerve
• Skin paraesthesia Cutaneous
branches of
median nerve
To Summarize…
• Wrist consists of 2 joints:
• Radiocarpal (flexion/extension)
• Distal Radioulnar (supination/pronation)
• All muscles entering the hand, cross the wrist

• Flexion/Extension movements primarily caused by “Carpi” muscles
• Supination/Pronation movements caused by: supinator, biceps, pronator

teres, pronator quadratus
• The flexor and extensor retinaculum hold tendons in place
• Flexor retinaculum forms the carpal tunnel
• Contains the Median N, which may become impinged
©
katelyn.wood@uwo.ca
& Movements
katelyn.wood@uwo.ca
Learning Outcomes

Anatomical Planes &
Sections
and belly button
finger
toe
and back
bottom
Anatomical Sections
Anatomical Sections

plane

Anatomical Terms
Superior (rostral)
Anatomical Terms

amongst a team

Inferior (caudal)
Term Explanation
Caudal


Fibular
(peroneal)
Palmar

Anatomical Cavities
the mediastinum)

Common Movements
Wikimedia Commons

PROTRACTION
scapula
RETRACTION
scapula
Wikimedia Commons

ROTATION
internal/external
internal
external

Wikimedia Commons
Wikimedia Commons

frontal plane
ADDUCTION ABDUCTION
other digits

DORSIFLEXION
(extension)
EVERSION INVERSION
PLANTARFLEXION
(flexion)
To Summarize…

2D clinical scans

©
Ankle + Foot
katelyn.wood@uwo.ca
Learning Outcomes

Lower Limb Overview
The Lower Limb Hip
LOWER LIMB
pelvic bones
femur Thigh
patella Knee
tibia
fibula
tarsal bones
metatarsals
phalanges
Shank/Leg
Ankle
Foot
Tibia + 75 aspect
Inferior

- lateral malleolus
shaped
Ankle Mortise
I II III
IV
V
lateral view
Cuneiforms
Navicular Cuboid
medial view
Talus
Calcaneus
Distal

Middle
Foot phalanx
Proximal
phalanx
Cuneiforms
Metatarsal
Cuboid
Calcaneus
Tarsal
bones
Talus Navicular
Lateral Ankle
Anterior Posterior
Fibula
Tibia
Talus
Navicular
Lateral Cuneiform
Calcaneus

Surface Anatomy
Joints of the Ankle
Subtalar Joint

Talocrural joint
Subtalar joint
Medial
Ankle Mortise
Medial Malleolus
Lateral Malleolus
Talocrural Joint

Posterior Leg
Anterior Posterior
Fibula
Tibia

Navicular
Subtalar Joint
Calcaneus

Interosseous
Membrane


held
Fibula
Tibia
Anterior
Tibiofibular
Ankle Mortise

High Ankle Sprain
fracture
ankle mortise
rotation of foot

Crural Joint
Calcaneonavicular
Deltoid
ligament
Calcaneofibular
- common
- ATL = anterior
medial
talus
bone
Anterior
ligament

Talus + Calcaneus +
Navicular
• Anterior =
complex
Talocalcaneal lig
Ligaments
Cervical lig

Muscle Summary
Longus Longus
Longus Longus

Longus • Soleus
Brevis
• Popliteus
Flexors Extensors
Digitorum
Longus Longus
Hallucis
Longus Longus
Gastrocnemii
Achilles ---
Plantaris
Soleus
provides eversion
Peroneus Brevis
Peroneal ---
Peroneus Longus
Attachment Summary
Flexor Digitorum
Longus Longus
Longus
Flexor Hallucis
Longus
Peroneus
Tibialis Anterior
Tibialis Posterior
Tibialis
Digitorum
Hallucis
Peroneal
Achilles Achilles
sprain
• Signs/Symptoms:
To Summarize…
©
katelyn.wood@uwo.ca
katelyn.wood@uwo.ca

What system does?
Learning Outcomes
Homeostasis


this internal state

the blood
The ANS at work
Stand up


BP Detect BP

activity activity
Negative Feedback
vasoconstrict

sensory motor

voluntary control)

Somatic
Autonomic
motor
Motor Systems
Somatic Autonomic
postganglionic)
ACh ACh, E,Eoror
ACh, NENE
Yes Pre – yes

Pre --> Yes
Post - no
Cardiac Muscle
Heart:
GI:
ANS input
SNS only:
• Sweat glands
PNS only:
miosis mydriasis
For example:


Parasympathetic NS

• Signals to:
organs
very short

ganglion
Posterior ramus
of spinal nerve

nerve
of spinal nerve

Urinary bladder
1 preganglionic N
with 1 target
Sympathetic NS
• Signals to:
(like a hormone)
Posterior
Sympathetic NS root
ganglion
spinal nerve
nerve
3
nerve
1 Sympathetic
4
(unmyelinated)
ganglion
(celiac ganglion)
collateral ganglia

Anterior view

NT = NE
ACh
Spinal cord
SNS

NT = ACh
NT = ACh
ACh
Long Preganglionic

at once
BUT…

Receptor Summary
• Cholinergic
• Subtypes:
• Adrenergic
• Subtypes:
SNS vs PSNS Neurons
SNS PSNS
ganglionic
Myelination? Thin
Thin Thin
Thin
Pre-
Axon Length Short

Short Long
Long

Nicotinic, ACh
ACh

collateral
ganglia or or
@ targetorgan
organ
ganglionic
Myelination? None
None None
None
Post-
Axon Length Long

Long Short
Short
Adrenergic, NE,NE
or or
E E Muscarinic,
Muscarinic, ACh
ACh
Many One
One
Referred Pain

the arm
To Summarize…


©
katelyn.wood@uwo.ca
Arm
katelyn.wood@uwo.ca
Learning Outcomes

Upper Limb Overview
The Upper Limb
Shoulder
UPPER LIMB
Arm
scapula
clavicle
Elbow
humerus
radius
ulna Forearm
carpal bones
Wrist
metacarpals
phalanges Hand
The Humerus
Anatomical
neck
- has 2 necks:
sulcus (groove)
is going to run
Medial epicondyle

elbow
Muscles of the Arm

radial nerve
common function
posterior
Radial N
Anterior (flexors)
Musculocutaneous N
anterior
Flexors (anterior)
Arm Flexors
Biceps Brachii
- has 2 heads:

repaired
brachialis
Musculocutaneous N
• Course:

dislocation

• Arm Extension
• Long Head

Head
• Population:
energy trauma
• Older people,
osteopenia

be impaired
Anterior
Coracoid
process of
Humerus
Radial nerve
Media
Later
l
al

Glenoid of
scapula
Acromion of scapula

Posterior
Radial N
in the arm
• Course:
• behind humerus,
triceps
Cadaveric Specimens
Arm
To Summarize…


©
katelyn.wood@uwo.ca
The Axial Skeleton
katelyn.wood@uwo.ca
Learning Outcomes

AXIAL
The Skeleton skull

mandible
sternum
ribs (costa)
Functions vertebrae
cervical (7)
thoracic (12)
sacrum + coccyx
Storage of minerals
APPENDICULAR
The Skull
The Skull
Bones Bones
Frontal Ethmoid
Parietal Lacrimal
Sphenoid Zygomatic
Temporal Vomer
Mandible
Maxilla
Nasal
Palatine
Neurocranium
Parietal bone
Sphenoid bone
Temporal
bone
Occipital
bone
Neurocranium Bones
Frontal
Occipital
Parietal
Sphenoid
Temporal
Neurocranium
Parietal bone


articulate with the
Internal Auditory
saddle

Occipital
bone
Neurocranium Bones
Occipital Condyles
Frontal
Occipital
Parietal
Sphenoid
Temporal
The Skull
Neurocranium
Parietal bone
Temporal
bone
Occipital
bone
Neurocranium Bones
Frontal Magnum
Occipital
Parietal
Sphenoid
Temporal
Neurocranium
Parietal bone
Sphenoid bone

portion of the bone
- greater wing
Temporal
bone
Internal Auditory
Meatus
Lesser Wing

bone
Neurocranium Bones
Foramen Magnum
Frontal
Occipital
Parietal
Sphenoid
Temporal
Sutures
Frontal bone
Coronal suture
Sagittal suture
Parietal
bones
Labdoid suture
Squamoid suture
Occipital bone
Temporal bone
Fontanelles
Viscerocranium
Lacrimal bone
Nasal
bone
Viscerocranium
(Facial) Bones
Ethmoid Zygomatic
bone
Lacrimal
Zygomatic
Vomer
Mandible
Nasal
Palatine Mandible
Viscerocranium
Nasal
bone
Viscerocranium
Ethmoid
Nasal
Concha
Lacrimal
Vomer
Zygomatic
bone
Vomer Palatine bone
Mandible
Maxilla bone
Maxilla
Nasal
Mandible
Palatine
The Skull
Viscerocranium
Viscerocranium
(Facial) Bones
Ethmoid
Vomer
Lacrimal bone
Zygomatic
Palatine bone
Mandible Concha
Maxilla
Nasal Maxilla bone
Mandible
Palatine
Viscerocranium
Zygomatic
Lacrimal bone bone
Vomer
Ethmoid bone bone
Viscerocranium
(Facial) Bones
Ethmoid
Inferior Nasal
Lacrimal
Concha
Zygomatic
Vomer
Mandible
Maxilla
Nasal Maxilla bone
Mandible
Palatine
The Spine
+ Vertebrae
SUPERIOR
The Spine
1
2
3
4 Cervical
5
6
7
vertebrae (7)
1
2
3
24 Vertebrae 4
5
7 Cervical 6
7
8
Thoracic
5 Lumbar 10
11
1 Sacrum 12
1
5 fused vertebrae 2
1 Coccyx 3 Lumbar
4 vertebrae (5)
5
Sacrum (1)
Intervertebral
disc Coccyx (1)

Surface Anatomy
General Vertebral
Anatomy
Body
(body)
Pedicle
(arm)
Transverse Pr.
Lamina (elbow)
(forearm)
Spine
(hands)
General Vertebral
Vertebral Articular
Notch Facet
Spinal nerve
Cervical Spine
7 vertebra
Lordosis
Key Features:
Bifid spinous pr.
Transverse Foramen
C1 (Atlas)
No body or spine
C2 (Axis)
Dens
anterior
Cervical Spine
lateral
superior
anterior
Cervical Spine
Atlas (C1)
lateral
superior
anterior
Cervical Spine
Axis (C2)
lateral
superior
Vertebral Artery
superior view
vertebral
artery
Thoracic Spine
Kyphosis
12 vertebra
Key Features:
Heart-shaped bodies
Costal facets
lateral
superior
Lumbar Spine
Lordosis
5 vertebra
Key Features:
Squat, thick bodies
lateral
superior
Normal Osteoporotic
Osteoporosis
activity
Symptoms:
Back pain
Sacrum + Coccyx
Kyphosis
5 Fused vertebra
Key Features:
Promontory
Auricular surface
lateral
Sacrum + Coccyx
posterior anterior
Costal facets and

articular facets

Atlas Small

surface

Ligaments of
the Spine
Anterior
Broad fibrous band
Posterior
Narrow fibrous band
Ligamentum Flavum
Joints of the Spine
Joints of the Spine
Zygapophyseal Jt
Intervertebral Jt
*Costovertebral Jts
condyles of skull
2 lateral (LAJ)
Transverse
Ligament of
Atlas
superior
Joints
vertebrae
Stabilize column

Joints
vertebrae
Stabilize column


Not between C1 & C2

C1 has no body
Intervertebral Disc

Thick Fibrous Ring

Gelatinous centre
Avascular
L3
Disc Herniation
Joints
Thoracic Cage
Thoracic Cage
Composed of
12 Ribs (X2)
Costal Cartilage
Sternum
Manubrium
Body
Xyphoid Process

Suprasternal notch
Manubrium
Sternal angle
Facet for
Xyphoid
Anterior view
process
Rib Anatomy

Articular Facet for
Tubercle
Costal angle
Costal groove Body
(c) Posterior view




©
katelyn.wood@uwo.ca
Spine + Back
katelyn.wood@uwo.ca
Learning Outcomes
Bone Review

of costal cartilage

a common piece of

costal cartilage
• Manubrium
• Body
• Xyphoid Process

the head of the rib

SUPERIOR
The Spine
1
2
3
4 Cervical
5
6
7
vertebrae (7)
1
2
3
• 24 Vertebrae 4
5
• 7 Cervical 6
7
Thoracic
• 12 Thoracic 8
9 vertebrae (12)
• 5 Lumbar 10
11
• 1 Sacrum 12
1
4 vertebrae (5)
5
Sacrum (1)
Intervertebral
disc Coccyx (1)

Anatomy
Body
(body)
Pedicle
(arm)

(elbow)
(forearm)
Spine
(hands)
Sacrum + Coccyx
• Key Features:
• Promontory
of the pelvis
The Os Coxae
lateral view
Surface
PSIS
ASIS
Pubic
PIIS Tubercle
AIIS Acetabulum
Ischial
Spine
Obturator
Foramen Fossae:
- Gluteal
- Iliac
Sacrum
Os Coxae
Sacroiliac
Joint
Pubic
Spinal Nerves
Spinal Cord

going in the body
vertebra
artery
vertebra
Spinal Cord
Sensory
neurons
Dorsal Root
ventral rami
Dorsal Rami
body
plexuses
Ventral Horn
Ventral Rami
Spinal Nerve
Motor
Ventral Root
Spinal Nerve
Posterior Rami
in situ
zygapophyseal joint
deep back
Spinal Nerve
Spinal cord
the posterior ramus
root
Cervical vertebra
Larynx
ANTERIOR
Deep Back Muscles
Deep Back Muscles
• Superficial
• Iliocostalis
• Longissimus
• Spinalis
• Deep
• Semispinalis
• Rotatores
• Multifidus


Nerve: posterior
rami of spinal n.
Splenius Cervicis,



Nerve: posterior
rami of spinal n.
Semispinalis
Capitis
Actions:
the thoracic spine
Multifidus
the thoracic spine
Nerve: posterior
rami of spinal n.
• Longissimus
• Spinalis
• Rotatores
• Multifidus
Cadaveric
Splenius cervicis
Spinalis
Longissimus
Iliocostalis
Multifidus
To Summarize…
• Bony Anatomy

are crossed!

©
katelyn.wood@uwo.ca
Bones
katelyn.wood@uwo.ca
Learning Outcomes

Appendicular vs
Axial Skeleton
AXIAL
The Skeleton skull

mandible
sternum
ribs (costa)
Functions vertebrae
cervical (7)
thoracic (12)

Storage of minerals
APPENDICULAR
APPENDICULAR
Elbow Upper Limb
Wrist
Hip
Lower Limb Knee
Ankle
The Skeleton
Arm
APPENDICULAR
Upper Limb
Hand
Thigh
Lower Limb
Shank/Leg
Foot
The Skeleton
APPENDICULAR
UPPER LIMB
scapula
humerus
- 3 cuneiforms
tibia
fibula Carpals
Tarsals
tarsal bones
metatarsals
phalanges

Sesamoid - Patella
Long - Humerus
tubular
tubular in-->shape
provide strength,
cuboidal in shape
and stability and
with limited
carpalbones, tarsal
skullskull
oddly shaped
Sesamoid bones
develop--
in protect
tear

Boney Landmarks
Attachments

CREST ridge of bone
Boney Landmarks
Joints

FACET
Boney Landmarks

SINUS sac or cavity
Surface Anatomy
Knowledge Check-in

Landmarking
Bone Structure
mold

cartilaginous plate
Epiphyseal
Plate
Epiphyseal
Line

Bone Cells
osteoblasts
called canaliculi

Bone Types


Trabecular Bone
(spongy/cancellous)

degrade bone
derived from
WBC lineage
create bone
Osteoporosis
bone
genetic females
SEM 30x SEM 30x

Compact Bone
(cortical)

haversian canal
concentric rings
Compact Bone
(cortical)

"sharpy fibers"
anchor to bone
highly vascularized
Fractures
Fractures
Comminuted
pieces bones
pressed inward
Ragged break due to
comminuted
depressed
compressed
spiral
epiphyseal
green stick
Fractures
Aging + Exercise
Aging

Exercise
• Weakened Bones:
To Summarize…



©
katelyn.wood@uwo.ca
The Brachial Plexus
katelyn.wood@uwo.ca
Learning Outcomes

The Brachial Plexus

disease
• 5 portions:
Roots
• _______________
Trunks
• _______________
Divisions
• _______________
Cords
• _______________
Branches
• _______________
Trunks C5
Brachial Plexus
Divisions C6
Ant/Post
Cords C7
T1
named vertebra.
Axillary

Radial

Musculocutaneous
arm flexors (C5-7)
cords
Drink
and ColdforBeer”
Ulnar
upper limb.
Brachial Plexus C6

U
C8
divisions level T1
lateral medial
L
axillary
nerves
cord
ulnar
Anterior/posterior
C4 Musculocutaneous
Lateral
C5
Upper
C5
C6
C6
Middle Axillary
C7 Median
Posterior
C7 Radial
C8
Lower
T1
T1 Medial Ulnar
T2
Lat. Pectoral
Musculocutaneous
Suprascapular
C5
these 9
peripheral C6
nerves go
on to supply
muscles Axillary
pectoral
region, Radial
superficial
back, or the C8
upper limb
Upper & Lower
Subscapular
T1
Med. Pectoral Ulnar

Med Cutaneous Arm
Lat. Pectoral
Musculocutaneous
Suprascapular
C5
axillary and the
upper and lower
from C5 and C6.
blue -->
Axillary
middle trunk Median
C7 Thoracodorsal
green -->
lower trunk Radial
C8
Upper & Lower

Subscapular
T1
Med. Pectoral Ulnar

Med Cutaneous Arm
Brachial Plexus
Lateral pectoral C5
C6
C7
Suprascapular
C8
Medial pectoral T1
Upper subscapular
Posterior cord
Axillary
Medial cord
Radial
Long thoracic
Median Lower
subscapular
Ulnar
Thoracodorsal
Brachial Plexus
Extensor
Compartment
Nerves
and teres minor
axillary nerve.
of the upper limb
Flexor
Compartment
Nerves
musculocutaneous.

Nerves + Axillary
Muscles Radial
Median
Nerves C4
T2
C6 T2 T5 Radial
the way to T1
Medial
cutaneous
C6
C7
C8

(usually C5/C6)
impaired
brachialis
forearm

overhead
• Outcome:
distal hand
Lat. Pectoral
Musculocutaneous
Suprascapular
C5
C6
Axillary
Radial
C8
Upper & Lower

Subscapular
T1
Med. Pectoral Ulnar
Long Thoracic
Med Cutaneous Arm
To Summarize…
median

©
katelyn.wood@uwo.ca
Cardiac Cycle
+ ECG
katelyn.wood@uwo.ca
Learning Outcomes

each

Heart Review
The Heart
they need to pump
top bottom

Vessels create a
closed loop!
back to the heart
no longer need it
Veins/
Capillaries
Sinuses
Venules
and upper limbs
Blood Flow
lung left lung
3. 6. 5.
5.
Key: 10.
Oxygen-rich blood
Oxygen-poor blood
and lower limbs
Great Vessels
Cardiac Muscle +
Contraction
wall

differently
slightly
longitudinal

the picture
1. Pacemaker
could contract on
repolarizing
Action Potentials



rushes in
channels open
SA Node = pacemaker
everything else

contract
adjacent cells
Electrocardiogram
(ECG)
cardiomyocytes
and we can measure

electrodes
deflection

ECG
-
Sassi et al 2017


these key parts
are reading an ECG
atrial contraction
depolarization
The Cardiac Cycle
The Cardiac Cycle
• 7 Phases
• Recordings:
• ECG
•
couple points
Basic Principles:


that

volume
ventricles
closes AV-Valve

changing
• Atria relax

isovolumentric

starts
Rapid Ejection

open
pulmonary trunk
rapidly
the aorta
the ventricles

blood
their contraction
- electrical signal
and starting to
repolarize here
sound S2

• Heart sound S2
relaxation
Systolic Volume
Rapid Filling

valves open
rises
Reduced Filling

arteries
Heart Rate Control
Autonomic Control

Parasympathetic NS
Autonomic Control
norepinephrine

• Receptors:
causes relaxation

To Summarize…
ECG
the heart
©
katelyn.wood@uwo.ca
Cartilage
katelyn.wood@uwo.ca
Learning Outcomes

Cartilage
Cartilage Types
synovial joints
Elastic Cartilage
Fibrocartilage


• No blood supply
Function


Composition

• Collagen
• Proteoglycans
• Lipids
• Collagen
• Proteoglycans
3 zones:

the force
the bone
Distribute Force
Fluid Storage
Bony Connection
load
joint capsule

which expands
Synovial Membrane
accomplished!
H20 H20
Cartilage Injury
Arthritis



joint infection
Cartilage Injury
Arthritis

late
feel the pain
To Summarize…


©
katelyn.wood@uwo.ca
CNS Overview
katelyn.wood@uwo.ca
Learning Outcomes
spinal cord
conus medullaris


sensory motor

voluntary control)
or SLUDD)
White & Gray Matter
The Brain
The Brain Cerebral
hemisphere
Diencephalon
Cerebellum
Lateral view
Brainstem:
Midbrain

The Brain
Corpus Callosum

Neuro Terms
Gyrus
Fissure
Sulcus

Central sulcus
Postcentral gyrus
Precentral gyrus
POSTERIOR
ANTERIOR

get into the insula
Frontal lobe
POSTERIOR
ANTERIOR
Occipital
lobe Temporal
lobe (cut)
Pons
Spinal cord
Frontal Lobe
judgement)


language
Parietal Lobe
• Touch
• Proprioception
Temporal Lobe
• Processes Smell
the lateral fissure
Occipital Lobe
Parieto-occipital
information sulcus
Thalamus
• Thalamus
information
• Hypothalamus
• Pituitary Gland
Pituitary gland

Inferior
Brainstem
• Midbrain
• Pons
medulla
from periphery

• Olive (lateral)
Cerebellum
movement
equilibrium

plan
Fourth Ventricle
fluid Cerebellum
Cerebrum
Diencephalon:
Thalamus
Hypothalamus
Brain stem:
Midbrain
Cerebellum
Pons
Medulla oblongata
Spinal cord
The Spinal Cord
Spinal Cord in Situ
L1-L2
(horse tail)
Did you know…
to the brain
White Matter:
Periphery
Sensory (to brain)
Gray Matter:
Contains:
Neuron Cell Bodies
Glial Cell Bodies
Meninges
Lateral ventricles
foramen
Third ventricle
Cerebral Aqueduct
in the brain Fourth
Central canal
• 3 parts:
foramen


inter-thalamic
adhesion (the left
and right thalamus
are connected
through the hole)
Dura mater

Arachnoid mater
- much thinner
Pia mater
cushioning
Brain/Spinal Cord
dura mater
Meninges

vasculature
damage
• Alongside CSF


• Falx cerebri

blood.
base of the brain
pia = red
arachnoid = green
dura = blue
Epidural Space
Arachnoid Mater
Dura Mater
Subarachnoid
Space
Pia Mater
View
Transverse
plane
Dura mater and
arachnoid mater

of vertebra
Pia mater
Subarachnoid space
Epidural space
Posterior (dorsal)
facet of vertebra

Anterior (ventral)
Spinal nerve
root of spinal
foramen
Vertebral artery in
ANTERIOR
Lumbar Puncture +
Epidurals
needles coming in)

and green)
spinal nerves
area
the anesthetic)
To Summarize…
• Cerebellum
©
katelyn.wood@uwo.ca
Muscle Compartments
katelyn.wood@uwo.ca
Learning Outcomes
fibrous sheaths

Compartments
Limb Compartments
brown

within the limbs



L Upper Limb
Compartments
Arm
Forearm

cause extension
Arm Forearm L
Flexors (anterior)
Arm Forearm L
Radial N
Anterior (flexors)
Musculocutaneous N
Ulnar N
side)
Arm Forearm L
Brachial Plexus arm

forearm
C6
the shoulder)
upper limb
C8
divisions level T1

Roots: C5 – T1
axillary
musculocutaneous
radial

ulnar
Extensor
Compartment
Nerves
Flexor
Compartment
Nerves
stops
Flexors (posterior)
Thigh Leg
Lat.

- pain is a sign of
trauma, Trauma/
Flow
blood flow to the
swelling,
pain
nerve
Bleeding

Fasciotomy

compartments
To Summarize…
within the limbs
syndrome)
©
katelyn.wood@uwo.ca
Elbow
katelyn.wood@uwo.ca
Learning Outcomes
elbow
the elbow
Upper Limb Overview
The Upper Limb
Shoulder
UPPER LIMB
Arm
scapula
clavicle
Elbow
humerus
radius
ulna Forearm
carpal bones
Wrist
metacarpals
phalanges Hand
The Humerus

the elbow
side)
Olecranon fossa
Medial epicondyle
Capitulum
Trochlea
Lateral epicondyle

Olecranon

ulna
Notch
going to
Head elbow
articulating
the radius,
process, and
ulnar
tuberosity
Coronoid
Process
Ulnar Tuberosity
Bones of
Lateral
epicondyle
Capitulum Trochlear
Notch
Trochlea
Olecranon
Coronoid
Process
Radial
Tuberosity

Joints of the Elbow
Joints of the Elbow
Humeroradial

Cubital Joint
• flexion
Proximal Radioulnar
• supination

joint
Medial
Olecranon of ulna
Lateral
Capitellum of
Head of radius
Neck of radius
Radial tuberosity
Proximal radioulnar
Radius joint
Ulna

superior view

anterior view
lateral view
(green)
Cubital + Proximal
Radioulnar Joints
b c
Elbow Dislocation
Cubital Joint


therapist
Radial Head
Subluxation



normal position
subluxation)
The Cubital Fossa
Cubital Fossa
Radial N
Median N
Brachial A
Cubital Veins
Brachioradialis
Pronator Teres

3. pronator teres
Elbow
• Brachialis

To Summarize…



©
katelyn.wood@uwo.ca
Forearm
katelyn.wood@uwo.ca
Learning Outcomes

Upper Limb Overview
The Upper Limb
Shoulder
UPPER LIMB
Arm

clavicle
Elbow
humerus
radius
ulna Forearm
carpal bones
Wrist
metacarpals
phalanges Hand
Head
articulates at the
elbow
Radial Tuberosity
Interosseous
Boarder

Styloid Process
down at the wrist

Colle’s Fracture
Hand
dinner fork
Radial Notch
The Ulna Trochlear

Notch
Radial Notch
Olecranon
Coronoid
posterior aspect
attachment Boarder
Head of

The Forearm
• Supination:
radius & ulna
are parallel
(anatomical
position)
overtop of the ulna
Radius
Ulna
• Supination:
radius & ulna
are parallel
(anatomical
position)
• Pronation:
radius & ulna
are crossed

Distal
Middle
of the Hand phalanx
DIP
Proximal
Joints: phalanx PIP


Carpal
bones

Radius Ulna
anterior view
posterior
Radial N
Anterior (flexors)
Median N
Ulnar N
anterior
Flexors (anterior)
Brachioradialis‡
Superficial Layer
Pronator Teres

Flexor Carpi
Flexor Carpi
• Nerves: fail”
Flexor Dig.

Profundus*

Flexor Dig.
Profundus*

Quadratus
anterior view
• Nerves:
• Median Flexor
Retinaculum
• *Ulnar
Forearm Flexors
humerus
of humerus
Palmaris longus
Supinator
quadratus
Pronator quadratus
profundus (cut)
Palmar aponeurosis
Flexor digitorum
superficialis (cut)

wrist
• Course:

Ulnar N
- funny bone
forearm
• Course:
epicondyle

Supinator
Lateral
Epicondyle
Carpi Radialis

Digitorum
forearm
to the pinky
lateral epicondyle
epicondyle
Carpi Ulnaris
Ulnaris
• Nerve: Radial
Lateral epicondyle
Brachioradialis
- part of flexor
Extensor
carpi
radialis brevis
Extensor
digitoru
m
Extensor
carpi ulnaris
Extensor
digiti
minimi
Golfer’s Elbow
Epicondylitis
• Inflammation of
tendons at either
medial or lateral
epicondyle
epicondyle
Tennis Elbow
Extensor Carpi
*Abductor Pollicis
Pollicis Longus
*Extensor
Extensor Indicis
• Nerve: Radial
posterior view
Forearm Extensors
Ulna
Abductor pollicis
Extensor pollicis
Extensor indicis
groove

• Course:
• Splits to form
supinator)
To Summarize…



©
katelyn.wood@uwo.ca
Hand
katelyn.wood@uwo.ca
Learning Outcomes

Upper Limb Overview
The Upper Limb
Shoulder
UPPER LIMB
Arm
scapula
clavicle
Elbow
humerus
radius
ulna Forearm
carpal bones
Wrist
metacarpals
phalanges Hand
V II
Thumb
- 8 carpal
Hamate bones
Capitate
Pisiform
Carpals
Lunate
Scaphoid
palmar view
Distal
Middle
of the Hand phalanx
DIP
Proximal
Joints: phalanx PIP


Carpal
bones Carpal

Radius Uln

segment
- no reunion of the

snuff box
compromise proximal
segment
Radial artery
Forearm Muscles
Acting on the Hand
Flexors Extensors
Carpi the
Extensor Digitorum
Flexor Digitorum
Carpi Muscles

the muscles

- special muscle
- flexor
Digitorum Muscles
- first 3
are on
the
aspect Text
(yellow)

profundus through

Outcropping Muscles
Abductor Pollicis

Longus
posterior view
Carpi
Digitorum

Extensor
Flexor carpi
Extensor radialis
pollicis brevis
Extensor
pollicis longus
Flexor digitorum
Extensor
superficialis
digitorum

digiti minimi
Intrinsic Muscles
of the Hand


contract
1 and 2 are
innervated by

midline
• Nerve: Ulnar
- D = dorsal

itself
• 3 PAD
palmar views
Lumbricals
Palmar Interossei
Dorsal Interossei

pinky move?
hypothenar muscles
superficial deep
Thenar muscles
Hypothenar muscles
thumb and pinkie
ulnar
ulnar
syndrome
Nerves:
To Summarize…
To Summarize…

©
katelyn.wood@uwo.ca
Heart Anatomy
katelyn.wood@uwo.ca
Learning Outcomes

The Thorax
Thoracic Cage
Composed of
• 12 Ribs (X2)
• Sternum
• Manubrium
• Body
• Xyphoid Process

Middle Mediastinum
the heart
Middle
mediastinum


Thoracic Inlet
to the base of T4
Diaphragm
Contents:
• Sup. Vena Cava
• Left Subclavian
stomach
Middle Mediastinum
Contents:
• Heart
• Pericardium
• Fibrous
• Serous
• Ascending Aorta
• Pulmonary Trunk
Contents:
• Esophagus
• Vagus Nerve
Contents:
Pleural Cavities
Contents:
• Lungs
• Pleura

• Pulmonary Veins
• Primary Bronchi
The Heart +
Pericardium
muscle

• 2 halves
• 4 Valves
hard
with more pressure


itself


L. Atrium
R. Atrium R. Atrium
L. Ventricle

Sulcus
posterior view
R. Ventricle
Cardiac Apex
those three sources

Aortic Arch
Pulmonary Trunk
+ Arteries Superior
Vena Cava
Vena Cava
Cardiac Sinus
Inferior
Vena Cava
Inferior
flipped
comes in veins
Atria
anterior
Veins

posterior
Atria
the lungs
• Key Landmarks:

(AV) valve

pectinate muscle
left side


Left AV Valve
Ventricles

pulmonary trunk

posterior

bypassing the lungs


left side

- 4 valves in total
into the ventricle
Valves
• Pulmonary
backflow
Semilunar Valves

to fill
chordae tendonae
posterior
AV Valves
Semilunar Valves
Valve Mechanics
forces them open
semilunar valves
other
AV Valves
L Subclavian


shape
• Arch
• Descending

Great Vessels
pulmonary veins
Arteries
• Pulmonary Trunk
going to lungs
Veins
lungs
Great Vessels
and upper limbs
Blood Flow
lung left lung
3. 6. 5.
5.
Oxygen-rich blood
Heart Failure
well as it should =
coughing
fashion



arteries

- peri means around
Pericardium


to fuse into
Continuous with
of the heart)
diaphragm
Continuous with
Aorta
the heart)
ascending aorta
Backflow of blood
seal off
to to

• Arteries
Diagonal

L Marginal
Great Cardiac
• Veins
sulcus


Middle Cardiac

• Risk Factors:


To Summarize…

Arch of aorta
Superior vena cava

veins
Pulmonary trunk
Right atrium
Right ventricle
sulcus
posterior view

Right ventricle
Left ventricle
sulcus
©
katelyn.wood@uwo.ca
Hip + Pelvis
katelyn.wood@uwo.ca
Learning Outcomes
pelvis
Lower Limb Overview
is grasping and the
smaller bones
larger bones
you move throughout
when you get to the
lower limb

posterior
laterally
L2

L2-L4
L5
Terminal Branches
OBTURATOR NERVE
S1
brachial plexus
common sheath
nerves
TIBIAL NERVE
obturator
FIBULAR NERVE
(common peroneal)
L4-S2
Arterial Supply
the pelvis
aspect of the shank
Deep Veins To heart
Venous Supply
iliac vein

during exercise
along
back to the heart
Popliteal V.
Superficial veins
From leg
return blood @
Muscle contractions
Valves force blood
return to heart
Fascia Lata
abdominal wall
aspect of the thigh
deep fascia of the
shank
“Crural Fascia”
The Lower Limb Hip
LOWER LIMB
pelvic bones
femur Thigh
patella Knee
tibia
fibula
tarsal bones
metatarsals
phalanges
Shank/Leg
Ankle
Foot
fovea


joint

posterolateral view
The Os Coxae
glutes
to the sacrum
• Other Terms:
• Innominate bone
• Hemipelvis
The Os Coxae
lateral view
Surface
PSIS
ASIS
Pubic
PIIS Tubercle
AIIS Acetabulum
Greater Sciatic
Notch
Ischial
Spine
Fossae:
- Gluteal
Foramen landmark
- Iliac
pubis
acetabulum
Sacrum
Os Coxae
Femur

Surface Anatomy
Ilium
Sacrum
Femur Coccyx
Pubis
Obturator Foramen
Ischium

Pelvic radiograph
Iliac Crest
superiorly
together
Anterior Superior
Iliac Spine (ASIS)
Anterior Inferior
Ischial Spine
Iliac Spine (AIIS)
Acetabulum
Pubic Symphysis


of head Greater
of femur trochanter
of femur
Lesser
femur
Shaft of femur

spine
coxae
posterior view
anterior view
anterior view
medial view
medial view
superior view
superior view
anterior view
Sacroiliac (SI)

and the ilium
the pelvis
Hip
Pubic Symphysis
Sacroiliac Joint
anterior view
• Sacrum + Ilium
due to strong
ligaments
Sacroiliac
Pubic Symphysis
anterior view
• Symphysis
ends of bones,
between
mobile
Open Book Fracture
Symphysis
• Normal = 4-5mm
• 2 main causes:
• Complications:
cavity
Hip Joint
anterior view
• Femoral Head +
Acetabulum
Joint
• Highly mobile
Hip Joint
Ligaments

pubis to the femur
Iliofemoral
Pubofemoral
Ischiofemoral
Acetabular Labrum

Femur

Hip Joint
Summary
Joint
capsule
Acetabular
Labrum
Acetabular Fovea
fossa
Obturator Greater
head of
femur
Lesser
trochanter
crossover bone
• Trochanteric
greater trochanter
• Ischiogluteal
tuberosity
• Iliopsoas
Fracture
external rotation
external group =
rotation internal
FOOT DROP
Why?
accident
the dash
posteriorly
sciatic nerve

eversion
in hip flexion
arteries

avascular necrosis
Obturator A
Epiphyseal Plate

Hip
• Gluteus Minimus
• Flexors
Semimembranosus,
Magnus, Gracilis
(within thigh)
Iliopsoas
Gluteals
Deep Rotators
Iliopsoas

Iliacus
aspect of the joint
flexion
of hip
Gluteus
Medius
Gluteals *
Gluteus Maximus
Tensor
Fascia Latae
• Function
Gluteus Maximus
nerve
Rotation Minimus
bone on either side
of the lower limb
Medial
Rotation
Obturator Externus
Deep Rotators
abduction

• Hip Abduction

Femoris
• Obturator N
Lateral
• Sciatic N
nerve

inferior
2. Inferior
superior

Obturator Foramen
4. Obturator N
Femoral Triangle
5. Femoral N
6. Femoral A & V
To Summarize…

the Hip

©
katelyn.wood@uwo.ca
Intro to Neuro
katelyn.wood@uwo.ca
Learning Outcomes

neurotransmitters

Nervous System
Function + Cells
environments



Neurons Neuroglia

Trigger zone
Axon terminal
(Axon Hillock)
helps with faster
connecting the cell
conduction
body to the
transmitted down
potential
Node of Ranvier
Dendrites
Did you know…


Cell body Node of
zone

Receptor Organ
CNS
peripheral process)
cell body and brain
signaling
Central process
Peripheral process
Axon terminal

Schwann cell
Node of
Node of Ranvier
Ranvier
Nucleus Myelin
Myelin sheath
Axon Axon
Nucleus
Myelination
Node of Ranvier
Myelin sheath
Unmyelinated
Myelinated axon
axons

K+
manner
polarization
Na+Cl-
K+
Depolarization

(takes longer)
Depolarization
3-120 m/s 0.5-2.0 m/s

Neuronal Synapse
effector organ
Neuronal Synapse
membrane
Structure Function


transmission
neuron/structure

generated here
conduction)
transmission
Nervous System
Structure
• Glands
• Everything else
PNS:
- the
CNS vs PNS
CNS:
Brain
Cranial
nerves
Spinal
Sensory Ganglia
receptor (in skin)

Axon

Ventral
plexuses
Ventral horn
Central Cell body
Spinal nerve
Efferent in small
Axon
canal White axon
matter

Sensory
receptors
in skin
CNS vs PNS
CNS vs PNS

sensory motor

voluntary control)
or SLUDD)
White & Gray Matter
White & Gray Matter
White matter
Gray matter

To Summarize…


©
katelyn.wood@uwo.ca
Joints
katelyn.wood@uwo.ca
Learning Outcomes

Joints
Classification
(ex. finger joint)

Fibrous

Joints
Cartilaginous

Joints
Synovial

• discs, menisci
• 6 joint classes
hip
base of your wrist


elbow knee
Joints
give up the other.
have more stability

Shoulder + Hip



Shoulder + Hip
Hinge Joints
Elbow + Knee
• Uniaxial joint*

motion
more *usually
Hinge Joints
Elbow + Knee
elbow --> ulna

a lot of stability
and the femoral
and is aided by the
menisci and intra
Muscles
Bones
Intra-Articular
Structures
menisci, the
+ Capsule labrum
a strain?
Sprains

synovial cavity
• Articular Discs
• Absorb shock
• Labrum
much wear and tear
Bursitis

• Trauma
To Summarize…
Some movement,
Free movement
allow growth forfor
between bones
new bone
Stability Most
Most Middle
Middle Least
Least
Smaller fibres
= less
classes
Joint
Jointcapsule
capsule
movement
movement
Both
Bothhyaline
hyaline & &
Cartilage? No!
NO!Fibres
Hyaline
fibrocartilage
Suture, 6 6classes:
classes: pivot,
pivot,
Epiphysial plate
Suture, gomphosis,
plane, hinge,
hinge,
syndesmosis
disc
ball & socket
To Summarize…

©
katelyn.wood@uwo.ca
Knee
katelyn.wood@uwo.ca
Learning Outcomes
the knee


Lower Limb Overview
The Lower Limb Hip
LOWER LIMB
pelvic bones
femur Thigh
patella Knee
tibia
fibula
tarsal bones
metatarsals
phalanges
Shank/Leg
Ankle
Foot
supination
Bones of
the Knee
force from pelvis
through the knee
• Tibia = weight
stability
force production
(moment arm) at
joint
Surface Anatomy
Anterior Posterior
Joints of the Knee
Lateral
Joints of the Knee

Transverse
tibiofibular joint
Proximal/Superior
Tibiofibular jt
Anterior Posterior
Knee Function
hinge joint
aspect of the knee

Lateral Knee
Femur
Quadriceps tendon
Patellofemoral Jt

to insert onto
patellar ligament
- There's the
Patellar ligament
the tibial plateau
Fibula Tibia
Posterior Anterior



Stability Mobility
Bony Contacts
bones alone

• MENISCI!!
Tibial Plateau
cause damage


Medial
Meniscus
Lateral Meniscus
1 2
Anterior View
1 2
Number 1
- normal knee
whole joint
- right knee
Number 2
- left knee
with each other
Anterior View
Collateral

Named based on
Cruciate
means crossed
tibia
tibia
inferiorly

Named based on
Cruciate
of the femur
Foot Planted:
Foot Free:
Lateral
Named based on

Foot Planted:
Foot Free:
Lateral femur
Named based on
- crossing of these
sagittal plane
being the posterior
cruciate ligament
PCL ACL
Named based on
ACL
PCL
Lateral Anterior
of knee knee
triad
force
Blow to
Tibial Plateau

Thigh Musculature
• Plantaris

• Semi-Tendinosus
Movements?


Walking
What
is Energy
about Intensive
Standing?
unstable joint
when standing
efficiency
lock
• Medial Meniscus
medial femoral
Popliteus
Attachments
• Posterior Tibia

- triangular muscle
opposing directions
The Patellofemoral
Joint
Transverse

quadriceps act at
Patella
Axis of
rotation
Force from Quads

shank
Force
Force w Patella
inferior
extension
patellar tendon
patellar tendon
patella patella
the knee
flexion extension
patella laterally
medialis) up
• Resisted by:
• Vastus medialis
Knee Bursae
• Fluid filled
sacs
important for
cushioning
and reducing
friction
femur
ligament
To Summarize…


©
katelyn.wood@uwo.ca
Lung + Pleura
Anatomy
katelyn.wood@uwo.ca
Learning Outcomes

Middle Mediastinum
Middle
mediastinum

Pleural Cavities
Contents:
• Lungs
• Pleura
Hilum:
• Pulmonary Veins
• Primary Bronchi
Airway branching
branches # of tubes
Trachea 1
Main bronchi 1
Lobar and segmental

Bronchial Tree
bronchi
Segmental = 10

11–16
bronchioles
Divisions

Respiratory zone
capillary
Alveolar sacs 23
The Lungs
Trachea
Lungs in Situ
and right sides
Right main bronchus
Right lobar bronchi

Right segmental
bronchus
Right bronchiole

segments
respiratory zone
reserved.
• Contents:
exchange)

Lungs
as well

midline
left
back again

apex
Right Lung
superior lobe
Lateral View
anterior border
horizontal fissure
costal surface
middle lobe
inferior lobe
oblique fissure
base
inferior border
apex

Left Lung
Lateral View
superior lobe
costal surface
inferior lobe
lingula
inferior border
Hilum Structures

• Inferior
supply to the lung
apex
R. Hilum
branches of right
pulmonary a.
superior lobe
mediastinal surface
Root of the Lung
oblique fissure
anterior border
hilium
branches of right
inferior lobe

part
pulmonary ligament
middle lobe
diaphragmatic base
parietal
Pleura
Pleural Cavities

and visceral layers
Pleural Cavities
• Costal = ribs
• Cervical = neck



the pleura:

What muscles
fluid can collect
the diaphragm
To Summarize…
©
katelyn.wood@uwo.ca
Breathing + Gas
Exchange
katelyn.wood@uwo.ca
Learning Outcomes

Thoracic MSK Review
Bony Anatomy
• Thoracic Cage
vertebrae
via two joints
Thoracic Muscles


• Diaphragm
Sternum:
changes Inhalation
Diaphragm:
the thoracic cage
inspiration




• Air flows in
- black = trachea
Air
Pressure = A
pleura)
you)
- diaphragm drops
A
collapse in
A-4
lower
Pneumothorax
changes
wanting to contract
space

space


Air Pressure = A
Pneumothorax
- black = trachea
- green = lungs
- red = diaphragm
conditions
in a pneumothorax:
- air can flow in
A
lungs
collapses
AA - 4
Gas Exchange
From aorta or
intercostal As)

A = arteries
V = veins


move down from the
A: center of
bronchopulmonary
segment Oxygenate
V: outside of blood
out to the lungs
bronchopulmonary
segment
A: center of
out to the lungs
pulmonary vein
Bronchial Artery
Pulmonary
Artery
pulmonary veins
the periphery
Bronchopulmonary
segment Pulmonary
Vein
Capillary bed
on Alveolus
alveoli
segment


O2 CO2
blood
top left
diffusion occurring
reach the blood
opposite directiom


Alveoli


occur


alveoli



lungs
To Summarize…
collapse


©
katelyn.wood@uwo.ca
Muscle Basics
katelyn.wood@uwo.ca
Learning Outcomes

Muscle Types
3 types of muscle

for a given cell

heat to be produced

pump blood

neuromuscular cleft
2. Contractility
force

in chambers)
surface of bone


muscle

around

sacromeres
together
Myofibre
units of sarcomeres
Thick & Thin

filaments
Endomysium

I-Band M-Line


is present

actin

be the same width
actin and myosin
A-Band
Z-Disk/Line

Muscle Contraction
Muscles pull Bones
• Tendons are a
continuation of the
same fascial layers
that encase the
muscle
brain to the muscle
Upper Motor Neuron

Motor Signals (UMN)
Spinal Cord
Lower Motor Neuron

(LMN)
Muscle
Motor Neurons
Motor
spinal cord
side of the body
neurons
large motor units
recruited

Fatigue
Type Name Force
Rate

towards the H-band

region

2. Power Stroke
3. Rigor State
1. Bound State

4. Relaxed State
and is stuck there
Bound State
Pi
Power Stroke
rigor state
- bound to ADP
Rigor State
contraction
Rigor State
Relaxed State
binding state
ATP
Binding State
ATP + 2+
ATP
CALCIUM
Actin
actin
Troponin Complex
all the calcium

muscle contraction
the t-tubules

To Summarize…

©
katelyn.wood@uwo.ca
Muscle Force
katelyn.wood@uwo.ca
Learning Outcomes

Review
Last Module:
muscle
- tendons are

Last Module:
4. Contraction

Force Production

Acting Area


or less force

force production

changing length
Z M Z 2
1 3
Force
Length



One more thing…
but…

force
the contraction
ground
velocity = 0
maximal

Torque =
acting the body

angles
that a joint is in

force
circle)
3. Moment arm at 1
2
3

going to change
4
5
- if you pull with
produce different
the moment arm
1 2 3 4 5
Biceps Brachii
Brachialis

Avg Weighted
which a muscle is
- biceps brachii,
Brachioradialis
Sum Moment
Torque (N/cm)
the girth of muscle
Angle (deg)



moves the shoulder
B = bipennate
C = multipennate

area of a muscle



Acting Area

Exercise
Strain
• Grading:
• Symptoms:
force all the way

connective tissue.

onwards

is decreased
feedback

feedback)
force

strength
Exercise + Muscle

• Benefits:
stress the bone it

To Summarize…

©
katelyn.wood@uwo.ca
The Peripheral
Nervous System
katelyn.wood@uwo.ca
Learning Outcomes
Nervous System
Structure

everything else
sensory motor

voluntary control)

exiting
Spinal Cord
• Cervical plexus
• Brachial plexus
• Lumbar plexus
• Sacral plexus


Periphery
Sensory (to brain)
Gray Matter:
Contains:
Neuron Cell Bodies
Glial Cell Bodies
Spinal Cord

Spinal Cord
comes back into and
structures)
ventral and dorsal
roots come together
to form a spinal
again to form rami
Ventral Rami
Root --> Nerve -->

Ramo Spinal Nerve

Ventral = Anterior
Spinal Cord
Sensory Pathway
Dorsal Root
Dorsal Horn
Dorsal Rami
Ventral Horn
Ventral Rami

Spinal Cord
Motor Pathway
Dorsal Root
Dorsal Horn
Dorsal Rami
Ventral Horn
Ventral Rami

Spinal Cord
Dorsal Root
Dorsal Horn
Dorsal Rami
Ventral Horn
Ventral Rami
Spinal Nerve

Ventral Root
sensory and motor
Spinal Cord
Structure Contents
Motor Neurons
Dorsal Root Sensory
Sensory neurons
Neurons
Cellbody
Bodyof
ofsensory
Sensoryneurons
Neurons
(goes through
foramen
Autonomics (most
(mostnamed
namednerves)
nerves)
motor Neurons
neurons -–to
todeep
deepback
back&&Z-joints
Z-joints(smaller
(smallerbranches)
branches)
Spinal Cord
everything else
Thoracic Region
Plexus & Peripheral



Dermatomes vs C3
Cutaneous Maps C4
T2
C5 T3
the way to T1
T4
radial nerve
cutaneous
C6

everything else
Epidural space
Spinal cord


Spinal Nerve

Subarachnoid space
(contains CSF)
Rami communicantes
Pedicle of vertebra
(cut)

Dura mater and

arachnoid mater

To Summarize…
(dorsal) root

peripheral nerves
levels combine
©
katelyn.wood@uwo.ca
The Respiratory
System
katelyn.wood@uwo.ca
Learning Outcomes

and function
The Respiratory
System
has 2 components:
lungs

gas exchange occurs
Bronchioles
Alveoli
• Gas Exchange
The Conducting Zone
Naso
Oro Pharynx
Laryngo
Larynx
Trachea
Bronchi
1. nasopharynx
2. oropharynx
3. laryngopharynx
• Mucous Linings
Inferior
meatus
•
bounded by:
serves 2 purpose:
Nasopharynx
uvula
with conchae

mucous membrane
• Three sections:
larynx
hyoid
thyroid epiglottis
Larynx
cuneiform
• Functions:
trachea

Cartilage
• Thyroid

Vocal fold
superior view
• Vestibular Fold


going to go with it

bundle
Alveolar duct
bronchiole
network
Alveolar sac
TYPE I PNEUMOCYTES
circulation

drops in the lung
• Two Cell Types:


capillaries
• Cuboidal
surface tension
popped open
Airway branching
branches # of tubes
Trachea 1
Main bronchi 1
Lobar and segmental

Bronchial Tree
bronchi
Segmental = 10

11–16
bronchioles
Divisions
Respiratory
17–19
bronchioles
Respiratory zone
Alveolar sacs 23

To Summarize…


©
katelyn.wood@uwo.ca
Shank (leg)
katelyn.wood@uwo.ca
Learning Outcomes

Lower Limb Overview
The Lower Limb Hip
LOWER LIMB
pelvic bones
femur Thigh
patella Knee
tibia
fibula
tarsal bones
metatarsals
phalanges
Shank/Leg
Ankle
Foot
Tibia +
Fibula
of the shank

medial and
articulate at the
knee, not the
fibula
Head of Fibula
Ankle Mortise
Medial Malleolus
Lateral Malleolus
Popliteal Fossa
Popliteal Fossa
• Boarders:
• Semimembranosus
• Biceps femoris
back of the knee
shank
• Popliteal Vein
• Sciatic N
• Tibial N
- key boundaries:
Popliteal Fossa

deeper
Common Peroneal
nerve
sciatic nerve
Lesser saphenous v.
Shank Compartments
anterior
4 compartments:
peroneal nerve
different)
Tibial N
Shank R
Anterior
ankle
(fibular) N
Dorsiflexion
Lateral
Compartment
• Ankle Eversion

Base of the 5th

metatarsal
Peroneal (Fibular)
N
head of fibula
Deep Branch
Superficial
Branch
lateral
malleolus
Superficial *
Posterior Knee
Flexion
Compartment * ‡
- posteriorly
Plantarflexion

Compartment longus
- posterior
• Plantar Flexion
• *Inversion
FDL Tib A Post.
TP Tib N

n of ankle
FHL
Gateway to the Foot

Tibial N
Muscle Summary
Longus Longus
Longus Longus

Longus • Soleus
Brevis
• Popliteus
Cadaveric Specimens
To Summarize…
are crossed!

©
katelyn.wood@uwo.ca
Shoulder
katelyn.wood@uwo.ca
Learning Outcomes

Upper Limb Overview

Arterial
Anastomosis

Palmar Arches
to brachial v
superficial side
deep side
Venous Supply

cephalic vein
the cubital fossa
basilic vein
(drawing blood)
Superficial Deep
The Upper Limb
3 joints: Shoulder
1. shoulder
2. elbow
3. wrist UPPER LIMB
1. arm Arm
2. forearm
3. hand scapula
clavicle
Elbow
humerus
radius
ulna Forearm
carpal bones
Wrist
metacarpals
phalanges Hand
Fossae:
- Subscapular
Scapula
- Supraspinous
- Infraspinous
the anterior border
aspect Scapular
scapula
spine
Spine
Glenoid
Medial Fossa
tubercle
key muscle
attachment
Lateral point

below the spine

(sub = under)
glenohumeral joint
Clavicle Sternal
Articular
Surface

Shaft

thorax
there Acromial
shaft Articular
sternum
Surface
clavicle clavicle
acromion
acromion
coracoid
process
glenoid spine of
fossa the
scapula
sternum

Acromion of scapula

Lateral
Medial
humerus
Spine of scapula
Lateral border of
scapula
Medial border of
scapula
1st rib
clavicle

and clavicle
sternum
clavicle
acromion
Coracoacromial Lig
humeral
key ligaments:
coracoid process
anterior view

Glenohumeral Joint
Joint Capsule
(synovial
membrane)
glenoid
fossa
humeral
head
scapular
spine
Glenohumeral Joint
Thickenings of the
superiorly and
glenohumeral lig.
head
humeral head (cut)
Inferior
glenohumeral lig.
posterior view
acromion
long head of
coracoid
• Thickening of
the glenoid fossa
glenoid fossa
humeral head
joint capsule
dislocations
Glenohumeral Joint
it's a dislocation
anteriorly
this space
1. Axillary
Allows for
acromion
movement between
the scapula +
humeral
is critical for arm

also to the scapula
clavicle
superior view

• > 30°= GH jt +
• 2° : 1°, GH to ST
degree

The Axilla
The Axilla
nodes
limb
- cone-shaped area
arteries and veins




Shoulder
trapezius
• Trapezius
latissimus
• Thoracodorsal N
rotate humerus
spinal nerve
are activated
rhomboids
• Rhomboids
and spine

• Teres Major
Arm

posterior
abduction
Infraspinatus
scapula, posterior
• Suprascapular N

greater tubercle
POSTERIOR VIEW

• Axillary N
Teres Minor
• Upper & Lower

Subscapular Ns
ANTERIOR VIEW
SUPERIOR VIEW
(deltoid removed)
infraspinatus
teres minor

Pectoralis Major
Pectoral Pectoralis
Minor
Winged Scapula
- pectoral muscles
to move backwards
• What nerve?
• Long Thoracic
Deltoid
• Axillary N
ABDUCTION 90°
• Flexion
• Extension
• Abduction
round shape
to 90 degrees
joint


(Cranial Nervenerve
XI)XI thoracic

Cadaveric
Specimens
Pectoral Region
Cadaveric Specimens
Rotator Cuff
cuff muscle
Cadaveric
Specimens
Superficial Back
To Summarize…

arm abduction


©
katelyn.wood@uwo.ca
Thigh
katelyn.wood@uwo.ca
Learning Outcomes

Lower Limb Overview
The Lower Limb Hip
LOWER LIMB
pelvic bones
femur Thigh
patella Knee
tibia
fibula
tarsal bones
metatarsals
phalanges
Shank/Leg
Ankle
Foot
Femur
Proximal End
the femur attaches

Femur
Distal End

knee
muscle attachment
aspect
Articular Cartilage

Femur

Acetabulum
Neck
Fovea for Head
ligament
of head Greater
of femur trochanter
of femur
Lesser
femur
Shaft of femur

are regards to the
knee
bone traversing
Femoral N
Medial (adductors)
Obturator N
Posterior (Flexors)
posterior
Sciatic N (tibial)
Thigh R
Anterior *
Femoris”
flexion *
of hip
extension
of knee
patella
patellar ligament
tibial tuberosity
muscles
Medial
hip
Compartment flexion
Pectineus

hip
*
medial rotation
Medial
Posterior
of hip
• Knee Flexion
• Hip Extension
rounder in shape
sheath Medial
thigh

• Gracilis
• Semitendinosis
Muscle Summary
• Medialis
• Intermedius
• Posterior Thigh
• Semi-Tendinosis
• Biceps Femoris
Cadaveric Specimens
Neurovascular
Pathways
Nerve Summary
Femoral Triangle
• Contents:
• Femoral N
• Femoral Sheath
• Femoral A & V
• Borders:
• Sartorius
• Adductor Longus

3. Pudendal N
Obturator Foramen
out of the pelvis
Femoral Triangle
5. Femoral N
6. Femoral A & V
Adductor Hiatus
canal

compartments
Adductor Hiatus
magnus

To Summarize…

the lower limb

©
katelyn.wood@uwo.ca
Thoracic Wall +
Abdominals
katelyn.wood@uwo.ca
Learning Outcomes
innervations

Spinal Nerves
Spinal Cord
Dorsal rami

Spinal Nerve
Posterior Rami
Anterior Rami
everywhere else
and posterior ramus
Intercostal Nerves
“VAN”
protection
the thorax
and the back
the body
Thoracic Muscles
Intercostal Muscles
• External
fibers


Diaphragm
• Central Tendon
• 3 openings
• Aortic hiatus
volume
- 3 openings:
• External
• Internal
• Innermost
from the abdonimal
cavity
Slide 13

(childbirth)
Slide 14
abdominus
Abdominal Muscles
Compress Abdomen
actions

Abdominal Muscles
linea alba
external oblique
aponeurosis
internal oblique
semilunaris
(posterior)
transversalis
inguinal fascia
ligament
arcuate line
Compress Abdomen
actions

Anterior Body Wall
- a complete rectus
Below Arcuate Line
linea alba
Diastasis Recti

• Age 35+
linea alba
• Treatment:
improve function.
abdominal walls



Cadaveric
Specimens
appearance
Cadaveric Specimens
Cadaveric Specimens
To Summarize…

crossed

©
katelyn.wood@uwo.ca
Vessel Anatomy
katelyn.wood@uwo.ca
Learning Outcomes

Vessel Anatomy
3 types of vessels

helps promote blood
compressed easily

occur anymore
the distance
• Venous Sinus:
Vessels create a
closed loop!
Arteries Arterioles
Veins/
Capillaries
Sinuses
Venules
Varicose Veins

level of the heart


aging

removal
Vasculature Review
the arm
Anastomosis

to brachial v
superficial side
Venous Supply

Deep side
palmar venous arch
interosseous vein
Superficial Deep
Arterial Supply
limb or shank
Deep Veins To heart
Venous Supply
arteries
Popliteal V.
Superficial veins
From leg
return blood @
Muscle contractions
To Summarize…
Venules Veins Heart
Limbs
©
katelyn.wood@uwo.ca
Wrist
katelyn.wood@uwo.ca
Learning Outcomes
carpal bones


Upper Limb Overview
The Upper Limb
Shoulder
UPPER LIMB
Arm
scapula
clavicle
Elbow
humerus
radius
ulna Forearm
carpal bones
Wrist
metacarpals
phalanges Hand
Right Forearm!
The Ulna + Radius

Distal Aspect

Ulnar carpals
Notch
Head of
IV III
II
V

I
- pisiform looks
like a pea —>
small round and
circular
-triquetrum —>
begins with tri
pneumonic)
- trapezoid and
Carpals
palmar view
Bones of

Ulna
Scaphoid
Ulnar Notch
Styloid Process
of Radius
posterior view
Joints of the Wrist
carpals
Radiocarpal
Joint
Carpal
bones Ulna


and palmer aspect
(dorsal / palmar)

Radioulnar Lig
(dorsal / palmar)

Radioulnar Ligs
Joints of the Wrist

supination
Interosseous
Membrane
radius + ulna
Ulna
Radius

Joints of the Wrist
Radiocarpal Joint
Triquetrum
Scaphoid

from distal
radioulnar joint
Wrist


The Carpal Tunnel
Hamate
Capitate
Pisiform
Trapezoid
Lunate Scaphoid
palmar view
flip
& flex
Carpal Tunnel
Radial A
Flexor Retinaculum
Median N Ulnar
A&N Median N
Carpal Tunnel
Hamate
First
metacarpal
Hand Muscles
(hypothenar)
Median
Nerve Ulnar nerve
Hand Muscles Ulnar
artery
Median nerve

Muscular
median nerve
branches of
median nerve
To Summarize…


©
katelyn.wood@uwo.ca
& Movements
katelyn.wood@uwo.ca
Learning Outcomes

Anatomical Planes &
Sections
and belly button
finger
toe
and back
bottom
Anatomical Sections
Anatomical Sections

plane

Anatomical Terms
Superior (rostral)
Anatomical Terms

amongst a team

Inferior (caudal)
Term Explanation
Caudal


Fibular
(peroneal)
Palmar

Anatomical Cavities
the mediastinum)

Common Movements
Wikimedia Commons

PROTRACTION
scapula
RETRACTION
scapula
Wikimedia Commons

ROTATION
internal/external
internal
external

Wikimedia Commons
Wikimedia Commons

frontal plane
ADDUCTION ABDUCTION
other digits

DORSIFLEXION
(extension)
EVERSION INVERSION
PLANTARFLEXION
(flexion)
To Summarize…

2D clinical scans

©
Ankle + Foot
katelyn.wood@uwo.ca
Learning Outcomes

Lower Limb Overview
The Lower Limb Hip
LOWER LIMB
pelvic bones
femur Thigh
patella Knee
tibia
fibula
tarsal bones
metatarsals
phalanges
Shank/Leg
Ankle
Foot
Tibia + 75 aspect
Inferior

- lateral malleolus
shaped
Ankle Mortise
I II III
IV
V
lateral view
Cuneiforms
Navicular Cuboid
medial view
Talus
Calcaneus
Distal

Middle
Foot phalanx
Proximal
phalanx
Cuneiforms
Metatarsal
Cuboid
Calcaneus
Tarsal
bones
Talus Navicular
Lateral Ankle
Anterior Posterior
Fibula
Tibia
Talus
Navicular
Lateral Cuneiform
Calcaneus

Surface Anatomy
Joints of the Ankle
Subtalar Joint

Talocrural joint
Subtalar joint
Medial
Ankle Mortise
Medial Malleolus
Lateral Malleolus
Talocrural Joint

Posterior Leg
Anterior Posterior
Fibula
Tibia

Navicular
Subtalar Joint
Calcaneus

Interosseous
Membrane


held
Fibula
Tibia
Anterior
Tibiofibular
Ankle Mortise

High Ankle Sprain
fracture
ankle mortise
rotation of foot

Crural Joint
Calcaneonavicular
Deltoid
ligament
Calcaneofibular
- common
- ATL = anterior
medial
talus
bone
Anterior
ligament

Talus + Calcaneus +
Navicular
• Anterior =
complex
Talocalcaneal lig
Ligaments
Cervical lig

Muscle Summary
Longus Longus
Longus Longus

Longus • Soleus
Brevis
• Popliteus
Flexors Extensors
Digitorum
Longus Longus
Hallucis
Longus Longus
Gastrocnemii
Achilles ---
Plantaris
Soleus
provides eversion
Peroneus Brevis
Peroneal ---
Peroneus Longus
Attachment Summary
Flexor Digitorum
Longus Longus
Longus
Flexor Hallucis
Longus
Peroneus
Tibialis Anterior
Tibialis Posterior
Tibialis
Digitorum
Hallucis
Peroneal
Achilles Achilles
sprain
• Signs/Symptoms:
To Summarize…
©
katelyn.wood@uwo.ca
katelyn.wood@uwo.ca

What system does?
Learning Outcomes
Homeostasis


this internal state

the blood
The ANS at work
Stand up


BP Detect BP

activity activity
Negative Feedback
vasoconstrict

sensory motor

voluntary control)

Somatic
Autonomic
motor
Motor Systems
Somatic Autonomic
postganglionic)
ACh ACh, E,Eoror
ACh, NENE
Yes Pre – yes

Pre --> Yes
Post - no
Cardiac Muscle
Heart:
GI:
ANS input
SNS only:
• Sweat glands
PNS only:
miosis mydriasis
For example:


Parasympathetic NS

• Signals to:
organs
very short

ganglion
Posterior ramus
of spinal nerve

nerve
of spinal nerve

Urinary bladder
1 preganglionic N
with 1 target
Sympathetic NS
• Signals to:
(like a hormone)
Posterior
Sympathetic NS root
ganglion
spinal nerve
nerve
3
nerve
1 Sympathetic
4
(unmyelinated)
ganglion
(celiac ganglion)
collateral ganglia

Anterior view

NT = NE
ACh
Spinal cord
SNS

NT = ACh
NT = ACh
ACh
Long Preganglionic

at once
BUT…

Receptor Summary
• Cholinergic
• Subtypes:
• Adrenergic
• Subtypes:
SNS vs PSNS Neurons
SNS PSNS
ganglionic
Myelination? Thin
Thin Thin
Thin
Pre-
Axon Length Short

Short Long
Long

Nicotinic, ACh
ACh

collateral
ganglia or or
@ targetorgan
organ
ganglionic
Myelination? None
None None
None
Post-
Axon Length Long

Long Short
Short
Adrenergic, NE,NE
or or
E E Muscarinic,
Muscarinic, ACh
ACh
Many One
One
Referred Pain

the arm
To Summarize…


©
katelyn.wood@uwo.ca
Arm
katelyn.wood@uwo.ca
Learning Outcomes

Upper Limb Overview
The Upper Limb
Shoulder
UPPER LIMB
Arm
scapula
clavicle
Elbow
humerus
radius
ulna Forearm
carpal bones
Wrist
metacarpals
phalanges Hand
The Humerus
Anatomical
neck
- has 2 necks:
sulcus (groove)
is going to run
Medial epicondyle

elbow
Muscles of the Arm

radial nerve
common function
posterior
Radial N
Anterior (flexors)
Musculocutaneous N
anterior
Flexors (anterior)
Arm Flexors
Biceps Brachii
- has 2 heads:

repaired
brachialis
Musculocutaneous N
• Course:

dislocation

• Arm Extension
• Long Head

Head
• Population:
energy trauma
• Older people,
osteopenia

be impaired
Anterior
Coracoid
process of
Humerus
Radial nerve
Media
Later
l
al

Glenoid of
scapula
Acromion of scapula

Posterior
Radial N
in the arm
• Course:
• behind humerus,
triceps
Cadaveric Specimens
Arm
To Summarize…


©
katelyn.wood@uwo.ca
The Axial Skeleton
katelyn.wood@uwo.ca
Learning Outcomes

AXIAL
The Skeleton skull

mandible
sternum
ribs (costa)
Functions vertebrae
cervical (7)
thoracic (12)
sacrum + coccyx
Storage of minerals
APPENDICULAR
The Skull
The Skull
Bones Bones
Frontal Ethmoid
Parietal Lacrimal
Sphenoid Zygomatic
Temporal Vomer
Mandible
Maxilla
Nasal
Palatine
Neurocranium
Parietal bone
Sphenoid bone
Temporal
bone
Occipital
bone
Neurocranium Bones
Frontal
Occipital
Parietal
Sphenoid
Temporal
Neurocranium
Parietal bone


articulate with the
Internal Auditory
saddle

Occipital
bone
Neurocranium Bones
Occipital Condyles
Frontal
Occipital
Parietal
Sphenoid
Temporal
The Skull
Neurocranium
Parietal bone
Temporal
bone
Occipital
bone
Neurocranium Bones
Frontal Magnum
Occipital
Parietal
Sphenoid
Temporal
Neurocranium
Parietal bone
Sphenoid bone

portion of the bone
- greater wing
Temporal
bone
Internal Auditory
Meatus
Lesser Wing

bone
Neurocranium Bones
Foramen Magnum
Frontal
Occipital
Parietal
Sphenoid
Temporal
Sutures
Frontal bone
Coronal suture
Sagittal suture
Parietal
bones
Labdoid suture
Squamoid suture
Occipital bone
Temporal bone
Fontanelles
Viscerocranium
Lacrimal bone
Nasal
bone
Viscerocranium
(Facial) Bones
Ethmoid Zygomatic
bone
Lacrimal
Zygomatic
Vomer
Mandible
Nasal
Palatine Mandible
Viscerocranium
Nasal
bone
Viscerocranium
Ethmoid
Nasal
Concha
Lacrimal
Vomer
Zygomatic
bone
Vomer Palatine bone
Mandible
Maxilla bone
Maxilla
Nasal
Mandible
Palatine
The Skull
Viscerocranium
Viscerocranium
(Facial) Bones
Ethmoid
Vomer
Lacrimal bone
Zygomatic
Palatine bone
Mandible Concha
Maxilla
Nasal Maxilla bone
Mandible
Palatine
Viscerocranium
Zygomatic
Lacrimal bone bone
Vomer
Ethmoid bone bone
Viscerocranium
(Facial) Bones
Ethmoid
Inferior Nasal
Lacrimal
Concha
Zygomatic
Vomer
Mandible
Maxilla
Nasal Maxilla bone
Mandible
Palatine
The Spine
+ Vertebrae
SUPERIOR
The Spine
1
2
3
4 Cervical
5
6
7
vertebrae (7)
1
2
3
24 Vertebrae 4
5
7 Cervical 6
7
8
Thoracic
5 Lumbar 10
11
1 Sacrum 12
1
5 fused vertebrae 2
1 Coccyx 3 Lumbar
4 vertebrae (5)
5
Sacrum (1)
Intervertebral
disc Coccyx (1)

Surface Anatomy
General Vertebral
Anatomy
Body
(body)
Pedicle
(arm)
Transverse Pr.
Lamina (elbow)
(forearm)
Spine
(hands)
General Vertebral
Vertebral Articular
Notch Facet
Spinal nerve
Cervical Spine
7 vertebra
Lordosis
Key Features:
Bifid spinous pr.
Transverse Foramen
C1 (Atlas)
No body or spine
C2 (Axis)
Dens
anterior
Cervical Spine
lateral
superior
anterior
Cervical Spine
Atlas (C1)
lateral
superior
anterior
Cervical Spine
Axis (C2)
lateral
superior
Vertebral Artery
superior view
vertebral
artery
Thoracic Spine
Kyphosis
12 vertebra
Key Features:
Heart-shaped bodies
Costal facets
lateral
superior
Lumbar Spine
Lordosis
5 vertebra
Key Features:
Squat, thick bodies
lateral
superior
Normal Osteoporotic
Osteoporosis
activity
Symptoms:
Back pain
Sacrum + Coccyx
Kyphosis
5 Fused vertebra
Key Features:
Promontory
Auricular surface
lateral
Sacrum + Coccyx
posterior anterior
Costal facets and

articular facets

Atlas Small

surface

Ligaments of
the Spine
Anterior
Broad fibrous band
Posterior
Narrow fibrous band
Ligamentum Flavum
Joints of the Spine
Joints of the Spine
Zygapophyseal Jt
Intervertebral Jt
*Costovertebral Jts
condyles of skull
2 lateral (LAJ)
Transverse
Ligament of
Atlas
superior
Joints
vertebrae
Stabilize column

Joints
vertebrae
Stabilize column


Not between C1 & C2

C1 has no body
Intervertebral Disc

Thick Fibrous Ring

Gelatinous centre
Avascular
L3
Disc Herniation
Joints
Thoracic Cage
Thoracic Cage
Composed of
12 Ribs (X2)
Costal Cartilage
Sternum
Manubrium
Body
Xyphoid Process

Suprasternal notch
Manubrium
Sternal angle
Facet for
Xyphoid
Anterior view
process
Rib Anatomy

Articular Facet for
Tubercle
Costal angle
Costal groove Body
(c) Posterior view




©
katelyn.wood@uwo.ca
Spine + Back
katelyn.wood@uwo.ca
Learning Outcomes
Bone Review

of costal cartilage

a common piece of

costal cartilage
• Manubrium
• Body
• Xyphoid Process

the head of the rib

SUPERIOR
The Spine
1
2
3
4 Cervical
5
6
7
vertebrae (7)
1
2
3
• 24 Vertebrae 4
5
• 7 Cervical 6
7
Thoracic
• 12 Thoracic 8
9 vertebrae (12)
• 5 Lumbar 10
11
• 1 Sacrum 12
1
4 vertebrae (5)
5
Sacrum (1)
Intervertebral
disc Coccyx (1)

Anatomy
Body
(body)
Pedicle
(arm)

(elbow)
(forearm)
Spine
(hands)
Sacrum + Coccyx
• Key Features:
• Promontory
of the pelvis
The Os Coxae
lateral view
Surface
PSIS
ASIS
Pubic
PIIS Tubercle
AIIS Acetabulum
Ischial
Spine
Obturator
Foramen Fossae:
- Gluteal
- Iliac
Sacrum
Os Coxae
Sacroiliac
Joint
Pubic
Spinal Nerves
Spinal Cord

going in the body
vertebra
artery
vertebra
Spinal Cord
Sensory
neurons
Dorsal Root
ventral rami
Dorsal Rami
body
plexuses
Ventral Horn
Ventral Rami
Spinal Nerve
Motor
Ventral Root
Spinal Nerve
Posterior Rami
in situ
zygapophyseal joint
deep back
Spinal Nerve
Spinal cord
the posterior ramus
root
Cervical vertebra
Larynx
ANTERIOR
Deep Back Muscles
Deep Back Muscles
• Superficial
• Iliocostalis
• Longissimus
• Spinalis
• Deep
• Semispinalis
• Rotatores
• Multifidus


Nerve: posterior
rami of spinal n.
Splenius Cervicis,



Nerve: posterior
rami of spinal n.
Semispinalis
Capitis
Actions:
the thoracic spine
Multifidus
the thoracic spine
Nerve: posterior
rami of spinal n.
• Longissimus
• Spinalis
• Rotatores
• Multifidus
Cadaveric
Splenius cervicis
Spinalis
Longissimus
Iliocostalis
Multifidus
To Summarize…
• Bony Anatomy

are crossed!

©
katelyn.wood@uwo.ca
Bones
katelyn.wood@uwo.ca
Learning Outcomes

Appendicular vs
Axial Skeleton
AXIAL
The Skeleton skull

mandible
sternum
ribs (costa)
Functions vertebrae
cervical (7)
thoracic (12)

Storage of minerals
APPENDICULAR
APPENDICULAR
Elbow Upper Limb
Wrist
Hip
Lower Limb Knee
Ankle
The Skeleton
Arm
APPENDICULAR
Upper Limb
Hand
Thigh
Lower Limb
Shank/Leg
Foot
The Skeleton
APPENDICULAR
UPPER LIMB
scapula
humerus
- 3 cuneiforms
tibia
fibula Carpals
Tarsals
tarsal bones
metatarsals
phalanges

Sesamoid - Patella
Long - Humerus
tubular
tubular in-->shape
provide strength,
cuboidal in shape
and stability and
with limited
carpalbones, tarsal
skullskull
oddly shaped
Sesamoid bones
develop--
in protect
tear

Boney Landmarks
Attachments

CREST ridge of bone
Boney Landmarks
Joints

FACET
Boney Landmarks

SINUS sac or cavity
Surface Anatomy
Knowledge Check-in

Landmarking
Bone Structure
mold

cartilaginous plate
Epiphyseal
Plate
Epiphyseal
Line

Bone Cells
osteoblasts
called canaliculi

Bone Types


Trabecular Bone
(spongy/cancellous)

degrade bone
derived from
WBC lineage
create bone
Osteoporosis
bone
genetic females
SEM 30x SEM 30x

Compact Bone
(cortical)

haversian canal
concentric rings
Compact Bone
(cortical)

"sharpy fibers"
anchor to bone
highly vascularized
Fractures
Fractures
Comminuted
pieces bones
pressed inward
Ragged break due to
comminuted
depressed
compressed
spiral
epiphyseal
green stick
Fractures
Aging + Exercise
Aging

Exercise
• Weakened Bones:
To Summarize…



©
katelyn.wood@uwo.ca
The Brachial Plexus
katelyn.wood@uwo.ca
Learning Outcomes

The Brachial Plexus

disease
• 5 portions:
Roots
• _______________
Trunks
• _______________
Divisions
• _______________
Cords
• _______________
Branches
• _______________
Trunks C5
Brachial Plexus
Divisions C6
Ant/Post
Cords C7
T1
named vertebra.
Axillary

Radial

Musculocutaneous
arm flexors (C5-7)
cords
Drink
and ColdforBeer”
Ulnar
upper limb.
Brachial Plexus C6

U
C8
divisions level T1
lateral medial
L
axillary
nerves
cord
ulnar
Anterior/posterior
C4 Musculocutaneous
Lateral
C5
Upper
C5
C6
C6
Middle Axillary
C7 Median
Posterior
C7 Radial
C8
Lower
T1
T1 Medial Ulnar
T2
Lat. Pectoral
Musculocutaneous
Suprascapular
C5
these 9
peripheral C6
nerves go
on to supply
muscles Axillary
pectoral
region, Radial
superficial
back, or the C8
upper limb
Upper & Lower
Subscapular
T1
Med. Pectoral Ulnar

Med Cutaneous Arm
Lat. Pectoral
Musculocutaneous
Suprascapular
C5
axillary and the
upper and lower
from C5 and C6.
blue -->
Axillary
middle trunk Median
C7 Thoracodorsal
green -->
lower trunk Radial
C8
Upper & Lower

Subscapular
T1
Med. Pectoral Ulnar

Med Cutaneous Arm
Brachial Plexus
Lateral pectoral C5
C6
C7
Suprascapular
C8
Medial pectoral T1
Upper subscapular
Posterior cord
Axillary
Medial cord
Radial
Long thoracic
Median Lower
subscapular
Ulnar
Thoracodorsal
Brachial Plexus
Extensor
Compartment
Nerves
and teres minor
axillary nerve.
of the upper limb
Flexor
Compartment
Nerves
musculocutaneous.

Nerves + Axillary
Muscles Radial
Median
Nerves C4
T2
C6 T2 T5 Radial
the way to T1
Medial
cutaneous
C6
C7
C8

(usually C5/C6)
impaired
brachialis
forearm

overhead
• Outcome:
distal hand
Lat. Pectoral
Musculocutaneous
Suprascapular
C5
C6
Axillary
Radial
C8
Upper & Lower

Subscapular
T1
Med. Pectoral Ulnar
Long Thoracic
Med Cutaneous Arm
To Summarize…
median

©
katelyn.wood@uwo.ca
Cardiac Cycle
+ ECG
katelyn.wood@uwo.ca
Learning Outcomes

each

Heart Review
The Heart
they need to pump
top bottom

Vessels create a
closed loop!
back to the heart
no longer need it
Veins/
Capillaries
Sinuses
Venules
and upper limbs
Blood Flow
lung left lung
3. 6. 5.
5.
Key: 10.
Oxygen-rich blood
Oxygen-poor blood
and lower limbs
Great Vessels
Cardiac Muscle +
Contraction
wall

differently
slightly
longitudinal

the picture
1. Pacemaker
could contract on
repolarizing
Action Potentials



rushes in
channels open
SA Node = pacemaker
everything else

contract
adjacent cells
Electrocardiogram
(ECG)
cardiomyocytes
and we can measure

electrodes
deflection

ECG
-
Sassi et al 2017


these key parts
are reading an ECG
atrial contraction
depolarization
The Cardiac Cycle
The Cardiac Cycle
• 7 Phases
• Recordings:
• ECG
•
couple points
Basic Principles:


that

volume
ventricles
closes AV-Valve

changing
• Atria relax

isovolumentric

starts
Rapid Ejection

open
pulmonary trunk
rapidly
the aorta
the ventricles

blood
their contraction
- electrical signal
and starting to
repolarize here
sound S2

• Heart sound S2
relaxation
Systolic Volume
Rapid Filling

valves open
rises
Reduced Filling

arteries
Heart Rate Control
Autonomic Control

Parasympathetic NS
Autonomic Control
norepinephrine

• Receptors:
causes relaxation

To Summarize…
ECG
the heart
©
katelyn.wood@uwo.ca
Cartilage
katelyn.wood@uwo.ca
Learning Outcomes

Cartilage
Cartilage Types
synovial joints
Elastic Cartilage
Fibrocartilage


• No blood supply
Function


Composition

• Collagen
• Proteoglycans
• Lipids
• Collagen
• Proteoglycans
3 zones:

the force
the bone
Distribute Force
Fluid Storage
Bony Connection
load
joint capsule

which expands
Synovial Membrane
accomplished!
H20 H20
Cartilage Injury
Arthritis



joint infection
Cartilage Injury
Arthritis

late
feel the pain
To Summarize…


©
katelyn.wood@uwo.ca
CNS Overview
katelyn.wood@uwo.ca
Learning Outcomes
spinal cord
conus medullaris


sensory motor

voluntary control)
or SLUDD)
White & Gray Matter
The Brain
The Brain Cerebral
hemisphere
Diencephalon
Cerebellum
Lateral view
Brainstem:
Midbrain

The Brain
Corpus Callosum

Neuro Terms
Gyrus
Fissure
Sulcus

Central sulcus
Postcentral gyrus
Precentral gyrus
POSTERIOR
ANTERIOR

get into the insula
Frontal lobe
POSTERIOR
ANTERIOR
Occipital
lobe Temporal
lobe (cut)
Pons
Spinal cord
Frontal Lobe
judgement)


language
Parietal Lobe
• Touch
• Proprioception
Temporal Lobe
• Processes Smell
the lateral fissure
Occipital Lobe
Parieto-occipital
information sulcus
Thalamus
• Thalamus
information
• Hypothalamus
• Pituitary Gland
Pituitary gland

Inferior
Brainstem
• Midbrain
• Pons
medulla
from periphery

• Olive (lateral)
Cerebellum
movement
equilibrium

plan
Fourth Ventricle
fluid Cerebellum
Cerebrum
Diencephalon:
Thalamus
Hypothalamus
Brain stem:
Midbrain
Cerebellum
Pons
Medulla oblongata
Spinal cord
The Spinal Cord
Spinal Cord in Situ
L1-L2
(horse tail)
Did you know…
to the brain
White Matter:
Periphery
Sensory (to brain)
Gray Matter:
Contains:
Neuron Cell Bodies
Glial Cell Bodies
Meninges
Lateral ventricles
foramen
Third ventricle
Cerebral Aqueduct
in the brain Fourth
Central canal
• 3 parts:
foramen


inter-thalamic
adhesion (the left
and right thalamus
are connected
through the hole)
Dura mater

Arachnoid mater
- much thinner
Pia mater
cushioning
Brain/Spinal Cord
dura mater
Meninges

vasculature
damage
• Alongside CSF


• Falx cerebri

blood.
base of the brain
pia = red
arachnoid = green
dura = blue
Epidural Space
Arachnoid Mater
Dura Mater
Subarachnoid
Space
Pia Mater
View
Transverse
plane
Dura mater and
arachnoid mater

of vertebra
Pia mater
Subarachnoid space
Epidural space
Posterior (dorsal)
facet of vertebra

Anterior (ventral)
Spinal nerve
root of spinal
foramen
Vertebral artery in
ANTERIOR
Lumbar Puncture +
Epidurals
needles coming in)

and green)
spinal nerves
area
the anesthetic)
To Summarize…
• Cerebellum
©
katelyn.wood@uwo.ca
Muscle Compartments
katelyn.wood@uwo.ca
Learning Outcomes
fibrous sheaths

Compartments
Limb Compartments
brown

within the limbs



L Upper Limb
Compartments
Arm
Forearm

cause extension
Arm Forearm L
Flexors (anterior)
Arm Forearm L
Radial N
Anterior (flexors)
Musculocutaneous N
Ulnar N
side)
Arm Forearm L
Brachial Plexus arm

forearm
C6
the shoulder)
upper limb
C8
divisions level T1

Roots: C5 – T1
axillary
musculocutaneous
radial

ulnar
Extensor
Compartment
Nerves
Flexor
Compartment
Nerves
stops
Flexors (posterior)
Thigh Leg
Lat.

- pain is a sign of
trauma, Trauma/
Flow
blood flow to the
swelling,
pain
nerve
Bleeding

Fasciotomy

compartments
To Summarize…
within the limbs
syndrome)
©
katelyn.wood@uwo.ca
Elbow
katelyn.wood@uwo.ca
Learning Outcomes
elbow
the elbow
Upper Limb Overview
The Upper Limb
Shoulder
UPPER LIMB
Arm
scapula
clavicle
Elbow
humerus
radius
ulna Forearm
carpal bones
Wrist
metacarpals
phalanges Hand
The Humerus

the elbow
side)
Olecranon fossa
Medial epicondyle
Capitulum
Trochlea
Lateral epicondyle

Olecranon

ulna
Notch
going to
Head elbow
articulating
the radius,
process, and
ulnar
tuberosity
Coronoid
Process
Ulnar Tuberosity
Bones of
Lateral
epicondyle
Capitulum Trochlear
Notch
Trochlea
Olecranon
Coronoid
Process
Radial
Tuberosity

Joints of the Elbow
Joints of the Elbow
Humeroradial

Cubital Joint
• flexion
Proximal Radioulnar
• supination

joint
Medial
Olecranon of ulna
Lateral
Capitellum of
Head of radius
Neck of radius
Radial tuberosity
Proximal radioulnar
Radius joint
Ulna

superior view

anterior view
lateral view
(green)
Cubital + Proximal
Radioulnar Joints
b c
Elbow Dislocation
Cubital Joint


therapist
Radial Head
Subluxation



normal position
subluxation)
The Cubital Fossa
Cubital Fossa
Radial N
Median N
Brachial A
Cubital Veins
Brachioradialis
Pronator Teres

3. pronator teres
Elbow
• Brachialis

To Summarize…



©
katelyn.wood@uwo.ca
Forearm
katelyn.wood@uwo.ca
Learning Outcomes

Upper Limb Overview
The Upper Limb
Shoulder
UPPER LIMB
Arm

clavicle
Elbow
humerus
radius
ulna Forearm
carpal bones
Wrist
metacarpals
phalanges Hand
Head
articulates at the
elbow
Radial Tuberosity
Interosseous
Boarder

Styloid Process
down at the wrist

Colle’s Fracture
Hand
dinner fork
Radial Notch
The Ulna Trochlear

Notch
Radial Notch
Olecranon
Coronoid
posterior aspect
attachment Boarder
Head of

The Forearm
• Supination:
radius & ulna
are parallel
(anatomical
position)
overtop of the ulna
Radius
Ulna
• Supination:
radius & ulna
are parallel
(anatomical
position)
• Pronation:
radius & ulna
are crossed

Distal
Middle
of the Hand phalanx
DIP
Proximal
Joints: phalanx PIP


Carpal
bones

Radius Ulna
anterior view
posterior
Radial N
Anterior (flexors)
Median N
Ulnar N
anterior
Flexors (anterior)
Brachioradialis‡
Superficial Layer
Pronator Teres

Flexor Carpi
Flexor Carpi
• Nerves: fail”
Flexor Dig.

Profundus*

Flexor Dig.
Profundus*

Quadratus
anterior view
• Nerves:
• Median Flexor
Retinaculum
• *Ulnar
Forearm Flexors
humerus
of humerus
Palmaris longus
Supinator
quadratus
Pronator quadratus
profundus (cut)
Palmar aponeurosis
Flexor digitorum
superficialis (cut)

wrist
• Course:

Ulnar N
- funny bone
forearm
• Course:
epicondyle

Supinator
Lateral
Epicondyle
Carpi Radialis

Digitorum
forearm
to the pinky
lateral epicondyle
epicondyle
Carpi Ulnaris
Ulnaris
• Nerve: Radial
Lateral epicondyle
Brachioradialis
- part of flexor
Extensor
carpi
radialis brevis
Extensor
digitoru
m
Extensor
carpi ulnaris
Extensor
digiti
minimi
Golfer’s Elbow
Epicondylitis
• Inflammation of
tendons at either
medial or lateral
epicondyle
epicondyle
Tennis Elbow
Extensor Carpi
*Abductor Pollicis
Pollicis Longus
*Extensor
Extensor Indicis
• Nerve: Radial
posterior view
Forearm Extensors
Ulna
Abductor pollicis
Extensor pollicis
Extensor indicis
groove

• Course:
• Splits to form
supinator)
To Summarize…



©
katelyn.wood@uwo.ca
Hand
katelyn.wood@uwo.ca
Learning Outcomes

Upper Limb Overview
The Upper Limb
Shoulder
UPPER LIMB
Arm
scapula
clavicle
Elbow
humerus
radius
ulna Forearm
carpal bones
Wrist
metacarpals
phalanges Hand
V II
Thumb
- 8 carpal
Hamate bones
Capitate
Pisiform
Carpals
Lunate
Scaphoid
palmar view
Distal
Middle
of the Hand phalanx
DIP
Proximal
Joints: phalanx PIP


Carpal
bones Carpal

Radius Uln

segment
- no reunion of the

snuff box
compromise proximal
segment
Radial artery
Forearm Muscles
Acting on the Hand
Flexors Extensors
Carpi the
Extensor Digitorum
Flexor Digitorum
Carpi Muscles

the muscles

- special muscle
- flexor
Digitorum Muscles
- first 3
are on
the
aspect Text
(yellow)

profundus through

Outcropping Muscles
Abductor Pollicis

Longus
posterior view
Carpi
Digitorum

Extensor
Flexor carpi
Extensor radialis
pollicis brevis
Extensor
pollicis longus
Flexor digitorum
Extensor
superficialis
digitorum

digiti minimi
Intrinsic Muscles
of the Hand


contract
1 and 2 are
innervated by

midline
• Nerve: Ulnar
- D = dorsal

itself
• 3 PAD
palmar views
Lumbricals
Palmar Interossei
Dorsal Interossei

pinky move?
hypothenar muscles
superficial deep
Thenar muscles
Hypothenar muscles
thumb and pinkie
ulnar
ulnar
syndrome
Nerves:
To Summarize…
To Summarize…

©
katelyn.wood@uwo.ca
Heart Anatomy
katelyn.wood@uwo.ca
Learning Outcomes

The Thorax
Thoracic Cage
Composed of
• 12 Ribs (X2)
• Sternum
• Manubrium
• Body
• Xyphoid Process

Middle Mediastinum
the heart
Middle
mediastinum


Thoracic Inlet
to the base of T4
Diaphragm
Contents:
• Sup. Vena Cava
• Left Subclavian
stomach
Middle Mediastinum
Contents:
• Heart
• Pericardium
• Fibrous
• Serous
• Ascending Aorta
• Pulmonary Trunk
Contents:
• Esophagus
• Vagus Nerve
Contents:
Pleural Cavities
Contents:
• Lungs
• Pleura

• Pulmonary Veins
• Primary Bronchi
The Heart +
Pericardium
muscle

• 2 halves
• 4 Valves
hard
with more pressure


itself


L. Atrium
R. Atrium R. Atrium
L. Ventricle

Sulcus
posterior view
R. Ventricle
Cardiac Apex
those three sources

Aortic Arch
Pulmonary Trunk
+ Arteries Superior
Vena Cava
Vena Cava
Cardiac Sinus
Inferior
Vena Cava
Inferior
flipped
comes in veins
Atria
anterior
Veins

posterior
Atria
the lungs
• Key Landmarks:

(AV) valve

pectinate muscle
left side


Left AV Valve
Ventricles

pulmonary trunk

posterior

bypassing the lungs


left side

- 4 valves in total
into the ventricle
Valves
• Pulmonary
backflow
Semilunar Valves

to fill
chordae tendonae
posterior
AV Valves
Semilunar Valves
Valve Mechanics
forces them open
semilunar valves
other
AV Valves
L Subclavian


shape
• Arch
• Descending

Great Vessels
pulmonary veins
Arteries
• Pulmonary Trunk
going to lungs
Veins
lungs
Great Vessels
and upper limbs
Blood Flow
lung left lung
3. 6. 5.
5.
Oxygen-rich blood
Heart Failure
well as it should =
coughing
fashion



arteries

- peri means around
Pericardium


to fuse into
Continuous with
of the heart)
diaphragm
Continuous with
Aorta
the heart)
ascending aorta
Backflow of blood
seal off
to to

• Arteries
Diagonal

L Marginal
Great Cardiac
• Veins
sulcus


Middle Cardiac

• Risk Factors:


To Summarize…

Arch of aorta
Superior vena cava

veins
Pulmonary trunk
Right atrium
Right ventricle
sulcus
posterior view

Right ventricle
Left ventricle
sulcus
©
katelyn.wood@uwo.ca
Hip + Pelvis
katelyn.wood@uwo.ca
Learning Outcomes
pelvis
Lower Limb Overview
is grasping and the
smaller bones
larger bones
you move throughout
when you get to the
lower limb

posterior
laterally
L2

L2-L4
L5
Terminal Branches
OBTURATOR NERVE
S1
brachial plexus
common sheath
nerves
TIBIAL NERVE
obturator
FIBULAR NERVE
(common peroneal)
L4-S2
Arterial Supply
the pelvis
aspect of the shank
Deep Veins To heart
Venous Supply
iliac vein

during exercise
along
back to the heart
Popliteal V.
Superficial veins
From leg
return blood @
Muscle contractions
Valves force blood
return to heart
Fascia Lata
abdominal wall
aspect of the thigh
deep fascia of the
shank
“Crural Fascia”
The Lower Limb Hip
LOWER LIMB
pelvic bones
femur Thigh
patella Knee
tibia
fibula
tarsal bones
metatarsals
phalanges
Shank/Leg
Ankle
Foot
fovea


joint

posterolateral view
The Os Coxae
glutes
to the sacrum
• Other Terms:
• Innominate bone
• Hemipelvis
The Os Coxae
lateral view
Surface
PSIS
ASIS
Pubic
PIIS Tubercle
AIIS Acetabulum
Greater Sciatic
Notch
Ischial
Spine
Fossae:
- Gluteal
Foramen landmark
- Iliac
pubis
acetabulum
Sacrum
Os Coxae
Femur

Surface Anatomy
Ilium
Sacrum
Femur Coccyx
Pubis
Obturator Foramen
Ischium

Pelvic radiograph
Iliac Crest
superiorly
together
Anterior Superior
Iliac Spine (ASIS)
Anterior Inferior
Ischial Spine
Iliac Spine (AIIS)
Acetabulum
Pubic Symphysis


of head Greater
of femur trochanter
of femur
Lesser
femur
Shaft of femur

spine
coxae
posterior view
anterior view
anterior view
medial view
medial view
superior view
superior view
anterior view
Sacroiliac (SI)

and the ilium
the pelvis
Hip
Pubic Symphysis
Sacroiliac Joint
anterior view
• Sacrum + Ilium
due to strong
ligaments
Sacroiliac
Pubic Symphysis
anterior view
• Symphysis
ends of bones,
between
mobile
Open Book Fracture
Symphysis
• Normal = 4-5mm
• 2 main causes:
• Complications:
cavity
Hip Joint
anterior view
• Femoral Head +
Acetabulum
Joint
• Highly mobile
Hip Joint
Ligaments

pubis to the femur
Iliofemoral
Pubofemoral
Ischiofemoral
Acetabular Labrum

Femur

Hip Joint
Summary
Joint
capsule
Acetabular
Labrum
Acetabular Fovea
fossa
Obturator Greater
head of
femur
Lesser
trochanter
crossover bone
• Trochanteric
greater trochanter
• Ischiogluteal
tuberosity
• Iliopsoas
Fracture
external rotation
external group =
rotation internal
FOOT DROP
Why?
accident
the dash
posteriorly
sciatic nerve

eversion
in hip flexion
arteries

avascular necrosis
Obturator A
Epiphyseal Plate

Hip
• Gluteus Minimus
• Flexors
Semimembranosus,
Magnus, Gracilis
(within thigh)
Iliopsoas
Gluteals
Deep Rotators
Iliopsoas

Iliacus
aspect of the joint
flexion
of hip
Gluteus
Medius
Gluteals *
Gluteus Maximus
Tensor
Fascia Latae
• Function
Gluteus Maximus
nerve
Rotation Minimus
bone on either side
of the lower limb
Medial
Rotation
Obturator Externus
Deep Rotators
abduction

• Hip Abduction

Femoris
• Obturator N
Lateral
• Sciatic N
nerve

inferior
2. Inferior
superior

Obturator Foramen
4. Obturator N
Femoral Triangle
5. Femoral N
6. Femoral A & V
To Summarize…

the Hip

©
katelyn.wood@uwo.ca
Intro to Neuro
katelyn.wood@uwo.ca
Learning Outcomes

neurotransmitters

Nervous System
Function + Cells
environments



Neurons Neuroglia

Trigger zone
Axon terminal
(Axon Hillock)
helps with faster
connecting the cell
conduction
body to the
transmitted down
potential
Node of Ranvier
Dendrites
Did you know…


Cell body Node of
zone

Receptor Organ
CNS
peripheral process)
cell body and brain
signaling
Central process
Peripheral process
Axon terminal

Schwann cell
Node of
Node of Ranvier
Ranvier
Nucleus Myelin
Myelin sheath
Axon Axon
Nucleus
Myelination
Node of Ranvier
Myelin sheath
Unmyelinated
Myelinated axon
axons

K+
manner
polarization
Na+Cl-
K+
Depolarization

(takes longer)
Depolarization
3-120 m/s 0.5-2.0 m/s

Neuronal Synapse
effector organ
Neuronal Synapse
membrane
Structure Function


transmission
neuron/structure

generated here
conduction)
transmission
Nervous System
Structure
• Glands
• Everything else
PNS:
- the
CNS vs PNS
CNS:
Brain
Cranial
nerves
Spinal
Sensory Ganglia
receptor (in skin)

Axon

Ventral
plexuses
Ventral horn
Central Cell body
Spinal nerve
Efferent in small
Axon
canal White axon
matter

Sensory
receptors
in skin
CNS vs PNS
CNS vs PNS

sensory motor

voluntary control)
or SLUDD)
White & Gray Matter
White & Gray Matter
White matter
Gray matter

To Summarize…


©
katelyn.wood@uwo.ca
Joints
katelyn.wood@uwo.ca
Learning Outcomes

Joints
Classification
(ex. finger joint)

Fibrous

Joints
Cartilaginous

Joints
Synovial

• discs, menisci
• 6 joint classes
hip
base of your wrist


elbow knee
Joints
give up the other.
have more stability

Shoulder + Hip



Shoulder + Hip
Hinge Joints
Elbow + Knee
• Uniaxial joint*

motion
more *usually
Hinge Joints
Elbow + Knee
elbow --> ulna

a lot of stability
and the femoral
and is aided by the
menisci and intra
Muscles
Bones
Intra-Articular
Structures
menisci, the
+ Capsule labrum
a strain?
Sprains

synovial cavity
• Articular Discs
• Absorb shock
• Labrum
much wear and tear
Bursitis

• Trauma
To Summarize…
Some movement,
Free movement
allow growth forfor
between bones
new bone
Stability Most
Most Middle
Middle Least
Least
Smaller fibres
= less
classes
Joint
Jointcapsule
capsule
movement
movement
Both
Bothhyaline
hyaline & &
Cartilage? No!
NO!Fibres
Hyaline
fibrocartilage
Suture, 6 6classes:
classes: pivot,
pivot,
Epiphysial plate
Suture, gomphosis,
plane, hinge,
hinge,
syndesmosis
disc
ball & socket
To Summarize…

©
katelyn.wood@uwo.ca
Knee
katelyn.wood@uwo.ca
Learning Outcomes
the knee


Lower Limb Overview
The Lower Limb Hip
LOWER LIMB
pelvic bones
femur Thigh
patella Knee
tibia
fibula
tarsal bones
metatarsals
phalanges
Shank/Leg
Ankle
Foot
supination
Bones of
the Knee
force from pelvis
through the knee
• Tibia = weight
stability
force production
(moment arm) at
joint
Surface Anatomy
Anterior Posterior
Joints of the Knee
Lateral
Joints of the Knee

Transverse
tibiofibular joint
Proximal/Superior
Tibiofibular jt
Anterior Posterior
Knee Function
hinge joint
aspect of the knee

Lateral Knee
Femur
Quadriceps tendon
Patellofemoral Jt

to insert onto
patellar ligament
- There's the
Patellar ligament
the tibial plateau
Fibula Tibia
Posterior Anterior



Stability Mobility
Bony Contacts
bones alone

• MENISCI!!
Tibial Plateau
cause damage


Medial
Meniscus
Lateral Meniscus
1 2
Anterior View
1 2
Number 1
- normal knee
whole joint
- right knee
Number 2
- left knee
with each other
Anterior View
Collateral

Named based on
Cruciate
means crossed
tibia
tibia
inferiorly

Named based on
Cruciate
of the femur
Foot Planted:
Foot Free:
Lateral
Named based on

Foot Planted:
Foot Free:
Lateral femur
Named based on
- crossing of these
sagittal plane
being the posterior
cruciate ligament
PCL ACL
Named based on
ACL
PCL
Lateral Anterior
of knee knee
triad
force
Blow to
Tibial Plateau

Thigh Musculature
• Plantaris

• Semi-Tendinosus
Movements?


Walking
What
is Energy
about Intensive
Standing?
unstable joint
when standing
efficiency
lock
• Medial Meniscus
medial femoral
Popliteus
Attachments
• Posterior Tibia

- triangular muscle
opposing directions
The Patellofemoral
Joint
Transverse

quadriceps act at
Patella
Axis of
rotation
Force from Quads

shank
Force
Force w Patella
inferior
extension
patellar tendon
patellar tendon
patella patella
the knee
flexion extension
patella laterally
medialis) up
• Resisted by:
• Vastus medialis
Knee Bursae
• Fluid filled
sacs
important for
cushioning
and reducing
friction
femur
ligament
To Summarize…


©
katelyn.wood@uwo.ca
Lung + Pleura
Anatomy
katelyn.wood@uwo.ca
Learning Outcomes

Middle Mediastinum
Middle
mediastinum

Pleural Cavities
Contents:
• Lungs
• Pleura
Hilum:
• Pulmonary Veins
• Primary Bronchi
Airway branching
branches # of tubes
Trachea 1
Main bronchi 1
Lobar and segmental

Bronchial Tree
bronchi
Segmental = 10

11–16
bronchioles
Divisions

Respiratory zone
capillary
Alveolar sacs 23
The Lungs
Trachea
Lungs in Situ
and right sides
Right main bronchus
Right lobar bronchi

Right segmental
bronchus
Right bronchiole

segments
respiratory zone
reserved.
• Contents:
exchange)

Lungs
as well

midline
left
back again

apex
Right Lung
superior lobe
Lateral View
anterior border
horizontal fissure
costal surface
middle lobe
inferior lobe
oblique fissure
base
inferior border
apex

Left Lung
Lateral View
superior lobe
costal surface
inferior lobe
lingula
inferior border
Hilum Structures

• Inferior
supply to the lung
apex
R. Hilum
branches of right
pulmonary a.
superior lobe
mediastinal surface
Root of the Lung
oblique fissure
anterior border
hilium
branches of right
inferior lobe

part
pulmonary ligament
middle lobe
diaphragmatic base
parietal
Pleura
Pleural Cavities

and visceral layers
Pleural Cavities
• Costal = ribs
• Cervical = neck



the pleura:

What muscles
fluid can collect
the diaphragm
To Summarize…
©
katelyn.wood@uwo.ca
Breathing + Gas
Exchange
katelyn.wood@uwo.ca
Learning Outcomes

Thoracic MSK Review
Bony Anatomy
• Thoracic Cage
vertebrae
via two joints
Thoracic Muscles


• Diaphragm
Sternum:
changes Inhalation
Diaphragm:
the thoracic cage
inspiration




• Air flows in
- black = trachea
Air
Pressure = A
pleura)
you)
- diaphragm drops
A
collapse in
A-4
lower
Pneumothorax
changes
wanting to contract
space

space


Air Pressure = A
Pneumothorax
- black = trachea
- green = lungs
- red = diaphragm
conditions
in a pneumothorax:
- air can flow in
A
lungs
collapses
AA - 4
Gas Exchange
From aorta or
intercostal As)

A = arteries
V = veins


move down from the
A: center of
bronchopulmonary
segment Oxygenate
V: outside of blood
out to the lungs
bronchopulmonary
segment
A: center of
out to the lungs
pulmonary vein
Bronchial Artery
Pulmonary
Artery
pulmonary veins
the periphery
Bronchopulmonary
segment Pulmonary
Vein
Capillary bed
on Alveolus
alveoli
segment


O2 CO2
blood
top left
diffusion occurring
reach the blood
opposite directiom


Alveoli


occur


alveoli



lungs
To Summarize…
collapse


©
katelyn.wood@uwo.ca
Muscle Basics
katelyn.wood@uwo.ca
Learning Outcomes

Muscle Types
3 types of muscle

for a given cell

heat to be produced

pump blood

neuromuscular cleft
2. Contractility
force

in chambers)
surface of bone


muscle

around

sacromeres
together
Myofibre
units of sarcomeres
Thick & Thin

filaments
Endomysium

I-Band M-Line


is present

actin

be the same width
actin and myosin
A-Band
Z-Disk/Line

Muscle Contraction
Muscles pull Bones
• Tendons are a
continuation of the
same fascial layers
that encase the
muscle
brain to the muscle
Upper Motor Neuron

Motor Signals (UMN)
Spinal Cord
Lower Motor Neuron

(LMN)
Muscle
Motor Neurons
Motor
spinal cord
side of the body
neurons
large motor units
recruited

Fatigue
Type Name Force
Rate

towards the H-band

region

2. Power Stroke
3. Rigor State
1. Bound State

4. Relaxed State
and is stuck there
Bound State
Pi
Power Stroke
rigor state
- bound to ADP
Rigor State
contraction
Rigor State
Relaxed State
binding state
ATP
Binding State
ATP + 2+
ATP
CALCIUM
Actin
actin
Troponin Complex
all the calcium

muscle contraction
the t-tubules

To Summarize…

©
katelyn.wood@uwo.ca
Muscle Force
katelyn.wood@uwo.ca
Learning Outcomes

Review
Last Module:
muscle
- tendons are

Last Module:
4. Contraction

Force Production

Acting Area


or less force

force production

changing length
Z M Z 2
1 3
Force
Length



One more thing…
but…

force
the contraction
ground
velocity = 0
maximal

Torque =
acting the body

angles
that a joint is in

force
circle)
3. Moment arm at 1
2
3

going to change
4
5
- if you pull with
produce different
the moment arm
1 2 3 4 5
Biceps Brachii
Brachialis

Avg Weighted
which a muscle is
- biceps brachii,
Brachioradialis
Sum Moment
Torque (N/cm)
the girth of muscle
Angle (deg)



moves the shoulder
B = bipennate
C = multipennate

area of a muscle



Acting Area

Exercise
Strain
• Grading:
• Symptoms:
force all the way

connective tissue.

onwards

is decreased
feedback

feedback)
force

strength
Exercise + Muscle

• Benefits:
stress the bone it

To Summarize…

©
katelyn.wood@uwo.ca
The Peripheral
Nervous System
katelyn.wood@uwo.ca
Learning Outcomes
Nervous System
Structure

everything else
sensory motor

voluntary control)

exiting
Spinal Cord
• Cervical plexus
• Brachial plexus
• Lumbar plexus
• Sacral plexus


Periphery
Sensory (to brain)
Gray Matter:
Contains:
Neuron Cell Bodies
Glial Cell Bodies
Spinal Cord

Spinal Cord
comes back into and
structures)
ventral and dorsal
roots come together
to form a spinal
again to form rami
Ventral Rami
Root --> Nerve -->

Ramo Spinal Nerve

Ventral = Anterior
Spinal Cord
Sensory Pathway
Dorsal Root
Dorsal Horn
Dorsal Rami
Ventral Horn
Ventral Rami

Spinal Cord
Motor Pathway
Dorsal Root
Dorsal Horn
Dorsal Rami
Ventral Horn
Ventral Rami

Spinal Cord
Dorsal Root
Dorsal Horn
Dorsal Rami
Ventral Horn
Ventral Rami
Spinal Nerve

Ventral Root
sensory and motor
Spinal Cord
Structure Contents
Motor Neurons
Dorsal Root Sensory
Sensory neurons
Neurons
Cellbody
Bodyof
ofsensory
Sensoryneurons
Neurons
(goes through
foramen
Autonomics (most
(mostnamed
namednerves)
nerves)
motor Neurons
neurons -–to
todeep
deepback
back&&Z-joints
Z-joints(smaller
(smallerbranches)
branches)
Spinal Cord
everything else
Thoracic Region
Plexus & Peripheral



Dermatomes vs C3
Cutaneous Maps C4
T2
C5 T3
the way to T1
T4
radial nerve
cutaneous
C6

everything else
Epidural space
Spinal cord


Spinal Nerve

Subarachnoid space
(contains CSF)
Rami communicantes
Pedicle of vertebra
(cut)

Dura mater and

arachnoid mater

To Summarize…
(dorsal) root

peripheral nerves
levels combine
©
katelyn.wood@uwo.ca
The Respiratory
System
katelyn.wood@uwo.ca
Learning Outcomes

and function
The Respiratory
System
has 2 components:
lungs

gas exchange occurs
Bronchioles
Alveoli
• Gas Exchange
The Conducting Zone
Naso
Oro Pharynx
Laryngo
Larynx
Trachea
Bronchi
1. nasopharynx
2. oropharynx
3. laryngopharynx
• Mucous Linings
Inferior
meatus
•
bounded by:
serves 2 purpose:
Nasopharynx
uvula
with conchae

mucous membrane
• Three sections:
larynx
hyoid
thyroid epiglottis
Larynx
cuneiform
• Functions:
trachea

Cartilage
• Thyroid

Vocal fold
superior view
• Vestibular Fold


going to go with it

bundle
Alveolar duct
bronchiole
network
Alveolar sac
TYPE I PNEUMOCYTES
circulation

drops in the lung
• Two Cell Types:


capillaries
• Cuboidal
surface tension
popped open
Airway branching
branches # of tubes
Trachea 1
Main bronchi 1
Lobar and segmental

Bronchial Tree
bronchi
Segmental = 10

11–16
bronchioles
Divisions
Respiratory
17–19
bronchioles
Respiratory zone
Alveolar sacs 23

To Summarize…


©
katelyn.wood@uwo.ca
Shank (leg)
katelyn.wood@uwo.ca
Learning Outcomes

Lower Limb Overview
The Lower Limb Hip
LOWER LIMB
pelvic bones
femur Thigh
patella Knee
tibia
fibula
tarsal bones
metatarsals
phalanges
Shank/Leg
Ankle
Foot
Tibia +
Fibula
of the shank

medial and
articulate at the
knee, not the
fibula
Head of Fibula
Ankle Mortise
Medial Malleolus
Lateral Malleolus
Popliteal Fossa
Popliteal Fossa
• Boarders:
• Semimembranosus
• Biceps femoris
back of the knee
shank
• Popliteal Vein
• Sciatic N
• Tibial N
- key boundaries:
Popliteal Fossa

deeper
Common Peroneal
nerve
sciatic nerve
Lesser saphenous v.
Shank Compartments
anterior
4 compartments:
peroneal nerve
different)
Tibial N
Shank R
Anterior
ankle
(fibular) N
Dorsiflexion
Lateral
Compartment
• Ankle Eversion

Base of the 5th

metatarsal
Peroneal (Fibular)
N
head of fibula
Deep Branch
Superficial
Branch
lateral
malleolus
Superficial *
Posterior Knee
Flexion
Compartment * ‡
- posteriorly
Plantarflexion

Compartment longus
- posterior
• Plantar Flexion
• *Inversion
FDL Tib A Post.
TP Tib N

n of ankle
FHL
Gateway to the Foot

Tibial N
Muscle Summary
Longus Longus
Longus Longus

Longus • Soleus
Brevis
• Popliteus
Cadaveric Specimens
To Summarize…
are crossed!

©
katelyn.wood@uwo.ca
Shoulder
katelyn.wood@uwo.ca
Learning Outcomes

Upper Limb Overview

Arterial
Anastomosis

Palmar Arches
to brachial v
superficial side
deep side
Venous Supply

cephalic vein
the cubital fossa
basilic vein
(drawing blood)
Superficial Deep
The Upper Limb
3 joints: Shoulder
1. shoulder
2. elbow
3. wrist UPPER LIMB
1. arm Arm
2. forearm
3. hand scapula
clavicle
Elbow
humerus
radius
ulna Forearm
carpal bones
Wrist
metacarpals
phalanges Hand
Fossae:
- Subscapular
Scapula
- Supraspinous
- Infraspinous
the anterior border
aspect Scapular
scapula
spine
Spine
Glenoid
Medial Fossa
tubercle
key muscle
attachment
Lateral point

below the spine

(sub = under)
glenohumeral joint
Clavicle Sternal
Articular
Surface

Shaft

thorax
there Acromial
shaft Articular
sternum
Surface
clavicle clavicle
acromion
acromion
coracoid
process
glenoid spine of
fossa the
scapula
sternum

Acromion of scapula

Lateral
Medial
humerus
Spine of scapula
Lateral border of
scapula
Medial border of
scapula
1st rib
clavicle

and clavicle
sternum
clavicle
acromion
Coracoacromial Lig
humeral
key ligaments:
coracoid process
anterior view

Glenohumeral Joint
Joint Capsule
(synovial
membrane)
glenoid
fossa
humeral
head
scapular
spine
Glenohumeral Joint
Thickenings of the
superiorly and
glenohumeral lig.
head
humeral head (cut)
Inferior
glenohumeral lig.
posterior view
acromion
long head of
coracoid
• Thickening of
the glenoid fossa
glenoid fossa
humeral head
joint capsule
dislocations
Glenohumeral Joint
it's a dislocation
anteriorly
this space
1. Axillary
Allows for
acromion
movement between
the scapula +
humeral
is critical for arm

also to the scapula
clavicle
superior view

• > 30°= GH jt +
• 2° : 1°, GH to ST
degree

The Axilla
The Axilla
nodes
limb
- cone-shaped area
arteries and veins




Shoulder
trapezius
• Trapezius
latissimus
• Thoracodorsal N
rotate humerus
spinal nerve
are activated
rhomboids
• Rhomboids
and spine

• Teres Major
Arm

posterior
abduction
Infraspinatus
scapula, posterior
• Suprascapular N

greater tubercle
POSTERIOR VIEW

• Axillary N
Teres Minor
• Upper & Lower

Subscapular Ns
ANTERIOR VIEW
SUPERIOR VIEW
(deltoid removed)
infraspinatus
teres minor

Pectoralis Major
Pectoral Pectoralis
Minor
Winged Scapula
- pectoral muscles
to move backwards
• What nerve?
• Long Thoracic
Deltoid
• Axillary N
ABDUCTION 90°
• Flexion
• Extension
• Abduction
round shape
to 90 degrees
joint


(Cranial Nervenerve
XI)XI thoracic

Cadaveric
Specimens
Pectoral Region
Cadaveric Specimens
Rotator Cuff
cuff muscle
Cadaveric
Specimens
Superficial Back
To Summarize…

arm abduction


©
katelyn.wood@uwo.ca
Thigh
katelyn.wood@uwo.ca
Learning Outcomes

Lower Limb Overview
The Lower Limb Hip
LOWER LIMB
pelvic bones
femur Thigh
patella Knee
tibia
fibula
tarsal bones
metatarsals
phalanges
Shank/Leg
Ankle
Foot
Femur
Proximal End
the femur attaches

Femur
Distal End

knee
muscle attachment
aspect
Articular Cartilage

Femur

Acetabulum
Neck
Fovea for Head
ligament
of head Greater
of femur trochanter
of femur
Lesser
femur
Shaft of femur

are regards to the
knee
bone traversing
Femoral N
Medial (adductors)
Obturator N
Posterior (Flexors)
posterior
Sciatic N (tibial)
Thigh R
Anterior *
Femoris”
flexion *
of hip
extension
of knee
patella
patellar ligament
tibial tuberosity
muscles
Medial
hip
Compartment flexion
Pectineus

hip
*
medial rotation
Medial
Posterior
of hip
• Knee Flexion
• Hip Extension
rounder in shape
sheath Medial
thigh

• Gracilis
• Semitendinosis
Muscle Summary
• Medialis
• Intermedius
• Posterior Thigh
• Semi-Tendinosis
• Biceps Femoris
Cadaveric Specimens
Neurovascular
Pathways
Nerve Summary
Femoral Triangle
• Contents:
• Femoral N
• Femoral Sheath
• Femoral A & V
• Borders:
• Sartorius
• Adductor Longus

3. Pudendal N
Obturator Foramen
out of the pelvis
Femoral Triangle
5. Femoral N
6. Femoral A & V
Adductor Hiatus
canal

compartments
Adductor Hiatus
magnus

To Summarize…

the lower limb

©
katelyn.wood@uwo.ca
Thoracic Wall +
Abdominals
katelyn.wood@uwo.ca
Learning Outcomes
innervations

Spinal Nerves
Spinal Cord
Dorsal rami

Spinal Nerve
Posterior Rami
Anterior Rami
everywhere else
and posterior ramus
Intercostal Nerves
“VAN”
protection
the thorax
and the back
the body
Thoracic Muscles
Intercostal Muscles
• External
fibers


Diaphragm
• Central Tendon
• 3 openings
• Aortic hiatus
volume
- 3 openings:
• External
• Internal
• Innermost
from the abdonimal
cavity
Slide 13

(childbirth)
Slide 14
abdominus
Abdominal Muscles
Compress Abdomen
actions

Abdominal Muscles
linea alba
external oblique
aponeurosis
internal oblique
semilunaris
(posterior)
transversalis
inguinal fascia
ligament
arcuate line
Compress Abdomen
actions

Anterior Body Wall
- a complete rectus
Below Arcuate Line
linea alba
Diastasis Recti

• Age 35+
linea alba
• Treatment:
improve function.
abdominal walls



Cadaveric
Specimens
appearance
Cadaveric Specimens
Cadaveric Specimens
To Summarize…

crossed

©
katelyn.wood@uwo.ca
Vessel Anatomy
katelyn.wood@uwo.ca
Learning Outcomes

Vessel Anatomy
3 types of vessels

helps promote blood
compressed easily

occur anymore
the distance
• Venous Sinus:
Vessels create a
closed loop!
Arteries Arterioles
Veins/
Capillaries
Sinuses
Venules
Varicose Veins

level of the heart


aging

removal
Vasculature Review
the arm
Anastomosis

to brachial v
superficial side
Venous Supply

Deep side
palmar venous arch
interosseous vein
Superficial Deep
Arterial Supply
limb or shank
Deep Veins To heart
Venous Supply
arteries
Popliteal V.
Superficial veins
From leg
return blood @
Muscle contractions
To Summarize…
Venules Veins Heart
Limbs
©
katelyn.wood@uwo.ca
Wrist
katelyn.wood@uwo.ca
Learning Outcomes
carpal bones


Upper Limb Overview
The Upper Limb
Shoulder
UPPER LIMB
Arm
scapula
clavicle
Elbow
humerus
radius
ulna Forearm
carpal bones
Wrist
metacarpals
phalanges Hand
Right Forearm!
The Ulna + Radius

Distal Aspect

Ulnar carpals
Notch
Head of
IV III
II
V

I
- pisiform looks
like a pea —>
small round and
circular
-triquetrum —>
begins with tri
pneumonic)
- trapezoid and
Carpals
palmar view
Bones of

Ulna
Scaphoid
Ulnar Notch
Styloid Process
of Radius
posterior view
Joints of the Wrist
carpals
Radiocarpal
Joint
Carpal
bones Ulna


and palmer aspect
(dorsal / palmar)

Radioulnar Lig
(dorsal / palmar)

Radioulnar Ligs
Joints of the Wrist

supination
Interosseous
Membrane
radius + ulna
Ulna
Radius

Joints of the Wrist
Radiocarpal Joint
Triquetrum
Scaphoid

from distal
radioulnar joint
Wrist


The Carpal Tunnel
Hamate
Capitate
Pisiform
Trapezoid
Lunate Scaphoid
palmar view
flip
& flex
Carpal Tunnel
Radial A
Flexor Retinaculum
Median N Ulnar
A&N Median N
Carpal Tunnel
Hamate
First
metacarpal
Hand Muscles
(hypothenar)
Median
Nerve Ulnar nerve
Hand Muscles Ulnar
artery
Median nerve

Muscular
median nerve
branches of
median nerve
To Summarize…


©
katelyn.wood@uwo.ca

Kin2222 - Anatomical Terms, Planes - Movements 2 2

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Kin2222 - Anatomical Terms, Planes - Movements 2 2

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Anatomical Terms, Planes

• Use common language to discuss/identify anatomical

Coronal Plane (MR, T1W)

Axial Plane (MR, T1W)

image is from front to back

Sagittal Plane (MR, T1W)

Upper Limb Anatomy Tutorial Using an Imaging Platform https://www.mededportal.org/publication/10167/

• Important for establishing Lateral

• All terms are in reference Posterior

Anatomical Terms Cranial

Pertaining to, or located toward, the tail

Pertaining to, or located toward, the front

Pertaining to, or located toward, the back

Term Explanation Superior Upper or Above

Deep Situated beneath the surface

External Outer or lateral

Hands & Feet Internal Inner or medial

Term Explanation Apical Pertaining to the top or apex

Pollicis Pertaining to the thumb Basal Pertaining to the bottom or base

Coronal Situated parallel to the coronal suture (pertaining to

Abdominal Regions - Epigastric means above the stomach

Protraction/Retraction & Elevation/Depression Elevation: move in a superior direction

Common Movements Supination*: palm/sole rotates upward

Lateral/External Rotation: away from the

*doesn’t happen @ ankle

Hands & Thumb Adduction: align thumb with hand

FLEXION EXTENSION OPPOSITION ADDUCTION ABDUCTION

• Anatomical Planes are used to divide the body into

• Anatomical terms are precise ways of communication

• Identify the location, components (bones + ligaments + associated structures) of the

Fibula - medial malleolus

Bones of the phalanx

Lower Limb Radiology Tutorial –

Distal tibiofibular joint

Lower Limb Radiology Tutorial –

Talocrural Joint Talus

Lower Limb Radiology Tutorial –

Distal Tibiofibular Joint

• Articulation between tibia and fibula

Distal Tibiofibular Joint

• Articulation between Ankle Mortise (tibia + fibula) and Talus

• Articulation between the

Lateral Talocalcaneal lig

• Lateral • Superficial Posterior

Do you have control over these processes?

• Describe the role the ANS plays in regulating homeostasis

• Compare/contrast the somatic and autonomic NS in terms of physical anatomy

• Allows for ideal bodily conditions

ex. if you are starting to sweat when it

• Interprets and integrates a variety of signals

Visceral Receptors Afferent (sensory) Cardiovasc Control in

Gravity causes AP frequency Integrate info in

Efferent (motor) Pathway

Heart + Blood Vessels SNS PSNS

Peripheral Nervous System

Somatic Autonomic Autonomic Somatic

Sympathetic Parasympathetic SLUDD:

Yes Pre – yes

Sympathomimetic (mimics sympathetic innervation) drugs will:

*sexual simulation is a special circumstance requiring both PSNS

• Rest, Relax, Ruminate + SLUDD

Parasympathetic NS Posterior root

1. Pre-ganglionic PSNS signals travel Sacral spinal