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The Structure and Function of Breathing
CHAPTERCONTENTS The structure-function continuum 1 Multiple Influences: biomechanical, biochemical and psychological 1 The structure and Homeostasis and heterostasis 2 OBJECTIVE AND METHODS 4 function of breathing NORMAL BREATHING 5 Respiratory benefits 5 Leon Chaitow The upper airway 5 Dinah Bradley Thenose 5 The oropharynx 13 The larynx 13 Pathological states affecting the airways 13 Normal posture and other structural THE STRUCTURE-FUNCTION considerations 14 Further structural considerations 15 CONTINUUM Kapandji's model 16 Nowhere in the body is the axiom of structure Structural features of breathing 16 governing function more apparent than in its Lung volumes and capacities 19 relation to respiration. This is also a region in Fascla and resplrstory function 20 which prolonged modifications of function - Thoracic spine and ribs 21 Discs 22 such as the inappropriate breathing pattern dis- Structural features of the ribs 22 played during hyperventilation - inevitably intercostal musculature 23 induce structural changes, for example involving Structural features of the sternum 23 Posterior thorax 23 accessory breathing muscles as well as the tho- Palpation landmarks 23 racic articulations. Ultimately, the self-perpetuat- NEURAL REGULATION OF BREATHING 24 ing cycle of functional change creating structural Chemical control of breathing 25 modification leading to reinforced dysfunctional Voluntary control of breathing 25 tendencies can become complete, from The autonomic nervous system 26 whichever direction dysfunction arrives, for Sympathetic division 27 Parasympathetic division 27 example: structural adaptations can prevent NANC system 28 normal breathing function, and abnormal breath- THE MUSCLES OF RESPIRATION 30 ing function ensures continued structural adap- Additional soft tissue influences and tational stresses leading to decompensation. -
Anatomical Variants of the Musculocutaneous Nerve- Report of Two Cases
Open Access CRIMSON PUBLISHERS C Wings to the Research Research in Anatomy ISSN: 2577-1922 Case Report Anatomical Variants of the Musculocutaneous Nerve- Report of Two Cases Fernando Martinez1,2 and Guzmán Ripoll1* 1Anatomy Department, Facultad de Medicina Universidad Claeh, Uruguay 2Neurosurgery Department, Universidad de la República, Uruguay *Corresponding author: Guzmán Ripoll, AnatomyDepartment, Facultad de Medicina Universidad Claeh, Maldonado, Uruguay, Email: Submission: February 22, 2018; Published: April 19, 2018 Abstract Introduction: The muscle-cutaneous nerve (MCN) is a mixed nerve, which is mainly responsible for shoulder flexion, elbow flexion and supinationMaterial of theand hand. method: The anatomical variations in this nerve are relatively frequent, fact with clinical and surgical implications. Results: Two variants were A retrospective found in the review 20 cases of 20studied patients (10% operated of the cases): on with anastomosis the Oberlin betweentechnique MCN was and made. median nerve, and absence of the MCN.Discussion: MCN variants are frequently described by the different authors. This has an embryological and phylogenetic explanation: the lateralConclusion: and medial cords form the flexor plane of the muscles of the upper limb. We present 2 cases: an unusual one of median nerve-MCN, and another absence of it. We emphasize that the knowledge of these variants have clinical, surgical and neuro-physiological applications. Introduction The musclecutaneous nerve (MCN) is a mixed nerve, which from basically the use of fascicles of the median nerve to reinforce the ulnar nerve (Figure 1). The modifications of this technique are the motor point of view is mainly responsible for shoulder flexion, brachial plexus injuries with involvement of the upper trunk (C5- the muscles that innervate: coracobrachial, biceps brachialis and anterior brachial muscle (Figure 2). -
Redalyc.Variations in Branching Pattern of the Axillary Artery: a Study
Jornal Vascular Brasileiro ISSN: 1677-5449 [email protected] Sociedade Brasileira de Angiologia e de Cirurgia Vascular Brasil Astik, Rajesh; Dave, Urvi Variations in branching pattern of the axillary artery: a study in 40 human cadavers Jornal Vascular Brasileiro, vol. 11, núm. 1, marzo, 2012, pp. 12-17 Sociedade Brasileira de Angiologia e de Cirurgia Vascular São Paulo, Brasil Available in: http://www.redalyc.org/articulo.oa?id=245023701001 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative ORIGINAL ARTICLE Variations in branching pattern of the axillary artery: a study in 40 human cadavers Variações na ramificação do padrão da artéria axilar: um estudo em 40 cadáveres humanos Rajesh Astik1, Urvi Dave2 Abstract Background: Variations in the branching pattern of the axillary artery are a rule rather than an exception. The knowledge of these variations is of anatomical, radiological, and surgical interest to explain unexpected clinical signs and symptoms. Objective: The large percentage of variations in branching pattern of axillary artery is making it worthwhile to take any anomaly into consideration. The type and frequency of these vascular variations should be well understood and documented, as increasing performance of coronary artery bypass surgery and other cardiovascular surgical procedures. The objective of this study is to observe variations in axillary artery branches in human cadavers. Methods: We dissected 80 limbs of 40 human adult embalmed cadavers of Asian origin and we have studied the branching patterns of the axillary artery. -
Anatomical Variations of the Brachial Plexus Terminal Branches in Ethiopian Cadavers
ORIGINAL COMMUNICATION Anatomy Journal of Africa. 2017. Vol 6 (1): 896 – 905. ANATOMICAL VARIATIONS OF THE BRACHIAL PLEXUS TERMINAL BRANCHES IN ETHIOPIAN CADAVERS Edengenet Guday Demis*, Asegedeche Bekele* Corresponding Author: Edengenet Guday Demis, 196, University of Gondar, Gondar, Ethiopia. Email: [email protected] ABSTRACT Anatomical variations are clinically significant, but many are inadequately described or quantified. Variations in anatomy of the brachial plexus are important to surgeons and anesthesiologists performing surgical procedures in the neck, axilla and upper limb regions. It is also important for radiologists who interpret plain and computerized imaging and anatomists to teach anatomy. This study aimed to describe the anatomical variations of the terminal branches of brachial plexus on 20 Ethiopian cadavers. The cadavers were examined bilaterally for the terminal branches of brachial plexus. From the 40 sides studied for the terminal branches of the brachial plexus; 28 sides were found without variation, 10 sides were found with median nerve variation, 2 sides were found with musculocutaneous nerve variation and 2 sides were found with axillary nerve variation. We conclude that variation in the median nerve was more common than variations in other terminal branches. Key words: INTRODUCTION The brachial plexus is usually formed by the may occur (Moore and Dalley, 1992, Standring fusion of the anterior primary rami of the C5-8 et al., 2005). and T1 spinal nerves. It supplies the muscles of the back and the upper limb. The C5 and C6 fuse Most nerves in the upper limb arise from the to form the upper trunk, the C7 continues as the brachial plexus; it begins in the neck and extends middle trunk and the C8 and T1 join to form the into the axilla. -
Brachial-Plexopathy.Pdf
Brachial Plexopathy, an overview Learning Objectives: The brachial plexus is the network of nerves that originate from cervical and upper thoracic nerve roots and eventually terminate as the named nerves that innervate the muscles and skin of the arm. Brachial plexopathies are not common in most practices, but a detailed knowledge of this plexus is important for distinguishing between brachial plexopathies, radiculopathies and mononeuropathies. It is impossible to write a paper on brachial plexopathies without addressing cervical radiculopathies and root avulsions as well. In this paper will review brachial plexus anatomy, clinical features of brachial plexopathies, differential diagnosis, specific nerve conduction techniques, appropriate protocols and case studies. The reader will gain insight to this uncommon nerve problem as well as the importance of the nerve conduction studies used to confirm the diagnosis of plexopathies. Anatomy of the Brachial Plexus: To assess the brachial plexus by localizing the lesion at the correct level, as well as the severity of the injury requires knowledge of the anatomy. An injury involves any condition that impairs the function of the brachial plexus. The plexus is derived of five roots, three trunks, two divisions, three cords, and five branches/nerves. Spinal roots join to form the spinal nerve. There are dorsal and ventral roots that emerge and carry motor and sensory fibers. Motor (efferent) carries messages from the brain and spinal cord to the peripheral nerves. This Dorsal Root Sensory (afferent) carries messages from the peripheral to the Ganglion is why spinal cord or both. A small ganglion containing cell bodies of sensory NCS’s sensory fibers lies on each posterior root. -
Ch22: Actions of the Respiratory Muscles
CHAPTER 22 ACTIONS OF THE RESPIRATORY MUSCLES André de Troyer he so-called respiratory muscles are those muscles that caudally and ventrally from their costotransverse articula- Tprovide the motive power for the act of breathing. Thus, tions, such that their ventral ends and the costal cartilages although many of these muscles are involved in a variety of are more caudal than their dorsal parts (Figure 22-2B, C). activities, such as speech production, cough, vomiting, and When the ribs are displaced in the cranial direction, their trunk motion, their primary task is to displace the chest wall ventral ends move laterally and ventrally as well as cra- rhythmically to pump gas in and out of the lungs. The pres- nially, the cartilages rotate cranially around the chon- ent chapter, therefore, starts with a discussion of the basic drosternal junctions, and the sternum is displaced ventrally. mechanical structure of the chest wall in humans. Then, the Consequently, there is usually an increase in both the lateral action of each group of muscles is analyzed. For the sake of and the dorsoventral diameters of the rib cage (see Figure clarity, the functions of the diaphragm, the intercostal mus- 22-2B, C). Conversely, a displacement of the ribs in the cau- cles, the muscles of the neck, and the muscles of the abdom- dal direction is usually associated with a decrease in rib cage inal wall are analyzed sequentially. However, since all these diameters. As a corollary, the muscles that elevate the ribs as muscles normally work together in a coordinated manner, their primary action have an inspiratory effect on the rib the most critical aspects of their mechanical interactions are cage, whereas the muscles that lower the ribs have an expi- also emphasized. -
Microlymphatic Surgery for the Treatment of Iatrogenic Lymphedema
Microlymphatic Surgery for the Treatment of Iatrogenic Lymphedema Corinne Becker, MDa, Julie V. Vasile, MDb,*, Joshua L. Levine, MDb, Bernardo N. Batista, MDa, Rebecca M. Studinger, MDb, Constance M. Chen, MDb, Marc Riquet, MDc KEYWORDS Lymphedema Treatment Autologous lymph node transplantation (ALNT) Microsurgical vascularized lymph node transfer Iatrogenic Secondary Brachial plexus neuropathy Infection KEY POINTS Autologous lymph node transplant or microsurgical vascularized lymph node transfer (ALNT) is a surgical treatment option for lymphedema, which brings vascularized, VEGF-C producing tissue into the previously operated field to promote lymphangiogenesis and bridge the distal obstructed lymphatic system with the proximal lymphatic system. Additionally, lymph nodes with important immunologic function are brought into the fibrotic and damaged tissue. ALNT can cure lymphedema, reduce the risk of infection and cellulitis, and improve brachial plexus neuropathies. ALNT can also be combined with breast reconstruction flaps to be an elegant treatment for a breast cancer patient. OVERVIEW: NATURE OF THE PROBLEM Clinically, patients develop firm subcutaneous tissue, progressing to overgrowth and fibrosis. Lymphedema is a result of disruption to the Lymphedema is a common chronic and progres- lymphatic transport system, leading to accumula- sive condition that can occur after cancer treat- tion of protein-rich lymph fluid in the interstitial ment. The reported incidence of lymphedema space. The accumulation of edematous fluid mani- varies because of varying methods of assess- fests as soft and pitting edema seen in early ment,1–3 the long follow-up required for diagnosing lymphedema. Progression to nonpitting and irre- lymphedema, and the lack of patient education versible enlargement of the extremity is thought regarding lymphedema.4 In one 20-year follow-up to be the result of 2 mechanisms: of patients with breast cancer treated with mastec- 1. -
Study Guide Medical Terminology by Thea Liza Batan About the Author
Study Guide Medical Terminology By Thea Liza Batan About the Author Thea Liza Batan earned a Master of Science in Nursing Administration in 2007 from Xavier University in Cincinnati, Ohio. She has worked as a staff nurse, nurse instructor, and level department head. She currently works as a simulation coordinator and a free- lance writer specializing in nursing and healthcare. All terms mentioned in this text that are known to be trademarks or service marks have been appropriately capitalized. Use of a term in this text shouldn’t be regarded as affecting the validity of any trademark or service mark. Copyright © 2017 by Penn Foster, Inc. All rights reserved. No part of the material protected by this copyright may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner. Requests for permission to make copies of any part of the work should be mailed to Copyright Permissions, Penn Foster, 925 Oak Street, Scranton, Pennsylvania 18515. Printed in the United States of America CONTENTS INSTRUCTIONS 1 READING ASSIGNMENTS 3 LESSON 1: THE FUNDAMENTALS OF MEDICAL TERMINOLOGY 5 LESSON 2: DIAGNOSIS, INTERVENTION, AND HUMAN BODY TERMS 28 LESSON 3: MUSCULOSKELETAL, CIRCULATORY, AND RESPIRATORY SYSTEM TERMS 44 LESSON 4: DIGESTIVE, URINARY, AND REPRODUCTIVE SYSTEM TERMS 69 LESSON 5: INTEGUMENTARY, NERVOUS, AND ENDOCRINE S YSTEM TERMS 96 SELF-CHECK ANSWERS 134 © PENN FOSTER, INC. 2017 MEDICAL TERMINOLOGY PAGE III Contents INSTRUCTIONS INTRODUCTION Welcome to your course on medical terminology. You’re taking this course because you’re most likely interested in pursuing a health and science career, which entails proficiencyincommunicatingwithhealthcareprofessionalssuchasphysicians,nurses, or dentists. -
Neurology of the Upper Limb
Neurology of the Upper limb Donald Sammut Hand Surgeon Kings Upper Limb Anatomy plus lecture notes The$Neck$ The$Nerve$roots$which$supply$the$Upper$Limb$are$C5$to$T1$ Pre<fixed$(C4$to$C8)$and$Post<fixed$(C6$to$T2)$plexus$not$uncommon.$ Also$common$contributions$from$C4$and$from$T2$in$a$normally$rooted$plexus.$ $ The$anterior$nerve$roots$emerge$between$the$vertebrae$and$immediately$pass$ $through$the$first$area$of$possible$compression:$ The$root$nerve$canal$is$bounded$$ Anteriorly$by$the$posterior$margin$of$the$intervertebral$disc$and$$ Posteriorly,$by$the$facet$joint$between$vertebrae.$ $ Pathology$of$the$disc,$or$joint,$or$both,$can$narrow$this$channel$and$compress$ $the$nerve$root$ The$roots$emerge$from$the$cervical$spine$into$the$plane$between$$ Scalenius$Anterior$and$Scalenius$Medius.$$ $ Scalenius*Anterior:** Origin:$Anterior$tubercles$of$Cervical$vertebae$C3$to$6$(C6$tubercle$is$the$Carotid$tubercle)$ Insertion:$The$scalene$tubercle$on$inner$border/upper$surface$1st$rib$ $ Scalenius*Medius:* Origin:$Posterior$tubercles$of$all$cervical$vertebrae$ Insertion:$Quadrangular$area$between$the$neck$and$subclavian$groove$1st$rib$ $ Exiting$from$the$Scalenes,$the$trunks$lie$in$the$posterior$triangle$of$the$neck.$ The$posterior$triangle$is$bounded$anteriorly$by$SternoCleidoMastoid$and$$ posteriorly$by$the$Trapezius.$ The$inferior$border$is$the$clavicle$.$ The$apex$of$the$triangle$superiorly$is$at$the$back$of$the$skull$on$the$superior$nuchal$line$ $ $ The$Posterior$Triangle$ SternoCleidoMastoid$ Trapezius$ Scalenius$Medius$ Scalenius$Anterior$ -
Muscle Attachment Sites in the Upper Limb
This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. Muscle Attachment Sites in the Upper Limb The Clavicle Pectoralis major Smooth superior surface of the shaft, under the platysma muscle Deltoid tubercle: Right clavicle attachment of the deltoid Deltoid Axillary nerve Acromial facet Trapezius Sternocleidomastoid and Trapezius innervated by the Spinal Accessory nerve Sternocleidomastoid Conoid tubercle, attachment of the conoid ligament which is the medial part of the Sternal facet coracoclavicular ligament Conoid ligament Costoclavicular ligament Acromial facet Impression for the Trapezoid line, attachment of the costoclavicular ligament Subclavian groove: Subclavius trapezoid ligament which binds the clavicle to site of attachment of the Innervated by Nerve to Subclavius which is the lateral part of the the first rib subclavius muscle coracoclavicular ligament Trapezoid ligament This document was created by Alex Yartsev ([email protected]); if I have used your data or images and forgot to reference you, please email me. The Scapula Trapezius Right scapula: posterior Levator scapulae Supraspinatus Deltoid Deltoid and Teres Minor are innervated by the Axillary nerve Rhomboid minor Levator Scapulae, Rhomboid minor and Rhomboid Major are innervated by the Dorsal Scapular Nerve Supraspinatus and Infraspinatus innervated by the Suprascapular nerve Infraspinatus Long head of triceps Rhomboid major Teres Minor Teres Major Teres Major -
Brachial Plexus and Branches Axillary A
Regional Anatomy of the Upper Limb 1 Wu Genghua Medical College Yangzhou University Anterior surface of the •Incisions: Upper Limb Make the skin incisions indicated in figure and reflect the skin flaps. Be careful not to cut too deep. As you remove the skin, look for the cephalic v., basilic v. and median cubital v. Superficial veins and nerves Mamma Structures Contains skin, mammary glands and adipose tissue Consists of 15 to 20 Lobes of mammary gland that radiate outward from the nipple lactiferous duct lactiferous sinuse Suspensory ligaments of breast (cooper’s ligaments): connective tissue septa that extend from the skin to the deep fascia Pectoral Region Superficial structures Superficial n. Supraclavicular n. Anterior cutaneous branches of intercostal n. lateral cutaneous branches of intercostal n. Muscles connecting the upper limb to the thoracic wall Pectoralis major 胸大肌 Subclevius 锁骨下肌 Pectoralis minor 胸小肌 Serratus anterior 前锯肌 Pectoral Region Deep structures clavipectoral fascia The deep fascia which extends between subclavius, coracoid process and pectoralis minor muscles The structures pass through the clavipectoral fascia . Cephalic v. Thoracoacromial a. Lateral pectoral n. Axillary region 腋区 Boundaries of the axillary fossa Apex is bounded by Middle 1/3 of clavicle Lateral border of first rib Upper border of the scapula Base is formed by the skin stretching between the anterior and posterior walls Anterior wall Formed by pectoralis major, pectoralis minor and subclavius muscles Boundaries of the axillary fossa The posterior wall latissimus dorsi teres major subscapularis and scapula Trilateral and quadrilateral space The posterior humeral circumflex a. and axillary n. pass through the quadrilateral foramen. -
Examination of the Shoulder Bruce S
Examination of the Shoulder Bruce S. Wolock, MD Towson Orthopaedic Associates 3 Joints, 1 Articulation 1. Sternoclavicular 2. Acromioclavicular 3. Glenohumeral 4. Scapulothoracic AC Separation Bony Landmarks 1. Suprasternal notch 2. Sternoclavicular joint 3. Coracoid 4. Acromioclavicular joint 5. Acromion 6. Greater tuberosity of the humerus 7. Bicipital groove 8. Scapular spine 9. Scapular borders-vertebral and lateral Sternoclavicular Dislocation Soft Tissues 1. Rotator Cuff 2. Subacromial bursa 3. Axilla 4. Muscles: a. Sternocleidomastoid b. Pectoralis major c. Biceps d. Deltoid Congenital Absence of Pectoralis Major Pectoralis Major Rupture Soft Tissues (con’t) e. Trapezius f. Rhomboid major and minor g. Latissimus dorsi h. Serratus anterior Range of Motion: Active and Passive 1. Abduction - 90 degrees 2. Adduction - 45 degrees 3. Extension - 45 degrees 4. Flexion - 180 degrees 5. Internal rotation – 90 degrees 6. External rotation – 45 degrees Muscle Testing 1. Flexion a. Primary - Anterior deltoid (axillary nerve, C5) - Coracobrachialis (musculocutaneous nerve, C5/6 b. Secondary - Pectoralis major - Biceps Biceps Rupture- Longhead Muscle Testing 2. Extension a. Primary - Latissimus dorsi (thoracodorsal nerve, C6/8) - Teres major (lower subscapular nerve, C5/6) - Posterior deltoid (axillary nerve, C5/6) b. Secondary - Teres minor - Triceps Abduction Primary a. Middle deltoid (axillary nerve, C5/6) b. Supraspinatus (suprascapular nerve, C5/6) Secondary a. Anterior and posterior deltoid b. Serratus anterior Deltoid Ruputure Axillary Nerve Palsy Adduction Primary a. Pectoralis major (medial and lateral pectoral nerves, C5-T1 b. Latissimus dorsi (thoracodorsal nerve, C6/8) Secondary a. Teres major b. Anterior deltoid External Rotation Primary a. Infraspinatus (suprascapular nerve, C5/6) b. Teres minor (axillary nerve, C5) Secondary a.