The Muscular System
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The Anatomy of the Rectum and Anal Canal
BASIC SCIENCE identify the rectosigmoid junction with confidence at operation. The anatomy of the rectum The rectosigmoid junction usually lies approximately 6 cm below the level of the sacral promontory. Approached from the distal and anal canal end, however, as when performing a rigid or flexible sigmoid- oscopy, the rectosigmoid junction is seen to be 14e18 cm from Vishy Mahadevan the anal verge, and 18 cm is usually taken as the measurement for audit purposes. The rectum in the adult measures 10e14 cm in length. Abstract Diseases of the rectum and anal canal, both benign and malignant, Relationship of the peritoneum to the rectum account for a very large part of colorectal surgical practice in the UK. Unlike the transverse colon and sigmoid colon, the rectum lacks This article emphasizes the surgically-relevant aspects of the anatomy a mesentery (Figure 1). The posterior aspect of the rectum is thus of the rectum and anal canal. entirely free of a peritoneal covering. In this respect the rectum resembles the ascending and descending segments of the colon, Keywords Anal cushions; inferior hypogastric plexus; internal and and all of these segments may be therefore be spoken of as external anal sphincters; lymphatic drainage of rectum and anal canal; retroperitoneal. The precise relationship of the peritoneum to the mesorectum; perineum; rectal blood supply rectum is as follows: the upper third of the rectum is covered by peritoneum on its anterior and lateral surfaces; the middle third of the rectum is covered by peritoneum only on its anterior 1 The rectum is the direct continuation of the sigmoid colon and surface while the lower third of the rectum is below the level of commences in front of the body of the third sacral vertebra. -
Defining the Morphometrics of the First Metacarpal for the Development of an Osseointegrated Prosthesis
Defining the Morphometrics of the First Metacarpal for the Development of an Osseointegrated Prosthesis Authors: JJ Vaux OMS-IV1, RR Hugate, M.D.2, JW Hills3, RF Grzybowski, D.O.4, CK Funk. Ph.D.1 Affiliations: 1Rocky Vista University College of Osteopathic Medicine, 2Colorado Limb Consultants, 3Dept of Materials and Mechanical Engineering, Denver University, 4Diversified Radiology Objective: Amputation of the thumb presents a serious insult to the hand and can result in up to a 22% loss of functionality in that limb (2,3). To date, several different techniques have been explored for reconstruction of the thumb, however none seem to be incredibly successful (1,4). We believe the answer lies in an osseointegrated prosthesis within the first metacarpal. In order to successfully create an osseointegrated prosthesis, the morphometrics of the first metacarpal are needed. The aim of this study was to define the geometry of the first metacarpal in order to help create a standardized set of stems and prostheses to treat patients who have suffered amputation of the thumb at the level of the first metacarpal phalangeal joint (MCPJ). Methods: A total of eighty first metacarpals from forty-one cadavers were studied. All soft tissues were removed and the first metacarpals were imaged by computed tomography (CT). Three-dimensional models were constructed using cuts from the coronal, sagittal, and axial planes. Using a HyperMesh software, the individual first metacarpals were analyzed and measurements were taken for overall length, radius of curvature, medullary canal diameter, cortical thickness, and distance from the distal end to the center of the isthmus. -
Original Article Pictorial Atlas of Symptomatic Accessory Ossicles by 18F-Sodium Fluoride (Naf) PET-CT
Am J Nucl Med Mol Imaging 2017;7(6):275-282 www.ajnmmi.us /ISSN:2160-8407/ajnmmi0069278 Original Article Pictorial atlas of symptomatic accessory ossicles by 18F-Sodium Fluoride (NaF) PET-CT Sharjeel Usmani1, Cherry Sit2, Gopinath Gnanasegaran2, Tim Van den Wyngaert3, Fahad Marafi4 1Department of Nuclear Medicine & PET/CT Imaging, Kuwait Cancer Control Center, Khaitan, Kuwait; 2Royal Free Hospital NHS Trust, London, UK; 3Antwerp University Hospital, Belgium; 4Jaber Al-Ahmad Molecular Imaging Center, Kuwait Received August 7, 2017; Accepted December 15, 2017; Epub December 20, 2017; Published December 30, 2017 Abstract: Accessory ossicles are developmental variants which are often asymptomatic. When incidentally picked up on imaging, they are often inconsequential and rarely a cause for concern. However, they may cause pain or discomfort due to trauma, altered stress, and over-activity. Nuclear scintigraphy may play a role in the diagnosis and localizing pain generators. 18F-Sodium Fluoride (NaF) is a PET imaging agent used in bone imaging. Although commonly used in imaging patients with cancer imaging malignancy, 18F-NaF may be useful in the evaluation of benign bone and joint conditions. In this article, we would like to present a spectrum of clinical cases and review the potential diagnostic utility of 18F-NaF in the assessment of symptomatic accessory ossicles in patients referred for staging cancers. Keywords: 18F-NaF PET/CT, accessory ossicles, hybrid imaging Introduction Accessory ossicles are developmental variants which are often asymptomatic. When inciden- Bone and joint pain is a common presentation tally picked up on imaging, they are often incon- in both primary and secondary practice. -
Female Perineum Doctors Notes Notes/Extra Explanation Please View Our Editing File Before Studying This Lecture to Check for Any Changes
Color Code Important Female Perineum Doctors Notes Notes/Extra explanation Please view our Editing File before studying this lecture to check for any changes. Objectives At the end of the lecture, the student should be able to describe the: ✓ Boundaries of the perineum. ✓ Division of perineum into two triangles. ✓ Boundaries & Contents of anal & urogenital triangles. ✓ Lower part of Anal canal. ✓ Boundaries & contents of Ischiorectal fossa. ✓ Innervation, Blood supply and lymphatic drainage of perineum. Lecture Outline ‰ Introduction: • The trunk is divided into 4 main cavities: thoracic, abdominal, pelvic, and perineal. (see image 1) • The pelvis has an inlet and an outlet. (see image 2) The lowest part of the pelvic outlet is the perineum. • The perineum is separated from the pelvic cavity superiorly by the pelvic floor. • The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue. (see image 3) We will talk about them more in the next lecture. Image (1) Image (2) Image (3) Note: this image is seen from ABOVE Perineum (In this lecture the boundaries and relations are important) o Perineum is the region of the body below the pelvic diaphragm (The outlet of the pelvis) o It is a diamond shaped area between the thighs. Boundaries: (these are the external or surface boundaries) Anteriorly Laterally Posteriorly Medial surfaces of Intergluteal folds Mons pubis the thighs or cleft Contents: 1. Lower ends of urethra, vagina & anal canal 2. External genitalia 3. Perineal body & Anococcygeal body Extra (we will now talk about these in the next slides) Perineum Extra explanation: The perineal body is an irregular Perineal body fibromuscular mass. -
Risk of Encountering Dorsal Scapular and Long Thoracic Nerves During Ultrasound-Guided Interscalene Brachial Plexus Block with Nerve Stimulator
Korean J Pain 2016 July; Vol. 29, No. 3: 179-184 pISSN 2005-9159 eISSN 2093-0569 http://dx.doi.org/10.3344/kjp.2016.29.3.179 | Original Article | Risk of Encountering Dorsal Scapular and Long Thoracic Nerves during Ultrasound-guided Interscalene Brachial Plexus Block with Nerve Stimulator Department of Anesthesiology and Pain Medicine, Wonkwang University College of Medicine, Wonkwang Institute of Science, Iksan, *Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, University of Seonam College of Medicine, Jeonju, Korea Yeon Dong Kim, Jae Yong Yu*, Junho Shim*, Hyun Joo Heo*, and Hyungtae Kim* Background: Recently, ultrasound has been commonly used. Ultrasound-guided interscalene brachial plexus block (IBPB) by posterior approach is more commonly used because anterior approach has been reported to have the risk of phrenic nerve injury. However, posterior approach also has the risk of causing nerve injury because there are risks of encountering dorsal scapular nerve (DSN) and long thoracic nerve (LTN). Therefore, the aim of this study was to evaluate the risk of encountering DSN and LTN during ultrasound-guided IBPB by posterior approach. Methods: A total of 70 patients who were scheduled for shoulder surgery were enrolled in this study. After deciding insertion site with ultrasound, awake ultrasound-guided IBPB with nerve stimulator by posterior approach was performed. Incidence of muscle twitches (rhomboids, levator scapulae, and serratus anterior muscles) and current intensity immediately before muscle twitches disappeared were recorded. Results: Of the total 70 cases, DSN was encountered in 44 cases (62.8%) and LTN was encountered in 15 cases (21.4%). Both nerves were encountered in 10 cases (14.3%). -
The Carpometacarpal Joint of the Thumb: MR Appearance in Asymptomatic Volunteers
Skeletal Radiol (2013) 42:1105–1112 DOI 10.1007/s00256-013-1633-4 SCIENTIFIC ARTICLE The carpometacarpal joint of the thumb: MR appearance in asymptomatic volunteers Anna Hirschmann & Reto Sutter & Andreas Schweizer & Christian W. A. Pfirrmann Received: 23 January 2013 /Revised: 1 April 2013 /Accepted: 21 April 2013 /Published online: 15 May 2013 # ISS 2013 Abstract subjects. The AOL showed a variable SI (36 %/42 % low, Purpose To prospectively characterize the MR appearance 27 %/27 % increased, 36 %/30 % striated). The IML was the of the carpometacarpal (CMC) joint of the thumb in asymp- thickest ligament with a mean of 2.9 mm/3.1 mm and the tomatic volunteers. DRL the thinnest (1.2 mm/1.4 mm). There was a mean Materials and methods Thirty-four asymptomatic volun- dorsal subluxation of 1.8 mm/2.0 mm and radial subluxation teers (17 women, 17 men, mean age, 33.9±9.2 years) of 2.8 mm/3.4 mm of the metacarpal base. The AOL was underwent MR imaging of the thumb after approval by the significantly thicker in men (1.7 mm) than in women local ethical committee. Two musculoskeletal radiologists (1.2 mm; p=0.02). Radial subluxation was significantly independently classified visibility and signal intensity (SI) larger in men (3.4 mm) than in women (2.2 mm; p=0.02). characteristics of the anterior oblique (AOL/beak ligament), No subluxation in palmar or ulnar direction was seen. the posterior oblique (POL), the intermetacarpal (IML), and Conclusions Radial and dorsal subluxation of the CMC the dorsoradial ligaments (DRL) on a three-point Likert joint can be a normal finding in a resting position at MR scale. -
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 -
Musculoskeletal Morphing from Human to Mouse
Procedia IUTAM Procedia IUTAM 00 (2011) 1–9 2011 Symposium on Human Body Dynamics Musculoskeletal Morphing from Human to Mouse Yoshihiko Nakamuraa,∗, Yosuke Ikegamia, Akihiro Yoshimatsua, Ko Ayusawaa, Hirotaka Imagawaa, and Satoshi Ootab aDepartment of Mechano-Informatics, Graduate School of Information and Science and Technology, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan bBioresource Center, Riken, 3-1-1 Takanodai, Tsukuba-shi, Ibaragi, Japan Abstract The analysis of movement provides various insights of human body such as biomechanical property of muscles, function of neural systems, physiology of sensory-motor system, skills of athletic movements, and more. Biomechan- ical modeling and robotics computation have been integrated to extend the applications of musculoskeletal analysis of human movements. The analysis would also provide valuable means for the other mammalian animals. One of current approaches of post-genomic research focuses to find connections between the phenotype and the genotype. The former means the visible morphological or behavioral expression of an animal, while the latter implies its genetic expression. Knockout mice allows to study the developmental pathway from the genetic disorders to the behavioral disorders. Would musculoskeletal analysis of mice also offer scientific means for such study? This paper reports our recent technological development to build the musculoskeletal model of a laboratory mouse. We propose mapping the musculoskeletal model of human to a laboratory mouse based on the morphological similarity between the two mammals. Although the model will need fine adjustment based on the CT data or else, we can still use the mapped musculoskeletal model as an approximate model of the mouse’s musculoskeletal system. -
Head & Neck Muscle Table
Robert Frysztak, PhD. Structure of the Human Body Loyola University Chicago Stritch School of Medicine HEAD‐NECK MUSCLE TABLE PROXIMAL ATTACHMENT DISTAL ATTACHMENT MUSCLE INNERVATION MAIN ACTIONS BLOOD SUPPLY MUSCLE GROUP (ORIGIN) (INSERTION) Anterior floor of orbit lateral to Oculomotor nerve (CN III), inferior Abducts, elevates, and laterally Inferior oblique Lateral sclera deep to lateral rectus Ophthalmic artery Extra‐ocular nasolacrimal canal division rotates eyeball Inferior aspect of eyeball, posterior to Oculomotor nerve (CN III), inferior Depresses, adducts, and laterally Inferior rectus Common tendinous ring Ophthalmic artery Extra‐ocular corneoscleral junction division rotates eyeball Lateral aspect of eyeball, posterior to Lateral rectus Common tendinous ring Abducent nerve (CN VI) Abducts eyeball Ophthalmic artery Extra‐ocular corneoscleral junction Medial aspect of eyeball, posterior to Oculomotor nerve (CN III), inferior Medial rectus Common tendinous ring Adducts eyeball Ophthalmic artery Extra‐ocular corneoscleral junction division Passes through trochlea, attaches to Body of sphenoid (above optic foramen), Abducts, depresses, and medially Superior oblique superior sclera between superior and Trochlear nerve (CN IV) Ophthalmic artery Extra‐ocular medial to origin of superior rectus rotates eyeball lateral recti Superior aspect of eyeball, posterior to Oculomotor nerve (CN III), superior Elevates, adducts, and medially Superior rectus Common tendinous ring Ophthalmic artery Extra‐ocular the corneoscleral junction division -
The Appendicular Skeleton Appendicular Skeleton
THE SKELETAL SYSTEM: THE APPENDICULAR SKELETON APPENDICULAR SKELETON The primary function is movement It includes bones of the upper and lower limbs Girdles attach the limbs to the axial skeleton SKELETON OF THE UPPER LIMB Each upper limb has 32 bones Two separate regions 1. The pectoral (shoulder) girdle (2 bones) 2. The free part (30 bones) THE PECTORAL (OR SHOULDER) GIRDLE UPPER LIMB The pectoral girdle consists of two bones, the scapula and the clavicle The free part has 30 bones 1 humerus (arm) 1 ulna (forearm) 1 radius (forearm) 8 carpals (wrist) 19 metacarpal and phalanges (hand) PECTORAL GIRDLE - CLAVICLE The clavicle is “S” shaped The medial end articulates with the manubrium of the sternum forming the sternoclavicular joint The lateral end articulates with the acromion forming the acromioclavicular joint THE CLAVICLE PECTORAL GIRDLE - CLAVICLE The clavicle is convex in shape anteriorly near the sternal junction The clavicle is concave anteriorly on its lateral edge near the acromion CLINICAL CONNECTION - FRACTURED CLAVICLE A fall on an outstretched arm (F.O.O.S.H.) injury can lead to a fractured clavicle The clavicle is weakest at the junction of the two curves Forces are generated through the upper limb to the trunk during a fall Therefore, most breaks occur approximately in the middle of the clavicle PECTORAL GIRDLE - SCAPULA Also called the shoulder blade Triangular in shape Most notable features include the spine, acromion, coracoid process and the glenoid cavity FEATURES ON THE SCAPULA Spine - -
Little Bones the Sesamoids
Erica Chu 3/7/2014 Foot . Hallucal sesamoids . Lesser metatarsal sesamoids . Interphalangeal joint sesamoid of great toe . Os peroneum . Sesamoid within tibialis anterior tendon . Sesamoid within the posterior tibialis tendon Hand . Pollicis sesamoids . Second and fifth metacarpal sesamoids . Interphalangeal joint sesamoid of thumb . Pisiform Patella Fabella Small round or ovoid bones embedded in certain tendons Usually related to joint surfaces Osseous surfaces covered by cartilage Intimate with synovial- lined cavity Resnick D, Niwayama G, Feingold ML. The sesamoid bones of the hands and feet: participators in arthritis. Radiology 1977; 123:57- 62. Two types . Type A: Sesamoid located adjacent to articulation ▪ Patella ▪ Hallucis sesamoids ▪ Pollicis sesamoids . Type B: Bursa separates sesamoid from adjacent bone Type A Type B ▪ Sesamoid of peroneus longus Resnick D, Niwayama G, Feingold ML. The tendon sesamoid bones of the hands and feet: participators in arthritis. Radiology 1977; 123:57-62. Function . Protect tendons from damage . Increase efficiency or mechanical advantage of their associated muscle ▪ Part of gliding mechanism ▪ Modify pressure ▪ Decrease friction ▪ Alter muscle pull “in proportion as the pastern is oblique or slanting, two consequences will follow, less weight will be thrown on the pastern, and more on the sesamoid…and in that proportion concussion will be prevented.” Located in tendons that wrap around bony or fibrous pulleys . Peroneus longus tendon . Posterior tibialis tendon Adaptation to help maintain tendon structure . Resists compression or shear . Fibrous tissue ▪ Flexibility ▪ Toughness . Cartilaginous tissue ▪ Elasticity Can alter tendon appearance on MR Didolkar MM, Malone AL, Nunley JA, et al. Pseudotear of the peroneus longus tendon on MRI, secondary to a fibrocartilaginous node. -
Trapezius Origin: Occipital Bone, Ligamentum Nuchae & Spinous Processes of Thoracic Vertebrae Insertion: Clavicle and Scapul
Origin: occipital bone, ligamentum nuchae & spinous processes of thoracic vertebrae Insertion: clavicle and scapula (acromion Trapezius and scapular spine) Action: elevate, retract, depress, or rotate scapula upward and/or elevate clavicle; extend neck Origin: spinous process of vertebrae C7-T1 Rhomboideus Insertion: vertebral border of scapula Minor Action: adducts & performs downward rotation of scapula Origin: spinous process of superior thoracic vertebrae Rhomboideus Insertion: vertebral border of scapula from Major spine to inferior angle Action: adducts and downward rotation of scapula Origin: transverse precesses of C1-C4 vertebrae Levator Scapulae Insertion: vertebral border of scapula near superior angle Action: elevates scapula Origin: anterior and superior margins of ribs 1-8 or 1-9 Insertion: anterior surface of vertebral Serratus Anterior border of scapula Action: protracts shoulder: rotates scapula so glenoid cavity moves upward rotation Origin: anterior surfaces and superior margins of ribs 3-5 Insertion: coracoid process of scapula Pectoralis Minor Action: depresses & protracts shoulder, rotates scapula (glenoid cavity rotates downward), elevates ribs Origin: supraspinous fossa of scapula Supraspinatus Insertion: greater tuberacle of humerus Action: abduction at the shoulder Origin: infraspinous fossa of scapula Infraspinatus Insertion: greater tubercle of humerus Action: lateral rotation at shoulder Origin: clavicle and scapula (acromion and adjacent scapular spine) Insertion: deltoid tuberosity of humerus Deltoid Action: