Axial Skeleton: Muscle and Joint Interactions
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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. -
Vertebral Column and Thorax
Introduction to Human Osteology Chapter 4: Vertebral Column and Thorax Roberta Hall Kenneth Beals Holm Neumann Georg Neumann Gwyn Madden Revised in 1978, 1984, and 2008 The Vertebral Column and Thorax Sternum Manubrium – bone that is trapezoidal in shape, makes up the superior aspect of the sternum. Jugular notch – concave notches on either side of the superior aspect of the manubrium, for articulation with the clavicles. Corpus or body – flat, rectangular bone making up the major portion of the sternum. The lateral aspects contain the notches for the true ribs, called the costal notches. Xiphoid process – variably shaped bone found at the inferior aspect of the corpus. Process may fuse late in life to the corpus. Clavicle Sternal end – rounded end, articulates with manubrium. Acromial end – flat end, articulates with scapula. Conoid tuberosity – muscle attachment located on the inferior aspect of the shaft, pointing posteriorly. Ribs Scapulae Head Ventral surface Neck Dorsal surface Tubercle Spine Shaft Coracoid process Costal groove Acromion Glenoid fossa Axillary margin Medial angle Vertebral margin Manubrium. Left anterior aspect, right posterior aspect. Sternum and Xyphoid Process. Left anterior aspect, right posterior aspect. Clavicle. Left side. Top superior and bottom inferior. First Rib. Left superior and right inferior. Second Rib. Left inferior and right superior. Typical Rib. Left inferior and right superior. Eleventh Rib. Left posterior view and left superior view. Twelfth Rib. Top shows anterior view and bottom shows posterior view. Scapula. Left side. Top anterior and bottom posterior. Scapula. Top lateral and bottom superior. Clavicle Sternum Scapula Ribs Vertebrae Body - Development of the vertebrae can be used in aging of individuals. -
Synovial Joints Permit Movements of the Skeleton
8 Joints Lecture Presentation by Lori Garrett © 2018 Pearson Education, Inc. Section 1: Joint Structure and Movement Learning Outcomes 8.1 Contrast the major categories of joints, and explain the relationship between structure and function for each category. 8.2 Describe the basic structure of a synovial joint, and describe common accessory structures and their functions. 8.3 Describe how the anatomical and functional properties of synovial joints permit movements of the skeleton. © 2018 Pearson Education, Inc. Section 1: Joint Structure and Movement Learning Outcomes (continued) 8.4 Describe flexion/extension, abduction/ adduction, and circumduction movements of the skeleton. 8.5 Describe rotational and special movements of the skeleton. © 2018 Pearson Education, Inc. Module 8.1: Joints are classified according to structure and movement Joints, or articulations . Locations where two or more bones meet . Only points at which movements of bones can occur • Joints allow mobility while preserving bone strength • Amount of movement allowed is determined by anatomical structure . Categorized • Functionally by amount of motion allowed, or range of motion (ROM) • Structurally by anatomical organization © 2018 Pearson Education, Inc. Module 8.1: Joint classification Functional classification of joints . Synarthrosis (syn-, together + arthrosis, joint) • No movement allowed • Extremely strong . Amphiarthrosis (amphi-, on both sides) • Little movement allowed (more than synarthrosis) • Much stronger than diarthrosis • Articulating bones connected by collagen fibers or cartilage . Diarthrosis (dia-, through) • Freely movable © 2018 Pearson Education, Inc. Module 8.1: Joint classification Structural classification of joints . Fibrous • Suture (sutura, a sewing together) – Synarthrotic joint connected by dense fibrous connective tissue – Located between bones of the skull • Gomphosis (gomphos, bolt) – Synarthrotic joint binding teeth to bony sockets in maxillae and mandible © 2018 Pearson Education, Inc. -
Thoracic and Lumbar Spine Anatomy
ThoracicThoracic andand LumbarLumbar SpineSpine AnatomyAnatomy www.fisiokinesiterapia.biz ThoracicThoracic VertebraeVertebrae Bodies Pedicles Laminae Spinous Processes Transverse Processes Inferior & Superior Facets Distinguishing Feature – Costal Fovea T1 T2-T8 T9-12 ThoracicThoracic VertebraeVertebrae andand RibRib JunctionJunction FunctionsFunctions ofof ThoracicThoracic SpineSpine – Costovertebral Joint – Costotransverse Joint MotionsMotions – All available – Flexion and extension limited – T7-T12 LumbarLumbar SpineSpine BodiesBodies PediclesPedicles LaminaeLaminae TransverseTransverse ProcessProcess SpinousSpinous ProcessProcess ArticularArticular FacetsFacets LumbarLumbar SpineSpine ThoracolumbarThoracolumbar FasciaFascia LumbarLumbar SpineSpine IliolumbarIliolumbar LigamentsLigaments FunctionsFunctions ofof LumbarLumbar SpineSpine – Resistance of anterior translation – Resisting Rotation – Weight Support – Motion IntervertebralIntervertebral DisksDisks RatioRatio betweenbetween diskdisk thicknessthickness andand vertebralvertebral bodybody heightheight DiskDisk CompositionComposition – Nucleus pulposis – Annulus Fibrosis SpinalSpinal LigamentsLigaments AnteriorAnterior LongitudinalLongitudinal PosteriorPosterior LongitudinalLongitudinal LigamentumLigamentum FlavumFlavum InterspinousInterspinous LigamentsLigaments SupraspinousSupraspinous LigamentsLigaments IntertransverseIntertransverse LigamentsLigaments SpinalSpinal CurvesCurves PosteriorPosterior ViewView SagittalSagittal ViewView – Primary – Secondary -
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. -
The Erector Spinae Plane Block a Novel Analgesic Technique in Thoracic Neuropathic Pain
CHRONIC AND INTERVENTIONAL PAIN BRIEF TECHNICAL REPORT The Erector Spinae Plane Block A Novel Analgesic Technique in Thoracic Neuropathic Pain Mauricio Forero, MD, FIPP,*Sanjib D. Adhikary, MD,† Hector Lopez, MD,‡ Calvin Tsui, BMSc,§ and Ki Jinn Chin, MBBS (Hons), MMed, FRCPC|| Case 1 Abstract: Thoracic neuropathic pain is a debilitating condition that is often poorly responsive to oral and topical pharmacotherapy. The benefit A 67-year-old man, weight 116 kg and height 188 cm [body of interventional nerve block procedures is unclear due to a paucity of ev- mass index (BMI), 32.8 kg/m2] with a history of heavy smoking idence and the invasiveness of the described techniques. In this report, we and paroxysmal supraventricular tachycardia controlled on ateno- describe a novel interfascial plane block, the erector spinae plane (ESP) lol, was referred to the chronic pain clinic with a 4-month history block, and its successful application in 2 cases of severe neuropathic pain of severe left-sided chest pain. A magnetic resonance imaging (the first resulting from metastatic disease of the ribs, and the second from scan of his thorax at initial presentation had been reported as nor- malunion of multiple rib fractures). In both cases, the ESP block also pro- mal, and the working diagnosis at the time of referral was post- duced an extensive multidermatomal sensory block. Anatomical and radio- herpetic neuralgia. He reported constant burning and stabbing logical investigation in fresh cadavers indicates that its likely site of action neuropathic pain of 10/10 severity on the numerical rating score is at the dorsal and ventral rami of the thoracic spinal nerves. -
Muscles of the Thorax, Back & Abdomen
MUSCLES OF THE THORAX, BACK & ABDOMEN Muscles of the Thorax Thoracic Muscles Origin Insertion Action Innervation M. pectoralis clavicula pars clavicularis major (medial ½ ) manubrium sterni et adduction, internal M. pectoralis pars crista tuberculi cartilagines costae rotation, arm flexion; major sternocostalis majoris (2nd-7th) auxiliary inspiratory m. M. pectoralis vagina musculi recti pars abdominalis major abdominis Plexus brachialis processus pulls the clavicle; M. pectoralis minor 3rd - 5th rib coracoideus auxiliary inspiration m scapulae pulls clavicule → clavicula indirectly the shoulder M. subclavius first rib (inferior surface) distoventrally; auxiliary inspiration m. pulls the clavicle from scapula the backbone; pulls M. serratus anterior cranial 9 ribs (margo medialis et inferior angle laterally → angulus inferior) rotates scapula; auxiliary respirat. m. Thoracic Muscles Origin Insertion Action Innervation inferior margin of ribs - superior margin of elevation of lower ribs, from the costal tubercle Mm. intercostales externi ribs immediately thorax expansion → to the beginning of rib below inspiratory m. cartilage inferior margin of adduction of cranial superior margin of ribs - Nn. Mm. intercostales interni ribs immediately ribs to caudal ribs → intercostales costal angle to sternum above expiratory m. internal surface of cartilagines costae M. transversus thoracis xiphoid process and expiratory muscle verae body of sternum inner surface of xiphoid Diaphragma sternal part process inner surface of Diaphragma costal part cartilage of ribs 7-12 main inspiratory Plexus central tendon muscle; abdominal ligamentum cervicalis lumbar part, press Diaphragma longitudinale anterius medial crus (vertebrae lumbales) ligaments jump over the lumbar part, Diaphragma psoas and quadratus lateral crus muscles Muscles of the Back Superficial muscles . functionally belong to the upper limb Intermediate muscles . -
Skeletal System? Skeletal System Chapters 6 & 7 Skeletal System = Bones, Joints, Cartilages, Ligaments
Warm-Up Activity • Fill in the names of the bones in the skeleton diagram. Warm-Up 1. What are the 4 types of bones? Give an example of each. 2. Give 3 ways you can tell a female skeleton from a male skeleton. 3. What hormones are involved in the skeletal system? Skeletal System Chapters 6 & 7 Skeletal System = bones, joints, cartilages, ligaments • Axial skeleton: long axis (skull, vertebral column, rib cage) • Appendicular skeleton: limbs and girdles Appendicular Axial Skeleton Skeleton • Cranium (skull) • Clavicle (collarbone) • Mandible (jaw) • Scapula (shoulder blade) • Vertebral column (spine) • Coxal (pelvic girdle) ▫ Cervical vertebrae • Humerus (arm) ▫ Thoracic vertebrae • Radius, ulna (forearm) ▫ Lumbar vertebrae • Carpals (wrist) • Metacarpals (hand) ▫ Sacrum • Phalanges (fingers, toes) ▫ Coccyx • Femur (thigh) • Sternum (breastbone) • Tibia, fibula (leg) • Ribs • Tarsal, metatarsals (foot) • Calcaneus (heel) • Patella (knee) Functions of the Bones • Support body and cradle soft organs • Protect vital organs • Movement: muscles move bones • Storage of minerals (calcium, phosphorus) & growth factors • Blood cell formation in bone marrow • Triglyceride (fat) storage Classification of Bones 1. Long bones ▫ Longer than they are wide (eg. femur, metacarpels) 2. Short bones ▫ Cube-shaped bones (eg. wrist and ankle) ▫ Sesamoid bones (within tendons – eg. patella) 3. Flat bones ▫ Thin, flat, slightly curved (eg. sternum, skull) 4. Irregular bones ▫ Complicated shapes (eg. vertebrae, hips) Figure 6.2 • Adult = 206 bones • Types of bone -
Digital Motion X-Ray Cervical Spine
NAME OF PATIENT: CASE STUDY 4 DATE OF REPORT: DATE OF EXAMINATION: REFERRING PHYSICIAN: TESTING FACILITY: Digital Motion X-ray Cervical Spine 1. In the neutral lateral projection: Shows reversal of the cervical lordosis. The integrity of the cervical lordosis and overall condition of the cervical spine is evaluated. The loss of the cervical lordosis may be a result of damage to the posterior longitudinal, capsular or interspinous ligaments. Neutral lateral projection 2. Motion in the neutral lateral projection to full flexion: Is restricted. There is a tilting of C1 laterally. There is an anterolisthesis of C2 on C3. There is increased separation between the spinous processes at C2-C3. This view examines the integrity of the posterior longitudinal ligament demonstrated by a forward (anterior) movement of one vertebrae over the vertebrae below or by the posterior widening of the intervertebral disc space (increased disc angle). Widening of posterior disc space Anterolisthesis The integrity of the interspinous ligament is evaluated in the lateral flexion view. Damage to this ligament results in increased separation of the spinous processes in flexion. Damaged Interspinous Ligament Full flexion projection 3. Motion in the neutral lateral projection to full extension: Is restricted. There is a retrolisthesis of C4 on C5. This view examines the integrity of the anterior longitudinal ligament demonstrated by a backward (posterior) movement of one vertebrae over the vertebrae below or by the anterior widening of the intervertebral disc space (increased disc angle). Retrolisthesis Widening of the anterior disc Full Extension 4. Motion in the oblique flexion projection: Is restricted. There is gapping of the facet joints at C6-C7 bilaterally and C7-T1 bilaterally. -
Active Release Techniques Spine Level 2
Active Release Techniques Spine Level 2 Dates of program- Montvale, NJ February 18-21, 2021 Colorado Springs, CO March 4-7, 2021 Orlando, FL June 10-13, 2021 Chicago, IL September 30 – October 3, 2021 Total Hours: 24 Summary: Active Release Techniques® Spine Level 2 offers intense training in 75 manual treatment protocols of the cervical, thoracic, and lumbar spine. ART® treatment utilizes manual techniques to move tissues and joints while under tension. The system allows for relative motion between the tissues and articulations. This seminar emphasizes the manipulation of the neuromusculoskeletal system to diagnose and correct alterations in tissue texture, tension, movement, and function between tissues. Evaluation and treatment occur simultaneously. Learning Outcomes: 1. By the end of the seminar, learners will be able to correctly identify (palpate) 75 facial seams of soft-tissue structures within the spine. 2. By the end of the seminars, learners will be able to correctly state the muscle actions of two adjacent spinal muscles. 3. By the end of the seminar, learners will be able to effectively recognize common symptom patterns of spinal neuromuscular injuries and disorders. 4. By the end of the seminar, learners will correctly identify the structure treated and associated concentric and eccentric muscle actions via video presentations. 5. By the end of the seminar, the learner will correctly move the muscle from its shortened position to elongated position using two-hand placement techniques. 6. By the end of the seminar, the learner can successfully differentiate between healthy and unhealthy tissue utilizing hands-on palpation techniques. 7. By the end of the seminar, the learner will proficiently palpate 75 anatomical soft-tissue structures within the spine, using an appropriate tension, depth, and motion to properly perform the treatment protocol. -
Functional Morphology of the Vertebral Column in Remingtonocetus (Mammalia, Cetacea) and the Evolution of Aquatic Locomotion in Early Archaeocetes
Functional Morphology of the Vertebral Column in Remingtonocetus (Mammalia, Cetacea) and the Evolution of Aquatic Locomotion in Early Archaeocetes by Ryan Matthew Bebej A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy (Ecology and Evolutionary Biology) in The University of Michigan 2011 Doctoral Committee: Professor Philip D. Gingerich, Co-Chair Professor Philip Myers, Co-Chair Professor Daniel C. Fisher Professor Paul W. Webb © Ryan Matthew Bebej 2011 To my wonderful wife Melissa, for her infinite love and support ii Acknowledgments First, I would like to thank each of my committee members. I will be forever grateful to my primary mentor, Philip D. Gingerich, for providing me the opportunity of a lifetime, studying the very organisms that sparked my interest in evolution and paleontology in the first place. His encouragement, patience, instruction, and advice have been instrumental in my development as a scholar, and his dedication to his craft has instilled in me the importance of doing careful and solid research. I am extremely grateful to Philip Myers, who graciously consented to be my co-advisor and co-chair early in my career and guided me through some of the most stressful aspects of life as a Ph.D. student (e.g., preliminary examinations). I also thank Paul W. Webb, for his novel thoughts about living in and moving through water, and Daniel C. Fisher, for his insights into functional morphology, 3D modeling, and mammalian paleobiology. My research was almost entirely predicated on cetacean fossils collected through a collaboration of the University of Michigan and the Geological Survey of Pakistan before my arrival in Ann Arbor. -
Respiratory Function of the Rib Cage Muscles
Copyright @ERS Journals Ltd 1993 Eur Respir J, 1993, 6, 722-728 European Respiratory Journal Printed In UK • all rights reserved ISSN 0903 • 1936 REVIEW Respiratory function of the rib cage muscles J.N. Han, G. Gayan-Ramirez, A. Dekhuijzen, M. Decramer Respiratory function of the rib cage muscles. J.N. Han, G. Gayan-Ramirez, R. Respiratory Muscle Research Unit, Labo Dekhuijzen, M. Decramer. ©ERS Journals Ltd 1993. ratory of Pneumology, Respiratory ABSTRACT: Elevation of the ribs and expansion of the rib cage result from the Division, Katholieke Universiteit Leuven, co-ordinated action of the rib cage muscles. We wished to review the action and Belgium. interaction of the rib cage muscles during ventilation. Correspondence: M. Decramer The parasternal intercostal muscles appear to play a predominant role during Respiratory Division quiet breathing, both in humans and in anaesthetized dogs. In humans, the para University Hospital sternal intercostals act in concert with the scalene muscles to expand the upper rib Weligerveld 1 cage, and/or to prevent it from being drawn inward by the action of the diaphragm. B-3212 Pellenberg The external intercostal muscles are considered to be active mainly during inspira Leuven tion, and the internal intercostal muscles during expiration. Belgium The respiratory activity of the external intercostals is minimal during quiet breathing both in man and in dogs, but increases with increasing ventilation. In Keywords: Chest wall mechanics contractile properties spiratory activity in the external intercostals can be enhanced in anaesthetized ani rib cage muscles mals and humans by inspiratory mechanical loading and by col stimulation, rib displacement suggesting that the external intercostals may constitute a reserve system, that may be recruited when the desired expansion of the rib cage is increased.