AFAMS

The Muscular System

عضلی سیستم

07/05/2012

EDO 001.10

AFAMS

The Muscular System

عضلی سیستم

Learning Objective: The Physical Therapy Technician will gain an understanding of the anatomy and physiology of the muscular system and its purpose within the body.

Estimated Time to Complete: 140 minutes.

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برای تعینشده زمان : لکچر این 140تکمیل

دقیقه

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Teaching Points

تدریس نکات

1. How skeletal muscle produce movement.

2. How skeletal muscle are named.

3. Principal skeletal muscles.

4. Homeostatic imbalances related to the muscular system.

5. Surface Anatomy.

6. Questions.

7. In-class assignment.

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The Muscular System Movement عضالت سیستم

• Skeletal muscle major groupings

• How movements occur at specific joints

• Learn the origin, insertion, function and innervation of major muscles

• Important to allied health care and physical rehabilitation students

اسکلیتی • عضالت بزرگ گروپهای

مخصوص • مفاصل در حرکات

. میگردد واقع چطور

و • وظایف، دخول، و ارتکاز منشآ،

را بزرگ عضالت تمام تعصیب

بیاموزید.

و • صحی های مراقبت تداوم برای

مهم محصلین فزیکی توانایی

میباشد.

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Muscle Attachment Sites: Origin and Insertion

: دخول و منشاء عضله اتصال محالت• Skeletal muscles shorten & pull on the bones they are attached to• Origin is the bone that does not move when muscle shortens

(normally proximal)• Insertion is the movable bone (some 2 joint muscles)

• Fleshy portion of the muscle in between attachment sites = belly

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کش • و کوتا باعث است وصل آنها که عظام به اسکلیتی عضله . میگردد آنها شدن

که • است عظم حقیقت در منشاء میگردد کوتاه عضله زمانیکه( قریبه ( نارمل بشکل کند نمی حرکت

مفصل ( • دو ها بعضی است حرکت قابل عظم حقیقت در دخول( است عضلی

• = بطن میباشد اتصالی ناحیه بین حقیقت در عضله فربه قسمت

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Muscles that Move the Head

باعثحرکترأسمیگردد که عضالت• Sternocleidomastoid muscle:

– arises from sternum & clavicle & inserts onto mastoid process of skull

– innervated by cranial nerve XI (spinal accessory)

– contraction of both flexes the cervical vertebrae & extends the head

– contraction of one laterally flexes the neck and rotates the face in opposite direction

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ماستوید • کلیدو سترنو یا عنق عضلهاز – و گرفته منشاء ترقوه و قص عظم از حقیقت در عضله این

. میگردد جمجمه داخل ماستوید بارزه قسمت– . ( است ( تعصیبشده فرعی نخاعی یازدهم قحفی توسطعصبرأس – بسط و رقبی قبضفقرات باعث عضله دو هر این تقبض

میگردد. به – را وجه و نموده قبض وحشی بطرف را عنق آنها از یکی تقبض و

. میدهد تدور مخالف جانب

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Surface Anatomy

• A branch of gross anatomy that examines shapes and markings on the surface of the body as they relate to deeper structures.

• Essential in locating and identifying anatomic structures prior to studying internal gross anatomy.

• Health-care personnel use surface anatomy to help diagnose medical conditions and to treat patients.

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Surface Anatomy

• four techniques when examining surface anatomy • visual inspection

– directly observe the structure and markings of surface features• palpation

– feeling with firm pressure or perceiving by the sense of touch)– precisely locate and identify anatomic features under the skin

• percussion– tap sharply on specific body sites to detect resonating vibrations

• auscultation– listen to sounds emitted from organs

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Triangles of the Neck

• Neck/cervical region/cervix is a complex region that connects the head to the trunk.

• Spinal cord, nerves, trachea, esophagus, and major vessels traverse this highly flexible area.

• Neck contains other organs and several important glands.• Neck can be subdivided into anterior, posterior, and lateral regions.

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The Anterior Region of the Neck

• Has several palpable landmarks, including the larynx, trachea, and sternal notch.

• The larynx. – found in the middle of the neck – composed of multiple cartilages – thyroid cartilage

• “Adam’s apple” • Inferior to the larynx are the cricoid cartilage and trachea. • Terminates at the sternal (jugular) notch of the manubrium and the left

and right clavicles.

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The Clavicles

• Paired clavicles and the sternal (jugular) notch represent the border between the thorax and the neck.

• On the superior anterior surface where they extend between the base of the neck on the right and left sides laterally to the shoulders.

• Left and right costal margins of the rib cage form the inferior boundary of the thorax.

• Costal angle (costal arch) is where the costal margins join to form an inverted V at the xiphoid process.

• On a thin person, many of the ribs can be seen. • Most of the ribs (with the exception of the first one) can be palpated.

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Muscles of Abdominal Wall

بطن جدار عضالت• Notice 4 layers of muscle in the abdominal wall

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جدار • در عضلی طبقه چهار شناختبطن.

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Muscles of Abdominal Wallبطن جدار عضالت

• 4 pairs of sheet like muscles– rectus abdominis = vertically oriented– external & internal obliques and

transverses abdominis• wrap around body to form

anterior body wall• form rectus sheath and linea alba

• Inguinal ligament from anterior superior iliac spine to upper surface of body of pubis

• Inguinal canal = passageway from pelvis through body wall musculature opening seen as superficial inguinal ring

• Inguinal hernia = rupture or separation of abdominal wall allowing protrusion of part of the small intestine (more common in males)

مانند 4• شیت یا ورق عضالت جوره– = عمود به تمایل ابدومین رکتوس

دارد.و – خارجی و داخلی مایل عضالت

مستعرض بطنیجدار • تا شده پیچیده بدون تدور

. بسازد را بدن قدامیرا • البا لینا و رکتوس پوشعضله

میسازد. علوی • قدامی قسمت از مغبنی اربطه

جانب به و شروع حرقفی گی برامده . میرود عانه جسم

• = حوصله از عبوری راه یک مغبنی کانالکه بوده باز عضلی جدار جسم به تا

دیده سطحی مغبنی حلقه یک بشکلمیشود.

• = جدار تجرید یا گی پاره مغبنی فتقامعأی از بخشی تا میدهد اجازه بطن

مردها ( نزد بیشتر که گردد خارج رقیقه(. است معمول

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Transverse Section of Body Wallبدن بخشیمستعرضجدار

• Rectus sheath formed from connective tissue aponeuroses of other abdominal muscles as they insert in the midline connective tissue called the linea alba

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دیگر • پوشوتری و یافته ترکیب منظم انساج از ریکتوس پوشمیگردد منظم انساج متوسط خط داخل که مجرد به بطن عضالت

. میگردد یاد البا لینا بنام

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Muscles Used in Breathingمیگردد تنفساستعمال فعل در که عضالت

• Breathing requires a change in size of the thorax

• During inspiration, thoracic cavity increases in size– external intercostal lift the ribs – diaphragm contracts & dome is

flattened • During expiration, thoracic cavity

decreases in size– internal intercostal mm used in

forced expiration• Diaphragm is innervated by phrenic

nerve (C3-C5) but intercostals innervated by thoracic spinal nerves (T2-T12)

اندازه • تا است تنفسضرور فعل هنگام در . نماید تغیر قفسصدری

اندازه • نظر از جوفصدر شقیق، زمان در. میگردد بزرگ

بلند – را اضالع الضلعی بین خارج عضلهمینماید.

گنبد – شکل و نموده تقلص عاجز حجاب . میگردد هموار آن مانند

اندازه • نظر از جوفصدر زفیر، زمان در . میگردد کوچک

زفیر – جریان در الضلعی بین داخل عضله . میگردد استعمال جبری

حجاب ( • فرینیک عصب توسط عاجز حجاببین) C3-C5حاجزی) ( اما شده تعصیب

نخاعی ( صدری اعصاب توسط -T2اضالعT12. است) شده تعصیب

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Muscles Used in Breathingتنفساستعمال فعل در که عضالت

میگردد

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SURFACE ANATOMY OF THE LUNGS

SURFACE ANATOMY OF THE LUNGS

Where to stick your stethoscope.

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Surface anatomy of the lungs

• Apices: 2.5cm above the medial 1/3rd of clavicle.

• Medial border: pass behind the sternoclavicular joint and down to the sternal angle. On left the border deviates to the left 3cm at 4th costal cartilage, then continues down to the 6th.

• The lower borders of the lung are:

– T6 - mid-clavicular line (anterior)

– T8 - mid-axillary line (Lateral)

– T10 - posteriorly

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Surface anatomy (cont)

• The lower borders of the pleura are:– T8 - mid-clavicular line

– T10 - mid-axillary line

– T12 - posteriorly

• Lung Fissures:– Oblique fissure runs from the spinal process of T3 posteriorly to the

level of T6 anteriorly;

– The transverse fissure is on the right at T4.

• Lobes: Lobes are created by the fissures.– Right lung: upper, middle and lower lobe

– Left lung: upper and lower lobe.

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Surface anatomy (cont)

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• The anterior aspect of the chest wall:

– Upper lobe – right and left.

– T4-T6 is the middle lobe – right only.

• The axilla and lateral aspect of the chest wall:

– upper, middle (right) and lower lobes.

• The posterior aspect of the chest wall:

– Lower lobes – right and left.

Surface anatomy (cont)

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Front of thorax, showing surface relations of bones, lungs (purple), pleura (blue), and heart (red outline).

Side of thorax, showing surface markings for bones, lungs (purple), pleura (blue), and spleen (green).

Surface anatomy of the lungs

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Surface anatomy of the lungs

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Thorax

• The superior portion of the trunk sandwiched between the neck superiorly and the abdomen inferiorly.

• Consists of the chest and the “upper back.” • On the anterior surface of the chest are the two dominating

surface features of the thorax.– the clavicles and the sternun

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The Sternum

• Palpated readily as the midline bony structure in the thorax.

• The manubrium, the body, and the xiphoid process may also be palpated.

• Sternal angle can be felt as an elevation between the manubrium and the body.

• Sternal angle is clinically important because it is at the level of the costal cartilage of the second rib.– it is often used as a landmark for counting the ribs

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The Abdomen

• On the anterior surface of the abdomen, the umbilicus (navel) is the prominent depression or projection in the midline of the abdominal wall.

• In the midline of the abdominal anterior surface is the linea alba, a tendinous structure that extends inferiorly from the xiphoid process to the pubic symphysis.

• The left and right rectus abdominis muscles and their tendinous insertions are referred to as “six-pack abs.”

• The superior aspect of the ilium (iliac crest) terminates anteriorly at the anterior superior iliac spine.

• Attached to the anterior superior iliac spine is the inguinal ligament, which forms the lower boundary of the abdominal wall.

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The Inguinal Ligament

• Terminates on a little anterior bump on the pubis called the pubic tubercle.

• Superior to the medial portion of the inguinal ligament is the superficial inguinal ring. – a superficial opening in the lower anterior abdominal

wall– represents a weak spot in the wall – can be palpated to detect an inguinal hernia

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Lever Systems and Leverageاهرمی برده بکار شیوه اهرمیو سیستم

• Muscle acts on rigid rod (bone)that moves around a fixed point called a fulcrum

• Resistance is weight of bodypart & perhaps an object

• Effort or load is work doneby muscle contraction

• Mechanical advantage

– the muscle whose attachment is farther from the joint will produce the most force

– the muscle attaching closer to the joint has the greater range of motion and the faster the speed it can produce

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• ( ثابت ( نکته یک بدور که مینماید عمل عظم میله یک باالی عضلهبنام و مینماید . fulcrumحرکت میگردد یاد اتکاه نقطه یا

یک • هم است ممکن و نموده مقاومت بدن وزن از بخشی مقابل در . باشد هدف

تقلصعضلی • توسط شده انجام کاری حقیقت در فشار یا کوششمیباشد.

میخانیکی • فواید

نیروی – حقیقت در شده واقع دورتر مفصل از آن اتصال که عضله . کرد خواهد تولید را بیشتری

حرکت – دامنه دارای است نزدیکتر مفصل به آن اتصال که عضله. نماید تولید را سریعتر سرعت میتواند و بزرگ

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First - Class Leverاول درجه اهرم

• Can produce mechanical advantage or not depending on location of effort & resistance

– if effort is further from fulcrum than resistance, then a strong resistance can be moved

• Head resting on vertebral column

– weight of face is the resistance

– joint between skull & atlas is fulcrum

– posterior neck muscles provide effort

تولید • را میخانکی فواید میتواندخود این که ننماید یا نماید

کوششو موقعیت به وابسته . است مقاومت

مقاومت – به کوششنظر اگرباشد، دورتر اتکاه نقطه ازمقاومت اینصورت پسدر

داده حرکت میتواند قویشود.

استاده • فقرات ستون باالی رأس . است شده

حقیقت – در وجه وزن . است مقاومت

فقره – و جمجمه بین مفصلنقطه حقیقت اطلسدر

. است اتکاه

را – کوشش عنق خلفی عضله. مینماید فراهم

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Second - Class Leverدوم درجه اهرم

• Similar to a wheelbarrow

• Always produce mechanical advantage

– resistance is always closer to fulcrum than the effort

• Sacrifice of speed for force

• Raising up on your toes

– resistance is body weight

– fulcrum is ball of foot

– effort is contraction of calf muscles which pull heel up off of floor

• . است دستی چرخ یک به مشابه

تولید • را میخانیکی فواید همیشهمینماید.

به – نزدیک هیمشه مقاومتکوشش به نظر بوده اتکاه

• . فشار برای سرعت کاری فدا

• . مینماید بلند را شما انگشتان

– . مینماید مقاومت را بدن وزن

حقیقت – در اتکاه نقطه. است پا پنجه زیر گوشت

تقلص – حقیقت کوششدرپا کری که بوده پا ساق عضله

. مینماید بلند زمین از را

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Third - Class Leverسوم درجه اهرم

• Most common levers in the body

• Always produce a mechanical disadvantage

– effort is always closer to fulcrum than resistance

• Favors speed and range of motion over force

• Flexor muscles at the elbow

– resistance is weight in hand

– fulcrum is elbow joint

– effort is contraction of biceps brachii muscle

اهرم • معمولترین از یکی

را • میخانیکی فواید همیشه . مینماید تولید

به – نظر کوششهمیشهاتکاه نقطه به مقاومت

. است نزدیک

دامنه • و سرعت طرفداری . است قوه از باالتر حرکت

آرنج • در کننده قبض عضله

وزن – حقیقت در مقاومت . است دست

حقیقت – در اتکاه نقطه . است آرنج مفصل

بای – کوششتقلصعضله. میباشد براخی سپس

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Fascicle Arrangements

• A contracting muscle shortens to about 70% of its length– muscles with longer fibers have a greater range of motion– a short fiber can contract as forcefully as a long one.

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الیافعضالتی تنظیمحدود • در عضله حقیقتطول تقلصدر کاهش% 70یک

میدهد. حرکت – دامنه حقیقت در دارد الیافطویل که عضالت

. دارند طوالنیتر–. نمایند تقلص الیافطویل مانند میتواند کوتا الیاف

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Coordination Within Muscle Groupsگروپهایعضلی بین در هماهنگی

• Most movement is the result of several muscle working at the same time

• Most muscles are arranged in opposing pairs at joints

– prime mover or agonist contracts to cause the desired action

– antagonist stretches and yields to prime mover

– synergists contract to stabilize nearby joints

– fixators stabilize the origin of the prime mover

• scapula held steady so deltoid can raise arm

چندین • کارکرد نتیجه در حرکات اکثریت . است زمان عین در عضله

بشکل • مفصل ناحیه در اکثریتعضالت . اند شده تنظیم باهمدیگر مخالف

تقلصمضطرب – یا محرک عامل . میگردد میل قابل عمل یک سبب

سبب – محصول و کششمخالف . میگردد محرک عامل

را – نزدیک مفصل تا تقلصکمکی. دهد ثبات

را – محرک منشاءعامل کننده تثبیت . میبخشد ثبات

عضله • همنواخت بشکل کتفبتواند تا نگهداشته را دلتوید

. نماید بلند را بازو

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Muscles that Move the Arm

• Deltoid arises from acromion & spine of scapula & inserts on arm

– abducts, flexes & extends arm

• Rotator cuff muscles extend from scapula posterior to shoulder joint to attach to the humerus– supraspinatus & infraspinatus : above & below spine of scapula– subscapularis on inner surface of scapula

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میدهد حرکت را بازو که عضله• . میگردد بازو داخل و منشاءگرفته کتف گی برامده و قلعه از دلتوید عضله

– . میدهد بسط قبضو تبعد، را بازو

و • یافته وسعت شانه مفصل به تا کتف خلفی قسمت از دهنده تدور عضالت . میابد اتصال عضد با

– : پاین و باال کتف برامده قسمت از انفراسپیناتوس و سوپراسپیناتوسیا – الکتفی تحت موقعیت subscapularisعضله کتف داخل سطح در

داخل.

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Shoulder and Upper Limb Region

• Clinically important because of frequent trauma to these body regions.• Vessels of the upper limb are often used as pressure sites and as sites for

drawing blood, providing nutrients and fluids, and administering medicine.

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Shoulder

• The scapula, clavicle, and proximal part of the humerus collectively form the shoulder. The acromion is the bump on your anterior shoulder.

• The rounded curve of the shoulder is formed by the thick deltoid muscle, which is a frequent site for intramuscular injections.

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Axilla

• Commonly called the armpit, is clinically important because of the nerves, axillary blood vessels, and lymph nodes located there.

• The pectoralis major forms the fleshy anterior axillary fold, which acts as the anterior border of the axilla.

• The latissimus dorsi and teres major muscles form the fleshy posterior axillary fold, which is the posterior border of the axilla.

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Flexors of the Forearm (elbow)• Cross anterior surface of elbow joint & form flexor

muscle compartment

• Biceps brachii

– scapula to radial tuberosity

– flexes shoulder and elbow & supinates hand

• Brachialis

– humerus to ulna

– flexion of elbow

• Brachioradialis

– humerus to radius

– flexes elbow

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( ) آرنج ساعد قبضکنندهقابضه • عضله جز و آرنج قدامی سطح

. مینماید عبور را ساعد

Biceps brachiiبایسپسعضدی •

گی – برامده قسمت به تا کتفکعبره

دست – و داده قبض را آرنج و شانه . میدهد وضعیت باال بطرف را

•Brachialisعضدی

زند – به تا عضد

آرنج – قبض

•Brachioradialis کعبری عضدی

کعبره – به تا عضد

آرنج – قبض

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Arm

• The brachium which extends from the shoulder to the elbow on the upper limb.

• On the anterior side of the arm, the cephalic vein is evident in muscular individuals as it traverses along the lateral border of the entire upper limb.

• This vein originates in a small surface depression, bordered by the deltoid and pectoralis major muscles, called the clavipectoral triangle.

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Arm

• The basilic vein is sometimes evident along the medial side of the upper limb.

• Brachial artery becomes subcutaneous along the medial side of the brachium, and its pulse may be detected here.

• Clinically important in measuring blood pressure.

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The Arm and Elbow

• The biceps brachii muscle becomes prominent when the elbow is flexed.

• Located on the anterior surface of the elbow region, the cubital fossa is a depression within which the median cubital vein connects the basilic and cephalic veins.

• The cubital fossa is a common site for venipuncture (removal of blood from a vein).

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The Arm and Elbow

• The bulk of the posterior surface of the brachium is formed by the triceps brachii muscle.

• Three bony prominences are readily identified in the distal region of the brachium near the elbow.

• The lateral epicondyle of the humerus is a rounded lateral projection at the distal end of the humerus.

• The olecranon of the ulna is palpated easily along the posterior aspect of the elbow.

• The medial epicondyle of the humerus is more prominent and may be easily palpated.

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Extensors of the Forearm (elbow)• Cross posterior surface of elbow joint & forms extensor muscle compartment

• Triceps brachii

– long head arises scapula

– medial & lateral heads from humerus

– inserts on ulna

– extends elbow & shoulder joints

• Anconeus

– assists triceps brachii in extending the elbow

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( ) آرنج ساعد کننده بسطجز • و آرنج مفصل خلفی سطح

عبور را ساعد باسطه عضلهمینماید.

ترایسپس • Triceps brachiiعضدی

کتف – از آن طویل شعبهمنشاءگرفته

از – آن از انسی و وحشی شعبه . منشاءمیگرد عضد

– . میگردد زند داخل

وسعت – را آرنج و شانه مفاصلمیدهد.

•Anconeus

عضله – آرنج دادن وسعت درTriceps brachii. مینماید کمک را

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Cross-Section Through Forearmساعد طریق از عرضانی شق

• If I am looking down onto this section is it from right or left arm?•. چپ یا است راست بازو از بخش این آیا کنیم نگاه پائین بطرف اگر

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طریقساعد از عرضانی شق

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Forearm

• The radius, the ulna, and the muscles that control hand movements form the forearm, or antebrachium.

• Proximal part of the forearm is bulkier, due to the fleshy bellies of the forearm muscles.

• Distally, the forearm becomes thinner as you are palpating the tendons of these muscles.

• The styloid processes of the radius and ulna are readily palpable as the lateral and medial bumps along the wrist, respectively.

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The Forearm

• Tendons of the extensor pollicis brevis, abductor pollicis longus, and extensor pollicis longus muscles mark the boundary of the triangular anatomic snuffbox.

• Palpate the pulse of the radial artery here. • Palpate the scaphoid bone in this region.

AFAMS64

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Retinaculumریتناکولم

• Tough connective tissue band that helps hold tendons in place • Extensor & Flexor retinaculum cross wrist region attaching from bone to bone

(carpal tunnel syndrome = painful compression of median nerve due to narrowing passageway under flexor retinaculum

AFAMS

Retinaculum ریتناکولم

شان • محل در را ها اربطه تا مینماید کمک ارتباطی انساج نوار نگهدارد.

یک • از و نموده عبور را دست بند ناحیه باسطه و قابضه ریتیناکولم = فشار ( تحت سندروم تونل کارپال دارد اتصال دیگر عظم به عظم

در مسیر شدن تنگ از ناشی متوسط عصب دردناک گرفتن قرار( قابضه ریتیناکولم تحت

AFAMS

Intrinsic Muscles of the Handداخلیدست عضالتحقیقی

• Origins & insertions are within the hand• Help move the digits• Thenar muscles move the thumb• Hypothenar muscles move the little finger• Opposition, flexion, extension, abduction & adduction

AFAMS

Intrinsic Muscles of the Handداخلی عضالتحقیقی

دست

• . است شده واقع دست بین در آن دخول منشاءو• . نماید حرکت انگشتان تا نموده کمک• . میگردد انگشتشصت حرکت سبب کفدست تینار عضالت. Hypothenarعضالت • میدهد حرکت را کوچک انگشت•). تقرب و تبعد بسط، تقبض، oppositionمتقابل، ، flexion ، extension ، abduction و

adduction(

AFAMS69

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Muscles Crossing the Hip Joint

• Iliopsoas flexes hip joint– arises lumbar vertebrae & ilium– inserts on lesser trochanter

• Quadriceps femoris has 4 heads– Rectus femoris crosses hip– 3 heads arise from femur– all act to extend the knee

• Adductor muscles – bring legs together– cross hip joint medially– see next picture

• Pulled groin muscle– result of quick sprint activity– stretching or tearing of iliopsoas

or adductor muscle

AFAMS

عبور فخذی حرقفی مفصل از که عضالتمینماید •Iliopsoas فخذی حرقفی قبضمفصل سبب

میگردد. –. منشاءمیگرد حرقفه و قطنی فقرات از–. میگردد ضغیر تروخانتیر داخل

رأس Quadriceps femorisعضله • چهار دارایمیباشد.

حرقفی Rectus femorisعضله – مفصل ازمینماد عبور فخذی

–. منشاءمیگرد فخذ از آن رأس سهفعالیت – زانو وسعت برای آنها تمام

مینماید. دهنده • تقرب عضله

– . میسازد یکجا باهمدیگر را پاهاعبور – را فخذی حرقفی مفصل وسطأ

مینماید. – . کنید تماشا را بعدی تصویر

مغبنی • کششعضله– . میشود باعث را سریع دویدن فعایتعضله – گی پاره یا کشش iliopsoasسبب

. میگردد دهنده تقرب یا

AFAMS13-72

Gluteal Region

• The inferior border of the gluteus maximus muscle forms the gluteal fold.

• The gluteal (natal) cleft extends vertically to separate the buttocks into two prominences.

• In the inferior portion of each buttock, an ischial tuberosity can be palpated; these tuberosities support body weight while seated.

• The gluteus maximus muscle forms most of the inferolateral “fleshy” part of the buttock.

• The gluteus medius muscle may be palpated only in the superolateral portion of each buttock.

AFAMS

Adductor Muscles of the Thigh

• Adductor group of muscle extends from pelvis to linea aspera on posterior surface of femur– pectineus– adductor longus– adductor brevis– gracilis– adductor magnus

(hip extensor)

AFAMS

ران دهنده تقرب عضلهدهند • تقرب عضالت گروپ

از فخذ خلفی سطخ درتا linea asperaحوصله

. مینماید وسعت–pectineusدهنده – longusتقربدهنده – brevisتقرب–gracilisدهنده – magnusتقرب

ران( ) دهنده بسط

AFAMS13-75

The Thigh

• Many muscular and bony features are readily identified in the thigh, which extends between the hip and the knee on each lower limb.

• An extremely important element of thigh surface anatomy is a region called the femoral triangle.

• The femoral triangle is a depression inferior to the groove that overlies the inguinal ligament on the anteromedial surface in the superior portion of the thigh.

• The femoral artery, vein, and nerve travel through this region, making it an important arterial pressure point for controlling lower limb hemorrhage.

AFAMS13-76

Thigh and Knee

• On the distal part of the anterior thigh, are the three parts of the quadriceps femoris as they approach the knee.

• Still on the anterior side of the thigh, three obvious skeletal features can be observed and palpated: – (1) The greater trochanter is palpated on the superior lateral

surface of the thigh; – (2) the patella is located easily within the patellar tendon; and – (3) the lateral and medial condyles of both the femur and tibia are

identified and palpated at each knee.

AFAMS77

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Muscles of the Calf (posterior leg)

• 3 muscles insert onto calcaneus– gastrocnemius arises femur

• flexes knee and ankle– plantaris & soleus arise from leg

• flexes ankle• Deeper muscles arise from tibia or

fibula– cross ankle joint to insert into

foot • tibialis posterior• flexor digitorum longus• flexor hallucis longus

– flexing ankle joint & toes

AFAMS

( خلفی ( پای پا عضالتساقکالکانوسداخل • به عضله سه

میگردد.–gastrocnemius منشاء فخذ از

است گرفتهقبض • را القدم عنق و زانو

میدهد. –plantaris وsoleus پا از

منشاءمیگیرد.القدم • قبضعنق

شزیه • و قصبه از عمیقتر عضالتمنشاءمیگرد.

عبور – را القدم عنق مفصل . میگردد پا داخل و نموده

خلفی • قصبهقابضله ••flexor hallucis longus

را – انگشتان و القدم عنق مفصل . مینماید قبض

AFAMS

Muscles of the Leg and Foot

• Anterior compartment of leg– extensors of ankle & toes

• tibialis anterior• extensor digitorum longus• extensor hallucis longus

– tendons pass under retinaculum• Shin splits syndrome

– pain or soreness on anterior tibia– running on hard surfaces

• Lateral compartment of leg– peroneus muscles plantarflex the

foot– tendons pass posteriorly to axis of

ankle joint and into plantar foot

AFAMS

قدم و پا عضالتپا • بخشقدامی

و – القدم عنق دهنده بسطانگشتان

قصبه • قدامیدهنده • digitorum longusبسطدهنده • hallucis longusبسط

عبور – ریتیناکولم تحت از که اربطهمینماید.

Shinsplitsسندروم •قدامی – قسمت در ناراحتی یا درد

قصبهسخت – بسیار سطح باالی دویدن

پا • بخشوحشیکف peroneusعضله – قبضکننده

پامفصل – محور خلفأ که های اربطه

به و نموده عبور را القدم عنق . میرسد پا کف

AFAMS82

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Muscles of the Plantar Foot

• Intrinsic muscles– arise & insert in foot

• 4 layers of muscles– get shorter as go into

deeper layers• Flex, adduct & abduct toes• Digiti minimi muscles

move little toe• Hallucis muscles move

big toe• Plantar fasciitis (painful

heel syndrome) chronic irritation of plantar aponeurosis at calcaneus– improper shoes &

weight gain

AFAMS

پالنتر یا پا عضالتکفحقیقی • عضالت

– . است قدم آن دخول منشاءو• . دارد طبقه چهار عضالت

عمیق – طبقه به که اندازه هر به . میگردد تر کوتاه عضله فرومیرود

• . میدهد تبعد و تقرب قبض، را انگشتانکوچک Digiti minimiعضالت • انگشت

. میدهد حرکت رارا Hallucisعضالت • پا بزرگ انگشت

. میدهد حرکتدردناک ( • سندروم پا کف سفاق التهاب

( پوششوتری تخریشمزمن پا کری. کالکانوس ناحیه

وزن – گرفتن و نامناسب های بوت

AFAMS13-87

Foot and Toes

• The phalanges, metatarsophalangeal joints, PIP and DIP joints, and toenails are obvious surface landmarks readily observed when viewing either the lateral side or the dorsum of the foot.

• The medial surface of the foot clearly illustrates the high, arched medial longitudinal arch.

• At the distal end of the medial longitudinal arch, the head of metatarsal I appears as a prominent bump.

AFAMS88

AFAMS89

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Homeostatic Imbalances Related to Muscle System

• Muscular Dystrophy• Rhabdomyolysis• Compartment

Syndrome

AFAMS

Muscular Dystrophy

• Group of muscle diseases (Duchenne, Becker, limb-girdle, oculopharyngeal are among the major types)

• Genetically inherited• progressive skeletal muscle weakness, defects in muscle proteins, and

the death of muscle cells and tissue• Most often effects males, but females can be carriers• No cure, but physiotherapy, low intensity exercise, steroids, prednisone

can help manage disease• Morbidity and mortality vary greatly with type and severity of disease

AFAMS

Rhabdomyolysis

• associated with rapid skeletal muscle destruction• muscle breaks down into myoglobin released in the urine • may lead to kidney failure as high concentrations of myoglobin is harmful to the

kidneys • symptoms include muscle weakness, stiffness, and pain• treatment includes early use of intravenous fluid, dialysis as well as

hemofiltration in severe cases

AFAMS

Compartment Syndrome

• Is a limb-threatening condition which occurs after an injury, when there is insufficient blood to supply the muscles and nerves because of the raised pressure (due to swelling) within the compartment such as the arm, leg or any enclosed space (muscle covered in fascia does not allow for much swelling)

• 6 P’s :– Pain (seemingly out of proportion for nature of injury)– Parasthesia– Pallor– Paralysis– Pulselessness (very late, not often found)– Pressure

• Treatment, if pressure sufficiently high, is fasciotomy

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Questions? (Insert Dari)

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In-class assignment(insert dari)

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1. Identify the following muscles:(Insert Dari)

8. 9.

10.

11.

12.

1.

2.

3.

4.

5.

6.

7.

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1. Insert Dari

2. Insert Dari

3. Insert Dari

4. Insert Dari

5. Insert Dari

6. Insert Dari

7. Insert Dari

12. Insert Dari

11.Insert Dari

10. Insert Dari

9. Insert Dari

8. Insert Dari

1. Answer

AFAMS98

2.Identify the following muscles:(Insert Dari)

AFAMS99

2.Identify the following muscles:(Insert Dari)

AFAMS100

3.Identify the following muscles:(Insert Dari)

2

1

5

4

3

7

6

AFAMS101

3.Identify the following muscles:(Insert Dari)

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4. Which of the following means rapid muscle destruction?(Insert Dari)

A) AtrophyB) HypertrophyC) Rhabdomylosis

(Insert Dari)

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4. Which of the following means rapid muscle destruction?(Insert Dari)

A) AtrophyB) HypertrophyC) Rhabdomylosis

(Insert Dari)

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5.Identify the types of levers in the diagrams below:Dari

AFAMS

5.Identify the types of levers in the diagrams below:Dari