Anatomy of the Musculoskeletal System · 3 Anatomy of the Musculoskeletal System October 13, 2018 Coding Fiesta 2018 Kyle E. Rarey, PhD Professor & Director of Center for Anatomical

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Anatomy of the Musculoskeletal System

Kyle E. Rarey, Ph.D.

Professor & Director of Center for Anatomical Sciences Education

Department of Anatomy & Cell Biology and Otolaryngology

University of Florida College of Medicine

Outline of Presentation

• Vertebral Column

• Upper Extremities

• Lower Extremities

Anatomy of the Musculoskeletal System October 13, 2018

Coding Fiesta 2018 Kyle E. Rarey, PhD Professor & Director of Center for Anatomical Sciences Education

UF Department of Anatomy & Cell Biology and Otolaryngology

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I. Vertebral Column




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Lumbar vertebrae(Isolated and articulated)

Intervertebral Disc

Lumbar Disc Herniation: Usually 2° protruding nucleuspulposus lateral to posterior longitudinal ligament resulting in compression of the spinal roots as they fuse to form the spinalnerve.

Herniatednucleuspulposus

Spinal nerve rootsCauda equina

Annulus fibrosus




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Scoliosis Kyphosis

Spinal Alignment Abnormalities

Scoliosis before and after correction




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Abnormal development of vertebrae

Effects of osteoporosis on the vertebral column

Dislocation of cervical vertebrae

Lumbar spinal stenosis

Herniation of nucleus pulposus

Disc degeneration treated by graft and spinal fusion. Lateral views




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Lumbar puncture




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Herniation of nucleus pulposus

Disc degeneration treated by graft and spinal fusion. Lateral views




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Hangman’s fracture

II. Upper Extremities




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Clinical Significance

• Nearly 20 million people are affected by an upper extremity injury or disorder every year in the United States.

• Over 70 million adults currently suffer from arthritis or some other debilitating chronic joint disorder ‐ most commonly involving the arms, hands or fingers

• Over 25% of all work related injuries involve the upper extremity and nearly

• 70% of all upper extremity injuries occur to individuals in their working years.

• Nearly 35% of all acute injuries seen in the emergency rooms involve the upper extremity.

• Repetitive stress injuries (RSI's) are on the rise and affect about 12 million people each year.

• Carpal tunnel syndrome (CTS) accounts for the large majority of these reported RSI's. About 50% of all work‐related injuries are CTS. They have become the leading cause of lost workdays and are costing industry in the United States over $100B per year

http://www.wristiciser.com/downloads/WPROplussystem.pdf

Muscles of Upper Extremities




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Vasculature of Upper Extremities

Major arteries of the arm, forearm, and hand

Subclavian

Brachial

Anterior humeral circumflex

Posterior humeral circumflex

Thoracodorsal

Subscapular

1st Part of Axillary

Circumflex scapular

Long thoracic

2nd Part of Axillary

Superior thoracic

Lateral thoracic

Thoracoacromial

3rd Part of Axillary




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Venous System Overview

In both the upper and lowerextremities, there are two sets of veins which create a deep and superficialsystem.

The deep system of veins parallels the arterial system; therefore, the veins of the deep system are named similarly to the arteries.

Major arteries of the arm, forearm, and hand




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Joints of Upper Extremities

Shoulder Joint ‐ AcromioclavicularGlenohumeral joint




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http://www.cksn.ca/files/2014/03/Separated-Shoulder.jpg

Shoulder separation

http://www.sportsortho.co.uk/data/images/Grade%20III_1_1.jpg

(c) Frontal section

Frontal plane

Acromion of scapula

SUBACROMIAL BURSA

ARTICULAR CAPSULE

Head of humerus

Tendon sheath

Tendon of biceps brachii muscle (long head)

Acromioclavicular ligament

Clavicle

Tendon of supraspinatus muscle

GLENOID LABRUM

Scapula

GLENOID CAVITY

Articular cartilage

GLENOID LABRUM

ARTICULAR CAPSULE:

Synovial membrane

Fibrous membrane

Humerus

Right Glenohumeral Joint: Frontal Section

Rotator Cuff

Supraspinatus, infraspinatus and teres minor:along with the subscapularis form the rotatorcuff (scapulohumeral muscles forming a circumferential muscular sling about theglenohumeral joint)




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(b) Lateral view (opened)POSTERIOR

Tendon of teres minor muscle

Tendon of infraspinatus muscle

ANTERIOR

Tendon of subscapularis muscle

Tendon of supraspinatus muscle

SUPERIOR

View

http://exercisesforrotatorcuff.net/wp‐content/uploads/2009/10/Rotator‐Cuff‐Tears‐1.jpg

http://warnockmd.com/wp‐content/uploads/2013/07/rotator‐cuff‐injury‐culprits.jpg

http://www.aaos.org/news/aaosnow/may09/clinical12‐1.gif

https://stemcelldoc.files.wordpress.com/2009/01/shoulder_mri_cuff‐i.jpg?w=255&h=202

http://healthfavo.com/wp-content/uploads/2013/07/anterior-dislocated-shoulder-on-healthfavo.jpg

Shoulder dislocation




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Fracture of olecranon of ulna

http://www.nlm.nih.gov/medlineplus/ency/images/ency/fullsize/17259.jpg

http://images.radiopaedia.org/images/935521/8d33d61a95c5d64d2d318f3534b536.jpg

http://www.wheelessonline.com/image4/i1/raddh1.jpg

http://2.bp.blogspot.com/‐cmF0cO7fFHA/ThySRQfsd3I/AAAAAAAAACc/x47rHWd8Gio/s1600/elbow_fracture_1.jpg

http://po.simplifypr.com/wp‐content/uploads/2013/02/broken‐bones‐3.jpg

http://www.healthhype.com/wp‐content/uploads/Humerusfraktur_nach_OP.jpg




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http://accesspediatrics.mhmedical.com/data/Books/shah2/shah2_c019f026.png

http://medacad.wikispaces.com/file/view/Colles'_Fracture.jpg/190025382/560x352/Colles'_Fracture.jpg

http://img.medscape.com/pi/emed/ckb/radiology/336139‐398406‐7418.jpg

Dinner fork fracture of distal radius

UpperTrunk

Musculocutaneous

Axillary

Upper subscapular

Lateral cord

Lateral pectoral

Middle Trunk

Medial pectoral

Radial

Suprascapular

N. To Subclavius

Dorsal scapular

Long thoracic

Ulnar

Lower subscapular

LowerTrunk

ThoracodorsalPosterior cord

Medial cord

Median

C5

C6

C7

C8

T1Brachial plexus

Nerves of the Upper Extremities




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Injury to brachial plexus

C5

C6C7C8T1

Musculocutaneous nerve –

dominant nerve to anterior

compartment elbow flexors

Median nerve –

dominant nerve to anteriorcompartment muscles of forearm (wrist flexors) and thenar hand muscles

Radial nerve –dominant nerve to

posterior compartmentsof both arm and

forearm

Ulnar nerve – dominant nerve to muscles of the hand; innervates one and part of another

forearm flexor muscles

Upper Extremity NervesNerves to shoulder muscles: e.g., Axillary nerve, suprscapular, dorsal scapular, medial pectoral, lateral pectoral, long thoracic, upper and lower supsacuplaris, thoracodorasal, (Spinal accessory)

Winging of the scapula




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Carpal tunnel syndrome

Nerves

Musculocutaneous nerveAxillary nerve (fx of surgical neck)Radial nerve (fx of mid‐shaft)Median nerveUlnar nerve (fx of medial epicondyle)

Cutaneous nerves

Tommy John Procedure

Dislocated elbowDislocated or proximal radio‐ulnar joint




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Fracture of scaphoid

Mallet finger

III. Lower Extremities




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Intraosseous infusion(method of delivering hydration blood, and medications directly into medullary cavity of a bone when peripheral venous access is difficult or impossible)

Major arteries of the thigh, leg, and foot




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Pulse for posterior tibial artery Pulse for posterior dorsalis pedis artery




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Gluteal region: position of sciatic nerve

Trendelenburg sign/gait

Blood supply to head and neck of femur




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Hip replacement

Hip with moderate arthritis

Hip dislocation




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Medial and lateral menisci

Anterior and posterior cruciate ligaments

Anterior cruciate

Posterior cruciate

http://www.islandorthotics.org/img/services/pcl_injury_visual.jpg




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Sagittal MRI of knee showing tear of posterior horn of medial meniscus

Sagittal MRI of knee showing a tear of the ACL

Knee replacement




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Hyperextension

Knee Dislocation

RVG




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Fractures of the lateral and medial malleoli

Ankle joint demonstrated radiographically




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https://orthoinfo.aaos.org/en/diseases‐‐conditions/tibia‐shinbone‐shaft‐fractures




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Anatomy of the Musculoskeletal System · 3 Anatomy of the Musculoskeletal System October 13, 2018 Coding Fiesta 2018 Kyle E. Rarey, PhD Professor & Director of Center for Anatomical