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Superficial Back

Gluteus medius/maximus, passage of nerves sacral plexus,

compartment system

Muscles promoting action of the hip

The shoulder

The wrist/ hand

STRUCTURE OF THE BACK

Vertebrae

The vertebral column consists of 33 bones:

7 cervical
12 throacic
5 lumbar
5 sacral (fused)
4 coccygeal (fused)

STRUCTURE OF THE VERTEBRAL BODY

KEY CHANGES IN VERTEBRAL ANATOMY

Cervical

Thoracic

Lumbar

Vertebral body

Small and wide

Heart-shaped

Massive; kidneyshaped

Vertebral
foramen

Large and triangular

Smaller and
circular

Transverse
Process

Foramina transversarii, Long and strong,

contain vertebral
extned
arteries, venous and
posterolaterally
sympathetic plexus
(C1-C6), C7 transmits
small accessory veins

Articular
Processes

Spinous
processes

Nearly vertical
articular facets

Short (C3-5)
Bifid (C3-6)
Long (C7) vertebra

Long, slope
postero-laterally

Thick and sturdy,

hatchet shaped

EXAMPLE Q- WHICH LEVEL VERTEBRAE?

ATLAS AND AXIS BONES OF THE NECK

VERTEBRAL SURFACE ANATOMY

C7 vertebral spine is the most prominent on flexion of the

neck

Ala of the iliac crest is located at L3

MAJOR LIGAMENTS OF THE SPINAL

COLUMN
Name the joints:
Anulus fibrosis
Zygapophyseal joint
Ligamentum flavum
Posterior longitudinal ligament
Anterior longitudinal ligament

MUSCLES OF THE BACK

Extrinsic Muscles:

Trapezius

Latissimus dorsi

Levator scapulae

Rhomboids

Receive input from the anterior rami of the cervical nerves

Intrinsic Muscles:

Enclosed by deep fascia

Superficial, intermediate and deep layers

EXTRINSIC MUSCLES OF THE BACK

What are they?

Individual modes of action?

Nerve supply?

SUPERFICIAL INTRINSIC MUSCLES OF

THE BACK

INTERMEDIATE INTRINSIC MUSCLES OF

THE BACK

DEEP INTRINSIC MUSCLES OF THE BACK

PRACTICE QS

Which muscles are involved in lateral flexion of the thoracic

spine?

Which muscles are involved in forward flexion of the spine?

ANATOMY OF THE PELVIS

THE ACETABULUM

LIGAMENTS OF THE HIP

FRACTURES OF THE FEMUR

One of the most common orthopaedic presentations

You will see a lot of this in the repat

The neck of the femur is the most commonly fractured as it

is the narrowest and weakest part of the femur, as well as
being at the line of weight bearing.

Other fractures include intertrochanteric fracture

(stumbling or stepping down hard) and transcervical
(middle of the neck)

MAJOR MUSCLES ACTING ON THE HIP

Movements of the hip include:

Flexion

Extension

External rotation

Internal rotation

Abduction

Adduction

WHAT ARE THE MAJOR FLEXORS OF THE

HIP?

MAJOR FLEXORS OF THE HIP JOINT

Iliopsoas Psoas minor +
Psoas major
+
Iliacus
Sartorius (lesser extent)

MAJOR EXTENSORS OF THE HIPGLUTEUS MAX

Gluteus maximus = extension and lateral rotation of the thigh
Proximal attachment = ilum posterior to gluteal line, posterior
surface of the sacrum and coccyx
Distal attachment = iliotibial tract which mostly inserts into
the lateral condyle of the tibia

HIP EXTENSORS/KNEE FLEXORS-HAMSTRINGS

Semitendinosus (Ischial tuberosity) (superior tibia)

Semimembranosus (Ischial tuberosity) (medical condyle of

the tibia)

Biceps femoris (Ischial tuberosity + linea aspera) (lateral

side head of fibula)

The hamstrings are unique in that they cross 2 different joints,

why is this important?

WHICH MUSCLES ARE IN USE?

ABDUCTORS OF THE THIGH

Gluteus medius

Gluteus minimus

Tensor fascia latae

(Abduction of a flexed thigh, lateral rotation of an extended

thigh)

Piriformis (pear)

Obturator internus

Superior and inferior gemelli

TRENDELENBURGS TEST

What is it?

Which muscles are affected?

Paralysis of which nerve causes this sign?

ADDUCTORS OF THE THIGH

Origins typically the ischiopubic ramus of the pelvis.
Attachments are along the medial edge of the femur

Adductor longus

Adductor brevis

Adductor magnus

Gracilis

Obturator externus

COMPARTMENTS OF THE THIGH

How do we remember the nervous supply/action of all these
muscles?!?!?!

Anterior compartment: Femoral Nerve

Medial compartment: obturator nerve
Posterior compartment: Sciatic nerve

GENERALLY SPEAKING
Anterior compartment: flexors of the hip; extensors of the knee
Medial compartment: adductors of the thigh
Posterior compartment: extensors of the thigh, flexors of the
knee

DIVIDED BY INTERMUSCULAR SEPTA

THE SHOULDER- LIGAMENTS OF THE

SHOULDER

MUSCLES AFFECTING THE SHOULDER

Main movements of the shoulder?

What muscles create those movements?

What are their proximal/distal attachments?

nerve supply?

FOSSA OF THE SKULL

IMPORTANT STRUCTURES OF THE SKULL

Sutures of the skull (Lambdoid, coronal, sagittal)

Which sutures/bones make up the pterion, why is it

important?

Structure of the sphenoid bone, be able to label it

Bones that make up the orbits of the eyes

HANDY MNEMONICS FOR REMEMBERING

FORAMINA OF THE SKULL
Cleaners only spray smelly stuff right on smelly idiots in
jumbled junkyards juggled high
Carl only swims south. Silly roger only swims in infiniti jacuzzis.
Jane just hitchhikes

THE WRIST/HAND