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EXSS 175 Final Exam Study Guide

by: Lynde Wangler

EXSS 175 Final Exam Study Guide EXSS 175

Marketplace > University of North Carolina - Chapel Hill > EXSS 175 > EXSS 175 Final Exam Study Guide
Lynde Wangler
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This study guide covers all the content from the entire semester. No muscles.
Dr. Johna Register-Mihalik
Study Guide
Human, anatomy
50 ?





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This 64 page Study Guide was uploaded by Lynde Wangler on Monday May 2, 2016. The Study Guide belongs to EXSS 175 at University of North Carolina - Chapel Hill taught by Dr. Johna Register-Mihalik in Spring 2016. Since its upload, it has received 161 views.


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Date Created: 05/02/16
 Introduction to Human Anatomy – Lecture One o Anatomy: study of body structures and relationships between them o Physiology: study of the functions of structures of the body  Types of Anatomy o Gross Anatomy o Clinically Oriented Anatomy o Surface  Skeletal System o Parts: bones, cartilages, and joints o Functions: provides frame to support and protect body; site where muscles attach; facilitates body movements; blood cells are stored and created by cells of the bones  Articular System: o Usually considered in conjunction with the skeletal system; consists of the “joints” of the body  Anatomical Terminology: Learn the Language of Anatomy!!! o Anatomical Position: refers to a person standing upright, arms at sides, palms facing forward, head looking straight ahead, feet planted facing forward flat on the ground o “Prone” – facing downward o “Supine” – facing upward o Regional Names:  Head: skull and face  Neck: supports the head and attaches it to the trunk of the body  Trunk: refers to chest, abdomen, and pelvis  Upper limbs/extremities: includes shoulder, armpit, arm, forearm, wrist, hand, and fingers  Lower limbs/extremities: includes buttock, thigh, leg, ankle, foot, and toes  Names derived from Greek or Latin (Ex: Axilla  Axillary Nerve)  Directional Terms: used by anatomists to describe location of body structures in relation to one another; usually paired terms (i.e., anterior/posterior)  Superior (cranial or cephalic): towards the head or upper body – Axial Skeleton  Inferior (caudal): towards the tail of lower body – Axial Skeleton  Anterior (ventral or belly side): towards the front  Posterior (dorsal or back): towards the back  Medial: near the midline (ex. pinky is medial to thumb)  Lateral: further from the midline (ex. thumb is lateral to pinky)  Proximal: near attachment point on trunk (for limbs) – Appendicular Skeleton  Distal: farther from attachment point on trunk – Appendicular Skeleton  Superficial: towards the surface  Deep: away from surface  Internal (central): towards interior (mostly refers to internal organs)  External (peripheral): towards exterior (ex. skin is an exterior organ)  Ipsilateral: same side  Contralateral: opposite side  Parietal: outer wall of body cavity; superficial to visceral layer  Visceral: in ventral cavity film closest to organ  Body Cavities: protect; store, and separate organs o Principle Body Cavities: Cranial & Vertebral (both encased in three protective layers called the meninges; 1. Pia mater, 2. Subarachnoid membrane, 3. Dura mater – most superficial and durable), Thoracic, and Abdominopelvic  Cranial Cavity: formed by cranial bones; contains brain  Vertebral Cavity: formed by vertebral column; contains spinal cord  Thoracic (“Chest”) Cavity: formed by ribs, diaphragm, sternum, and thoracic part of V.C. (vertebral column) o Three Compartments  Pericardial Cavity: space surrounding heart; filled with fluid  Pleural Cavities (2): space around each lung; also contains small amount of liquid  Mediastinum: space between lungs from sternum to V.C. and neck to diaphragm; contains heart, esophagus, trachea, thymus, and many large blood vessels (all organs of thoracic cavity except for the lungs) o Diaphragm separates thoracic cavity from abdominopelvic cavity  Abdominopelvic Cavity: from diaphragm to groin and enclosed by abdominal wall and pelvic bones and muscles o Two Compartments:  Abdominal Cavity: houses stomach, spleen, liver, gallbladder, small intestine and most of large intestine  Pelvic Cavity: houses urinary bladder, part of large intestine, and internal reproductive organs o Viscera – the term for organs that are housed inside the thoracic and abdominopelvic cavities  Abdominopelvic Cavity – clinically divided into four sections (labelled according to the subject’s perspective – think about regions on your body): Right Upper Quadrant (RUQ)  liver, gallbladder, ascending colon, right kidney; Right Lower Quadrant (RLQ) cecum, appendix; Left Upper Quadrant (LUQ) spleen, body of stomach, descending colon, left kidney, pancreas; and Left Lower Quadrant (LLQ) sigmoid colon ***Anatomical studies often use a 9-region division  Bone Markings: o Depressions and Openings – allow for formation of joints and passage of soft tissues o Processes: basically projections on the ends of bones; help to form joints; sites of attachment for connective tissues  Depressions and Openings:  Foramen – opening for blood vessels, nerves, and ligaments to pass through  Notch – indentation found at the bones edge  Meatus – enters but does not pass through structure (ex. auditory canal)  Fossa – shallow depression in a bone  Sulcus – furrow on the surface of the bone that accommodates blood vessels, nerves, or tendons  Processes (that form joints): o Condyle – large, round protuberance at the end of the bone o Facet – smooth, flat articular surface o Head – rounded articular projection supported on the neck of a bone (ex. head of the femur)  Processes (that form attachment joints):  Crest – prominent ridge or elongated projection (ex. iliac crest of hip bone)  Epicondyle – projection above a condyle (ex. medial epicondyle of elbow)  Spinous Process – sharp, slender projection (ex. S.P. of vertebra)  Trochanter – very large projection (ex. greater trochanter of femur)  Tubercle – small, rounded projection (ex. greater tubercle of the humerus)  Tuberosity – large, rounded, usually roughened projection (ex. ischial)  Important Muscular Terms: o Origin – placement of muscle attachment for the stationary bone o Insertion – placement of the muscle attachment for the bone it moves o Innervation – the nervous supply to a muscle o Action – the motion the muscle creates  Planes: a two-dimensional consisting of three points that are not on the same line; MOTION OCCURS “IN A PLANE”  Axis: a line passing perpendicular to a plane; MOTION OCCURS “ABOUT AN AXIS”  Planes and Axes of Motion: o Planes – describe relative movements o Axes – describes lines around which motion occurs o Planes have corresponding perpendicular axes  Anatomical Planes of Motion: o Sagittal – divides the body into left and right parts o Frontal (coronal) – divides the body into anterior and posterior parts o Transverse – divides the body into superior and anterior parts  Sagittal and Mid-sagittal Planes: o Sagittal – divides the body into unequal left and right portions o Mid-sagittal – divides the body into equal left and right portions  Anatomical Axes of Motion: perpendicular to anatomical planes o Anterio-posterior (AP) Axis – perpendicular to frontal plane (runs front to back) o Mediolateral Axis (Transverse Axis) – perpendicular to sagittal plane (runs side to side) o Longitudinal Axis – perpendicular to transverse plane (runs up and down)  Identifying Planes and Axes of Motion: (think: the plane moves along its axis)  Planes & respective Axes:  Sagittal/Mediolateral  Frontal/AP  Transverse/Longitudinal  Basic Joint Actions: Sagittal Plane: o Flexion – decrease angle o Extension – increase angle  Basic Joint Actions: Frontal Plane: o Abduction – move away from midline of body o Adduction – move towards midline of body  Basic Joint Actions: Transverse Plane: o Medial (Internal) Rotation: anterior surface of body moves toward midline o Lateral (External) Rotation: anterior surface of the body moves away from midline  Basic Joint Actions: Forearm: o Supination – rotation of hand/forearm laterally; think holding the soup o Pronation – rotation of hand/forearm medially; think pouring the soup out  Basic Joint Action: Wrist: o Radial Flexion or Deviation – move wrist outward away from body; deviate toward radius o Ulnar Flexion or Deviation – move wrist inward toward midline of body; deviate toward ulna  Basic Joint Actions: Ankle: o Plantarflexion – pointing toes/foot downward; think planting the foot o Dorsiflexion – pointing toes/foot upward; think lifting foot off the gas pedal o Inversion – moving sole of foot inward o Eversion – moving sole of foot outward  Basic Joint Actions: Scapula: o Protraction – moving forward on a plane parallel to the ground; think the motion to punch someone/thing o Retraction – moving backward on a plane parallel to the ground; think starting up a lawnmower o Upward Rotation – upward movement, come apart o Downward Rotation – downward movement, come together o Elevation – movement upwards o Depression – movement downwards  Basic Joint Actions: o Circumduction – Latin for “around;” both flexion/extension and abduction/adduction Muscular System:  Muscle Functions: movement, stabilization, regulate volume of organs (via bands of smooth muscle called sphincters), movement of substances (blood, lymph, urine, air, food and fluids, sperm, etc.), heat production (shivering – involuntary muscle contractions)  Properties of Muscles: Excitability (responds to external stimuli and conducts electrical signals), Contractility (ability to contract – shorten – and produce force), Extensibility (flexibility – must be able to extend without impairing muscle), Elasticity (return to normal length after being stretched), Thermal (heat production)  Types of Muscle Tissue: o Skeletal Muscle – attaches to bone, skin, and fascia; striated (banded look due to arrangement of proteins); voluntary control; multi- nucleated cells o Cardiac Muscles – striated; involuntary control (regulated by internal pacemaker); only one nucleus per cell o Smooth Muscles – attached to hair follicles; exist in walls of hollow organs (blood vessels and GI tract, for ex.); non-striated; involuntary  Composition & Structure of Muscles – fascicles, muscle fibers, myofibrils, sarcomeres, filaments  Connective Tissue Structures: o Epimysium – envelops muscle (fascia) o Perimysium – covers the fascicles o Endomysium – covers individual muscle fibers  Composition: o Myofibrils – main constituent of muscle fibers; contractile elements of the muscle o Sarcomere – functional unit of contraction o Both are composed of protein filaments  Myofibrils: serves as the contractile element of muscles; composed of many sarcomeres that extend from Z-line to Z-line; sarcomeres are composed of thick and thin filaments  Thick (myosin) and Thin (actin, troponin, tropomyosin) filaments are composed of contractile and regulatory proteins  Myosin: component of thick fibers; each molecule has two myosin heads (extend toward thin filament) and one tail; molecule held in place by M line proteins  Actin: each actin molecule has a myosin-binding site that is covered by tropomyosin in relaxed muscles; thin molecules held in place by Z lines (Z line to Z line is a sarcomere)  Motor Units: functional unit of skeletal muscle; constituents: one motor neuron, muscle fibers that it innervates; one motor endplate on each muscle cell each cell has one nerve and one nerve can innervate many muscle cells  Muscular Contraction Chain of Events – action potential travels down the motor neuron to the axon terminal which releases the neurotransmitter, acetylcholine (Ach) into the synaptic cleft Ach binds to receptors on the motor endplate electrical impulse is sent to the muscle fiber; spreads through the muscle cell membrane and down to the t-tubules sarcoplasmic reticulum releases calcium into the muscle fiber calcium binds to troponin causing tropomyosin to move away from binding sites on axons myosin heads bind to actin; myosin heads pivot to shorten length of sarcomere muscle contraction is stopped when acetylcholinerase (AChE) is released into the synaptic cleft to break down the Ach calcium goes back to sarcoplasmic reticulum troponin and tropomyosin go back to covering the binding sites on actin FINALLY sarcomere returns to relaxed state/length  Cross-bridges: action is analogous to pulling a rope hand-over-hand  Isometric tension is greatest at physiological resting length  Isotonic and Isometric Contraction: o Isotonic Contraction – moving a load  Concentric Contraction: muscle shortens to produce force or movement  Eccentric Contraction: muscle lengthens while maintaining force & action o Isometric Contraction – no movement; tension is created without a shortening of the muscles (ex. maintaining posture or objects in fixed position 3A: The Axial Skeleton  Skull, facial bones, spinal cord  Types of Bones: o Long – compact, strong (femur, humerus) o Short – spongy on inside, not on surface (trapezoid, wrist bone) o Flat – plates of compact bone enclosing spongy (sternum, scapula) o Irregular – some compact, some spongy, varies depending on bone itself(vertebrae) o Sesamoid – develop in tendons or ligaments (patella) o Sutural Bones: in joints between skull bones  The Human Skeleton: 206 bones in the human body o The Axial Skeleton:  80 bones; lie on longitudinal axis; includes skull, hyoid (only bone in body that does not articulate with another bone), ribs, sternum, vertebrae, & ear ossicles (teeny bones in ears that help with hearing) o Appendicular Skeleton:  Upper and lower limbs and extremities, pelvic bones, & pectoral girdles  Skull (22 bones): cranial (cranium) and facial (face) bones o Features – skull forms large cranial cavity and smaller cavities (nasal cavities and orbits); paranasal sinuses: mucus-lined cavities in skull that help to keep skull lighter and filter air that we breath in; mandible: only bone that can be moved voluntarily in the skull; sutures: joints that do not move and hold the skull bones together  The 8 Cranial Bones: Frontal, Parietal (2), Temporal (2), Occipital, Sphenoid (holds everything together, articulates with the other bones), Ethmoid o These bones protect the brain and ear ossicles, as well as allow for jaw, neck, and facial muscles to attach o 14 Facial Bones – protect sense organs for smell (nose), taste (mouth), vision (eyes); entrance to digestive and respiratory systems  Frontal Bone: forehead, roof of orbits (eye sockets), & anterior cranial floor/border, supraorbital margin (brow line; not a lot of muscle or fascia skin prone to bruising black eye), and frontal sinus (filter air and contribute to light weight of skull)  Parietal Bones: sides and roof of cranial cavity; lateral aspects of skull  Temporal Bones: temporal squama, zygomatic process forms part of arch (stereotypical cheek bone), external auditory meatus (hole for ear/sound), mastoid process (posterior to ear, you can feel it), styloid process (sits right below mastoid process; muscular attachment), stylomastoid foramen (CN VII), mandibular fossa (TMJ), petrous portion (CN VIII) o Carotid foramen (carotid artery bringing blood to the brain); jugular foramen (jugular vein that brings blood to the heart from brain)  Occipital Bones: most posterior bone; foramen magnum (pathway for spinal cord to enter/exit skull), occipital condyles (bottom of skull; where skull sits on spinal cord), external occipital protuberance “bump of knowledge” (attachment site for ligamentum nuchae which allows skull movement and supports the spinal cord), superior and inferior nuchal lines (important muscular and fascia attachment sites)  Sphenoid Bones: base of skull (articulates with many bones), pterygoid processes (attachment sites for jaw muscles), body is in the middle cube-like and holds sphenoid sinuses, greater and lesser wings (anterior view); optic foramen goes through so that optic nerve can innervate eyes; sella turcica holds pituitary gland  Ethmoid Bone: forms part of the anterior portion of the cranial floor, medial wall of orbits, superior portion of nasal septum, most of superior sidewalls of nasal cavity; major superior supporting structure of nasal cavity; Crista galli – attaches to the membranes covering the brain (3 meninges) and is almost embedded in the brain (sometimes blunt force trauma can push this bone into the brain); responsible for deviated septums (when people break their noses) o More – lateral masses contain ethmoid sinuses (filtering and warming air and making skull lighter); perpendicular plate is upper part of nasal septum; superior and middle nasal concha or turbinates (filter and warm air that is breathed in)  14 Facial Bones: Nasal – form bridge of noes (2), Mandible – lower jaw bone, Inferior nasal conchae – sit deep inside the skull (2), Maxillae – sit right in middle of face (2), Lacrimal – medial aspect of obits for tear ducts (2), Zygomatic – essentially, cheek bones(2), Palatine (2), Vomer- forms part of nasal passageway (1) o Maxillary Bones – floor of orbit, floor of nasal cavity or hard palate; maxillary sinus; alveolar processes (hold upper teeth); cleft palate – condition in infants when maxillary bones do not come to grow together very fixable o Zygomatic Bones – cheekbones; forms lateral wall of orbit along with sphenoid bones; forms part of zygomatic arch along with part of temporal bone (easily injured) o Lacrimal Bones and Inferior Nasal Concha or Turbinates (not part of ethmoid bone) – forms part of medial wall of eye socket; lacrimal fossa houses lacrimal sack (where tears are produced) o Mandible – only voluntarily moveable bone in the skull; body (main portion), angle (jaw bone – sticks out on some individuals; susceptible to fracture), and rami (portions that sit just anterior and inferior to ears); condylar and coronoid processes (help to form temporal mandibular joint TMJ); alveolar processes for lower teeth; mandibular and mental foramen (nerves pass through here – some innervate muscles of mouth or face) o TMJ: mandible articulates with temporal bone to form temporomandibular joint; TMJ syndrome is dysfunction of this joint (causes and treatments are numerous and vary) o Palatine – L-shaped with one end functioning as the back part of the hard plate and the other end is part of the orbit o Vomer – posterior part of nasal septum (sits just superior to palatine bone) o Nasal Septum – divides nasal cavity into left and right sides (ideally perfectly bisected into equal left and right sides but can be born different or have broken nose that causes deviated septum); formed by vomer, perpendicular plate of ethmoid, and septal cartilage o The Orbits (eye sockets) – contain eyeballs and associated structures and are formed by seven bones of the skull; 5 important foramina are associated with each eye socket (so that nerves can pass through and muscles can move the eyes)  Bones of the Orbit: roof – frontal and sphenoid; lateral wall – zygomatic and sphenoid; floor – maxilla, zygomatic, and sphenoid; medial wall – lacrimal, ethmoid, sphenoid, and maxilla (there are also orbital fissures and optic foramen)  Foramina of the Skull: (5)  Foramen magnum – occipital bone; inferior part of brain connects with spinal cord (CN XI); vertebral and spinal arteries pass through this opening  Optic foramen – sphenoid bone; optic nerve (CN II) and ophthalmic artery  Mandibular foramen – mandible  Carotid foramen – temporal bones (between greater and lesser wings); internal carotid artery; supplying blood to brain  Stylomastoid foramen – temporal bone (between mastoid and styloid processes); CN VII (facial – allows for facial expression) and stylomastoid artery  Unique Features of the Skull: o Sutures – immovable joints found only between skull bones;  Coronal: joins frontal and both parietal bones  Sagittal: joins two parietal bones  Lambdoid: joins both parietal bones to the occipital bone  Squamous: joins parietal and temporal bones o Paranasal Sinuses – cavities in bones of skull that communicate with the nasal cavity; have mucus-lined membranes; lighten the skull; serve as resonating chambers for speech (someone sounds nasally if their sinuses are filled or inflamed); cranial bones contain sinuses (frontal, sphenoid, ethmoid, maxillae); sinusitis – membranes of sinuses get inflamed due to infection or allergy (feels like pressure inside head and generally, painful) o Fontanels – dense connective tissue membrane-filled spaces between the cranial bones of fetuses and infants (remain unossified at birth but closes during early child development)  Functions: (1) enable fetal skull to modify size and shape as it passes through the birth canal, and (2) allows for rapid brain growth during infancy  Major fontanels: anterior, posterior, anterolaterals, and posterolaterals (correspond with location of sutures of the skull later in life) o Hyoid Bone – U(nique)-shaped; single bone that does not articulate with any other bones; suspended by ligaments and muscles from the skull; supports tongue; provides attachment site for tongue, neck, and pharyngeal muscles (often fractured when an individual is strangled)  Vertebral Column: o Spine has 26 vertebrae o 5 vertebral regions: cervical vertebrae (7), thoracic vertebrae (12), lumbar vertebrae (low back region, 5), sacrum (5, fused into one; number varies), coccyx (4, fused into one solid bone)  Intervertebral Discs: between vertebrae; absorb vertical shock; allows various movements of the vertebral column (prevent bones from rubbing directly on each other); fibrocartilaginous ring with a pulpy center (gets squeezed out when someone has a herniated disc); intervertebral foramen  Normal Curves of the Vertebral Column: o 4 normal vertebral curves – cervical and lumbar (anteriorly convex curves) & thoracic and sacral (anteriorly concave curves) o Fetus – only one single anteriorly concave curve; cervical curve develops as child begins to hold head erect (4 months); lumbar curve develops as child begins to walk (1 year); all curves fully developed by age 10  Typical Vertebrae: body portion is weight bearing; vertebral arch (pedicles & laminae); 7 processes (2 transverse, 1 spinous, and 4 articular); vertebral foramen (allows for passage of spinal cord all the way down the vertebra); vertebral notches (forms the vertebral foramen)  Intervertebral Foramen and Spinal Canal: the spinal canal is made from all of the vertebral foramen put together; intervertebral foramen are between two vertebral notches together (superior and inferior)  Cervical Region: o There are 7 cervical vertebrae – 1) atlas – supports the skull; 2) axis – a process that runs up through atlas allowing head to move from side to side; 3-6) have structural patterns of typical cervical vertebrae; 7) vertebra prominens – somewhat different structure; when you flex head forward, that vertebra sticks out o Atlas (C1) – ring of bone; superior facets hold occipital condyles; atlanto-occipital joint used for nodding head “yes” o Axis (C2) – body of axis is dens or odontoid process; movement at atlanto-axial joint signifies “no”  Typical Cervical Vertebrae (C3-C7): smaller bodies with larger spinal canals because the spinal cord is thicker where exiting the skull; transverse processes are shorter and have transverse foramen for vertebral artery to run through; spinous processes of C2-C6 often bifid (have two posterior projections)  Thoracic Vertebrae (T1-T12): large, strong bodies (not as much as lumbar); longer transverse and spinous processes; facets or demifacets on body to articulate with head of ribs; facets on transverse processes (T1-T10) for tubercle of rib  Lumbar Vertebrae: strongest and largest (have to support the most amount of weight) with short, thick spinous and transverse processes; attachment site for back musculature allowing for stabilization and standing upright  Sacrum: union of 5 vertebrae (S1-S5) by age 30; median sacral crest was spinous processes but is now fused together to form one crest; sacral ala “wing” is fused transverse processes; sacral canal ends at sacral hiatus (area for spinal cord to pass through and exit and terminate); auricular surface and sacral tuberosity of SI (sacrum and ilium) joint (overuse injury site in runners and other athletes)  Coccyx: union of 4 vertebrae fused together by age 30; caudal or epidural anesthesia during childbirthinto sacral hiatus: anesthetize sacral and coccygeal nerves (waist down); sacral and coccygeal cornu are important landmarks  Thorax: refers to the entire chest area o The skeletal part of the thorax (aka the bony cage, flattened from front to back) consists of the sternum (manubrium, body, and xiphoid process; sits anteriorly), costal cartilages, ribs (1-7 vertebrosternal true ribs, 8-12 vertebralchondral false ribs, 11-12 are floating), and the bodies of the thoracic vertebrae o Encloses and protects organs in the thoracic and superior abdominal cavities; provides support for the bones of the shoulder girdle and upper limbs  Sternum – located on anterior midline of thoracic wall; consists of three parts – 1) manubrium (1 and 2 ndribs, clavicular notch – where clavicle attaches), 2) body (costal cartilages of 2-10 ribs), 3) xiphoid (ossifies by age 40 or earlier; area for CPR position)  Ribs: o 12 pairs of ribs provide structural support to the sides of the thoracic cavity; 7 are true and 5 are false with the last two considered floating; rib fractures are the most common type of chest injuries or costal cartilages o There is an increase in length from ribs 1-7 but then decrease in length thereafter; head and tubercle of the ribs articulate with facets of thoracic vertebrae; body of the rib contains costal groove containing nerve & blood vessels; intercostal spaces (space between the ribs) contain intercostal muscles  Rib Articulation: tubercle articulates with transverse process at the facet; head articulates with vertebral bodies at superior demifacet  Disorders: “common” orthopaedic pathologies herniated disc; abnormal curvature of the spine o Herniated (slipped) disc – protrusion of the nucleus pulposus; most common in lumbar region from excessive stress or strain; pain due to pressure on spinal nerves; laminectomy (remove the lamina portion of the bone to alleviate pressure) allows for surgical removal of the disc o Homeostatic Imbalances (not in ideal condition) – abnormal curvatures of the vertebral column  Scoliosis – lateral bending of the vertebral column; can be congenital or can develop over time  Kyphosis – exaggerated thoracic curvature; extremely concave; humpback appearance  Lordosis (lords of medieval ages) – exaggerated lumbar curvature; most common; too far convex anteriorly; pelvis sticks out  Spina bifida – congenital defect caused by the vertebral laminae to unite at the midline; may involve more than one vertebrae; nervous tissue (that should be contained) may or may not protrude through the skin APPENDICULAR SKELETON  Pelvic girdle, upper and lower extremities; all bones that make up the UE (upper extremity) and LE (lower extremity); bones that allow attachment to the axial skeleton  Primary function: axial – protect vital organs and support stability; appendicular – allow for movement  Upper Extremity o 64 bones total (32 on each side) o Bones of UE – scapula (shoulder blades), clavicle (collar bone), humerus, radius (thumb side), and ulna (pinky side; all are 1 per side); 16 carpals (8 per side); 10 metacarpals (5 per side); 28 phalanges (14 per side)  Pectoral (or Shoulder) Girdle – consists of scapula (does not have a bony attachment but does have a number of muscular attachments) and clavicle (only bony attachment of the UE to the axial skeleton)*; attaches appendicular upper extremities to axial skeleton  Scapula: flat, triangular, large; on posterior thorax; shoulder blade nd th o Location: between 2 and 7 ribs (thoracic ribs) o Landmarks:  Borders – superior, medial (vertebral; sits near vertebral side), lateral (axillary; sits near armpit/ axillary region) nd  Angles – superior (point at the top) at T2 (2 rib level); inferior (point at the bottom) at T7 (7 rib level) ideal locations but can be slightly different  Scapular Spine – sharp ridge that widens to flat acromion process (forms AC joint but is not a bone just a landmark on the bone); at T4 (4 rib level)  Scapular Notch – allows for suprascapular nerve and artery to pass through and innervate associated muscles  Fossae:  Supraspinous – superior to spine  Infraspinous – inferior to spine  Glenoid – lateral depression (head of humerus sits to form the shoulder joint)  Subscapular – anterior surface (subscapularous muscle)  Processes:  Acromion – terminal end of scapular spine (forms acromioclavicular joint)  Coracoid – anterior projection off of scapula (ligament attachments that provide stability to the shoulder) o Clavicle Landmarks: extends from sternum to scapula above first rib; weakest point (most susceptible to injury) is between middle and lateral curves 1/3 of the way down  Sternal (medial) end – articulates with sternum (sternoclavicular joint; only bony articulation with axial skeleton)  Acromial (lateral) end – articulates with acromion (acromioclavicular joint; bones that articulate are clavicle and scapula acromion is only a process, not a bone)  S-shaped bone with two curves – medial curve is anteriorly convex (closest to sternum) and lateral curve is anteriorly concave  Conoid tubercle – attachment of conoid ligament  Trapezoid line – ridge where trapezoid ligament attaches; conoid and trapezoid form the coracoclaviclar ligament  Deltoid tubercle – anterior deltoid site of origin (muscle on lateral side of should that helps with abduction)  Subclavian groove – allows for passage of subclavian artery (important artery for UE)  Proximal Humerus: consists of head (round bony protuberance articulates with glenoid fossa), anatomical neck, tubercle (greater (sits more laterally ; and lesser (sits more medially), intertubercular sulcus (bicipital groove; between tubercles – long head of biceps run through), surgical neck (common site for fractures), deltoid tuberosity (sits on lateral aspect of should), shaft (runs all the way down to elbow joint)  Distal Humerus: capitulum (articulates with head of radius; rounded in shape which allows radius to pronate and supinate more easily), trochlea (articulates with ulna), radial fossa (elbow into elbow flexion), coranoid fossa (coranoid process coming off of ulna when elbow flexed), olecranon fossa (posterior depression for olecranon process of ulna during extension), medial and lateral epicondyles (forearm muscle attachment site), supracondylar ridges (common site for fractures)  Proximal Ulna and Radius: o Ulna (medial/pinky side)  Trochlear notch articulates with humerus; radial notch articulates with radial head (where it fits into ulna it is on the ulna!); olecranon process forms point of elbow (when elbow is flexed); coronoid process (fits into coronoid fossa on the humerus) o Radius (lateral/thumb side)  Head articulates with capitulum of humerus and radial notch of ulna; radial neck; radial tuberosity (important attachment site for muscles)  Distal Radium and Ulna: o Ulna  Head, styloid process (commonly fractured off in wrist fractures); the ulna has no direct contact with the wrist bones triangular fibrocartilage disc (sits in between the head of the ulna and the carpal bones) o Radius  Styloid process (also commonly fractured off), forms wrist joint with wrist bones (carpal surface), forms distal radioulnar joint with head of ulna  Hand Regions: carpal (8) Some Lovers Try Positions That They Can’t Handle, metacarpal (5), phalangeal (14)  Carpal bones – Scaphoid, Lunate, Triquetrium, Pisiform (first four on proximal row/ next four  on distal row), Trapezium, Trapezoid, Capitate, Hamate (hook of hamate, which is important for some nervous structures to pass through) lateral to medial  Carpal Tunnel – tunnel floor formed by carpal bones; tunnel roof formed by flexor retinaculum (transverse carpal ligament; band of fascia that helps to hold the tendons down); Contains 10 Structures o Flexor tendons of the fingers:  1 flexor pollicis (thumb) longus  4 flexor digitorum profundus (deeper)  4 flexor digitorum superficialis (more superficial) o Median nerve (problem with carpal tunnel syndrome when nerve gets pinched or pressed)  Metacarpals: 10 in total/ 5 per hand; numbered 1-5 (thumb = 1 ); Landmarks  base (proximal articulation), shaft, head (forms joint with fingers; knuckles), condyles (ligaments connect metacarpals to phalanges)  Phalanges: 28 bones total/ 14 per side o Fingers = 3 each (total 12) o Thumb = 2 each (total 4) o Regions: proximal (closest to metacarpals), middle, distal (most distal bone in UE) o Landmarks: base, shaft, head (from proximal to distal) o Named by number and region (ex. 2 nddistal phalanx) Lecture 3D Appendicular Skeleton – Lower Extremity (LE)  LE: 62 bones in total; hipbone (2), Femur (2), Tibia – shin bone (2), Fibula – lateral shin bone (2), Patella – kneecap (2), Tarsals (14), Metatarsals (10), Phalanges (28)  Pelvic Girdle: hipbone = “coxal bone”, formed by the fusion of three bones  ilium (superior; iliac crest), ischium (inferior and posterior; ischial tuberosity is what you sit on when you sit in a chair), and pubis (inferior and anterior); provides support for vertebral column and viscera; acetabulum articulates with femoral head  Ilium (superior): “flank” sits on the lateral side of abdomen, most superior and largest of the hipbones; landmarks: ASIS (anterior superior iliac spine – important site for muscular attachment; prominent and palpable), AIIS (anterior inferior iliac spine – not palpable because of overlying muscle), PSIS (posterior superior iliac spine – easily palpated, “back dimples”), Iliac crest (prominent; hand on hips site), Gluteal lines (attachment site for gluteal muscles), Greater sciatic notch (sciatic nerve bundle that provides innervation and sensation for LE), Iliac fossa (medial side of bone), Auricular surface (articulation with the sacrum)  Ischium: inferior, posterior portion of the hipbone; landmarks – ischial spine (sits deep), lesser sciatic notch (part of sciatic nerve comes through), ischial tuberosity (portion of bone you sit on and major attachment site for hamstring muscles), ischial ramus (muscular site), obturator foramen (allows obturator nerve to pass through; innervates medial thigh musculature)  Pubis (inferior and anterior): landmarks – inferior pubic ramus (attachment site for muscles), superior pubic ramus (attachment site for muscles), body, pubic tubercle, pubic symphasis (not a portion of pubic bone; cartilage piece that sits and connects the two pubic bones together anteriorly; relaxes during child birth)  Other Pelvic Girdle Landmarks: o Pubic Symphasis: (mentioned above) o Acetabulum: head of femur sits here; composed of all three bones o Acetabular Notch: allows nerves and other structures to run through  Pelvis: together with the sacrum and coccyx, the 2 hipbones for the pelvis (basin-like); Pelvic Brim/Inlet – separates inferior and superior portions of the pelvis; superior boundary of pelvis is the oblique plane  Pelvis Types: o Greater “false” pelvis – above the pelvic brim; borders the lumbar vertebrae, upper portions of hipbones, and abdominal wall; contains the urinary bladder when full and uterus during pregnancy o Lesser “true” pelvis – below the pelvic brim; borders the sacrum & coccyx, ilium & ischium, and pubic bones; surrounds pelvic cavity; Pelvic Brim/Inlet – superior opening of lesser pelvis; Pelvic Outlet – inferior opening  Female pelvis – wide pelvic outlet; shallow; pubic arch >90 degrees  Male pelvis – narrow pelvic outlet; deep; pubic arch <90 degrees  Femur: thighbone; longest, heaviest, and strongest bone in the body; proximal articulation with hipbone (in acetablulum); distal articulation with tibia and patella (forming the knee joint)  Femur – proximal end: head, neck, greater trochanter (can feel on lateral aspect of thigh), lesser trochanter, intertrochanteric line; intertrochanteric crest (posterior aspect of femur); fovea (on the head of the femur allowing for attachment of ligament to hold femur in correct location)  Femur – Shaft: femoral shaft (body); linea aspera (important for a number of muscular attachments)  Femur – Distal End: medial/lateral condyle (form the knee joint); medial/lateral epicondyle (site for ligament and muscle attachments; palpable); adductor tubercle (adductor muscles insert here; enlarged in cowboys); medial supracondylar line; lateral supracondylar line; popliteal surface (posterior aspect of femur; back of the knee); patellar surface (right between medial and lateral condyles where the patella sits and rides up and down as the knee flexes)  Tibia: medial (middle; the one that gets hit) shinbone; larger, medial bone of lower leg; bears majority of bodies weight (89%); proximal articulation is with femur and fibula and forms the knee joint; distal articulation with fibula and talus forming the ankle joint  Tibia – Proximal End: intercondylar eminence (sits between two condyles of the femur and provide stability to knee joint); medial condyle; lateral condyle; tibial tuberosity (quadriceps muscles come together to form the patellar tendon which inserts on tibial tuberosity)  Tibia – Shaft: anterior border (crest; hurts when you get kicked); soleal line (where soleus muscle originates off the posterior aspect of the tibia)  Tibia – Distal End: medial malleolus (“medial ankle bone”) and fibular notch (shaft of the fibula fits into the tibia to provide stability)  Fibula: lateral shinbone; thinner and smaller of the two shin bones; “non- weight bearing” – does not bear much of body weight (about 11%, differs from person to person and book to book) o Head & Styloid process (articulate with the tibia); Lateral malleolus (distally; to form lateral ankle bone)  Patella: “kneecap”; largest sesamoid bone (form within tendons and ligaments; patellar tendon); increases leverage for quadriceps muscles (by increasing angle, quads do not have to work as hard because they are at a mechanical advantage); lies anterior to distal femur; subcutaneous and easily palpated  Tarsal Bones: foot and ankle bones o Calcaneus (heel bone); Talus (most superior and articulates with tibia); Navicular (sits o medially); Cuboid (sits laterally); Cuneiforms… (most medial to most lateral)  Medial (1 ) nd  Intermediard (2 )  Lateral (3 ) o Medial Longitudinal Arch – 1 metatarsal, 1 cuneiform, navicular, and calcaneus (when you look at the inside of someone’s foot to examine arch) o Lateral Longitudinal Arch – calcaneus, cuboid, 5 metatarsal (not as pronounced)  Metatarsals: 5 per foot and numbered 1-5 from big toe (“hallucis”) to little toe o Landmarks (proximal to distal) – base, shaft, head, and condyles  Phalanges: 14 bones of the toes on each foot (3 per toe and 2 per big toe same as hand); regions – proximal, middle, distal; landmarks – base, shaft, and head o Sesamoid Bones – 2 sesamoid bones on inferior surface of the foot; head of 1 metatarsal; commonly found in every individual – usually not a problem unless inflammation occurs or stress fractures 4A Articular System  Articular System: Joints o Hold bones together but permit movement; point of contact occurs between 2 bones, between cartilage and bone, or between teeth and bones; arthrology = study of joints; kinesiology = study of motion  Classification of Joints: o Based on the presence or absence of a synovial (joint) cavity and type of connecting tissue…  Structural classification (of joints) – fibrous, cartilaginous, and synovial  Functional classifications (based upon movement) – immoveable: synarthrosis; slightly moveable: amphiarthrosis; freely moveable: diarthrosis  Fibrous Joints: o Lack a synovial cavity; bones held closely together by fibrous connective tissue; little or no movement (synarthroses or amphiarthroses); 3 structural types:  Sutures  Syndesmoses  Gomphoses (hold teeth in place)  Fibrous Joints: Sutures – thin layer of dense fibrous connective tissue unites bones of the skull; immovable (synarthrosis); fuse completely in adults and become a synostosis (i.e. frontal bone)  Fibrous Joints: Syndesmosis – bones united by ligament; slightly moveable (amphiarthrosis); ex. anterior tibiofibular ligament and interosseous membrane  Fibrous Joints: Gomphosis – ligament holds cone-shaped peg in bony socket; immoveable (synarthrosis); ex. teeth in alveolar processes  Cartilaginous Joints o Lacks a synovial cavity; allows little or no movement; bones tightly connected by hyaline cartilage or fibrocartilage; 2 types of joints– synchondroses and symphyses (most common one is the pubic symphysis  Cartilaginous Joints: Synchondrosis – connecting material is hyaline cartilage; immoveable (synarthrosis); ex. epiphyseal plate (growing bones) or joints between ribs and sternum (costal (hyaline) cartilage)  Cartilaginous Joints: Symphysis – fibrocartilage is connecting material; slightly moveable (amphiarthroses); ex. intervertebral discs and pubic symphysis  Synovial Joints o General Structure: o 1) Joint Cavity – separates articulating bones o 2) Articular Cartilage – reduces friction, absorbs shock o 3) Articular Capsule – synovial membrane (secretes synovial fluid containing slippery hyaluronic acid allowing joint to move more easily; brings nutrients to articular cartilage; cartilage itself is avascular); fibrous capsule (provides stability and gives it structural strength) o 4) Synovial Fluid – separates articulating bones; joint lubrication; shock absorption; supply oxygen and nutrient to articular cartilage o 5) Accessory ligaments and discs – extracapsular ligament (thickenings of fibrous capsule; MCL for example) and intracapsular ligament (inside the articular capsule) o 6) Articular Discs (menisci) – subdivide the synovial cavity to allow separate movements; allow 2 bones of different shape to fit tightly; increase joint stability; also help with shock absorption to some (debated) extent  Synovial Joint: Articular Capsule o Surrounds a diarthrosis, encloses the synovial cavity, and unites the articulating bones; the articular capsule is composed of two layers:  Outer fibrous capsule (may contain ligaments)  Inner synovial membrane (secretes synovial fluid) o The flexibility of the fibrous capsule permits considerable movement at a joint, whereas its great tensile strength helps prevent bones from dislocating; other capsule features include ligaments (thickening in the fascia) and articular fat pads (fatty deposits that help to protect the joint)  Bursae and Tendon Sheaths: o Bursae – fluid-filled saclike extensions of the joint capsule; reduce friction between moving structures (skin rubs over bone, tendon rubs over bone, and ligament rubs over bone) (ex. greater trochanter bursa sac – trochanter bursitis is common in runners) o Tendon Sheaths – tube-like bursae that wrap around tendons at wrist and ankle where many tendons come together in a confined space; important because they help tendons slide on each other without the constant rubbing o Bursitis – chronic inflammation of a bursa (attempt to protect the joint itself)  Types of Synovial Joints: o Planar Joint – bone surfaces are flat or slightly curved; side to side movement only; rotation prevented by ligaments; ex. intercarpal or intertarsal joints, sternoclavicular joint, vertebrocostal joints between vertebral bodies and ribs o Hinge Joint – convex surface of one bone fits into concave surface of nd 2 bone; uniaxial like a door hinge; ex. knee, elbow, ankle, IP joints; movements produced  Flexion: decreasing the joint angle  Extension: increasing the joint angle  Hyperextension: opening the joint beyond the anatomical position o Pivot Joint – rounded surface of bone articulates with ring formed by 2 nd bone and ligament; monoaxial since it only allows rotation around longitudinal axis; ex. proximal radioulnar joint, supination, pronation, atlanto-axial joint (turning head side to side “no”) o Condyloid or Ellipsoidal Joint – oval-shaped projection fits into oval depression; biaxial = flex/extend or abduct/adduct is possible; ex. wrist and metacapophalangeal joints for digits 2 to 5 o Saddle Joint – one bone is saddle-shaped and the other bone fits as a person would sitting in that saddle; biaxial: (only found in the thumbs)  Circumduction – allows tips of thumb to travel in circle  Opposition – allows tip of thumb to touch tip of other fingers  Ex. trapezium of carpus and metacarpal of the thumb o Ball and Socket Joint – ball fitting into a cuplike depression; multiaxial (flexion/extension, abduction/adduction, and rotation); ex. shoulder joint and hip joint o Common Joint Injuries:  Sprain – injury to the ligament/joint capsule; twisting of joint that stretches or tears ligaments; ex. ankle sprain  Strain – injury to the muscle/tendon; ex. hamstring strain  Grade 1 (mild stretching of the fibers), Grade 2 (increased stretching of the fibers with some structural damage) and Grade 3 (complete rupture)  Dislocation – bones are forced out of their normal positions at joint; ex. shoulder dislocation or fingers  Cartilage damage – tearing of the cartilage; meniscus tear o Osteoarthritis: Degenerative joint disease (aging, wear and tear); Non- inflammatory no swelling – only cartilage is affected not synovial membrane; deterioration of cartilage produces bone spurs (restricts movement); pain upon awakening (disappears gradually with movement) 4B  Selected Joints of the Body  Temporomandibular Joint (TMJ): o Combined hinge and planar joint; formed by the:  Condylar process of the mandible  Mandibular fossa and articular tubercle of the temporal bone  Temporomandibular Joint: synovial joint, articular disc, gliding above disc, hinge below disc, movements (depression, elevation, protraction, and retraction)  Shoulder Joint: ball-and-socket formed by the head of the humerus and the glenoid cavity of the scapula (allows a lot of motion at the expense of stability) o Movements – flexion/extension; abduction/adduction; medial/lateral rotation; circumduction o Rotator cuff injury and dislocation (GH) or separated (AC) shoulder are the most common injuries to this joint  Glenohumeral (Shoulder) Joint – articular capsule from glenoid cavity to anatomical neck; glenoid labrum deepens socket; many nearby bursa (subacromial)  if bursa becomes inflamed, it puts pressure on long head of biceps tendon and can cause a lot of pain  Supporting Structures at Shoulder: AC Joint – associated ligaments strengthen joint capsule; transverse humeral ligament holds biceps tendon in place (unique in that it doesn’t connect two bones but two bony prominences together – greater and lesser tubercles)  Rotator Cuff Muscles – attach the humerus to the scapula; encircle the joint supporting the capsule; hold head of humerus in socket  Elbow Joint: Humeroulnar Joint o Hinge joint formed by the trochlea of the humerus, the trochlear notch of the ulna, and the head of the radius o Movements at this joint are flexion and extension of the forearm o Common Pathologies: tennis elbow (lateral epicondylitis), Golfer’s elbow (medial epicondylitis), dislocation of the radial head (common in youth)  medial lateral epicondyles are a major attachment site for many of the muscles of the forearm o Articular Capsule of the Elbow Joint – radial annular ligament hold head of radius in place; collateral ligaments maintain integrity of joint (damaged in baseball players)  Wrist Joints: o Distal radioulnar joint – pivot, supination/pronation o Radiocarpal joint – condyloid/ellipsoidal; flexion/extension; abduction/adduction; circumduction  Hand Joint: o Intercarpal Joints – gliding o Carpometacarpal (CMC) – gliding o Metacarpophalangeal (MCP) – condyloid; “knuckles;” flexion/extension; abduction/adduction o Interphalangeal (IP) – hinge; flexion/extension  Wrist & Hand Joints  Radial Collateral Ligament: o Attaches from the radial styloid process to the scaphoid bone and a portion of the trapezium bone; limits excessive ulnar deviation  Ulnar Collateral Ligament: o Attaches from the ulnar styloid process to the triquetral bone and the pisiform form; limits excessive radial deviation  Flexor Retinaculum: o Also referred to as the transverse carpal ligament; attaches from the hook of hamate and pisiform (medially) to the tubercle of the trapezium and tuberosity of the scaphoid (laterally); forms the roof of the carpal tunnel  Carpal Tunnel: located on anterior surface of wrist; contents of the tunnel are contained y the flexor retinaculum; anatomical structures of the carpal tunnel: median nerve, finger flexors, flexor pollicis longus 4C  Hip Joint: o 3 major areas  Hip joint proper – head of femur in acetabulum  Sacroiliac joint  Symphysis pubis – junction between pubic bones  Hip Joint Proper: ball-and-socket joint is formed by the head of the femur and the acetabulum of the hip bone; sacrifices mobility for stability; movements at this joint include…  Flexion/extension  Abduction/adduction  Circumduction  Medial and lateral rotation of the thigh o This is an extremely stable joint due to the bones making up the joint and the ligaments and muscles o Hip Joint: head of femur and acetabulum of hip bone; ball and socket type of joint; all types of movement possible because it is a ball-and- socket joint o Hip Joint Structures: acetabular labrum (deepens socket and causes negative pressure to help hold it in place), ligament of the head of the femur, articular capsule  Hip Joint Capsule: o Dense, strong capsule reinforced by ligaments – iliofemoral ligament (two parts; wide ligament), ischiofemural ligament, pubofemural ligament  Hip Joint Ligaments: o Iliofemoral ligament – one of the strongest ligaments in the body; prevents hyperextension o Pubofemoral ligament – pubic portion of acetabular rim to neck of femur; prevents excessive abduction o Ischiofemoral ligament – ischial portion of acetabular rim to neck of femur; prevents hyperextension; weakest of the three hip proper ligaments  All three limit medial rotation of the hip  Sacroiliac (SI) Joint o Synovial (gliding) o Stability – Ligaments: anterior sacroiliac, posterior sacroiliac, sacrotuberous, sascrospinous (ischial spine), iliolumbar o Movements – very limited but does occur; mostly gliding  Symphysis Pubis: o Cartilaginous – symphysis  fibrocartilaginous disc o Stability – ligaments: superior pubic (between pubic crests), arcuate pubic (between inferior pubic rami  Knee Joints: o This is the largest and most complex joint of the body and consists of three joints – tibiofemoral (“true knee joint”), patellofemoral, proximal tibiofibular o Movements at this joint include flexion, extension, slight medial rotation, and lateral rotation of the leg in a flexed position o Some common injuries are rupture of the medial collateral ligament and a dislocation of the knee  Tibiofemoral Joint: o Between femur, tibia, and patella; hinge joint between tibia and femur; gliding joint between patella and femur; flexion, extension, and slight rotation of tibia on femur when knee is flexed o Articular capsule (mostly ligs and tendons); lateral and medial menisci = articular discs; many bursae; vulnerable joint; knee injuries damage ligaments and tendons since bones do not fit together well o Intracapsular Structures of Knee: medial meniscus (C-shaped fibrocartilage); lateral meniscus (nearly circular); posterior cruciate ligament; anterior cruciate ligament  Menisci: o Fibrocartilaginous discs: shock absorbers, provide stability, compensate for lack of geometric congruity, move with tibia in flex/ext; with femur in rotation o Two at “knee joint”  Medial meniscus – “C-shaped,” slip from MCL  Lateral meniscus – nearly circular  Patellofemoral: o Synovial – saddle joint; runs in groove between femoral condyles o Main movement: gliding o Provides increased pull for quadriceps musculature  Patellofemoral Dysfunction (“Runner’s/Jumper’s Knee) o Patellar tracking/ patellar stress syndrome  Weakness of medial musculature; excessive pull of lateral musculature; excessive tension in lateral stabilizing elements (lateral retinaculum, iliotibial band)  Proximal Tibiofibular Joint – synovial vs. fibrous: plane or gliding vs. syndesmosis  Trauma to the Knee: o Anterior cruciate ligament (ACL) ruptures are common (females > males) o Medial collateral ligament (MCL) occur more frequently o Medial meniscal tears occur more often than later o The Unhappy Triad: Injury to all three of these structures (ACL, MCL, Med. Meniscus)  Ankle Region Joints:  Talocrural Joint – “true ankle joint” (the ankle mortise); synovial – hinge (talus sits in mortise – distal tib-fib)  Talus: o Wide anterior – sits in mortise when in neutral/dorsi flexion o Narrow posterior – sits in mortise when in plantar flexion  Talocrural Joint: o Stability: medial, thicker & stronger than lateral ligaments; muscular support o Stability: lateral ligaments – Anterior Talofibular (ATF), Calcaneofibular (CF), Posterior Talofibular (PTF); muscular support  Distal Tibiofibular Joint: Fibrous – syndesmosis; stability: ligaments – Anterior Tibiofibular Ligament, Posterior Tibiofibular Ligament, Strong interosseous membrane  Other Foot Joints: subtalar – inversion/eversion; tarsometatarsal – gliding; intertarsal – gliding; metatarsophalangeal – ellipsoid (sup-pro); interphalangeal – flexion/extension (toes 2-5 – proximal & distal)  Ankle Injuries: o Sprains – most common injuries in sports setting; Lateral (plantar flexion/inversion) more common than medial (eversion) longer lateral malleolus, stronger medial ligaments, and shape of talus  Arthroscopy = examination of joint; instrument is the size of a pencil; remove torn knee cartilages and repair ligaments; small incision only  Arthroplasty = preplacement of joints; total hip replaces acetabulum and head of femur;


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