Monday, 17 November 2014

Subclavius muscle Detail :

Subclavius muscle:-

The subclavius is a small triangular muscle, placed between the clavicle and the first rib. Along with the pectoralis major and pectoralis minor muscles, the subclavius muscle makes up the anterior wall of the axilla.
 

Structure:-

It arises by a short, thick tendon from the first rib and its cartilage at their junction, in front of the costoclavicular ligament.

The fleshy fibers proceed obliquely superolaterally, to be inserted into the groove on the under surface of the clavicle between the trapezoid ligament and conoid ligaments, which collectively form the coracoclavicular ligament.
 

Innervation:-

The nerve to subclavius (or subclavian nerve), which arises from the point of junction of the fifth and sixth cervical nerves, where is called the upper trunk of brachial plexus, innervates the muscle .
Variation:-


Insertion into coracoid process instead of clavicle or into both clavicle and coracoid process. Sternoscapular fasciculus to the upper border of scapula. Sternoclavicularis from manubrium to clavicle between pectoralis major and coracoclavicular fascia.
 

Function:-


The subclavius depresses the shoulder, carrying it downward and forward. It draws the clavicle inferiorly as well as anteriorly.

The subclavius protects the underlying brachial plexus and subclavian vessels from a broken clavicle - the most frequently broken long bone.


Origin:-
    first rib and cartilage
 

Insertion:-
    subclavian groove of clavicle (inferior surface of middle third of clavicle)
 

Artery:-
    thoracoacromial trunk, clavicular branch
 

Nerve:-
    nerve to subclavius
 

Actions:-     depression of clavicle.

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Saturday, 15 November 2014

The Sternocleido-Mastoid Muscle Detail

The sternocleidomastoid  muscle:-

   In human anatomy, the sternocleidomastoid muscle also known as sternomastoid and commonly abbreviated as SCM, is a paired muscle in the superficial layers of the anterior portion of the neck; it is one of the largest and most superficial cervical muscles.


Structure:-The sternocleidomastoid passes obliquely across the side of the neck.

It is thick and narrow at its central part, but broader and thinner at either end.

    The medial or sternal head is a rounded fasciculus, tendinous in front, fleshy behind, which arises from the upper part of the anterior surface of the manubrium sterni, and is directed superiorly, laterally, and posteriorly.

    The lateral or clavicular head, composed of fleshy and aponeurotic fibers, arises from the superior border and anterior surface of the medial third of the clavicle; it is directed almost vertically upward.

The two heads are separated from one another at their origins by a triangular interval (supraclavicular fossa) but gradually blend, below the middle of the neck, into a thick, rounded muscle which is inserted, by a strong tendon, into the lateral surface of the mastoid process, from its apex to its superior border, and by a thin aponeurosis into the lateral half of the superior nuchal line of the occipital bone.usculus sternocleidomastoideus

Origin:-
    Manubrium sterni and medial portion of the clavicle
 

                                              Insertion:-
 
Mastoid process of the temporal bone, superior nuchal line

Artery:-
  
Occipital artery and the superior thyroid artery
 

Nerve:-    Motor: accessory nerve
                       sensory: cervical plexus

Actions:-     Unilaterally; cervical rotation to opposite side, 
                            cervical lateral flexion to same side
                         Bilaterally; cervical flexion, raises the sternum and assists in forced inspiration.


Related Post :


Deltoid And Other Muscle

TRAPEZIUS MUSCLE:-

TRAPEZIUS MUSCLE:-
Trapezius Muscle Area

In human anatomy, the trapezius is a large superficial muscle that extends longitudinally from the occipital bone to the lower thoracic vertebrae and laterally to the spine of the scapula (shoulder blade). Its functions are to move the scapulae and support the arm.

The trapezius has three functional regions: the superior region (descending part), which supports the weight of the arm; the intermediate region (transverse part), which retracts the scapulae; and the inferior region (ascending part), which medially rotates and depresses the scapulae.Structure

STRUCTURE:-
The trapezius muscle resembles a trapezium (trapezoid in American English), or diamond-shaped quadrilateral. The word "spinotrapezius" refers to the human trapezius, although it is not commonly used in modern texts. In other mammals, it refers to a portion of the analogous muscle.
Position of trapezius and its parts.
  Superior fibers of the trapezius
  Middle fibers of the trapezius
  Inferior fibers of the trapezius

The superior or upper (or descending) fibers of the trapezius are formed from the external occipital protuberance, the medial third of the superior nuchal line of the occipital bone (both in the back of the head), the ligamentum nuchae, and the spinous processes of C1-C7. From this origin they proceed downward and laterally to be inserted into the posterior border of the lateral third of the clavicle.

The middle fibers, or transverse of the trapezius arise from the spinous process of the seventh cervical (both in the back of the neck), and the spinous processes of the first, second, and third thoracic vertebrae. They are inserted into the medial margin of the acromion, and into the superior lip of the posterior border of the spine of the scapula.

The inferior or lower (or ascending) fibers of the trapezius arise from the spinous processes of the remaining thoracic vertebrae (T4-T12). From this origin they proceed upward and laterally to converge near the scapula and end in an aponeurosis, which glides over the smooth triangular surface on the medial end of the spine, to be inserted into a tubercle at the apex of this smooth triangular surface.

At its occipital origin, the trapezius is connected to the bone by a thin fibrous lamina, firmly adherent to the skin. The superficial and deep epimysia are continuous with an investing deep fascia that encircles the neck and also contains both sternocleidomastoid muscles.

At the middle, the muscle is connected to the spinous processes by a broad semi-elliptical aponeurosis, which reaches from the sixth cervical to the third thoracic vertebræ and forms, with that of the opposite muscle, a tendinous ellipse. The rest of the muscle arises by numerous short tendinous fibers.

Origin:- external occipital protuberance, nuchal ligament, medial superior nuchal line, spinous processes of vertebrae C7-T12
Insertion:-posterior border of the lateral third of the clavicle, acromion process, and spine of scapula
Artery:-
    superficial branch of transverse cervical artery or superficial cervical artery
Nerve:-
    accessory nerve (motor)
cervical spinal nerves C3 and C4 (motor and sensation)
Actions:-     rotation, retraction, elevation, and depression of scapula


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Friday, 14 November 2014

Deltoid Muscle Detail :

Deltoid Muscle :

In human anatomy, the deltoid muscle is the muscle forming the rounded contour of the shoulder.
Anatomically, it appears to be made up of three distinct sets of fibers though electromyography suggests that it consists of at least seven groups that can be independently coordinated by the central nervous system.

It was previously called the deltoideus (plural deltoidei) and the name is still used by some anatomists. It is called so because it is in the shape of the Greek letter Delta (triangle). It is also known as the common shoulder muscle, particularly in lower animals (e.g., in domestic cats). Deltoid is also further shortened in slang as "delt".

A study of 30 shoulders revealed an average mass of 191.9 grams (6.77 oz) (range 84 grams (3.0 oz)–366 grams (12.9 oz)) in humans.


Origin: 
(proximal attachments)
a. Anterior head: anterior surface of the lateral clavicle.
b. Middle head: acromion process and spine of the scapula.

insertion:

(distal attachments)
a. Deltoid tuberosity of the humerus.


Actions:

Anterior head:
a. Flexes the arm at the shoulder.
b. Medially rotates the arm at the shoulder.
Middle head:
a. Abducts the arm at the shoulder.



 




Nerve supply:
a. Nerve: Axillary nerve
b. Nerve roots: C5 and C6


Action :


Abduction Of Sholder ( Middle Fiber )
Flextion Of Sholder ( Anterior Fiber )
Extension Of Sholder ( Posterior Fiber )

Strenthening Exercise Video On Youtube :






Applied Anatomy :
  
Rupture of the deltoid muscle
       
Diagnosis:     RUPTURE OF THE DELTOID MUSCLE
(Ruptura M deltoideus)

Anatomy: The large Deltoid muscle (M Deltoideus) is a thick triangular muscle, emanating around the shoulder, covering the shoulder joint and forming the rounding of the shoulder. The muscle is fastened on the humerus. The various parts of the deltoid muscle take part in nearly all movements of the shoulder jo
int.
SHOULDER AND UPPER ARM MUSCLES FROM THE FRONT

Cause: When a muscle is subjected to a load beyond the strength of the muscle (butterfly swimming, weight training, weight lifting) a rupture occurs. Most ruptures in athletes are partial ruptures. The rupture can be located both in the front and the back as well as at the attachment to the upper arm (humerus).

Symptoms: In light cases a localised tenderness can be felt following the load (“muscle strain”, “imminent pulled muscle”). In more severe cases sudden shooting pains in the muscle can be felt (“partial muscle rupture”) and in the worst cases a sudden snap is felt, rendering the muscle unusable (“total muscle rupture”) this is very rare, and is almost only seen in conjunction with other damage in the shoulder. With muscle injuries the following three symptoms are characteristic: pain upon pressure, stretching and activating against resistance.

Acute treatment: Acute treatment starts as quickly as possible after the injury has been incurred. The objective of the acute treatment is primarily to prevent additional injury and reduce bleeding as much as possible. Effective acute treatment will reduce bleeding, formation of scar tissue, the number of complications, which can arise, and the rehabilitation period.
Treatment follows the so-called "RICE" principles:                                                                               R;-
   Continued sports activity is immediatel  stopped(Rest)                                                     As soon as is possible, Ice should be placed on the injured area. The cold ice makes the blood vessels contract, thereby stopping the bleeding. Cold spray has no effect in such circumstances. The ice must not come into direct contact with the skin, which should be covered with a thin layer of, for example, elastic bandage. Ice treatment should be given for twenty minutes in each of the first three hours after injury.

 I:- As far as is possible the treatment should furthermore comprise:                                              

C-:   A Compression bandage should be applied, however, must not be so tight as to prevent the blood flow. The compression bandage should be removed at night, but applied again each morning until the swelling goes down. The effect of the compression can be enhanced if a piece of felt, for example, of approx. one cm. thickness is placed under the bandage and directly above the haemorrhaging.                                                                                                                                             
E:-  The injured area is kept as high as possible, and preferably above the heart (Elevation). The haemorrhaging will stop when it comes above the level of the heart. Elevation of the affected area should be performed as much as possible as long as swelling is in evidence.



Examination: Light cases with only minimal tenderness and no discomfort when using the arm do not necessarily require medical examination. The extent of the tenderness is, however, not always a mark of the degree of the injury. In case of more pronounced tenderness medical examination is advised with the aim of securing a correct diagnosis and treatment. Pain will be present when pressure is applied to the damaged muscle, which will be aggravated when the muscle is activated against resistance and when the muscle is stretched. Ultrasound is well suited to ensure the diagnosis.

Treatment: The treatment primarily involves relief, discontinuance of the injury inducing activity, stretching and increasing fitness training.

Rehabilitation: INSTRUCTION
GENERAL STEP1 STEP2 STEP3 STEP4
Complications: If satisfactory progress is not made, a physician should be consulted to ensure that the diagnosis is correct and that no complications have arisen. Amongst others the following should be considered:

    Rupture of the upper shoulder blade muscle
    Inflammation of the upper shoulder blade muscle
    Rupture of the lower shoulder blade muscle
    Tendon sheath inflammation of the biceps
    Luxation in the joint between the shoulder blade and the collarbone
    Partial luxation in the shoulder joint
    Frozen shoulder
    Muscle infiltrations
    Sprained shoulder (distorsio art. humeroscapularis)
    Meniscus lesion in the shoulder (laesio labrum glenoidale)
    Impingement
    Nerve entrapment on the back of the shoulder blade


Related Post :


Sternocleidomustoid Muscle




Saturday, 20 September 2014

CERVICAL SPONDYLOSIS

CERVICAL SPONDYLOSIS
Cervical spondylosis is usually an age-related condition that affects the joints in your neck. It develops as a result of the wear and tear of the cartilage and bones are of the cervical spine. While it is largely due to age, it can be caused by other factors as well. Alternative names for it include cervical osteoarthritis and neck arthritis.

Spending hours bent over a computer or laptop or carrying heavy handbags can often have us reaching for the back of our neck, massaging it for some form of pain relief.


What is cervical spondylosis? 


Cervical spondylosis is another name for osteoarthritis in the joints of the vertebrae in the neck. This means that it is a degenerative disease where bony surfaces, in this case in the cervical vertebrae, have lost their cartilage lining. If there is inflammation of the joint associated with this degeneration, one would use the term, spondylitis to describe it.

the discs–that lie between successive vertebrae. Just as a degenerated joint alone will produce some symptoms of its own, a degenerated will be responsible for some, possibly different, complaints too.

Who can suffer from it? What predisposes people to this condition?

Changes will be seen on x-ray in anyone who is around 50 years of age. Changes are seen earlier and to a greater degree in those whose joints have been subjected to strain more than usual. Strain could be owing to excessive body weight, the spinal column being a weight-bearing structure, poor muscle tone or bad posture, and there is, of course, a genetic predisposition to this disease. Arthritis tends to run in families.


Symptoms


Neck and shoulder pain are the most common symptoms. Types of neck and shoulder pain include:

  • Stiff neck, most often one of the very first signs. 
  • Neck stiffness tends to grow progressively worse over time.
  •     Radiating pain to the bottom of the skull and/or to the shoulder and down the arm. This radiating pain may seem like a stabbing or a burning, or it might present itself as a dull ache.

Along with pain, cervical spondylosis can be accompanied by parathesias and muscle weakness in the neck, shoulders, arms and hands, and a syndrome called “numb, clumsy hands”. In cases of cervical spondylosis with myelopathy, the legs may be affected, leading to an interruption of stability while walking. Loss of balance might also occur. When myelopathy is present, incontinence may become a problem. Muscle wasting also accompanies cervical spondylosis with myelopathy.

How can one prevent the onset of the condition?

The onset of osteoarthritis can be slowed down with

  •     Weight loss
  •     Exercises specific to the joint is question so that the transmission of weight through it is more balanced
    Intake of a balanced diet, in terms of the calorific and protein intake, and one which provides anti-oxidants (vitamins and minerals) in sufficient quantity. I recommend fish, fresh fruits and milk/yoghurt to one and all.
    Ensuring that the joints (in the neck in this case) are not subjected to persistent and repetitive strain and stress, which means that one should take frequent breaks, and perhaps stretch a little, while one is to work
    There are some medicines which will make the cartilage lining stronger, and if the treating doctor deems fit, they can be tried, in addition. Such medicines are of no help in advanced disease when there is no cartilage left to strengthen. And hope for the best!


DIAGNOSIS
Doctors diagnose cervical spondylosis by means of neck flexibility tests and imaging techniques.

Neck flexibility tests are used to identify any instability that may be present in the neck. The tests include:

  •    Tilting head to either side,
  •     Rotating head to either side


An x-ray of the Cervical Spine is usually enough to confirm the diagnosis of spondylosis/spondylitis, if suspected.

 
 When the patient presents to him, the doctor will take a detailed history and conduct a thorough clinical examination, and will, once in a while, order more tests like an MRI to look for the effects of the spondylosis in structures that don’t show up on x-ray, and to correlate the changes and effects with the patient’s symptoms.

degenerative changes seen on x-ray.

Other imaging diagnostics include:

    MRIs – Particularly useful for viewing the condition of the spinal nerves and the spinal cord. MRIs take pictures from many angles.
    CT scans provide good views of the bones, especially where they encroach on nervous tissue due to their reshaping over time.

MYELOGRAM
  This imaging technique enhances the visibility of x-rays. They are especially good for seeing problems located at nerve roots.
Physiotherapy and exercises remains the mainstay of treatment. Physiotherapy is safe and reduces inflammation and pain; exercises keep your joints moving.

Risk Factors for Cervical Spondylosis

Cervical spondylosis is common in people who have had neck injuries. Below is a list of common pre-cursors to neck arthrtis relevant to active people:

  •     Carrying axial loads on your head (for example, carrying a heavy surfboard down the beach to the waves)
  •    Professional dancing
  •     Professional gymnastics.

For more typical cases of neck arthritis, congenital, genetic and acquired risk factors have been identified by researchers. You might consider that:

    Neck arthritis, like some other types of back problems, may run in families.
    A congenitally narrow spinal canal increases the risk of developing cervical spondylosis with myelopathy. With a narrow spinal canal, the spinal cord -- a very sensitive structure that relays feelings to the brain and movement commands from the brain to the muscles -- has less space to fit inside the column of bone it occupies.

    Narrowing of the spinal canal can also be caused by thickening of spinal ligaments and bone; although these are age related changes, they have the same effect as congenital narrowing.

Treatment of neck arthritis (cervical spondylosis) generally aims to reduce pain and irritation to spinal cord and nerves, while also improving activities of daily living. Treatment modalities may include:

  •     Use of a neck brace to immobilize the neck
  •     Medication
  •    Physical therapy
  •     Possible traction and epidurals, depending on the findings from diagnostic imaging tests.

It is time to seek medical help for cervical spondylosis when:

  •     your over-the-counter pain mediation does not keep your pain at bay
  •     your pain continues to worsen
  •     your arms and/or legs develop numbness
  •     you experience weakness
  •     you experience bowel or bladder incontinence

Cervical traction can be used for a variety of purposes. It can be used to help decrease compressive forces in the neck, which can help take pressure off of the discs that reside between the vertebrae (spinal bones) in the neck. It can also open up the spaces where nerves exit the spinal canal, which can help relieve pressure off of a compressed nerve. Traction can also help stretch the muscles and joint structures around the neck.


PHYSIOTHERAPY TREATMENT


Heat Modalities

Heat is an effective mean of reducing and relieving pain in cervical osteoarthritis. The modalities that can be used are:-


a)Hot packs for moist heat.


b)SWD (pulsed or continous) for dry heat.

Once the pain subside to a tolerable limit, then exercises should be started and progressed gradually according to the conditions and requirements of the patient.

Static Contractions and Strengthening Exercises

Isometric contractions of the cervical muscles improve the muscle endurance and tone as the contractions improve the blood supply thereby the nutrition to the muscle is increased and hence muscle strengthening is done.


The basic technique of this exercise is that both Physiotherapist and patient exert equal pressure so that static; non dynamic action takes place in the cervical muscles. During all the movements, shoulder girdle should be stabilised so as to avoid trick movements. The pressure can be applied by the physiotherapist or by the patient himself after teaching him the technique properly.

Soft tissue technique

Kneading helps to release tightness of upper fibre of trapezius. Picking up, wringing and skin rolling also helps in relieving the tightness of scalene muscles, interspinous ligaments, paravertebral muscles and trapezius.

Traction

Oscillatory traction is considered to be effective in mobilizing the stiff neck. Continuous traction is used to relieve nerve root pressure.

Traction is always given in comfortable position with minimum weight which should be graduated slowly as for the patient's recovery. This depends on the frequency of remissions and exacerbations of the condition. It can be given in sitting or lying position. The traction can be given either in the form of manual traction or positional traction.

Hydrotherapy

Postural Awareness

As the condition progresses, the abnormality of posture also increases, thus from the initial stage itself, postural awareness through proper advice and education should be planned and initiated by the physiotherapist.

The ideal posture is straight neck with chin tucked in and back straight with no compensatory actions or any trick movements. While sitting a high backed chair is provided to the patient with head, neck and shoulder supported; a small pillow in the lumbar spine, feet properly supported and arms resting on a pillow over the lap or on the arms of the chair.

While sleeping, side lying is the most preffered position, supine lying is also adviced. A single pillow under head for head support is allowed. A Butterfly pillow is the best support for a patient

Support

Support for the neck are of great importance to keep the neck steady and to relieve the pain. A firm neck collar is very beneficial especially during activities or during travelling. While patient is resting or sitting, the collar should be removed but then also the neck should be supported by pillows or head rest.

Relaxation

Due to pain and spasm of cervical muscle, patient is always in discomfort and uneasiness. So to alleviate these undesirable situations, relaxation techniques are taught in various positions that is during rest, work or play.

While lying on bed, patient is adviced to loosen his entire body and stretch for few times so as to reduce the muscular tension to a minimum. While relaxing the whole body should be fully supported by pillows. He is then encouraged to think of something pleasent which will facilitate comfortable and relaxed sleep.