1.
Joints (Articulations)
Definition: Junctions between two or more bones, enabling movement or stability.
Classification:
• Structural:
• Fibrous: Bones joined by dense connective tissue (e.g., sutures of the skull).
• Cartilaginous: Bones united by cartilage.
• Primary (synchondrosis): Temporary (epiphyseal plate).
• Secondary (symphysis): Permanent (pubic symphysis).
• Synovial: Most mobile joints. Enclosed in a capsule with synovial fluid.
• Functional:
• Synarthroses: Immovable
• Amphiarthroses: Slightly movable
• Diarthroses: Freely movable
Synovial Joint Anatomy:
• Articular cartilage
• Joint (synovial) cavity
• Synovial fluid (lubrication and nutrient medium)
• Fibrous joint capsule
• Synovial membrane (produces fluid)
• Accessory structures: ligaments, tendons, bursae, menisci
Clinical Correlations:
• Osteoarthritis
• Rheumatoid arthritis
• Joint dislocation and sprain
2. Median Nerve
Origin: From the lateral and medial cords of the brachial plexus (C5–T1).
Course:
• Travels with the brachial artery in the arm
• Enters forearm through the cubital fossa
• Passes between two heads of pronator teres
• Travels beneath flexor digitorum superficialis
• Enters hand via the carpal tunnel
Motor Innervation:
• Forearm: Pronator teres, FCR, palmaris longus, FDS, part of FDP, FPL, pronator quadratus
• Hand: Thenar muscles (OP, APB, FPB), first and second lumbricals
Sensory Innervation:
• Lateral palm and palmar side of thumb, index, middle, and half of ring finger
• Dorsal distal tips of same fingers
Clinical:
• Carpal Tunnel Syndrome: Entrapment under flexor retinaculum
• Pronator Syndrome: Compression in forearm
• Ape hand deformity: Thenar atrophy due to prolonged injury
3. Sciatic Nerve
Origin: Lumbosacral plexus (L4-S3)
Course:
• Exits pelvis via greater sciatic foramen below piriformis
• Descends posterior thigh deep to biceps femoris
• Divides near popliteal fossa into tibial and common fibular nerves
Motor Supply:
• Hamstring muscles (except short head of biceps femoris)
• All muscles of leg and foot via branches
Sensory Supply (via branches):
• Posterior thigh, leg, sole, lateral foot
Clinical:
• Sciatica: Nerve irritation causing radiating pain
• Piriformis Syndrome: Compression within gluteal region
• Iatrogenic Injury: Improper gluteal injections (avoid lower medial quadrant)
4. Deltoid Muscle
Origin:
• Anterior: Lateral third of clavicle
• Middle: Acromion
• Posterior: Spine of scapula
Insertion: Deltoid tuberosity of humerus
Function:
• Anterior: Flexion and medial rotation of arm
• Middle: Abduction (primary)
• Posterior: Extension and lateral rotation
Innervation: Axillary nerve (C5-C6)
Blood Supply: Posterior circumflex humeral artery
Clinical:
• Injury to axillary nerve: Common in shoulder dislocations or surgical neck fractures
• Intramuscular injections: Done in central thick portion
5. Brachial Artery
Origin: Continuation of axillary artery at lower border of teres major
Course:
• Runs medial to humerus and brachial vein
• At cubital fossa, divides into radial and ulnar arteries
Branches:
• Profunda brachii (deep artery of arm)
• Nutrient artery to humerus
• Superior/inferior ulnar collateral arteries
Clinical:
• Pulse palpated medially in cubital fossa
• Compression can reduce hemorrhage in arm
• Common site of arterial cannulation in infants
6. Gluteus Maximus
Origin: Posterior ilium, dorsal sacrum, coccyx, sacrotuberous ligament
Insertion:
• Iliotibial tract (major part)
• Gluteal tuberosity (minor part)
Function:
• Extends and laterally rotates thigh
• Stabilizes hip joint and pelvis
Innervation: Inferior gluteal nerve (L5-S2)
Blood Supply: Superior and inferior gluteal arteries
Clinical:
• Gluteal injections: Done in upper outer quadrant to avoid sciatic nerve
• Paralysis causes difficulty rising, climbing stairs
7. Femoral Artery
Origin: Continuation of external iliac artery under inguinal ligament
Course:
• Through femoral triangle (NAVL: Nerve, Artery, Vein, Lymphatics)
• Through adductor canal and hiatus
• Becomes popliteal artery
Branches:
• Superficial circumflex iliac
• Superficial epigastric
• Profunda femoris (deep artery of thigh)
• Lateral/medial femoral circumflex arteries
Pulse: Palpable below inguinal ligament midway between ASIS and pubic symphysis
Clinical:
• Artery access for coronary angiography
• Injury in femoral triangle leads to rapid bleeding
8. Hamstring Muscles
Components:
• Biceps Femoris (long & short head)
• Semitendinosus
• Semimembranosus
Origin: Ischial tuberosity (except short head of biceps: linea aspera)
Insertion:
• Biceps femoris: Head of fibula
• Semitendinosus: Medial tibia (pes anserinus)
• Semimembranosus: Posterior tibial condyle
Function:
• Hip extension (except short head)
• Knee flexion
• Assist in medial/lateral rotation of leg
Innervation:
• Tibial part of sciatic nerve (long head, semis)
• Common fibular nerve (short head)
Clinical:
• Prone to strains/tears in athletes
• Avulsion fractures at ischial tuberosity in adolescents
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