A course manual in laboratory anatomy for physical therapy students

Citation preview

A COURSE MANUAL IN LABORATORY ANATOMY FOR PHYSICAL THERAPY STUDENTS

A Project Presented to the Faculty of the School of Education The University of Southern California

In Partial Fulfillment of the Requirements for the Degree Master of Science in Education

by Genevieve Lescsak January 1950

UMI Number: EP45931

All rights reserved INFO RM A TIO N TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion.

Dissertation Publishing

UMI EP45931 Published by ProQuest LLC (2014). Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code

ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 4 8 1 0 6 - 1346

fed 1s'O LCp'&y This project report, w ritten under the direction o f the candidate’s adviser and app ro ved by h im , has been presented to and accepted by the F a c u lty o f the School o f Ed u catio n in p a r t ia l fu lfillm e n t of the requirements f o r the degree

of M a s t e r of

Science in Education.

Date..............................

A d v is e r

Dean

ii TABLE OF CONTENTS CHAPTER

PAGE

PART I. THE INTRODUCTION HOW TO GET THE MOST OUT OF LABORATORY ANATOMY 1.

THE APPLICATION:

HOW TO APPLY LABORATORY ANATOMY

TO CLINICAL U S E ............................. A.

MOTIVATION:

3

Values which you may expect if

you "begin now to apply your laboratory work to real clinical situations • • • . . • • • . . B.

DIRECTIONS:

3

Guiding principles and techniques

for applying laboratory anatomy to clinical use . . . . . . .

.........

1.

How to get the most out of

FIELD TRIPS:

. . . . . . . . . .

your observation. • • • • . . . . . • • • • 2.

CLASSROOM SUGGESTIONS:

3

3

How to utilize"

your laboratory dissection and your work in other related courses. . . C.

ACTIVITY ASSIGNMENTS:

.............

4

Suggested projects to

help you make laboratory anatomy applicable to clinical use • • • • • • . D.

EVALUATION:

...........

...

5

A sample evaluation instrument

that may be employed In relation to applying anatomy to the clinic . . . . . . . 2.

THE STUDENT: A.

...........

HOW TO STUDY FOR LABORATORY ANATOMY

MOTIVATION:

6 8

Rewards to be gained from sound

methods of study................................

8

iii CHAPTER B.

PAGE DIRECTIONS;

Suggestions for making anatomy

a course that will be the mainstay of your training 1,

3

ASSIGNMENTS;

How to proceed from day to

d a y ................................... . 2.

STUDY AIDS;

How to insure your daily

progress C.

9

ACTIVITY ASSIGNMENTS;

Projects to perfect

your ability to study for laboratory anatomy D.

EVALUATION;

3

13

Samples of some evaluation tech­

niques that may be employed to check your mastery of study habits 5.

THE COURSE; A.

............. 13

HOW TO PREPARE FOR LABORATORY WORK

MOTIVATION;

16

Gains that accrue from good plan­

ning and forethought concerning the work to be done in the laboratory • B.

DIRECTIONS;

Helpful hints to follow in pre­

paring for your work in the laboratory . . . . 1.

16

YOUR CLOTHES;

16

How to protect your wearing

apparel in the laboratory. . . . . . . . .

16

2.

YOUR HANDS;

17

3.

YOUR CADAVER;

How to provide for their care How to maintain the useful­

ness of your dissection body . . . . . . .

17

iv CHAPTER

PAGE 4.

YOUR INSTRUMENTS:

How to secure the ne­

cessary tools for dissection and how to care for t h e m .......... .. C.

ACTIVITY ASSIGNMENTS:

18

Suggested projects to

determine the exact extent of your mastery of laboratory preparation . . . . . . . . . . . D.

EVALUATION:

19

A sample evaluation technique

which may be applied to check your knowledge of laboratory preparation . . .

..............

19

PART II. THE UPPER LIMB HOW TO DISSECT THE UPPER EXTREMITY 4.

THE UPPER BACK AND SHOULDER GIRDLE:

HOW TO DIS­

SECT THE'PROXIMAL ASPECT OF THE UPPER EXTREMITY . A.

MOTIVATION:

83

Benefits that will be yours if

you plan your attack wisely in this area of dissection. . . . . . . . . . . . . . . . . . B.

DIRECTIONS:

83

Guiding steps in performing the

dissection of the upper back and shoulder g i r d l e ......................................... S3 1.

THE UPPER BACK AND POSTERIOR SHOULDER: How to proceed with your dissection in this area

S.

THE ANTERIOR SHOULDER:

S3 How to dissect the

pectoral region • • • • • • • • • • • • .

S7

CHAPTER

PAGE 3.

THE AXILLARY REGION:

How to explore the

complexed structures of this area . . . . C.

ACTIVITY ASSIGNMENTS:

29

Suggested learning ex­

periences to enhance what you have gained in this chapter. • D.

EVALUATION:

30

A sample evaluation instrument

which may be employed in relation to this chap­ ter 5.

..........

THE ARM AND FOREARM:

30

HOW TO DISSECT THE MIDDLE

ASPECT OF THE UPPER E X T R E M I T Y ...................... 32 A.

MOTIVATION: .Advantages to be obtained by a careful exploration of the arm and forearm. .

B.

DIRECTIONS:

Procedures to be followed in ex­

ploring the arm and forearm . . . . . . . . . 1.

THE ANTERIOR ARM:

THE POSTERIOR ARM:

..........

THE ANTERIOR FOREARM:

THE POSTERIOR FOREARM:

ACTIVITY ASSIGNMENTS:

35

How to dissect the

back of the lower arm . . . . . . . . . . C.

34

How to dissect the

front of the lower arm. . • • • • . . • • 4.

32

How to dissect the

back of the arm 3.

32

How to dissect the

front of the arm. • • • • » • • • • . . . 2.

32

38

Projects to aid you in

making practical application of the material you have learned in this chapter............... 40

vi CHAPTER D.

PAGE EVALUATION:

A sample evaluation instrument

which you may use to check your mastery of arm and forearm dissection. . . . . . . . . . 6.

THE HAND:

41

HOW TO DISSECT THE DISTAL ASPECT OF

THE UPPER E X T R E M I T Y ................................ 42 A.

MOTIVATION:

Outcomes that you may expect"

following the successful completion of hand dissection. . . • « • . • • • • • • • • • • • B.

DIRECTIONS:

Key steps to follow in progress­

ing with hand dissections • • . . . • • • , . 1.

THE DORSAL SURFACE OF TEE HAND: proceed step by step

2.

42

How to

. . . . . . . . . .

THE VOLAR SURFACE OF THE HAND:

42

42

How to

continue your dissection of the palmer aspect..................... 0.

ACTIVITY ASSIGNMENTS:

44

Proposed projects to

help your perfect your accomplishments in hand dissection. • • • • • • • • • • • • • • • • • D.

EVALUATION:

48

A sample of one way in which your

mastery of hand dissection may be checked . .

48

PART III. THE LOWER LIMB HOW TO DISSECT THE LOWER EXTREMITY 7.

THE HIP AND THIGH:

HOW TO DISSECT THE PROXIMAL

ASPECT OF THE LOWER EXTREMITY

52

vii CHAPTER A.

PAGE MOTIVATION;

Benefits which you may experience

following a thorough exploration of the hip and thigh, • • • • • • • • • • . • • . . . . . B.

DIRECTIONS;

52

Procedures to he followed in dis­

secting the hip and t h i g h * ................ 1.

THE HIP:

How to explore the gluteal reg­

ion 2.

. ................... 52

THE POSTERIOR THIGH;

How to dissect the

back of the thigh and the popliteal space 3.

52

THE ANTERIOR THIGH:

56

How to dissect the

front of the thigh . . . . . . . . . . . . . ' 5 7 4.

THE MEDIAL THIGH:

How to dissect the in- .

ner aspect of the thigh. C.

ACTIVITY ASSIGNMENTS:

............... 60

Projects to help you

master the anatomy of the hip and thigh. . . . D.

EVALUATION:

62

Samples of some evaluation tech­

niques that may be used to check your under­ standing of this chapter • • • • • • • . . . . 8.

THE LEG:

HOW TO DISSECT THE MIDDLE ASPECT OF THE

LOWER EXTREMITY. . . . . . . . . . . . A.

62

MOTIVATION:

............

64

Outcomes of lower extremity dis­

section that may enhance your professional ability as a physical therapist. • • • • . • • B.

DIRECTIONS:

64

Points to follow in exploring the

l e g ............................................. 64

viii CHAPTER

PAGE 1.

THE ANTERIOR LEG:

How to proceed with the

investigation of the structures of this area 64 2. C.

THE POSTERIOR LEG:

ACTIVITY ASSIGNMENTS:

How-to explore the calf Projects to help you mas­

ter the anatomy of the leg, . . . . . . . . . . D.

EVALUATION:

Samples

66

67

of ways in which you may

check your knowledge of the work covered in this chapter. 9.

THE FOOT:











..............

. . . . . . . . . . 6 8

HOW TO DISSECT THE DISTAL ASPECT OF THE

LOWER EXTREMITY................. A.

MOTIVATION:

70

Rewards that you may enjoy follow­

ing the careful dissection of the f o o t B.

DIRECTIONS:

The steps necessary to complete the

investigation of the foot. 1.

70

.............. 70

THE DORSAL SURFACE OF THE FOOT:

How to dis­

sect the structures in this area . • . . . . 7 0 2.

THE PLANTAR SURFACE OF THE FOOT:

How to dis­

sect the structures of this- area . . . . . . C.

ACTIVITY ASSIGNMENTS:

72

Projects suggested to

help you master the material in this chapter . . 74 D.

EVALUATION:

Samples of ways in which you may

check your knowledge of the work covered in this section ...........

. . . . . . . . . . . . 7 4

ix CHAPTER

PAGE PART IV. THE TRUNK HOW TO DISSECT THE TORSO

10s

THE BACK: A.

HOW TO DISSECT THE POSTERIOR TRUNK . . 79

MOTIVATION:

The advantages .of making a sound

analysis of the hack EB.

DIRECTIONS:



..........

79

Key steps to follow in proceed­

ing with the dissection in this region . . . .79 1.

THE SUPERFICIAL BACK MUSCLES:

How to

complete the dissection of the outer layer of muscles 2.

. . . . . . . . . . . . 7 9

THE DEEP BACK MUSCLES: the,erector spinae group

C.

ACTIVITY ASSIGNMENTS:

How to explore . . . . . . . .

Suggested projects to

perfect your ability in back dissection . . . D.

EVALUATION:

80

83

A sample of an evaluation tech­

nique that may be employed to check your mastery of this chapter « ........... 11.

THE ABDOMINAL AREA: TRUNK . . . . . . . A.

MOTIVATION:

. . . . 8 4

HOW TO DISSECT THE ANTERIOR .

Values

............ . . . . . .

. . 85

to be gained by a care­

ful exploration of the anterior trunk . . . . B.

DIRECTIONS:

Points

85

to follow in exploring

the anterior t r u n k ........................... 35 1.

THE SUPERFICIAL AREA OF THE ABDOMEN:

How

to dissect the external section ........

85

X

CHAPTER

PAGE 2,

THE DEEP AREA OF THE AB&OMEN:

How to ex­

plore ..the internal section of the anterior trunk C.

....................38

ACTIVITY ASSIGNMENTS your understanding

D.

EVALUATION:

Projects to perfect

ofabdominalexploration

. 89

A sample evaluation techniques

which may be- applied to abdominal expibration B I B L I O G R A P H Y ............

90 91

xi FIGURES

PAGE LIST OF FIGURES 10

1.

DEMONSTRATING MUSCLE ACTION...........

2.

DIAGRAMATIC DRAWING. . . ........................ 12

3.

MUSCLE CORD. .

4.

BACK AND POSTERIOR SHOULDER I N C I S I O N .......... 24

5.

ANTERIOR SHOULDER INCISION

6.

ANTERIOR ARM INCISION...........

33

7.

DORSAL HAND INCISION

43

8.

HIP AND POSTERIOR THIGH INCISION

9.

ANTERIOR AND MEDIAL THIGH INCISION . . . . . . .

.................................. 14

..................... 28

.............. .

53 59

10.

ANTERIOR LEG AND FOOT INCISION . . ............. . 6 5

11.

PLANTAR FOOT INCISION............................. 7 3

12.

ANTERIOR TRUNK INCISION......................... 06

xii PREFACE! TO THE INSTRUCTOR Physical therapists are

in demand today and the need

will -undoubtedly become even greater in the succeeding years.

The recent war and the efforts of such prominent

organizations as the National Foundation for Infantile Paralysis have given added impetus to this growing field. The responsibility for preparing individuals to answer this current need lies with the facility of those colleges and universities offering physical therapy as a part of their undergraduate program. lum are threefold;

The goals of such a curricu­

First, to foster the continued growth

of the profession; secondly, to develop in the individual physical therapy student the skills necessary to carry on her work with confidence; and

thirdly, to insure the pro­

spective patients the finest treatment possible. These objectives can most readily be satisfied if the student therapist has a good foundation in the sub­ jects basic to her profession.

That anatomy is one of the

most important courses upon which to build the physical therapy curriculum is a reasonable conclusion based on the experience of those practicing in the field.

Without a

secure foundation in this area the rest of the subject structure will be weak. The need for a therapist anatomy dissection manual

xiii is evident and it is the purpose of this project to make a start at fulfilling that want.

An introduction is in­

cluded to help orient and prepare the student for the laboratory work.

Only directions for dissecting those

sections of the body considered most important to the therapist have been included in this manual.

If more

than one semester can be devoted to the course it would be profitable to include directions for dissecting the thorax, neck, head, brain and other regions of the body. Sincerest thanks are due to Mrs. Roxy Morris, In­ structor of Physical Therapy, University of Southern Cali­ fornia, whose excellent course in dissection anatomy was the basis of this manual.

x iy .

PREFACE TO .S.TODENTS You are entering the profession.

At least that’s what

your presence in this laboratory anatomy course for pro­ spective physical therapists would indicate.

Before you

decided upon this field you may have spent hours investi­ gating the training facilities and the entrance requirements of various institutions.

If you did, you undoubtedly found

one thing common to the curriculum of all schools offering physical therapy, and that would have been the inc3.usion of anatomy as a basic part of your required undergraduate program. There is a sound reason for the exalted position of this course.

If your foundation in anatomy is good your

chances of successfully building your professional career are greatly enhanced.

Therapeutic exercise, voluntary

muscle testing, massage, electrical stimulation, and other essential courses can only be fully mastered and apprec­ iated if they are based on a sound understanding of the bodies structures. In using this manual you must remember that its in­ tended purpose is to help you display the various struc­ tures of the body in an orderly fashion.

It is not a

textbook and before preceding with the dissection of any part it is essential that you familiarize yourself with the descriptive account of the structures involved by re-

ferring to one of the books your instructor will recommend to you.

During the course of your exploration it will fre­

quently be necessary for you to -use the text references given in the directions of each chapter.

Using such texts

will help to clarify your work and enable you to proceed without destroying structures you may later want to save or identify. Proceed with your dissection using the manual step by step, finding and identifying each part as indicated. carefully to avoid error.

Be thorough however, for clean

structures are more easily recognized. ask questions of your instructor. you whatever help she can.

Work

Always feel free to

She is willing to offer

1

PART I. THE INTRODUCTION HOW TO GET TxiE MOST OUT OP i^iBOhATORY

a NATOMY

2

PART I. THE INTRODUCTION HOW TO GET THE MOST OUT OF LABORATORY ANATOMY The time you spend in any course can result in a fruit ful or barren accomplishment, the deciding factor being the manner in which you employ your periods of work and study. Since this course in anatomy dissection will consume many hours of your time, in and out of the laboratory, the re­ sults of your effort should be proportionately great.

To

make certain that you do get the maximum benefit from your labor, the following three chapters are suggested for your consideration.

CHAPTER 1. THE APPLICATION HOW TO APPLY LABORATORY ANATOMY TO CLINICAL USE A.

MOTIVATION:

Values which you may expect if you begin

now to apply your laboratory work to real clinical situations, 1,

STIMULATION OF INTEREST:

Being exposed to clinical

work will make you see the reason for being so well prepared in anatomy and give purpose and incentive to your dissection, 2,

AID TO RETENTION:

Application to a life situation

of what you have mastered in the laboratory, will aid you greatly in remembering the material, 3,

UNDERSTANDING OF DIFFERENCES:

Most laboratory

cadavers have a good musculature and it is well to realize that clinically, not all of your pat­ i e n t s muscles will be as well developed, or as easy to identify, B.

DIRECTIONS:

Guiding principles and techniques for ap­

plying laboratory anatomy to clinical use, 1.

FIELD TRIPS:

How to get the most out of your obser^

vation, a*

Visit physical therapy and occupational therapy departments and observe the patients ■undergoing treatment.

b.

Ask questions of the head of the department and of the therapist in charge of a particular pat­ i e n t s treatment.

Do so in a manner that will

in no way be awkward or embarrassing to either the patient or the therapist. c.

Jot down the diagnosis of several patients hav­ ing peripheral nerve injuries and later in the laboratory check the exact nerve and muscle in­ volvement on your cadaver.

d.

Request to see patients that will demonstrate injuries to the particular part of the body with which you are working at the time.

CLASSROOM SUGGESTIONS:

How to utilize your labora­

tory dissection and your work in other related courses. a.

Apply your work in the laboratory directly to other related subjects, such as therapeutic exercise and voluntary and electrical muscle testing.

b.

Carry out all your exploration keeping in mind the function of the structures dissected.

Re­

member that each muscle, nerve, and blood ves­ sel has an intended purpose, essential to our well being. c.

Get the actual diagnosis of patients with peri-

pheral nerve injuries from advanced physical therapy students doing clinical work and check the exact involvement on your cadaver, d.

Jot down the clinical picture you feel would be demonstrated by the patient and have it con­ firmed or corrected by the person who gave you the diagnosis,

e.

Follow the suggestions given in chapter two, which deals with how to study for laboratory anatomy.

The ideas presented will help you

make anatomy a more functional course. f.

Observe closely patients that may be brought into any of your physical therapy classes for demonstration purposes.

A part of the patient*s

anatomy has been affected whether he has a burn, an amputation, a fracturej or some other dis­ ease or injury. g.

Ask your instructor for help whenever it is difficult for you to transfer your laboratory work to a concrete clinical example.

h.

Use the ideas gained from movies, pictures, and slides on gait training, muscle testing and other related subjects.

C.

ACTIVITY ASSIGNMENTS;

Suggested projects to help you

make laboratory anatomy applicable to clinical use 1.

DEBATE:Prepare

to defend, before your class, the

assumption that laboratory anatomy can be made functional. 2.

SELECTION:

From the points given in the directions,

choose one suggestion that you consider most importu

ant and give reasons to support your point of view. D.

EVALUATION:

A sample evaluation instrument that may be

employed-in relation to applying anatomy to the clinic. 1.

TRUE-FALSE:

Place X in the correct space for true

or false. a.

T ( )

F ( ) You can logically assume that if you proceed well with your laboratory work day

by day, it will be easy to make

the

transition from the laboratory to

the clinic when you reach that point in training. ( )

( ) Visiting physical therapy and occupation­ al therapy clinics early In your training is a.dangerous practice, for such trips may tend to confuse you.

c.

( )

( ) Asking your instructor for clinical ex­ amples to highlight your laboratory work is a good policy.

7 d.

( ) ( )

Applying information, ideas, and tech­ niques learned in one class to other related classes is a recommended pro­ cedure.

e.

( ) ( )

A good practice is to always keep in mind the functional aspect of the structures you are dissecting.

8 CHAPTER 2. THE STUDENT HOW TO STUDY FOR LABORATORY ANATOMY A,

MOTIVATION:

Rewards to be gained from sound methods of

study, 1.

FACILITATION OF LEARNING:

Learning will be faster,

and it will be more a process of logical conclusions rather than rote memorization, 2.

GREATER RETENTION:

Learning based on understanding

rather than memorization will enable you to recall necessary information for use on examinations, and more important, it will assist you time and time again in your clinical experience. 3.

REDUCTION OF NERVOUS STRAIN:

Perhaps it may take

almost as long to study this way but the confidence gained by mastering the subject will make it easier for you in both the classroom and the clinic. B.

DIRECTIONS:

Suggestions for making anatomy a course that

will be the mainstay of your training. 1.

ASSIGNMENTS: a.

How to proceed from day to day.

Take each day»s work as it comes, and do not let your assignments to be done outside of the laboratory, pile up on you.

b.

Familiarize yourself with the structures to be dissected each day, for it will make your pro-

gress in the laboratory faster and more meaning­ ful if you do so. 2.

STUDY AIDS: a.

How to insure your daily progress.

Check your own cadaver and those of your fellow students very minutely.

The actual dissection

should be a period of concentrated effort.

Lab­

oratory time is valuable so don’t waste it.

If

you are working in pairs be sure to acquaint yourself with the work done by your partner. b.

Take a piece of cloth, or some such material, and use it with a skeleton to demonstrate muscle action for yourself. . Run the cloth from the origin to the insertion of a particular muscle and it will give you a vivid picture of the muscle’s location and angle of pull.

(See Fig­

ure 1.) c.

Choose a study partner, and make sure she is one who is willing to help and be helped by you. Take turns teaching the material- to each other. The ability to explain and put the lesson across 'to someone else is a real test of what you know. The fact that you both have a common interest in the subject will make such study possible.

d.

Check out the various bones available in the department for home study use.

Many of the

FIGURE 1 DEMONSTRATING MUSCLE ACTION

11 bones have muscle origins and insertions painted on them.

Seeing the actual angles, ridges, de­

pressions, et cetera of a bone gives you a more accurate perspective than you would get from pictures. e.

Sketch or make diagramatie drawings of your own, for difficult material.

f.

(See Figure 2.)

Get a copy of Catherine Worthingham *s Upper and Lower Extremity Muscle and Innervation Charts. Stanford University Press, Stanford, California.

g.

Palpate your own muscles and tendons and those of your classmates.

It is more reasonable to

recognize and know how to call into action the different tendons as they cross the wrist or ankle than it is to be able to list them from memory. h.

Reason, don’t memorize, unless there is no other way open to you.’ Logical thinking will pay greater dividends in the long run.

I.

Call on the wealth of material available In anatomy text books.

Read the descriptive sec­

tions in Gray’s Anatomy of the Human Body per­ taining to each d a y ’s assignment.

Grant’s

Atlas of Anatomy offers some excellent drawings. Make use of them.

12

nrterial blood Cupolv to the * r m

brachial Profunda .

Posterior Profunda

interior °ranch of"-Profunda

buoerior Ulnar Collateral •Inferior Ulnar Collateral

uadial Collateral

Posterior Ulnar «ec\irrent

lladial Recurrent

interior Ulnar Recurrent

•‘•nterosseous Re cu r r e n t —

nadial-—

Uinar

interosseous ^orsal i nterosseous------ , A

FIGUKE

olar interosseous

2

DI a O k AM a TIG DhAWING

j.

Make a set of muscle cards on three or five or five by eight cards.

Include the origin

and insertion, the nerve supply, action, and a picture of the particular muscle on each, card, C,

(See Figure S.)

ACTIVITY ASSIGNMENTS:

Projects to perfect your ability

to study for laboratory anatomy. 1,

PLANKING:

Take the first dayfs laboratory assign­

ment and show exactly how you would approach its study. 2.

PRACTICE:

List in outline form the steps you con­

sider most logical in studying the muscles of the shoulder. D.

EVALUATION:

Samples of some evaluation techniques that

may be employed to check your mastery of study habits. 1.

TRUE-FALSE:

Place X in the correct space for true

or false. a.

T F ( )( )

Generally speaking, you should do all your studying alone,

k*

( )( )

Observing the laboratory work done by fellow classmates is a bad practice and may lead you to confusion,

c*

( )( )

Using your own muscles and tendons as

ILIAGUS

Origin--* — Iliac fossa and. hart of the anterior gar face of the sacrum„ inser tion — m i o the tendon of the psoas major and with it tne lesser trochanter.

aw

a srrosnw

Nerverc tion‘■r

Q c ; ►* W OS

‘arinh from the femoral,

B,

Review the pelvic bone-and the femur*

ACTIVITY ASSIGNMENTS;

Proieots-to help you master the

anatomy of the hip and thigh. 1.

OBSERVATION:

Inspect the cadavers of other students

to compare size and location of structures indi­ cated.

It will be necessary to identify structures

on the cadavers of others for practical examination. 2.

ANALYZING:

List the muscles, nerves and blood ves­

sels that might be involved if a patient received a gunshot wound through the middle of the upper thigh. D.

EVALUATION:.

Samples of some evaluation techniques that

may be used to check your understanding of this chapter. 1.

TRUE-FALSE: or false.

Place IT in the correct space for true

65

a.

T F ( ) ( )

The quadriceps are innervated by the femoral nerve,

b.

( ) ( )

The nerves and blood vessels to the gluteus maximus enter on the lateral aspect of the muscle.

c.

() ( )

The ligament that stretches upward

and

medially from the ischial tuberosity is the sacro-tuberous. d.

() ( )

The adductor magnus has a duel nerve supply.

2.

RATING SCALE:

Place X in each space for which you

qualify. a.

()

You have completed the dissection of the hip and thigh.

b. ()

You are familiar with the location of the muscles, nerves, arteries and other struc­ tures of this area.

o. ()

You would be able to identify similar structures on another cadaver. *

64 CHAPTER 8. THE LEG HOW TO DISSECT THE MIDDLE ASPECT OF THE LOWER EXTREMITY A.

MOTIVATION:

Outcomes of lower extremity dissection

that may enhance your professional ability as a physical therapist. 1.

GETTING REGISTERED:

Qualifying for-the registry

examination is one thing, and passing it is another, so face the test with confidence by sound prepara­ tion here and now, 2,

LANDING A JOB:

The leg is commonly involved in t

traumatic accidents and the individual who can demonstrate her competence in the care of such cases, has an advantage In competing for a posi­ tion. B.

DIRECTIONS: 1.

Points to follow in exploring the leg.

THE ANTERIOR LEG:

How to proceed with the investi­

gation of the structures of this area, a.

Cut vertically along the midline of the leg and the dorsum of the foot to the root of the middle toe.

(See Figure 10.)

Try to stay

off the anterior border of the tibia.

Be

careful over the dorsum of the foot because important structures lie just underneath the skin.

Carefully cut transversely across

t IGUh.E

AwTifiwIOtt

Aj*D

10

mCxSLoXS

the skin at the ankle and at the root of the toes. b.

Skin the four areas thus mapped out.

Clean and identify the anterior tibial, extensor hallucis longus, extensor digitorum longus, and peroneus tertius.

(Gray, page 480 to 483,

and 641.) g

. Find

the deep peroneal nerve and the anterior

tibial vessels between the extensor hallucis longus and the anterior tibial muscle.

(Gray,

page 983 and 641.) d*

Find the nerve branches from the deep peroneal to the anterior tibial, extensor digitorum longus, extensor hallucis longus and the peroneus tertius.

THE POSTERIOR LEG; a.

How to explore the calf.

Remove the skin from the leg.

Be careful on the

lateral side of the knee region because the com­ mon peroneal nerve wraps around the head of the fibula and is very superficial. b.

Clean the fascia and fat from the popliteal re­ gion.

Note the popliteal vessels, tibial and

common peroneal nerves. c.

(Gray, page 638 and 991.)

Follow the three hamstring muscles, the sartorius, and the gracilis to their insertions.

d.

Find the two heads of the gastrocnemius and clean

67 the full length of the muscle.

Lift up the

muscle and carefully clean under it. e.

Find the plantaris muscle as it originates from the lateral condyle.

f.

Find branches of the tibial nerve to the two heads of the gastrocnemius and to the plantaris muscle.

g.

Cut the gastrocnemius about 2§« from its origin. Leave the nerve with the proximal end.

h.

Find the nerve to the soleus and then work under and free the muscle.

Get help from your instruct­

or and then reflect the soleus. i.

Find the division of the popliteal vessels into the anterior and posterior tibial vessels. Trace the posterior tibial vessels and find the peroneal branch from it.

Note the anterior

tibial vessel at the proximal end of the pos­ terior tibial muscle. j.

Follow the tibial nerve and find branches to the popliteus, flexor hallucis longus, flexor digitorum longus and the posterior tibial. Trace the nerve to the medial side of the ankle. Note the accompanying posterior tibial vessels.

C.

ACTIVITY ASSIGNMENTS; anatomy of the leg;

Projects to help you master the

68 1.

VOCABULARY:

Make a check list of all the terms of

words in this section that are new or vague to you and give the medical definition for each, 2,

EXAMINATION:

Prepare a written examination that

you would consider fair and adequate for the mat­ erial in this section, D.

EVALUATION:

Samples of wavs in which you may check

your knowledge of the work covered in this chapter. 1,

TRXJE-FALSE:

Place X in the correct space for true

or false, a,

T F ( ) ( )

You should find branches of the tibial nerve to the two heads of the gastro­ cnemius,

b,

( ) ( )

The plantaris muscle will be found originating from the medial condyle.

c,

( ) ( )

The peroneal nerve is found between the extensor hallucis longus and the anterior tibial muscle,

d,

( ) ( )

You should be careful dissecting around the lateral side of the knee because the common peroneal nerve is very superficial there.

BEST ANSWER:

Place the number of the best answer

in the parentheses, a,

( )

The popliteal region contains one:

(1)

Popliteal vessels, tibial and common pero­ neal nerves, nerve,

(2) Medial sural cutaneous

(3) Medial plantar and lateral

plantar nerves. b,

( )

(4) Deep peroneal nerve.

The sciatic nerve divides into the:

(1)

Deep peroneal nerve and the superficial peroneal nerve.

(2

Saphenous nerve and

the common peronal nerve,

(3) Tibial

nerve and the common peroneal.

(4) Medial

sural cutaneous and the peroneal anasto­ motic .

70 CHAPTER 9. THE FOOT HOW TO DISSECT THE DISTAL ASPECT OF THE LOWER EXTREMITY A.

MOTIVATION;

Rewards that you may enjoy following the

careful dissection of the foot* 1.

GIVE' A GOOD POSTURE TEST:

Most authorities agree

that the feet are extremely important to correct hody alignment and should be the basis of a sound posture examination* 2.

SERVE A MAJOR NEED:

Statistics compiled as re­

cently as 1949 show that approximately ninety per­ cent of the adult population have some foot com­ plaint*

As a physical therapist you should be well

prepared to deal with such patients and this is the logical place to start your understanding of foot structure. B.

DIRECTIONS:

The steps necessary to complete the in­

vestigation of the foot. 1.

THE DORSAL SURFACE OF THE FOOT:

How to dissect

the structures in this area. a.

Note and study the fascia about

the ankle region.

(Gray, page 489 to 481 and the diagram on page 487.) b.

Slit the retinaculum lengthwise

to expose the

following structures from the medial to the

lateral side. (1)

The anterior tibial tendon.

(2)

The extensor hallucis longus.

(3)

The vessels and deep peroneal nerve.

(4)

The extensor digitorum longus tendon.

(5)

The peroneus tertius.

Clean the lateral side of the ankle to see the inferior peroneal retinaculum binding down the peroneals on the lateral side.

Separate the

peroneus longus and brevis muscles.

Find the

superficial peroneal nerve and its branches to the peroneus longus and brevis. Cut the tendons of the peroneus tertius and the extensor digitorum longus at the ankle.

Reflect

these to expose the extensor digitorum brevis. Find the tendons from it to the four medial toes. Skin and clean some of the toes to see the exten­ sor expansion. Trace the anterior tibial artery to the foot where it becomes the dorsalis pedis.

Find the

arcuate branchy from the dorsalis pedis. page 641.)

(Gray,

Trace some of the dorsal metatarsal

branches of the arcuate to their bifurcation at the root of the toes. Follow the muscle tendons to their insertions

72 into the bones or until they disappear under other structures. 2.

THE PLANTAR SURFACE OF THE FOOTs

How to display

the structures of this area. a.

Skin the sole of the foot by making an incision from the base of the toes to the heel. Figure 11. study it.

(See

Note the plantar aponeurosis and (Gray, page 491.)

Slit the aponeuro­

sis lengthwise to reveal the flexor digitorum brevis. b.

Carefully remove the aponeurosis.

Study layer 1, which includes the flexor digi­ torum brevis, abductor hallucis and abductor digiti quinti.

Find the medial plantar nerve

and vessels between the abductor hallucis and flexor digitorum brevis. 493.) c.

(Gray, page 492 to

Find the branch to the abductor hallucis.

Cut across the belly of the flexor digitorum brevis.

Reflect it and study layer II which

contains flexor accessories, four lumbricales, flexor hallucis longus and the tendon of the flexor digitorum longus and flexor hallucis longus.

Find the nerve and vessels medial to

the quadratus plantae. d.

Find the branches from the medial plantar nerve to lumbrical one, flexor digitorum brevis,

73

ir XCxUjrtJE

11

PiutWl’Aft F u OT IN C ISIO N S

74 flexor hallucis brevis and abductor hallucis. Find the branches from the lateral plantar nerve to the three lateral lumbricales, abductor digit! quinti and the flexor accessories. e.

Gut (the flexor digitorum longus and the quadratus i

plantae at the distal margin of the fleshy part of the quadratus. longus tendon. III.

Also cut the flexor hallucis

Reflect these and study layer

(Gray, page 494 to 496 and 993.

The

muscles in this layer include the flexor hallucis brevis, adductor hallucis, and flexor digiti quinti. f.

Note the interossei which comprise the fourth layer.

C.

Find the nerve branches to these muscles.

(Gray, page 496.)

ACTIVITY ASSIGNMENTS!

Projects suggested to help you

master the material in this chapter. 1.

A QUIZ:

Prepare a practical anatomy test for this

chapter suitable for laboratory use. S.

INSPECTING:

Examine the cadavers available to you

in the laboratory and list those that best demon­ strate the structures of the foot. D.

EVALUATION:

Samples of ways in which you mav check

knowledge of the work covered in this section. 1.

TRUE-FALSE:

Place X in the correct space for true

75 or false. a.

T F ( ) ( ) You should find that the inferior per­ oneal retinaculum binds down the peroneals on the lateral side of the ankle,

h.

( 0 (

) To expose the extensor digitorum brevis it is necessary for you to feflect the peroneus tertius and the extensor digitorum longus at the ankle,

c*

( ) (

) Following the tibial nerve you should find branches to the plantaris and other posterior leg muscles.

S.

BEST AITSWEB:

Place the number of the best.,answer

in the parentheses. a.

( )

The muscles and tendons found or contained in the second layer of the plantar surface of the foot are:

(1) The four lumbricales,

flexor hallucis brevis and the adductor hallucis.

(2) The fourlurabricals, the

flexor hallucis longus and the tendon of the flexor hallucis longus and flexor digi­ torum longus.

(5) The flexor digitorum

brevis, flexor hallucis brevis and flexor hallucis longus.

(4) The flexor hallucis

brevis, flexor digiti quinti, adductor

.

76 hallucis and the interossei. b.

( )

The tendons and vessels as they cross the ankle anteriorly from medial to lateral are:

(1) The extensor hallucis longus,

anterior tibial tendon, vessels and deep peroneal nerve, extensor digitorum longus tendon and peroneus tertius,

(2) Anterior

tibial tendon, vessels and deep peroneal nerve, extensor hallucis longus, extensor digitorum longus tendon and peroneus tertius,

(3) Anterior tibial, extensor

hallucis longus, vessels and deep peroneal nerve, extensor digitorum longus ten­ don and the peroneus tertius.

(4)

Ant­

erior tibial tendon, extensor hallucis longus, vessels and deep peroneal nerve, peroneus tertius and extensor digitorum longus tendon.

7.7'

PAhT IV. THE ThUNK HOW TO DISSECT THE TOkSO

ib:

78

PAST-IV. THE T R U M HOW TO DISSECT THE TORSO To walk, to stand, to sit, or even to turn over in bed would be a major problem if we were to do so without the full assistance of our trunk muscles.

Even the upper

and lower extremities must depend upon the torso if they are to function most effectively.

In the next two chap­

ters the back and abdominal area are explored and you will be exposed to Information vital to your future as a physi­ cal therapist. exposdnci takes.

For your own best interest see that the

CHAPTER 10, THE BACK HOW TO DISSECT THE POSTERIOR TRUNK A.

MOTIVATION:

The advantages of m a k i n g a sound analysis

of the back, 1.

EVENTUAL ADVANCEMENT:

Many therapists do not have

a clear or adequate understanding of the back reg­ ion, so here is your chance to prepare for a future promotion, 2,

IMPROVED MASSAGE:

Knowing the location of the back

muscles and their direction of pull will help you to localize and reduce spasm when massage is pre­ scribed, 5,

INSURED MASTERY:

A thorough understanding of the

musculature in this region will enable you to dir­ ect a sound therapeutic exercise program for sco­ liosis and other back conditions, B.

DIRECTIONS:

Key steps to follow in proceeding with

the dissection in this region. 1.

THE SUPERFICIAL BACK MUSCLES:

How to complete the

dissection of the outer layer of muscles. a.

Cut the latissimus dorsi muscle from the lumbodorsal fascia and remove it,being careful not to cut the serratus posterior inferior.

b.

Remove the trapezius and rhomboids from the

vertebrae, being careful not to cut the serratus posterior superior. c.

Make a midline incision in the skin of the neck and remove the skin and the fascia up to the occipital bone.

d.

Remove the upper trapezius.

Study the serratus posterior superior and infer­ ior after having removed the above-named musc­ les.

Clean and study the splenius capitis and

cemvicis.

(Grant, page 354.)

Note the direc­

tion of the fibers of the serratus posterior inferior and superior and decide what their action on the ribs would be.

Note the direc­

tion of the fibers of the splenius. e.

Cut the serratus posterior from its thin fascia attachments to the vertebrae and draw it lateralward

f.

Work under the splenius to free the muscle from the deeper muscles of the back.

Cut the thin

muscle belly about the middle and turn the ends back so that the deeper layer of back muscles come into view. THE DEEP BACK MUSCLES:

How to explore the erector

spinae group. a.

Note that you are not looking at the superficial layer of the erector spinae (sacrospinalis)

81

muscles which are also termed the deep muscles of the back. d.

Divide the superficial layer into the castalis, longissimus, and spinalis divisions,

(Grant,

page 355 and Gray, page 380.) c.

Note now how each, the castalis and the long­ issimus f can be divided into three parts from the sacrum to the neck.

Make use of text pic­

tures. d.

Pull the ilio-castalis column laterally as de­ monstrated in Grantis An Atlas of Anatomy, page 355 and study the attachment of the slips as you do so.

e.

Cut across the longissimus at about the level of the last rib.

Work under it to free it for

a ways up and down the vertebrae.

Again study

the attachments as you do so. f.

Work under the spinalis in the thoracic region. Free it and draw it medially up and over the spinous processes.

g.

Note that you are now looking at the second layer of the erector spinae; muscles.

Study the

layer noting particularly the directions of the fibers (lateral to medial) and the shorter slips which pass over fewer vertebrae.

Separate, in the middle region, at one level examples of the following. (1)

The semispinalis and relays of its slips from the loin to the skull which cover about five vertebrae.

(2)

The multifidus and relays of its muscular slips from the loin to C2 which covers about three vertebrae.

(3)

The rotators, whose muscle slips are chiefly in the thoracic region and go from the transverse process of one ver­ tebrae to the lamina of the next.

Try

to have each of the three muscles come from the same transverse process so it is easy to note the segments over which each passes. Work along the sides of the spines in the up­ per lumbar region to see if you can demonstrate the interspinous muscles.

The interspinous

ligament will be in the middle between the spinous processes and a very small muscle on either side of it. Clean and study the eleven pairs of the levator costorum which pass from the transverse pro­ cesses of the vertebrae to the ribs.

Note

the direction of the fibers.

How would they

affect respiration? k.

Study the four suboccipital muscles on demon­ stration material.

1.

Determine the nerve supply to the deep back muscles.

Study the cross section of the spinal

cord again. m.

Think of muscle action and note how the direc­ tion of fibers change rotation.

Lateral to

medial fibers will rotate to the opposite side, and medial to lateral fibers will rotate to the same side, n.

Study the dissected back so you can locate any of the superficial and deep back muscles. Study both typical and a atypical vertebrae for each region, sacrum, ribs, and sternum.

Learn

the origin and insertions of these muscles. C.

ACTIVITY ASSIGNMENTS:

Suggested projects to perfect

your ability in back dissection. 1.

CHECK AGAIN:

Select four muscles dissected in

this area and identify them on two other cadavers. 3.

TEACH A CLASS:

Prepare yourself to instruct your

class on any two muscles of the back, giving ori­ gin, insertion, nerve supply, action and any other information pertinent to the discussion.

8&

D.

EVALUATION:

A sample of an evaluation technique that

may be employed to check your mastery of this section. 1.

TRUE-FALSE:

Place X In the correct space for true

or false. a.

T F ( ) ( )

You can assume that since the rhom­ boids are not superficial, they are part of the deep musculature of the back.

( ) ( )

the second layer of the erector spina.! muscles you will find the muscle fibers running from distal to proximal•

c.

()

()

The costalis and longissimus can be divided into three parts running from the sacrum to the neck.

d.

( )

()

You should find the slips of the rotatores muscle chiefly in the thoracic region.

e.

()

( )

The multifidus muscle slips usually cover about three vertebrae.

8 ’5

CHAPTER 11. THE ABDOMINAL AREA HOW TO DISSECT THE ANTERIOR TRUNK A.

MOTIVATION:

Values to be gained by a careful explora­

tion of the anterior trunk. 1.

UNDERSTAND TRUNK BALANCE:

The abdominals are ex­

tremely important muscles in maintaining pelvic stability and knowing their function will help you to comprehend the explanation of this idea. 2.

HELP TO CORRECT POSTURE:

Poor abdominal muscles

are the basis of many faulty familiar

postures and being

with their location and function will

make it possible for you to help patients with such complaints. B.

DIRECTIONS:

Points to follow in exploring the anterior

trunk. 1.

THE SUPERFICIAL AREA OF THE ABDOMEN:

How to dis­

sect the external area. a.

Make a midline skin incision from the xiphoid to the pubis, and transversely to each side. (See Figure 12.)

Reflect the skin and clean

off the fascia to expose the tough fibrous aponeurosis of the external oblique muscle. b.

Note the following structures: (1)

The linia alba.

86

P I G Uh E

12

A N T E h l u n T h U N K INCISIQES

(2)

The external inguinal ring about one-half inch above the inguinal ligament,

(5)

The inguinal ligament.

(4)

The spermatic cord as it exits from the abdomen.

Reflect the external oblique muscle by cutting one-half inch lateral to the rectus abdominis and by detaching it from the ribs.

Lift it

laterally and observe the internal oblique muscle fibers beneath. place.

Leave the fibers in

See the nerves to the abdominal externus

as you reflect it.

(The last seven intercostal

nerves and the ilio-hypogastric nerve.) Study the origin and insertion of the oblique internus and the direction of the fibers.

Re­

flect it as you did the externus and the transversus abdominis will be exposed. nerves to the oblique internus.

Find the (The last three

intereostals, ilio-hypogastric and ilio­ inguinal.) Study the transversus abdominis. Slit the sheath of the rectus down the center and reflect it to both sides to expose the rectus abdominis.

Study the muscle and lift

it up to find its nerve supply.

(The last six

intercostals.) g.

Study the sheath of the rectus.

Note that in

the upper two thirds of the rectus the sheath is made by the external oblique fascia passing anterior to the rectus; one-half of the internal oblique and the transversus fascia passing pos­ terior to the rectus.

In the lower one-third

of the rectus the fascia of all three muscles passes anterior to the rectus. h.

Find the inguinal canal under the subcutaneous inguinal ring.

Note the abdominal inguinal

ring at the other end of the canal. inguinal canal and inguinal hernias.

Study the (Gray,

page 395 to 399 and Grant, page 89 to 93.) THE DEEP AREA OF THE ABDOMEN:

How to explore the

internal section of the anterior trunk. a.

Separate the transversus abdominis from the peritoneal lining below it.

Cut the rectus at

about the middle and separate it from the peri­ toneum. b.

Slit the parietal peritoneum to expose the vis­ cera below.

c.

Identify the liver, gall bladder, stomach, dia­ phragm, and greater omentum. to 1267.)

(Gray, page 1266

d.

Lift up the greater omentum to see the small intest ion,- and the colon,

e.

Study the greater omentum and look under it to see its attachments,

f.

Study the falciform ligament (old ventr'afl, mesentery),

g.

(Grant, page 100,)

(Grant, page 101,)

Study the diaphragm and learn its origin,insertion, action and nerve supply.

Understand

what happens to the abdominal viscera when it contracts, h.

Slit the diaphragm, after you have studied it, to improve the view of the abdominal viscera. Feel around the liver to see where the peri­ toneum does not cover it. and stomach*

i.

See the esophagus

Find the spleen.

Find the lesser omentum (ventral mesentery be­ tween the liver and the stomach). contents of it.

Dissect the

The common bile duct, hepatic

artery and the portal vein. C.

ACTIVITY ASSIGNMENTS:

Projects to perfect your under­

standing of abdominal exploration. 1.

PERFORMANCE:

Prepare to identify on your own cad­

aver, for the members of your class, the structures listed in the directions of this chapter.

2.

DISCUSS:

Choose one major structure in this area

and using several textbooks and other available sources of information make a short report about the structure for the benefit of the entire class, D.

EVALUATION:

Sample evaluation technique which may be

applied to abdominal dissection. 1,

RATING SCALE:

Place an X in each space for which

you qualify. a.

(

) You know the location and the action of the abdominal muscles.

b.

(

) You can identify the inguinal ring.

c.

(

) You can locate the liver, gall bladder, stomach and diaphragm.

d.

(

) You are familiar with the origin and in­ sertion of the abdominal muscles.

e.

(

) You can explain the action of the diaphragm.

f.

(

) You could successfully complete a practical or written examination covering the material in this section.

YJNTVERSITY OF SOUTHERN CALIFORNIA LTBRAWT

BIBLIOGRAPHY A.

BOOKS

Bowen, Wilbur Pardon, Applied Anatomy and Kinesiology. Philadelphia! Bea & P'ebiger, 1941. 361 pp. A textbook written for students of physical ed­ ucation, and as the title suggests It deals primarily with muscle action. A good reference for all those interested in muscle performance. Cunningham, Daniel John, Cunningham’s Manual of Practi­ cal Anatomy. New York: Oxford University Press, 1945. 500 pp. A dissector’s guide for medical students with primary emphasis on internal dissection. A discription of the structures including the location, function and other information is in­ cluded proceeding the dissection instructions. ______ , Cunningham’s Text-Book of Anatomy. New York: Oxford University Press, 1937. 1506 pp. P'rohse, Pranz, Max Bpodel, and Leon Schlossberry, Atlas of Human Anatomy. New York: Barne3