Physio Anatomy PDF

THE UNIVERSITY OF MELBOURNE
DEPARTMENT OF PHYSIOTHERAPY
Independent Learning Guide
Phys@tomy
FOR
Doctor of Physiotherapy
Introduction:
Welcome to the Doctor of Physiotherapy Program. Phys@tomy is a self directed
learning package that has been developed to facilitate student revision and
preparation for entry into the Doctor of Physiotherapy Program at the University
of Melbourne.
The material outlined in this package will form the basis of the theoretical
background in Functional Anatomy that will be in part assumed knowledge and
will be built upon throughout the graduate program. The material will be
presented in a series of modules each of which will have detailed learning
objectives that are designed to direct and sequence the learning.
It is advised that the student complete each module one at a time prior to moving
onto the next. It is recommended that the student take approximately 4 hours to
complete each module.
Modules:
Module 1: Introductory Osteology and Arthrology
Module 2: The Shoulder, Upper Arm and Elbow
Module 3: The Forearm, Wrist and Hand
Module 4: Nerve and Blood Supply of the Upper Limb
Module 5: The Pelvis, Hip and Knee
Module 6: The Lower Leg and Foot
Module 7: The Nerve and Blood Supply to the Lower Limb
Module 8: The Head and Neck
Module 9: The Abdomen and Trunk
Module 10: The Heart and Lungs
Learning Objectives
Material in:
bold print: form the structures that require identification. An
anatomical atlas or model may be used for this purpose
regular print: form the independent learning questions to be answered
from the recommended texts and lectures provided
italic blue print: form the quiz questions that are aiming to extend
knowledge into application
bold orange print: form the surface anatomy objectives
REFERENCES
Highly recommended resources to guide your completion of each module:
Textbook: Moore KL (2006) Clinically Orientated Anatomy (5th ed.)
Baltimore: Lippincott Williams & Wilkins*.
Atlas: Rohen J, Yokochi C, Lutjen-Drecoll E (2002) Color Atlas of
Anatomy: A Photographic Study of the Human Body. Lippincott, Williams
& Wilkins*
Web based Materials: Eizenberg N, Briggs C, Barker P & Grkovic I
(2010)An@tomedia CD-ROMs: (Available from University Bookshop and
also available to all students on the computers in the Department of

Physiotherapy computer laboratory)
Additional references for anatomy

In addition other resources that would be appropriate for completion of these
modules are:
Netter FH (2006) Atlas of Human Anatomy (4th ed. (Elsevier)
Agur A, Dalley F (eds) (2005) Grant's Atlas of Anatomy (12th ed.)
Philadelphia : Lippincott Williams & Wilkins
Schuenke M, Schulte E, Schumacher U (Ross LM & Lamperti ED
Consulting eds). (2006). Thieme. Atlas of Anatomy: General anatomy
and musculoskeletal system. Stuttgart, Thieme Publisher
Oatis CA (2009) Kinesiology: The mechanics and Pathomechanics of
human movement. 2nd ed*
Levangie, P. K. and C. Norkin (2005). Joint Structure and Function:
A Comprehensive Analysis (4th ed). Philadelphia, F.A.Davis.
Neumann, D. (2002). Kinesiology of the Musculoskeletal System.
Foundations for Rehabilitation. St. Louis, Mosby
Bogduk (2008) Clinical Anatomy of the Lumbar spine & Sacrum (6th
Edn). Churchill Livingstone.
Phys@natomy
FOR
(Module 1: Introductory Osteology and Arthrology)
Dr Do El-Ansary, BAppSc(Phty), PhD

Dr Elizabeth Tully, BAppSc(Phty), Dip Ed, PhD
Introduction:
Welcome to the Doctor of Physiotherapy Program. Phys@natomy is a self directed
preparation for entry into the Doctor of Physiotherapy Program at the University of
Melbourne.
background in Functional Anatomy that will be in part assumed knowledge and will
be built upon throughout the graduate program. The material will be presented in
a series of modules each of which will have detailed learning objectives that are
designed to direct and sequence the learning.
Modules:
Module 5: The Hip and Knee
Module 9: The Trunk
Learning Objectives
Material in:
bold print: form the structures that require identification. An anatomical
atlas or model may be used for this purpose
regular print: form the independent learning questions to be answered from
the recommended texts and lectures provided
italic blue print: form the quiz questions that are aiming to extend knowledge
into application
University of Melbourne
Independent Learning Package in Functional Anatomy
Dr Doa El-Ansary and Dr Elisabeth Tully
REFERENCES
Anatomy: A Photographic Study of the Human Body. Lippincott, Williams &
Wilkins*
(2010)An@tomedia CD-ROMs: (Available from University Bookshop and also
available to all students on the computers in the Department of Physiotherapy
computer laboratory)

modules are:
Schuenke M, Schulte E, Schumacher U (Ross LM & Lamperti ED Consulting
eds). (2006). Thieme. Atlas of Anatomy: General anatomy and
musculoskeletal system. Stuttgart, Thieme Publisher
Bogduk (2008) Clinical Anatomy of the Lumbar spine & Sacrum (6th Edn).
Churchill Livingstone.
1. INTRODUCTORY OSTEOLOGY
1.1.
Define the anatomical position
1.2.
Define the following terms of position and direction which are related to the
standardised anatomical positions:
1.2.1. median (midsagittal) plane
1.2.2. sagittal plane
1.2.3. coronal (frontal) plane
1.2.4. horizontal (transverse) plane
1.2.5. anterior; posterior (ventral; dorsal)
1.2.6. superior; inferior (rostral/cephalic; caudal)
1.2.7. medial; lateral
1.2.8. proximal; distal
1.2.9. superficial; deep
1.2.10. palmar; dorsal
1.2.11. plantar; dorsal
1.3.
Classify bones according to shape and give an example of each type.

1.3.1. Long
1.3.2. Short(cuboid)
1.3.3. Flat
1.3.4. Irregular
1.3.5. Sesamoid
1.4.
Draw a typical long bone and Illustrate the following features:

1.4.1. diaphysis
1.4.2. metaphysis
1.4.3. epiphysis
1.4.4. articular surfaces
1.5.
Describe and state the functions of bony markings and find an example of
each type of marking.
1.5.1. Condyle
1.5.8. Tuberosity
1.5.2. Crest
1.5.9. Trochanter
1.5.3. Epicondyle
1.5.10. Trochlear
1.5.4. Process
1.5.11. Facet
1.5.5. Line
1.5.12. Canal
1.5.6. Lamina
1.5.13. Fissure
1.5.7. Spine
1.5.14. Foramen
1.5.15.
1.5.16.
1.5.17.
1.5.18.
1.5.19.
Groove
Meatus
Fossa
Notch
Sulcus
2. Introductory Arthrology
1.6.
Define a joint or articulation.
1.7.
Describe the general structure and the relative amount of movement

available at each of the following types of joints, and give an example:
1.8.
1.9.
1.7.1.
fibrocartilaginous
1.7.2.
hyaline and fibrocartilaginous
1.7.3.
synovial
1.7.4.
Classify synovial joints, and give an example, according to:
1.8.1.
structure
1.8.2.
hinge
1.8.3.
pivot
1.8.4.
ellipsoid
1.8.5.
condyloid
1.8.6.
saddle
1.8.7.
ball & socket (plane/gliding)
1.8.8.
1.8.9.
1.8.10.
1.8.11.
degrees of freedom
uniaxial
biaxial
multiaxial
1.8.12.
complexity of organisation (shape of articular surfaces,

number of mating pairs).
Describe 3 principal axes of motion about synovial joints.

1.9.1.
1.9.2.
1.9.3.
1.10.
Define and demonstrate the following types of movement about

synovial joints:
1.10.1.
active
1.10.2.
passive (physiological; accessory)
1.11.
Define the following terms with respect to the ways in which articular
surfaces move in relation to each other
1.11.1.
spin
1.11.2.
roll
1.11.3.
glide
1.12.
Describe the characteristics of the "close-packed" position of a joint.
1.13.
List the anatomical features which can limit movement at a joint.
Quiz Questions
Discuss the advantages and disadvantages of the types of joint
classification schemes.
Define and list the functions of: bursae, discs, ligaments
PHYS@TOMY
FOR
(Module 2: Shoulder, Upper Arm and Elbow)

Independent Learning Package - Anatomy
Introduction:
Welcome to the Doctor of Physiotherapy Program. Phys@tomy is a self directed learning
package that has been developed to facilitate student revision and preparation for entry into
the Doctor of Physiotherapy Program at the University of Melbourne.
The material outlined in this package will form the basis of the theoretical background in
Functional Anatomy that will be in part assumed knowledge and will be built upon
throughout the graduate program. The material will be presented in a series of modules
each of which will have detailed learning objectives that are designed to direct and sequence
the learning.
It is advised that the student complete each module one at a time prior to moving onto the
next. It is recommended that the student take approximately 4 hours to complete each
module.
Modules:
Module 9: The Trunk
Learning Objectives
Material in:
bold print: form the structures that require identification. An anatomical atlas or
model may be used for this purpose
regular print: form the independent learning questions to be answered from the
recommended texts and lectures provided
italic blue print: form the quiz questions that are aiming to extend knowledge into
application
Dr Doa El-Ansary and Dr Elizabeth Tully
REFERENCES
Textbook: Moore KL (2006) Clinically Orientated Anatomy (5th ed.) Baltimore:
Lippincott Williams & Wilkins*.
Atlas: Rohen J, Yokochi C, Lutjen-Drecoll E (2002) Color Atlas of Anatomy: A
Photographic Study of the Human Body. Lippincott, Williams & Wilkins*

In addition other resources that would be appropriate for completion of these modules are:
Agur A, Dalley F (eds) (2005) Grant's Atlas of Anatomy (12th ed.) Philadelphia :
Lippincott Williams & Wilkins
Schuenke M, Schulte E, Schumacher U (Ross LM & Lamperti ED Consulting eds).
(2006). Thieme. Atlas of Anatomy: General anatomy and musculoskeletal
system. Stuttgart, Thieme Publisher
Oatis CA (2009) Kinesiology: The mechanics and Pathomechanics of human
movement. 2nd ed*
Neumann, D. (2002). Kinesiology of the Musculoskeletal System. Foundations for
Rehabilitation. St. Louis, Mosby
Bogduk (2008) Clinical Anatomy of the Lumbar spine & Sacrum (6th Edn). Churchill
Livingstone.
BONES, JOINTS, MUSCLES OF THE SHOULDER

1.1
Identify and classify the bones of the shoulder girdle; clavicle and scapula.
1.2
On the clavicle identify:

(i)
(ii)
(iii)
(iv)
(v)
sternal end
acromial end
impression for the costoclavicular ligament
trapezoid line
conoid tubercle
1.3
Identify the jugular notch/interclavicular notch between clavicles.
1.4
On the scapula (shown below) identify:

(i)
(ii)
(iii)
(iv)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
dorsal surface
costal surface
superior, inferior, lateral borders
superior, inferior, lateral angles
spine
acromion and coracoid processes
subscapular, supraspinous, infraspinous fossae
glenoid fossa
suprascapular notch
supraglenoid and infraglenoid tubercles
1.5 On the humerus identify:

(i)
proximal end
- head
- anatomical and surgical necks
- greater and lesser tubercles
- bicipital (intertubercular) groove
- medial and lateral lips of bicipital groove
(ii)
shaft
- medial,lateral and posterior surfaces
- (spiral) groove for radial nerve
(iii)
distal end
- lateral and medial supracondylar ridges
- lateral and medial epicondyles
- capitulum
- trochlea
- olecranon, coronoid and radial fossae
1.6
Identify and classify the joints of the shoulder girdle:

(i) glenohumeral
(ii) sternoclavicular joint
(ii) acromioclavicular joint
1.7
At the acromioclavicular joint identify its:

(i)
(ii)
articular surfaces
joint capsule
(ii)
1.8
coracoclavicular ligament (conoid and trapezoid parts)
Describe the arrangement of bursae in the shoulder region. What is their function?
1.9
Describe the attachments and state the nerve supply of the following
muscles
Muscle
Pectoralis major(sternal head)
Origin
Insertion
Nerve supply
Latissimus dorsi
Muscle
Trapezius
Origin
Rhomboid major
Rhomboid minor
Levator scapulae
Pectoralis minor
Serratus anterior
Subclavius
Insertion
Nerve supply
Muscle
Origin
Pectoralis major(clavicular head)

Deltoid
Coracobrachialis
Teres major
Teres minor
Subscapularis
Supraspinatus
Infraspinatus
Insertion
Action
Functional
activity
1.10. Name the muscles labelled 1, 2, & 3 below in figure 1
3
\
4
1.11
(a) Name the structures labelled 1- 8 in figure 2a below.

(b) Identify and label the component parts of the capsuloligamentous complex on
Figure 2b
(c) State 3 functions of the glenoid labrum
(d) State the functions of the coracohumeral and transverse ligaments
Figure 2a
Figure 2b
1.12. (a) Identify the shoulder muscles shown in figures 3a and 3b below
1.13. (a) Identify the muscles labelled 1 - 4 on the figure below

(b) State the nerve supply to these muscles
3
4
Figure A
Figure B
Image: Hansen JT Net

1.14 Identify the nerves labelled 1-6 on Figure A, and 1-9 on Figure B, state their root values
THE SCAPULA
1.14. For the healthy shoulder,
a Describe the posture of the scapula on the thoracic wall with reference to adjacent
bony landmarks
b Describe the orientation of the glenoid cavity in the erect position
1.12 (a) Use table form (as shown below) to list all muscles attached to the scapula and their
actions
Muscle
UR
E.g. Upper trapezius
DR
El
Dep
(b) Indicate the attachments of these muscles on the diagrams below
Pro
Ret
X
Images: Thieme 2006

1.13.
(a) Describe changes in scapulo humeral
rhythm during arm elevation
(b) State the advantages of upward
rotation
(c) Name the muscles that are antagonist
to scapula upward rotation
(d) How may increased thoracic kyphosis
affect arm elevation?
1.14 Scapula Movements: Name the movements of the scapula on the diagrams above
THE CLAVICLE
1.15
For the sterno clavicular joint, describe
(a)
shape of the articulating surfaces.
(b)
role of the disc in the joint.
(c)
joint movement ( in terms of rolls, slides and spin) during
the following shoulder girdle movements

elevation and depression
protraction and retraction
posterior rotation of the clavicle
(d)
What is the approximate range of each of these movements of the clavicle?
BONES, JOINTS AND MUSCLES OF THE ELBOW REGION

2.1
On the ulna identify:

(i)
proximal end
-
(ii)
olecranon and coronoid processes

trochlear and radial notches
supinator fossa
ulnar tuberosity
shaft
-
interosseus border
surfaces (medial,anterolateral,posterolateral)
(iii) distal end

-
2.2
head
styloid process
On the radius identify:

(i)
proximal end
-
(ii)
head
neck
radial tuberosity
shaft
-
interosseus border
surface (lateral, anteromedial, posterolateral)
impression for pronator teres
(iii) distal end

2.3
styloid process
ulnar notch
carpal (inferior) articular surface
Classify the elbow joint and identify and describe its:

(i)
(ii)
(iii)
articular
joint capsule and synovial membrane
ligaments and their specific functions
-
medial (ulnar collateral)

lateral (radial collateral)
anular
(iv) subcutaneous bursae and fat pads
2.4
Identify and classify the radio-ulnar joints:

(i)
(ii)
2.5
At the proximal radio-ulnar joint identify and describe its:

(i)
(ii)
(iii)
2.6
superior (proximal)
inferior (distal)
articular surfaces
joint capsule
anular ligament and its specific mechanical functions
At the distal radio-ulnar joint identify and describe its:
(i)
(ii)
(iii)
articular surfaces
joint capsule
articular disc
2.7
Identify the interosseus membrane (intermediate radio-ulnar joint) and list its
functions.
2.8
Define, demonstrate and analyse movements at the elbow joint and the radioulnar
joints.
Movement
Description
Functional activity
2.9
State the close-packed position of the elbow and radioulnar joints.
2.10
Describe the "carrying angle" of the forearm.
2.11
Identify, describe the attachments and deduce the actions of the

following muscles:
Muscle
Origin
Insertion
Action
Biceps brachii
Brachialis
Brachioradialis
Triceps brachii
Anconeus
Pronator teres
Pronator
quadratus
Supinator
2.12
List the factors responsible for maintaining stability at the:

(i)
(ii)
(iii)
elbow joint
superior radioulnar joint
inferior radioulnar joint
Functional
activity
Surface Anatomy
2.13 Demonstrate on a living subject the principle bony features of the shoulder
region: (remember consent first)
scapula
- acromion
- spine-T3
- vertebral border
- inferior-T7
- coracoid process: press firmly upwards and laterally into the junction
of the middle and lateral thirds of the clavicle
clavicle
- sternal end: bulbous
- acromial end: flattened
humerus
- head
- greater tubercle: most lateral part covered by deltoid
- deltoid tuberosity
- medial and lateral epicondyles
- medial and lateral supracondylar ridges
sternoclavicular joint
acromioclavicular joint
9.25
Observe and palpate the following muscles of the axilla and scapula regions
in a relaxed and contracted state
(i)
(ii)
(iii)
(iv)
(vi)
(vii)
(viii)
(ix)
trapezius
serratus anterior
latissimus dorsi-posterior axillary fold
teres major
pectoralis major-anterior fold
deltoid
infraspinatus
tendons of the rotator cuff muscles
Quiz Questions
(1).
The shoulder joint is designed for mobility.

Describe the contribution of the following structural features to mobility at the
glenohumeral joint.
(a)
bony design
(b)
bony congruence
(c)
glenoid labrum
(c)
capsule
(d)
capsular ligaments
(2).
deltoid as the arm is raised into full elevation via abduction. Use a diagram to
aid you answer.
(i.e. bony architecture, passive structures (ligaments etc.), and dynamic structures
(muscles etc.)
(3).
Define the following terms relating to muscle function:

(i)
(ii)
spurt
shunt
Give examples of each of these at the shoulder and the elbow joints.
PHYS@TOMY
FOR
2010
(Module 3: The Forearm, Wrist and Hand)

2
Introduction:
preparation for entry into the Doctor of Physiotherapy Program at the University
of Melbourne.
background in Functional Anatomy that will be in part assumed knowledge and
will be built upon throughout the graduate program. The material will be
presented in a series of modules each of which will have detailed learning
objectives that are designed to direct and sequence the learning.
Modules:
Module 9: The Trunk
Learning Objectives
Material in:
bold print: form the structures that require identification. An
anatomical atlas or model may be used for this purpose
italic blue print: form the quiz questions that are aiming to extend
knowledge into application
University
of Melbourne
REFERENCES
Highly recommended
Independent
Learning Package resources
- Anatomy
to guide your completion of each module:

3
REFERENCES
Recommended References for anatomy
Any good anatomy textbook /atlas would be appropriate for completion of these
modules. In the past many students have found the following anatomy texts to be
useful:
Moore KL (2006) Clinically Orientated Anatomy (5th ed.) Baltimore:
Lippincott Williams & Wilkins.
Rohen J, Yokochi C, Lutjen-Drecoll E (2002) Color Atlas of Anatomy: A
Photographic Study of the Human Body. Lippincott, Williams & Wilkins
Web based Materials:
Eizenberg N, Briggs C, Barker P & Grkovic I (2010)An@tomedia CD-ROMs:
(Available from University Bookshop and also available to all students on
the computers in the Department of Physiotherapy computer laboratory)
Recommended References for applied anatomy:
human movement. 2nd ed
4
1.
1.1
THE WRIST JOINT AND JOINTS OF THE HAND
Identify the bony groups in the articulated hand:

(i)
(ii)
(iii)
(iv)
8 carpals
5 metacarpals
14 phalanges
2 sesamoid bones (radiographs)
5
1.2
Identify the individual carpal bones and some features of these

carpal bones, on the articulated hand:
(i)
(ii)
(iii)
(iv)
scaphoid and its tubercle

lunate
triqetrium
pisiform
)
) proximal row
)
)
(v)
(vi)
(vii)
(viii)
trapezium and its tubercle

trapezoid
capitate
hamate and its hook
)
) distal row
)
)
1.3
On the metacarpals identify

-
1.4
base
shaft
head
Identify proximal, middle and distal phalanges and on each phalanx

identify:
-
base
shaft
head
1.5
Describe the axis of the hand and state the function of the axial line in
regard to force transmission.
1.6
Classify the wrist (radiocarpal) joint and describe its:

(i)
(ii)
(iii)
(iv)
1.7
articular surfaces
joint capsule
articular disc
ligaments
- palmar and dorsal radiocarpal
- radial and ulnar collateral
Describe and demonstrate movements at the wrist joint.

Movement
Description
Functional activity
1.8
State the close-packed position of the wrist joint.
1.9
Identify, classify, describe and demonstrate the movements at the

following joints of the hand:
Movement
Description
Midcarpal
Movements:
carpometacarpal
of thumb
movements:
carpometacarpal
of other digits
Functional activity
8
1.10
State the contributions of midcarpal and radiocarpal joints to movements of

the hand.
1.11
Identify, classify and describe certain features of the joints of the

fingers:
(i)
(ii)
(iii)
(iv)
(i)
(ii)
(iii)
articular surfaces
ligaments and their functions
- collateral
- palmar
- deep transverse metacarpal
- extensor aponeurosis
movements
sesamoid bones of the thumb and their functions
articular surfaces
ligaments and their functions
- collateral
- extensor aponeurosis
- palmar
movements
9
2.
2.1
MUSCLES OF THE FOREARM AND HAND
Identify, describe the attachments and deduce the action(s) of the

muscles of the forearm:
Muscle
Origin
Superficial layer
Pronator teres
Flexor carpi
radialis
Palmar longus
Flexor digitorum
superficialis
Flexor carpi ulnaris
Deep layer
Flexor digitorum
profundus
Flexor pollicis
longus
Pronator
quadratus
Insertion
Action
Functional
activity
10
ateral) group:
Muscle
Origin
Superficial layer
Brachioradialis
Extensor carpi
radialis longus
Extensor carpi
radialis brevis
Extensor digitorum
Extensor digiti
minimi
Extensor carpi
ulnaris
Anconeus
Deep layer
Supinator
Abductor pollicis
longus
Extensor pollicis
brevis
Extensor indicis
Insertion
Action
Functional
activity
11
2.2
Identify the flexor and extensor retincula and state the function(s) of
retincula.
12
2.3
Identify, describe the attachments and deduce the actions of the

intrinsic muscles of the hand:
Muscle
Origin
flexor pollicis
brevis
thenar eminence
abductor pollicis
brevis
opponens pollicis
hypothenar
eminence
flexor digiti minimi
abductor digiti
minimi
Insertion
Action
Functional
activity
13
opponens digiti
minimi
Other Intrinsics
adductor pollicis
lumbricals
dorsal interossei
palmar interossei
14
Anterior View
Superficial forearm muscles
Anterior View
Deep forearm muscles
15
Posterior View
Superficial forearm muscles
Posterior View
Deep forearm muscles.
16
2.4
2.5
2.6
Identify and describe the extent, and describe the function(s) of:
(i)
palmar aponeurosis
(ii)
intertendinous connections
(iii)
synovial sheaths
(iv)
extensor aponeurosis
Define the position of function of the hand.
Describe the role of the interossei and lumbricals in producing normal digital
sweep.
SURFACE ANATOMY OF THE ARM, FOREARM AND HAND
2.7
Demonstrate on a living subject:
(i)
ulnar
- olecranon process
- posterior borders-intervenes between the two functional
groups of the muscles of the forearm.
- head
- styloid process-best felt when the forearm is pronated
(ii)
radius
- head
- styloid process
the following muscles and tendons of the arm and forearm:
17
(i)
(ii)
(ii)
biceps brachii
triceps brachii
anconeus
- this is a triangular muscle whose angles are formed by the
olecranon process, lateral epicondyle, and a point on the
posterior border of the ulna about 10cm distal to the
olecranon process
(iii)
(iv)
(v)
(vi)
(vii)
brachioradialis
cubital fossa
extensor compartment (group) of the forearm
flexor compartment (group) of the forearm
tendons of the following muscles on the anterior aspect of the
wrist:
- flexor carpi radialis
- palmaris longus
- flexor digitorum superficialis
- flexor carpi ulnaris
(ix) extensor carpi radialis longus

(x)
extensor carpi radialis brevis
all the carpal bones and some of their features
(i)
hook of hamate
- can be felt by deep pressure in the hypothenar eminence,
distal to the pisiform and closer to the centre of the palm
(ii)
tubercle of the scaphoid

- at the proximal edge of the thenar eminence, adjacent to
the distal crease of the wrist
the following muscles and tendons of the hand:
(i)
(ii)
tendons of extensor digitorum

the "anatomical snuff box" (evident when the thumb is
extended) bounded by the tendons of:
- extensor pollicis longus
- extensor pollicis brevis
- abductor pollicis longus
(iii) thenar and hypothenar eminence

(iv) 1st dorsal interosseus muscle
the relative mobility of the metacarpals and list them in
decreasing order of mobility.
2.8
18
Draw a pattern of the hand, and on it draw the palmar creases. Relate
the following creases of the hand to the underlying joints on your
drawing:
(i)
creases of the wrist:

- proximal
- middle
- distal
(ii)
creases of the palm:

- longitudinal palmar ("life line")
- middle palmar ("destiny line")
- proximal transverse ("head line")
- distal transverse ("heart line")
(iii)
creases of the digits:

- proximal
- middle
- distal
19
Quiz Questions
1.
Demonstrate different types of precision and power grips and discuss the
differences in terms of:
(i)
(ii)
the muscles involved

the position of the wrist and hand
PHYS@TOMY
FOR
(Module 4: The Nerve and Blood Supply of the Upper Limb)

Introduction:
preparation for entry into the Doctor of Physiotherapy Program at the University of
Melbourne.
background in Functional Anatomy that will be in part assumed knowledge and will
be built upon throughout the graduate program. The material will be presented in
a series of modules each of which will have detailed learning objectives that are
designed to direct and sequence the learning.
Modules:
Module 9: The Trunk
Learning Objectives
Material in:
bold print: form the structures that require identification. An anatomical
atlas or model may be used for this purpose
italic blue print: form the quiz questions that are aiming to extend knowledge
into application
REFERENCES
Anatomy: A Photographic Study of the Human Body. Lippincott, Williams &
Wilkins*

modules are:
4
NERVE SUPPLY TO THE UPPER LIMB
1.1
Describe the following features of the brachial plexus:

(i)
(ii)
(iii)
(iv)
(v)
1.2
its formation from ventral rami

its trunks
its division
its cords
the position of each of the above in the shoulder region
Identify the following branches of the brachial plexus and state their
motor distribution (the muscles each supplies):
(i)
(ii)
dorsal scapular
long thoracic
(iii)
(iv)
(v)
(vi)
(vii)
(viii)
suprascapular
upper subscapular
lateral pectoral
medial scapular
thoracodorsal
lower subscapular
5
1.3
Identify the following sensory branches of the brachial plexus and

state the root value and distribution of each:
(i)
(ii)
1.4
Identify the peripheral nerves of the brachial plexus:

(i)
(ii)
(iii)
(iv)
(v)
1.5
medial cutaneous nerve of arm

medial cutaneous of forearm
axillary (circumflex)
radial and its posterior interosseus branch
musculocutaneous
median and its anterior interosseus branch
ulnar
For each of the peripheral nerves listed in 14.4:

(i)
(ii)
(iii)
(iv)
state its root value

identify its course through the upper limb
describe its sensory distribution
describe its motor distribution
1.6
Describe the innervation of the following joints:

(i)
(ii)
(iii)
shoulder
elbow
wrist
and deduce a general rule for nerve supply to joints.
7
ACTIVITIES AND QUIZ QUESTIONS:
1.
Describe the functional motor loss and deformity resulting from a lesion to the
following nerves in the area indicated:
(i)
(ii)
(iii)
2.
radial nerve - in the axilla

ulnar nerve - at the medial epicondyle of the humerus
median nerve - at the wrist
Complete the following chart to summarise objective 14.5.

PERIPHERAL NERVES TO THE UPPER LIMB
Peripheral
Nerve
Medial cutaneous
nerve of arm
Nerve
Root Value
Medial cutaneous
of forearm
Axillary (circumflex
Radial and its

posterior
interosseus branch
Musculocutaneous
Median and its

anterior
interosseus branch
Ulnar
Motor
Distribution
Sensory
Distribution
3.
Colour in the distribution of the cutaneous nerves on the dorsal and palmar
aspects of the hand:
Palm
Dorsum
9
2.
BLOOD SUPPLY TO THE UPPER LIMB
Objectives
2.1 Identify:
(i) ascending aorta
(ii) arch of aorta
(iii) descending thoracic aorta
(iv) brachiocephalic artery
(v) L common carotid artery
(vi) L subclavian artery
(vii) R common carotid artery
(viii) R subclavian artery
)
) branches of aorta
)
) branches of brachiocephalic
) artery
2.2 Briefly state the area of supply of the arteries listed in objective 15.1
10
2.3 Identify and describe the course and general areas of supply of the
arteries of the upper limb:
(i) axillary
(ii) brachial
(iii) profunda brachii
(iv) radial
(v) ulnar
(vi) superficial palmar arch
(vii)deep palmar arch
11
12
2.4 Palpate the pulses of the upper limb at the following positions:
(i) subclavian artery - above medial end of the clavicle
(ii) brachial artery - between the heads of biceps brachii (median bicipital
furrow) and at the cubital fossa
(iii) radial artery - on the antero-lateral aspect of the wrist
(iv) mark on the diagrams where you found them.
2.5 Describe the arrangement of the veins of the upper limb into a superficial and a
deep group and deduce the functional significance of this arrangement.
13
2.6 Identify and describe the course opf the deep veins:
(i) radial
(ii) ulnar
(iii) brachial
(iv) axillary
2.7
Identify and describe the course of the superficial veins of the upper
limb:
(i) dorsal venous arch
(ii) palmar venous arch
(iii) cephalic
(iv) basilic
(v) median antebrachial
(vi) median cubital
14
2.8 Identify the veins transporting blood from the upper limb to the heart:
(i) subclavian
(ii) brachiocephalic
(iii) superior vena cava
15
Final feedback questionnaire

Thank you for assisting in evaluation of the anatomy resources for students completing postgraduate
studies at the University of Melbourne.
Please answer these statements by circling the appropriate response:
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THE UNIVERSITY OF MELBOURNE

also available to all students on the computers in the Department of

Additional references for anatomy

THE UNIVERSITY OF MELBOURNE

Dr Do El-Ansary, BAppSc(Phty), PhD

Additional references for anatomy

Define the anatomical position

Classify bones according to shape and give an example of each type.

Draw a typical long bone and Illustrate the following features:

Define a joint or articulation.

Describe the general structure and the relative amount of movement

complexity of organisation (shape of articular surfaces,

Describe 3 principal axes of motion about synovial joints.

Define and demonstrate the following types of movement about

Describe the characteristics of the "close-packed" position of a joint.

List the anatomical features which can limit movement at a joint.

THE UNIVERSITY OF MELBOURNE

Dr Do El-Ansary, BAppSc(Phty), PhD

Additional references for anatomy

BONES, JOINTS, MUSCLES OF THE SHOULDER

On the clavicle identify:

Identify the jugular notch/interclavicular notch between clavicles.

On the scapula (shown below) identify:

1.5 On the humerus identify:

Identify and classify the joints of the shoulder girdle:

At the acromioclavicular joint identify its:

coracoclavicular ligament (conoid and trapezoid parts)

Pectoralis major(clavicular head)

1.10. Name the muscles labelled 1, 2, & 3 below in figure 1

(a) Name the structures labelled 1- 8 in figure 2a below.

1.13. (a) Identify the muscles labelled 1 - 4 on the figure below

Image: Hansen JT Net

E.g. Upper trapezius

(b) Indicate the attachments of these muscles on the diagrams below

Images: Thieme 2006

For the sterno clavicular joint, describe

shape of the articulating surfaces.

role of the disc in the joint.

joint movement ( in terms of rolls, slides and spin) during

the following shoulder girdle movements

What is the approximate range of each of these movements of the clavicle?

BONES, JOINTS AND MUSCLES OF THE ELBOW REGION

On the ulna identify:

olecranon and coronoid processes

(iii) distal end

On the radius identify:

(iii) distal end

Classify the elbow joint and identify and describe its:

medial (ulnar collateral)

(iv) subcutaneous bursae and fat pads

Identify and classify the radio-ulnar joints:

At the proximal radio-ulnar joint identify and describe its:

At the distal radio-ulnar joint identify and describe its:

State the close-packed position of the elbow and radioulnar joints.

Describe the "carrying angle" of the forearm.

Identify, describe the attachments and deduce the actions of the

List the factors responsible for maintaining stability at the:

The shoulder joint is designed for mobility.

Define the following terms relating to muscle function:

THE UNIVERSITY OF MELBOURNE

Dr Do El-Ansary, BAppSc(Phty), PhD

to guide your completion of each module: