Muscles, Nerves and Movement Third edition Barbara Tyldesley

Appendix I: Bones 243

244 Muscles, Nerves and Movement

Appendix I: Bones 245

246 Muscles, Nerves and Movement

Appendix I: Bones 247

248 Muscles, Nerves and Movement

Appendix I: Bones 249

250 Muscles, Nerves and Movement

Appendix I: Bones 251

Appendix II Segmental Nerve Supply of Muscles

Appendix II: Segmental Nerve Supply of Muscles 253 Table A2.1 Cranial nerves I Olfactory Sensory from roof of the nose. Smell II Optic Sensory from retina of the eye. Vision Note: Cranial nerves III Oculomotor Motor to four of the muscles of the eye supplying muscles contain (superior, inferior and medial rectus, inferior sensory proprioceptor IV Trochlear oblique), motor to the sphincter muscle of the fibres, except the facial V Trigeminal iris and the ciliary muscle of the lens nerve. Proprioception from Motor to the superior oblique eye muscle facial muscles is carried in Abducens Sensory to the skin of the face and anterior the trigeminal nerve Facial tongue Motor to salivary glands and muscles of VI Vestibulocohlear mastication (temporalis and masseater) VII Motor to the lateral rectus eye muscle Glossopharyngeal Sensory to anterior tongue. Taste Motor to VIII Vague muscles of the face and salivary glands Sensory from vestibule. Balance IX Spinal assessory Sensory from coclear of ear. Sound X Cranial root Sensory from posterior tongue. Taste Spinal root (C1–C5) Sensory and motor to pharynx, larynx, thoracic XI Hypoglossal and abdominal organs XII Motor to the muscles of the pharynx and larynx Motor to sternomastoid and trapezius Motor to muscles of the tongue Table A2.2 Spinal nerves C5, C6 Shoulder Abductors and lateral rotators C5, C6, C7, C8 Flexors, extensors, adductors and medial rotators Segmental origin in the C5, C6 Elbow Flexors spinal cord of the nerves C7, C8 Extensors supplying the muscle C5, C6 Forearm Supinators groups moving the limbs C6, C7, C8 Pronators C6, C7, C8 Wrist Flexors, extensors and deviators C7, C8, T1 Digits Long flexors and extensors C8, T1 Hand Intrinsic muscles L2, L3 Hip Flexors L2, L3, L4 Abductors L4, L5, S1 Knee Extensors, medial and lateral rotators and Flexors abductors L2, L3, L4 Ankle Extensors L4, L5, S1, S2 L4, L5, S1 Foot Dorsiflexors L4, L5, S1, S2 Plantarflexors L4, L5, S1 Invertors L5, S1 Evertors L5, S1, S2 Intrinsic muscles

254 Muscles, Nerves and Movement Table A2.3 Segmental innervation of the muscles of the upper limb [after Basmajian J. (ed.) (1980) Grant’s Method of Anatomy, 10th edn, published by Williams & Wilkins]

Appendix II: Segmental Nerve Supply of Muscles 255 Table A2.4 Segmental innervation of the muscles of the lower limb [after Basmajian J. (ed.) (1980) Grant’s Method of Anatomy, 10th edn, published by Williams & Wilkins]

0 Glossary abduction movement of a body segment that ATP (adenosine triphosphate) the major energy- takes it away from the midline of the body in the storing molecule in the cells of the body. coronal (frontal) plane. autonomic nervous system part of the peripheral action potential reversal of the membrane poten- nervous system that innervates cardiac and tial in a localised area of a neurone or muscle smooth muscle, and glands. fibre due to the movement of charged particles (ions) across the membrane. axon main process of the neurone that conducts impulses away from the cell body to another neu- adduction movement of a body segment towards rone or an effector. the midline of the body in the corona1 (frontal) plane. basal ganglia subcortical motor nuclei that mod- ulate the activity in the descending motor system. aerobic metabolism chemical reactions in the mitochondria of a cell that replenish ATP using body scheme the perception of the position of oxygen and glucose. parts of the body in space and their relationship to each other. afferent ‘towards’, e.g. afferent (sensory) neurones carry impulses towards the central nervous bouton enlarged bulbous end of a terminal system. branch of an axon or dendrite. agonist see prime mover brachial related to the upper limb. allodynia the experience of pain from a stimulus brain stem a long cylindrical structure at the base that would not normally be harmful. of the brain leading to the spinal cord. There are ampulla a specialised receptor area in one of the three parts: midbrain, pons and medulla. bursa a closed sac of fibrous tissue, containing syn- semicircular canals of the inner ear. ovial fluid associated with the large joints. Bur- antagonist a muscle that opposes the action of the sitis is inflammation of a bursa. agonist (prime mover). capsule the sleeve of dense fibrous tissue sur- aponeurosis a broad sheet of dense fibrous tissue rounding and uniting the ends of the bones in a synovial joint. that: (i) attaches muscles to each other, e.g. abdominal muscles; (ii) forms the attachment of carpal one of eight bones of the wrist, which link a muscle to bone, e.g. tensor fascia lata; or (iii) the radius and the ulna of the forearm with the forms a protective layer for tendons, e.g. plantar metacarpals in the hand. aponeurosis. arthroplasty replacement of a joint by an artificial carpal tunnel anatomical space on the palmar sur- one. face of the wrist for the long tendons passing astereognosis inability to identify an object by from the forearm into the hand. manipulation in the hand without vision. ataxia movement errors that include the inability CAT scan (computed axial tomography) A thin, to place a body part accurately, or to perform fan-shaped X-ray beam views a ‘slice’ of the smooth, co-ordinated movement of the limbs. brain. The X-ray tube revolves round the

Glossary 257 patient so that the brain is viewed from all angles. depolarisation a change in the electrical potential A computer combines all the views, and the across the membrane of a neurone, produced by changes in soft tissue at the lesion site are the movement of charged particles (ions). revealed in a single image. cauda equina the lower spinal nerves that lie in the dermatome sensory innervation of one spinal spinal canal below the level of the first lumbar nerve. vertebra. central nervous system division of the nervous sys- diaphysis the shaft of a long bone. tem containing the brain and spinal cord. diencephalon part of the forebrain found buried centre of gravity the point around which the body’s weight and mass are equally balanced in all deep in the cerebral hemispheres that includes directions. the thalamus and hypothalamus. cerebral vascular accident (CVA) a stroke: the dorsiflexion movement of the foot at the ankle joint term used to describe rapidly developing focal that lifts the toes up towards the leg. brain damage resulting from a reduction in blood dysmetria inability to make active placement of a flow (ischaemia) or a haemorrhage in the brain. body part, e.g. touching the nose. cerebrospinal fluid circulates in the cavities of the brain, the central canal of the spinal cord and the eccentric muscle work active muscles lengthening subarachnoid space of the meninges. to control the effect of an external force, such as circumduction circular (conical) movement made gravity. by a body segment (not to be confused with rota- tion movement at a joint). efferent away from, e.g. efferent (motor) neurones closed loop motor control that uses feedback to carry impulses away from the central nervous sys- make corrections during the progress of a tem (motor). movement. cognition the ability to organise and use knowledge epiphyseal plate cartilaginous layer between the about oneself and the environment to function epiphysis and diaphysis of long bone during effectively. growth in length. cognitive system a complex system of interrelated parts that processes visual and spatial perception, epiphysis the end of a long bone that develops attention, body scheme, memory and the exec- from a secondary centre of ossification. utive functions. collagen fibrous protein found in connective tissue equilibrium reaction a reflex response to a dis- that has tensile strength. turbance of balance, e.g. when the line of grav- concentric muscle work active muscles shorten to ity of the body moves outside the base of support. produce a movement. conduction velocity the speed at which a neurone eversion movement in the joints of the foot that conducts impulses. turns the sole of the foot outwards or laterally. contracture the permanent shortening of a mus- cle or tendon producing a deformity and limit- excitation changes in the membrane of a neurone ing movement. that allows impulses to be propagated. contralateral the opposite side of the body. corpus callosum a thick band of axons connecting executive functions the mental operations involv- the right and left hemispheres in the forebrain. ed in goal setting, organising, monitoring and corpus striatum collective term used for the cau- completing action and behaviour. date, putamen and globus pallidus, which form the main components of the basal ganglia. extension return movement from flexion in the cortex outer layer of an organ, e.g. surface grey sagittal plane back to the anatomical position. matter of cerebral hemispheres or cerebellum. Extensor muscles increase the joint angle or cranial nerve one of 12 pairs of nerves leaving the straighten a limb when they contract. brain, which are sensory, motor or mixed. extrafusal fibres form the bulk of a skeletal muscle. extrapyramidal system polysynaptic descending pathways from cortical and subcortical brain areas involved in motor control, balance and posture. fascia lata see iliotibial tract fasciculus bundle of muscle fibres or axons sur- rounded by fibrous connective tissue. fast muscle fibres (glycolytic, type II) generate ener- gy from glycogen without oxygen. Specialised for short bursts of high-level muscle activity.

258 Muscles, Nerves and Movement feedback control the modification of action as it hypotonia muscle tone that is lower than normal progresses based on changes in the environment. which is felt as decreased resistance to passive stretch of a limb. feedforward control the modification of the motor command for action before the movement is iliotibial tract (fascia lata) a band of dense executed. fibrous tissue on the lateral side of the thigh, extending from the iliac crest to below the pos- first-order neurone the initial neurone in a sensory terior aspect of the lateral tibial condyle. system that carries information from the recep- tors to the central nervous system. impulse (nerve) a localised change in the mem- brane potential in a neurone, which is self- flaccidity state of hypotonia in muscles that is char- propagating and travels down the axon in one acteristic of lower motor neurone lesions. direction only. flexion movement in the sagittal plane that moves inhibition a decrease in the excitability of a neu- body segments towards each other. rone so that no impulses can be propagated. The source of inhibition may be from presynaptic force (muscle) is generated by the tension in a interneurones or the release of inhibitory neu- muscle acting at its point of attachment to a rotransmitter substances. bone. innervation the nerve supply to a muscle or to an forearm body segment between the elbow and the end organ or gland. wrist containing the radius and the ulna. insertion the distal or lateral attachment of a mus- fusimotor neurone innervates the intrafusal mus- cle to a bone that usually moves when the mus- cle fibres found inside a muscle spindle. cle contracts. ganglion a collection of the cell bodies of neurones interneurone a neurone in the central nervous sys- located in the peripheral nervous system. tem that has no branches in a peripheral nerve. girdle the bones that attach the limbs to the body; intrafusal muscle fibres lie in a muscle spindle the pectoral girdle for the upper limb, and the innervated by annulospiral (sensory) and pelvic girdle for the lower limb. fusimotor nerve endings. grey matter collections of the cell bodies of neu- inversion movement in the joints of the foot that rones, their dendrites and the neuroglia cells turns the sole of the foot inwards or medially. that support them within the central nervous system. ipsilateral the same side of the body. isometric (static) muscle work active muscles gyrus a raised area of cortex seen on the surface of the cerebral hemisphere or cerebellum. that remain the same length to hold a position hemianopia ‘blindness’ in part of the visual field kyphosis an increase in the primary thoracic of one or both eyes, originating in a lesion in the curve of the spine, which may appear as round- occipital lobe of the cerebral hemisphere. ed shoulders. hierarchy the organisation of levels of neural pro- labyrinth (bony) a system of tunnels within part of cessing in a ranked order in relation to one the temporal bone containing the utricle, saccule another. and semicircular canals of the inner ear. hippocampus a curved gyrus that lies deep in the lentiform nucleus the putamen and globus pallidus medial temporal lobe, adjacent to the temporal of the basal ganglia. part of the lateral ventricle, forming part of the limbic system. lesion focal damage of brain tissue, vascular in ori- gin. homunculus a representation of the parts of the body in the brain, usually drawn as a distorted lever a rigid bar (or bone) that moves about a pivot image of a person. (fulcrum). hypertonia muscle tone that is higher than normal ligament dense fibrous tissue that joins bone to which is felt as increased resistance to passive bone around a joint in the form of a cord or stretch of a limb. band. The fibrous capsule that surrounds syn- ovial joints is also known as a capsular ligament. hypothenar muscles in the palm of the hand at the base of the little finger.

Glossary 259 limbic system a complex system of interconnect- The base level of response may be raised or low- ed structures in the cerebral hemispheres and the ered in the short term or the long term. diencephalon, including the cingulate gyrus of moment of force the product of the magnitude of the medial cerebral cortex, and the hippocampus a force and its distance from the fulcrum (cen- of the temporal lobe. The limbic system attrib- tre of the joint). utes emotional value to movement and behav- momentum of a moving body part, generated by iour. muscle action, depends on the product of its mass and its speed of movement. lobe discrete rounded part of an organ, e.g. the motor neurone see efferent brain. motor programme a plan for action that includes force, timing and sequence of muscle activity. lordosis an increase in the secondary lumbar motor unit one motor neurone in the spinal cord curve of the spine, often referred to as hollow and all the muscle fibres supplied by it. back. MRI (magnetic resonance imaging) A strong magnetic field is produced by electromagnets dis- lower motor neurone originates in the anterior tributed around the head. A radio pulse excites horn of the spinal grey matter and its axon sup- the hydrogen atoms in the water in the brain plies skeletal muscle fibres (also used to tissue. A computer translates the signals from the describe the neurones of cranial motor nerves). movement of the hydrogen atoms into an image, which identifies where lesions have occurred. lower motor neurone lesion interruption of nerve muscle fibre multinucleated unit of structure of impulses at any point in a lower motor neurone. skeletal muscle. The result is loss of muscle tone and of tendon muscle spindle a complex receptor lying in paral- reflexes. lel with skeletal muscle fibres that is stimulated by changes in muscle length. macula lutea (fovea) area of the retina of the eye muscle tone the tension in a muscle resulting from opposite the lens where visual acuity is greatest. background neural activity in the muscle stretch reflex. Clinically, muscle tone is felt as the resist- mechanoreceptor a receptor found in the skin ance that is felt when passively manipulating the that responds to touch and pressure stimuli. limb of a patient. Those in the palm of the hand and the sole of myelin sheath a fatty layer surrounding the axon the foot are important in the manipulation of some neurones that acts as an insulator and of objects, and for the balance of the body in increases the rate of conduction of impulses. standing, respectively. myofibril strand of protein along the whole length of a muscle fibre. There are several hun- membrane potential the electrical potential due to dred myofibrils in each muscle fibre. the distribution of ions across a cell membrane. myofilaments strands of actin and myosin, arrang- ed in a particular way in a sarcomere. meninges the membranes that surround and pro- myotome all the muscles supplied by one spinal tect the brain and spinal cord. segment and its pair of spinal nerves. metacarpal one of five bones found in the palm of nerve tract bundle of parallel axons in the central the hand and the base of the thumb. The meta- nervous system carrying information towards carpals join the distal row of carpals to the prox- (ascending) or away from (descending) centres imal phalanges of the fingers and the thumb. in the brain. metatarsal one of five bones in the forefoot that neuroglia support cells in the nervous system, link the distal row of tarsals with the proximal other than neurones, which are not primarily phalanges of the toes. involved in the propagation of nerve impulses. mitochondrion a sausage-shaped structure with a neuromuscular junction a specialised synapse double membrane, found in the cytoplasm of between a motor neurone and a muscle fibre. cells, forming the site of production of ATP. mixed nerve contains both sensory and motor axons. modality a system of receptors that respond to specific type of stimulus, e.g. tactile, visual, auditory. modulation the process by which the level of excitability of a group of neurones is changed.

260 Muscles, Nerves and Movement neuropathy a pathology that affects the peripher- coronal (frontal) plane passes through the body al nervous system. from top to bottom, dividing it into anterior and posterior halves. Abduction and adduction neuroplasticity structural and biochemical changes movements occur in this plane. in neurones that may establish new learning or transverse (horizontal) plane passes through restore function in the brain. the body horizontally, dividing it into upper and lower parts. Rotation movements occur in this neurotransmitter a specific chemical released by a plane. presynaptic neurone that crosses the synaptic plantar flexion movement of the foot at the ankle cleft and stimulates or inhibits the postsynaptic joint that points the toes downwards, or in stand- neurone. ing, lifts the body on to the toes. plaque an area of demyelination in the central nociceptor a receptor responding to harmful nervous system. stimuli that lead to the perception of pain. plexus network of nerves or blood vessels branch- ing and joining, e.g. brachial plexus. nucleus pulposus semi-fluid central portion of the popliteal fossa posterior region of the knee. intervertebral disc. power grip all the fingers are flexed and the thumb is curled in the opposite direction around a han- nystagmus movement of the eyes from side to side dle or an object. with alternate slow and fast phases. power (muscle) the product of force times speed of movement. A high level of muscle power is opposition movement of the thumb that turns the required for fast dynamic movement such as pad or the tip of the thumb towards one or more jumping and throwing. fingers. precision grip the hand holds an object between the pads or the tips of the thumb and one, two osteoblast a bone-forming cell. or three fingers. osteoclast a cell that absorbs bone in remodelling prime mover see agonist processing a series of operations in the nervous during growth or repair. system directed to some end. The output of the activity in a processing centre or neural network pennate muscle fasciculi of muscle fibres arrang- is relayed to other centres. ed diagonally along a common tendon like a serial processing occurs in centres that are feather. arranged in serial order. perception the integration of all the sensory infor- parallel processing occurs simultaneously in dif- mation entering the brain to make a meaning- ful whole. ferent centres and the outputs are integrated in another centre. peripheral nervous system the division of the nerv- pronation movement of the radius over the ulna ous system that conducts information towards in the forearm that turns the palm of the hand and away from the brain and spinal cord. downwards or backwards. proprioceptors the receptors lying in skeletal PET scan (positron emission tomography) reveals muscle, tendon and joints, which collectively the level of activity in the different areas of the respond to changes in the length and tension in brain over time. A solution containing a radio- muscle and the angulation of joints. active isotope is injected intravenously and pyramidal system the monosynaptic descending accumulates in the brain in amounts propor- pathway from the primary motor area to the tional to the local blood flow. The positrons emit- lower motor neurones. ted by the isotope are detected by sensors placed around the head. receptor a specialised area of membrane at the dis- tal end of a sensory neurone, which responds to phalanx a bone of a finger or toe (plural = a specific stimulus. phalanges). pia mater innermost layer of the meninges cover- ing the brain and spinal cord. plane of movement an imaginary line of reference passing through the body in a particular direc- tion used to describe movement. sagittal plane passes through the body from front to back, dividing it into right and left halves. Flex- ion and extension movements occur in this plane.

Glossary 261 reciprocal innervation the integration of spinal substantia gelatinosa a band of grey matter in the motor neurones to excite one muscle group and spinal cord round the apex of the posterior horn. inhibit the opposing group. The neurones form a spinal control mechanism in the transmission of nociception to the brain. red nucleus an area of grey matter in the midbrain receiving fibres from the cerebellum and pro- sulcus (also known as a fissure) a groove or fur- jecting fibres into the rubrospinal tract for acti- row between adjacent gyri on the surface of the vation of the proximal muscles of the limbs in brain. positioning movements. supination movement of the radius around the reticular formation a diffuse network of neurones ulna that turns the palm of the hand to face in the brain stem concerned with levels of upwards or forwards. arousal. suture a fibrous joint between the bones of the skull. retinaculum a band of dense fibrous tissue that binds symphysis a secondary cartilaginous joint where the tendons of muscles and prevents bowstring. the bones are joined by fibrocartilage. rigidity the resistance to passive movement over synapse a junction between a neurone with anoth- the whole range of movement at a joint, due to the presence of abnormal muscle tone. er neurone, a muscle fibre or a cell of a gland, where the transmission of nerve impulses occurs. sarcomere the unit of the myofibril between synaptic cleft the microscopic space between the adjacent Z-lines. membranes of the presynaptic and postsynaptic neurones at a synapse. scoliosis lateral curvature of the spine. syndesmosis the type of fibrous joint where the semicircular canals thin tubes found in the inner bones are a distance apart and they are con- nected by a sheet or band of fibrous tissue, e.g. ear with receptors responding to movements of middle radio-ulnar joint. the head in three planes. synergist a muscle, other than the agonist or antag- sensory neurone see afferent onist, whose activity assists in a movement. sesamoid bone found within a tendon, e.g. patella. synergy co-ordinated activity in muscle groups act- skeletomotor neurone innervates skeletal muscle ing over several joints to perform commonly fibres. occurring movements of a limb. slow muscle fibres (aerobic, type I) generate synovial fluid viscous fluid secreted by the synovial energy from ATP in the presence of oxygen. membrane into the cavity of a joint or a tendon Specialised for long periods of muscle activity sheath. without fatigue. synovial joint the articulation of the ends of two somatic referring to the skin and the muscles. bones that are separated by a joint cavity and sur- somatosensory the part of the nervous system rounded by a fibrous capsule lined with a synovial concerned with information from the body, membrane. including the skin, muscles and joints. spasticity a pathological state of hypertonia. tarsal one of seven bones that link the tibia and spinal nerve one of 31 pairs of nerves leaving the fibula of the leg with the bones of the forefoot spinal cord. Each nerve is formed by the joining (metatarsals and phalanges). of an anterior and a posterior root from the spinal cord. tectum the roof of the midbrain. spinal segment portion of the spinal cord that gives tendon a cord or band of dense fibrous tissue that origin to one pair of spinal nerves. stereognosis the ability to identify an object by unites muscle to bone. manipulation and without vision. tension (muscle) force generated by an active striate cortex the area of the cerebral cortex on the medial aspect of the occipital lobe where pro- muscle to produce movement, or to resist cessing of visual information occurs. movement. subarachnoid space the space, filled with cere- thalamus the large oval mass of grey matter in the brospinal fluid, between the arachnoid mater and diencephalon on either side of the slit-like third the pia mater of the meninges. ventricle. thenar muscles in the palm of the hand at the base of the thumb.

262 Muscles, Nerves and Movement tremor involuntary rhythmic contractions of ago- vestibule the part of the inner ear with receptors nist and antagonist muscles, commonly in the dis- responding to the position of the head with tal segments of the limbs. May occur at rest, or respect to gravity. on initiation of a movement (intention tremor). vestibulo-ocular reflex the reflex movement of the tubercle a lump on a bone, created by muscle trac- eyes in the opposite direction to the movement tion. of the head that maintains a constant image on the retina. upper motor neurone originates in a motor area of the brain that regulates the activity in lower visceral referring to internal organs. motor neurones via descending pathways in the visual field the area of the visual world that is spinal cord. visible out of the eye in a given position. upper motor neurone lesion an interruption of conduction of nerve impulses at any point in white matter the parts of the central nevous sys- upper motor neurones. The outcome is an exag- tem that are mainly composed of collections of geration of reflexes, abnormal movement pat- axons whose myelin sheaths give a white terns and changes in muscle tone. appearance. ventricle a cavity inside the brain filled with cere- Z-line the dark line seen by the electron micro- brospinal fluid. scope that marks the separation of adjacent sarcomeres in a myofibril.

Index Abdominal cavity 161 Body scheme 22, 48 Abdominal muscles 166–168 Brachial plexus 121–122 Achilles’ tendon 145–146 Adenosine triphosphate ATP 14 terminal branches 123–129 Agonist (prime mover) 30 Brain Anatomical position 25 Ankle development 40–41 injury 17 bones 135 main areas 55–56 joint 136–137 Brain stem 42, 53, 197, 199, 204 movements 137 motor nuclei 199–200 muscles 142–143, 145–146 Breathing 169–173 Antagonist 30, 61 abdominal muscles 166–167 Anterior abdominal wall diaphragm 172–173 functions 168 rib movements 170–172 in breathing 173 muscles 166–167 Canadian Occupational Performance Measure nerve supply 175 (COPM) 223 Anterolateral (spinothalamic) pathway Carpal tunnel 111 181–182 Centre of gravity 33–34, 190, 214 Ape hand 125, 127 Cerebellum 54–55, 202–203 Aponeurosis Cerebral hemispheres 43–50 palmar 103, 111 functional areas 47 plantar 151 lateralisation 49–50 Arches of the foot 148–151 see also Frontal lobe, Occipital lobe, Arcuate ligaments 172 Arousal 54 Parietal lobe, Temporal lobe Assessment of motor and process skills Cerebrospinal fluid 40–42, 58 Cervical plexus 65–66 (AMPS) 224 Claw hand 125, 127 Attention 208–209 Cognition 46, 49, 209, 224, 233, 235, Autonomic nervous system 72–75 239 ganglia 73 Connective tissues 4–8 parasympathetic 74–75 sympathetic 74 bone 6–8 cartilage 5–6 Basal ganglia (nuclei) 50, 201 dense fibrous tissue 4–5 Base of support 33–34, 208, Core positions/movements 210 Corona radiata 51 214–215 Corpus callosum 43 Behaviour 49, 235 Corpus striatum, see Basal ganglia Costal cartilage 170

264 Index Cranial nerves Fusimotor neurone, see Motor neurone abducent 70 facial 71–72 Gait, see Walking hypoglossal 72 Glycogen 14 oculomotor 70 Golgi tendon organ 22, 194–195 optic 190 Grips 117–119 spinal accessory 129, 174 Group action of muscles 29–30 trigeminal 71–72 Gyrus 44 trochlear 70 vestibulocochlear 70 cingulate 52 postcentral 48 Cutaneous nerves precentral 46 foot 159 hand 124–126, 129 Hand functions 105, 235–236 Dermatome 66–67 joints (fingers) 106 lower limb 160 muscles moving 108–115 upper limb 129–130 see also Thumb Diaphragm 172–173 Hip Diencephalon 40, 51 joint 132–133, 137 Dorsiflexion 137 movements 133 muscles 138–142 muscles 142–143 Dura mater, see Meninges Hippocampus 49, 52, 209 Hypothalamus 51–52, 74, 185 Elbow 92–97 Hypothenar muscles 110–115 joint 92 movements 93 Iliotibial tract 137 muscles 93–97 Inguinal ligament 132, 141, 153, 166 Inhibition 16, 61, 187, 196 Emotion 52–53, 187, 208 Internal capsule 51 Environment 220, 225, 227, 234–235, 237, Interneurone 18, 59, 194–196 Intervertebral disc 10, 163 239 Inversion (foot) 147 Equilibrium reactions 34 Eversion (foot) 147–148 muscles 147–148 Executive functions 48, 210 Extra-pyramidal system 200 Joints (named) acromioclavicular 81 Fascia lata, see Iliotibial tract ankle 135–137 Finger carpometacarpal (thumb) 106–107 costovertebral 170 joints 106–107 elbow 92 muscles glenohumeral (shoulder) 81–83 hip 132–133 extrinsic 108–109, 111–113 interphalangeal 106 intrinsic 110, 114–115 knee 134–135 Flexor tendon sheaths (hand) 111 metacarpophalangeal 106 Foot midcarpal (hand) 101 arches 148–149, 151 midtarsal 147 functions 145 pubic symphysis 9, 132 movements 137–147 radiocarpal (wrist) 101 muscles 150–151, 147–149 radioulnar (proximal and distal) 100 Force, see Moment of force sacroiliac 132 Forearm 98 sternoclavicular 80–81 joints, radio-ulnar 100 muscles, pronators/supinators 150–151 Frontal lobe 46–48, 185

Index 265 sternocostal 170 Motor performance 202 subtalar 147 closed/open loop 193 wrist 101 Joints (types) Motor planning 47, 201 cartilaginous 8–9 Motor skills 202, 224 fibrous 8 Motor speech area 47–48 synovial 9–10, 27–28 Motor unit 19–20 Movement terms 28–29 Knee Muscle, skeletal 10–15 joint 135 movements 135 elastic component 12 muscles 141–142 energy supply 14 fasciculus 11–12, 14 Kyphosis 163 fibre types I and II 14–15, 20 group action 30 Levers, principles of 34–36 Muscle spindle 22, 194–195 adaptation of tools 36, 38 Muscle tone 22–23, 211, 221 Muscle work, types Lifting 36–37, 162, 165–166 concentric/eccentric/static 30–31, 144–145, 215, Limbic system 48, 52–53, 74, 185 Lordosis 163, 173, 214, 217 219 Lower limb Muscles (named) functions 131 abductor digiti minimi (hand) 113 joints 132–137 abductor hallucis 150 muscles 138–145 abductor pollicis brevis 113 Lower motor neurone 65, 193, 197 abductor pollicis longus 112 Lumbar plexus 153 adductor group (hip) 139, 173 position and formation 153–154 adductor hallucis 150–151 terminal branches 154–155 adductor pollicis 109–110 Lumbar puncture 58 anconeus 94 Lung ventilation 169–170 biceps brachii 93, 101 Lying 211 biceps femoris, see Muscles, hamstrings brachialis 94 Macula (fovea) of retina 189, 192 brachioradialis 94–96 Medulla oblongata 53–54, 181, 197–198 coccygeus 174 Memory 48, 204, 209–210 coracobrachialis 91 Meninges 40, 57–58 deltoid 88 Midbrain 53–54 diaphragm 172–173 Mitochondrion 14 erector spinae 164 Modulation 179, 186–187, 204 extensor carpi radialis longus/brevis Moment of force 32 Motor behaviour 48, 211 103–104 Motor control theories 63, 203–204, 207 extensor carpi ulnaris 103–104 Motor cortex, primary 46 extensor digiitorum (forearm) 111 extensor digitorum longus (leg) 143 descending pathways 197–199 extensor digiti minimi 111 links with basal ganglia and cerebellum 50, extensor hallucis longus 142–143 extensor indicis 112 201–202 extensor pollicis longus/brevis 112 Motor homunculus 46 external oblique (abdominal) 166–167 Motor (efferent) neurone 18, 65 flexor carpi radialis 102–103 flexor carpi ulnaris 102–103 fusimotor (gamma) 194, 199 flexor digiti minimi (hand) 110 lower 65, 193, 197 flexor digitorum accessorius 146 pool 19 flexor digitorum brevis (foot) 150 skeletomotor (alpha) 23, 199 flexor digitorum longus (leg) 145–146 upper 197

266 Index Muscles (named) (cont’d) splenius capitis/cervicis 168–169 flexor digitorum profundus 108–109 sternocleidomastoid 169–171 flexor digitorum superficialis 108–109 subclavius 169 flexor hallucis brevis 150 subscapularis 87 flexor hallucis longus 145–146, 150 supinator 101 flexor pollicis brevis 109 supraspinatus 87 flexor pollicis longus 108 temporalis 72 gastrocnemius 145–146 tensor fascia lata 138, 141, 143, 173 gluteus maximus 143, 173 teres major 91 gluteus medius/minimus 138, 173 teres minor 87 gracilis 139 tibialis anterior 142–143 hamstrings 142, 173 tibialis posterior 145–146 biceps femoris/semimembranosus/ transversus abdominis 167–168 semitendinosus 141, 151, 159 trapezius 84 iliopsoas 140–141, 173 triceps brachii 94 infraspinatus 87 Myelin sheath (axon) 16 intercostals (external, internal) Myofibril 11, 14 170–171 Myosin 11, 14 internal oblique (abdominal) 166–167 Myotome 68 interossei, dorsal/palmar lower limb 160 foot 151 upper limb 130 hand 114–115 latissimus dorsi 89, 171, 174 Nerve (named) levator ani 174 anterior interosseous 125 levator scapulae 84 axillary 122, 124 lumbrical cranial, see Cranial nerves foot 150 femoral 154–156 hand 114 genitofemora1 154 masseter 72 gluteal, superior/inferior 157 opponens digiti minimi 109 iliohypogastric 154 opponens pollicis 109 ilioinguinal 154 palmaris longus 102–103 intercostal 175 pectineus 139 lateral cutaneous (thigh) 154, 156 pectoralis major 89 median 125, 127 pectoralis minor 86, 171 musculocutaneous 125–126 peroneus longus/brevis/tertius 147–149 obturator 154, 156 piriformis 157 peroneal, common, deep, superficial pronator quadratus 101 159 pronator teres 95–96,101 phrenic 174 quadratus femoris 157 plantar, medial/lateral 160 quadratus lumborum 165, 168, 172, 174 posterior interosseous 123 quadriceps femoris 141, 143–145 pudendal 160 rectus femoris, vastus medialis, intermedius, radial 123–124 lateralis 140, 142–144, 151 saphenous 154–155 rectus abdominis 166–167, 173 sciatic 158–159 rhomboids 85 suprascapular 129 sartorius 141, 173 sural 159 scalenus anterior, medius, posterior tibial 159 169–171 ulnar 127–129 semispinalis 165 serratus anterior 85 Nerve impulse 16 soleus 145 Neuroglia 42 Neuro-imaging 44–46

Index 267 Neurone 15–19 Propulsion (lower limb) 143–145 fusimotor 68 Psychosocial factors 224, 226, 234 interneurone 18, 59, 194–196 Pyramidal system 200 motor (efferent) 18 sensory (afferent) 18 Reaching/retrieving 221–222 skeletomotor 22–23, 68, 196 Receptor 20–22, 185 Neuroplasticity 17–18, 45, 187, 232 adaptation 21 Neurotransmitter 16–17 receptive field 20 types 21–22 acetylcholine 17 Reciprocal innervation 61–62, 194 adrenaline 17, 73 Red nucleus 200 dopamine 17, 51, 228 Reflexes (named) endorphin 187, 208 brain stem 70, 71 serotonin 17 crossed extensor 62 Nociceptor 22, 183–187 flexor (protective) 61 Nystagmus 71 Golgi tendon 194, 196 muscle stretch 22–23, 60, 194 Occipital lobe 49 spinal 60–61 striate cortex 49, 189 vestibulo-ocular 70–71, 190, 200 Reticular formation 54, 200 Pain 183–187, 231–232, 238 Retinaculum Pain gate control system 186 ankle (extensor) 142 Palmar aponeurosis 111 wrist (extensor and flexor) 103, 109–110, Parasympathetic nervous system 74–75 Parietal lobe 48 112 Pectoral girdle 80–81, 221 Role 224 Pelvic floor 174 Rolling 211–212 Pelvis Rotator cuff muscles 87 girdle 214 Saccule 188 joints 132 Sacral plexus 157 pelvic tilt 132, 214–215, 217 Perception 185, 209, 216, 219–220 position/formation 157 Peripheral nerve composition 68–69 terminal branches 157–160 Planes of movement 26 Sarcomere 11 Plantar flexion 137 Scoliosis 163 muscles 145 Semicircular canals 188–189 Pleura 169 Sensory neurone (afferent) 18, 65 Plexus Shoulder girdle, see Pectoral girdle brachial 121–122 Shoulder (glenohumeral) joint 81–83 cervical 65–66 Sitting 95, 141, 168, 212–213, 239 lumbar 153–154 Sit/stand 140–141, 214–215 sacral 153, 157 Somatosensory system 180–183 Pons 53–54 primary area 48 Posterior abdominal wall 168 Speech Posterior/dorsal column 181–182 motor area 47 Postural control 190–191, 199–200 receptive (Wernicke’s) area 47, 49 Posture, upright 162–163 Spinal cord 56–60 Prefrontal cortex 46, 48 functions 62 Premotor cortex 46 segmentation 56 Processing 224 substantia gelatinosa 185–186 Processing skills 224 Spinal nerves 65–66 Pronation 99–100 Spinothalamic tract, see Anterolateral Proprioceptor 22, 68, 194–195 pathway

268 Index Squatting 144, 216–217 descending Stability 32–43, see also Base of support, corticobulbar 197–199 corticospinal 197–199 Centre of gravity reticulospinal/rubrospinal/tectospinal/ Stairs ascent/descent 219–220 vestibulospinal 199 Standing 162–163, 217 Stereognosis 44, 48, 105 Traumatic brain injury, see Brain injury Stretch reflex, see Reflexes Trunk Striate cortex 49, 189 Substantia nigra 50–51 functions 162 Sulcus 44 movements 163 calcarine 47, 49 Upper limb function central 45 elbow 92 lateral 45 forearm 98 Supination 99–100 hand 105 Supplementary motor area 46–47 shoulder 78, 80 Support in standing 137–139, 217 Swing phase (walking) 140–143 Upper motor neurone 197–200 Sympathetic nervous system 74 Utricle 188 Synapse 16–17 Synergist 30, 104 Ventricles (brain) 40–41 Synergy 92, 197, 202, 204 Vertebral column Synovial joint, see Joints (types) abnormal posture 163 Tectum 199–200 bones/joints 162–163 Temporal lobe 48, see also Hippocampus movements 163–164 Thalamus 51 muscles 164–168 Thoracic cavity 161 Vestibular nucleus 71, 200 Thorax 169–170 Vestibule (utricle and saccule) 71, 188 Vestibular system 187–189 joints 170 Visual field 214 movements/muscles 170–171 Visual system 189–190 Thumb joints/movements 106–107 Walking 217–219 muscles 108–113 propulsion 143–145 Tracts (central nervous system) 58–60 support 137–139 ascending swing 140–143 anterolateral 180–181 Wrist posterior column 181–182 drop 123–125 spinocerebellar 60, 183 joints 101 movements/muscles 102–105

Index of Clinical Notepads Achilles tendon injury 8E 145 Hemianopia 3E 49 Ankle, Pott’s fracture 8C 137 Hemiballismus 3G 51 Ankylosing spondylitis 11A 183 Hemiplegia 3A 46, 12B 200 Arthritis Herpes Zoster 4A 67 Huntingdon’s chorea 3G 51 osteoarthritis 1C 10 Intervertebral disc prolapse 10A 163 rheumatoid arthritis 1C 10 Knee injuries 8B 135 rheumatoid hand 6D 116, 6E 117 Lower motor neurone lesion 12A 197 Astereognosis 3C 48 Menière’s disease 11C 189 Asthma 10C 172 Motor neurone disease 1G 20 Ataxia 3H 55 Multiple sclerosis 1E 16 Bell’s palsy 4C 72 Myopathies 1D 15 Brachial plexus lesions 7A 122 Nerve lesions Carpal tunnel syndrome 6C 111, 7D 127 Cerebellar dysfunction 3H 55 axillary nerve 7B 123 Cerebral lesions common peroneal nerve 9A 159 frontal lobe 3B 47, 3G 51 median nerve 7D 126 occipital lobe 3E 49, 3G 51 radial nerve 7C 123 parietal lobe 3C 48 superficial peroneal nerve 9A 159 temporal lobe 3D 48 ulnar nerve 7E 129 Cerebrovascular accident, CVA 3A 46 Neuropathies 1F 19 Cervical spine injuries 10E 175 Osteoporosis 1B 6 Chronic obstructive airways disease (COAD) Parkinson’s disease 3G 51 Perceptual and cognitive impairments 10C 172 Chronic pain 11B 187 13A 210 Contracture 1A 5 Peripheral nerve injury 4B 70 Cumulative trauma disorder (CTD) 6E 117 Pneumothorax 10B 170 Duchenne muscular dystrophy 1D 15 Prolapsed intervertebral disc 10A 163 Duypuytren’s contracture 6B 111 Repetitive strain injury (RSI) 6E 117 Dysexecutive syndrome (DES) 3B 47 Shingles 4A 67 Finger deformities 6E 117 Shoulder joint (frozen shoulder, periarthritis, Flat foot 8F 151 Fracture of neck of femur 8A 133 subluxation) 7E 83 Fractures of forearm and wrist 6A 102 Spinal cord injury 4D 74 Freidrich’s ataxia 3H 55 Guillain-Barré syndrome 1F 19 sensory loss 11A 183 Hallux valgus 8F 151 Stress incontinence 10D 174 Stroke, see CVA Tennis elbow 5B 93

270 Index of Clinical Notepads Tenosynovitis 6C 111 Upper motor neurone lesion 12B 200 Traumatic brain injury 3F 49 Vertigo 11C 189 Trendelenburg’s sign 8D 138 Visual agnosia 3E 49 Unilateral neglect 3C 48 Visual impairment 11D 190