functional anatomy -- clinic

8/18/2019 Functional Anatomy -- Clinic

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Functional Anatomy

Department of Rehabilitation Sciences

The Hong Kong Polytechnic University


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Aims

Apply anatomy knowledge

in a functional perspective.in the understanding of

pathological conditions


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Functional Anatomyof Lower Limbs

Examples


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Functions of lower limbs

Support Locomotion

bipedal


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Body weight is transferred from:

Weight bearing

bones – strong joints – stable

base – wide & adaptable

Support - skeletal system

ADAM

h e a d > V C

h i p > f e

m u r

t i b i a > t a l u s >

c a l &

M T


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Support FunctionBalance:

Related to falling eg, ‘keeping one’s balance’

Body dynamics:

Inertial forces acting on the bodyCharacteristics of the body segments


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Support Function

Posture

Orientation of body/body segment

Usually measured with referenceto the vertical

Good

Posture


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Maintaining Balance

Complicated Activity . . .Requires integrity ofMusculoskeletal System

Postural musclesNervous System

Reflex loops

Somatosensory inputVestibular

Vision


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Support Locomotion

Initial

Static

Semi-static position

Final

Dynamic movement


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Eye muscles

Gaze stabilization

Postural muscles

Balance control


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Falls of elderly


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Hip Joint Range required in sitting

Depends on posture, chair height & depth, activit ies


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Sit to standKinematics Hip

from flex to ext.

about 800-1000 flex is required.

Knee

from flex to ext

range depends on height of

seat

Ankle from plantarflexion

to neutral

Muscular Actions Gluteus max.

Hamstrings

Quadriceps

Note positions

of joints


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Sit to stand: Two main phases . . .Phase 1

Forward rotation of trunk over stationary thigh base of support = chair; controlled eccentrically by hip

extensors therefore hip flexion occurs.Phase 2

Raising of the COM above feet

new base of support = feet; Hip & knee extension;Ankle plantarflexes to neutral.

P

H

A

S

E

2


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How does a person with functionalimpairment of lower limbs stand up?

Push up w/ UL;

Lat dorsi + triceps


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How does a person with progressivemuscular dystrophy rise to a standingposition?

Gowers’ sign: arms push body to (B), using arms to

‘walk’ to (C), then climb up on legs to erect position (D).

Shands’

Walk back to C

C

L

I

M

B

A to B


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How does impaired function inlower limbs affect the ADL?

Toileting

Dressing

Note hip ROM

Getting intoBath tub


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Locomotion – Walking, Running . .Functional kinetic chain

Interrelated systems

Compensation takesplace when one

system / structure isimpaired


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Walking (Locomotion)


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Locomotion Function

Challenges

Controlling foot trajectory.

Evidence that the average toe

clearance above the groundduring swing phase:


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Functional Impairment due to Nerve / Muscles /

Tendon Injuries to ankle dorsiflexor . . . .

Unable to control foot

Slapping noise compensation

Unable to hold foot up

Dragging of Toes

foot-strike to mid support forward swing phase


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High steppage gait

Go to media clip


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Up/down stairs

Joint range required ?

Muscles required ?

Nerve required ?

Plantar FlexorsIliopsoasQuadriceps


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Functional impairment due to Nerve /Muscle / Bone injury to hip region . . .


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Trendelenburg Sign on single leg standing

& Gait 3 factors for normal fx: • normal fx glut med & min

• hip joint located

• femoral neck intact

(R) CDH

Abductors:

• maintain / raise

pelvis level to

enable the other

leg to swing

forwards

Weight of leg drags

the pelvis down

(L)

Another patient


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Trendelenburg gait

Go to media clip


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Injuries to other structures . . .

Anterior cruciate ligament (ACL)

injury is quite common (Miyasaka et al. 1991)

Operative & Non-operative procedure (Johnson et al. 1992)

Go to media clip


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Anterior Cruciate Ligament: action

Primal


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Anterior Cruciate Ligament: testing

PrimalNote excessive

movement. Go to Clip


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Anterior Cruciate Ligament:

grafting

Wilk & Andrews 1992Intensive Rehab is required

Go to media clip


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ADAM

Rehabilitation

Surgery: grafting why the exercise on the right

is not suitable for early phaseof rehab?

Function: prevent forward

displacement of tibia

early phase: graft not secured

very large anterior displacement

by the strong quadriceps muscle,

may damage the healing graft.


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Foot Conditions

Hallus Valgus & Bunion

Flat Foot

Foot Pronation

Fallen arch

Foot Supination


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Foot conditions

correction by realignment

Normal Pronation

Orthotics:

(insole)

(special shoes)


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Loss of function - supportBone & Joint

Muscles & ligaments

Go to media clip


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How can we help? Artificial system

e.g. replacement, wheelchair, brace, crutches

Compensatory system -

strengthening ex.


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Functional Anatomy

Upper LimbExamples


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Stability vs Mobility

articular surfaces

shape, size, & arrangement

ligament & capsule

muscle tone around the joint


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How can we help?

Right deltoid atrophy from axil lary n. paralysis

following dislocation of shoulder (Shands’ p212).

Ball bearing or Rocker Feeder

Places arm in posit ion for feeding


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Conditions Affecting the Hand:

Rheumatoid arthritis,osteoarthritis

Industrial Accident

Lost digits

Congenital Conditions


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How can we help?

Exercise,

Special Aids,Splints


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Functions of handIntegration of systems

Grasping mechanism STRENGTH

PRECISION

Sensory

Expression


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Factors influencing grip

Shape of objectSize of object

Physical factors

weight, texture, temp.

Intended activity


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The End

functional anatomy -- clinic

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