Ανατομία των μυών αερισμού /αναπνοής MARIOS MITSIOU PT,MSc Week.6.Tutorial 2. 10_11

Πλάνο για σήμερα Η διάλεξη την Πέμπτη είναι υποχρεωτική – Blood Borne infections Νεύρα - συνοπτικά Muscles of ventilation In groups locate the muscles and describe them to the rest of the group All except the diaphragm Next Monday Tute 1a Quiz if time Movement Studies - Student Viewpoint feedback on S’Net ? there if not watch out for and complete please Week.6.Tutorial 2. 10_11

Συνοπτική θεώρηση των νεύρων Μεταβιβάζουν μηνύματα, αίσθησης και κίνησης από το σώμα στον εγκέφαλο και αντίστροφα διαμέσου του νωτιαίου μυελού Εισέρχονται και εξέρχονται διαμέσου ριζών Enter and leave spinal cord via roots Πρόσθιες ή κινητικές ρίζες είναι κινητικές (φυγόκεντρες) Οπίσθιες ή αισθητικές ρίζες είναι αισθητικές (κεντρομόλες) Αυτές συνδέονται για να σχηματίσουν τα νωτιαία νεύρα (τα οποία ονομάζονται βάσει του επιπέδου που βρίσκονται στο νωτιαίο μυελό Α6, Θ5 κτλ.), οι οποίες εξέρχονται από τη σπονδυλική στήλη μέσω των μεσοσπονδύλιων τρημάτων και Και μετά διασπώνται σε οπίσθιες και πρόσθιες διακλαδώσεις (ramus=κλάδος/ rami=κλάδοι) Και τα νωτιαία νεύρα και οι κλάδοι περιέχουν αισθητικές και κινητικές ίνες και σχηματίζουν τα εν λόγω νεύρα Η κύρια φροντίδα μας προς το παρόν είναι το νωτιαίο επίπεδο της νευρικής τροφοδότησης, π.χ. από ποιο σημείο εξέρχεται της σπονδυλικής στήλης Week.6.Tutorial 2. 10_11

Διάγραμμα νωτιαίων νεύρων κτλ. http://upload. wikimedia Διάγραμμα νωτιαίων νεύρων κτλ. http://upload.wikimedia.org/wikipedia/commons/thumb/d/d2/Spinal_nerve.svg/800px-Spinal_nerve.svg.png Week.6.Tutorial 2. 10_11

Επίπεδα νωτιαίων νεύρων ως προς τους σπονδύλους http://www.maturespine.com/images/spinal_nerves.jpg Week.6.Tutorial 2. 10_11

Μύες αερισμού/αναπνοής Να θυμάστε Βασικές Συνάψεις Νευρική Τροφοδότηση (σπονδυλικά επίπεδα) Λειτουργία αερισμός αλλού Διαβάζοντας θα βρείτε και άλλους, αλλά οι μύες που θα καλύψουμε σήμερα είναι οι βασικοί που χρειάζεται να γνωρίζετε για την πρακτική της φυσικοθεραπείας Week.6.Tutorial 2. 10_11

Ας ξεκινήσουμε με τους μεσοπλεύριους μύες Εσωτερικοί Εξωτερικοί (ατελές μυϊκό στρώμα-αγνοείστε το) Γενικότερα αποδεκτοί ρόλοι, αν και όχι πλήρως ξεκάθαροι Συνάψεις Νευρική τροφοδοσία Λειτουργία αερισμός αλλού Week.6.Tutorial 2. 10_11

Επισκόπηση και άλλων μυών Αναγκαστική εισπνοή Σκαληνοί μύες Στερνοκλειδομαστοειδής Ιερονωτιαίος μυς Θωρακικός/ πρόσθιος οδοντωτός μυς pectorals/serratus anterior (rev O+I) Αναγκαστική εκπνοή κοιλιακοί Πλατύς ραχιαίος μυς Τετράγωνος οσφυϊκός μυς Therefore coughing and huffing And at fast respiratory rates And if the work of breathing increases in disease etc Week.6.Tutorial 2. 10_11

Muscles of ventilation/respiration Forced inspiration scalenes grp 1 sternocleidomastoid grp 1 erector spinae grp 2 pectorals/ serratus anterior ( rev O+I) grp 2 Forced expiration Κοιλιακοί μύες Ορθοί κοιλιακοί rectus abdominis + εγκαρσιοι κοιλιακοί transversus grp 3 internal + external obliques grp 4 quadratus lumborum/ latissimus dorsi grp 5 Week.6.Tutorial 2. 10_11

For your muscle group identify Βασικές συνάψεις και τοποθεσία στο σώμα Λειτουργία Αναπνοή Αλλού Νευρική τροφοδοσία/ παροχή Week.6.Tutorial 2. 10_11

Scalenes Scalenes - 3 in all - anterior, medius and posterior Actions Transverse processes of cervical vertebrae to anterolateral aspects of the first 2 ribs Actions side flexes the neck to same side both acting together - flex the head elevates and stabilises the first two ribs to facilitate external intercostal action Nerve supply C3-8 Week.6.Tutorial 2. 10_11

Sternocleidomastoid Also called sternomastoid Two heads Action tendon from the superior aspect of the medial aspect of the manubrium sterni muscular attachment for the upper surface of the medial 1/3rd of the clavicle mastoid process of temporal bone and lateral 1/3rd of superior nuchal line on occipital bone Action side flexes head to the same side and rotates to the opposite side - together cause neck flexion Week.6.Tutorial 2. 10_11

Sternocleidomastoid contd Action in respiration when head is fixed elevates clavicle and sternum and hence rib cage Nerve supply spinal part of the 11th cranial nerve C2-4 Week.6.Tutorial 2. 10_11

Erector spinae Long muscle of many parts Actions Nerve supply runs from a large tendon in the lumbar region divides into three (iliocostalis, logissimus and spinalis) taking attachments from the medial posterior aspect of ribs and thoracic/cervical vertebrae up to C2 Actions extends the spine hence stabilising rib cage for other inspiratory muscles to work more effectively Nerve supply relevant spinal nerves Week.6.Tutorial 2. 10_11

Pectorals - Major and Minor Pectoralis Major manubrium and body of the sternum, upper 6 costal cartilages and medial half of the clavicle into the intertubercular groove of the humerus Actions adducts, medially rotates and flexes the humerus or pulls trunk up In respiration with the arms fixed elevates upper ribs and sternum Nerve supply C5 - T1 Week.6.Tutorial 2. 10_11

Pectorals contd Pectoralis minor anterior surfaces of either ribs 2-4 or 3-5 into the coracoid process of the scapula Actions pulls scapula down and forwards In respiration elevates ribs if scapula and humerus fixed Nerve supply C6-8 Week.6.Tutorial 2. 10_11

Serratus anterior Lies between the scapula and the ribs Actions anterior ribs 1-8/9 in the region of the midaxillary line to the costal surface of the medial border of the scapula anterior attachments interdigitates with external obliques Actions protracts the scapula In respiration if scapula fixed elevates the ribs Nerve supply C5-7 Week.6.Tutorial 2. 10_11

The muscles of forced expiration Abdominals Quadratus lumborum Latissimus dorsi Week.6.Tutorial 2. 10_11

Rectus abdominis The lateral wall of the abdomen is in three layers which then enfold the anterior muscle - Rectus abdominus in the rectus sheath Linea alba 3 horizontal tendinous intersections – the lowest one at the umbilicus and two more between this one and the xiphoid Six pack!! Week.6.Tutorial 2. 10_11

Rectus abdominis contd Attachments Symphysis pubis and pubic crest to xiphoid process and 5-7 costal cartilages Actions flexes and rotates lumbar spine stabilises pelvis in standing and walking increases intra-abdominal pressure during forced expiration and Valsalva manoeuvre Nerve supply T6 - 12 Week.6.Tutorial 2. 10_11

Transversus abdominis Deepest abdominal muscle Attachments lateral 1/3rd of the inguinal ligament (ASIS to pubis) iliac crest, lumbar fascia, cartilages of the last 6 ribs into the linea alba and the pubic crest Actions increases intra-abdominal pressure Nerve supply T7 - L1 Week.6.Tutorial 2. 10_11

Internal obliques Attachments Actions lumbar fascia, iliac crest and lateral 2/3rds of the inguinal ligament the last 3-4 ribs, costal margin, linea alba and pubic crest Actions individually rotate and side flex the spine to that side together flex the trunk increase intra- abdominal pressure Nerve supply of internal and external obliques T7 - L1 Week.6.Tutorial 2. 10_11

External obliques Most superficial of the 3 muscles of the lateral abdominal wall Fibres pass as if you have your hands on your pockets Attachments anterior aspect of the lower 8 ribs mainly insert into the linea alba Actions individually rotate and side flex the spine to that side together flex the trunk increase intra- abdominal pressure Nerve Supply T7-L1 Week.6.Tutorial 2. 10_11

Quadratus lumborum Attachments Actions Nerve supply Posterior iliac crest transverse processes of lumbar vertebrae medial half of the lower border of the 12th rib Actions side flexion of the trunk to the same side stabilises 12th rib during inspiration and pulls 12th rib down during forced expiration Nerve supply T12 - L4 Week.6.Tutorial 2. 10_11

Latissimus dorsi Large broad muscle Actions Nerve supply - lower 6 thoracic, all lumbar vertebrae and the sacrum lower 3/4 ribs, inferior angle of the scapula and iliac crest into the intertubercular groove on the anterior humerus Actions extends, adducts and medially rotates the shoulder, depresses scapula lifts trunk up if humerus fixed in forced expiration compresses the thorax Nerve supply - C6 – C8 Week.6.Tutorial 2. 10_11

Have so far omitted the main player DIAPHRAGM For next week Look up in more than one text and have a look at the anatomy site link on the reading list for the:- main attachments on the sternum, ribs, costal cartilage, lumbar vertebrae and fascia and the Central Tendon nerve supply function apertures Week.6.Tutorial 2. 10_11

Conclusion Learning outcomes Relate to Mrs Fletcher Practical - surface marking of the lungs and pleura – please print off the handout on StudyNet so that you have at least one between two for the practical NOW - Quiz if time! Week.6.Tutorial 2. 10_11

Learning outcomes identify the muscles of respiration describe the position of the main muscles of respiration discuss the contribution to respiration of the individual muscles of respiration describe the attachments, position and function of the main muscles of respiration both in quiet respiration and forced manoeuvres (precise muscles required to be identified by CResp staff in the tutorial) begin to identify the anatomy and function of the diaphragm and identify independent study needs for the first tutorial next week Week.6.Tutorial 2. 10_11

Quiz What muscles are used in quiet ventilation? Intercostals Diaphragm Week.6.Tutorial 2. 10_11

Quiz Why did Christopher Reeve end up on a ventilator? He fractured C1/C2 and therefore had no nerve supply to his diaphragm – all his respiratory muscles were de - innervated Week.6.Tutorial 2. 10_11

Quiz What have you learnt today that is applicable to Mrs Fletcher post operatively? Her incision will be through her abdominal muscles so any forced expiratory manoeuvre is potentially painful Other movements such as sitting up in bed will also be sore if pain relief is inadequate Week.6.Tutorial 2. 10_11

Quiz What are the accessory muscles of inspiration? Scalenes Sternomastoid Pectorals Erector spinae Serratus anterior (superior fibres of trapezius) Week.6.Tutorial 2. 10_11

Accessory muscles Week.6.Tutorial 2. 10_11

Quiz How would the ventilation of a person with a fractured 6th thoracic vertebra and subsequent transection of the spinal cord be affected? Their ability to cough would be severely impeded. Week.6.Tutorial 2. 10_11

Remember your support pack info on surface marking and:- DIAPHRAGM For next Monday Look up in more than one text and have a look at the anatomy site link on the reading list for the:- main attachments on the sternum, ribs, costal cartilage, lumbar vertebrae and fascia and the Central Tendon nerve supply function apertures Week.6.Tutorial 2. 10_11

Bibliography Anatomy TV. http://www.anatomy.tv/home.aspx NB don’t access this from the Web, go through StudyNet – UH has paid the subscription Drake,, R.L., Vogl, W. & Mitchell, A.W.M. (2005). Gray’s anatomy for students. Spain: Churhill Livingstone. Hough, A. (2001). Physiotherapy in respiratory care. (3rd ed.). Cheltenham: Nelson Thornes. Pryor, J. A. & Prasad, S. A. (Eds). (2002). Physiotherapy for respiratory and cardiac problems - adults and paediatrics. (3rd ed.). Edinburgh: Churchill Livingstone. Marieb, E. N. (2004). Human anatomy and physiology. (6th ed). London: Pearson Benjamin Cummings. Martini, F. H. (2006). Fundamentals of anatomy and physiology. (7th ed.). San Francisco: Pearson Benjamin Cummings. Moore, K. L. & Dalley, A. F. (1999). Clinically orientated anatomy. (4th ed). Baltimore: Lippincott Williams & Wilkins Palastanga, N., Field, D. & Soames, R. (2002). Anatomy and human movement. (4th ed). Oxford: Butterworth Heinemann Thibodeau, G. A. & Patton, K. T. (2007). Anatomy and physiology. (6th ed.). St Louis, Missouri: Mosby Elsevier. Wilkins, R. L., Sheldon R. L. & Krider, S. J. (2005). Clinical assessment in respiratory care. (5th ed.). Missouri: Elsevier Mosby. Week.6.Tutorial 2. 10_11