Anatomy

Boundries
inguinal ligament (superior)
sartorious (lateral)
adductor longus (medial)
illiopsoas (floor)
pectineus (floor)
fascia lata (roof)

Contents
femoral Nerve
femoral Artery
femoral Vein
femoral canal (Lyphatics)

rhomboid major & minor
levator scapulae

tibialis anterior
extensor digitorum longus
extensor hallucis longus

Tibialis posterior
flexor hallucis longus
flexor digitorum longus
Gastrocnemius
Soleus
Popliteus
Plantaris

fibularis brevis
fibularis longus

Same as Deep + Superfiial fibular n
tibialis anterior (d)
extensor digitorum longus (d)
extensor hallucis longus (d)
fibularis brevis (s)
fibularis longus(s)

Does NOT innervate muscles
rather cutaneous portion in medial part of leg

deltoid
teres minor

brachialis
coracobrachialis
biceps

supraspinatus
infraspinatus

latissimus dorsi

biceps femoris
semitendinosus
semi membranosus

Subscapularis (upper/lower)
teres major (lower)

large calfs
exxagerated lumbar lordosis
contracture achilles/illiotibial band
VERY elevated creatine kinase
Use of Gowers manuver
Proximal muscles > distal muscles

fibers replaced by CT/fat after about 7 cycles

Block muscle degeneration
bypass stop codon (gentamiacin/ataluren)
MIcro-dystrophin vector (fx'ing dystrophin protein)
In situ gene repair (permanent repair pt mutation)
Exon skipping (antisense oligos - prevent frameshift)

most common MD
Abnormal dystrophin protein

ensures randomization truly is random and strengthens internal validity

study measuring what it claims
proper controls present

1.Decision support - pt centered
2.Use community resources for 3.what docs can't provide
pt self management (goals)

places stress gleno-humeral ligaments (abduction + lateral rotation)

Supraspinatus (post) suprascapular n. abd humerus
Infraspinatus (post) suprascapular n. lat. rotate humerus
Teres Minor (post) axillary n. lat rotate humerus
Subscapularis (ant) sup&inf Subscapularis n med rotate humerus
Lesser tubercle = ant muscle
Greater Tubercle = post/sup muscles

betw/ 60-120deg, causes:
generalized increase (edema, hemmorhage)
Bony protrusion (congenital/OA)

90% anterior dislocation
Dead arm syndrome - damage axillar n. (quadrangular space) result is loss deltoid fx & overlying cutaneous deficit

Anterior Superficial (median n.)
Pronator Teres
Flexi carpi radialis
Palmaris longus
Flexor carpi ulnaris (ulnar n.)

Anterior Intermediate (median n.)
Flexor digitorum superficialis

Anterior Deep
Flexor digitorum profundus (50% ulnar&50% median)
Flexor pollicis longus (median n.)

Elbow joint fx
Brachioradialis (radial n.)
Supinator (deep radial n.)

Extend/Abduct/adduct hand at wrist joint
Extensor carpi radialis longus (radial n.)
Extensor carpi radialis brevis (deep radial n.)
Extensor carpi ulnaris (deep radial n.)

Extend fingers
Extensor digitorum (deep radial n.)

Extend/Abduct the thumb (deep radial n.)
Abductor pollicis longus
Extensor pollicis brevis
Extensor pollicis longus

Thenar (recurrent br. Median n.)
Abductor pollicis brevis
Flexor pollicis brevis
Opponens pollicis

Hypothenar (deep branch ulnar n.)
Abductor digiti minimi
Flexor digiti minimi brevis
Opponens digiti minimi

Adductor (deep ulnar n.)
Adductor pollicis

Central
Lumbricals (50% common br. Median n & 50% deep ulnar n.)

Deep central (deep ulnar n.)
Palmar interosseous
Dorsal interosseous

Anterior (femoral n.)
Vastus lateralis
Vastus medialis
Vastus intermedius
Rectus femoris
Sartorious

Posterior (Sciatic n superior then Tibial n. inferiorly)
Semitendinosus (S)
Semimembranosus (S)
Biceps femoris (LH = S) (short head common fibular n.)
Popliteus (T)
Plantaris (T)

Medial (obturator n.)
Illiopsoas (lumbar ventral n. + sciatic n.)
Adductor longus
Adductor magnus (+ Sciatic n.)
Pectineus (+ Femoral n.)
Gracilis

Gluteal (gluteal branch n.)
Gluteus Maximus (Inf. Gluteal n.)
Gluteus Medius (Sup. Gluteal n.)
Gluteus Minimus (Sup. Gluteal n.)
Tensor Fascia Lata (Sup. Gluteal n.)
Piriformis (Ventral rami L5,S1,S2)

Anterior (deep fibular n.)
Tibialis Anterior
Extensor digitorum longus
Extensor hallucis longus

Posterior (tibial n.)
Gastrocnemius
soleus

Deep Posterior (tibial n.)
Tibialis posterior
Flexor digitorum longus

Lateral (superficial fibular n.)
Fibularis longus
Fibularis brevis

initiates actin-myosin x-bridge

releases actin-myosin x-bridge

storage & release of Ca. Also, re uptakes Ca to terminate contraction (muscular version of RER)

extension of plasma membrane transversely that helps spread the AP between fibers

No striations (sarcomeres). Have lots of thin filaments but little thick filaments
No troponin, rather actin-myosin interaction regulate by myosin conform.(enzyme) & thick-filament assembly
No T-tubules, but adjacent cells have gap junctions = slow wave contractions

Everything is the same (fibrils, organization)
Different is E-C coupling @ organelle/molecule level

Clinical presentation: adult/↓children, characteristic skin lesion (heliotrope rash = eyelids/face)
Histology: interfascicular inflammation, perifascicular atrophy (atrophy only near skin/periphery) = pathognomic

Clinical presentation: adult women, onset week-month, Proximal weakness, ↑ CK, responds to corticosteroids
Histology: necrosis, regeneration (enlarged nuclei), inflammation (lymphocytes)

angular atrophy
fiber type grouping

present birth floppy baby, slowly progressive, genetic errors in metabolism machinary
-defect storage/synthesis glycogen
- defect carnitine palmiiotoyltransferase
-defect respiratory chain

K+ high inside cell (2) &Na+ low inside cell (3) = (Na/K ATPase) & cell becomes more negative inside

Skeletal cell HIGH Cl- permeability results in only more Em negative by 3mV.

- Decreases spontaneous excitability (requires large stimulus) & slave to NS
- Relieves need for K efflux (repolarization) thus uses less ATP in ATPase pump