4. Head, Neck, Trunk asdwlokasdlkansdlkajsdl

asd;lkwadlaknjdslansdlikwnalsd,nlwiaknsldnwlaiknsldknnfdlonflaksnflaknflwaiknflaksnflaknsflaknsfwadasdas

1. Head Neck
Trunk
Pembimbing:
Dr.Siti AnnisaNuhonni, SpKFR(K)
Presentan:
EgaJaya################

2. INTRODUCTION
Skeleton as a whole is divided into:
•AXIAL
•APPENDICULAR
Brunnstorm’s,ClinicalKinesiology 6
th
edition, 2012. 4 :315
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 307.
cranium, vertebral column, ribs, sternum
extremities, clavicle, scapula, pelvis

3. INTRODUCTION
Functionsofaxialskeleton:
protectingorgans(viscera,spinalcord)
vitalfunctionsofbreathing,chewing,swallowing
supportingagainstforceofgravity
providingstabilityandmobility
Brunnstorm’s,ClinicalKinesiology 6
th
edition, 2012. 4 :315
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 307.

4. CURVATUREOFVERTEBRALCOLUMN
C. 1 y.ostanding –walking
hip flexor lumbar lordosis
A. Birth thoracicdan sacral
kyphotic primary curve
B. 2-3 moraising head, develops
to sit cervical lordosis
Secondary curve
Brunnstorm’s,ClinicalKinesiology 6
th
edition, 2012. 4 :315 –316
Reyes TM, Reyes OL. KinesiologyThe PhillipinePhysical Therapy. 1978. 4: 21 –22
D. 10 y.o= adult 4 curvature
cervical concave post ; thoracic convex post
lumbar concave post ; sacral convex post

5. CENTER OF GRAVITY
•Totalmassofbodyasif
concentratedin1point
•It lies 1 inch in front of second sacral
segmen
•Lineofgravity(LOG)passes
through:
-Processusmastoideusdi tulangtemporal
-Anterior dariS2
-Posterior darihip
-Anterior dariknee dan ankle
Brunnstorm’s,ClinicalKinesiology 6
th
edition, 2012. 4 :316
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 314
Reyes TM, Reyes OL. KinesiologyThe PhillipinePhysical Therapy. 1978. 4: 22 –23

6. ANATOMY
•Bones
-Cranium
-Cervical
-Thoracal
-Lumbal
-Sacrococcygeal
•Ligaments
•Discs
•Muscles

7. CRANIUM
•Protectingbrainandsensoryorgans
•Temporal,Occipital,Frontal,Parietal
•TemporalProcessusMastoidserves
attachmentformuscles
•Occipital(base)ForamenMagnum
passagewayforspinalcord;nuchallineas
attachmentformuscles
•.
Brunnstorm’s,ClinicalKinesiology 6
th
edition, 2012. 4 :317 –319
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 309 –310

8. THORAX (RIB CAGE)
33 vertebral bones
7 Cervical
12 Thoracic
5 Lumbar
5 Sacral
4 Coccygeal
1 –7 attached to sternum
8 –10 joins at the upper sternum
11 –12 unattached to sternum
Brunnstorm’s,ClinicalKinesiology 6
th
edition, 2012. 4 :321
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 311
Reyes TM, Reyes OL. KinesiologyThe PhillipinePhysical Therapy. 1978. 4: 23 -24
Vertebra Sternum
(Front)
Ribs

9. VERTEBRA
Supports the weight
= neutral arch
Protects spinal cord, provides
attachment for ligaments and muscles
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 310
Reyes TM, Reyes OL. KinesiologyThe PhillipinePhysical Therapy. 1978. 4: 25 -26

10. Cylindrical,upperandlower
flattened;rough for
attachmentsofintervertebral
discs
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 311
Reyes TM, Reyes OL. KinesiologyThe PhillipinePhysical Therapy. 1978. 4: 25 -26

11. Twoprocessesoneithersideextending
posteriorlyfromupperpartofthebody;
Connectsvertebralbodytoposterior
vertebra
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 311
Reyes TM, Reyes OL. KinesiologyThe PhillipinePhysical Therapy. 1978. 4: 25 -26

12. Twobroadplatesdirectedposteriorly
andmediallyfromthepedicles;theyfuse
inthemidlinetoformthebaseof
spinousprocess
Protectsposterioraspectsofspinalcord
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 311
Reyes TM, Reyes OL. KinesiologyThe PhillipinePhysical Therapy. 1978. 4: 25 -26

13. Dorsal midline projection of bone from lamina
Midline attachment for muscles and ligaments
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 311
Reyes TM, Reyes OL. KinesiologyThe PhillipinePhysical Therapy. 1978. 4: 25 -26

14. Projectedoneithersidefromthepoint
wherethelaminajoinsthepedicle
betweenthesuperiorandinferior
articularprocess
Attachmentsformuscles,ligaments,ribs
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 311
Reyes TM, Reyes OL. KinesiologyThe PhillipinePhysical Therapy. 1978. 4: 25 -26

15. Twoinnumberforeachandspring
fromthejunctionsofpediclesand
lamina
Formpairedapophysealjoints
(synovial)guidedirectionand
magnitudeofintervertebral
movements
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 318
Reyes TM, Reyes OL. KinesiologyThe PhillipinePhysical Therapy. 1978. 4: 27

16. CERVICAL
•Smallest and most mobile
•Unique feature:
transverse foramen
vertebral artery ascends 
blood supply
•Typical: C3 –C6
Atypical: C1, C2, C7
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 318

17. Typical C3 –C6
•Bodysmallrectangular,dense,
widersidetosidethanfronttoback,
concavesuperiorsurfaceuncinate
processuncovertebraljoint(=
jointsofLuschka)
•Pedicles,spinousprocess,transverse
processshort
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 320 –321

18. ATLAS (C1)
•Body, lamina, pedicles, spinosusprocess absence
•Transverse processmost prominent
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 321 –322

19. AXIS (C2)
•Large and tall bodybase for odontoid process (Dens)
•Spinous processbifida, very broad attachment for muscle
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 322

20. VERTEBRA PROMINENCE (C7)
•The largest, having characteristics of thoracic vertebra
•Spinosus& transversus process large
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 322

21. CERVICAL
•0 –C1 (Occipital –Atlas)
-“Yes” movement (flexion, extension)
•C1 –C2 (Atlanto–Axial)
-“No” movement (rotation) due to
axis of motion is vertical
•C2 –C7 (Typical vertebral)
-Articulatingsurfacesoffacetjoints:
horizontalplaneto45°permits
motionineachplane
Total
Cervical
Motion
0 –C1C1 –C2C2 –C7
Flexion60° 10° 5° 45°
Extension80° 25° 10° 45°
Rotation
(to either
side)
75° - 45° 30°
Lateral
flexion
(to either
side)
45° 5° 10° 30°
Reyes TM, Reyes OL. KinesiologyThe PhillipinePhysical Therapy. 1978. 4: 30 -31
Brunnstorm’s,ClinicalKinesiology 6
th
edition, 2012. 4 :325
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 341

23. THORACAL
•Size of bodies gradually increases as
downward
•Transverseprocessfacesposteriorly
•Vertebralcanal:smaller
•Lamina:thick,short
•Articular facet orientation :
-T1 –T10>> frontal plane
-T10 –T12>> sagittal plane
Reyes TM, Reyes OL. KinesiologyThe PhillipinePhysical Therapy. 1978. 4: 32
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 323

24. THORACAL
•Flexiondanextensionlimited
dueto:
-Articularfacetorientation:T10–
T12aremorefreelyinflexiondan
extension
-Ribslimitflexion
-Spinousprocesseslimitextension
Reyes TM, Reyes OL. KinesiologyThe PhillipinePhysical Therapy. 1978. 4: 32
Brunnstorm’s,ClinicalKinesiology 6
th
edition, 2012. 4 :325
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 341

25. LUMBAR
•Mass5lumbar=2x7cervical
•Body:massivewidesupportwhole
weight
•Spinosusprocess:heavierandwider
•Laminadanpedicle:shortandthick
•Articularfacetorientation:
-L1–L4:sagittalplane
-L4–L5:>>frontalplane
ReyesTM,ReyesOL.KinesiologyThePhillipinePhysicalTherapy.1978.4:32–33
Neumann,DonaldA.KinesiologyoftheMusculoskeletalSystem2
nd
Edition.3:323–324

26. LUMBAR
•Flexiondanextension:relatively
morefreedueto:
-large bodies and discs
-articular facet orientation
Reyes TM, Reyes OL. KinesiologyThe PhillipinePhysical Therapy. 1978. 4: 32 –33
Brunnstorm’s,ClinicalKinesiology 6
th
edition, 2012. 4 :325
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 341

27. SACRUM
•Triangularbone,5fusedsegments
•Function:transmitsvertebral
columnloadstopelvis
•Attachfirmlytobothilia1unit
pelvis
•Lumbo–sacralangle:30°
ReyesTM,ReyesOL.KinesiologyThePhillipinePhysicalTherapy.1978.4:34
Neumann,DonaldA.KinesiologyoftheMusculoskeletalSystem2
nd
Edition.3:325–326

29. Vertebral Joints, Ligaments,
Motions
•Jointintervertebraldisc–vertebracartilaginous
•Facetjointsynovial(diarthrosis)
•Bonyandligamentsbiomechanicallydivided:
•Anterior:tobearweight
•Posterior:tocontrolmotion
Brunnstorm’s,ClinicalKinesiology 6
th
edition, 2012. 4 :321

30. Motions
•Motion segment: 2 adjacent vertebra + 3 intervertebral joint + soft
tissues of intervertebral discs + ligaments + capsule of facet joint
•Most vertebral joints 3°of motions
Brunnstorm’s,ClinicalKinesiology 6
th
edition, 2012. 4 :321 –322
Sagittal plane
Frontal plane
Horizontal plane
Flexion –extension
Lateral flexion
Rotation

31. Anterior Vertebral Joint
•Vertebral body + intervertebral disc + longitudinal ligament
•Biomechanics function:
•Bodyresistancetocompressiveforces,musclecontraction,
externalloads(lifting,pulling,pushing)
•Discs chief structural unit between adjacent vertebral bodies
25% total length of spinal column (no disc at 0-C1 and C1-C2)
function: bind vertebra, allow motion, contribute formation
of spinal curves
end plates + annulus fibrosus + nucleus pulposus
Brunnstorm’s,ClinicalKinesiology 6
th
edition, 2012. 4 :321 –322
Reyes TM, Reyes OL. KinesiologyThe PhillipinePhysical Therapy. 1978. 4: 35 -37

32. Anterior Vertebral Joint
•Endplateshyalinecartilagecoversbonysurfaceofvertebral
bodies,semipermeablemembrane,anchorsattachmentofannulus
fibrosus.
•Annulusfibrosusstrongstructureconsistsoffibroelasticstructure
tissue,anterioristhickerthanposterior.
•Nucleuspulposus80%waterPascal’sLaw
Reyes TM, Reyes OL. KinesiologyThe PhillipinePhysical Therapy. 1978. 4: 35 -37

33. PASCAL’S LAW
Externalforcesappliedtoanypointistransmittedtoeveryunit
areaofinteriorofthecontainingvessel

34. •Longitudinal ligaments anterior (ALL)
and posterior (PLL)
•ALL
•attaches to annulus and edge of vertebral
bodies
•limits backward bending
•PLL
•attaches to annulus and sup margin body
•restrain forward flexion, but relatively low
Anterior Vertebral Joint
Brunnstorm’s,ClinicalKinesiology 6
th
edition, 2012. 4 :321 –322

35. Posterior Vertebral Joint
•Transverse&spinousprocess+bilateral
facetjoints+jointcapsule+ligaments
•Facetjoints
•Formedbyinfandsuparticulatingprocess
•Tocontrolvertebralmotionsandtoprotect
discfromexcessivemovement
•Ligaments:
•Flava:23intersegmentconnectinglaminaof
2adjacentvertebra(C2–sacrum)
•Interspinous
•Supraspinous
•Intertransverse
Brunnstorm’s,ClinicalKinesiology 6
th
edition, 2012. 4 :321 –322

36. Ligaments
1.Intersegmental
-Longitudinal tract binds vertebra
-ALLuniting vertebral bodies, taut on extension
-PLL uniting vertebral bodies, taut on flexion
-Supraspinous uniting post column, taut on flexion
2.Intrasegmental
-Longitudinal system secures segment to segment
-Interspinous taut on flexion only after supraspinous
-Intertransverse unite transverse process, taut on side
bending
-Flavum uniting lamina/arch, taut on flexion only after
supra & interspinous
-Reinforcing ligaments 0-C1 & C1-C2
Reyes TM, Reyes OL. KinesiologyThe PhillipinePhysical Therapy. 1978. 4: 35 -37

38. Coupling Motion
•Vertebraljointsmotionsseldomoccurinpureplanar,but
ratherincombinedmotionCoupling
•Duetoorientationofleftandrightfacetjointsand
limitationofmotionprovidedbydiscs,ligaments,fasciaand
muscles.
•Complexityofcouplinginspinesidebendingand
rotation.
•Neutralposition:rotationandsidebendingoccur
contralaterally.
•Nonneutralposition:rotationandsidebendingoccur
ipsilaterally.
Brunnstorm’s,ClinicalKinesiology 6
th
edition, 2012. 4 :325
Neumann, Donald A. Kinesiology of the Musculoskeletal System 2
nd
Edition. 3 : 341

40. MUSCLES

41. NECK FLEXORS

42. NECK FLEXORS

43. NECK FLEXORS

44. NECK EXTENSORS

45. NECK EXTENSORS

47. POSTERIOR TRUNK
Superficial
Intermediate
Deep
Trapezius, Latissimus
dorsi, Rhomboid,
Levatorscapula,
Serratus anterior
Serratus posterior
superior and inferior
Erector spinae
Spinallis
Longissimus
Illiocostalis
Transversospinal
semispinalis
multifidus
rotators
Short segmental
interspinalis
intertransvers
arius

48. TRUNK EXTENSORS

49. ERECTOR SPINAE
Prime Mover

50. TRANSVERSOSPINALIS

51. SHORTSEGMENTAL

52. TRUNK EXTENSOR

53. TRUNK FLEXOR

54. TRUNK FLEXORS

55. PATHOMECHANIC
Kyphosis
Lordosis Scoliosis
•Kelengkungan
tulangbelakangke
arahdorsal.
•Normal pada
segmenthoracalis.
•Dapatdisebabkan
oleh kelainan
posturatauPott’s
disease
•Kelengkungan
tulangbelakang
abnormalke
arahlateral.
•Dapatterjadi
padavertebra
cervicalis,
thoracalis,dan
lumbalis.

56. PATHOMECHANIC
Spondylosis Spondylolysis Spondylolithesis
Kelainanstrukturtulangvertebra
akibatprosesdegeneratif.
Ditandaidengan:
1.Osteofit
2.Kekakuanligamentum
3.↓kemampuanpenyerapanair
olehdiskusintervertrebralis
tinggidiskusyangmemendek
Defekpadaparsinterartikularisos
vertebra(padalaminaantaraprosesus
artikularissuperiordaninferior)tanpa
disertaiperubahanposisi/pergeseran
corpusvertebralisatasterhadap
bawahnya.
Pergeseranatauperubahan
letakcorpus vertebra
terhadapcorpus vertebra di
bawahnya.

57. PATHOMECHANIC
Spina Bifida
Hernia Nucleus
Pulposus
Defekataucleftpadaarkusposteriortulang
belakangtanpaadanyaprotursimedula
spinalis(okulta)ataudisertaiadanyaprotursi
medulaspinalis(manifesta)
Migrasiposteriorataupostero-lateraldari
nucleuspulposuskearahjaringan-jaringansaraf
yangsensitif.