MARIAN DIAMOND: Let's
continue with our muscles,
our muscles of the trunk,
and upper extremities.
So we were doing that trapezius.
What's trapezius mean?
Trapezoid.
So you remember that
from your geometry.
So with a trapezoid, at
least two sides are parallel.
So they thought that's
what they were seeing
with that trapezius muscle.
So we had the, if you
recall, the occipital bone.
Because this muscle is
going to be on the posterior
surface and superior surface.
We're going to see it's going
a form a trapezoid like this
as it comes down.
So we're going to
start with the occiput,
and then we have the vertebra,
the cervical, thoracic
vertebra, and
there is a ligament
that runs between the spines.
The ligamentum,
ligamentum nuchae,
which runs between cervical
and thoracic spines.
So it will be coming down here.
And then we need the
spine of the scapula.
The spine of the scapula.
And now we're ready to
fill in our trapezoid,
so we'll have the origin,
will be on the occipital
bone, the ligamentum nuchae.
Ligamentum nuchae.
And it will come up and insert--
we've got them coming--
let's do them a different color.
We'll be coming over
this way to insert
on the spine of the scapula,
insert spine of scapula.
And the lateral third,
lateral third, of what?
STUDENT: The clavicle.
MARIAN DIAMOND: Of
the clavicle, right.
So we'll have this
muscle coming from here,
but it's got to go around
the corner to the clavicle
and I can't do that on
this two dimensional plane,
so we'll just tell you.
So, roughly, we
have our trapezoid,
with these being parallel,
these being parallel.
So now you can figure
out the action.
Once you know origin
insertion, then you
can think of what
it's going to do.
So if these muscles
here that are attaching
to the ligamentum, coming
from the scapula contract,
what are they doing?
They're adducting the scapula.
Adduct scapula.
If these contract, what
are they going to do?
Depress the scapula.
They're going to
bring it down, right?
So, depress scapula.
If these attached to the
skull are going to contract,
what are they going
to do to the scapula?
Pardon?
Come on, what are
they going to do?
These are going to contract,
what are they going to do?
STUDENT: Raise.
MARIAN DIAMOND:
Raise the scapula.
You can figure it
out, can't you?
Or you don't want to think?
Raise scapula.
So we've adducted them,
we've depressed them,
we've raised them, what
can it do to the head
if these contract?
They're going to
extend the head.
Because flex goes this way.
Extend goes this way.
So they're going
to extend the head.
I want you to learn
to work this out,
then you don't memorize
charts and then you
have tools to work
with, wherever you are.
The next one is the
latissimus dorsi.
Latissimus just means broad.
It doesn't help
us much, but it's
going to be a broad muscle,
so just put broad here.
And it's going to be
inferior posterior.
So we're going to be
in the lower back.
And you've learned the terms
now, just inferior, posterior.
You want to be very specific.
So what we'll need here will
be the crest of the ilium,
this is posterior.
Going to go from crest of ilium
posteriorly, sacrum, lumbar,
thoracic vertebra spines,
up to the humerus.
So let's put our
little cartoon diagram.
We've got crest of ilium.
We've got crest of ilium
over here, too, obviously.
And the sacrum in the middle.
Then we'll have our lumbar
vertebra and lower thoracic.
So these will be the lumbar.
These will be thoracic.
So now we're ready for the
origin of the latissimus dorsi.
It's going to arise from a heavy
fascia called the thoracolumbar
fascia.
Thoraco-- lumbar.
What is fascia?
Fascia is a layer of
strong, connective tissue.
Layer of strong CT.
We've had fascia
as an aponeuroses.
Essentially, that was a layer
of thick, heavy, connective
tissue.
fascia is essentially the same.
So we have fascia now
coming up from the sacrum.
From the ilium.
Looks like this.
So in yellow we've put in
our thoracolumbar fascia.
Attached to the
crest of the ilium,
to the sacrum, all
the lumbar spines,
and lower thoracic spines.
So these were our lumbar,
these were our thoracic,
and this is all fascia.
And then it's going to attach
to the latissimus dorsi.
All this connective
tissue then is
going to blend with the
latissimus dorsi muscle.
This now is our
latissimus dorsi.
And it will come together and
insert on the intertubercular
groove of the humerus.
Remember?
Between the two tubercles.
Intertubercular
groove of humerus.
So if you want to complete the
drawing, you can sort of make--
you'll enter a tubercular
groove here on your humerus
and bring these over
to insert there.
This is the intertubercular
groove, this groove
between your two tubercles.
And you see it clearly.
Your greater tubercle,
your lesser tubercle,
and the intertubercular groove.
So, you see, this as anterior.
So you've got this
posterior muscle
coming up that's going to
insert into the anterior
intertubercular groove.
So now, to figure
out its functions.
What's it going to
do to the humerus?
Elevate it or depress it?
Where is it coming from?
It's coming from lower back.
You have all of this
fascia here giving strength
to lower back muscles with
that connective tissue.
Your thoracolumbar
fascia and then
coming up as muscle
coming around and into
your intertubercular groove.
So it's going to medial
rotate the humerus.
Action, medial rotate the
humerus and it's got--
is it going to abduct or adduct?
STUDENT: Adduct.
MARIAN DIAMOND: Adduct.
And it's going to draw it down.
Depress.
So these upper fibers
can help it adduct.
Other ones take it down.
All right, what's
the next muscle.
Let's take an anterior
muscle, anterior superior.
What's the anterior
superior muscle?
Pectoralis major,
the chest muscle.
Chest muscle is your
pectoralis major.
There's a pectoralis
minor, but we're just
giving samples of muscles here.
Just to let you know
the basic principles
and to have a foundation on
which to build when you go on.
So this is pectoralis major.
It's a chest muscle, so what
bones do we have here for it?
We're going to have
the sternum, and we're
going to have the clavicle, and
we're going to have the ribs.
So we'd have one costal
cartilages, two, three, four,
five, six.
We just want six.
And now we're ready to
show the pectoralis major,
except we need something
for it to insert on.
So we're going to give us our
intertubercular groove again.
This is my humerus.
The intertubercular groove.
And we're ready for our muscles.
Let's do it in pink this
time for something different.
So we're going to have origin.
Origin will be the sternum.
Medial clavicle.
Medial clavicle.
And two to six
costal cartilages.
Costal cartilages.
Review, review.
And the insertion
will be the outer lip
of the intertubercular groove.
Insertion, outer lip, of
intertubercular groove.
Working our way down here.
I hope that shows.
Yes.
So we're coming then across
here, medial clavicle, sternum,
take it all over.
So what's it going to do when
this chest muscle contracts.
Put your hands on
your chest muscle
and then make those
fingers pretend
like they're contracting.
And what are they doing with
the humerus when they contract?
Are they abducting or adducting?
Adducting, sure.
Action, adduct humerus.
And since they're
on the outer lip
here, what are they going
to do on this outer lip
when they contract?
They're going to medial
rotate the humerus.
Bring it clear over.
Play with your body.
Play and see what they
can do, all right?
Medial rotate.
All right, that gives
us our pectoralis major.
Now let's move over.
We've got David and Stephanie,
so we can take them off.
Let's take the deltoid.
Most people know the deltoid.
It's an easy one to figure out.
Where it-- please?
STUDENT: [INAUDIBLE]
MARIAN DIAMOND: No,
it comes around,
as I showed one time and
the next time I was just
going fast.
It comes around from--
so when it--
STUDENT: [INAUDIBLE]
MARIAN DIAMOND: When it
rotates, medial rotate.
That's correct.
So let's get the deltoid.
What did we say it meant?
Do you remember the very
first time we talked about--
STUDENT: The shape.
MARIAN DIAMOND: Shape.
Yeah, a delta.
Greek D, deltoid.
So it's going to give the
shape to the shoulder.
Shape to shoulder.
All right, where is
it going to originate?
If it's giving
shape to shoulder.
Displace your hand
up here, it's going
to be lateral clavicle and the
spine of the scapula, right?
Lateral clavicle and
spine of scapula.
And where is it going to insert?
A deltoid tuberosity on
the shaft of the humerus,
because it's coming over.
If you put your hand here, it's
going to be the apex down here.
So it's going to insert on
that deltoid tuberosity,
on the humerus.
So when you contract
your fingers,
you've got them placing
is imitating a deltoid,
what's it going to
do to the humerus?
STUDENT: Abduct.
MARIAN DIAMOND: Abduct.
Yeah, it's going to pull it up.
Abduct.
It also will assist the
biceps and the triceps.
Assists biceps and triceps.
Which are coming from the
scapula to the humerus, too,
so it doesn't only work alone.
Now, we can move on
down and look at the--
take the rotator cuffs next.
How many have torn
rotator cuffs?
Nobody in this whole group?
Two of us, three
of us, that's all?
Four.
So let's see what
a rotator cuff is.
It would be interesting to
talk to a geriatric group
and ask these questions
and see the proportion who
raised their hands.
So if you learn these early
and learn to take care of them,
then you won't fall and
do all these things.
So we're doing rotator cuffs.
And these will all be going
from the scapula to the humerus.
From scapula to humerus.
And I'll give them to you,
because you've already
had all the parts of
the bones involved.
So we're going to have the
scapula, spine, acromion,
glenoid fossa, and down.
So who can tell me
what we call this area
superior to the spine?
STUDENT: Supraspinous fossa.
MARIAN DIAMOND:
Supraspinous fossa.
it's a supraspinous muscle.
Then we had below the spine--
STUDENT: Infraspinous.
MARIAN DIAMOND:
The infraspinous.
So we have the
infraspinous muscle.
Just so you've been
introduced to rotator cuffs
because their tears are
very frequent later.
And then these were
supraspinous, infraspinous.
And what do we call
the one on the anterior
side of the scapula?
Subscapularis.
So we have a
subscapularis, but I've
got to do three and make it
curve around to the other side.
So it's going to
be subscapularis.
And then we have one more
that's going to be coming
from down on this lower aspect.
Does anybody know that one?
Those who take your
physical education
usually know your
rotator cuffs well.
STUDENT: Teres minor.
MARIAN DIAMOND:
Teres minor, correct.
The teres minor.
So these collectively-- so
just that you get the idea,
the whole scapula is sending
its information to the humerus
out here.
Going up, over, and
so the insertion.
These are all origins.
Insertion will be
the proximal humerus.
I'm not going to
give you the detail.
But since there are many
of them, they will adduct.
No, abduct humerus.
They'll medial and
lateral rotate.
So did you have surgery?
Did anybody-- somebody
said they had.
Where were they?
I saw a hand.
No.
All right.
You did?
No.
Nobody.
All right.
Anyhow, you can have
surgery and have
these sewn back on, because
they do tear very easily
later on when you fall.
All right, deltoid,
rotator cuffs, what's next?
Let's go directly then
to the arm and forearm.
All you have to
do is use your arm
and appreciate how
many muscles it
takes to just erase the board.
This is arm and forearm.
Arm muscles are
designed for what?
If you had your choice,
for strength or dexterity?
STUDENT: Strength.
MARIAN DIAMOND: Strength, sure.
Arm designed for strength.
And forearm for dexterity.
So let's take some arm muscles.
Those you've already heard
of, biceps and triceps.
Biceps, as we said, two heads.
And both of these heads are
going to be on the scapula.
Had you ever heard your
scapula before, class?
Ever thought about it?
How much of a role it plays
for you, to do everything,
you toss your ball,
you do anything,
all these muscles are
attached to your scapula.
So you will be able
to draw in your sleep.
You dream about your muscles?
What do you dream about?
Not going to tell me.
All right, this is our scapula.
We want to put it on our car--
this is the posterior view.
We have a coracoid process
that I'm accentuating here,
but you've seen it.
It's hard to see, because
this is my spine, my acromion,
and this coracoid process
sneaks in under my scapula.
But I can't put it in that
way so I put it up above.
So what we could do is
do something like this,
so you'd see that
it's really behind.
So this is coracoid process
and this is our glenoid fossa.
So we have two
heads to our biceps.
Now we have a short
head and a long head.
Short head will come
from our coracoid process
and our long head
from the superior lip
of the glenoid fossa.
Glenoid fossa.
I mean, you always think this
is so much, but all I have to do
is run into my students
over at UCSF in the elevator
and they say, we never realized
how much anatomy really is.
Right, they thought
this was a lot.
I'm just telling that so
that you release the stress.
It's not a lot compared
to what you're in for.
All right, so we have our two
heads, our long and our short
and they're going to insert
on the radial tuberocity.
Where's that?
Here's our radius lateral here.
And see that bump?
That's where it's
going to insert.
So they're coming down from--
here's my coracoid process.
Here's my glenoid fossa.
Can't see it too well
from front down here.
So what's going to be a function
when that muscle contracts?
This radial tuberosity is on the
medial surface of the radius.
So if it's going
to contract, it's
going to bring the hand
into a supinated position.
So it's a powerful supinator.
The biceps function as
a powerful supinator.
And the function
that you all know.
Whats its other function?
STUDENT: Flex.
MARIAN DIAMOND: Flex
the forearm, sure.
Show your biceps.
You know, when you're
teaching in Australia,
the kids, when you ask them
to show their masculinity--
little kids here, you ask them
to show, they show you biceps--
little kids there show you
their abdominal muscles
because they get beer
bellies, and that's
supposed to be masculinity.
A difference in cultures.
So powerful supinator
and it's flexor.
All right, so that's our biceps.
What about our triceps?
Three heads.
We'll summarize those so
it's not too much for you.
Three heads.
One head will be on the
scapula, two on the humerus.
Got to be distal or proximal,
if it's originating?
STUDENT: Proximal.
MARIAN DIAMOND: Sure, proximal.
Thinking.
Learn to think.
Do you thank you
have two centers?
One for memorization
and one to think?
Right, so where on the scapula?
This, our one on
the scapula, will
be on the intraglenoid
tubercle, which
would just sit about here.
The origin
intraglenoid tubercle.
And the other
heads, two of them,
will be, as I said,
on the proximal.
We'll just put it
proximal humerus.
So we've got our humerus here.
And the others will
be coming from here.
Actually, they're coming from
medial, lateral, posterior,
to show what kind of
action we can get.
Now, where is it
going to insert?
Our humerus is coming down.
It's going to articulate
with two bones here.
Where is our triceps
going to insert?
Do you remember the name?
Right.
Which bone is medial
in the forearm?
Everybody knows that, right?
Which is it?
You did-- thank you.
So this is going to be
the olecranon process.
Olecranon process of ulna.
So that's where our
triceps will be coming.
Olecranon process of ulna.
And the action then?
Coming in here,
what's it going to do?
It contracts, it's going
to extend the forearm.
Opposite from your biceps.
Extend forearm.
Can't you feel your
olecranon process?
I mean, the radius has the head,
so that's very easy to remember
and allows us to rotate.
So it's going to be
dealing with muscles
that supinate and rotate.
But now, if we get the
posterior side of our ulna,
we have this big
olecranon process,
which allows us to extend,
because the muscle's
on the posterior
surface of the arm.
But it will also
stabilize that joint.
You know, if you want to use
this as a rod and not flex it,
really get a powerful--
all these muscles up here.
So it stabilizes the joint.
Stabilizes elbow joint.
That's not so good.
All right, that gets
us through our triceps.
We mentioned the
brachioradialis.
Do you remember that?
By just its name,
you know where it's
going, where it's coming from.
Where is it coming from?
STUDENT: Humerus.
MARIAN DIAMOND: The humerus.
Where is it going?
STUDENT: Radius.
MARIAN DIAMOND: Radius.
Again, to be able to put them
together, brachioradialis.
How many play tennis?
How many are right-handed?
And which is your
brachioradialis larger on?
Your right forearm
or your left forearm?
Put them out and look at them.
You see the difference?
See how big that gets when
you use only one muscle there?
That's the lateral
shape of the forearm
is your brachioradialis.
Make them fun.
Make them work.
Don't just memorize.
So brachioradialis is
your lateral forearm.
Gives the shape to
lateral forearm.
Brachioradialis,
shape lateral forearm.
So then let's go to the forearm.
We're going to just
collectively say the forearm.
On the anterior surface of
the forearm, we have flexors.
On the posterior surface,
we have extensors.
They all have specific
names, but we're not
going to give them to you.
All right, so forearm
muscles, anterior flexors,
flexors of wrist and fingers.
Posterior extensors of fingers,
yes, extending, flexing.
All right, that will
take care of forearm,
and let's then go to--
which ones?
Do you want your
abdominal muscles?
Do we have time to get started?
Muscles of the abdominal wall.
Well, I'd like to mention your
thenar eminence before we do,
because it's a muscle in the
palm at the base of your thumb.
Do you see a big swelling,
base of your thumb down here?
That's your thenar eminence?
Has anybody ever
run a condenser tube
through your thenar eminence?
I have.
Right.
When I first learned.
All right.
Thenar eminence, base of thumb.
Just one big muscle.
Base of thumb.
Because may be curious
if you look at your hand
and see only at the
thumb do you have
a great big mass like that.
So the function of the
thumb itself is a lecture.
All right, now
abdominal muscles.
Why do you have all
these abdominal muscles?
What are they doing for you?
Abdominal muscles.
Well, they're going
to protect and they're
going to support your
abdominal and pelvic viscera.
So you need all these muscles.
You've got all these
abdominal viscera.
You've got your
spleen, and you've
got your pancreas,
and your liver.
We've got to support them.
Down here we have to
support our pelvic viscera.
So functions,
support and protect,
abdominal and pelvic viscera.
Thank you.
What else do they do?
If they're going to
contract, they're
all on the anterior
side of your body,
and they're going to contract.
Sure, what are they doing?
Flexing the spine, right?
The vertebral column.
All right.
Very important function.
Flex vertebral column.
So the next lecture, we'll
see how they're supported.
You have a lot of heavy
connective tissue,
because when the
female is pregnant,
she gets her abdominal
muscles out here,
she needs a lot of
supportive connective tissue.
Let's look at our
slides, so we'll
see how they're arranged, with
muscles and support, right?
My daughter-in-law had twins,
you know, she was way out.
So glad, supporting.
STUDENT: You've
got your pointer?
MARIAN DIAMOND:
I've got my pointer.
I'm all set.
First slide, please.
Sarah, slide.
We've got it.
Here we go.
All right, let's just
take the few we've had.
Here's your sternum.
Here's your clavicle.
What muscle is this?
STUDENT: Pectoralis major.
MARIAN DIAMOND:
Pectoralis major.
What muscle is this?
STUDENT: Deltoid.
MARIAN DIAMOND: Deltoid.
What muscle is this?
STUDENT: Biceps.
MARIAN DIAMOND: Biceps.
Complete biceps femoris?
No.
Biceps what?
STUDENT: Brachii.
MARIAN DIAMOND: Brachii.
Sure.
We're going to biceps
femoris down here.
We just did brachioradialis
coming out here.
We're going to see the
external oblique next time.
The transverse, the
rectus abdominus here.
How it differs in the lower
part of the abdominal wall
versus the upper part.
Let's see, we have triceps here
on the posterior surface coming
to the olecranon process.
All the muscles of the forearm
on this side would be flexors,
they're flexing.
Extensors on the other side.
Trapezius came up
over the corner
here to come on to the clavicle,
lateral clavicle, trapezius.
What's this one coming from
the sternum and clavicle
going to the mastoid process?
Sternocleidomastoid.
Next one.
And this shows the
abdominal muscles.
I'm sorry we didn't
get there, but it
shows the pectoralis major very
well for a medial clavicle,
sternum, two to six
costal cartilages,
was coming over to the
intratubercular groove
in the humerus.
Here's the deltoid coming from
the lateral clavicle coming
down to the deltoid
tuberocity on the humerus.
This is all a connective tissue
supporting your abdominal wall.
But you had the
same on the back.
You had the thoracolumbar
heavy connective tissue.
And the next one.
We need that support
because we're upright.
Well, I guess these are ones
that I'll get to next time
with the abdominal muscles.
Let's keep going.
I'm just going to go
through them fast.
I'm not going to give detail.
Next slide.
This was just showing
again the deltoid,
but how important it'll be
when you see all the vessels
and nerves that are underneath.
And the next one.
And this now is our trapezius.
We had the occipital origin,
down the ligamentum nuchae,
in the spine of the vertebrae at
cervical thoracic, coming over
to insert some of it on the
lateral clavicle, scapula.
Here we have the portion coming
from the thoracic vertebra
coming up to insert.
What big muscle is this coming
into the insert on the humerus?
Latissimus dorsi.
What muscle is this?
STUDENT: Deltoid.
MARIAN DIAMOND: Deltoid.
Easy because of its shape.
Next one.
What one's this?
What one's this?
STUDENT: Trapezius.
MARIAN DIAMOND: Trapezius
coming around the corner.
What one's this?
STUDENT: Deltoid.
MARIAN DIAMOND: Deltoid.
What one's this?
STUDENT: Tyrell.
MARIAN DIAMOND: Tyrell.
Terrific.
You've really got it.
Next one.
And then this is what we
could have done to you.
For your forearm.
Isn't that amazing?
All those tendons, all
those bellies of muscles?
All right, next one.
It's just another
one to give you
an example of how much more
we could have given you.
What is this one?
STUDENT: Triceps.
MARIAN DIAMOND: This
is triceps coming down
to the olecranon process.
Next one.
And this is what you
really have to know,
because when you
become a practitioner,
you have to know what's
beneath the surface.
So if I ask you
what muscle's here?
STUDENT: Pectoralis major.
MARIAN DIAMOND:
Pectoralis major.
What muscle's here?
STUDENT: Deltoid.
MARIAN DIAMOND: Deltoid.
What muscle's here?
STUDENT: Triceps.
MARIAN DIAMOND: Triceps.
Good for you.
So, these are easy
but it gives you
an idea of what our goal is to
recognize from the surface what
lies beneath.
So, I think that's it.
