- supinator: supinator, biceps brachii, extensor pollicis longus - pronator: pronator teres, pronator quadrstus, flexor carpi radialis 손목관절주위에위치한근육들과작

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1 2016 학년도학기강의핵심노트 강좌명기능해부학강좌번호 PTR07-01 이수구분전공필수사전학습 20% 학점 3 강의시간화15,16,17 점수비율목13,14,15 선수과목인체해부학후수과목임상운동학, 정형도수치료학 교원 정보 담당교수남기원소속물리치료학과 nkw1212@hanmail.net 면담가능시간 수 4,5,6,7 연구실보건복지 2 관 312 호 연구실번호및연락처 교과목개요인체해부학적지식을바탕으로인체의기능적인움직임과관련해근육학, 관절의구조와기능및운동학을학습함으로써근골격계질환및신경계질환자의기능적움직임을이해하기위한기초지식을습득하고물리치료사가지녀야할기본소양을학습한다. 2. 사전학습 : 다음근육들에대한이는곳 (origin), 닿는곳 (insertion), 신경지배 (nerve supply), 작 용 (action) 을예시와같이정리하고반드시숙지할것!! 예시 ) Serratus anterior O: outer surface of upper 8 ribs I: vertebral border of scapula N: long thoracic nerve A: protraction, upward rotation of scapula, stabilizes scapula against chest wall 어깨복합체에위치한근육들과작용 - scapular elevator: upper trapezius, lavator scapular, rhomboid - scapular depressor: lower trapezius, latissimus dorsi, pectoralis minor, subscapularis - scapular protractor: serratus anterior - scapular retractor: middle trapezius, rhomboid, lower trapezius - scapular upward rotator: serratus anterior, upper & lower trapezius - scapular downward rotator: rhomboid, pectoralis minor - GH joint abductor: anterior deltoid, middle deltoid, supraspinatus - GH joint flexor: anterior deltoid, long head of biceps, coracobrachialis - GH joint internal rotator: pectoralis major, teres major, subscapularis, latessimus dorssi - GH joint external rotator: infraspinatus, teres minor, posteror deltoid 팔꿉관절및아래팔에위치한근육들과작용 - elbow flexor: biceps brachii, brachioradialis, brachialis - elbow extensor: anconeus, triceps trachii

2 - supinator: supinator, biceps brachii, extensor pollicis longus - pronator: pronator teres, pronator quadrstus, flexor carpi radialis 손목관절주위에위치한근육들과작용 - wrist extensor: extensor carpi radialis longus & brebis, extensor ulnaris, extensor digitorum, extensor indicis, extensor digiti minimi, extensor pollicis longus - wrist flexor: flexor carpi radialis, flexor crapi ulnaris, palmaris longus, flexor digitorum profundus, flexor digitorum superficialis, flexor pollicis longus - wrist radial deviator: extensor carpi radialis longus & bravis, extensor pollicis lingus & brevis, flexor carpi radialis, abductor pollicis longus - wrist ulnar deviator: extensor carpi ulnaris, flexor carpi ulnaris 손가락의움직임에작용하는근육들 - 손의외재근 (extrinsic muscle) Flexors of the finger: flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus Extensors of the finger: extensor digitorum, extensor indicis, extensor digiti minimi Extensors of the thumb: extensor pollicis longus & brevis, abductor pollicis longus - 손의내재근 (intrinsic muscle) Thenar eminence: abductor pollicis brevis, flexor pollicis brevis, oppenes pollicis Hypothenar eminence: abductor digiti minimi, flexor digiti minimi, opponens digiti minimi, palmaris brevis Adductor pollicis, lumbrical, interossei 척주세움근과척주사이근 - Erector spinae muscles Longissimus thoracis, longissimus cervicis, longissimus capitis Iliocostalis lumborum, iliocostalis thoriacis, iliocostalis cervicis Spinalis thoracis, spinalis cervicis, spinalis capitis - Interspinalis semispinalis capitis, semispinalis cervicis, semispinalis thoracis rotator longus, rotator brevis, multifidus, interspinalis, intertransvers 씹기와호흡에작용하는근육들 - 씹기근 (mastication muscle) Temporalis, masseter, lateral pterygoid muscle, medial pterygoid muscle - 호흡근 (respiratory muscle) Inspiratory muscle: diaphragm, scalene, external intercostalis, serratus posterior superior & inferior, sternocleidomastoid, latissimus dorsi, iliocostalis thoracis & cervicis, pectoralis minor & major, serratus anterior, quadratus lumborum

3 Expiratory muscle: rectus abdominos, obliquus abdominis, transversus abdominis, transversus thoracis, internal intercostalis 엉덩관절에작용하는근육들 - Hip flexor Psoas major, iliacus, sartorius, rectus femoris, pectineus - Hip extensor Gluteus maximus, biceps femoris(long head), semimembranosus, semitendinosus - Hip abductor pectineus, adductor longus & brevis, gracilis, adductor magnus - Hip adductor Gluteus medius, tensor fasciae latae - Hip external rotator Gluteus maximus, piriformis, gemellus superior & inferior, obturator internus & externus, quadratus femoris 무릎관절에작용하는근육들 - Knee extensor Sartorius, vastus medialis, vastus lateralis, vastus intermedius, rectus femoris - Knee flexor Biceps femoris, semimembranosuss, semitendinosuss, gastrocnemius 아래다리와발의근육들 - Anterior part of the tibia Tiialis anterior, extensor digitorum longus, extensor hallucis longus, fibularis tertius - Lateral part of the fibular Fibularis longus & brevis - Posterior part of the tibia Gastrocnemius, soleus, plantaris, tibialis posterior, flexor digitorum longus, flexor hallucis longus - 발등의근육 (intrinsic muscle) Extensor digitorum brevis, dorsal interossei - 발바닥의근육 (intrinsic muscle) Abductor hallucis, flexor digitorum brevis, abductor digiti minimi, lumbricals, quadratus plantae, flexor hallucis brevis, adductor hallucis, flexor digiti minimi brevis, plantar interossei

4 3. 선행학습목차 1주 : 기능해부학소개및개요 2주 : 인체관절들의기본구조와기능 3주 : 근육생리에대한이해 4주 : 어깨복합체의운동학 5주 : 팔꿈치와아래팔의운동학 6주 : 손목관절의운동학 7주 : 손의운동학 8주 : 어깨복합체및상지의근육요약 9주 : 몸통뼈대의운동학 10주 : 씹기와환기의운동학 11주 : 엉덩관절의운동학 12주 : 무릎관절의운동학 13주 : 발목과발의운동학 14주 : 걷기의운동학 15주 : 몸통및하지의근육들요약

5 4. 선행학습내용 1 주 : 기능해부학소개및개요 1. 학습개요 기능해부및인체운동학에대한소개 2. 학습목표 기능해부학및인체운동학의기초와개요를학습함으로써인체관절의운동학을이해하기위 한기본지식을습득한다. 3. 학습내용 Kinesiology 에대한정의 : Kinesis(move) + logy(study) 근육뼈대계장애를평가하고진단하며, 효과적인치료를위한기초자료를제공 Kinetics 와 Kinematics 를구분 Kinetics: 운동을만들어내는힘이나토크를고려해인체에대한힘의효과를설명 Kinematics: 운동을만들어내는힘이나토크를고려하지않고인체의운동만을묘사 운동자유도 : 관절에서허용되는독립적인움직임의수 허용된각운동 (angular motion) 의면과축들의수 Open kinematic chain과 closed kinematic chain을구분 - Open kinematic chain: 운동형상학적사슬의먼쪽분절이지면이나다른고정된물체에고정되어있지않는상황, 먼쪽분절의움직임이자유로움 Closed kimenatic chain: 운동형상학적사슬의먼쪽분절이지면이나다른고정된물체에고정되어있는상황, 몸쪽분절의움직임이자유로움 관절운동형상학 (arthrokinematics): 관절면사이에서일어나는운동 3 basic arthrokinematics(joint play) - Roll: 돌림하고있는관절면의여러점들이이와마주보고있는다른관절면의여러점과접촉 - Slide(glide): 한관절면에위치한한점이이와마주보고있는다른관절면의여러점들과접촉 - Spin: 한관절면에위치한한점이이와마주보고있는다른관절면의한점과접촉 지렛대의유형과인체의적용원리 - 1형지레 : 받침점이무게와힘의중간에위치, 균형의이점, 대표관절 : occipitoaxial joint - 2형지레 : 무게가받침점과힘의중간에위치, 힘의이점, 대표관절 : ankle joint - 3형지레 : 힘이받침점과무게의중간에위치, 속도의이점, 대표관절 : elbow joint 4. 정리하기 Kinetic와 Kinematic의개념을구별할수있는가? 관절면에서일어나는움직임에따라 convex-concave rule을설명할수있는가? Open kinematic chain과 closed kinematic chain의원리에따라운동을구분할수있는가? 관절에작용하는근육들이어느유형의지레에해당하는지설명할수있는가?

6 2 주 : 인체관절들의기본구조와기능 1. 학습개요 인체관절들의기본구조와기능 2. 학습목표 인체관절들을움직임에따라종류를분류하고운동학적특성및관절주위결합조직의조직 학적구성을학습한다. 3. 학습내용 부동관절과가동관절을분류 - 부동관절 : 움직임이없거나아주적은움직임만을허용뼈들사이를강력하게연결하고힘을전달하는기능 - 가동관절 : 체액으로차있는관절공간을가지는관절중간정도에서광범위한범위까지의움직임을허용 가동관절의종류 - Hinge joint : Flexion과 extension만허용예 ) humeroulnar joint, interphalangeal joint - Pivot joint : 단일돌림축에대해 spin만허용예 ) proximal raioulnar joint, atlantoaxial joint - Ellipsoidal joint : Flexion과 extension, abduction과 adduction을허용예 ) radiocarpal joint - Ball-and-socket joint : Flexion과 extension, abduction과 adduction, internal & external rotation을허용예 ) glenohumeral joint, coxofemoral joint - Plan joint : slide 또는 combined slide와 rotation만허용예 ) intercarpal joint, intertarsal joint - Saddle joint : 각각의관절면은직각방향으로오목면과볼록면을소유예 ) carpometacarpal joint of thumb, sternoclavicular joint - Condyloid joint : Flexion & extension and abduction & adduction, flexion & extension and internal & external rotation을허용예 ) metacarpophalaneal joint, tibiofemoral joint 관절주위결합조직의조직학적구성 - Fibrous protein: collagen fiber, elastic fiber - Ground substance: glycosaminoglycan, water, solute - Cells

7 관절의조직학적구조 Wolff's law - 뼈는외적인힘들에대한반응으로형태, 내구력및밀도를항상변화시킬수있는조직 - 뼈는스트레스를많이받는곳에서는침착되고스트레스를적게받는곳에서는흡수된다 4. 정리하기 부동관절과가동관절의형태와움직임을설명할수있는가? 관절주위결합조직의종류와역할을설명할수있는가? 관절연골의구조와치료시조직학적변화를설명할수있는가? Wolff s law의치료적의미를설명할수있는가?

8 3 주 : 근육생리에대한이해 1. 학습개요 근육의미세구조, 근수축기전을이해 근육훈련, 사용감소, 노화에따른근육의변화이해 2. 학습목표인체의세부관절의움직임을학습하기이전에관절움직임의기본이되는근육의미세구조와수축기전을학습한다. 근육훈련, 사용감소및노화에따른근육의변화를이해함으로써치료에응용한다. 3. 학습내용 뼈대근육의구조적구성 - Sarcomere, contractile protein, non-contractile protein, extracellular connective tissue - epimysium, perimysium, endomysium 근수축과힘의발생 근육훈련에따른근육의변화 - 근력 : 최대수의적노력동안근육이나근육군에의해생산된최대의힘 - 1RM: 관절의완전가동범위를통해근육이수축하여한번들어올릴수있는최대부하 - 근비대 : 근섬유내의단백질합성증가로근섬유의가로단면증가

9 - 근력증가에따른신경계통의적응 운동과제동안대뇌겉질내에서의활동영역증가 supraspinal 운동자극증가 운동신경세포의흥분성증가 척추와척추위신경성억제감소 운동단위의방전빈도증가 사용감소 (disuse) 에따른근육의변화 - 근육사용의감소 : 고정, 장기간의침상안정 단백질합성감소로인한근위축발생 - 건강산사람이 10일고정 초기 1RM 근력의 40% 까지감소 - 고정이후감소된근력은근위축의 2배 ( 가로단면적 20% 감소는근력 40% 감소 ) - 짧아진길이상태에서고정되어근섬유들의느슨함이커질수록수축단백질의분해촉진 - 항중력근, 한관절근육은만성적으로고정된팔다리의다른근육들보다더빠르게위축 노화에따른근육의변화 - 60세이후건강한노인의최대근력 매 10년마다약 10% 의감소, 75세이후에는급격히감소 - 노인성근육감소증 (senile sarcopenia): 운동단의점진적붕괴로인해근섬유들의크기감소는물론섬유의실제숫자도감소 - slow twitch muscle보다 fast twitch muscle이상대적으로빠르게위축 4. 정리하기 뼈대근육의조직학적구조와미세구조를이해하고있는가? 근수축기전과힘발생기전을이해하고있는가? 운동, 미사용, 노화에따른근육의변화를설명할수있는가?

10 4 주 : 어깨복합체의운동학 1. 학습개요 어깨복합체의구조와운동학 2. 학습목표 어깨복합체주위의골학, 근육학등구조와운동학을이해함으로써어깨질환및치료에대한 이론적배경을학습한다. 3. 학습내용 다음근육들의 origin, insertion, nerve supply, action 숙지!! - scapular elevator: upper trapezius, lavator scapular, rhomboid - scapular depressor: lower trapezius, latissimus dorsi, pectoralis minor, subscapularis - scapular protractor: serratus anterior - scapular retractor: middle trapezius, rhomboid, lower trapezius - scapular upward rotator: serratus anterior, upper & lower trapezius - scapular downward rotator: rhomboid, pectoralis minor - GH joint abductor: anterior deltoid, middle deltoid, supraspinatus - GH joint flexor: anterior deltoid, long head of biceps, coracobrachialis - GH joint internal rotator: pectoralis major, teres major, subscapularis, latessimus dorssi - GH joint external rotator: infraspinatus, teres minor, posteror deltoid 어깨복합체의구성 - 5 bones: sternum, clavicle, scapula, humerus, ribs - 4 joints: glenohumeral joint, sternoclavicular joint, acromioclavicular joint, scapulothoracic joint 어깨복합체의운동 - glenohumeral joint: flexion & extension, abduction & adduction, internal & external rotation, circumduction

11 - SC joint: elecation & depression, protraction & retraction, axial rotation of clavicle - AC joint: upward & downward rotation, internal & external rotation, ant. & post. tilting - ST joint: elevation & depression, protraction & retraction, upward & downward rotation Scapulohumeral rhythm : 어깨관절 full abduction 동안 humerus : scapula 가 2 : 1 의일정한비율로움직임 4. 정리하기 어깨복합체주위근육의부착부와작용, 신경지배를숙지하고있는가? 어깨복합체를구성하는뼈대와관절의종류를알고있는가? 어깨복합체각관절의관절운동을설명할수있는가? Scapulohumeral rhythm을설명할수있는가?

12 5 주 : 팔꿈치와아래팔의운동학 1. 학습개요 팔꿈치와아래팔의구조와운동학 2. 학습목표 팔꿈치와아래팔주위의골학, 근육학등구조와운동학을이해함으로써팔질환및치료에대 한이론적배경을학습한다. 3. 학습내용 다음근육들의 origin, insertion, nerve supply, action 숙지!! - elbow flexor: biceps brachii, brachioradialis, brachialis - elbow extensor: anconeus, triceps trachii - supinator: supinator, biceps brachii, extensor pollicis longus - pronator: pronator teres, pronator quadrstus, flexor carpi radialis 팔꿉관절과아래팔복합체의구성 - 3 bones: humerus, ulna, radius - 4 joints: humeroulnar joint, humeroradial joint, proximal radioulnar joint, distal radioulnar joint Cubitus valgus(carrying angle): 13±6 도, 여성 > 남성 Cubitus varus: gunstock deformity 아래팔에서뼈사이막의기능 - radius를통해몸쪽으로향하는힘의일부를 ulna로전달 - 먼쪽으로힘이전달 : taut structure oblique cord, annular ligament, brachioradialis slack structure interosseous membrane Humerolunar joint 의관절운동형상학

13 Humeroradial joint 의관절운동형상학 pronation 과 supination 의관절운동형상학 4. 정리하기 팔꿉및아래팔주위근육의부착부와작용, 신경지배를숙지하고있는가? 팔꿉및아래팔복합체를구성하는뼈대와관절의종류를알고있는가? 팔꿉및아래팔복합체각관절의관절운동을설명할수있는가? 정상적인팔꿉관절각도와과도하게변형된각을설명할수있는가?

14 6 주 : 손목관절의운동학 1. 학습개요 손목관절의구조와운동학 2. 학습목표 손목관절주위의골학, 근육학등구조와운동학을이해함으로써팔질환및치료에대한이론 적배경을학습한다. 3. 학습내용 다음근육들의 origin, insertion, nerve supply, action 숙지!! - wrist extensor: extensor carpi radialis longus & brebis, extensor ulnaris, extensor digitorum, extensor indicis, extensor digiti minimi, extensor pollicis longus - wrist flexor: flexor carpi radialis, flexor crapi ulnaris, palmaris longus, flexor digitorum profundus, flexor digitorum superficialis, flexor pollicis longus - wrist radial deviator: extensor carpi radialis longus & bravis, extensor pollicis lingus & brevis, flexor carpi radialis, abductor pollicis longus - wrist ulnar deviator: extensor carpi ulnaris, flexor carpi ulnaris [ 손목관절주위근육들의위치 ] 손목관절의구성 - radiocarpal joint, midcarpal joint, intercarpal joint Carpal tunnel: transverse carpal ligament 에의해구성 - tubercle of scaphoid - pisiform, tubercle of trapezium - hamate hook

15 손목관절의운동 - flexion & extension - deviation 4. 정리하기 손목관절주위근육의부착부와작용, 신경지배를숙지하고있는가? 손목관절을구성하는뼈대와관절의종류를알고있는가? 손목관절의관절운동을설명할수있는가? 손목굴의구조와손목굴증후군을설명할수있는가?

16 7 주 : 손의운동학 1. 학습개요 손의구조와운동학 2. 학습목표 손주위의골학, 근육학등구조와운동학을이해함으로써손질환및치료에대한이론적배 경을학습한다. 3. 학습내용 다음근육들의 origin, insertion, nerve supply, action 숙지!! - 손의외재근 (extrinsic muscle) Flexors of the finger: flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus Extensors of the finger: extensor digitorum, extensor indicis, extensor digiti minimi Extensors of the thumb: extensor pollicis longus & brevis, abductor pollicis longus - 손의내재근 (intrinsic muscle) Thenar eminence: abductor pollicis brevis, flexor pollicis brevis, oppenes pollicis Hypothenar eminence: abductor digiti minimi, flexor digiti minimi, opponens digiti minimi, palmaris brevis Adductor pollicis, lumbrical, interossei 손의뼈 - carpal bone, metacarpal bone, proximal & middle & distal phalanx 손의관절 - carpometacarpal joint(cm joint), metacarpophalangeal joint(mp joint), proximal interphalangeal joint(pip joint), distal interphalangeal joint(dip joint) 손관절의운동 - CM joint(2nd ~ 5th):

17 - CM joint of the thumb: - Opposition of the CM joint: - MP joint: 손목과손의기능적자세 : 손가락굽힘근을최적의길이로유지하는자세 - Wrist: extension with slight ulnar deviation - MP joint: 45 flexion - IP joint: 15 flexion - Thumb: 45 abduction 4. 정리하기 손주위근육의부착부와작용, 신경지배를숙지하고있는가? 손을구성하는뼈대와관절의종류를알고있는가? 손에위치한관절들의관절운동을설명할수있는가? 손목과손의기능적자세를설명할수있는가?

18 8 주 : 어깨복합체및상지의근육 어깨복합체에위치한근육들의작용 - scapular elevator: upper trapezius, lavator scapular, rhomboid - scapular depressor: lower trapezius, latissimus dorsi, pectoralis minor, subscapularis - scapular protractor: serratus anterior - scapular retractor: middle trapezius, rhomboid, lower trapezius - scapular upward rotator: serratus anterior, upper & lower trapezius - scapular downward rotator: rhomboid, pectoralis minor - GH joint abductor: anterior deltoid, middle deltoid, supraspinatus - GH joint flexor: anterior deltoid, long head of biceps, coracobrachialis - GH joint internal rotator: pectoralis major, teres major, subscapularis, latessimus dorssi - GH joint external rotator: infraspinatus, teres minor, posteror deltoid 팔꿉관절및아래팔에위치한근육들과작용 - elbow flexor: biceps brachii, brachioradialis, brachialis - elbow extensor: anconeus, triceps trachii - supinator: supinator, biceps brachii, extensor pollicis longus - pronator: pronator teres, pronator quadrstus, flexor carpi radialis 손목관절주위에위치한근육들과작용 - wrist extensor: extensor carpi radialis longus & brebis, extensor ulnaris, extensor digitorum, extensor indicis, extensor digiti minimi, extensor pollicis longus - wrist flexor: flexor carpi radialis, flexor crapi ulnaris, palmaris longus, flexor digitorum profundus, flexor digitorum superficialis, flexor pollicis longus - wrist radial deviator: extensor carpi radialis longus & bravis, extensor pollicis lingus & brevis, flexor carpi radialis, abductor pollicis longus - wrist ulnar deviator: extensor carpi ulnaris, flexor carpi ulnaris 손가락의움직임에작용하는근육들 - 손의외재근 (extrinsic muscle) Flexors of the finger: flexor digitorum superficialis, flexor digitorum profundus, flexor pollicis longus Extensors of the finger: extensor digitorum, extensor indicis, extensor digiti minimi Extensors of the thumb: extensor pollicis longus & brevis, abductor pollicis longus - 손의내재근 (intrinsic muscle) Thenar eminence: abductor pollicis brevis, flexor pollicis brevis, oppenes pollicis Hypothenar eminence: abductor digiti minimi, flexor digiti minimi, opponens digiti minimi, palmaris brevis Adductor pollicis, lumbrical, interossei

19 9 주 : 몸통뼈대의운동학 1. 학습개요 몸통뼈대의구조와운동학 2. 학습목표 몸통뼈대를구성하는골학, 근육학등의구조와운동학을이해함으로써손질환및치료에대 한이론적배경을학습한다. 3. 학습내용 다음근육들의 origin, insertion, nerve supply, action 숙지!! - Erector spinae muscles Longissimus thoracis, longissimus cervicis, longissimus capitis Iliocostalis lumborum, iliocostalis thoriacis, iliocostalis cervicis Spinalis thoracis, spinalis cervicis, spinalis capitis - Interspinalis semispinalis capitis, semispinalis cervicis, semispinalis thoracis rotator longus, rotator brevis, multifidus, interspinalis, intertransvers 몸통뼈대 (axial skeleton) - skull, cervical spine, thoracic spine, lumbar spine, sacrum, coccyx, sternum, ribs 척주의인대 - Ligamentum flavum, supraspinous & interspinous ligament, intertransverse ligament, anterior & posterior longitudinal ligament, joint capsule 척주의관절 - Apophyseal joint: 척추뼈사이의움직임을안내 - Interbody joint; 충격흡수, 부하분산, 척추뼈사이의안정성제공 - Atlanto-occipital joint: sup. articular process of C1(concave) + occipital condyle(convex) - Atlantoaxial joint: apophyseal joint + median joint 척추사이원반 (intervertebral disc) - Nucleus pulposus: 70-80% 가수분으로구성 부하분산, 충격흡수 - Annulus fibrosus: 속질핵을물리적으로고정, 충격흡수, 안정성제공 Movement of the C-spine - Protraction: C1, C2 extensioin, C3-C7 flexion - Retraction: C1, C2 flexion, C3-C7 extension

20 [Extension of the C-spine] [Flexion of the C-spine] [Rotation of the C-spine] [Lateral flexion of the C-spine] Movement of the thoracolumbar [Thoracolumbar flexion] [Thoracolumbar extension]

21 [Thoracolumbar axial rotation] [Thoracolumbar lateral flexion] Anterior & posterior tilt of the pelvis Movement of the SI joint - Nutation: 엉덩뼈에대한엉치뼈의전방돌림운동엉치뼈에대한엉덩뼈의후방돌림운동 - Counternutation: 엉덩뼈에대한엉치뼈의후방돌림운동엉치뼈에대한엉덩뼈이전방돌림운동 4. 정리하기 척추뼈주위근육의부착부와작용, 신경지배를숙지하고있는가? 몸통을구성하는뼈대와관절의종류를알고있는가? 몸통뼈대관절들의관절운동을설명할수있는가? 척수사이원반의구조와기능을설명할수있는가?

22 10 주 : 씹기와환기의운동학 1. 학습개요 씹기와환기기관의구조와운동학 2. 학습목표 씹기및환기와관련된골학, 근육학등의구조와운동학을이해함으로써턱관절과호흡질환 및치료에대한이론적배경을학습한다. 3. 학습내용 다음근육들의 origin, insertion, nerve supply, action 숙지!! - 씹기근 (mastication muscle) Temporalis, masseter, lateral pterygoid muscle, medial pterygoid muscle - 호흡근 (respiratory muscle) Inspiratory muscle: diaphragm, scalene, external intercostalis, serratus posterior superior & inferior, sternocleidomastoid, latissimus dorsi, iliocostalis thoracis & cervicis, pectoralis minor & major, serratus anterior, quadratus lumborum Expiratory muscle: rectus abdominos, obliquus abdominis, transversus abdominis, transversus thoracis, internal intercostalis 턱관절 - Mandibular fossa(concave) + condyle of the mandible(convex) 턱관절의운동 [Protrusion] [Retrusion] [Lateral excursion] [Depression] [Elevation] [Arthrokinematics of the TM joint]

23 폐용량과폐용적 - Tidal volume, inspiratory reserve volume, expiratory reserve volume, residual volume - Vital capacity, inspirator capacity, functional residual capacity, total lung capacity 호흡운동 - Bucket-handle movement, pump-handle movement 4. 정리하기 씹기와호흡근의부착부와작용, 신경지배를숙지하고있는가? 씹기와호흡에관여하는뼈대와관절의종류를알고있는가? 씹기와호흡에관여하는관절들의관절운동을설명할수있는가? 폐용량과폐용적을설명할수있는가?

24 11 주 : 엉덩관절의운동학 1. 학습개요 엉덩관절의구조와운동학 2. 학습목표 엉덩관절주위의골학, 근육학등구조와운동학을이해함으로써엉덩관절질환및치료에대 한이론적배경을학습한다. 3. 학습내용 다음근육들의 origin, insertion, nerve supply, action 숙지!! - Hip flexor Psoas major, iliacus, sartorius, rectus femoris, pectineus - Hip extensor Gluteus maximus, biceps femoris(long head), semimembranosus, semitendinosus - Hip abductor pectineus, adductor longus & brevis, gracilis, adductor magnus - Hip adductor Gluteus medius, tensor fasciae latae - Hip external rotator Gluteus maximus, piriformis, gemellus superior & inferior, obturator internus & externus, quadratus femoris 엉덩관절의뼈구성 - acetabulum(concave) + femoral head(convex) 엉덩관절의정상적인배열 : 비정상적인배열시탈구와뼈관절염유발

25 엉덩관절의잠긴위치 : Full extension + slight internal rotation & abduction 엉덩관절의 osteokinematics Pelvic-on-femoral osteokinematics: anterior & posterior pelvic tilt 4. 정리하기 엉덩관절주위근육의부착부와작용, 신경지배를숙지하고있는가? 엉덩관절을구성하는뼈대와관절의종류를알고있는가? 엉덩관절의관절운동을설명할수있는가? 엉덩관절잠긴위치의임상적의미를설명할수있는가? 골반의전방경사와후방경사의관절운동형상학을설명할수있는가?

26 12 주 : 무릎관절의운동학 1. 학습개요 무릎관절의구조와운동학 2. 학습목표 무릎관절주위의골학, 근육학등구조와운동학을이해함으로써무릎질환및치료에대한이 론적배경을학습한다. 3. 학습내용 다음근육들의 origin, insertion, nerve supply, action 숙지!! - Knee extensor Sartorius, vastus medialis, vastus lateralis, vastus intermedius, rectus femoris - Knee flexor Biceps femoris, semimembranosuss, semitendinosuss, gastrocnemius 무릎관절의뼈 - Femur, tibia, fibula, patella 무릎관절의내외측인대 - Medial collateral ligament: attach the medial meniscus, resissts valgus(abduction) - Lateral collateral ligament: does not attach lateral meniscus, resists varus(adduction) 무릎관절의내부구조물 - Medial meniscus: oval or C shape, attach to MCL & capsule Lateral meniscus: circular, attach only to the lateral capsule - Anterior cruciate ligament: resistance to the anterior translation of the tibia(85%) sports injury, anterior draw test Posterior cruciate ligament: resistance to the posterior translation of the tibia(95%) dashboard injury, posterior draw test Unhappy triad - 무릎주위의연부조직손상시주로 ACL, MCL, Medial meniscus 가동반손상 Knee alingnment [Normal] [Valgus] [Varus] [Recurvatum]

27 Q-angle - Line connecting ASIS to midpoint of patella Line connection the tibial tuberosity with the midpoint of patella - Male: 11.2, female: Q-angle > 15 patellofemoral pain syndrome, chondromalacia, patellar dislocation 무릎관절의운동 : Flexion & extension, slight axial rotation Screw home motion = Automatic rotation = Terminal rotation = Locking mechanism - 요인 : Shape of medial femoral condyle, tension in ACL, lateral pull of quadriceps 4. 정리하기 무릎관절주위근육의부착부와작용, 신경지배를숙지하고있는가? 무릎관절주위연부조직의기능과손상기전을설명할수있는가? 무릎관절의관절운동을설명할수있는가? 무릎관절에서발생하는 screw home motion의발생기전을설명할수있는가?

28 13 주 : 발목과발의운동학 1. 학습개요 발목과발의구조와운동학 2. 학습목표 발목과발주위의골학, 근육학등구조와운동학을이해함으로써발목과발질환및치료에 대한이론적배경을학습한다. 3. 학습내용 다음근육들의 origin, insertion, nerve supply, action 숙지!! - Anterior part of the tibia Tiialis anterior, extensor digitorum longus, extensor hallucis longus, fibularis tertius - Lateral part of the fibular Fibularis longus & brevis - Posterior part of the tibia Gastrocnemius, soleus, plantaris, tibialis posterior, flexor digitorum longus, flexor hallucis longus - 발등의근육 (intrinsic muscle) Extensor digitorum brevis, dorsal interossei - 발바닥의근육 (intrinsic muscle) Abductor hallucis, flexor digitorum brevis, abductor digiti minimi, lumbricals, quadratus plantae, flexor hallucis brevis, adductor hallucis, flexor digiti minimi brevis, plantar interossei 발의뼈 - talus, calcaneous, mavicular, cuboid, 1 st, 2 nd, 3 rd cuneiform, metatarsal bone, phalageal bone 발의관절 - Talocrural joint, subtalar joint, chorpart joint, Lisfrac joint, MP joint, IP joint Movement of the talocrural joint - Flexion & extension

29 Movement of the subtalar joint - Abduction & adduction Pronation & supination of the foot [Pronation] [Supination] Foot arch - Medial longitudinal arch: 1st metatarsal bone, medial cuneiform, navicular, talus, calcaneus를통과 - Lateral longitudinal arch: 5th metatarsal bone, cuboid, calcaneus를통과 - Transverse arch: cuneiform, cuboid를가로로통과 4. 정리하기 발과발목주위근육의부착부와작용, 신경지배를숙지하고있는가? 발과발목을구성하는뼈대와관절의종류를알고있는가? 발에위치한관절들의관절운동을설명할수있는가? Foot arch의종류와평발의임상적의미를설명할수있는가?

30 14 주 : 걷기의운동학 1. 학습개요 보행의운동학 2. 학습목표 정상적인보행의구성요소와보행주기를이해함으로써비정상적인보행을평가하고치료에활 용할수있도록학습한다. 3. 학습내용 보행의공간적서술 - Step length, stride length, step width, foot angle 보행주기 (gait cycle) - Stance phase: heel strike, foot flat, mid stance, heel off, toe off - Swing phase: acceleration, mid swing, deceleration 보행시운동에너지와위치에너지의관계

31 보행의운동형상학 [Lower extremity] [Pelvis and hip] [Knee] [Hip joint] [Knee joint] [Subtalar joint] 비정상적인보행패턴 [Normal gait] [Painful gait] [Hemiparesis gait] [Parkinson's gait] 4. 정리하기 정상보행주기를이해하고비정상보행을평가할수있는가? 보행시하지관절들의관절운동형상학을설명할수있는가? 에너지소비를최소화할수있는보행패턴을이해하고있는가?

32 15 주 : 몸통및하지의근육들 척주세움근과척주사이근 - Erector spinae muscles Longissimus thoracis, longissimus cervicis, longissimus capitis Iliocostalis lumborum, iliocostalis thoriacis, iliocostalis cervicis Spinalis thoracis, spinalis cervicis, spinalis capitis - Interspinalis semispinalis capitis, semispinalis cervicis, semispinalis thoracis rotator longus, rotator brevis, multifidus, interspinalis, intertransvers 씹기와호흡에작용하는근육들 - 씹기근 (mastication muscle) Temporalis, masseter, lateral pterygoid muscle, medial pterygoid muscle - 호흡근 (respiratory muscle) Inspiratory muscle: diaphragm, scalene, external intercostalis, serratus posterior superior & inferior, sternocleidomastoid, latissimus dorsi, iliocostalis thoracis & cervicis, pectoralis minor & major, serratus anterior, quadratus lumborum Expiratory muscle: rectus abdominos, obliquus abdominis, transversus abdominis, transversus thoracis, internal intercostalis 엉덩관절에작용하는근육들 - Hip flexor Psoas major, iliacus, sartorius, rectus femoris, pectineus - Hip extensor Gluteus maximus, biceps femoris(long head), semimembranosus, semitendinosus - Hip abductor pectineus, adductor longus & brevis, gracilis, adductor magnus - Hip adductor Gluteus medius, tensor fasciae latae - Hip external rotator Gluteus maximus, piriformis, gemellus superior & inferior, obturator internus & externus, quadratus femoris 무릎관절에작용하는근육들 - Knee extensor Sartorius, vastus medialis, vastus lateralis, vastus intermedius, rectus femoris - Knee flexor Biceps femoris, semimembranosuss, semitendinosuss, gastrocnemius

33 아래다리와발의근육들 - Anterior part of the tibia Tiialis anterior, extensor digitorum longus, extensor hallucis longus, fibularis tertius - Lateral part of the fibular Fibularis longus & brevis - Posterior part of the tibia Gastrocnemius, soleus, plantaris, tibialis posterior, flexor digitorum longus, flexor hallucis longus - 발등의근육 (intrinsic muscle) Extensor digitorum brevis, dorsal interossei - 발바닥의근육 (intrinsic muscle) Abductor hallucis, flexor digitorum brevis, abductor digiti minimi, lumbricals, quadratus plantae, flexor hallucis brevis, adductor hallucis, flexor digiti minimi brevis, plantar interossei