Active and Passive insufficiency

Question 1

Active insufficiency

Answer 1

2 joint muscles cannot exert enough
tension to shorten enough to allow full
ROM in both joints at the same time.

(For example, the finger flexes cannot produce a tight fist when the wrist is fully flexed, as they can when it is in neutral position.

Active insufficiency occurs to the agonist (the muscle that is contracting)

Active insufficiency of hamstrings - you can do hip extension or knee flexion in prone but not both simultaneously. If you flex your knee while your hip is extended in prone you cannot complete the full knee range. However when you grab your ankles and pull the knee into more flexion you’ll be able to do it.

(Only occurs in muscles that are placed in 2 joint kines 43)

Active insufficiency
• hip flexion and knee extension hamstrings.
• shoulder flexion and elbow extension

Question 2

Passive insufficiency

Answer 2

2 joint muscles cannot be stretched
enough to allow full ROM in both
joints at the same time.

ex:
the hamstring muscles is long enough to be stretched over each joint individually (hip flexion or knee extension) but not both. If you flex your hip with your knee flexed, you can complete the range. And you can touch your toes. The hamstrings are being stretched over one joint. You can also extend your knee fully when the hip is extended, because the hamstrings are being stretched over only the knee. However if you try to flex the hips to touch her toes which your knee extended you experience pain in the posterior thigh and you hamstrings will be passive insufficient.
(Passive insufficiency example to - a larger range of hyperextension is possible at the wrist when the fingers are not fully extended.)

Question 3

Biceps Brachii - position of active insufficiency

Answer 3

Shoulder and elbow flex

forearm supination

Question 4

Biceps Brachii - position of passive insufficiency

Answer 4

Shoulder and elbow ext

forearm pronation

Question 5

Triceps Brachii - position of active insufficiency

Answer 5

Shoulder and elbow ext

Question 6

Triceps Brachii - position of passive insufficiency

Answer 6

Shoulder flex and elbow flex

Question 7

Wrist extensors - active insufficiency

Answer 7

Elbow flex, wrist ext

Question 8

Wrist extensors - passive insufficiency

Answer 8

Elbow ext, wrist flex

Question 9

Wrist flexors - active insufficiency

Answer 9

Elbow flex, wrist flex

Question 10

Wrist flexors - passive insufficiency

Answer 10

Elbow ext, wrist ext

Question 11

Hamstrings - active insufficiency

Answer 11

Hip ext, knee flex

Question 12

Hamstrings - passive insufficiency

Answer 12

hip flex, knee ext

Question 13

Gastrocnemius - active insufficiency

Answer 13

Knee flex, ankle PF

Question 14

Gastrocnemius - passive insufficiency

Answer 14

Knee ext, Ankle DF

Question 15

Insufficiency - when does it come into play?

Answer 15

With two joint muscles.

Question 16

The photographs demonstrate a patient’s limits of passive hip range of motion. Which of the following causes is MOST likely responsible for the difference in hip range of motion between the two photographs?

1. Joint hypomobility
2. Joint hypermobility
3. Hip flexor weakness
4. Hip extensor tightness

Answer 16

Your Answer: unanswered
Correct Answer: 4
You have incorrectly answered the question.

References
Author: Kisner C, Colby LA
Title: Therapeutic Exercise: Foundations and Techniques
Edition: 6
Publisher: F.A. Davis
Year: 2012
Pages: 745, 748

Rationale

1. Joint hypomobility would not be affected by knee positioning during passive range of motion.
2. Joint hypermobility would not be affected by knee positioning during passive range of motion.
3. Hip flexor weakness cannot be determined because the patient was positioned passively in both photographs. The change in hip flexion range of motion with the knee flexed is more indicative of muscle tightness in the hamstrings.
4. When the hip is flexed to 60° with the knee extended, the hamstring muscles are being stretched over two joints. With the knee flexed, the hamstrings are being stretched over one joint. This limitation of hip flexion is due to lack of flexibility of the hamstrings.

Question 17

A patient performs the movement with the starting and ending positions shown in photographs A and B, respectively. Which of the following options BEST explains the end result demonstrated in photograph B?

1. Scapular elevation and downward rotation motions are limited.
2. Pectoralis major muscles are actively insufficient.
3. Glenohumeral joint extension range of motion is restricted.
4. Latissimus dorsi muscles are passively insufficient.

Answer 17

Your Answer: 3
Correct Answer: 4
You have incorrectly answered the question.

References
1. Author: Hislop HJ, Avers D, Brown M
Title: Daniels and Worthingham's Muscle Testing: Techniques of Manual Examination and Performance Testing
Edition: 9
Publisher: Elsevier Saunders
Year: 2014
Pages: 85, 89-90
2. Author: Dvorak L, Mansfield PJ
Title: Essentials of Neuroanatomy for Rehabilitation
Edition: 1
Publisher: Pearson
Year: 2013
Pages: 207-208
3. Author: Magee DJ
Title: Orthopedic Physical Assessment
Edition: 6
Publisher: Elsevier Saunders
Year: 2014
Pages: 341-344

Rationale
• 1. Scapular upward rotation and elevation are increased in the attempt to have the patient’s arms reach toward the table (Hislop, pp. 85, 89-90).
• 2. Tightness in the sternal portion of pectoralis major only could limit shoulder flexion, but a limitation in the patient’s shoulder flexion joint range of motion most commonly causes the passive insufficiency of the latissimus dorsi muscles so the arms can reach toward the table. This is a test for passive insufficiency, not active insufficiency. (Magee, pp. 343-344)
• 3. Based on the photograph, shoulder flexion is limited, not shoulder extension (Dvorak, pp. 207-208).
• 4. The latissimus dorsi muscles are being stretched beyond their physiologic length. The patient is demonstrating a substitution pattern common with shoulder flexion limitation. (Magee, pp. 341-342)