All questions Flashcards
Give example/s of a Daily Functional Activity where you use Elbow joint movements ?
What is function of elbow joint?
Reaching, Throwing, Eating. eating, drinking
Prime function is to position the hand
Can change the height and length of the arm
Rotation allows effective positioning
Ask your model to demonstrate the action of overhead reaching
What movement/s occurring at the elbow joint during overhead reach?
What muscle/muscle group produce the movements?
Movements: Flexion / Extension
Flexion Biceps brachii (A) Brachialis (B) Brachioradialis (B) Pronator teres (B)
Extension
Triceps (A)
(Anconeus)
Classify the elbow joint and describe its articulating surfaces and identify the ligaments.
Synovial hinge joint
1 degree of freedom
Movements
Flexion
Extension
Articulation between distal end of humerus and proximal end of radius and ulna
[1. Capitulum and radial head
2. Trochlea and olecranon ??]
Radial Collateral Ligament
Ulnar Collateral Ligament
Joint capsule / synovial fluid
Superficial olecranon bursa
Explain the attachments, morphology and actions of Latissimus Dorsi. Name the nerve that supplies the muscle.
- position - posterior side of back - very wide
- morphology - large flat trianglular, spiralised tendon muscle
- origin
(1) - Vertebral part: Spinous processes of vertebrae T6-T12, Thoracolumbar fascia
(2) Iliac part: Posterior third of crest of ilium
(3) Costal part: Ribs 9-12
(4) Scapular part: Inferior angle of scapula
Insertion
(1) - Intertubercular sulcus of the humerus, [between pectoralis major and teres major muscles
Mnemonic: Lady between two majors (lady refers to latissimus dorsi)]
A latvian pro spills 6 / 12ths of a cup to Tea (1) onto a lump (2) by because Thor (3) closes a door on his face (3)..mixes it with a rib (+) and a angler fish (+) and then posts (4) it with cress (4) to an Inn (5) via a tube (5) full of hummus (5)
- Describe the direction of fibres - Down and medially
- Actions - Shoulder Extension, medial rotation, adduction and shoulder girdle depression
- functions of daily living - pull up (depression),
- nerve supply - Thoracodorsal nerve (C6-C8)
- contraction? - make a fist - resist abduction
What is the root value of Common Peroneal nerve. Name the two branches?
What is the course of this nerve?
root value L 4, 5 S1,2
Muscles:
short head of the biceps femoris muscle
Superficial peroneal nerve: peroneous longus and brevis [lateral compartment of the leg]
Deep peroneal nerve: tibialis anterior, extensor digitorum longus and extensor hallucis longus [ anterior compartment of the leg]
Observe and identify curves on Cervical &Thoracic Spine.
Name two muscles that perform flexion/extension/rotation/side flexion in C/T spine.
Cervial -lordosis - 2ndary
Thoracic - kyphosis - primary
Lumbar - lordosis - 2ndary
Flexion:
- longus coli
- longus capitus
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Flexion: Rectus abdominus / int oblique / ext oblique / psoas major
Extension: Erectus spinae / QL / Multifidus
Side flexion: QL / Int / ext oblique
Rotation: Int / Ext oblique
- sternocleiomastoid
Extension:
- semispinalis capitus / cervius
- erectus spinae (same as lumbar / thoracic spine)
- levator scapulae (retreact / elevate scapular)
- trapezius (retreact / elevate scapular)
Side flexion:
- Scalenes
- Trapezius (retreact / elevate scapular)
- Levator scapulae (retreact / elevate scapular)
- sternocleiomastoid (ipsilateral)
Rotation:
- semi spinalis
- splendius
- sternocleiomastoid (contralateral)
What ROM? What are the normal movements of cervical spine? How would you measure this?
goniometer, incolmeter, eye ball / Tape measure
Flexion / extension: 130 in total, 100 from neurtral - chin to chest
Extension: 30 from neutral
Side flexion: 45 - distance of ear to shoulder
Rotation: 80-90 (30 (1/3) comes from the atlano-axial joint at C-spine) - chin to shoulder, tape measure
Put the Trapezius/Latissimus Dorsi muscle into action and identify the contraction.
Traps:
At C-spine: Cervical extension (when both sides contract), cervical side flexion (when one side contracts)
At shoulder girdle: Depression (lower), upward roation, elevation (upper), retraction (mid)
- Actions - Shoulder Extension, medial rotation, adduction and shoulder girdle depression
- functions of daily living - pull up (depression),
Lats / Extension / adduction / medial rotation
Palpate the head of the Humerus/ medial epicondyle/lateral epicondyle. Identify/palpate the common extensor tendon/ common flexor tendon
– see notes
Surface mark superior radio-ulnar joint/ inferior superior radio-ulnar joint line. Demonstrate a PAM of your choice at this joint.
https://www.youtube.com/watch?v=phfvhoa7pUc
Represented by a vertical line,approx. 1cm long, between the medial edge of the head of the radius; between radial head and the ulna. Palpable posteriorly
Key point: Medial part of radius articulates with lateral part of the ulnar
Find the HOR - ie inbetwen the lat condyle of humerus and the olecrenon .. then get pt to supineate / pronate - feel it moving
With the forearm in pronation the medial aspect of the radius will look like it is lateral.. however if refer back to the anatomical position it is actually medial
Name the muscles responsible for flexion/extension at wrist. Test and grade the flexors/extensors for strength.
Short / long flexors
Short flexors - only act on the wrist + a bit a the elbow
- Flexor carpi ulnaris (B)
- Flexor carpi radialis (B)
Long flexotrs - act on the hand AND wrist
- Flexor digitorum superficialis (flex fingers) (B)
- Flexor digitorum profundus (flex fingers) (B)
- Flexor pollicis (thumb) longus (flex thumb) (C)
ALL flex the wrist..
[+ lumbricles flex the finger] ========================== Short: - Extensor carpi radialis longus (B) +Extensor carpi radialis brevis (C - Tennis elbow ) - Extensor carpi ulnaris
Long
- Extensor digitorum - Work on fingers
- Extensor pollicis longus+ Extensor pollicis brevis - Extend thumb
- Extensor Indicis - extend index finger
Give example/s of a Daily Functional Activity where you use Shoulder girdle joints
Puching,climbing,throwing
Ask your model to demonstrate the action of punching
What movement is occurring at shoulder girdle ?
Identify all movements of shoulder girdle. Name the muscles responsible for elevation/protraction/retraction / depression / upward / downward rotation movement
Retraction / Protraction
Elevation :
- Rhomboids
- Upper trapezius
- Levator scapulae
Depression:
- Lower trapezius
- Pec minor
- Latissimus dorsi
Retraction
- Rhomboids
- Trapezius (mid)
- Levator scapulae
Protraction
- Seratus anterior
- Pec minor
Upward rotation:
- Upper trapezius
- Seratus anterior
Downward rotation:
- Rhomboids
- Pec minor
- Levator scapulae
Classify the GH joint. Describe the articulating surfaces and capsular support of GHJ.
- ART - head of humerous and glenoid fossa
- Synovial ball and socket
- 3 degrees of freedom
- Hyaline cartilage (on both articulating surfaces)
- Lambrum (collagen)
- GHJ capsule
- Subacromial bursa
- Superior / Middle / Inferior glenohumeral ligaments [Reinforcing the anterior glenohumeral joint capsule]
- Transverse humeral ligament - holds long head of biceps tendon in the groove
- Coracoidacromial ligament - resisits superior translation of the head of the humerous [provides superior stability]
- Coracohumeral ligament
Trans eating hummus who then places 2 x bets in Coral
- Rotator cuff tendons (very important for dynamic stabilty)
Explain the attachments, morphology and actions of Sternocleidomastoid/ Trapezius. Name the nerve that supplies.
Morph: large, thick, strap like muscle
Origin: Manbrium (sterno), medial portion of clavicle (cleo)
I: Mastiod process of temporal bone (Mastoid), superior nuchal line
Actions: contralateral cervical rotation, ipsolateral cervial side flexion, cervial flexion
i.e if left SCM contracts, it flexes the left side and rotates the right side
=====================================
Morph - large trianglular
Upper fibres - down / lat
Middle fibres - horizontal
Lower fibres - superiorially, lat
- O - occipital proterbance, nuchal line, upper portion of ligamentum nuchae, spinous process C7-T12
- I - lateral 1/3 of clavicle, acrominon process, spine of scapular
Occtopus (1) is protecting (1) a new child (2) watching UP when a ligar noob tubes (3) his spine (4).. then latvian x 3 arrive plying the clave (1) rhythm to try and heal the spine (2) with music from runeScape (2) while doing acro yoga (3)
Actions:
At C-spine: Cervical extension (when both sides contract), cervical side flexion (when one side contracts)
At shoulder girdle: Depression (lower), upward roation, elevation (upper), retraction (mid)
Motor: accessory nerve (CN XI)
Motor/Sensory: ventral rami of spinal nerves C3-C4 (via cervical plexus)
What is the root value of Median/Radial/Ulnar nerve and which muscles group does it supply?
Median - Lateral cord bracial plexus - C5, C6, C7
medial cord bracial plexus, C8, T1
[There is the Anterior interoseous nerve which is the deep branch of the median nerve ]
Muscles: The median nerve provides motor function to most all of the flexor and pronator muscles of the forearm...
Pronator teres
Flexor carpi radialis
[Flexor carpi sublimis]
Anterior interosseous (motor)
Flexor pollicis longus
Flexor digitorum profundus to 2nd & 3rd fingers
Pronator quadratus
=
Radial the posterior cord of the brachial plexus - C5, C6, C7 , C8, T1
Muscles:
Triceps (all 3 heads)
Anconeus
Brachialis (lateral third)
Extensor carpi radialis longus
Deep branch
Supinator
Extensor carpi radialis brevis
Extensor digitorum
Extensor carpi ulnaris
Extensor pollicis longus
=
ulnar arises from the medial cord of the brachial plexus C8,T1
Muscles:
flexor carpi ulnaris, flexor digitorum profundus, lumbrical muscles, opponens digiti minimi, flexor digiti minimi, abductor digiti minimi, interossei, adductor pollicis
Observe Elbow joint and explain why we see a ‘carrying angle’ at this joint.
Due to the orientation of the trochlear notch
Average angle:
Men: 10-15°
Women: 20-25°
Relevance?
Arms need to clear pelvis in gait
Allows greater ROM in flexion
Mechanical advantage for carrying heavy objects
Identify and where possible palpate the head of the Radius/head of Ulna
Synovial pivot
model in sitting
Find lateral epicondyle of humerus and point of olecranon. Palpate in dip midway between these two points, slightly distally. Check by pronating and supinating forearm can feel head rolling under fingers.
Surrounded by annular ligt
Name the ligament associated with the head of the radius.
Annular ligament
- Encirciles the head and neck of radius
- Provides fexibile support during pro/supination
Surface mark the Inferior Radio-ulnar joint. / type of J?
Represented by a vertical line, palpable posteriorly, between lateral edge of the head of the ulna and distal end of the radius.
‘Find the medial border of radius / ulnar and then palpate.. hand in pronation. NB: radius = bigger. J line more towards the lil finger side
https://www.youtube.com/watch?v=l_94hqe4mho
=
- Classification - synovial pivot joint
- uni axial (one pair of movements)
- Articulating surfaces
- Concave ulnar notch
- Medial aspect of the distal end of the radius
- Include Triangular fibrocartilage complex [TFCC]
Movements
- Supination - palm up
- Pronation - palm down
Demonstrate full active range of flexion/extension at the wrist and measure the movement using goniometer?
Flexion - 60-80 - Fulcrum on triquretum - moving hand on 5th met - firm end feel
Extension - 60-75 - Fulcrum on triquretum - moving hand on 5th met - firm end feel
Radial deviation / abduction - 15-25 - fulcrum on capiate / lateral epicondyle - moving arm on medial metacarpal
Ulnar deviation / adduction - 30-40
Supination - 90 - start in midprone (karate chop position) - pt to hold pen
Pronation - 90 - start in midprone - pt to hold pen
List the muscles responsible for flexion/extension at the wrist. Test and grade the wrist flexors/extensors for strength.
Short / long flexors
Short flexors - only act on the wrist + a bit a the elbow
- Flexor carpi ulnaris (B)
- Flexor carpi radialis (B)
Long flexotrs - act on the hand AND wrist
- Flexor digitorum superficialis (flex fingers) (B)
- Flexor digitorum profundus (flex fingers) (B)
- Flexor pollicis (thumb) longus (flex thumb) (C)
ALL flex the wrist..
[+ lumbricles flex the finger]
=====
Short:
- Extensor carpi radialis longus (B) +Extensor carpi radialis brevis (C - Tennis elbow )
- Extensor carpi ulnaris
Long
- Extensor digitorum - Work on fingers
- Extensor pollicis longus+ Extensor pollicis brevis - Extend thumb
- Extensor Indicis - extend index finger
Surface mark C6/C7 level.
Perform PAM PA at C2/C6/C7 spinous process
Find the atlando-ocipital joint
- Run thumb downwards.. can’t find c1 as there is NO spinous process
- The next boney thing is C2
- Thumb width C3 -thumb width C4 - ect.. ect..
- C6 ‘check’ will disapear on extnesion
- C7 is very prominent
===
use thumbs to kind of support eachother side by side, ie back of each thumb facing eachother
Test the flexibility (put the muscle on stretch) of Flexor Digitorum Superficialis / Flexor Digitorum Profundus.
Flexor digitorm superficalis - extend wrist + fingers [pressure on middle finger biases superficalis] - note FDS attaches to the middle phalanges of 2-5 mets
Flexor digitorum profundus - extend wrist + fingers [ pressure on end of finger biases prfondus] note this is where FDP attaches, the distal phalanges of the fingers 2-5
Extensor digitorum - flex wrist / finger
Give example/s of a Daily Functional Activity where you use Elbow joint movements
(examples-Reaching, Throwing, Eating etc)
Ask your model to demonstrate eating an apple
What movement is occurring at the wrist joint? Name two muscles associated with this movement.
Wrist extension, (also long / short flexors working as true neutilsers to make sure wrist ins’t fully extended)
=====
Short:
- Extensor carpi radialis longus (B) +Extensor carpi radialis brevis (C - Tennis elbow )
- Extensor carpi ulnaris
Long
- Extensor digitorum - Work on fingers
- Extensor pollicis longus+ Extensor pollicis brevis - Extend thumb
- Extensor Indicis - extend index finger
======
Short / long flexors
Short flexors - only act on the wrist + a bit a the elbow
- Flexor carpi ulnaris (B)
- Flexor carpi radialis (B)
Long flexotrs - act on the hand AND wrist
- Flexor digitorum superficialis (flex fingers) (B)
- Flexor digitorum profundus (flex fingers) (B)
- Flexor pollicis (thumb) longus (flex thumb) (C)
ALL flex the wrist..
[+ lumbricles flex the finger]
Classify the 1st Carpometacarpal joint of the thumb and articular surfaces. Identify two ligaments associated with the joints of Thumb or fingers.
Synovial saddle, flexion , ext, abd, add, opposition
Joint line between base of 1st metacarpal and distal border of Trapezium easiest to palpate lateral aspect of the joint
Metacarpophalangeal joints / Carpometacarpal strengthened by: collateral ligs and Palmer ligs
Explain the attachments, morphology and actions of Biceps/Triceps. Name the nerve supply.
Morphology - Fusiform, 3 Heads (long head, medial head & lateral head)
O- Infraglenoid tubercle (Long Head)
Lateral side (lateral head), of posterior surface of humerus medial side (medial head) of posterior surface of humerus
I-Olecranon process
An infared beam of light shines on glencoe which prevents lattitude from happening in a medevil castle so ole has to cancel his ticket
Action-
Extension of elbow and shoulder
Nerve - Radial
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Morphology - Fusiform, 2 Heads (short head and long head)
O- Supraglenoid tubercle (Long Head) Corocoid Process (Short head)
I-Radial Tuberosity
[+bicipital aponeurosis into deep fascia on medial part of forearm]
Super man jumps off glencoe and catches corona virus so jumps in a radioactive tube to get rid of it
Action-
Flexion of elbow and shoulder
Supinator of forearm
Nerve - Musculocutaneous
What is the root value of Axillary nerve/Musculocutaneous nerve and which muscles group does it supply? What is the course of this nerve?
Ax - C5 C6 , posteror cord of brachial plexus Muscles:
deltoid, teres mino
Mus - arises from the lateral cord of the brachial plexus root value C5,6,7
Muscles:
Corocobrachialis
Brachialis ( also has supply from Radial nerve)
Palpate the Greater tubercle/Lesser Tubercle/ intertubercular sulcus. Name a muscle that attach here.
Lesser Tubercle: subscapularis
intertubercular sulcus: lat dorsi, pec majjor , biceps tendon is in this region
model in high sitting
Palpate the greater tubercle, rotate arm laterally feel depression of intertubercular sulcus then up onto lesser tubercle. - Moving more anteriorally
Provides attachment for; Subscapularis
Surface mark GH joint.
Model in high sitting, identify coracoid process, move finger just laterally, joint line is represented by a line approx. 3cm long which runs downwards from this point
Notes: Acromion -> the lateral aspect of clavicle –> Just inferior is the subacromial bursa –> Rotator cuff tendns/ muscle attachment
Name the muscles responsible for flexion/extension/abduction at shoulder. Test and grade the flexors /extensors /abductors for strength.
Flexion:
Pectoralis major (A)
Deltoid (Anterior fibres) (A)
Biceps brachii (long head) (A)
Extension: Latissimus dorsi (A) Deltoid (posterior fibres) (A) Triceps (long head) (A) Teres major [Pec major]
abduction:
Supraspinatus (A)
Deltoid (middle fibres) (A)
Adductors:
Pec Major
Lat dorsi
Teres major muscle
