Arthrokinematics & Osteokinematics

Question 1

Joint motion is dependent on:

Answer 1

Integrity of joint surfaces
Mobility and pliability of S.T.
Degree of S.T. approximation
Degree of fibrosis (scarring)
Age
Gender
Co-morbidities

Question 2

AROM is dependent on:

Answer 2

Quantity
Willingness
Integrity of contractile & non-contractile tissues
Symptom reproduction
Pattern of motion restriction

Reduced vs. Normal vs. Excessive

Question 3

PROM is…

Answer 3

Info regarding the integrity of the inert tissues (non-contractile elements)
Allows for assessment of end-feel

Question 4

Kinematics is…

Answer 4

the study of motion

Question 5

Osteokinematics is…

Answer 5

bone on bone

Question 6

Arthrokinematics is…

Answer 6

joint movements

Question 7

What is “bone movement”?

Answer 7

When any object forms the radius of an imaginary circle about a fixed point.
Whole bone moving around a joint axis.

Question 8

What is “joint movement”?

Answer 8

Motion occurring at the joint surfaces

• Concave (tibia)
• Convex (femur)

aka “Joint Play” or “Accessory Motion”

Question 9

Restricted arthrokinematic motion will result in…

Answer 9

Decrease osteokinematic

Question 10

Do osteo and arthro motions occur simultaneously?

Answer 10

YES, directly proportional

Question 11

Does normal arthro motion must occur for full ROM onset motion?

Answer 11

YES

Question 12

Arthrokinemation motion has 3 motions:

Answer 12

Roll
Glide
Spine

Question 13

What is roll?

Answer 13

constantly changing surface on contact

Question 14

What is glide?

Answer 14

2 fixed surfaces that still translate

Question 15

What is spin?

Answer 15

rotation around, surface spinning on surface

Question 16

Which artho motion do we access?

Answer 16

Glide!

Linear motion of bone on another joint surface

Question 17

A glide is always accompanied by a roll. T/F?

Answer 17

TRUE

Question 18

Which is easier to treat? Roll or Glide?

Answer 18

Glide, you can feel the joint glide

Question 19

Roll occurs in the ___ direction as the bone movement.

Answer 19

SAME

Question 20

Glide depends on…

Answer 20

the SHAPE

Convex-Concave RULE!

Question 21

If the moving joint surface is Concave, the glide occurs…

Answer 21

in the SAME direction as osteokinematic

Question 22

If the moving joint surface is Convex, the glide occurs…

Answer 22

in the OPPOSITE direction as osteokinematic

Question 23

What does a loss of joint accessory motion tell us?

Answer 23

Testing the ability of a joint surface to glide on another

Question 24

Limited joint surface glide (artho) there will be…

Answer 24

Less ROM (osteo)

Question 25

Closed pack:

Answer 25

``` Max tautness of major lig. Max surface congruity Min joint volume Max stability of the joint Movements toward close-packed involved an element of compression ```

Question 26

Open pack:

Answer 26

All positions away from close-pack!

Question 27

How many resting positions are there?

Answer 27

ONE

Question 28

Open pack, resting position:

Answer 28

``` Slackening of major lig. Min surface congruity Min joint surface contact Max joint volume Min stability of the joint Movements toward open-packed involve an element of distraction Only one resting position ```

Question 29

Which position will there be the most glide of a joint?

Answer 29

Resting position, it can move...

Question 30

Resting position of the knee

Answer 30

25 - 45 flexion

Question 31

Close position of the knee

Answer 31

full extension, ER tibia

Question 32

What are we feeling?

Answer 32

``` Quantity of motion - Hypo/Hyper/Normal Quality - Crepitis End-feel - Normal, Boney, Firm (Capsular/Muscular), Soft Abnormal - Spring, Boggy, Spasm, Empty, Pain ```

Question 33

ACL: MOI

Answer 33

``` Valgus knee position Hyperextension, rotation 70% non-contact Deceleration phase Cutting, landing "Pop" Swelling, laxity, pain Chronic presentation - unstable joint, LOF (pain is gone) ```

Question 34

MCL: MOI

Answer 34

Valgus Force, knee collapsing inward Football, soccer, slip, direct blow to lateral knee Often injured concurrently w/ meniscus or ACL Medial Knee Pain Tender to palpate specifically at MCL Valgus Stress Test w/ delayed endfeel, w/ pain, w/o firm

Question 35

PCL: MOI

Answer 35

``` Hyperflexion Football, fall onto knees, dashboard Excessive tibial post translation C/O weakness, instability HS test will aggravate PCL ```

Question 36

Patellofemoral Pain Syndrome

Answer 36

``` Commonly overuse Running related Malalignment between patella & femur Reduces contact area w/ increased mechanical stress IR/ADD ```

Question 37

Patellofemoral Pain Syndrome: Impaired Hip Control

Answer 37

Femur moves independently during squatting | Quads contraction during WB anchors patella to stable tibia, allowing femur to move under extensor mechanism of knee jt

Question 38

Patellofemoral Pain Syndrome: Physical Exam

Answer 38

Tenderness along facets of patella Crepitis Passive patella compression w/ w/o QS LAQ elicits CC Squatting, kneeling, or stretch to the quads/ITB May reproduce sx

Question 39

ITBS

Answer 39

Tightness elicits increased rubbing, particularly in athletes performing repeated knee flexion/extension Runners, Triathletes, bikers, weight lifters, cross-fit participants Bursa, compressive forces Palpation is KEY! TIght ITB Hip muscle strength imbalances

Question 40

What are the most common fractures?

Answer 40

Patellar & Tibial Plateau Easy to Dx Geared back to baseline, pre-morbid