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Biomechanics 4 (Carnes) Final > Bio mech 4 Final Exam1 > Flashcards

Bio mech 4 Final Exam1 Flashcards

1
Q

What are the important joints of the shoulder complex (involved in arm movement)?

A

glenohumeral GH, Suprahumeral, scapulocostal, acromioclavicular AC, sternoclavicular SC.

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2
Q

Of all the important joints of the shoulder complex are not true anatomical joints?

A

Suprahumeral, scapulocostal.

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3
Q

name 5 other joints involved with the shoulder complex?

A
  1. Costosternal and costochondral joints. 2. Costotransverse and costovertebral joints. 3. cervical intervertebral. 4. Thoracic intervertebral. 5. Lumbar intervertebral.
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4
Q

What is the arm trunk mechanism called?

A

Scapulohumeral rhythm.

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5
Q

What is the arm trunk mechanism?

A

Complex movement involving many joints (described with flexion, abduction, extension, etc.)

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6
Q

What movements are important in the scapulohumeral rhythm?

A
  1. scapulocostal. 2. Sternoclavicular. 3. AC. 4. GH.
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7
Q

What is the “Shoulder Joint”?

A

GH.

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8
Q

What type of joint is the GH?

A

ball and socket (enarthrosis) like the hip joint, but not really it is much more gliding and less like a ball and socket.

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9
Q

Is the glenoid fossa shallow or deep?

A

shallow, smaller than the head of the humerus, only part of a socket, anteverted.

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10
Q

What is the significance of a shallow glenoid fossa?

A

decreased stability.

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11
Q

What is the significance of an anteverted glenoid fossa?

A

decreased anterior stability.

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12
Q

What would happen with a retroverted glenoid fossa?

A

decreased posterior stability.

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13
Q

What will increase the depth and size of the glenoid fossa?

A

the labrum.

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14
Q

What is the lip of the glenoid labrum made of and what shape does it create?

A

fibrocartilagenous lip and is a complete O.

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15
Q

Where will the glenoid labrum attach to?

A

the rim of the glenoid fossa, it is partially attached to the capsule, biceps long head partly or completely attaches to the superior labrum, rotater cuff attaches losely.

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16
Q

What happens with superior labrum lesions?

A

S.L.A.P. which is superior labrum anterior posterior lesion (typically seen due to the long head of the biceps tendon attachment causing wear and tear on the labrum and or causing avulsion

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17
Q

What is the healing of the labrum like and why will it need to heal?

A

It is poor healer due to fibrocartilage, but it is under constant loading and movement.

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18
Q

Why is the labrum important?

A

Important for GH stability and normal function

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19
Q

What are 3 common causes of labral damage?

A

dislocation, increased mobility (instability), overuse.

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20
Q

What are some humeral head features?

A

1/3 of a sphere, retroverted, much larger than the glenoid fossa.

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21
Q

What is the significance of a retroverted humeral head?

A

decreased congruency, decreased resistance to anterior translation, and increased posterior resistance.

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22
Q

What part of the humerus will act like the trochanters of the femur?

A

Greater and lesser tubercles.

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23
Q

What is in the intertubercular sulcus of the humerus?

A

The long head of the biceps tendon.

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24
Q

How is the tendon of the long head of the biceps brachii held in the intertubercular sulcus and what will this location be like?

A

It is held in place by the transverse ligament and tendons of subscap and pect. Tendon is vulnerable in the sulcus.

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25
Q

Where will the GH joint be strong and weak at?

A

Strong- anterior and inferiorly. Weak- posteriorly.

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26
Q

What will the axillary folds be like in the GH joint?

A

like an accordion.

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27
Q

What are the 4 ligaments of the GH joint?

A
  1. Coracohumeral. 2. Superior GH (SGHL). 3. Middle GH (MGHL). 4. Inferior GH (posterior and anteroir parts).
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28
Q

What is the most important ligament of the GH joint?

A

The inferior GH ligament.

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29
Q

What is F. Weitbrecht?

A

a large hole in the GH capsule between superior and middle GH ligaments (rotator cuff interval).

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30
Q

All the GH joint ligaments resist what motion?

A

External rotation.

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31
Q

What ligament will resist distraction and inferior translation of the GH joint and when?

A

Coracohumeral ligament with arm in a dependent position.

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32
Q

What is a dependent position?

A

arm is loosest pack positon which is when arm is dangling by the body resting.

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33
Q

What ligament will resist distraction , external rotation, and adduction of the GH joint and when?

A

Superior GH ligament with arm in a dempendent position.

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34
Q

What motion will the middle GH ligament resist and in what position?

A

Distraction, external rotation with arm abducted 45-60 degrees.

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35
Q

The inferior GH ligament is the most important ligament and is used when the arm is in what position?

A

> 90 degrees abduction.

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36
Q

What is the Inferior GH ligament like with adduction?

A

It folds like an accordion.

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37
Q

What is the resting and tight packed position of the GH joint?

A

Resting- dependent position. Tight packed- abducted and externally rotated.

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38
Q

What will instability of the GH joint lead to?

A

Dislocation.

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39
Q

What will the static stability of the GH joint be?

A

capsule (Inferior GH ligament is most important) and labrum

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40
Q

What will the dynamic stability of the GH joint be?

A

Rotator cuff, biceps and triceps (pectoralis major) muscles.

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41
Q

When will the rotator cuff especially be a dynamic stabilizer of the GH joint?

A

With arm abducted.

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42
Q

What will happen to the stability of the GH joint with increased age?

A

Both static and dynamic stability goes down.

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43
Q

When is the GH joint most vulnerable to dislocation?

A

abduction and external rotation or landing on outstretched hand.

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44
Q

Most GH joint dislocations are _____.

A

anterior.

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45
Q

Where is the suprahumeral joint located at and it is aka what?

A

between coracoacromial arch and humeral head. Aka subacromial joint.

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46
Q

What are the 3 parts of the coracoacromial arch?

A

Coracoid process, acromion, Fibrous part is the coracoacromial ligament.

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47
Q

What are the contents of the suprahumeral joint?

A

subacromial bursa, rotator cuff tendon- especially supraspinatus, biceps brachii long head.

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48
Q

What is an important and negative occurrence at the suprahumeral joint?

A

It is a common site of impingement- a superior shoulder impingment.

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49
Q

What will decrease impingement of the suprahumeral joint?

A

external rotation, inferior translation, cuff and biceps.

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50
Q

What will increase impingement of the suprahumeral joint?

A

internal rotation, superior translation or any superior movement, deltoid, internal rotators and tricpes(long head), pec. Minor.

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51
Q

What does kyphosis, shoulder hiking and protraction have in common?

A

They all increase impingement

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52
Q

What will the acromioclavicular joint be like from birth to adulthood?

A

Birth- fibrocartilaginous symphysis. 3-4 years 2 cavities with fibrocartilage disc. Becomes a meniscus between 10-20 years. Appears degenerated by age 20-30 with lots of crepitus.

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53
Q

Is the acromioclavicular joint a vulnerable or a strong joint?

A

Small vulnerable joint.

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54
Q

What injury is common in the acromioclavicular joint?

A

AC separation (essentially a dislocation but separation is the terminology)

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55
Q

Can the GH joint be separated?

A

No, the GH undergoes dislocation only the AC will undergo AC separation

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56
Q

Does the AC joint have a strong or weak capsule?

A

Weak capsule with small superior and inferior reinforcements/ligaments.

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57
Q

What are the extracapsular ligaments of the acromioclavicular joint like?

A

Most important stabilizers that resist all distractive forces.

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58
Q

What are the extracapsular ligaments of the acromioclavicular joint?

A

Coracoclavicular ligaments; conoid and trapezoid.

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59
Q

What is the difference between a mild and a severe sprain of the acromioclavicular joint?

A

No step defect in mild sprains.

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60
Q

What will cause distraction of the AC joint?

A

abduction and horizontal abduction, flexion, external rotation, lifting, pull-up or chin-up.

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61
Q

What will cause compression of the AC joint?

A

adduction, horizontal adduction, pushing, push-up, and resisted horizontal abduction.

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62
Q

How will the SC joint dislocate ? And why are these rare?

A

Dislocations will be anteriorly if they occur typically rare because it would be lethal to dislocate posteriorly since the great vessels and airways are posterior to it

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63
Q

What is the shape of the SC joint?

A

Shallow ball and socket.

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64
Q

Which joint is larger and more stable the SC or AC?

A

SC.

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65
Q

What is the articular surface of the SC joint made of?

A

fibrocartilagenous articular surface.

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66
Q

Name the fibrocartilagenous articular surfaces in the body?

A

SC, TMJ, AC, and 1/2 of SI.

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67
Q

How common is the SC joint dislocated and why?

A

Rare due to greater depth of joint.

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68
Q

Which joint socket is deeper the GH or SC?

A

SC.

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69
Q

Will the SC joint have supportive muscles?

A

Yes strong support from pec. Major, trap, SCM, Subclavius.

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70
Q

What muscle will regulate control of movement of the clavical?

A

The subclavius and its fasciae.

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71
Q

What is unique about the interclavicular ligament?

A

It is one of the few ligaments that crosses midline of the body and supports the superior capsule of both SC joints

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72
Q

The SC joint has a capsule with what type of ligaments?

A

Anterior and posterior SC ligaments.

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73
Q

What ligament is very important at resisting distraction of the SC joint?

A

Anterior division of the costoclavicular ligament.

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74
Q

What will the posterior division of the costoclavicular ligament do?

A

keeps the clavical from pinchin against the disc in the articular capsule. Also limits depression, elevation, and internal rotation at SC joint.

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75
Q

Besides resisting distraction what will the anterior division of the costoclavicular ligament resist?

A

Depression, elevation, and external rotation of clavical at SC joint.

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76
Q

Conjoint movement can occur at the SC joint and what is it?

A

Clavicla moves in same direction and same way as humerus.

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77
Q

What does the clavicle connect?

A

The upper limb with the axial skeleton.

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78
Q

What joint will movement happen for clavicular movement to occur?

A

SC.

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79
Q

What is the significance of the clavicle moving conjointly with the humerus?

A

This creates less torsion.

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80
Q

What are the phases of scapulohumeral rhythm?

A
  1. arm raised 0-30 degrees. 2. arm raised 30-90 degrees. 3. arm raised 90-180 degrees.
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81
Q

What accounts for 120 degrees of total scapulohumeral rhythm?

A

humerus at GH.

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82
Q

What accounts for the other 60 degrees of total scapulohumeral rhythm?

A

Scapula.

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83
Q

What will allow the clavicle to move during scapulohumeral rhythm and how?

A

SC joint results in 60 degrees of distal elevation.

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84
Q

What will allow the acromion to move during scapulohumeral rhythm and how?

A

AC joint resulting in 20 degrees total rotation with distal clavicle.

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85
Q

What is the big picture of scapulohumeral rhythm?

A

2/3 at GH and 1/3 involves shoulder girdle.

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86
Q

What position will the arm be in at the start of phase 1 of scapulohumeral rhythm?

A

dependent.

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87
Q

What is the GH:scap ratio during phase 1 of scapulohumeral rhythm?

A

it is 7:1.

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88
Q

What motion is happening at the GH joint during scapulohumeral rhythm during phase 1?

A

20-25 degrees GH abduction. Inferior slide and superior roll.

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89
Q

What muscle will abduct and elevate the humerus during phase 1?

A

deltoid.

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90
Q

What muscle will abduct and depress humerus during phase 1?

A

supraspinatus.

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91
Q

The rotator cuff does what during phase 1?

A

acts as a group to stabilize, depress and externally rotate throught all phases.

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92
Q

During phase 1 what muscles will initiate abduction?

A

Girdle- serratus anteiror(more important), trapezius. GH- supraspinatus(30-40%), deltiod(60-70%).

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93
Q

What happens to the scapula during phase 1?

A

variable at first and about 5 degrees of external rotation.

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94
Q

What muscles will create the 5 degrees of external rotation of the scapula during phase 1?

A

Serratus anterior, trapezius.

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95
Q

What happens if the trapezius are too involved in phase 1?

A

Premature, excessive or uneven hiking leading to increased impingment.

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96
Q

What will cause the trapezius muscle to get involved too early in phase 1?

A

weakness of the levator scapula.

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97
Q

What happens to the SC joint during phase 1?

A

about 5 degrees elevation of the clavicle, superior roll and inferior slide of SC joint done by the upper trapezius.

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98
Q

What happens at the AC joint during phase 1?

A

5 degrees rotation between clavicle and acromion.

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99
Q

What happens at the GH joint during phase 2?

A

about 40 more degrees of elevation done with inferior slide and superior roll, and has the same prime movers as phase 1.

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100
Q

What muscle will help abduct and depress the arm during phase 2?

A

Biceps helps if externally rotated

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101
Q

What will the rotator Cuff be doing during phase 2?

A

Depresses/ counteracts the deltoid muscle.

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102
Q

What muscles will externally rotate the arm during phase 2?

A

Teres minor and infraspinatus.

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103
Q

During which degrees of motion does maximum impingement occur?

A

70-120 degrees so during phase 2 and 3.

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104
Q

What happens to the scapula during phase 2?

A

additional 20-25 degrees done by the same muscles as phase 1, but upper trapezius is more involved than phase 1.

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105
Q

What is the major stabilizing muscle of phase 2 scapular movement?

A

Serratus anterior. If trapezius is too involved or uneven this can be bad.

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106
Q

What keeps the superior angle of the scapula from tiliting posterior? Why?

A

levator scapulae and this will avoid shoulder hiking?

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107
Q

What will the pectoralis minor muscle do during phase 2 if tight?

A

Antagonist and prevent external rotation of scapula.

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108
Q

What happens to the clavicle during phase 2?

A

SC- 20-25 degrees additional elevation done with inferior slide and superior roll done by the trapezius. AC- 0-5 degrees additional rotation.

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109
Q

Lack of SC motion during phase 2 leads to what?

A

increased motion and wear and tear on the AC joint.

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110
Q

How much of the movement have the clavicle and scapula moved at the end of phase 2?

A

half way.

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111
Q

What happens at the GH joint during phase 3?

A

additional 60 degrees of abduction, done by same kinematics and same primary movers.

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112
Q

When will shoulder impingment be a problem during phase 3?

A

up to 120 degrees and then again at 180 degrees.

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113
Q

What will the triceps long head do during phase 3?

A

reinforces the inferior GH capsule and this prevents the humerus from being instable inferiorly.

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114
Q

Most people have tight triceps and this might lead to what?

A

superior translation leading to impingment.

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115
Q

What prevnets anterior displacement of the GH joint during Phase 3?

A

inferior GH ligament, pectoralis major, subscapularis. If these muscles are tight it will decrease inferior translation and impingment.

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116
Q

GH ROM will be limited by what during phase 3?

A

Triceps, pectoralis major, subscapularis, latissimus dorsi, capsule especially inferior axillary fold.

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117
Q

What are the back muscles doing during phase 3?

A

externally and laterally flex spine while arm is raising.

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118
Q

What is happening to the scapula during phase 3?

A

additional 30 degrees external rotation done by same kinematics and muscles as other phases, but upper traps are more active.

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119
Q

What will limit scapular ROM during phase 3 and what is the significance?

A

Rhomoids, pectoralis minor, and middle traps. When tight it will increase movement somewhere else.

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120
Q

In general what will clavicular movement be like during phase 3?

A

Big changes.

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121
Q

What happens to the SC joint during phase 3?

A

additional 30 degrees elevation for a total of 60 degrees.

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122
Q

What causes rotation of the SC joint during phase 3?

A

conoid and trapezoid ligaments which pull the ligaments down to coracoid

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123
Q

SC ROM is limited by what during phase 3?

A

costoclavicular ligaments, subclavius, and pectoralis major.

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124
Q

What happens at the AC joint during phase 3?

A

10 degres of additional rotation for a total of 20 degrees.

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125
Q

What limits rotation of the AC joint during phase 3?

A

SC and AC ligaments, subclavius, pectoralis major.

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126
Q

What is the shape of the clavicle?

A

Crank shaped.

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127
Q

What happens to the clavicle during phase 1-2?

A

Mainly roll and slide.

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128
Q

What happens to the clavicle during phase 3?

A

Mainly external rotation due to taut ligaments.

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129
Q

What ligaments will be taut with calvicle movement during phase 3?

A

conoid and trapezoid ligaments.

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130
Q

What are the adductors at the GH that limit abduction?

A

Lats, teres major, pec major, triceps

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131
Q

What are the adductors at the girdle that limit abduction?

A

Rhomboids, traps and pec minor

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132
Q

What are the internal rotators at the GH that limit abduction?

A

Lat dorsi, pec major, teres major, subscapularis

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133
Q

What are the internal rotators at the girdle that limit abduction?

A

Lat dorsi, pec minor and rhomboids

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134
Q

What muscles limit flexion of the arm during phase 3?

A

Same as those that limit abduction.

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135
Q

What happens with tight muscles during phase 3?

A

causes impingment and limits movement.

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136
Q

What are the 3 joints of the elbow and what type of joints are they?

A
  1. Humeroulnar joint- hinge. 2. Humeroradial- pivot. 3. proximal radioulnar- gliding or pivot but really just gliding.
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137
Q

What part of the elbow will muscles attach to?

A

Epicondyles never Condyles.

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138
Q

Radius articulates with the ____ of the humerus and the ulna articulates with the _____ of the humerus.

A

capitellum and trochlea/ coronoid fossa.

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139
Q

What is the ulnar tuberosity an attachment site for?

A

Pronator teres and brachialis

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140
Q

What is the radial tuberosity an attachment site for?

A

Biceps

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141
Q

What part of the ulna articulates with the coronoid fossa?

A

coronoid process.

142
Q

What are the condyles of the humerus?

A

Capitellum and trochlea.

143
Q

What does trochlea mean

A

Spool.

144
Q

Which condyle of the humerus is longer?

A

Medial condyle aka trochlea

145
Q

Capitellum means what?

A

Little head.

146
Q

Will the arm and forearm be in a straigth line?

A

No.

147
Q

What will be larger the medial or lateral epicondyle of the humerus?

A

Medial is larger.

148
Q

How many muscles attach to the medial and lateral epicondyles of the humerus?

A

Medial- 5 muscles. Lateral- 5 muscles.

149
Q

What muscles and ligaments that attach to the medial epicondyle of the humerus?

A

Common Flexor Tendon (Pronator teres, Palmaris Longus, Flexor Carpi Ulnaris, Flexor carpi radialis, Flexor digitorum superficialis) and MCL or UCL

150
Q

What muscles and ligaments that attach to the lateral epicondyle of the humerus?

A

Common extensor tendon (5 muscles = Extensor Carpi Radialis Brevis, Extensor digitorium, Extensor carpi Ulnaris, Supinator and anconeus) and the LCL or RCL

151
Q

What is the carrying angle?

A

the elbow will be in valgus and this is only possible when the arm is extended and supinated like in anatomical position.

152
Q

Who has a larger carrying angle males or females?

A

Females > males.

153
Q

What causes varus of the elbow?

A

flexed, pronated and fracture leading to growth arrest.

154
Q

Cubital varum is aka?

A

Gun stock elbow. (elbows bent outwards)

155
Q

What is cubitus valgum?

A

Excessive valgus or forearm is more abducted

156
Q

What does cubitus mean?

A

Elbow.

157
Q

Gunstock elbows occur after what?

A

Fractures.

158
Q

How are the condyles of the elbow angled?

A

Forward 45 degrees.

159
Q

What will trochlear fossa position be like? Why?

A

Anterverted to increase flexion ROM.

160
Q

Fractures of the elbow cause malunion which leads to what?

A

change is flexion and extension ROM and may affect carrying angle.

161
Q

What happens to the humerus during development?

A

external torsion occurs.

162
Q

Distal end of humerus is about ____ degrees external (due to torsion) to proximal end?

A

15 degrees and this is opposite of the femur.

163
Q

Why will the humerus develop with 15 degrees external torsion?

A

TO increase supination ROM.

164
Q

When measuring flexion and extension of the elbow what is the neutral position?

A

0 degrees extended.

165
Q

What is the amount of flexion and extension of the elbow and is it greater in males or females?

A

flexion- 150 degrees. Extension- 0-15 degrees and larger ROM in females.

166
Q

Will males or females have a greater amount of flexion and extension of the elbow?

A

Women because women usually have more laxity of ligaments and less soft tissue than men

167
Q

When measuring supination and pronation of the forearm what is the neutral position?

A

Not anatomical, but elbow is at 90 degrees and thumb pointing up and arms in front of body.

168
Q

What are the amounts of supination and pronation?

A

Meausered at the hand- 90 degrees. Meausered at the forearm- 80 degrees.

169
Q

Who will have more supination and pronation ROM males or females?

A

Males.

170
Q

What is the tight packed position of the elbow?

A

Anatomical position.

171
Q

What is the resting position of the elbow?

A

70 degrees flexed and 10 degrees supinated.

172
Q

Why is the resting position of the elbow important?

A

This is how a sling should be put since it is the loosest position to allow for healing

173
Q

When will the anterior capule of the elbow be tight?

A

Only when fully extended.

174
Q

What is the most important ligament of the elbow?

A

Ulnar collateral.

175
Q

What ligament is most important when the elbow is flexed?

A

MCL.

176
Q

What is most important stabilizer when the elbow is straight?

A

Interlocking bones.

177
Q

Which ligament of the elbow is not very significant?

A

LCL.

178
Q

What stresses will the MCL of the elbow resist?

A

Hyperextension, distraction, valgus stress when the elbow is flexed.

179
Q

Where does the MCL originate and insert?

A

Medial epicondyle of humerus to medial proximal ulna

180
Q

What stresses will the anterior oblique capsular ligament of the elbow resist?

A

hyperextension, and varus and valgus when the elbow is extended.

181
Q

Where does the anterior oblique ligament originate and attach to?

A

medial epicondyle to the annular ligament and radius (allows for oblique reinforcement)

182
Q

What stresses will the annular ligaments of the elbow resist?

A

Resists radial head distraction

183
Q

Where does the annular ligament originate and attach to?

A

anterior and posterior edges of the radial notch, the lateral collateral and oblique capsular ligment attach to the annular ligament

184
Q

What does the LCL resist?

A

Resists varus stress

185
Q

What does the MCL resist?

A

Valgus stress (and resists throwing)

186
Q

Which collateral is small/weak?

A

LCL which attaches to the annular ligament

187
Q

What does the annular ligament resist?

A

Resists radial head distraction and varus stress

188
Q

What does the anterior oblique ligament resist?

A

Extension, distraction, varus and valgus

189
Q

Which ligament of the elbow complex is most important for stability?

A

Medial Collateral Ligament

190
Q

What allows for static stability in the elbow complex?

A

Bony lockout is most important between: trochlea and trochlear fossa, olecranon, cornoid and radial head and valgus stress

191
Q

How does valgus stress cause bony lockout on the radial head?

A

Valgus stress compresses the radial head

192
Q

Between the olecranon and the coronoid which is more important for stability?

A

The coronoid process and coronoid fossa

193
Q

What are the important ligaments that resist supination and pronation?

A

interosseous and oblique cord.

194
Q

What allows for dynamic stability for flexion in the elbow complex?

A

Primarily triceps

195
Q

What allows for dynamic stability for extension in the elbow complex?

A

Primarily brachialis and biceps brachii

196
Q

What allows for dynamic stability for Valgus in the elbow complex?

A

Muscles that form the common flexor tendon especially pronator teres and Flexor Carpi Ulnaris

197
Q

What allows for dynamic stability for varus in the elbow complex?

A

Muscles that form the common extensor tendon especially supinator and anconeus

198
Q

What allows for dynamic stability for pronation in the elbow complex?

A

Primarily the acnoneus, supinator and biceps brachii

199
Q

What allows for dynamic stability for supination in the elbow complex?

A

Pronator teres and quadratus

200
Q

What is the most important ligament to reinforce posterior slide of the elbow?

A

Since there is not a posteior capsular ligament there is only the posterior capsule so the tricpes tendon is the most important reinforecement.

201
Q

During throwing what forces are increased during overhand throws in the elbow complex ?

A

high valgus forces

202
Q

During throwing what side of the elbow complex distracts and which side compresses?

A

Medial side distracts and lateral side compresses

203
Q

What ligament is important in the elbow complex during throwing and what is a common instability?

A

Medial collateral ligament and a common instability incolves a lax or torn MCL

204
Q

During throwing what occurs between the radial head and capitulum in the elbow complex ?

A

Compresses radial head and capitellum which can lead to radial stress fractures and osteochondritis dessicans

205
Q

During throwing what is the effect on the olecranon in the elbow complex ?

A

Jams medial olecranon against medial side of olecranon fossa

206
Q

what is a fat pad sign? And what is it’s significance?

A

It is when something pushes the fat pad away from surrounding the humerous and it is significant because it means that there is a more serious underlying cause to the swelling in the elbow

207
Q

What is the most common thing done in sports and what is the second most common?

A

1- running. 2- overhand throw.

208
Q

What will overhand and underhand throwing lead to?

A

overhand- increased risk of injury. Underhand- decreased risk of injury.

209
Q

What are the 5 phases of overhand throwing?

A
  1. Wind-up. 2. cocking- acceleration 1. 3. Acceleration- part-2. 4. release. 5. Deceleration/ follow through.
210
Q

What happens in the wind-up part of overhand throwing?

A

balance and preparatory.

211
Q

How is the wind-up part of overhand throwing done?

A

starts with both feet planted and then pivot on ipsilateral leg, kick with contralateral leg. There are many different styles.

212
Q

What is the risk of injury like during the wind-up phase?

A

Low.

213
Q

What happens in the cocking phase?

A

Wind the spring to increase potential energy.

214
Q

How is the cocking phase done?

A

contralateral forward foot becomes fixed (takes a step forward). Contralateral trunk rotates and chest thrusts forward. Arm externally rotated.

215
Q

What muscles are important in contralateral trunk rotation during the cocking phase?

A

Abdominal and thigh muscles.

216
Q

What happens to the elbow during the cocking phase?

A

It is flexed by biceps and brachialis to decrease the risk of injury.

217
Q

What is the serratus anterior doing during the cocking phase?

A

Stabilizing the scapula and lattisumus dorsi.

218
Q

Where will the tension be during the cocking phase and what will the tension be like?

A

Pectoralis major, subscapularis, rotator cuff, anteiror GH capsule, Anterior labrum, Ulnar nerve, long head of biceps brachii. Tension will be very high.

219
Q

What part of the shoulder is unstable during the cocking phase and what may occur?

A

Anterior part is instable and shoulder impingement may occur.

220
Q

What are bankart lesions?

A

Anterior and SLAP (superior Labial anteior P ).

221
Q

What will a pitcher do to compensate for a sore cuff or impingment?

A

Switch from overhand throwing to side arm.

222
Q

What will side arm throwing stress?

A

Elbow.

223
Q

What happens during the acceleration phase when the body moves forward?

A

contralateral trunk rotation, contralateral flexion and extension as body moves forward.

224
Q

What happens during the acceleration phase at the GH joint?

A

internal rotation and horizontal adduction.

225
Q

How is the internal rotation and horizontal adduction of the GH joint during acceleration done?***

A

Latissimus dorsi, pectoralis major and subscapularis forefully move the arm at the GH joint and the shoulder acts as a complex.

226
Q

When throwing a ball it can go 0-80 mph how fast?

A

80 msec.

227
Q

Throwing a ball this fast places torque where? Causing what?

A

ON the humerus and this can lead to stress fractures and a single pitch can break the arm.

228
Q

What other stress is placed on the body during the acceleration phase of the overhand throw?

A

Increased GH compression leading to grinding on the labrum.

229
Q

What will control the position of the humerus during the acceleration phase of the overhand throw?

A

Cuff.

230
Q

What will cause injury later (from the acceleration phase) of the overhand throw?

A

Stong contraction but low distraction of the rotator cuff while controling the position of the Humerus.

231
Q

Will impingement of the GH joint still happen during acceleration phase of the overhand throw?

A

Yes.

232
Q

Acceleration of the overhand throw increases stress where?***

A

At the elbow.

233
Q

What kind of stress will be on the elbow during the acceleration phase of the overhand throw?

A

valgus, shear and compression.

234
Q

What happens during internal rotation at the GH joint during acceleration of the overhand throw?

A

Forearm and hand lag behind as internal rotation at GH begins

235
Q

What is happening with the elbow during accelerationof the overhand throw?

A

Medial elbow traction with lateral posterior compression leading to olecranon damage.

236
Q

What will late rapid extension during the acceleration of the overhand throw lead to?

A

Increase stress on biceps traction on the structures attaching to medial epicondyle and MCL

237
Q

The acceleration phase of the overhand throw and increased stress at the elbow may cause what to hypertrophy?

A

Medial epicondyle and common flexor and biceps later.

238
Q

Medial avulsion from the acceleration phase of the overhand throw are seen amoung who?

A

Young teens.

239
Q

What is most likely to fracture during the acceleration phase of the overhand throw due to hypertrophy?

A

Radial head/neck from stress fractures.

240
Q

Late rapid extension during the acceleration phase leads to what?

A

Increased stress on biceps causing more stress on ulnar nerve.

241
Q

Lateral compression during the acceleration phase leads to what?

A

Lateral osteochondritis of dissecans.

242
Q

Wha tis osteochondritis of dissecans?

A

Joint and cartilage lose blood supply. Elbows and knees are most commonly involved.

243
Q

When the medial epicondyle hypertrophies due to increased stress at elbow this causes what?

A

Avulsion fractures of medial epicondyle and radial head/neck stess fractures.

244
Q

What part of the elbow will have osteochondritis dissecans?

A

Capitellum.

245
Q

What nerve will be stressed during the acceleration phase of the overhand throw?

A

ULNAR.

246
Q

Maximum velocity of the arm during overhand throwing occurs when?

A

Release phase.

247
Q

What happens to the elbow during the release phase?

A

It is nearly fully extended due to the biceps and brachilais.

248
Q

What is happening with the wrist during release phase?

A

neutral but flexing.

249
Q

What puts spin on a baseball when throwing it?

A

Finger action.

250
Q

What faces the plate when throwing a fast, curve and change up?

A

fast- palm. Curve- palm/hypothernar. Change- released not from fingertips but more towards bases.

251
Q

Why is throwing a curve ball bad?

A

it delays release and reduces time for recovery and may add supination when pronation should occur (not natural). This also would increase stress on elbow and shoulder.

252
Q

The release phase increases what on the entire upper limb?

A

Distraction.

253
Q

How hard is it to decelerate a limb after an overhand throw?

A

2 times the inertia to declerate as it did to accelerate it. OR half as much energy is needed to accelerate an arm than to decelerate it.

254
Q

What happens during deceleration phase?

A

Internal rotation at GH joint, pronation/ flexion at elbow and wrist flexion.

255
Q

The GH joint will be distracted about how much during overhand throwing?

A

about 1 inch.

256
Q

What happens with distraction of the GH joint during the deceleration phase?

A

increased distraction accompanied by horizontal adduction especially posteriorly.

257
Q

What part of the cuff is most vulnerable to injury during the deceleration phase?

A

posterior/ superior cuff tears and tendonitis. (some supraspinatus but a lot on the posterior capsule

258
Q

What other tissues can be injured during the deceleration phase?

A

labrum (bankart tears), Cuff, tricpes, latissimus, traps, post deltoid..

259
Q

What will decelerate the arm?

A

Rotator cuff and it is most vulnerable to injury.

260
Q

Where will increased traction occur at during the deceleration phase?

A

Suprascapular nerve.

261
Q

Why do pitchers in baseball throw from a mound?

A

The body will fall forward and this will dissipate energy and decrease injury rates.

262
Q

What will the arm and forearm do during deceleration/ follow through?

A

Move across body.

263
Q

What are the natural motions of the arm, forearm and wrist during deceleration/ follow through?

A

internal rotation and pronation and also wrist flexion

264
Q

What delays the follow through phase and disrupts the natural flow of movement ?

A

supination and this disrupts the natural flow of movement.

265
Q

What happens with the body during deceleration/ follow through?

A

Body pivots at hip of stance limb; hip/knee/ankle torque leads to occasional injury.

266
Q

Why will the body pivot at hip stance limb during deceleration if this leads to hip/knee/ankle injuries occasionally?

A

To decrease arm stress.

267
Q

What is the final position of the upper limb at the end of follow through?

A

Internally rotated and adducted at the GH and pronated and flexed at the elbow.

268
Q

The end of follow through might increase tension on what?

A

Suprascapular and axillary nerve.

269
Q

When will there be less throwing velocity?

A

When lower extremities are not in contact with ground and not able to use lower limb muscles.

270
Q

What is the convex rule?

A

Direction of slide is opposite the direciton of roll. Angular movement is opposite of slide and same direction of roll.

271
Q

What is the Concave rule?

A

Direction of slide is the same as roll. Angular movement is in the same direction as slide and roll.

272
Q

With the convex and concave rules when will the motions be opposite?

A

Only convex will slide be opposite as roll.

273
Q

What is the top of part of the distal phalanx called?

A

Ungual tuft.

274
Q

What row of carpal bones is more stable?

A

Proximal less stable and distal is more stable.

275
Q

Name the stable bones of the wrist and hand?

A

Trapezium, trapezoid, capitate, hamate, 2 and 3 metacarpals.

276
Q

How many phalanges will each hand have?

A

14 of them.

277
Q

How many sesamoid bones are on each hand?

A

two.

278
Q

What is the keystone bone of the wrist?

A

Capitate.

279
Q

What is the bony meniscus of the wrist?

A

Proximal row.

280
Q

What is the purpose of the bony meniscus aka proximal row of carpal bones?

A

Increase mobility and act as a group.

281
Q

What is the main weight bearing carpal bone?

A

Scaphoid.

282
Q

What carpal bone is most often fractured?

A

Scaphoid.

283
Q

What is the most unstable carpal bone?

A

Lunate.

284
Q

How many carpal rows are there and how many carpal columns are there?

A

2 rows and 3 columns.

285
Q

What is the midcarpal complex?

A

The joint complex between the proximal and distal carpal rows.

286
Q

Name 2 more wrist complex joints?

A

Radiocarpal and ulnocarpal joint complexes.

287
Q

What is the pattern of stability like in the wrist?

A

Stability increases from proximal to distal (besides thumb).

288
Q

Name the arches of the hand and where they are at?

A
  1. Transverse- makes the carpal tunnel. 2. Longitudinal- from middle carpal to end of third finger. 3. Oblique- thumb to other fingers.
289
Q

What will the 3 arches of the hand improve?

A

Grip, flexibility, dexterity, wrist/forearm communicatino with vessels.

290
Q

The transvere arch = what?

A

Carpal gutter.

291
Q

What is found in the carpal tunnel?

A

Flexor tendons, median nerve. NO ARTERIES OR VEINS.

292
Q

How does the median nerve travel in the carpal tunnel and why is this significant?

A

Median nerve becomes more superficial in the carpal tunnel and the tendons are under it. Repetitive motions cause constant movement and can cause issues with the nerve

293
Q

what covers the superior part of the carpal tunnel?

A

The flexor retinaculum.

294
Q

What are the 3 positions that can compress the carpal tunnel?

A

Flexion, Extension, ulnar deviation aka adduction.

295
Q

What makes up the tunnel of Guyon?

A

Pisiform, hamate.

296
Q

What forms the bottom or floor of the tunnel of guyon?

A

Pisohamate ligament.

297
Q

What travels through the tunnel of guyon?

A

Ulnar nerve, artery and vein.

298
Q

Will the tunnel of guyon be part of the carpal tunnel?

A

No.

299
Q

What bone moves in the forearm?

A

The radius.

300
Q

When will the radius be parallel and when will it cross the ulna?

A

Parallel- supinated. Cross- pronated.

301
Q

What is the shape of the radius?

A

Crank.

302
Q

The forearm biomechanics and anatomy has a strong influence on what?

A

pronation and supination. At both R-U joints

303
Q

The radial head spins on what?

A

Capitellum.

304
Q

How will the distal radius move?

A

Swing/ slide on the head of the ulna.

305
Q

Where is the ulnar head found?***

A

Distally

306
Q

Where is the radial head found?***

A

Proximally

307
Q

What holds the radial head in place?

A

Annular ligament.

308
Q

What will stabilize the radius?

A

Interosseus membrane and the oblique cord. (if too tight, limits pronation)

309
Q

What is another name for the scaphoid?

A

Navicular bone.

310
Q

What is the main weight bearing part of the wrist?

A

Carpal surface of the radius.

311
Q

What are the main weight bearing carpal bones?

A

Mainly- SCAPHOID. a liitle from; lunate, and triquetral.

312
Q

Which forearm bone will have what % of the weight bearing load?

A

Radius- 60-90%. Ulna- 10-40%.

313
Q

What is the scaphoid and 4 X rule?

A

scaphoid fractures are about 80-90% of carpal fractures because the force on a fall to an outstretched hand causes a 4x increase of force on the scaphoid ie: 100lbs of force on fall = 400 lbs on scaphoid.

314
Q

What is the TFC?

A

Triangular fibrocartilage complex.

315
Q

The TFC is important in what motion?

A

Supination and pronation.

316
Q

Where is the TFC aka triangular fibrocartilage complex located at?

A

Ulnocarpal joint and distal Radio-ulnar joint aka DRUJ.

317
Q

Where will the TFC disc sweep under?

A

Ulnar head.

318
Q

The hand moves with what?

A

The radius.

319
Q

What does the TFC moves with?***

A

the radius and all other wrist motions

320
Q

What is TFCC?

A

Ligaments and cartilage of the DRUJ joint not just the cartilage.

321
Q

What are the 2 main arterial blood supplies to the hand?

A

Radial and ulnar arteries.

322
Q

What happens to the radial and ulnar arteries of the hand?

A

There form a deep and a superficila arch and have many anastomoses and collateral circulation.

323
Q

What is Volar?

A

another name for palmer or anterior hand.

324
Q

What is the function of the synovial tendon sheaths?

A

To guide, support, and lubricate the tendons.

325
Q

The thumb and pink synovial tendon sheaths commonicate with what?

A

The palm.

326
Q

Where will hand infections most commonly happen?

A

Finger creases

327
Q

Where are synovial tendon sheaths most superficial and what is it’s significance?

A

The sheaths are most superficial at the finger creases and the synovial fluid is connected all the way up the arm so infections can travel up this pathway.

328
Q

What is mesotenon?

A

Mesentery of the hand for vessels, nerves, and is necessary for tendon survival.

329
Q

what sensory area is supplied by the median nerve on the palmer?

A

Most of thumb besides lateral part, palm and fingers until middle of the 4th finger.

330
Q

what sensory area is supplied by the ulnar nerve on the volar surface?

A

Palm and fingers on medial side up to the middle of the 4th finger

331
Q

what sensory area is supplied by the radial nerve on the volar surface?

A

only lower lateral part of thumb

332
Q

what sensory area is supplied by the median nerve on the dorsal surface?

A

tips of the 2nd, 3rd and half of the 4th fingers

333
Q

what sensory area is supplied by the ulnar nerve on the dorsal surface?

A

back of hand and fingers medially up to the middle of the 4th finger

334
Q

what sensory area is supplied by the radial nerve on the dorsal surface?

A

thumb, back of hand and fingers up to the middle of the 4th finger (besides the distal phalanges of the 2nd 3rd and half of the 4th digitis).

335
Q

Where is the radial nerve pure patch?

A

Dorsal: at the web of the hand btw the 1st and 2nd digit

336
Q

Where is the median nerve pure patch?

A

Anterior: On the DIP of the 2nd digit

337
Q

Where is the ulner nerve pure patch?

A

Dorsal: over the Hammate area (dorsal part of the 5th digit)

338
Q

Where is the segmental dermatomes of C6,7 and 8?

A

C6 = lateral hand with only the thumb and 2nd digits C7 = middle part of hand and 3rd digit C8 = Medial hand and 4-5th digits

339
Q

What is the C7 Pure patch

A

tip of middle finger

340
Q

What is the C6 Pure Patch?

A

the DIP of the thumb

341
Q

What is the C8 Pure Patch?

A

The DIP of the 5th digit

342
Q

What is a site of early sensory loss from carpal tunnel?

A

The dorsal distal phalanges of 2nd 3rd and half of the 4th digits.

343
Q

What will the proximal carpal row do during wrist flexion and extension?

A

Flexion- dorsal slide and palmer roll. Extension- palmer slide and dorsal roll and proximal.

344
Q

With wrist flexion and extension which row of carpals will move more/

A

Flexion- distal row. Extension- proximal row.

345
Q

Which carpal bone is the oddball when it comes to flexion and extension and why?

A

Scaphoid moves away from lunate during extension and S-L ligament tears (SLAC lesion).

346
Q

What happens with the scaphoid during abduction and with extension and why is this important?

A

Scaphoid is impinged with abductin and extension and this is important with fractures.

347
Q

is there more ulnar or radial deviation ROM? Why?

A

More Ulnar deviation (30 degrees) than radial deviation (20 degrees) because the radius is longer and so the radial styloid blocks more motion.

348
Q

What is Madelung’s deformity?

A

Abnormally long Ulna (+ulnar variance) caused by distal radial growth arrest

349
Q

What wrist ligament is most commonly torn?

A

Scapholunate.

350
Q

What ligament helps keep the carpals together?

A

Radiate.

351
Q

Where else in the body is there a radiate ligament?

A

Ribs

352
Q

What ligament resists extension of the wrist?

A

Lunotriquetral.

Biomechanics 4 (Carnes) Final (1 decks)

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