Exam 1 Flashcards
What is kinesiology?
Study of how human movement and posture are produced
What are mechanical principles applied to human movement?
Biomechanics
What is kinematics?
Parameters related to kinetics
ie- mass, time, & speed
What are forces that cause movement?
Kinetics
What does ipsilateral mean?
It refers to same side of the body
What does contralateral mean?
It refers to the opposite side of the body
Linear motion occurs?
in a straight line
What is an example of rectilinear motion?
A child sledding down a hill, sail boat moving through the water or a baseball player running from home base to 1st base
Describe a curvilinear motion?
It is a curved path that isn’t circular
ie- a diver jumping off a diving board
What is movement of an object around a fixed point
Angular motion aka- rotary motion
How do the fundamental position and anatomical position differ?
Fundamental- palms facing the sides of the body
Anatomical- palms facing forward.
Describe ADduction?
Movement TOWARDS the midline
Desribe ABduction?
Movement AWAY from the midline
Dorsiflexion is…?
Extension of the wrist and ankle joint
What is hyperextension?
Continuation of movement/extension beyond the anatomical position
What is osteokinematics?
the movement of bones around a joint axis
ie- humerus moving on scapula
What is arthrokinematics?
Deals with the relationship of joint surface movement
ie- humeral head’s movement within glenoid fossa of scapula or the femoral head moving in the acetabulum
What are the 4 movements that make up circumduction?
- Flexion
- Extension
- Adduction
- Abduction
Describe the Frontal plane?
divides the body into front and back parts
What is the saggital plane?
divides the body into right and left parts
Which plane divides the body into top and bottom parts?
Transverse
What is the point where the 3 cardinal planes intersect with each other?
The center of gravity
What motions occur in the saggital plane?
flexion and extension
Rotation occurs in which plane of motion?
Transverse plane
What motions occur in the frontal plane?
abduction and adduction
A cardinal plane?
Divides the body into equal parts
What is another name for the frontal plane?
Coronal plane
What is another name for the transverse plane?
Horizontal plane
What are Axes?
They are points that run through a joint around which a part rotates
Which axis is a point that runs through a joint from front to back?
Sagittal axis
Where does the frontal axis occur?
It runs through a joint from side to side
What is another name for the vertical axis?
Longitudinal axis
This axis runs through a joint from top to bottom?
Vertical axis
Flexion/ extension, occur in which plane and axis
Sagital plane
Frontal axis
Which joint motions occur in the Frontal plane and Sagittal axis?
Abduction/adduction
radial/ ulnar deviation
Eversion/ inversion
Which joint motions occur in the transverse plane/ Vertical axis
Internal/ external rotation
Supination/ pronation
Horizontal abduction/ adduction
What is a dislocation?
the complete separation of the two articular surfaces of a joint.
A portion of the joint capsule surrounding the joint will be torn
Describe a subluxation?
a partial dislocation of a joint, usually occurs over a period of time
What is the difference between a sprain and a strain?
Sprain= partial or complete tearing of ligament fibers Strain= overstretching of muscle fibers
What is capsulitis?
inflammation of the joint capsule
What is tenosynovitis?
Inflammation of the tendon sheath
Often caused by repetitive use
Common sites are long head of the biceps/ flexor tendons of the hands
Looking at a spot on the ceiling directly over your head involves what joint motion?
Neck hyperextension
Putting your hand in your back pocket involves what SHOULDER joint rotation?
Shoulder internal rotation
Picking up a pencil on the floor besides your chair involves what trunk joint rotation?
Trunk lateral bending
Putting your right ankle on your left knee involves what type of hip rotation?
Hip external rotation
If you place your hand on the back of a dog, that is referred to as what surface? If you place your hand on the back of the person, that is referred to as what surface?
Dog = dorsal Person = posterior
A person lying on a bed staring at the ceiling is in what position?
Supine
A person wheeling across a room in a wheelchair uses both linear and angular motion. Describe when each type of motion is being used?
Angular motion is being used by the upper extremity joints- shoulders, elbows, wrists- to propel the wheelchair
Linear motion occurs as the person moves the across the room in the wheelchair
When touching the left shoulder with the left hand, is a person using the contralateral or ipsilateral hand?
Ipsilateral
What are the differences between the axial and appendicular skeletons?
Axial= contains no long or short bones/ provides support and protection Appendicular= contains no irregular bones/ provides framework for movement
Where is compact bone located?
Compact bone is found in the diaphysis of long bones
Where is cancellous bone located?
Cancellous bone is found in the metaphysis & epiphysis
Which is heavier, compact or cancellous bone? Why?
Compact bone because it is less porous
What type of bone is mainly involved in an individual’s growth in height? In what portion of the bone does this growth occur?
An individual’s height growth occurs mainly in long bones.
The growth occurs at the epiphysis of long bones
What is the purpose of a sesamoid bone?
They protect tendons from excess wear.
The patella has the additional function of increasing the angle of pull of the quadriceps muscle
What bone markings can be classified as depressions and openings?
Foramen, fossa, groove, meatus, sinus
A condyle, eminence, facet, and head are classified as?
Bone projections or processes that fit into joints
Name the bone markings that can be classified as projections or processes that attach connective tissue?
Crest, epicondyle, line, spine, trochanter, tuberosity, tubercle
What type of bone marking is the bicipital groove?
ditchlike DEPRESSION
The humeral head can be classified as which type of bone marking?
Rounded articular projection that fits into a joint
The acetabulum is classified as which type of bone marking
Deep depression
What is the name of the membrane that lines the medullary canal?
Endosteum
The main shaft of the bone is called what?
Diaphysis
In children, does long bone growth occur at a traction epiphysis or at a pressure epiphysis?
Pressure epiphysis
Is the sternum part of the axial or appendicular skeletal?
Axial
Is the clavicle part of the axial or appendicular skeletal?
Appendicular
Is the humerus part of the axial or appendicular skeletal?
Appendicular
What are 3 types of joints that allow little or no motion?
A joint that allows very little or no motion is a fibrous joint
The 3 types of fibrous joints are synarthrosis, syndesmosis, & gomphosis
What are the 2 terms for a joint that allows a great deal of motion?
A joint that allows for a great deal of motion is called a synovial joint or diarthrosis
What are the 3 features that describe diarthrodial joints?
Diathrodial joints can be described by
- number of axes
- the shape of the joint
- the joint motion involved
What type of structure connects bone to muscle?
Tendon
What type of joint structure pads and protects areas of great friction?
Bursa
How does hyaline cartilage differ from fibrocartilage?
Hyaline cartilage is located on the bone ends of synovial joints and provides a smooth articulating surface
Fibrocartilage is thicker and is located b/t bones to provide shock absorption and spacing
What are examples of fibrocartilage?
Menisci of the knee
Disks of the vertebrae
When the anterior surface of the forearm moves toward the anterior surface of the humerus, what joint motion is involved? In what plane is the motion occurring? Around what axis?
Elbow flexion
It occurs in the sagittal plane
Around the frontal axis
What joint motions are involved in turning the palm of the hand? In what plane and around what axis does that joint motion occur?
Forearm pronation
It occurs in the transverse plane
Around the vertical axis
What joint motion is involved in returning the fingers to anatomical position from the fully spread position? In what plane and what axis does this joint motion occur?
Finger adduction
It occurs in the sagittal plane
Around the frontal axis
Identify the 11 degrees of freedom of the upper extremity?
Shoulder=3 Elbow=1 Radioulnar= 1 Wrist=2 MCP=2 PIP=1 DIP=1
Give an example of a synarthrodial joint in the axial skeleton?
Bones in the skull
Diarthrodial, synovial, triaxial, & ball and socket are all terms that could be used to describe which joint of the upper extremity? Could these same terms apply to a joint in the lower extremity? If so what joint is it?
Glenohumeral joint
Yes, Hip joint
Diarthrodial, synovial, biaxial, and saddle are all terms that could be used to describe which joint?
CMC joint of the thumb
What are two joint terms that could be used to describe the symphysis pubis?
Amphiarthosis and cartilaginous
What joint structure surrounds and encases the joint and protects the articular surfaces?
Joint capsule
What are the skeletal system functions?
Provides a rigid framework
Shapes the body
Protects vital organs (brain, heart, liver, spleen, spinal cord)
Supports the soft tissues of the body
Assists in movement by providing a rigid structure for muscle attachment, and activation and leverage
Manufactures blood cells primarily in flat bones (Ilium, vertebra, sternum, and ribs)
How many bones are in the axial skeleton?
80 Cranium = 8 Face = 14 Thorax = 25 Vertebral column = 26 Other (hyoid/ear ossicles) =7
How many bones are in the appendicular skeleton?
126
UE = 64
LE = 62
Describe compact bone?
Hard, dense outer shell
Completely covers bone
Thick along shaft and plates of flat bones
Thin at ends of long bones
Describe cancellous bone?
Trabeculae area
Porous, spongy inner porition
same material as compact bone but more porous and contains less solid material
Loose mesh structure of pores filled w/ marrow = lighter
Makes up most of articular ends of bone
What is an osteon?
Fundamental unit of bone
What is haversian canal?
Small channel at center of each osteon
Contains blood vessels and nerve supply
Volkman’s canals- branches from central canal
What structure of the bone is located at the ends of the bone usually in the wider area?
Epiphysis
What structure of a bone is a hollow center where marrow and arteries are located?
Medullary cavity
This membranous structure of bone lines the medullary canal?
Endosteum
This bone structure is the main shaft of the bone composed of compact bone and provides strength?
Diaphysis
In children, this is the location where new longitudinal bone growth occurs
Epiphyseal plate
What is the thin fibrous membrane covering all of the bone except the articular surfaces that are covered by hyaline cartilage?
Periosteum
Which bone structure contains nerve and blood vessels that promote growth and repairs bones. Also serving as the attachment for tendons and ligaments?
Periosteum
What are the two types of epiphyses found in growing children?
Pressure epiphysis
Traction epiphysis
Which type of epiphyses is located where tendons attach to bones and are subjected to a pulling force?
Traction epiphysis
Examples: greater & lesser trochanters of the femur and tibial tuberosity
Which type of epiphyses is located at the ends of long bones where they receive pressure from the opposing bone making up that joint?
Pressure epiphysis
because this occurs where the growth in long bones occurs if the epiphysis of a growing bone is not firmly attached to the diaphysis, it can slip or become misshapen
What is the composition and function of long bones?
Composed of compact bone and surrounding marrow with a length greater than width. Function: Largest bones in the body, and comprise the appendicular skeleton . (Humerus, Femur, Tibia)
What is the composition and shape of a flat bone?
Composed of two layers of compact with cancellous bone, and marrow in between. Shape: Broad, and curved at the surface without increased thickness. (Scapula/Ilium)
Which type of bone’s function is to protect the tendon from excessive wear and shearing?
Sesamoid bone
What is the composition and shape of an irregular bone?
Composed of cancellous bone and marrow encased in a thin layer of cancellous bone. Shape: Bones are primary in a mixed shape. (Vertebrae and sacrum)
Describe the composition and shape of a short bone?
Composed of a thin layer of compact bone covering cancellous bone with a marrow cavity. Shape: Equal dimensions in height, length, and width, and have an increase in articular surface since they articulate with other bones. (Carpals-wrist /Tarsals-ankle)
Describe Legg-Calve Perthes disease?
pediatric disorders of the joint/bone; lack of blood flow to the head of the femur results in degeneration of the bone
What disease is caused by traction of the epiphyseal plate at the tibial tuberosity?
Osgood Schlatter disease
Describe slipped femoral capital epiphyses?
pediatric disorders of the joint/bone-separation of the femoral head from the hip joint (acetabulum) caused by inflammation or hormonal imbalances
Is shoulder flexion and extension an arthrokinematic type of motion or osteokinematic?
Osteokinematic
Is shoulder distraction an arthrokinematic or osteokinematic type of motion?
Arthrokinematic
You would feel what type of end feel at the end of the knee flexion range?
Soft tissue approximation
Flex the shoulder from the extended position.
Is the humerus moving on the scapula, or is the scapula moving on the humerus?
Humerus is moving on the scapula
Flex the shoulder from the extended position.
Is the proximal end of the humerus a concave or convex joint surface?
Proximal end of the humerus is convex
Flex the shoulder from the extended position.
Does the glenoid fossa of the scapula have a concave or convex joint surface?
Glenoid fossa of the scapula is concave
Flex the shoulder from the extended position.
Is the concave surface moving on a fixed convex surface or is a convex surface moving on a fixed concave surface?
Convex surface is moving on a fixed concave surface
Flex the shoulder from the extended position.
Is the joint surface moving in the same or opposite direction as the joint motion?
Opposite direction
Identify the accessory motion forces occurring in the following activities?
A. Leaning on a table w/ your elbows extended
B. Transferring from a wheelchair to the car using a sliding board
C. Picking up one end of table
D. Opening a jar
E. Swinging a child around by her arms
A = Compression or approximation B = Shear C = Traction or distraction D = Torsional E = Traction or distraction
Is the temporomandibular joint (TMJ) in the close-packed position when the teeth are clenched or when the mouth is slightly open?
Teeth clenched
Rotating a quarter on its edge across the table demonstrates what type of arthrokinematics motion?
Roll
Lay a quarter flat on the table and hit it with your finger, sending it across the table. This motion would be what type of arthrokinematic motion?
Glide
Hold a pencil vertically with the lead end on the table. Holding the eraser end b/t your thumb and index finger, roll the pencil b/t your fingers, keeping the lead end in contact withe the table. This is demonstrating what type of arthrokinematic motion?
Spin
Assuming muscles are of normal length and taking a person’s ankle into dorsiflexion, you would expect what type of end feel?
Soft tissue touch
A person bends down to touch the floor in the sagittal plane.
What type of force is applied to the anterior vertebra?
What type of force is applied to the posterior vertebra?
Anterior = Compression Posterior = Distraction
Sitting in a chair, a man turns around to look behind him. What type of force is being applied to the vertebral column?
Torsional
The surfaces of the thumb metacarpophalangeal (MCP) joint are what shape?
Ovoid
Is the rotational motion at the thumb carpometacarpal (CMC) joint considered a classical or an accessory movement? Why?
Accessory
Rotation can not be done alone. It occurs when that joint abducts and flexes, thereby accomplishing opposition.
This is a subjective assessment of the quality of the feel when slight pressure is applied at the end of the joint’s passive ROM?
End feel
Describe a normal end feel?
Full passive ROM at a joint, and the normal anatomical structures stop the movement.
What type of end feel is present when pain, muscle guarding, or swelling stops the joint movement?
Abnormal end feel
Name the end feel that occurs when muscle bulk is compressed, giving a soft end feel? Give an example?
Soft tissue approximation
ie- Elbow flexion is stopped by the approximation of the forearm & arm
Name the end feel that is characterized by a hard and abrupt limit to passive joint motion? What else could it be called? Give an example?
A painless, abrupt, hard stop to movement when bone contacts bone
ie- Normal terminal elbow ext. as the bony olecrannon process contacts the bony olecrannon fossa
List the NORMAL end feel terms?
Hard (bony)
Soft (soft tissue apposition)
Firm (soft tissue stretch)
Capsular stretch
Name the end feel that is a sudden hard stop usually felt well before the end of normal ROM?
Abnormal hard end feel
ie- joint that contains loose bodies, degenerative joint disease, dislocation, or a fracture
This end feel is often found in acute conditions in which soft tissue edema or synovitis?
Boggy end feel
What is a reflexive muscle guarding during motion?
Muscle spasm
In this type of end feel a rebound movement is felt at the end of the ROM, it usually occurs w/ INTERNAL DERANGEMENT of a joint, such as torn cartilage?
Springy block
ie- knee w/ torn meniscus
Which type of end feel has some slight give to it when the joint is taken to the end range?
Firm (soft tissue stretch)
List the abnormal end feels?
Hard Soft Firm Springy block Empty Spasm
What could a spasm end feel indicate?
Acute or subacute arthritis
Severe active lesion
Fracture
If pain is absent = lesion of the CNS w/ increased muscle tone
What is an empty end feel?
It occurs when the movement produces considerable pain
No mechanical limitation at end range b/c pt. will not let you move the part through further ROM
Define manipulation?
a passive movement applied within a short range and with a very forceful thrust that can not be stopped
This is described as a passive oscillatory motion or sustained stretch that is applied at a slow enough speed by an external force that the individual can stop the motion?
Joint mobilization
What are joint mobilizations used for?
To improve joint mobility or decrease pain of joint structures
Describe joint play?
Passive movement b/t joint surfaces done by passively applying external force
ie- includes motions such as glide, spin, roll
What are component movements?
motions that accompany active motion but are not under voluntary control
these motions must occur to have normal joint motion
Give examples of component movements?
Shoulder girdle must rotate upward for the shoulder joint to flex
Femur rotates on tibia during last few degrees of knee extension
Rotation occurs at the thumb during opposition
What type of joint has two bones forming a convex-concave relationship?
Ovoid joint
Give examples of an ovoid joint?
Metacarpophalangeal joint
Most synovial joints
What is a seller or saddle shaped joint?
A joint where each joint surface is concave in one direction and convex in another
ie- carpometacarpal (CMP) joint of the thumb, trapezium carpal bone is concave front to back and convex side to side
What are the arthrokinematic motions?
Roll, glide or slide, & spin
What type of arthrokinematic motion is linear motion of a joint surface parallel to the plane of adjoining joint surface?
Glide or slide
What type of arthrokinematic motion is the rotation of a movable joint surface on the fixed adjacent surface?
Spin
What type of arthrokinematic motion is movement of one joint surface over another?
Roll
What does the concave convex rule describe?
How the differences in the shapes of bone ends require joint surfaces to move in a specific way during joint movement
A concave joint surface will move on a fixed convex surface in the SAME direction the body segment is moving
Give an example of the concave convex rule?
The head of the humerus is convex and the glenoid fossa is concave
During shoulder flexion, the convex surface of the humeral head moves in the opposite direction (downward) from the rest of the humerus which is moving upward
Convex joint surface moves in the __________ direction of the body segment’s movement.
opposite
Concave joint surface moves in the __________ direction of the body segment’s movement.
same
What is the position of maximum incongruence?
Loose packed position
What accessory motion occurs when external force is exerted on a joint causing the joint to be pushed closer together? Give examples?
Approximation aka compression
ie- push ups bring the joint surfaces of the shoulder, elbow, and wrist to be approximated
What are the 3 types of accessory motion forces when applying joint mobilization? Which are the combination of forces?
Traction, compression, & shearing
Combo= bending and torsional
When a joint is congruent the joint surfaces have maximum contract with eachother and are tightly compressed. What is this know as?
Closed-packed position
What accessory motion occurs when external force is exerted on a joint causing the joint surfaces to pull apart? Give examples?
Traction (distraction or tension)
ie- carrying a heavy suitcase or hanging from an overhead bar causes traction to the shoulder, elbow, & wrist joints
What accessory motion forces occur parallel to the surface and result in a glide motion at the joint?
Shear
-ie anterior/posterior glide
What occurs during a bending accessory motion?
Compression on the concave side
Traction on the convex side
What occurs during a torsional accessory motion?
One force is turning on end of the bone around a longitudinal axis while the other force is fixed or turning in the opposite direction
What pathology refers to a complete separation of the two articular surfaces of a joint?
Dislocation
What is tendonitis?
Inflammation of a tendon
This refers to the overstretching of muscle fibers?
Strain
Name the type of arthritis that is caused by the breakdown and eventual loss of the cartilage of one or more joints? What areas of the body are at the highest risk?
Osteoarthritis
Hands, feet, spine, hips, and knees
What is inflammation to a bursa called?
Bursitis
Define capsulitis?
Inflammation of the joint capsule
What is a partial dislocation of a joint usually occurs over a period of time?
Subluxation
What is synovitis?
Inflammation of the synovial membrane
Define tendosynovitis?
Inflammation of the tendon sheath and is often caused by repetitive use
What is the purpose of the articular surface?
Provides joint stability & mobility
Name the different joint shapes?
Ball and socket Ellipsoid Hinge Saddle Gliding Pivot
A cartilaginous joint is separated by either ______ or ______ b/t the two bones.
Hyaline or fibrocartilage
What is another name of a cartilaginous joint? Describe it?
Amphiarthrodial joint
Allows for a small amount of motion, bending, twisting, and compression.
Provides a great deal of stability
Describe a synovial joint?
There is no direct union b/t bone ends
Cavity is filled w/ synovial fluid contained with in a sleevelike capsule
Outer layer of capsule= strong fibrous tissue that holds joint together
Inner layer lined with a synovial membrane that secretes synovial fluid
What is another name for a synovial joint?
Diarthrodial joint
Allows for free motion
Less stable
What is a nonaxial joint?
Joint surfaces flat & glide over one another
Movement is linear, not angular
Motion occurs secondary to other motion
Give an example is a non axial joint?
The carpal bones
ie- movement occurs here when the wrist flexes/extends or radial/ulnar deviation
What is a uniaxial joint?
Angular motion occuring in one plane around one axis
Give an example of a uniaxial joint? Explain why?
The elbow or knee (hinge joint)
The only motions possible are flexion/extension
Occurs in sagittal plane around frontal axis
What motion occurs in a pivot joint? Give an example
Rotation (therefore uniaxial)
Radius pivot around ulna during pronation/supination
Cervical vertebra rotate around the odontoid process of the 2nd vertebra
Explain a biaxial joint? Give an example?
A joint that allows for 2 directions of motion
The wrist can flex/extend in frontal axis and radial/ulnar deviation in sagittal axis
What types of joints are found in a biaxial joint?
Ellipsoid Saddle joint ( thumb CMC)
Explain how the CMC joint of the thumb is a unique biaxial joint?
CMC joint shape allows for rotation to occur as an accessory motion to the primary motions of the thumb (flex/ext, abd/add)
What are the shape of non axial joints?
Irregular
What are the joint motions that can occur in a triaxial or multiaxial joint?
Flexion/extension (sagittal plane/ frontal axis)
Abduction/Adduction (frontal plane/ sagittal axis)
Roation (transverse plane/ longitudinal axis)
Horizontal abduction/ adduction (transverse plane/ longitudinal axis
Give examples of triaxial joints?
Glenohumeral joint
Hip joint
What is another name for a triaxial joint?
Ball and socket joint
What type of cartilage acts as a shock absorber? Where are they located?
Fibrocartilage
Vertebra = intervertebral disks
Knee = menisci
Define ligaments?
Bands of fibrous connective tissue that provide attachment for cartilage, fascia, and muscle to bone
What is every synovial joint surrounded by? What does this structure do?
Capsule
Provides support and protection
Describe synovial fluid?
Thick, clear liquid that lubricates articular cartilage
Reduces friction to help the joint move freely
Provides nutrition to articular cartilage and some shock absorption
What is another name for hyaline cartilage? Where is it found?
Articular cartilage
Found on the ends of bones
What does hyaline cartilage provide?
A smooth articulating surface in all synovial joints
What are the types of fibrous joints?
Synarthrosis
Syndesmosis
Gomphosis
What is an example of a syndesmosis joint?
Distal tibifibular joint & distal radioulnar joint
Ligaments and interosseous membranes hold joint together
Slight joint motion
What is an example of a Gomphosis joint?
Occurs b/t a tooth and the wall of the dental socket of the mandible and maxilla
No joint motion
Gomphosis, means what in Greek?
Bolting together
What is a examples of a synarthosis joint?
Fibrous sutures found b/t the bones of the skill
No joint motion
What is osteokinematics?
Gross movements of bones at joints referred to movement that occurs b/t two bones at synovial joints
List some osteokinematic movements?
Flex/Ext
IR/ER
Abduction/Adduction
What are arthrokinematics?
Small amplitude motions of bones at joint surface aka- joint play
List the arthrokinematic motions?
Roll
Glide or slide
Spin
What is an isometric contraction?
Muscle contracts producing force without changing muscle length (no joint movement)
What is an isotonic contraction?
muscle contracts & muscle length & joint changes
What is another name for isometric contraction?
static or tonic contraction
What is another name for isotonic contraction?
phasic
What contraction consists of joint movement, muscle shorten, & muscle attachments (o&i) move toward each other ?
concentric muscle contraction
What contraction consists of joint motion but the muscle appears to lengthen, & the muscle attachments seperates
eccentric muscle contraction
What are some examples of information gained via visual observation?
facial expression, symmetrical or compensatory motion in functional activities, body posture, muscle contours, body proportions and color, condition & creases of the skin
What is the definition of palpation?
examination of the body surface by touch
Bony landmarks are used as _______ to assess limb or trunk circumference
reference points
Why is palpation preformed?
to asses bony & soft tissue contours, soft tissue consistency, and skin temperature & texture
How do you palpate a tendon?
place the tips of the index & middle fingers across the long axis of the tendon & gently roll forward & backward across the tendon
What type of muscle contraction should a patient perform when a pta is palpating a muscle or tendon?
isometrically - contracting and relaxing
What is optimal posture when working with a patient on a plinth?
broad base of support (ability to shift), knees slightly flexed, neutral lordotic posture
What are the 5 L’s?
Load, lever, lungs, lordosis, legs
Where is the center of gravity considered when supporting a limb ?
located apprx. at the junction of the upper & middle third of the segment
The study of movement of the bone in space is?
osteokinematics
What is joint movement?
The amount of movement that occurs at a joint to produce movement of a bone in space
This type of movement is performed when the patient contracts muscle to voluntarily move the body part through ROM
active range of motion AROM
This type of movement is performed when the patient can’t voluntary move and they need assistance from a therapies or another external force to move the body through ROM
passive range of motion (PROM)
An ______ _________ or _______ is formed when two bony articular surfaces, lined hyaline cartilage meet & movement is allowed to occur at the junction
anatomical joint, articulation
What are the two names for a joint that consists of two surfaces moving one with respect to the other; muscle & bone, muscle, bursa, and bone
physiological , functional joint
What are two examples of physiological joints?
scapulothoracic joint or subdeltoid joint
What is a syndesmosis joint?
opposing bone surfaces are relativity far apart & joined together by ligaments
What does angular motion refer to?
movements that produce an increase or decrease in the angle btw the adjacent bones
What movements does angular motion specifically refer to?
flexion, extension, abduction & adduction
Bending a part so the anterior surfaces come closer together is called
Flexion
When the dorsal surface of the foot is brought closer to the anterior aspect of the leg, the movement is called
Dorsiflexion
The straightening of a part and movement is i the opposite direction to flexion movements is called
Extension
When the plantar aspect of the foot is extended toward the posterior aspect of the leg, the movement is called
Plantarflexion
Movement that goes beyond the normal anatomical joint position of extension is called
Hyperextension
Movement away from the midline of the body or body part is called
Abduction
Abduction of the scapula is called
Protraction
Jimmy flexes and extends his elbow, name the plane and axis involved in this motion
Sagittal plane and Frontal axis
Jimmy abducts and adducts his shoulder, name the plane and axis involved in this motion
Frontal plane and Sagittal axis
Jimmy internally and externally rotates his shoulder, name the plane and axis involved in this motion
Transverse plane and Longitudinal axis
Scapula adduction is referred to as?
retraction
scapula abduction is referred to as?
protraction
Which digits in the hand & foot are considered midline for abduction & adduction?
hand- 3rd digit foot- 2nd digit
Neck rotation occurs around which vertebrae and around which axis?
atlantoaxial joint c1,c2 axis= vertical axis or longitudinal
What is opposition of the thumb?
the tips of the thumb & little fingers come together
When the thumb and little finger return to anatomical position from a position of opposition it is referred to ?
reposition of the thumb & little fingers
Tilt describes movement of which two bony structures?
scapula & pelvis
Describe “Anterior tilt of scapula”
The coracoid process moves in an anterior and caudal direction while the inferior angle moves in a posterior and cranial direction
Describe “Posterior tilt of scapula”
The coracoid process moves in a posterior and cranial direction while the inferior angle of the scapula moves in an anterior and caudal direction
Describe “Anterior pelvic tilt”
the anterior superior iliac spines of the pelvis move in an anterior and caudal direction
Describe “Posterior pelvic tilt”
the anterior superior iliac spines of the pelvis move in a posterior and cranial direction
Describe “Lateral pelvic tilt”
movement of the ipsilateral iliac crest in the frontal plane either in a cranial direction or in a caudal direction
Define Scaption?
when the plane of the scapula is 30 degrees to 45 degrees anterior to the frontal plane, and is the plane of reference for diagonal movements of shoulder elevation
A reduced amount of movement; joint ROM that is less than the normal ROM expected at the joint is referred to as
Hypomobility
An excessive amount of movement; joint ROM that is greater than the normal ROM expected at the joint is referred to as
Hypermobility
When the length of a muscle prevents full ROM at the joint or joints that the muscle crosses over, it is called
Passive insufficiency
The study of movement occurring within the joints, between the articular surfaces of the bones is called
Arthrokinematics
When assessing joint ROM you must know the _____ of the joint and observe which _____ of movement of the bone and understand which rul?
shape , direction, concave-convex
In the hip joint which portion is concave & which is convex?
acetabulum is concave, head of the femur is convex
The first carpometacarpal joint joint is formed by which surfaces?
distal surface of the trapezium & base of the first metacarpal
The first caropmetacarpal joint is an example of which type of joint?
saddle-shaped joint
Which two motions occur together at a joint?
glide & roll
Which type of motion is analogous to a car tire rolling over the ground?
Roll
Which type of motion is analogous to a car tire sliding over an icy surface?
glide
Restricted inferior glide of the convex humeral head would result in which motion in which joint?
decreased glenohumeral joint abduction ROM
Restricted anterior glide of the concave tibial articular surface would result in which motion
decreased knee extension ROM
When is AROM & PROM assessment contraindicated?
where muscle contraction or motion of the part could disrupt the healing process or further injure it
Should a therapist perform AROM and PROM assessment techniques when they suspect a subluxation or dislocation or fracture?
NO!
After ensuring their are no contraindications to AROM or PROM exist, the therapist must take care of ROM as precautions. Name a few
its painful, inflammation, patient is taking meds, osteoporosis, hyper mobile joint, hemophilia, hematoma, injury that affected soft tissue, recently healed fracture, prolonged immobilization of a part.
What phenomenon causes a temporary or permeant loss of strength due to excessively rigorous activity or exercise relative to the patients condition?
OVER WORK
What are some signs of fatigue?
tiredness, pain, muscular spasm, a slow response to contraction, tremor, and decreased ability to perform AROM
Hip flexion ROM is limited by the length of which muscle when the knee joint is held in extension?
hamstring muscles
PT is performing AROM assesment where strenuous & resisted movement could aggravate or worsen certain patient conditions. Please give a few examples.
neurosurgery, surgery on the abdomen, intervertebral disc pathology, herniation of a disk, cardiovascular problems (arrhythmias, aneurysm, recent embolus, obesity, MI’s, hypertension, etc.), cerebrovascular disorders
Patients should avoid which maneuver during the strength testing procedure?
valsalva maneuver
Fatigue maybe detrimental to or exacerbate patients with these types of pathologies (name a few)
extreme debility, malnutrition, malignancy, COPD, cardiovascular disease, MS, polio-myelitis, post polio myelitis syndrome, myasthenia gravis, lower motor neuron disease, intermittent claudication
While reaching back to stretch your shoulder you try to meet both hands in the middle. Shoulder A reaches down while shoulder B reaches up. Please describe the osteokinematic motions involved in shoulder A.
scapular abduction & lateral (upward rotation), shoulder elevation & external rotation, elbow flexion, forearm supination, wrist radial deviation and finger extension.
While reaching back to stretch your shoulder you try to meet both hands in the middle. Shoulder A reaches down while shoulder B reaches up. Please describe the osteokinematic motions involved in shoulder B
scapular adduction & medial (downward) rotation, shoulder extension & lateral rotation, elbow flexion, forearm pronation, wrist radial deviation, and finger extension
It is important to take AROM assesments on the affected joints and what other joints?
joints immediately proximal and distal to the affected joint(s), also test the unaffected side
If the pt presents with full PROM & muscle weakness how could you eliminate gravity to see if that increases AROM?
Vertical plane is working against gravity. To eliminated or decrease gravity have the pt perform the exercise in a horizontal plane (transverse)
How would you remove gravity example of an exercise were gravity has been removed
in the supine position hip abduction is a gravity-eliminated motion so that muscle which performs hip abduction (gluteus medius) is neither helped nor resisted by gravity
If the pt presents with full PROM & muscle weakness how could you eliminate gravity to see if that increases AROM?
Vertical plane is working against gravity. To eliminated or decrease gravity have the pt perform the exercise in a horizontal plane (transverse) This usually means side lying on the plinth
How could you position a patient so that during hip abduction gravity was eliminated?
in the supine position hip abduction is a gravity-eliminated motion so that muscle which performs hip abduction (gluteus medius) is neither helped nor resisted by gravity
In what order do you perform PROM, muscle strength, and AROM?
1) AROM-y? b/c you want to visually see the range, any signs of discomfort, etc. 2)PROM- you want to see how far YOU can move them 3) muscle strength- is it muscular weakness causing the lack of ROM?
What type of information does PROM provide?
amount of movement possible in the joint, factors limiting movement, movements that cause pain
Why is PROM slightly greater than AROM?
b/c the slight elastic stretch of tissues & decreased bulk of relaxed muscles
What type of information does PROM provide?
amount of movement possible in the joint, factors limiting movement, movements that cause pain, quality of movement, end feel, capsular vs. non capsular pattern
What part do you stabilize and what part do you when assessing PROM at a joint?
stabilize the proximal joint segment(s) and move the distal joint segment(s) through full PROM
What about the joint determines the direction & magnitude of its PROM?
anatomical structure : stretching of soft tissues, ligaments of the joint capsule, apposition of soft tissues, bone contacting bone
According to clarkson the end feel can be either normal aka? or abnormal aka?
normal= physiological or abnormal = pathological
How do you separate end feels when documenting multiple for one joint?
/ ex: soft/firm/hard
What is the difference between capsular pattern and non capsular pattern?
capsular pattern refers to joints that are controlled by muscles while non capsular pattern refers to structures within the joint
What is the difference between capsular pattern and non capsular pattern?
(both are patterns of joint movement restriction) capsular pattern refers to joints that are controlled by muscles while non capsular pattern refers to structures within the joint
True or false. All joints reflect the same capsular pattern
False, each joint differs(is unique): shoulder joint pattern differsthan the hip joint. But each joint is similar between people. My hip your hip.
Joints that rely primarily on ligaments for their stability express which type of pattern? capsular or non capsular?
non capsular pattern
If there are ligamentous sprains or adhesions, internal derangement, or extra articular lesions which type of capsular pattern is present?
noncapsular pattern
Involuntary muscle spasms that restrict joint motion would be which pattern restriction?
capsular pattern
What are some examples of extra-articular lesions that could affect non capsular structures?
muscle adhesions, muscle spasms, muscle strains, hematomas, cysts
This is an apparatus used to measure joint angles
goniometer
The temporomandibular joints (TMJs) are performed using what measurement tool?
ruler or calipers
What is validity?
The degree to which an instrument measures what it is suppose to measure (indicates accuracy of a measurement)
How do you establish validity?
Measures of the instrument being assessed are compared to the measures obtained with an instrument that is an accepted standard
What is reliability?
the extent to which the instrument yields the same measurement on repeated uses either by the same operator or different operators
This type of measurement tool is a 180 or 360 degree protractor with one axis that joins two arms
universal goniometer
What assessment tool is considered the most accurate means of assessing joint motion?
radiographs
Which is better intratester reliability or inter tester reliability?
Intratester= same therapist performing the measurement
Why must you assess & record the ROM of the uninvolved limb?
To determine the patient’s normal ROM & normal end feels
When assessing and measuring AROM & PROM it is important to ensure that only the desired movement occurs at the joint being tested. What is the name of movements that help increase the ROM of a joint that aren’t produced naturally?
Substitute movements
To eliminate substitute movements, the pta must?
properly position the patient, stabilize the proximal joint segment, practice measuring & assessing AROM & PROM, explain & instruct the patient regarding the movement
How might a pta stabilize the proximal joint segment?
manually ssing the pta’s weight to stabilize , using a belt or sandbags
Where should the pta stabilize when assessing hip extension with the patient prone on a plinth?
pta would apply external pressure to stabilize the pelvis (prevent it from lifting off the plinth)
When assessing ankle joint dorsiflexion and planter flexion which bones must be stabilized?
the tibia & fibula
According to clarkson is it necessary to measure the joint ROM when the involved joint has full AROM and PROM?
it is not necessary : Record it as full, normal (N), or within normal limits (WNL)
All joints must be measured from what type of defined position?
zero position, either anatomical position or a position specified as zero
What is the preferred placement of the Goniometer when measuring joint ROM
lateral to the joint, just off the surface of the limb; but it also may be placed over the joint using only light contact between the goniometer and the skin
What is used to represent the axis of motion when measuring the ROM of the joint
A specific bony prominence or anatomical landmark
The part of the goniometer that normally lies parallel to the longitudinal axis of the fixed proximal joint segment and / or points toward a distant bony prominence on the proximal segment is called
Stationary Arm
What part of the goniometer normally lies parallel to the longitudinal axis of the moving distal joint segment and/or points toward a distant bony prominence on the distal segment is called
Movable Arm
How is AROM measured with the Goniometer?
The patient moves actively through the full AROM and the PT either moves the movable arm of the goniometer along with the limb through the entire range of movement to the end of the AROM, or realign the goniometer at the end of the AROM
Describe the two techniques for measuring PROM with the goniometer
1) Have the Pt actively move through the joint ROM, and align the goniometer at the end of the AROM. Have the Pt relax & passively move the goniometer & the limb segment through the final degrees of the PROM
2) Passively move the movable arm of the goniometer & the limb segment through the entire range of movement to the end of the PROM
What is the type of goniometer has a compass inclinometer and consists of a fluid-filled rotatable container mounted on a plate
The OB “Myrin” Goniometer
List some advantages of using the OB Goniometer
1) It is not necessary to align the inclinometer w/ the joint axis, 2) Rotational movements are measured with ease, 3) Assessment of the trunk & neck ROM is measured with ease, and 4) PROM is more easily assessed
List some disadvantages of using the OB Goniometer
1) Expensive & bulky compared to universal goniometer, 2) It cannot be used on small joints of hand / foot, and 3) Magnetic fields other than those on earth will cause the compass needle to deviate & must be avoided
List some sources of error when measuring joint ROM
1) Reading the wrong side of the scale on the goniometer, 2) tendency to read values that end in a particular digit (i.e. “_0 degrees”), 3) Having expectations of what the reading should be and allowing it to influence results, 4) a change in the Pt’s motivation to perform, 5) taking successive ROM measurements at different times a day, and 6) Measurement procedure error (make sure ROM measurements are reliable)
List items that will give reliable ROM measurements
1) The same therapist should assess the ROM, 2) assess the ROM at the same time each day, 3) Use the same measuring tool, 4) Use the same Pt position, 5) Follow a standard measurement protocol, and 6) Assess ROM in a consistent manner relative to the application of treatment techniques
List the standard information that should be recorded on a ROM recording form
1) Pt’s name, 2) Date of birth or age, 3) Diagnosis, 4) Date of examination, 4) Assessing PT’s name, signature, & credentials, and 5) Type of ROM being recorded, AROM or PROM
Every space on the ROM recording form should include an entry. If a measurement is not performed, what should be entered in the line item for the measurement?
Not tested or NT
Pertaining to documentation, how should the information be recorded if the AROM or PROM are full
as Full, normal (N), within normal limits (WNL), or numerically
If the ROM is less than or greater than the normal ROM, how is the existing ROM indicated
on a pictorial chart or the number of degrees of motion is recorded on a numerical chart
What does “SFTR” stand for in the SFTR method of recording joint ROM
Planes of motion: S - Sagittal plane; F - Frontal plane; T - Transverse plane
R - rotational motions
Briefly describe the SFTR method of recording joint ROM
The letter representing the plane of motion being assessed is written followed by three numbers, the starting position is recorded as the middle number, and the ROM present on either side of the starting position is recorded before and after the start position (i.e. motion occurring in the sagittal plane is extension / flexion, the number to the left of starting position is extension and the number to the right is flexion - shoulder left S: 60-0-180 degrees; right S:60-0-80 degrees)
Motion in the Frontal (F) Plane is abduction (number to the left of start postion)/ adduction (number to right)
Motion in the Tranverse (T) plane is horizontal abduction & horizontal adduction and retraction / protraction. The number on the left indicates H. abduction / retraction and the number on the right indicates H adduction / protraction
R represents rotational motion. The number on the left represents ext. rotation, forearm supination, or spinal rotation to the left, and the number on the right represents int. rotation, forearm pronation, and spinal rotation to the right.
When assessing & measuring joint ROM with two- or multi-joint muscle in the same region, the PT should do what?
Move the nontest joint crossed by the muscle into position so that the two-joint or multi-joint muscle is placed on slack (i.e. when the hip is flexed to asses hip flexion, the knee is also placed in knee flexion to relax the hamstring muscles in order to prevent restriction of the hip flexion ROM due to passive insufficiency of the hamstrings)
