EXAM 1 - WRITTEN Flashcards
respiratory pathology - asthma
a spasm of the bronchial walls, which makes exhalation very difficult
joint congruency / joint surface position - open- / loose-packed / resting position
incongruent; parts of the capsule and supporting ligaments are lax; further passive separation of the joint surfaces can occur in this position
- joint mobilization techniques are best applied in the open-packed position; allow for the roll, spin, and glide
- joint play can be demonstrated in these open-packed positions; requires relaxed muscles and the external force of a trained practitioner to correctly demonstrate it
skeletal system pathologies - fracture / broken / cracked bone
break in the continuity of the bony cortex caused by direct force, indirect force, or pathology; described by type (closed), direction of fracture line (transverse), position of the bone fragments (overriding)
- children are incomplete (“green- stick”) or at the epiphysis
- elderly in the hip joint (proximal femur), resulting from a fall, or in the upper extremity from falling on the outstretched hand
circulatory pathology - thrombophlebitis / phlebitis
clot causes inflammation in a vein
joint end feel - boggy
ound in acute conditions in which soft tissue edema is present; has a soft, “wet sponge” feel
- immediately after a severely sprained ankle or with synovitis
PNS pathology - foot drop
damage to the common fibular (peroneal) nerve; compression of the common fibular nerve is often caused by cast pressure at the head of the fibula, where the nerve is quite superficial as it lies over the bony fibular head
simple machine types - pulley - movable
one end of the rope attached to a beam; the rope runs through the pulley to the other end where the force is applied; to increase the mechanical advantage of force
- load (resistance) is suspended from the movable pulley
vertebral column pathology - torticollis / wryneck
deformity of the neck; person’s head is laterally bent to one side and rotated toward the other side
osteokinematics - supination
rotation of the forearm that faces the palm of the hand forward, or anteriorly; elbow is flexed, the “palm up” position
arthrokinematics
joint surface motion; manner in which adjoining joint surfaces move on each other during osteokinematic joint movement
simple machine types - pulleys
grooved wheel that turns on an axle with a rope or cable riding in the groove; purpose is to either change the direction of a force or to increase or decrease its magnitude
PNS pathology - Cubital Tunnel syndrome
ulnar nerve crosses the medial border of the elbow as the nerve runs through a bony passageway called the cubital tunnel; tingling in the small and ring fingers from hitting the ulnar nerve at the cubital tunnel; ulnar nerve can also be compressed distally by sustained pressure on the hypothenar eminence
body planes / planes of action - sagittal plane
passes through the body from front to back and divides the body into right and left parts; vertical wall that the extremity moves along; motions occurring in this plane are flexion and extension; mid-sagittal plane would divide the body in the middle into equal right and left parts
articular system pathologies - tendonitis
inflammation of a tendon; present at either the musculotendinous junction, the tenoperiosteal junction, or within the body of the tendon
axial skeleton
forms the upright part of the body; 80 bones of the head, thorax, and trunk
muscle contraction - isotonic concentric
muscle contract, but this time there is joint motion; is joint move- ment, the muscles shorten, and the muscle attach ments (origin [O] and insertion [I]) move toward each other
degrees of freedom
number of planes, in which they can move
clinically significant:
- dealing with one or more distal joints: shoulder has 3 degrees of freedom, the entire limb from the finger to the shoulder would have 11
linear / translatory motion - rectilinear motion
movement that occurs in a straight line
accessory motion - component movements
small arthrokinematic joint motions that accompany active osteokinematic motion; no component motions can be done independently; they must accompany osteokinematic motions for normal joint motion to occur
muscle fiber arrangement - oblique type - multipennate
many tendons with oblique fibers in between
osteokinematics - protraction
linear movement along a plane parallel to the ground and away from the posterior midline
muscle fiber arrangement - parallel type
to the muscle’s long axis; tend to be longer and thus have a greater potential for shortening and producing more range of motion
respiratory pathology - bronchitis
involves the bronchi and their many subdivisions
CNS pathology - defect at the neuromuscular junction - Myasthenia Gravis
terminal axon synapses with the receptor site of muscles
- Symptoms: weakness and fatigue of skeletal muscles
circulatory pathology - aneurysm
abnormal outward bulging or ballooning that is often caused by a weakened area in the wall; may go undetected until it ruptures
osteokinematics
joint motion; the relationship of the movement of bones around a joint axis and through joint planes; at synovial joints
circulatory pathology - thoracic outlet syndrome
group of disorders involving compression of the brachial plexus and/or the subclavian artery and vein within in the spaced called the thoracic outlet; arious vascular, neurological, and muscular symptoms may result
joint types - fibrous joint
thin layer of fibrous periosteum between the two bones:
- synarthrosis
- syndesmosis
- gomphosis
length-tension relationship - total tension
combination of passive and active tension
muscle fiber arrangement - oblique type - bipennate
common feather pattern; fibers are obliquely attached to both sides of a central tendon
skeletal system pathologies - osteoporosis
loss of normal bone density, or bone mass; can weaken a bone to the point where it will fracture; vertebrae of an elderly person are common sites
PNS pathology - Bell’s Palsy
facial nerve (cranial nerve VII), which controls movement of facial muscles; usually temporary and typically affects only one side of the face; muscle paralysis
change in lever class
from a second-class (axis-resistance-force) to a third-class lever (axis-force-resistance)
- brachioradialis weight of the forearm and hand being the resistance.
1. middle of the forearm as its COG
2. weight of the forearm
3. hand (R) is located between the axis (elbow joint)
4. force (distal muscle attachment), - if you put a weight in the hand, the COG of the resistance is now located farther from the axis than the force (muscle); now working as a third-class lever.
direction of the movement in relation to gravity is another factor that will affect lever class
force
a push or pull action that can be represented as a vector; one object must act on another; can be a push, which creates compression; a pull, which creates tension; movement occurs if one opposing force pushes (or pulls) harder than the other or when two or more forces are working together.
- vector is a quantity having both magnitude and direction
- characteristics of force include:
1. Magnitude (each person is pushing equally in this case)
- Direction (shown by the arrow)
- Point of application (the same for both people)
circulatory pathology - arteriosclerosis
slow blood flow, “hardening” of the arteries; a problem in the legs and feet; vessel wall becomes less elastic and cannot dilate to allow greater blood flow when needed
osteokinematics - pronation
rotation of the forearm; the palm is facing backward, or posteriorly. When the elbow is flexed “palm down”
irregular bones
have a variety of mixed shapes that do not fit into the other cate- gories; allow them to fulfill a particular function; composed of cancellous bone and marrow encased in a thin layer of compact bone
exercise terminology
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arthrokinematic motion types - roll
rolling of one joint surface on another; ew points on each surface come into contact throughout the motion
osteokinematics - inversion
moving the sole of the foot inward at the ankle
respiratory pathology - hyperventilation
during rapid breathing when more carbon dioxide is removed from the system than is being produced metabolically
- common treatment for hyperventilation involves breathing into a paper bag to “rebreathe” carbon dioxide
PNS pathology - burner / stinger syndrome
following a stretch or compression injury to the brachial plexus from a blow to the head or shoulder
- symptoms: immediate burning pain, prickly paresthesia radiating from the neck, numbness, and even brief paralysis of the arm
- symptoms should resolve within minutes, although shoulder weakness and muscle tenderness of the neck may continue for a few days
PNS pathology - Carpal Tunnel syndrome
compression of the median nerve as it passes within the carpal tunnel; formed by the transverse carpal ligament superficially and the bony floor of the carpal bones deeply
articular system pathologies - osteoarthritis / degenerative arthritis
type of arthritis that is caused by the breakdown and eventual loss of the cartilage of one or more joints; frequently with age and commonly affects the hands, feet, spine, and large weight-bearing joints, such as the hips and knees
osteokinematics - horizontal adduction
cannot occur from the anatomical position; must be preceded by either flexion or abduction, then movement forward is horizontal adduction
circulatory pathology - embolism
blood clot (or other foreign matter, such as air, fat, or tumor) that becomes dislodged and travels to another part of the body through ever smaller vessels until becoming wedged, causing an obstruction
osteokinematics - dorsiflexion
movement toward the dorsum (superior aspect) of the arm or foot; at the wrist and ankle joints
joint types - synovial / diarthrodial joint - biaxial joint - condyloid joint
occurs in two different directions; flexion and extension occur around the frontal axis, and radial and ulnar deviation occur around the sagittal axis
respiratory pathology - flail chest
four or more ribs are fractured in two places (comminuted); causes that part of the chest wall to collapse rather than expand during inspiration; chest wall will also expand during expiration
CNS pathology - congenital defect - spina bifida
posterior segments of some of the vertebrae fail to close during embryo development
- occulta - small bony defect is present, but the spinal cord and nerves are usually normal
- meningocele - bony defect through which the meninges protrude; little or no nerve damage
- myelomeningocele - the meninges and spinal nerves come through the bony defect, causes nerve damage and severe disability.
simple machine types - lever - wheel and axle
wheel / crank attached to and turning together with an axle; large wheel connected to a smaller wheel and typically is used to increase the force exerted; turning around a larger wheel or handle requires less force, whereas turning around a smaller axle requires a greater force
length-tension relationship - active insufficiency
point at which a muscle cannot shorten any farther; occurs to the agonist (the muscle that is contracting/ shortening); myosin filaments are contacting the z-lines, and the sarcomere cannot get any shorter; the joint has not run out of range of motion
- hamstrings can perform either hip extension or knee flexion but cannot shorten enough to perform both simultaneously
- if you flex your knee while your hip is extended, you cannot complete the full knee flexion range
- inability to complete full knee flexion happens because the hamstrings are being asked to shorten over the hip and over the knee at the same time, and the muscle does not have the capability to shorten that much
skeletal system pathologies - osteopenia
reduced bone mass, not as severe as osteoporosis
CNS pathology - spinal cord trauma - incomplete spinal cord injury (SCI) - Brown-Séquard syndrome
injury to one side of the spinal cord, causing weakness and loss of proprioception on the side of the injury and loss of pain and thermal sensation on the opposite side
PNS pathology - Morton’s neuroma
enlarged nerve and usually occurs between the third and fourth toes (branches of the tibial nerve); enlargement usually involves nerve compression in a confined space; compression could be from a flattening of the metatarsal arch; transfering weight forward, putting more pressure on the metatarsal arch area; creating compression on the nerves as they pass between the metatarsals
joint end feel - empty
movement produces considerable pain and the patient stops the clinician from moving the joint beyond the painful point; clinician does not bring the joint to the end of its physiologic range of motion, there is no way to tell if a limitation may exist past the point of pain, or to determine the tissue type that would have been the cause of any potential limitation
articular system pathologies - subluxation
partial dislocation of a joint; occurs over a period of time
force type - resultant
overall effect of these two different forces lies somewhere in between
arthrokinematic motion types - spin
rotation of the movable joint surface on the fixed adjacent surface; same point on each surface remains in contact with each other
length-tension relationship - length
determines the amount of force a muscle can generate
- optimal length: slight stretch (but not overstretched)
1. maximum interface between actin and myosin filaments; every myosin head is bound to an actin filament.
2. some passive tension in the muscle.
respiratory pathology - hiccups
involuntary spasms of the diaphragm accompanied by rapid closure of the glottis which produces short, sharp, inspiratory sounds
bone markings - projections or processes that attach tendons, ligaments
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respiratory pathology - rib separation
dislocation between the rib and its costal cartilage
short bones
equal dimensions of height, length, and width, giving them a cube shape; lots of articular surface; articulate with more than one bone; a thin layer of compact bone covering cancellous bone, which has a marrow cavity in the middle
joint types - synovial / diarthrodial joint - uniaxial joint - pivot joint
in the transverse plane around the longitudinal axis
force type - concurrent
two or more forces must act on a common point but must pull or push in different directions
joint congruency / joint surface position
how well joint surfaces match or fit; surfaces of a joint are congruent in one position and incongruent in all other positions.
vertebral curves
lordosis - cervical and lumbar - concave posteriorly
kyphosis - thoracic and sacral - convex posteriorly
- more strength and resilience, approximately 10 times more than if it were a straight rod
- spine is a pillar to support the body’s weight and to protect the spinal cord; curves help the spine withstand great amounts of stress by providing a more even distribution of body weight
length-tension relationship - tenodesis / tendon action of a muscle
- rest your flexed elbow on the table in a pronated position, relax, and let your wrist drop into flexion, you will notice that your fingers have a tendency to extend passively
- supinate your forearm and relax your wrist into extension, your fingers will have a tendency to close; if tendons were a little tight, this opening and closing would be more pronounced
- use this principle to grasp and release light objects; supination of the forearm, the weight of the hand and gravity causes the wrist to fall into hyperextension; closes the fingers, creating a slight grasp; pronation of the forearm causes the wrist to fall into flexion, thus opening the fingers and releasing an object
osteokinematics - circumduction
motion that describes a circular, cone-shaped pattern; involves a combination of four joint motions:
(1) flexion, (2) abduction, (3) extension, and (4) adduction
joint end feel - soft / soft tissue approximation
muscle bulk is compressed, particularly evident on a person with well-developed muscles or who is extremely obese
muscle contraction - isokinetic
speed of the motion stays the same for the duration of the contraction; done only with special equipment that regulates the speed of motion; resistance to the part varies, but the speed stays the same
- body part to be exercised is usually connected to a machine that does not produce any movement itself, but limits the speed it will allow the body part to move when a contraction is performed
- tries to move faster than the speed limit, they will end up generating more resistance against the machine
- does not push as fast/hard, there will be less resistance
PNS pathology - wrist drop
loss of wrist extension and a weakened ability to release objects (finger extension) will result from a high radial nerve injury, which is often a complication of a mid-humeral fracture
vertebral column pathology - spondylolisthesis
results from a fracture, or giving way, of a defective pars inter- articularis; one vertebra slips forward in relation to an adjacent vertebra, usually L5 slipping anterior on S1
articular system pathologies - strains
overstretching of muscle fibers; strains are graded depending on severity
vertebral column pathology - whiplash
type of cervical sprain in which the head and neck suddenly and forcefully hyperextends then flexes, like the cracking of a whip
- common during a rear-end car accident; when the head and neck hyperextend, soft tissue structures (muscles, ligaments, joint capsules) on the anterior side of the neck are stretched; followed quickly by a forceful cervical flexion
- results in the overstretching of soft tissue structures on the posterior side; severity of the injury will dictate the amount of muscle, capsular, and ligamentous pain, and possible joint instability
bone types
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articular system pathologies - bursitis
inflammation of the bursa
osteokinematics - lateral / external rotation
rotation is movement of a bone or part around its longitudinal axis; if the anterior surface rolls outward, away from the midline
force type - parallel
same plane and in the same or opposite direction; middle force must always be located between the two parallel forces of sufficient strength to resist the other two forces; two forces must be of sufficient strength to resist the middle force
joint end feel - springy block
rebound movement is felt at the end of the ROM; occurs with internal derangement of a joint
- torn cartilage.
state of equilibrium
object is balanced, all torques acting on it are even, depends primarily on the relationship between the object’s center of gravity and its base of support
- gravity - mutual attraction between the earth and an object
- center of gravity - balance point of an object at which torque on all sides is equal; point at which the planes of the body intersect
- base of support - part of a body that is in contact with the supporting surface
vertebral column pathology - lordosis / swayback
abnormally increased curve from the normal anterior-posterior curvature of the lumbar spine
osteokinematics - horizontal abduction
cannot occur from the anatomical position; must be preceded by either flexion or abduction, then movement backward is horizontal abduction
CNS pathology - congenital defect - cerebral palsy
group of nonprogressive disorders of the brain that result from damage in utero, at birth, or soon after birth. It is not always congenital; signs and symptoms of cerebral palsy are variable and depend on the area of the brain that is damaged.
insertion
more movable bone; when muscle contracts, one end of the joint moves toward the other
osteokinematics - abduction
movement away from the midline of the body
simple machine types - lever - 2nd class
resistance is in the middle, with the axis at one end and the force at the other end; favors power because a relatively small force (the muscle) can move a large resistance (the body); the body can be raised only a fairly short distance.
- longer the FA
1. easier it is to move the part and the longer the RA
2. harder it is to move the part
circulatory pathology - hemorrhage / bleeding
break in a blood vessel allows blood to leak out of the closed system
length-tension relationship - passive insufficiency
multijoint muscle cannot be lengthened any farther without damage to its fibers; occurs to the antagonist (the relaxed muscle that is on the opposite side of the joint from the agonist—the contracting muscle); stretched over both joints at the same time and have become passively insufficient; cannot be stretched any farther.
- hamstring is long enough to be stretched over each joint individually (hip flexion or knee extension), but not both simultaneously
- flex your hip with your knee flexed, you can complete the range, can touch the toes by flexing both the hip and the knee
- hamstrings are being stretched over only one joint (the hip); can also extend your knee fully when the hip is extended because the hamstrings are being lengthened over only the knee
- try to flex your hips to touch your toes with your knee extended you will probably experience a stretch in the posterior thigh well before you reach full hip flexion
circulatory pathology - hemorrhage / bleeding - subdural bleeds
occurs from head trauma tends to be subdural (under the dura mater); occur in veins, which are under less pressure, so symptoms tend to develop more slowly
cervical plexus
anterior rami of the first four cervical nerves (C1 to C4) split and join together in a specific pattern to form the cervical plexus
- C2 goes to the sternocleidomastoid
- C3 and C4 supply the trapezius
- levator scapula receives innervation from C3 through C5
- anterior scalene gets some innervation from C4, and the middle scalene gets innervation from C3 and C4
- phrenic nerve, which is formed by branches of C3 through C5 and innervates the diaphragm
circulatory pathology - arteriosclerosis - heart attack / myocardial infarction
a complete atherosclerosis blockage
force type - linear
two or more forces are acting along the same line
accessory motion forces - bending and torsional
a combination
- bending occurs when an other-than-vertical force is applied, resulting in compression on the concave side and distraction on the convex side
- rotary or torsional forces involve a twisting motion; ne force is trying to turn one end or part about a longitudinal axis while the other force is fixed or turning in the opposite direction
circulatory pathology - heart murmur
extra or unusual heart sound in addition to the normal lub-dub sounds heard during a heart contraction; whooshing that can be heard through a stethoscope is usually turbulent blood back-flow; whooshing sound may be normal for that individual or a sign of valve pathology that allows blood to flow in the wrong direction
body axes
points that run through the center of a joint around which a part rotates
bone markings - projections or processes that fit into joints
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osteokinematics - plantar flexion
at ankle
accessory motion - joint mobilization
when accessory motion is limited, reduced joint motion usually results
- apply an external force to a patient’s joint to generate a passive oscillatory motion or sustained stretch between the joint surfaces; restores joint mobility or decrease pain originating from joint structures; to restore ROM, applied by generating passive arthrokinematic movement into the direction of restriction
open kinetic chain activities
kinetic chain consists of a series of rigid links connected in such a way as to allow motion; movement of one link causes motion at other links in a predictable way
- distal segment(s) is free to move while the proximal segment(s) can remain stationary; the limb segments are free to move in many directions; distal segment is not fixed but is free to move.
respiratory pathology - emphysema
emphysema, the walls of the alveoli become distended and lose their elasticity due to chronic bronchial obstruction.
vertebral column pathology - scoliosis
abnormal lateral curve from the normal anterior-posterior curvature of the spine
respiratory pathology - upper respiratory infection (URI)
infection confined to the nose, throat, and larynx (transition between the upper and lower airways)
- common cold the most frequent URI; influenza (flu), laryngitis, and rhinitis (inflammation of the nasal mucosa)
muscle fiber arrangement - parallel type - triangular
flat and fan-shaped, with fibers radiating from a narrow attachment at one end to a broad attachment at the other
concave-convex rule
differences in shapes of bone ends require joint surfaces to move in a specific way during joint movement; the joint surface of the moving bone (arthrokinematics) and the distal/opposite end of the moving bone (osteokinematics)
- concave joint surface will glide on a fixed convex surface in the same direction as the distal end of the moving bone; concave joint surface glides in the same direction as the distal end of the same bony segment.
- convex joint surface will glide on a fixed concave surface in the opposite direction as the distal end of the moving bone; the convex joint surface glides in the opposite direction as compared with the distal end of the same bony segment.
state of equilibrium - unstable
only a slight force is needed to disturb an object
length-tension relationship - tone
slight tension that is present in a muscle at all times, even when the muscle is resting; state of readiness that allows the muscle to act more easily and quickly when needed
body position
vertebral column pathology - compression fractures
result in the collapse of the anterior (body) portion of the vertebrae; caused by trauma in the lumbar region or by osteoporosis in the thoracic region
- does not commonly cause spinal cord damage and paralysis, because the fracture is usually stable; stable fracture does not have progressive displacement or dislocation
body planes / planes of action - transverse / horizontal plane
passes through the body horizontally and divides the body into top and bottom parts; rotation occurs in this plane
flat bones
very broad surface but are not very thick; have a curved surface rather than a flat one; made up of two layers of compact bone with cancellous bone and marrow in between
CNS pathology - defect at the muscle tissue - muscular dystrophy
hereditary and progressive disease; weakness of proximal muscles, followed by progressive involvement of distal muscles
temporomandibular joint / TMJ pathology - temporomandibular dysfunction (TMD)
- clenching or grinding of the teeth at nighttime problem that can lead to TMD; repetitive stress can also lead to degeneration of the joint surfaces
- clicking in the jaw when the articular disk is not positioned correctly
- associated with cervical dysfunction; hanges in posture of the cervical spine change the orientation of the head in space, and this in turn can alter the TMJ muscle line of pull, length-tension relationships, and overall TMJ mechanics
accessory motion forces - shearing
gliding motion in which the joint surfaces move parallel to one another
circulatory pathology - hemorrhage / bleeding - epidural bleeds
from head trauma tends to be either epidural - between the skull and the dura mater; occur in arteries; symptoms develop more quickly due to higher pressure within the vessel
inspiration
state of equilibrium - neutral
an object’s COG is neither raised nor lowered when it is disturbed
circulatory pathology - arteriosclerosis - stroke / cerebrovascular accident
complete atherosclerosis blockage in an artery to or in the brain
origin
stable bone; when muscle contracts, one end of the joint moves toward the other
CNS pathology - congenital defect - hydrocephalus
issue with cerebrospinal fluid (CSF) production, absorption, and flow through the ventricles and subarachnoid space; excessive accumulation of CSF results in an abnormal widening of the ventricles, which creates potentially harmful pressure on the brain tissues
vertebral column pathology - hangman’s fracture
fracture involving C2; occurs when there is a forceful, sudden hyperextension of the head; striking the head against the windshield in a motor vehicle accident is often the cause
- stable fracture, but without proper care and handling, it could become unstable; spinal cord paralysis at this level usually results in death because respiration stops
simple machine types - levers
rigid and can rotate around a fixed point when a force is applied
- resistance (R) / load - must be overcome for motion to occur; use COG of part
1. weight of the part being moved
2. the pull of gravity on the part
3. external weight being moved by the body part - axis (A) / fulcrum / joint - fixed point around which the lever rotates
- force (F) / effort / muscle - which causes the lever to move; use the point of attachment to the bone
- force arm (FA) - distance between the force and the axis
- resistance arm (RA) is the distance between the resistance and the axis
- arrangement of the axis (A) in relation to the force (F) and the resistance (R) determines the type of lever.
1. longer the FA, the easier it is to move the part; the part will be easier to move, but the FA will have to move a greater distance.
2. the longer the RA, the harder it is to move the part; it won’t have to move as far, but it will be harder to move
respiratory pathology - pneumothorax / collapsed lung
introducing air into or otherwise destroying the vacuum of the pleural cavity, thereby reducing ventilation capacity
PNS pathology - claw hand
loss of the intrinsic muscles due to ulnar nerve damage; proximal phalanges are hyperextended, and the middle and distal phalanges are in extreme flexion
CNS pathology - degenerative motor disease - Alzheimer’s disease
irreversible, progressive brain disorder causing dementia and loss of cognitive functioning; destroys a person’s ability to function
respiratory pathology - stitch
temporary condition common in runners; localized, sharp pain, usually felt just below the rib cage and commonly caused by a cramp in the diaphragm
PNS pathology - ape hand
loss of thumb opposition (median nerve injury)
joint types - fibrous joint - synarthrosis / suture joint
thin layer of fibrous periosteum between the two bones; ends of the bones are shaped to allow them to interlock; no motion between the bones; its purpose is to provide shape and strength
PNS pathology - neuropathy
accompanied by neurological deficits along the nerve pathway; classified according to cause or anatomical location; sensory distribution and clinical motor features of paralysis have been described earlier, with the individual nerves
joint end feel - firm
results from tension in the surrounding ligaments, capsule, and/or muscles and is perceived as a firm stop to the motion with only a “slight give” on over- pressure; most common end feel and is usually qualified by labeling the tissue type that limits the motion
- firm muscular end feel, firm capsular end feel, firm ligamentous end feel
osteokinematics - hyperextension
continuation of extension beyond the anatomical position
muscle pathology - trigger points
hyperirritable points within a tight band of muscle that refer pain to other areas of the body when they are active or when they are palpated; found in overworked muscle
osteokinematics - ulnar deviation
wrist adduction; hand moves medially from the anatomical position toward the little finger side at the wrist
body planes / planes of action - frontal / coronal plane
passes through the body from side to side and divides the body into front and back parts; motions occurring in this plane are abduction and adduction
vertebral column pathology - herniated disks
weakness or degeneration of the annulus fibrosus (outer layer); allows a portion of the nucleus pulposus to bulge, or herniate, through the annulus
- symptoms: when the herniation puts pressure on the spinal cord or, more commonly, on the nerve root
- common sites: L4 and L5, fourth and fifth lumbar nerve roots
skeletal system pathologies - Osgood-Schlatter disease
overuse can cause irritation and inflammation of any traction epiphysis where tendons attach to bone; at the traction epiphysis of the tibial tuberosity in children whose bones are still growing; usually exist only during the bone-growing years and not after the epiphyses have fused and bone growth stops
sesamoid bones
resemble the shape of sesame seeds, are small bones located where tendons cross the ends of long bones in the extremities; develop within the tendon and protect it from excessive wear; located on either side of the tendon near the head of the first metatarsal, providing a protective “groove” for the tendon to pass through this weight-bearing area; change the angle of a tendon’s attachment, which can increase its ability to generate force at the joints it crosses
accessory motion - joint play
happens between joint surfaces when an external force creates passive motion at the joint
vertebral column pathology - kyphosis
abnormally increased curve from the normal anterior-posterior curvature of the thoracic curve
osteokinematics - radial deviation
wrist abduction; hand moves laterally, or toward the thumb side
body planes / planes of action
fixed lines of reference along which the body is divided; each plane is at right angles, or perpendicular, to the other two
osteokinematics - eversion
moving the sole of the foot outward at the ankle
length-tension relationship - active tension
contractile units and the force generated can be compared with releasing one end of a stretched rubber band
PNS pathology - thoracic outlet syndrome
group of disorders that occur when the nerves of the brachial plexus and/or the subclavian artery and vein from neck to axilla become compressed in the thoracic outlet
- space between the clavicle and first rib and possibly the scalene muscles
- brachial plexus and subclavian artery pass between the anterior and middle scalene muscles, the first rib, and the clavicle
simple machine types - lever - 1st class
- axis is located between the force and the resistance
- axis is close to the resistance, the RA will be shorter and the FA will be longer; easy to move the resistance.
- axis is close to the force, the opposite will occur; it will be hard to move the resistance
- a longer FA (or a shorter RA):
1. easy to move the resistance (book),
2. resistance is moved only a short distance
3. force has to be applied through a long distance. - shorter FA (or a longer RA):
1. It is harder to move the resistance
2. The resistance moves a longer distance
3. The force is applied through a short distance
force types - stabilizing
perpendicular distance between the joint axis and the line of pull is very small; force generated by the muscle; nearly all of the force generated by the muscle is directed back into the joint, pulling the two bones together
osteokinematics - adduction
movement toward the midline
articular system pathologies - tenosynovitis
inflammation of the tendon sheath and is often caused by repetitive use
joint types - cartilaginous / amphiarthrodial joint
has hyaline cartilage or fibrocartilage between the two bones; allow a small amount of motion, such as bending or twisting, and some compression; these joints provide a great deal of stability
muscle fiber arrangement - oblique type - unipennate
look like one side of a feather; series of short fibers attaching diagonally along the length of a central tendon
vertebral column pathology - spinal stenosis
narrowing of the vertebral canal that houses the spinal cord or of the intervertebral foramen through which the nerve roots pass
force types - torque / moment of force / rotary
amount of torque a lever has depends on the amount of force exerted and the distance the force is from the axis; amount of force needed by a muscle contraction to cause rotary joint motion
- twisting force (torque) exerted by an arm can be increased:
1. Increasing the force applied to the handle
2. Increasing the length of the handle
appendicular skeleton
attaches to the axial skeleton; contains the 126 bones of the extremities
simple machine types - pulley - fixed
simple pulley attached to a beam; used only to change direction
- 1st class lever
- F on one side of the pulley (axis)
- R on the other
expiration
osteokinematics - medial / internal rotation
rotation is movement of a bone or part around its longitudinal axis; anterior surface rolls inward toward the midline
accessory motion forces - traction
cause joint distraction in which the joint surfaces pull apart from one another
- carrying a heavy suitcase or hanging from an overhead bar causes distraction at the shoulder, elbow, and wrist joints
muscle contraction - isotonic eccentric
continued to contraction, even though the joint motion is extension; joint motion but the muscle appears to lengthen; muscle attachments separate; muscle is actually returning to its normal resting position from a shortened position; can produce much greater force than can a concentric contraction
muscle fiber arrangement - parallel type - rhomboidal
four-sided, usually flat, with broad attachments at each end
body segments
- divided according to bones
- rarely used to describe joint motion
vertebral column pathology - spondylosis / spinal osteoarthritis
degenerative disorder of vertebral structure and function; from bony spurs, thickening of ligaments, and decreased disk height that results from reduced water content of the nucleus pulposus, a normal part of the aging process and results in nerve root and spinal cord compression
PNS pathology - Erb’s palsy / tip position
traction injury to a baby’s upper brachial plexus and occurs most commonly during a difficult childbirth; affected arm hangs in shoulder extension and medial rotation, elbow extended, forearm pronated, and wrist flexed
muscle contraction - isometric
muscle contracts, producing force without changing the length of a muscle; muscle contracted, but no joint motion occurred
muscle contraction
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articular system pathologies - synovitis
inflammation of the synovial membrane
angular / rotary motion
movement of an object around a fixed point / axis; all parts of the object DO NOT move the same distance, DO move through the same:
- angle, direction, time
most movement within the body is angular; joints serve as the axis around which angular motion occurs
- the individual parts (within the body) moving in an angular fashion
joint types - synovial / diarthrodial joint - biaxial joint - saddle joint
articular surface of each bone is concave in one direction and convex in the other; bones fit together like a horseback rider in a saddle; allows a slight amount of rotation; abduct and flex - the direction to which the pad is pointing has changed by approximately 90 degrees; rotation has occurred because of the joint’s shape
vertebral column pathology - sciatica
pain that tends to run down the posterior thigh and leg; caused by pressure on the sciatic nerve roots; symptomatic of an underlying pathology such as a herniated lumbar disc
PNS pathology - scapular winging
injury to the long thoracic nerve weakens or paralyzes the serratus anterior muscle, causing the medial border of the scapula to rise away from the rib cage
osteokinematics - extension
straightening movement of one bone away from another, causing an increase of the joint angle; returns the body part to the anatomical position after it has been flexed; anterior aspects of the joint surfaces tend to move away from each other
circulatory pathology - arteriosclerosis - atherosclerosis
an artery becomes narrow, blood flow will slow or stop; can be from a blood clot traveling through an artery or from deposits within an artery; when fatty deposits in the artery wall cause narrowing or blockage of the vessel; site of the blockage will determine the problem
joint types - synovial / diarthrodial joint - uniaxial joint - hinge joint
angular motion occurring in one plane around one axis; only motions possible are flexion and extension, which occur in the sagittal plane around the frontal axis
PNS pathology - Sciatica
irritation of the sciatic nerve roots, with pain radiating down the back of the leg; often caused by compression from a herniated lumbar disc
respiratory pathology - rib dislocation
displacement of the costal cartilage from the sternum
joint end feel
type of the resistance that a clinician feels when bringing a patient’s joint to the end of its passive range of motion, then applying a slight over-pressure; identifies what tissue was responsible for limiting further motion at the end range of a joint
- normal exists when there is full PROM at a joint, and the motion is limited by the expected anatomical structure(s) for that particular joint
- abnormal end feel may be present when pain, muscle guarding, swelling, or abnormal anatomy stops the joint movement; it can help to identify the “tissue at fault,” or the tissue creating the dysfunction; helps clinicians to direct treatment toward the true anatomical source of the problem
vertebral column pathology - spondylolysis
vertebral defect in the pars interarticularis (the part of the lami- na between the superior and inferior articular process- es).
- common in: L5 and less commonly in L4
CNS pathology - spinal cord trauma - incomplete spinal cord injury (SCI) - central cord syndrome
only part of the cord is damaged; greater loss of upper limb function compared with the lower limbs
CNS pathology - spinal cord trauma - spinal cord injury (SCI)
depending on (1) the spinal level and (2) the area of the damage; result in loss of sensation and muscle function
- quadriplegia, which refers to all four extremities, involves T1 and above
- paraplegia refers to lower extremity involvement of T2 and below
linear / translatory motion
occurs in straight line from one location to another; all parts of the object move the same:
- distance, direction, time
movement outside the body is linear
- the entire object moving in a linear fashion through space
respiratory pathology - lower respiratory infection (LRI) - pneumonia
structures from the trachea to the alveoli
- the most common LRI; inflammation of the alveoli caused by a bacterial or viral infection; can affect an entire lobe (lobar pneumonia) or can be scattered throughout the entire lung (bronchopneumonia)
- bronchopneumonia is more common in the very young and very old
- “walking pneumonia” not severe enough to confine the individual to bed or to be hospitalized
- bronchitis, emphysema, and asthma are others
force types - dislocating
past 90 degrees, the stabilizing force becomes a dislocating force because the force is directed away from the joint
- muscle is most efficient at moving, or rotating, a joint when the joint is at or near 90 degrees
- muscle becomes less efficient at moving or rotating when the joint angle is at the beginning or near the end of the joint range
length-tension relationship - stretching
agonist usually becomes actively insufficient (cannot contract any farther) before the antagonist becomes passively insufficient (cannot be stretched farther)
- done to increase the resting length of a muscle; performed on relaxed muscles.
- joint(s) the muscle crosses should be placed in a position that is opposite from the action of that muscle.
- multi-joint muscle: the muscle must be lengthened over all joints simultaneously in order to achieve a stretch
- one-joint muscle, it is necessary to put any two-joint muscles on a slack over the joint(s) not crossed by the one joint-muscle
closed kinetic chain activities
kinetic chain consists of a series of rigid links connected in such a way as to allow motion; movement of one link causes motion at other links in a predictable way
- distal segment is fixed (closed) and the proximal segment(s) moves
CNS pathology - spinal cord trauma - incomplete spinal cord injury (SCI) - anterior cord syndrome
injury affects the anterior spinal tracts; posterior part of the cord is spared, proprioception that is carried in that part of the cord is preserved, but muscle function, pain sensation, and thermal sensation are lost
joint types - synovial / diarthrodial joint - nonaxial joint - plane joint
movement is linear instead of angular; joint surfaces are flat and glide over one another; occurs secondarily to other motion
joint end feel - hard / bony
hard and abrupt limit to passive joint motion with no give on overpressure; when bone contacts bone at the end of the ROM
joint types - fibrous joint - gomphosis / peg-in-socket joint
between a tooth and the wall of its dental socket in the mandible and maxilla
state of equilibrium - stable
an object is in a position where disturbing it would require its COG to be raised
articular system pathologies - capsulitis
inflammation of the joint capsule; if inflammed for an extended time, it begins to lose its extensibility, and loss of joint motion results.
capsular pattern of motion restriction - each joint has a characteristic pattern of lost motion that presents when capsular tightness is present; aids the clinician in identifying the capsule as the source of the motion restriction and in directing appropriate treatment toward that structure
body axes - frontal axis
runs through a joint from side to side
CNS pathology - demyelinating disease - Multiple Sclerosis
breaking down of the myelin sheath around axons; interfere with normal nerve transmission; sclerosis refers to scars or lesions in the white matter of the brain and spinal cord
linear / translatory motion - curvilinear motion
movement occurs in a curved path that is not necessarily circular
vertebrae
- muscles take innervation from more than one spinal level; an injury at one spinal level may weaken a muscle, but some function will remain
joint congruency / joint surface position - close(d)-pack(ed)
congruent, the joint surfaces have maximum contact with each other, are tightly compressed, and are difficult to distract (separate); ligaments and capsule holding the joint together are taut; occurs at one extreme of the ROM.
- when ligaments and capsular structures are tested for stability and integrity, the joint is in this position often in this position when injured; when swollen, it cannot be moved into the close-packed position.
arthrokinematic motion types - glide / slide
linear movement of a joint surface parallel to the plane of the adjoining joint surface; one point on a joint surface contacts new points on the adjacent surface
muscle fiber arrangement - parallel type - fusiform
shape similar to that of a spindle; wider in the middle and tapers at both ends where it attaches to tendons; fibers run the length of the muscle; muscle may be any length or size, from long to short or large to small
articular system pathologies - dislocation
complete separation of the two articular surfaces of a joint; portion of the joint capsule surrounding the joint will be torn
long bones
length is greater than their width; the largest bones in the body; make up most of the appendicular skeleton; tube-shaped, with a shaft (diaphysis) filled with bone marrow (medullary canal) and two bulbous ends (epiphysis); the wide part of the shaft nearest the epiphysis is the metaphysis; body is still growing, bone growth occurs at the epiphyseal plate; over the articular surfaces of the epiphysis is a thin layer of hyaline cartilage.
accessory motion forces - compression
cause joint approximation in which the joint surfaces are pushed closer together
- doing a chair or floor push-up causes the joint surfaces of the shoulder, elbow, and wrist joints to be approximated.
reversal of muscle action
direction of movement can be reversed if the more movable end is stabilized by some external force or by another muscle contraction; instead of the insertion moving toward the origin, the origin is now moving toward the insertion
simple machine types
change the magnitude or direction of a force
accessory motion - manipulation
high-velocity, low-amplitude (HVLA) thrust; moving the joint with high speed through a very slight and calculated range that is just past where the joint play ends
articular system pathologies - sprains
partial or complete tearing of ligament fibers
- mild sprain - tearing of a few fibers with no loss of function
- moderate sprain - partial tearing of the ligament with some loss of function
- severe sprain - the ligament is completely torn (ruptured) and no longer functions
CNS pathology - degenerative motor disease - Amyotrophic Lateral Sclerosis (ALS) / Lou Gehrig’s disease
both upper and lower motor neurons
joint types - synovial / diarthrodial joint - triaxial / multiaxial joint - ball-and-socket joint
motion occurs actively around all three axes; allows more motion than any other type of joint; around the frontal axis (flexion and extension), around the sagittal axis (abduction and adduction), and around the vertical axis (rotation)
body axes - vertical / longitudinal axis
runs through a joint from top to bottom
angle / line of pull
between the origin and insertion of a muscle will dictate its action
- know the muscle’s attachment points, the relative position of these attachments to one another, which point is more moveable, the side of the joint(s) that the muscle crosses, the available motions at the joint(s) it crosses, the angle at which it pulls, including whether it wraps around any bony prominences between its origin and insertion
- most have a diagonal line of pull - resultant force of a vertical force and a horizontal force
body axes - sagittal axis
point that runs through a joint from front to back
bone markings - depressions and openings
.
circulatory pathology - lymphedema
drainage patterns important; lymphatic tissue or nodes have been damaged, destroyed, or removed, lymph cannot drain normally from the involved area; abnormal drainage will result in an accumulation of excess lymph and swelling; commonly involves the arms or legs
joint types - synovial / diarthrodial joint
no direct union between the bone ends; allows free motion; not as stable as the other types of joints but does allow a great deal more motion; there is a cavity filled with synovial fluid contained within a sleevelike capsule; outer layer made up of a strong fibrous tissue that holds the joint together; inner layer is lined with a synovial membrane that secretes the synovial fluid; articular surface is very smooth and covered with cartilage called hyaline or articular cartilage
PNS pathology - Saturday Night palsy
radial nerve becomes compressed as it spirals around the mid-humerus; the person, often intoxicated, falls asleep with his or her arm over the back of a chair
CNS pathology - spinal cord trauma - incomplete spinal cord injury (SCI) - autonomic dysreflexia / hyperreflexia
potentially life-threatening complication associated with spinal cord injuries at or above T10; triggered by a noxious stimulus below the level of injury, such as a distended bladder
- symptoms: severe headache, sudden hyperten- sion, facial flush, sweating, and gooseflesh, dangerous BP levels, stroke or death
vertebral column pathology - flat back
abnormally decreased curve from the normal anterior-posterior curvature of the lumbar spine
muscle fiber arrangement - oblique type
shorter but are more numerous per given area; have a greater strength potential but a smaller range-of-motion potential; feather arrangement in which a muscle attaches at an oblique angle to its tendon, much like feather tendrils attach to the quill
PNS pathology - pope’s blessing / hand of benediction
Inability to flex the thumb and index and middle fingers (also median nerve injury)
length-tension relationship - stretching
muscle builds up passive tension, much like stretching a rubber band, and involves the non-contractile units of a muscle
circulatory pathology - congestive heart failure
condition in which the heart can’t pump strongly enough to push an adequate supply of blood out to the various parts of the body; as blood flowing from the heart slows, blood returning to the heart through the veins backs up, causing congestion in the body’s tissues; results in edema, especially in the feet, ankles, and lungs
osteokinematics - flexion
bending movement of one bone on another, bringing the two segments together and causing a decrease in the joint angle; between anterior surfaces of adjacent bones, causing the anterior surfaces to move toward each other.
circulatory pathology - arteriosclerosis - ischemia
a partial atherosclerosis blockage that occurs and slows blood flow in a coronary artery, which supplies blood to the heart muscle
- causes angina - chest pain
muscle pathology - strain
overstretching of muscle fibers and can happen with different degrees of severity
vertebral column pathology - unstable fractures / fractures with dislocation
usually result in spinal cord injury and paralysis
osteokinematics - palmar flexion
at wrist
vertebral column pathology - ankylosing spondylitis
chronic inflammation of the vertebral column and sacroiliac joints, leads to fusion; progressive rheumatic disease; over time, it can lead to a total loss of spinal mobility
circulatory pathology - varicose veins
vein loses elasticity, it will stretch, when vein enlarges, the valve flaps will no longer meet properly and blood that should be flowing toward the heart will flow backward
- occur as the blood pools in the vein, enlarging it even more; more common in superficial veins of the leg, because standing subjects them to higher pressure; deep veins surrounded by muscles that, as they contract, assist the veins in pumping the blood onward
respiratory pathology - pleurisy
quiet, painful condition caused by inflammation of the pleura
force types - angular / movement
angle of pull is at 90 degrees, perpendicular distance between the joint axis and center the line of pull is much larger; force of joint generated by the muscle; most of the force generated by the muscle is directed at rotating, not stabilizing the joint
circulatory pathology - hemorrhage / bleeding - cerebral / stroke
serious because it occurs within the confines of the bony skull; nowhere for the blood to go
- can put pressure on vital structures within the brain, causing a stroke or even death
muscle fiber arrangement - parallel type - strap
long and thin with fibers running the entire length of the muscle
length-tension relationship - tension
refers to the force built up within a muscle
accessory motion
- motions that occur during active motion
- motions that occur during passive motion.
neither under voluntary control, but both are necessary for normal functional motion to occur
osteokinematics - retraction
a linear movement in the same plane but toward the posterior midline
skeletal system pathologies - Legg-Calvé-Perthes disease
epiphysis of a growing bone is not firmly attached to the diaphysis, can slip or become misshapen
- proximal head of the femur; when blood supply is interrupted to the femoral head, causing necrosis of the bone, at the pressure epiphysis in growing children
skeletal system pathologies - slipped capital femoral epiphysis
head of the femur becomes displaced due to a separation at the growth plate
joint types
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osteokinematics - lateral bending / flexion
neck or trunk moves sideways; the right or the left
force types - gravitational
directed vertically downward, toward the center of the earth
skeletal system pathologies - osteomyelitis
infection of the bone usually caused by bacteria; fracture that breaks through the skin (open fracture) poses a greater risk of developing osteomyelitis than a fracture that does not break the skin (closed fracture)
joint types - fibrous joint - syndesmosis / ligamentous joint
lot of fibrous tissue, such as ligaments and interosseous membranes, holding the joint together; small amount of twisting or stretching movement can occur in this type of joint
simple machine types - lever - 3rd class
force in the middle, with resistance and the axis at the opposite ends; RA doesn’t change, but the FA does; any gain in distance is lost in power; advantage is speed and distance; most common lever in the body; advantage gained from increased speed and distance is more important than the advantage gained from increased power
force couple
two or more forces act in different directions, resulting in a turning effect; pushing in different directions and cause continued movement
simple machine types - inclined plane
a flat surface that slants; exchanges increased distance for less effort
- longer the length of a wheelchair ramp, the greater the distance the wheel- chair must travel; requires less effort to propel the chair up the ramp because the ramp’s incline is less
