Exam 2 Flashcards
what joints make up the shoulder complex?
- sternoclavicular
- acromioclavicular
- glenohumeral
- scapulothoracic
what type of joint is the sternoclavicular
saddle joint
what does the sternoclavicular joint look like at rest?
joint space is wedge shaped and open superiorly
what does the sternoclavicular disc do?
- creates two joint spaces
- increases joint congruency
- absorbs forces
- helps limit medial movement of clavicle
osteokinematics of sternoclavicular joint
- elevation/depression
- protraction/retraction
- anterior/posterior rotation
in elevation/depression the SC joint moves….
convex on concave
elevation of SC joint is
superior roll, inferior glide
depression of SC joint is
inferior roll, superior glide
in protraction/retraction the SC joint moves….
concave on convex
protraction of SC joint is..
anterior roll and glide
retraction of SC joint is
posterior roll and glide
arthrokinematics of posterior rotation of SC joint
the inferior surface turns anteriorly
- also called backward rotation
arthrokinematics of anterior rotation of SC joint
inferior surface returns to inferior position
closed pack position of SC joint
full posterior rotation
what type of joint is the acromioclavicular joint
plane synovial
what is the primary function of the AC joint
to allow the scapula to rotate during arm movement
what are the osteokinematics of the AC joint
- internal/external rotation
- anterior/posteror tilting (tipping)
- upward/downward rotation
what is the plane of the scapula
35 degrees off of the frontal
what does internal/external rotation of the AC joint help with?
helps to maintain contact of scapula on curved thorax during protraction and retraction of clavicle
what does anterior/posterior tilting of the AC joint help with?
helps to maintain contact of scapula on curved thorax during elevation and depression of clavicle
upward rotation of AC joint is associated with..
scapula swings upwardly and outwardly
- component of abduction and flexion
what is the closed pack position of the AC joint
full upward rotation (in flexion or abduction)
what are the primary movements of the scapulothoracic joint
- elevation/depression
- protraction/retraction
- upward/downward rotation
what are the secondary movements of the scapulothoracic joint
- anterior/posterior tilting
2. internal/external rotation
what is the combined motion of elevation of the scapulothoracic joint?
combined motion of SC joint elevation and AC joint downward rotation
- shoulder shrug
what is protraction of the scapulothoracic joint
combination of SC joint protraction and slight AC joint IR
what is upward rotation of the scapulothoracic joint
summation of SC joint elevation and AC joint upward rotation
- observed during flexion/abduction
what is the GH angle of inclination
130-150 degrees in frontal plane
what is angle of torsion for GH joint
30 degrees posterior in transverse plane
retroversion of GH
- same as angle of torsion
- posterior orientation of humeral head with regards to condyles
increased humeral retroversion is associated with…
increased ER ROM and reduced IR ROM
glenoid labrum
enhances concavity and increases articular surface
- attachment for GH ligaments and tendon of biceps long head
GH joint capsule
- inf portion is slack in adducted position creating an axillary pouch
tightness in posterior shoulder capsule would result in…
increased anterior humeral head translation which will decrease the subacromial space
what are the ligaments of the GH joint
- superior
- middle
- inferior GH lig
- coracohumeral lig
what does the superior GH ligament do
limits ER and anterior and inferior translation at 0 degrees of abduction
- slackens when abducted beyond 35-45 degrees
what does the middle GH ligament do
limits anterior translation from 45-90 degree abduction and extremes of external rotation
what does the inferior GH ligament do
primary stabilizer beyond 45 degrees of abduction or with combined abduction and rotation
what are the components of the inferior GH ligament
- anterior band
- posterior band
- axilarry pouch
what does the coracohumeral ligament do
limits inferior translation and ER of humeral head with the arm in dependent position
what 2 areas foes the rotator cuff not reinforce
- inferiorly
2. region between subs cap and supraspinatus
arthrokinematics of GH flexion
superior roll, inferior glide
arthrokinematics of GH extension
inferior roll, superior glide
arthrokinematics of GH adduction
inferior roll, superior glide
arthrokinematics of GH abduction
superior roll, inferior glide
arthrokinematics of GH ER
posterior roll, anterior glide
arthrokinematics of GH IR
anterior roll, posterior glide
closed pack position of GH
90 degrees abducted and full ER or full abduction and ER
capsular pattern of GH
external rotation > abduction > IR
what is scapulohumeral rhythm
ratio of 2 degrees of GH to 1 degree of scapular motion
when the rhomboids and lower trap act together…
results in pure retraction
what is the force couple for upward rotation?
serrates anterior
upper trap
lower trap
what are the aspects of the joint capsule of the elbow complex
- weak anteriorly and posteriorly
- fat pads are located between the capsule
what is the carrying angle
medial portion of the trochlea projects more distally than the lateral portion
- combo of shoulder ER, elbow extension and forearm supination
- angle varies from 8-15 degrees
what does the lateral collateral ligament do
stabilizes agents varus torque and combined varus and supination torques
arthrokinematics of elbow flexion
roll anterior, slide anterior
arthrokinematics of elbow extension
roll posterior, slide posterior
closed pack humeroulnar
full extension and supination
closed pack humeroradial
90 degrees elbow flexion and 5 degree supination
open pack humeroulnar
flexed 70, supinated 10
open pack humeroradial
full extension and supination
elbow capsular pattern
flexion > extension
in a closed pack position moving into pronation requires what..`
requires ER of the humerus and ulna
what is the closed pack position of the proximal radioulnar joint
5 deg of supination
what is the open pack position of the proximal radioulnar joint
70 deg of flexion, 35 deg of supination
capsular pattern of proximal radioulnar joint
supination = pronation
closed pack position of distal radioulnar joint
5 deg of supination
open pack position of distal radioulnar joint
10 deg of supination
capsular pattern of distal radioulnar joint
supination = pronation
what is the law of parsimony
nervous system tends to activate the fewest muscles or muscle fibers possible for the control of a given joint action
what is the goal of the law of parsimony?
energy efficiency
what joints make up the wrist/hand
- distal radioulnar
- radiocarplal, midcarpal
- carpometacarpal
- metacarpal
- interphalangeal
what is the wrist joint
condyloid
how many tendons go through the carpal tunnel
9
arthrokinematics of wrist flexion
anterior roll, posterior glide
arthrokinematics of wrist extension
posterior roll, anterior glide
arthrokinematics of wrist radial deviation
lateral roll, medial glide
arthrokinematics of ulnar deviation
medial roll, lateral glide
closed pack position of the wrist
full extension w radial deviation
open pack position of the wrist
neutral flexion/extension with slight ulnar deviation
capsular pattern
flexion = extension, slight radial and ulnar deviation
at what position is max grip?
30 degrees of extension
which wrist flexor is the strongest?
flexor carpi ulnaris
where is peak wrist flexion torque
40 degrees of wrist flexion
what is active wrist extension typically coupled with?
active radial deviation
what do the ulnar and radial collateral ligaments do?
stabilize the thumb
what are the arthrokinematics of thumb abduction
anterior roll, posterior glide
what are the arthrokinematics of thumb adduction
posterior roll, anterior glide
what is moving on what in thumb abduction/adduction
convex articular surface of thumb metacarpal moving on concave trapezium
what is moving on what in thumb flexion/extension
concave surface of metacarpal moving on convex diameter of trapezium
what is moving on what in thumb flexion
medial roll and glide
what is moving on what in thumb extension
lateral roll and glide
what makes up thumb opposition
abduction, flexion, IR
what is moving on what in thumb reposition
adduction, extension, ER
what is the closed pack position of the 1st CMC joint
full opposition
what is the open pack position of the 1st CMC joint
mid flexion/extension and mid abduction/adduction
what is the closed pack position of the 2nd-5th CMC joint
full flexion
what is the open pack position of the 2nd - 5th CMC joints
mid flexion/extension
what is the capsular pattern of 1st CMC joint
abduction
what type of joint are the metacarpophalangeal joints
condyloid
what are the arthrokinematics of MCP flexion
anterior roll and glide
what are the arthrokinematics of MCP extension
posterior roll and glide
what are the arthrokinematics of MCP abduction
roll and glide away from 3rd digit
what are the arthrokinematics of MCP adduction
roll and glide toward 3rd digit
what is the closed pack position of the MCP
full flexion
what is the open pack position of the MCP
slight flexion
what is the capsular pattern pattern
flexion = extension
what are the arthrokinematics of IP flexion
roll palmar, slide palmar
what are the arthrokinematics of IP extension
roll dorsal, slide dorsal
what is the closed pack position of the IP joints
full extension
what is the open pack position of the IP joints
slight flexion
what is the capsular pattern of the IP joints
flexion = extension
what is the most prominent feature of the extensor mechanism
dorsal hood
how is the neck of the femur angulated?
so it faces medially, superiorly, and anteriorly with respect to femoral shaft and distal femoral condyles
what is the normal range for the angle of inclination
110 to 144
most about 125
what is the angle of inclination
between axis through femoral head/neck and longitudinal axis of femoral shaft
define coxa valga
> 125 degrees of angle of inclincation
define coxa vara
< 125 degrees of angle of inclination
what is the goal of the angle of inclination?
serves to optimize joint surface alignment
slipped capital femoral epiphysis (SCFE)
coxa vara + high BMI
what is the angle of torsion
between axis through femoral head/neck and the distal femoral condyles
what plane does the angle of torsion occur in
transverse plane
angle of torsion norms
8-20
15 deg is optimal
excessive anteversion of hip
increased angle of torsion
- associated with increased hip IR and decreased ER
- typically associated with coxa valga
- instability
retroversion of hip
decreased angle of torsion
- associated with increased hip ER and decreased IR
- may cause impingement
what is the center edge angle
measurement of acetabular depth
what is anteversion of the hip
extent to which acetabulum faces anteriorly
what is a Cam deformity
extra bone at anterior-superior region of femoral head and neck
- impingement
(maximized impingement with IR and flexion)
what is a Pincer deformity
abnormal bony extension of anterior-lateral rim of acetabulum
what is the hip’s position of maximal congruency in a non-weight bearing position
flexion, abduction, slight ER
in the bending moment of the hip
superiorly _____ force
inferiorly _____ force
superiorly: tensile force
inferiorly: compressive force
where is the hip capsule thick versus thin
thickened anterosuperiorly
thin posteroinferiorly
iliofemoral ligament
provides anterior stability
- Controls internal and external rotation
pubofemoral ligament
controls external rotation in extension
ischiofemoral ligament
primary restraint to internal rotation
- All tighten with hyperextension
transverse acetabular ligament
part of the labrum, no cartilage cells, protects blood vessels
acetabular labrum
wedge shaped, deepens concavity. Acts to seal maintain negative intra-articular pressure
ligamentum teres
Conduit for blood supply to the femoral head, excessive ER can strain/potentially tear
arthrokinematics OKC of hip flexion
superior roll and inferior glide
arthrokinematics OKC of hip extension
inferior roll and superior glide
arthrokinematics OKC of hip abduction
superior roll and inferior glide
arthrokinematics OKC of hip adduction
inferior roll and superior glide
arthrokinematics OKC of hip IR
medial roll and lateral glide
arthrokinematics OKC of hip ER
lateral roll, medial glide
arthrokinematics CKC anterior tilt
anterior roll and slide
arthrokinematics CKC posterior tilt
posterior roll and slide
in bilateral stance the pelvis can only…
drop
arthrokinematics CKC hip abduction
superior roll and slide
arthrokinematics CKC hip adduction
inferior roll and slide
what plane does forward/backward rotation occur in
transverse
arthrokinematics CKC hip forward rotation
anterior roll and slide
arthrokinematics CKC hip backward rotation
posterior roll and slide
what is the closed pack position of the hip
full extension with slight IR and abduction
what is the open pack position of the hip
moderate flexion, slight abduction, neutral rotation
what is the capsular pattern of the hip?
IR = flexion = abduction
what works together to produce anterior pelvic tilt (pelvic on femoral flexion)
hip flexors and low back extensors
what works together to produce posterior pelvic tilt (pelvic on femoral extension)
hip extensors and abdominal muscles
in the sagittal plane, hip adductor longus does…
when hip flexed, will contribute to extension
when hip extended, will contribute to flexion
what is trendelenburg sign
visualized weakness of glute medius in single leg stance
what is genu valgum
less than 165 deg
“knock knees
what is genu varum
greater than 180 deg
“bow legged”
what is the q-angle
line connecting ASIS to middle of patella and line connecting tibial tuberosity to middle of patella
what is the normal q-angle
13-15 deg
what are the functions of the meniscus
o Distribute weight bearing forces
o Increase joint congruence
o Shock absorption
what connects to the medial meniscus
MCL, ACL, PCL, semimembranosus
what connects to the lateral meniscus
ACL, PCL, popliteus
what is the MOI for meniscus
axial rotation of condyles over flexed and weight-bearing knee
what is the function of menisci
increases contact area and reduces joint stress
ACL function
primary restraint to anterior translation of tibia on femur
PCL function
resists posterior translation of tibia on femur
MCL function
resists valgus forces and lateral tibia rotation
LCL function
resists varus stresses
iliotibial tract function
assists ACL in resisting anterior translation of tibia on femur
what are the arthorokinematics of the knee in OKC flexion
posterior roll and glide
what are the arthorokinematics of the knee in OKC extension
anterior roll and glide
what are the arthorokinematics of the knee in CKC flexion
posterior roll, anterior glide
what are the arthorokinematics of the knee in CKC extension
anterior roll, posterior glide
what is the screw home mechanism
need 10 deg ER with terminal extension (valgus)
the knee must unlock with popliteus prior to preforming flexion (varus)
what is the closed pack position of the tibiofemoral joint
full extension
what is the open pack position of the tibiofemoral
25 deg of flexion
what is the capsular pattern of the tibiofemoral joint
flexion»_space; extension
what is patellofemoral pain syndrome
abnormal tracking of patella
what is the function of the patella
acts as a spacer between the femur and quad
what is the talocrural joint
distal tibia fib + talus
what is the subtalar joint
talocalcaneal joint
what makes up the transverse tarsal joint
talonavicular and calcaneocuboid
what makes up the hindfoot
- talus
2. calcaneus
what makes up the midfoot
- navicular
- cuboid
- 3 cuneiform bones
what makes up the forefoot
- metatarsals
2. phalanges
what type of joint is the proximal tibiofibular joint
plane synovial
what type of joint is the distal tibiofibular joint
synarthrosis
what is the closed pack position of the tibiofibular joint
weight bearing dorsiflexion
- point of greatest ligamentous tension
what motions go along with foot/ankle pronation
- eversion
- abduction
- dorsiflexion
what motions go along with foot/ankle supination
- inversion
- adduction
- plantar flexion
what type of joint is the talocrual joint
hinge
function of the medial collateral (deltoid) ligament
helps to limit eversion/pronation
- Very strong
function of the lateral collateral ligament
helps to limit inversion/supination
- Weaker and more susceptible to injury
what is the main motion of the talcrual joint
dorsi and plantar flexion
what are the arthokinematics of talocrural dorsiflexion
anterior roll, posterior glide
what are the arthokinematics of talocrural plantarflexion
posterior roll, anterior slide
what is the closed pack position of the talocrural joint
weight bearing dorsiflexion
what is the open pack position of the talocrural joint
10 deg of plantarflexion with neutral inversion/eversion
what is the capsular pattern of the talocrural joint
plantarflexion > dorsiflexion
what type of joint is the subtalar joint
three ovoid synovial joint
what are the main motions of the subtalar joint
inversion/eversion
adduction/abduction
supination of foot in weight bearing motions
calcaneous inverts
talus abductions and dorsiflexes
pronation of foot in weight bearing
calcaneous everts
talus adducts and plantarflexes
supination of foot in non-weight bearing
calcaneous inverts, adducts, plantarflexes
pronation of foot in non-weight bearing
cancaneous everts, abducts, dorsiflexes
what is the closed pack position of the subtalar joint
full inversion
what is the open pack position of the subtalar joint
mid inversion/eversion and mid plantarflexion/dorsiflexion
what type of joint is the transverse tarsal joint
modified ovid
what is the function of the transverse tarsal joint in open chain
add to the subtalar range
what is the function of the transverse tarsal joint in closed chain
compensate at the forefoot for hind foot pronation
what is the closed pack position of the transverse tarsal joint
supination
what is the open pack position of the transverse tarsal joint
mid range of supination/pronation
what is the capsular pattern of the transverse tarsal joint
limitations in dorsiflexion, plantarflexion, adduction and IR
what is the main function of the transverse tarsal joint
functions to regulate position of the forefoot in relation to the weight-bearing surface
- the tarsometatarsal joint will add to this with end-range subtalar motion
what is the supination twist
pronation in the hind foot results in supination of the transverse tarsal joint
- if this is not enough the entire foot will supinate
what is pronation twise
full subtalar supination results in supination of transverse tarsals as well
the forefoot must pronate in order to maintain contact with the ground
what is hallux limitus
posttraumatic condition, gradual and significant limitation of motion, articular degeneration and pain
- Most commonly happens with forceful hyperextension
- Big toe really can’t extend, basically fused
what is hallux valgus
progressive lateral deviation of great toe (bunion deformity)
- Can lead to lateral dislocation
what is the main role of the plantar fascia?
o Supports the medial longitudinal arch in weight bearing
what is the windlass effect
o When PF occurs, contraction lifts calcaneous, body weight is transferred over metatarsal heads, causes extension of metatarsophalangeal joints, winding up of plantar fascia supporting medial, longitudinal arch
o Strengthens the midfoot
what is pes planus
abnormally dropped medial longitudinal arch
what are the implications of pes planus
- This compromises ability to support and dissipate loads
- Requires significant work from extrinsic and intrinsic muscles that may lead to fatigue and overuse symptoms
what is the navicular drop test
o Measurement of distance between navicular tuberosity and ground in subtalar joint neutral and with relaxed foot posture
- 7 mm is normal
what role does the posterior tibialis muscle play in stance phase of ambulation?
o Decelerates pronating foot in loading response
o Results in gradual and controlled lowering of medial longitudinal arch
o Supinates rearfoot in mid to late stance to provide a stable foot for toe of
sensory perturbation
may be caused by altering visual input
mechanical perturbation
displacement causing changes in the relationship of body’s CoM to BoS
what are fixed support synergies
central organized patterns of muscle activity that occur in response to perturbations of standing postures
what are ankle synergies
discrete burts of muscle activity that occur in a distal-to-proximal pattern
what are hip synergies
discrete bursts of muscle activity that occur proximally-to-distally
define postural sway
constant swaying motion due to inertial and gravitational forces
define ground reaction force
force of the ground pushing back on the body in standing
what does GRF represent
represents magnitude and direction of loading applied to 1 or both feet
define line of gravity
line extending from center of gravity to BoS
define center of pressure
point of application of the GRFV
- located between the feet in bilateral stance
large deviations of ideal standing posture will result in..
- excessive strain on passive structures
2. increased muscular activity
long term deviations of ideal standing posture will result in..
structural changes
ideal standing posture is ______ to the external auditory meatus
through
ideal standing posture is ______ to the shoulder
through
ideal standing posture is ______ to the center of the hip joint
slightly posterior
ideal standing posture is ______ to the axis of the knee joint
slightly anterior
ideal standing posture is ______ to the lateral malleolus
slightly anterior
the LoG creates what kind of external moment arm at the ankle
dorsiflexion
the LoG creates what kind of internal moment arm at the ankle
plantarflexion
to maintain ideal posture, what contracts at the ankle
active contraction of soles with contributions from gastrocnemius
(concentric)
- no passive structures
the LoG creates what kind of external moment arm at the knee
extension
the LoG creates what kind of internal moment arm at the knee
flexion
to maintain ideal posture, what contracts at the knee
active contraction of hamstrings and gastrocnemius
- some passive tension from capsule and ligaments
the LoG creates what kind of external moment arm at the hip
extension
the LoG creates what kind of internal moment arm at the hip
flexion
to maintain ideal posture, what contracts at the hip
iliopsoas
- passive tension from ligaments of hip
the LoG creates what kind of external moment arm at the head and neck
flexion of cervical spine
the LoG creates what kind of internal moment arm at the head and neck
extension of cervical spine
to maintain ideal posture, what contracts at the head and neck
passive tension from ligaments and facet joint capsules
- active contraction of cervical extensors
how much out toeing is normal?
8-10 deg
where is the plumb line aligned in side view
anterior to lateral malleolus
what is handedness posture
- dominant shoulder lower
- pelvis shifts to dominant side
- dominant hip higher
- non dom foot more pronated
- spine deviation to non-dom side
excessive anterior pelvic tilt creates what type of moment?
increased extension moment
in forward head posture where is LoG
anterior to cervical joint axes
what does forward head posture result in?
- flexion moment
- constant isometric muscle tension to support head
what is present during pet planus
increase calcanea eversion
how are scoliosis diagnosis named?
according to direction of convexity and location of the curve
excessive genu valgum compresses what?
lateral compression and medial tension/distraction
excessive genu varum compresses what?
medial compression and lateral tension/distraction
