EXAM #2 Flashcards
The act of moving from one
place to the other
Locomotion
The manner of walking
Gait
A smooth, highly coordinated, rhythmical, undulating, reciprocal movement by which the body moves step by step in the required direction at the necessary speed
Walking
The period of time from one event (usually initial contact) of one foot to following occurrence of the same event with the ipsilateral foot
Gait cycle
Described as the period from the initial contact of a particular limb to the point of initial contact of the SAME limb and is equivalent to one gait cycle
stride
Described as the period from initial contact of one limb to the initial contact of the contralateral limb
Step
Normal Gait:
There are _ _ in each stride (or gait cycle)
two steps
Normal gait:
The period of time when the foot is in contact with the ground
stance phase (ST)
Normal gait:
The period of time when the foot is not in contact with the ground
swing phase (SW)
Normal gait:
The period of time when both feet are in contact with the ground
- This occurs twice in the gait cycle, at the beginning and end of the stance phase
Double support (DS)
Normal gait:
The period of time when only one foot is in contact with the ground
- In walking, this is equal to the swing phase of the other limb
single support (SS)
The point in the gait cycle when the foot initially makes contact with the ground
- Represents the beginning of the stance phase
Initial contact (IC)
The point in the gait cycle when the foot leaves the ground
- This represents the end of the stance phase or
beginning of the swing phase
- Also referred to as foot-off
Terminal contact (TC)
Normal gait:
When terminal contact is made with the toe
toe-off (TO)
Normal gait:
The point in time in the stance phase when the full foot is in contact with the ground
Foot flat (FF)
Normal gait:
The point in the stance phase when the heel leaves the ground
Heel off (HO)
Gait:
The distance from a point of contact with the ground of one foot to the following occurrence of the same point of contact with the other foot
- Expressed in meters (m)
Step length
Gait:
Is the period of time taken for one step and is measured from an event of one foot to the following occurrence of the same event with the other foot
- Expressed in seconds (s)
Step period
Gait:
The distance from initial contact of one foot to the following initial contact of the same foot
- Sometimes referred to as cycle length
- Expressed in meters (m
Stride length
Gait:
The period of time from initial contact of one foot to the following initial contact of the same foot
- Expressed in seconds (s)
Stride period or cycle time
Gait:
The rate of change of linear displacement along the direction of progression measured over one or more strides
- Expressed in meters per second (m/s)
Velocity
Gait:
Rate at which a person walks, expressed in steps per minute
Cadence
Gait:
The ratio of the stance period to the swing period
60% stance / 40% swing
Gait:
Controlled by the _ _ _ (postural reflex activity)
central nervous system
Gait:
Major afferent stimuli is provided by:
- Tactile impulses from the sole of the foot
- Proprioceptive impulses (from the lower limb,
trunk, and neck)
In normal walking: Approximately _ steps
are taken per minute
50-60
Phases of gait:
- The “weight-bearing” phase
- Provides the stability of the gait
- Necessary for accurate swing phase to take
place
Stance phase
Includes: 5 Stages of Gait Cycle
- Initial contact
- Loading response
- Mid-stance
- Terminal Stance
- Pre-Swing
Gait - Stance phase:
- First position of “double support”
- The _ _ of the leading stance foot and the toes of the other foot are both on the ground
Initial Contact
Gait - Stance phase:
- Weight transferred onto the outstretched limb
- The first period of double support
Loading Response
Gait - Stance phase:
- Defined as the time the opposite limb leaves the floor until the body weight is aligned over the forefoot
- Body progresses over a single, stable limb
Mid-Stance
Gait - Stance phase:
- The heel is raised as the body moves forward over the stance limb
- The body moves ahead of the limb
Terminal Stance
Gait - Stance phase:
- The second (and final) double support period
- Defined from the time of initial contact of
the contralateral limb to ipsilateral toe-off
- Unloading of the limb occurs as weight is transferred to the contralateral limb
Pre-Swing
Initial contact
Loading response
Mid-stance
Terminal stance
Pre-swing
Gait:
- Defined as the non-weight-bearing phase of
the reference limb
- Begins as soon as the foot of reference limb
leaves the ground (after foot-off), and finishes
just prior to initial contact of the same limb
Swing phase
Gait- Swing phase:
Begins once the foot of the swing limb leaves
the ground until the point at which the swing
limb is directly under the body or at maximum
knee flexion
Initial swing
Gait- Swing phase:
Begins from maximum knee flexion (when the
swing limb is under the body) until the swing
limb passes the stance limb and the tibia is in
a vertical position
Mid-swing
Gait - Swing phase:
From the point at which the tibia is in a
vertical position to the point just prior to
initial contact
- The momentum slows down as the limb
moves into the stance phase again
Terminal swing
Initial swing
Mid-swing
Terminal swing
Normal gait - joint position:
Initial contact
- Ankle
Neutral
- neither dorsiflexed nor plantar flexed
Normal gait - joint position:
Initial contact
- knee
Flexed
- Slight flexion helps absorb the impact of the foot contacting the ground
- Weight of body behind the knee
Normal gait - joint position:
Initial contact
- HIp
Flexed
- Lengthens limb in preparation for contact between heel and ground
- Helps provide for proper placement of foot so that the heel makes contact with the ground
Normal gait - joint position:
Mid-stance
- Ankle
dorsiflexed
Normal gait - joint position:
Mid-stance
- Knee
Extended
- Lengthens limb to help support weight of torso which is now directly over limb
Normal gait - joint position:
Mid-stance
- Hip
neutral
Normal gait - joint position:
Terminal stance
- Ankle
Plantar flexed
- Calf muscles begin to contract strongly bringing the ankle joint into a plantar flexed position
Normal gait - joint position:
Terminal stance
- Knee
Flexed
- Shortens limb to allow clearance from ground
Normal gait - joint position:
Terminal stance
- HIp
Extended
- Torso on the opposite side has moved forward of reference limb
Normal gait - joint position:
Swing phase
- Ankle
neutral
Normal gait - joint position:
Swing phase
- Knee
Flexed/extended
- shorten limb to maintain foot off of the ground
- Extend knee in preparation for initial contact
Normal gait - joint position:
Swing phase
- Hip
Flexed
- Limb catches up to and then passes the torso
Normal gait - Muscle action:
Ankle:
- Tibialis anterior and toe extensors (pre-tibial muscles) maintain foot position in preparation for loading response
Knee:
- Quadriceps contract to prepare for loading response
Hip:
- All hip extensors are active in preparation for their role in stabilizing the thigh during loading response
Initial contact
Normal gait - Muscle action:
Tibialis anterior muscles
swing phase
Normal gait - Muscle action:
Ankle:
- Plantar flexion torque quickly forces the foot to the floor
Knee:
- Eccentric quadriceps activity peaks to meet torque demands and to absorb shock
Hip:
- Extensor muscles fire to counteract flexion torque
- All gluteus muscles fire to stabilize pelvis in frontal plane
Loading response
Normal gait - Muscle action:
Gastrocnemius/soleus complex
stance phase
Normal gait - Muscle action:
Ankle:
- The soleus and gastrocnemius are active to control forward progression of the tibia
Knee:
- Quadriceps activity provides dynamic stability
- Calves act to restrain tibia, allowing femur to advance faster than tibia
Hip:
- Pelvis stabilized in frontal plane by hip abductors
Mid-stance
Normal gait - Muscle action:
Hamstring muscles
swing phase
Normal gait - Muscle action:
Ankle:
- Calf muscle activity peaks to prevent forward tibia collapse and allow the heel to rise
Knee:
- Restraint of the tibia by the calf muscles continue to stabilize the knee
Hip:
- TFL becomes active, possibly to restrain hyperextension of the hip (highly variable)
Terminal stance
Normal gait - Muscle action:
Gluteus medius
Stance phase
Normal gait - Muscle action:
Ankle:
- Residual plantar flexor activity and passive tension contributes to ankle moving into plantarflexion
Knee:
- Motion occurs with only minimal knee flexor activity from the gracilis
Hip:
- Adductor longus activity dynamically contributes to the femur flexing forward
Pre-swing
Normal gait - Muscle action:
Hip flexors
stance phase & swing phase
Normal gait - Muscle action:
Ankle:
- Pretibial muscles are active in preparation for ankle dorsiflexion
Knee:
- Activity peaks for biceps femoris short head, sartorius and gracilis (knee flexion)
- Knee flexion is aided by hip flexion
Hip:
- Iliacus, gracilis, and sartorius peak in activity (hip flexion)
Initial swing
Normal gait - Muscle action:
Quadriceps muscles
Stance phase & swing phase
Normal gait - Muscle action:
Ankle:
- Pretibial muscles are active
Knee:
- Knee extension is created by momentum and gravity
- Hamstrings become active in late mid-swing
Hip:
- Hamstrings initiate activity in late mid-swing
Mid-swing
Normal gait - Muscle action:
Ankle:
- The pretibial muscles are active
Knee:
- Quadriceps are active concentrically to ensure full knee extension
- Hamstring activity peaks in function to decelerate the thigh
Hip:
- Hamstrings peak in activity as they function to decelerate leg
- Gluteus muscles and TFL become active in preparation for role in weight acceptance
Terminal swing
Major Pathological Gait Defects
- Variance from the normal smooth locomotory function of gait can be associated with a deformity in:
- Osseous (developmental, congenital)
- Neurological (sensory, motor)
- Muscular soft tissue (laxity, fibrosis)
- Functional (lack of coordination, neuromuscular)
This is a characteristic gait of a spastic child
with marked bilateral adductor spasm at the
hips and equinus spasm in the ankle
scissoring gait
Also called “Festinating Gait”
- Gait is characterized by increase in cadence,
shortened stride, lack of heel strike and toe
off, as well as diminished arm swinging
Parkinson’s Gait
An interference on coordinating functions of
the cerebella, so the person tends to walk
with a wide base of gait with an unsteady
irregular gait, even if watching feet
Cerebellar gait
Spinal - proprioceptive pathways of the spine or
brainstem are interrupted
- Loss of position and motion sense
- Ambulates with a wide base of gait with foot slap at heel contact
- Often watch feet as they walk
Ataxic Gait
Pathological Gait:
Hip extensor weakness
- The individual will throw the hip backward
with a “lurch” using abdominal and paraspinal
muscle activation just after heel strike on the
affected side
- Also seen in dislocated hip and muscular
dystrophy
Gluteus Maximus Lurch
Pathological Gait:
Gluteus medius weakness
- Drop of the pelvis more than the usual 5°on the unaffected side beginning with initial contact on the affected side and continuing until initial contact on the unaffected side
- Lateral excursion occurs on the affected side
- May compensate by laterally bending trunk to the affected side
Trendelenburg Gait
Pathological Gait:
Most apparent during initial contact through the stance phase of gait
- The affected knee must be locked in
hyperextension at or preceding initial contact by compensatory activity of the gluteus maximus extending the femur and the soleus which extends the tibia
- Repetitive hyperextension of the knee results in stretching of the ligaments and capsule of the
knee and resultant recurvatum of the knee
during the stance phase
Quadriceps weakness
Pathological Gait:
- Results in loss of ankle plantarflexion control
- Foot-off will be delayed and the push-off
phase will be decreased
Gastrocnemius weakness
Pathological Gait:
Ankle dorsiflexion weakness
- With mild weakness, the gait abnormality will
be noted at heel-strike and results in loss of
plantarflexion control
- Loss of dorsiflexion produces a high knee lift
to raise the foot clear of the ground
“Drop Foot,” “Slap Foot” or “Steppage
Gait”
Pathological Gait:
- Person tries to avoid pain associated with
weight-bearing and ambulation
- Often quick, short, and soft foot steps
Antalgic gait
To go quickly by moving the legs more rapidly than at a walk and in such a manner that for an instant in each step all or both feet are off the ground
Running
Running vs. walking
Running requires:
- more balance
- more muscle strength
- more force absorption
- more ROM
- more energy/burns more calories
Running cycle swing to stance phase ratio
30% stance / 70% swing
Running: stance phase
- foot strike
- Midstance/midsupport
- take off
Running: stance phase
- follow through
- forward swing
- double swing/float
- foot descend
Running cycle:
- stride and step length _
- frequency of steps _
- increases
- increases
Running cycle:
As speed increases, stance time _ and swing time _
- decreases
- increases
Cadence = frequency of steps
walking: _ steps per minute
50-60
Cadence = frequency of steps
running: _ steps per minute
170-200
Running vs. walking: Base of support
walking: shoulder width
Running: narrow, both feet on one line
Running vs. walking:
- walking has double _
- Running has double _
- support
- swing (double “float”)
Walking vs. running:
Running requires more _
ROM
Walking vs. running: Range of motion
- Hip flexion walking at initial contact: _
- Hip flexion running at initial contact/foot strike: _
- 30 degrees
- 50 degrees
Walking vs. running: Range of motion
- Hip extension walking at push off: _
- Hip extension running as follow through: _
- 10 degrees
- 50 degrees
Walking vs. running: Range of motion
- Walking _ knee flexion at forward swing
- Running _ knee flexion at forward swing
- 60 degrees
- 125 degrees
Walking vs. running: Range of motion
- walking ankle dorsiflexion at midstance: _
- Running ankle dorsiflexion at midstance/mid support: _
- 10 degrees
- 30-40 degrees
Largest risk factor for running injuries
being female
_ lumbar vertebrae
_ of all the vertebrae
- 5
- largest
Lumbar Vertebrae: structure
- each vertebrae contains
- Body
- vertebral foramen
- Transverse process
- Spinous process
Lumbar Vertebrae: function
base of support
Lumbar Vertebrae: function
- Link between _
- protects _
- hip/pelvis and T-spine
- spinal cord
Lumbar Spine Joints
- intervertebral disc
- facet joints
Lumbar Spine Joints
Intervertebral disk make up _ of the height of the column and thickness varies from 3mm in _ region, 5mm in _ region to 9 mm in the _ region
- 20-30%
- cervical
- thoracic
- lumbar
Ratio between the vertebral body height
and the disk height will dictate the _ between the vertebra –
- Highest ratio in _ region allows for
motion
- Lowest ratio in _ region limits motion
- mobility
- cervical
- thoracic
Disc structure:
_ is located in the center except in lumbar lies slightly posterior
Nucleus Pulposus (NP)
Disc structure:
Hydration of the disc will also decrease with
_ _ - this loss of hydration decreases its mechanical function
compressive loading
Disc structure:
- 80-90% is H2O – decreases with age.
- Disc volume will reduce _ (reversible)
which causes a loss of 15-25 mm of height in the spinal column
- Acts as a hydrostatic unit allowing for uniform
distribution of pressure throughout the disc
20% daily
Spine joints:
- Articulation between the superior (concave) and inferior (convex) facets
- Guide intervertebral motion through their orientation in the transverse and frontal planes
Facet joint
Spine joints:
- Limit motions
- Resist both flexion and extension
- Resists rotation in lumbar region.
- Facet joints are synovial joints.
- Each joint is surrounded by a capsule of connective tissue and produces a fluid to nourish and lubricate the joint
- The joint surfaces are coated with cartilage allowing joints to move or glide smoothly against each other
Facet Joint Capsule
Lumbar Spine Ligaments (5)
- Anterior Longitudinal Ligament
- Posterior Longitudinal Ligament
- Ligamentum Flavum
- Supraspinous Ligament
- Interspinous Ligament
Lumbar spine ligament actions:
Anterior longitudinal ligament
- Resists lumbar extension
- Traverses entire anterior spinal column
Lumbar spine ligament actions:
Posterior Longitudinal Ligament
- Resists lumbar flexion
- Traverses entire spinal column
Lumbar spine ligament actions:
- Composed of mainly elastic fibers
- Yellow in color (flavum is Latin for yellow)
- It runs from an anterior-inferior surface
of a cranial lamina to the posterior-superior surface of the caudal lamina
Ligamentum Flavum
Lumbar spine ligament actions:
- Strong fibrous cord
- Connects together the apices of the
spinous processes
Supraspinous Ligament
Lumbar spine ligament actions:
- Connects spinous processes of adjacent
vertebrae
- Thin and membranous
Interspinous Ligament
3 layers of lumbar spine muscles
- superficial
- intermediate
- deep
3 layers of lumbar spine muscles fucntion
1. superficial
2. intermediate
3. deep
support
Lumbar spine muscles:
- superficial
- flexion to extension (bending over into an upright position)
erector spinae muscles
Lumbar spine muscles:
- support and stability
deep
Lumbar spine motion
- flexion/extension
- right and left lateral flexion
- rotation
Pathological Lumbar Curves:
- “Sway Back”
- Facilitated by high heels or lying on stomach
Hyperlodosis
Pathological Lumbar Curves:
- flat back
Hypolordosis
Many Different Treatments:
- No TX = Time
- Massage
- PT
- Acupuncture/Acupressure
- Chiropractic
- Surgery
- Low Back Pain Video
Lumbar pain
Best sleeping position
back sleeping - pillow under knees and neck
side sleeping - pillow between legs and under neck
Disc injuries
- lumbar disc herniation
- sciatica
- Degenerative disc disease
- Spondylolysis and Spondylolisthesis
- Scotty Dog Fracture
- Facet Joint Disease
- Lumbar Stenosis
Disc injuries:
- Anterior slippage of vertebrae
- Grades 1-4
- -lolysis = slippage with fracture of the pars
articularis (Scotty Dog Fracture)
- -listhesis = forward slippage may or may not
involve Scotty Dog Fracture
Spondylolysis and Spondylolisthesis
Disc injuries:
- Fracture of the pars articularis
- Occurs in spondylolysis
Scotty Dog Fracture
Disc injuries:
- caused by the cartilage in the joints being worn down as a result of wear and tear, aging, injury or misuse
Facet Joint Disease
Disc injuries:
- Definition = Narrowing
- Can be central (spinal canal) or lateral
Lumbar Stenosis
- Microdiscectomy
- Discectomy
- Laminectomy
- Fusion
- Artificial Disc Replacement
Lumbar Spine Surgeries
Lumbar Spine Surgeries:
- Non-invasive procedure involving replacing Discectomy (more invasive involving larger surgical incision)
Lumbar Microdiscectomy
Lumbar Spine Surgeries:
Laminectomy
Lumbar Spine Surgeries:
- Is an operation that causes the bones of the spine in the lower back to grow together
- The goal is to have the two vertebrae fuse (grow solidly together) so that there is no longer any motion between them
Lumbar Fusion
Lumbar Spine Surgeries:
- Emerging surgical procedure
- Replacing Lumbar Fusion
- Goal: Keep motion at that spinal segment
Artificial Disc Replacement
Composed of _ thoracic vertebra
12
12 pairs of ribs-all attaching posteriorly to thoracic vertebra
- _ true ribs (attach directly to the sternum)
- _ false ribs (3 attach to sternum via cartilage
and 2 are floating ribs(no sternal attachment)
- 7
- 5
Thoracic vertebra bones:
sternum
- Manubrium
- Body
- Xiphoid process
Spinal curves:
- Cervical – Lordosis (inward)
- Thoracic - _
- Lumbar- Lordosis (inward)
Kyphosis (outward)
Thoracic spine movements
- Flexion
- Extension
- Right and Left Rotation
- Right and Left Lateral Flexion
Thoracic joints:
- facet joints
- Costovertebral joints
Thoracic joints:
- articulations that connect the heads of the ribs with the bodies of the thoracic vertebrae
- Joining of ribs to the vertebrae occurs at
two places, the head and the tubercle of the
rib
Costovertebral joints
Thoracic ligaments
- Anterior longitudinal ligament
- Posterior longitudinal ligament
- Ligamentum flavum
- Interspinal ligament
- Supraspinal ligaments
Thoracic spine muscles:
Erector spinae muscle: extends on each side of the spinal column from pelvis to cranium
Divided into 3 muscles
- spinalis
- logissimus
- illocostalas
Thoracic spine muscles:
Aid in movement of spinal column
Abdominal muscles
Thoracic spine muscles:
abdominal muscles
- rectus abdominis
- internal/external oblique
- transverse abdominis
These muscles help aid in respiration
- Scalenes
- External intercostals
- Internal intercostals
- Diaphragm
- Levator costarum
- Subcostales
- Serratus anterior
- Serratus posterior
Muscles of the thorax - thoracic spine
Thoracic spine injuries:
The T-spine has a relatively low occurrence of
injuries due to increased _ from the ribs.
However some T-spine injuries include:
- Osteoporosis-causing excessive kyphosis
- Compression fractures
- Scoliosis
- Discogenic/disc bulge
- Rib fractures
stability
Thoracic spine injuries:
- Thinning of the bones that causes
them to become porous and fragile
- It affects women more than men, is
associated with aging, and progresses more
rapidly after menopause
- This disease is largely preventable and treatable
Osteoporosis causing excessive kyphosis
Thoracic spine injuries:
- MOI: Osteoporosis with or without trauma
- Signs and symptoms: pain and tenderness, decreased physical function, deformity
- Treatment for the vertebral fracture will
typically include non- surgical care, such as
rest, pain medication and slow return to
mobility
- Surgeries include:
- Vertebroplasty (bone cement is
injected into the fracture)
Compression fractures
Spine injuries:
- Describes an abnormal, side-to-side, curvature of the spine
- The spinal curve may develop as a single
curve (shaped like the letter C) or as two
curves (shaped like the letter S)
- known to be hereditary
scoliosis
Spine injuries:
- One shoulder is higher than the other
- One shoulder blade sticks out more than the other
- One side of the rib cage appears higher
than the other
- One hip appears higher or more prominent than the other
- The waist appears uneven
Scoliosis symptoms
Thoracic spine injuries:
- pain originating from a
damaged vertebral disc such as degenerative disc disease
- can usually be successfully treated with non-surgical treatments, such as pain medication and physical therapy and exercise, but chronic pain that is severe and limits the individual’s ability to function may need to be treated with surgery
Discogenic pain
Thoracic spine injuries:
Simple _ _ are the most common injury sustained following blunt chest trauma,
accounting for more than half of thoracic injuries from non-penetrating trauma
rib fractures
Thoracic spine injuries:
- Tenderness upon palpation, crepitus, and chest wall deformity
- Patients with rib fracture frequently complain of pain on inspiration and dyspnea.
- Swelling and bruising in the fracture area
- Severe local tenderness in the fracture area
- Internal bleeding
- Pain while breathing
signs and symptoms of a rib fracture
Thoracic spine injuries:
- Rest
- Protection
- Pain meds
- Physical therapy
- Breathing exercises
- Stretching
- Intercostal nerve blocks
- Epidural anesthesia
- Hospitalization
Rib fracture treatment
- Head
- vertebrae
- ribs
axial skeleton
- pelvis
- hips
- legs
- shoulders
- arms
appendicular skeleton
Cervical spine bones
- cranium
- vertebrae 1-7
- atlas
- axis
Cervical spine bones:
- Bones that protect the brain
- Mastoid process
- occipital bone
cranium
Cervical spine:
- _ bones called vertebrae
- Vertebrae 1 = _
- Vertebrae 2 = _
- Vertebrae 3-7 = normal
- 7
- atlas
- axis
Cervical spine Bones:
- 1st Cervical Vertebrae
- Supports the head
- Has no body
- Has no spinous process (has a posterior tubercle)
atlas
Cervical spine Bones:
- 2nd Cervical Vertebrae
- Rotation
- Has a dens, which is the body for the atlas
axis
Cervical spine movements
- Flexion
- Extension
- Rotation R, L
- Side Bending/Lateral Flexion R, L
- Protraction
- Retraction
- From the Spinal Cord
- Exit through the intervertebral foramen (canal) of the vertebrae
spinal nerves
Cervical spine nerves:
- Spinal Nerve exits neural (intervertebral)
foramen
Vertebral Neural Foramen
Cervical spine Joints:
- Facet Joint
- Intervertebral Disc
Cervical spine joints:
Movements:
- Flexion
- Extension
- Lateral (side) flexion
- “Yes” Joint
Atlanto-Occipital (A-O) Joint
Cervical spine joints:
Movements:
- Rotation
- Flexion
- Extension
- “No” joint
Atlanto-Axial (A-A) Joint
Cervical spine joints:
Movements:
- Flexion
- Extension
- Rotation
- Side flexion
Joints C3-C7
Spinal Segment includes:
- 2 vertebral bodies
- 1 intervertebral disc
Intervertebral Disc:
Outer _
- Tougher, rings
Inner _
- More fluid, higher water content
- Annulus Fibrosus
- Nucleus Pulposus
Cervical spine ligaments:
Limits extension of vertebral column
Anterior Longitudinal Ligament
Cervical spine ligaments:
Limits flexion at vertebral bodies
Posterior Longitudinal Ligament
Cervical spine ligaments:
Ligamentum Flavum limits _
flexion
Cervical spine ligaments:
Interspinous Ligament aids in limiting _
flexion
Cervical spine ligaments:
Supraspinous Ligament limits _ of vertebral column
flexion
Cervical spine muscles:
- Sternocleidomastoid
- Splenius Capitis
- Rectus Capitis
Cervical spine muscles:
- A: Both together = flexion
- R SCM = left rotation, right lateral flexion
- L SCM = right rotation, left lateral flexion
Sternocleidomastoid
Cervical spine muscles:
A: Extension, Same Side Rotation and Lateral Flexion
Splenius Capitis
Cervical spine muscles:
Rectus Capitis action
extension, same side rotation
cervical spine injuries
- Disc bulge/herniation
- Facet Pain
- Stinger
- Nerve Root Injury
- Fractures/Dislocations
- Cervical Stenosis
- Cervical Fusion
Shoulder bones
- clavicle
- scapula
- proximal humerus
Shoulder bones:
Only bony attachment between the trunk and upper limb
clavicle
3 anatomical shoulder joints:
- Glenohumeral joint (GH)
- Acromioclavicular joint (AC)
- Sternoclavicular joint (SC)
Shoulder joints:
Ball and socket joint
glenohumeral joint
shoulder joints:
- plane synovial joint
- weak joint capsule reinforced by ligaments
acromioclavicular joint
shoulder joints:
- saddle-shaped synovial joint
- poor joint congruence
sternoclavicular joint
Shoulder ligaments:
sternoclavicular joint - Four ligaments
- Anterior sternoclavicular ligament
- Posterior sternoclavicular ligament
- Interclavicular ligament
- Costoclavicular ligament
Shoulder ligaments:
Acromioclavicular joint - Three ligaments
- Acromioclavicular ligament
- Small - Coracoacromial Ligament
- Coracoclavicular ligament
- Larger
Shoulder ligaments:
Glenohumeral joint - Five ligaments
- Superior Glenohumeral ligament
- Middle Glenohumeral ligament
- Inferior Glenohumeral ligament
- Coracohumeral ligament
- Transverse humeral ligament
Shoulder ligaments:
- Fibrocartilage to deepen the shoulder socket
- Enhances stability and proprioception
shoulder labrum
- Flexion
- Extension
- Abduction
- Adduction
- Internal Rotation
- External Rotation
- Scapular Protraction
- Scapular Retraction
- Scapular Upward Rotation
- Scapular Downward Rotation
Shoulder movements
Shoulder muscles:
4 rotator cuff muscles
- Supraspinatus
- Infraspinatus
- Teres Minor
- Subscapularis
Shoulder Girdle bones:
- clavicle
- scapula
Shoulder Girdle Movements
- scapula elevation
- scapular depression
- scapular tipping
- scapular winging
Shoulder injuries:
- Shoulder Separation
- Shoulder Dislocation
- Adhesive Capsulitis
- Shoulder Impingement
- Rotator Cuff Tear
- Shoulder Labral Tear
- Total Shoulder
Shoulder injuries:
Occurs in overhead motions
- Swimmers, Throwers, Pole Vaulters, Painters
- Non-traumatic
Treatment:
- Increase the space
- Stretching
- Biomechanics
- Surgery
shoulder impingement
Shoulder injuries:
Some tears are not painful or pathologic
- Skin wrinkles
- Causes
- Overhead Throwing
- Dislocation
- Trauma
Treatment
- Restore Correct Biomechanics
- Check the Cervical Spine
- Surgery
shoulder labral tear
Shoulder injuries:
Last Resort for Shoulder Pain
- Done for Pain Relief
- not necessarily for mobility
shoulder replacement
