Exam # 3 Flashcards
1
Q
What does the median nerve innervate?
A
- Thenar Eminence
- Lateral two lumbricals
2
Q
What does the ulnar nerve innervate?
A
- Hypothenar
- Medial two lumbricals
- Adductor Pollicis
- Interosseus muscles
3
Q
What does the radial nerve innervate?
A
Extensors of the Thumb
EDC
EDI
EDM
4
Q
What nerve passes through the carpal tunnel?
A
Median nerve
5
Q
Extensor Hand Muscles:
A
Extensor Digitorum
Extensor Indicis
Extensor Digiti Minimi
Ext. D moves together despite obscene gesture
EI allows for isolated index extension
6
Q
Where do the extensors originate from?
A
Lateral epicondyle
7
Q
Extrinsic Thumb Extensors:
A
Thumb
Extensor Pollicis Longus
Extensor Pollicis Brevis
Abductor Pollicis Longu
8
Q
flexor that can move in isolation. To test hold all but one digit in PIP, DIP extension
A
Flexor Digitorum superficialis
9
Q
flexor that has isolated index flexion in majority of people. FDP 3rd -5th move in unison
A
Flexor Digitorum profundus
10
Q
Extrinsic Flexor of the Thumb:
A
Flexor Pollicis Longus
Only muscle to flexThumb IP
Texting has added new functional importance to thumb IP flexion
11
Q
Which wrist muscle inserts in the palmar fascia or Aponeurosis?
A
Palmaris longus
- Dupuytren’s contracture, thickening of the palmar fascia usually on ulnar side. Creates flexion deformity of ulnar 2 fingers
12
Q
What is the function of the pulleys of the fingers?
A
Redirect force, keep flexor tendons against fingers
13
Q
Soft Tissue of Hand(Extensor Expansion; Dorsal Hood):
A
Complex aponeurosis over dorsum (primarily)from MCP to insert onto the distal phalanx
Extensor digitorum inserts along middle of dorsum of digit Interossei and lumbricals insert laterally
14
Q
What bones articulate at the CMC joint?
A
Trapezium/ 1st metacarpal
15
Q
What motions occur at the CMC joint?
A
Flexion/extension/abd/add/opposition
16
Q
What type of joint is the CMC joint?
A
saddle joint
17
Q
Which finger CMC has the most motion?
A
fifth
18
Q
What are the motions of the fifth finger?
A
Flex/ext/Opposition(slight)
19
Q
What other CMC has motion (minimal)?
A
fourth
20
Q
What motions are allowed at the MCP of the thumb?
A
Flexion and Extension
21
Q
What motions are allowed at the MCP of the fingers?
A
Flex/ext/abd/add
22
Q
What is the significant ligament of the MCP joint?
A
collateral ligament
- close-packed
- flexion
23
Q
What motions occur at the IP joint?
A
flexion and extension
24
Q
How many IP joints in the fingers?
A
- Two (PIP & DIP)
25
How many joints are in the thumb?
*One (IP)
26
Ligaments of the IP joints:
1. “Volar” Plate: tough, ligamentous structure. When contracted, difficult to correct
2. Collateral ligaments: Short, Prevent lateral movement
27
Hand Intrinsic Muscles:
Thenar group: FPB,OP, AbdPB
Hypothenar: FDM, AbdDM, ODM
Deep Palm: D & P Interossei, Lumbricles, Add. Pollicis
28
Intrinsic “Plus” Position:
Lippert says only the lumbricals flex MCP, extend IP’s
Do a tip-to-tip pinch, palpate 1st dorsal interossei
*holding spreaded cards in hand*
29
Radial nerve injury:
(can person extend wrist, MCPs)
30
Median nerve injury:
(Can person oppose with thumb)
31
Ulnar nerve injury:
(Can person perform a strong lateral pinch – Froment’s Sign)
32
Grip and pinch :
Power grip:
Cylindrical, hook, spherical
Lateral Pinch (pad to side)
Three jaw chuck (pad to pad)
Precision (tip to tip)
33
4th and 5th CMC functional significance:
1. The motion of the fourth and fifth CMC allow for power grip in flexion
2. Also, allows ulnar two fingers to “get out of the way” for precision tasks
34
Which is the“power” side of the hand?
Ulnar side
35
Which is the precision side?
Radial side
36
What are the arches of the hand?
* Distal Carpal
* Proximal Carpal
* Longitudinal
37
is a common nerve compression affecting the ulnar nerve as it passes through a tunnel in the wrist called Guyon's canal. This problem is similar to carpal tunnel syndrome, but with the ulnar nerve
Guyon’s Canal Syndrome
38
Median Nerve Injury:
Issues with the thenar muscles.
Loss of ability to flex the thumb, index and middle fingers.
39
Intrinsic Minus:
Median Nerve
Thenar eminence
Lateral two lumbricals
Ulnar Nerve
Hypothenar
Medial two lumbricals
Adductor Pollicis
Interosseous muscles
40
Radial Nerve Palsy:
41
De quervain's tenosynovitis:
Treatment
Rest
Thumb Spica Splint
Gradual Strengthening as Pain Decreases
42
What 2 tendons are associated with De quervain's Syndrome?
Abductor Pollicis Longus (ABD-PL)
Extensor Pollicis Brevis (EPB)
43
If someone's hand is crushed from an injury where will you see swelling?
dorsal side of hand (intrinsic minus)
44
Boutonniere Deformity:
Trauma
Lesion of the extensor tendon at the level of the proximal interphalangeal joint
Rheumatoid Arthritis
The PIP is slowly forced into flexion by chronic synovitis of the joint, elongating the central slip and ultimately leading to rupture. Subsequent volar displacement of the lateral bands below the axis of the PIP rotation creates increased tension on the DIP extensor mechanism, leading to hyperextension and limited flexion of the DIP
45
Treatment of Boutonniere Deformity:
Splinting
AROM / PROM DIP
46
Swan Neck Deformity:
RA causes chronic swelling of the PIP joint, which in turn loosens the volar plate
Once loosened, this ligament tears easily, and when torn it leads to the hyperextension of the PIP joint.
This hyperextension in turn causes the extensor tendon of the DIP joint to fall out of balance, and that joint then hyperflexes
47
Treatment for Swan Neck Deformity:
Splinting
ROM
48
Treatment for Flexor Tendon Lacerations:
Initial Phase
Splinting
PROM within limits of splint
No Resistance
No hand use for ADLs, One handed techniques
Wound Care
Scar Massage
49
Extensor Tendon Injuries:
*Treatment
1. Immobilization Method
Very Young
Non Compliant
2. Early Passive Motion
Method
50
What nerve innervates the hypothenar group?
Ulnar
51
What nerve innervates the lumbricles of the 4th/5th digits?
Ulnar
52
What nerve innervates the thenar group?
Median
53
What nerve innervates the adductor pollicis?
Ulnar
54
What nerve innervates the interossei?
Ulnar
55
What nerve innervates the lumbricles of the 2nd/3rd digits innervate?
Median
56
What nerve innervates the extensor pollicis B & L?
Radial
57
What are the two bones of the Temporomandibular (TMJ)?
The two bones that form the TMJ are the mandible(jaw) located inferiorly, and the temporal bone of theskull (located more superiorly)
58
Motions of TMJ:
Depression (opening mouth)
Elevation (Closing mouth)
Lateral deviation (side-to-side motion)
Protrusion (Protraction)
Retrusion (Retraction)
59
Muscles of TMJ:
Masseter
Temporalis
60
What nerve is TMJ innervated by
CN V (Trigeminal)
61
Motions of TMJ:
Depression (opening
mouth
Elevation (Closing
mouth)
Lateral deviation (side to
side motion)
Protrusion (Protraction)
Retrusion (Retraction)
62
Temporomandibular Disorder:
Causes:
* Teeth (malocclusion)
* Malocclusion is a problem in the way the upper and lower teeth fittogether in biting or chewing.
* muscle imbalances
* head, neck, & facial postural abnormalities
* Forward head posture,
* tongue positioning
* Removal of teeth to relieve crowded situations may lead to the forward posturing of the tongue, resulting in over functioning of the masseter muscle and jaw pain
* Stress
* Clenching and Grinding
63
TMD Characteristics:
Forward head posture
Tight anterior chest wall
High costal breathing
* diaphragm is pushed upward, and the abdomen drawn in. The ribs are raised somewhat, and the chest is partially expanded.
Bruxism (teeth clenching and grinding)
Headaches
64
Mouth Considerations:
Tongue, lips help with mouth closure
Tongue must touch the hard palate for an efficient swallow
Cerebral Palsy-malocclusion common due to abnormal tone in face & tongue
65
Vertebrae:
Four Segments
First two cervicalvertebrae are called?
Atlas and Axis
66
Intervertebral Discs:
Allow small motions in every direction =“shock absorbers”
80% water, rest is cartilage
Herniated disk causes extreme pain
67
Motions of the spine:
* Cervical:
flexion/extension
rotation (atlanto-axial joint)
lateral flexion
* Thoracic:
lateral flexion
* Lumbar:
flexion/extension
rotation
68
Neck Muscles:
* Sternocleidomastoid
Unilateral contraction: lateral flexion of neck to the same side and rotation of head to opposite side
Bilateral contraction: flexion of neck
* Scalenes
Unilateral: assist in lateral flexion to the same side
Bilateral: raise first 2 ribs during forced inspiration; OR assistneck flexion
* Upper Trapezius
69
Thoracic Outlet Syndrome:
Scalene muscle tightness (& other anatomical anomalies)
*Cervical Rib
Impingement on brachial plexus and subclavian artery/vein
Painful with a variety of symptoms
70
Thoracic Outlet Syndrome Vascular Symptoms:
Swelling or puffiness in the arm or hand
Bluish discoloration of the hand
Feeling of heaviness in the arm or hand
Pulsating lump above the clavicle
Deep, boring toothache-like pain in the neck and shoulder region which seems to increase at night
Easily fatigued arms and hands
Superficial vein distention in the hand
71
Thoracic Outlet Syndrome Neurologic Symptoms:
Paresthesia along the inside forearm and the palm (C8, T1 dermatome)
Muscle weakness and atrophy of the gripping muscles (long finger flexors)and small muscles of the hand(thenar and intrinsic)
Difficulty with fine motor tasks of the hand
Cramps of the muscles on the inner forearm (long finger flexors)
Pain in the arm and hand
Tingling and numbness in the neck, shoulder region, arm and hand
72
Provacative Tests for TOS:
East Test
Adson's Maneuver
73
point of stability for the body “core strength”
trunk
74
Muscles of the trunk:
* Rectus abdominis
trunk flexion
* External abdominal oblique
Unilateral: lateral flexion, rotation to the opposite side
Bilateral: trunk flexion
* Internal abdominal oblique
Unilateral: lateral flexion, rotation to the same side
Bilateral: trunk flexion
* Quadratus lumborum
lateral trunk flexion
through reverse action: hikes up hip
75
ERECTOR SPINAE Muscles:
* Spinalis mms. = closest to the spine
* Longissimus mms. = in the middle
* Iliocostalis mms. = farthest from spine
Unilateral: lateral flexion of trunk
Bilateral: trunk extension
76
PELVIC TILT:
Abdominal and gluteal muscles are important for maintaining pelvic tilt
Some anterior pelvic tilt is normal, but if it is extreme there is increased lordosis and may lead to low back pain
77
increase in posterior convexity of the thoracic curve (hunch back)
kyphosis
78
SPINE ABNORMALITIES:
Kyphosis
Lordosis
Scoliosis
79
increase in the forward curve of the lumbar spine (i.e. pregnant women)
lordosis
80
lateral deviations in spine
scoliosis
81
Things to Remember Abut The Trunk:
Most trunk mms. exist in bilateral pairs but each can work independently
All trunk mms. interact to maintain stabilization
Trunk = point of stability for the body
Neck and trunk mms. are also involved in forceful breathing & coughing (quadriplegia/ SCI at risk for pneumonia due to weak cough)
82
Joints of the Pelvis:
Lumbosacral- allows motion
Sacroiliac (non-axial)
* Instability with pain common here
* Sacrum and ilium are held together by ligaments
Symphysis pubis (non-axial)
* Must stretch for childbirth
83
Bones of the Pelvis:
Ilium
Ischium (ischial tuberosities are your“sit bones”)
Pubis
Acetabulum (the hip“socket”) is made up of all three bones of the pelvis
The three pelvic bones (I, I & P) are fused to each other
84
Pelvic tilt and effects on biomechanics:
* Anterior – ASIS is forward of pubic symphysis
* Posterior – ASIS is behind pubic symphysis
Cause changes in curves of spine and position of shoulder girdle
* Lateral – iliac crests are not even
Causes changes in curves of spine
85
ASIS as important reference point:
Important reference point for visualizing pelvic tilt in all planes of movement.
Pelvis is “key point of control” in seating/positioning
Seat belts should reston ASIS
86
Pelvic Rotation:
(seen in people with Cerebral Palsy)
*In pelvic rotation the“axis” is weight-bearing hip joint on opposite side
*Forward rotation refers to one ASIS moving forward relative to the fixed hip position(which is in medial hip rotation)
*Backward rotation opposite
87
During an anterior tilt what is the vertebral column (L) and hip doing?
hyperextending; flexing
88
During an posterior tilt what is the vertebral column (L) and hip doing?
89
During an lateral tilt what is the vertebral column (L) doing?
* Lateral bend to the supported side
* Rotation forward: vertebrae rotate to the opposite side
* Hip: medial rotation on weight-bearing side
90
The incredible human hip:
Allows for walking upright
Stable AND Mobile(triaxial)
The “fulcrum” of the locomotion system
* Must sustain more than 2x the body weight with each step
* Helps elevate and lower the body
91
Hip muscle general actions/location
one-joint muscles:
Posterior:
1. Gluteus maximus & deep rotators
(Extend, hyperextend, and/or laterally
rotate)
2. Hamstrings (Extend)
Anterior:
1. Iliopoas (Flex)
2. Rectus femoris, sartorius (Flex)
Medial:
1. Pectineus
(some flexion and adductors)
Adduct hip
2. Gracilis (adduction)
Lateral:
1. Gluteus medius and minimus
Hip Abduction (min. internal/medial rotation)
2. Tensor Fascia Lata (Abducts and flexion)
92
Knee Muscles:
Quadriceps (extend)
Hamstrings (flex)
Gastrocnimeius (flex)
Popliteus (deep
flexor)
Which muscle is
exclusively a one-
joint muscle?
Popliteus
93
Hamstring muscles:
biceps femoris long and short head
semitendinosus
semimembranosus.
94
Quadriceps muscles:
rectus femoris
vastus lateralis
vastus intermedius
vastus medialis
95
Compression/irritation to the sciatic nerve
Tightness in the piriformis muscle (one of the“deep rotators”) often impinges on the sciatic nerve.
sciatica
96
"knee cap" that protects the knee
patella
97
Soft area, posterior knee
Important landmark when fitting for seating
popliteal space (fossa)
98
Terrible Triad:
Medial collateral, Anterior cruciate, Medial meniscus are all torn from a blow to the knee when the foot is planted
99
Angle decreases between the shaft of the femur and the tibia
Genu Valgum (knock knees)
100
Angle increases between the shaft of the femur and the tibia
Genu Valrum (bowleg)
101
Excessive hyperextension at the knee joint
Genu Recurvatum
102
Total hip replacement restrictions (anterior approach):
No Hip Extension
No Hip Abduction
No External Rotation
+ or – Weight Bearing Restriction
103
Total hip replacement restrictions (posterior approach):
No Hip Flexion
Limited to 70 – 90 degrees as defined by MD
No Internal Rotation
No Hip Adduction
+ or – Weight Bearing Restriction
104
Foot Drop:
Caused by damage to the dorsiflexors
Results in difficulty with ambulation
Utilization of an AFO for ambulation to increase safety
105
Trapezius (Upper, Middle, Lower):
Origin:
Superior nuchal line
External occipital
protuberance
Nuchal ligament
C7-T12 spinous processes
Insertion:
Lateral third of clavicle
Acromion
Spine of scapula
106
Rhomboid Minor:
Origin:
Nuchal ligament
Spinous processes C7-T1
Insertion:
Medial end of spine of
scapula
107
Rhomboid Major:
Origin:
Spinous processes of T2-T5
Insertion:
Medial border of the scapula
108
Subscapularis:
Origin:
Subscapular fossa of scapula
Insertion:
Lesser tubercle of humerus
109
Infraspinatus:
Origin:
Infraspinous fossa of the
scapula
Insertion:
Greater tubercle of the
humerus
110
Supraspinatus:
Origin:
Supraspinous fossa of scapula
Insertion:
Greater tubercle of humerus
111
Teres Minor:
Origin:
Lateral border of the Scapula
Insertion:
Greater tubercle of humerus
112
Deltoid:
Origin:
Lateral ⅓ of the clavicle, acromion, spine of scapula
Insertion:
Deltoid tuberosity of the humerus
113
Pectoralis Major:
Origin:
Anterior half of medial clavicle, anterior surface of
sternum, costal cartilages 1-6, aponeurosis of external
oblique
Insertion:
Crest of Greater Tubercle of humerus
114
Levator Scapulae:
Origin:
Transverse process of axis and atlas
C3 and C4 posterior tubercles
Insertion:
Superior part of medial aspect of scapula (Posterior)
115
Coracobrachialis:
Origin:
Coracoid process of the scapula
Insertion:
Anteromedial surface of the humerus
116
Latissimus Dorsi:
Origin:
T7-L5 Spinous Processes, sacrum, iliac crest, ribs (X-
XI)
Insertion:
Intertubercular groove of humerus
117
a contraction that occurs when there is joint movement, the muscles shorten and move toward each other (ex. Flexion)
Concentric contraction
118
a contraction occurs when there is joint motion but the muscle appears to lengthen (ex. Extension)
Eccentric contraction
119
What nerve goes through the carpal tunnel?
median nerve
120
Quick peripheral nerve tests:
Radial- can person extend wrist, MCP
Median- can a person oppose with a thumb
Ulnar- can the person perform a strong lateral pinch- Froment’s sign
121
Example of an opened kinetic chain applied to a person:
when you rise from a sitting position your knees extend, causing your hips and ankles to move as well
122
Example of a closed kinetic chain applied to a person:
when you remain seated and extend your knee, your hip, and ankle will not move
123
The three phases of stance include:
loading response
mid-stance
terminal stance
124
The four phases of swing in the gait cycle are:
pre-swing
initial swing
mid-swing
terminal swing
125
Flexor Digitorum superficialis
versus profundus:
FDS can move in
isolation. To test hold all
but one digit in PIP, DIP
extension
FDP has isolated index
flexion in majority of
people. FDP 3rd -5th
move in unison
126
Extrinsic Flexor of the Thumb:
Flexor Pollicis Longus
Only muscle to flex
Thumb IP
Texting has added new
functional importance to
thumb IP flexion
127
Intrinsic plus vs Intrinsic minus:
holding a sandwich and claw hand (ape hand)
128
Short, Prevent lateral movement
collateral ligaments
129
Effects of Radial Nerve Lesions:
loss of triceps
Elbow flexion and extension are performed by
concentric and eccentric contractions of the biceps
Loss of wrist extension
130
Effects of Median Nerve Lesions:
loss of pronator teres and pronator quadratus
Loss of pronation so can’t turn things like keys,
etc.
131
Effects of Musculocutaneous Nerve Lesions:
loss of biceps and brachialis
Elbow flexion is accomplished by brachioradialis,
pronator teres, extensor carpi radialis longus and
brevis
A person uses momentum to get flexion started
Can only lift light objects
132
Gait Sequence:
Walker, weak leg, strong leg
133
Platform Weight Bearing:
Weight may go through the forearm but not the wrist or
hand
