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DPT Semester 2 > Kinesiology > Flashcards

Kinesiology Flashcards

1
Q

what are Osteokinematics?

A

large scale movements that we can observe

“flexion of the shoulder”

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2
Q

what are arthokinematics?

A

the motion that occurs between joint surfaces, we cannot see or observe these

also known as “joint play”

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3
Q

what is the concave-convex rule?

A

roll and glide is in the SAME direction

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4
Q

what is the convex-concave rule?

A

roll and glide is in the OPPOSITE direction

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5
Q

T/F: rolls are generally in the same direction as the osteokinematic motion”

A

TRUE

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6
Q

Describe what movement “roll” is in arthokinematics

A

multiple points along one articulating surface rotating and making contact with multiple points on another articular surface

like a rotating tire making contact with the road

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7
Q

describe what movement “glide” is in arthorkinematics

A

a single point on one articular process making contact with multiple points on another articular process

like a tire that is being braked, one spot on the brake pad makes contact with multiple places on the tire

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8
Q

describe what movement “spin” is in arthrokinematics

A

a single point on one articular surface makes contact with a single point on another articular surface

the axis of the tire makes contact with one part of the tire

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9
Q

T/F: : After strain in the elastic region is removed from a tissue it results in a permanent change in tissue length

A

False,

strain in the plastic region results in permanent change in tissue length

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10
Q

Viscoelastic tissues are dependent on what 2 factors?

A

time

rate

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11
Q

Define Viscosity

A

resistance to flow

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12
Q

Define elasticity

A

ability to return to original length or shape after removal of deforming load

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13
Q

What is creep?

A

progressive strain of a material when exposed to a constant load over time

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14
Q

describe a first-class lever and give an example of one in the body

A

classic seesaw

axis is between opposing forces

head and neck extensor muscles is an example

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15
Q

describe a second-class lever and give an example of one in the body

A

wheelbarrow

axis is located at one end, resistance in the middle, force at the other end

standing on tip toes

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16
Q

describe a third-class lever and give an example of one in the body

A

axis at one end with force in the middle and resistance at the opposite end

elbow flexion

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17
Q

what is the most common lever type in the human body?

A

third-class lever

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18
Q

What are Newton’s 3 laws?

A
  1. Law of inertia
  2. Law of acceleration (F = ma)
  3. Law of action and reaction
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19
Q

Define inertia, what is it directly proportional to?

A

the amount of force required to move an object (object will remain at rest until a sufficent amount of force is applied)

directly proportional to mass

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20
Q

What is mass moment of inertia?

A

a quantity that indicates resistance to change in angular velocity

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21
Q

what does an electrogoniometer measure?

A

joint angular rotation during movement

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22
Q

What are 2 non-contractile proteins that make up a muscle?

what do they contribute?

A
  1. Titin
  2. Desmin

stabilization of contractile proteins

provide passive force

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23
Q

what are the most common muscle arrangement?

A

Fusiform

Pennate

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24
Q

What is a force couple?

A

When 2 muscles create force in 2 different linear directions that result in a produced torque in the same direction

pelvic tilting

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25
Q

When do we feel passive tension?

A

when a stretch is placed on connective tissue

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26
Q

T/F: putting a quick stretch on a muscle just prior to contraction will reduce the potential for force generated by that muscle

A

FALSE

quick stretch = increased potential for force generated

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27
Q

What is passive insufficiency?

A

limitation in ROM of muscle when that muscle is placed on stretch at both joints it crosses

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28
Q

What is active insufficiency?

A

limitation in the ability to produce force when a muscle is actively contracting at both joints it crosses

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29
Q

When attempting to stretch a one joint muscle must be aware that may need to place the two-joint muscle on __________in order to maximize the stretch at the one joint muscle.

A

slack

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30
Q

Tenodesis grip is a great example of ___________

A

passive insufficiency

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31
Q

Force-Velocity Curve

Concentric: velocity is ________ to load

Eccentric: velocity is _______ to load

A

Concentric: inversely related

Eccentric: proportional

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32
Q

What are the 7 elemental structures that are always present in synovial joints?

A
  1. Articular cartilage
  2. Joint capsule
  3. Synovial membrane
  4. Ligaments – protect from excessive movements
  5. Blood vessels
  6. Sensory nerves
  7. Synovial fluid – reduces friction and provide nutrients to the joint
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33
Q

what are the 7 different types of synovial joint?

A
  1. Hinge
  2. Pivot – radioulnar
  3. Ellipsoid
  4. Ball and socket
  5. Plane – intercarpal and intertarsal
  6. Saddle - CMC
  7. Condyloid – MCP, tibiofemoral
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34
Q

T/F: the axis of rotation at your joint is a fixed point

A

FALSE

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35
Q

What are the main components of connective tissue?

A
  1. Fibrous proteins
  2. Ground substance
  3. Cells
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36
Q

what are the 3 types of periarticular connective tissue?

A
  1. Dense connective tissue
  2. Fibrocartilage
  3. Articular cartilage
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37
Q

what are the 2 types of dense connective tissue?

A
  1. Regular - ligaments and tendons
  2. Irregular - joint capsule
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38
Q

What is the primary function of Hyaline cartilage and how does it recieve nutrients?

A

Distribute and absorb joint forces and reduce joint friction

compression results in more synovial fluid which is how it recieves nutrients

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39
Q

what is an example of fibrocartilage?

A

menisci

labrum

articular discs

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40
Q

what is the primary function of fibrocartilage?

A

Support and mechanically stabilize joints, dissipates loads across multiple planes and guide complex arthrokinematics

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41
Q

name the craniovertebral ligaments

A
  1. posterior atlanto-occipital membrane
  2. posterior atlanto-axial membrane
  3. anterior atlanto-occipital membrane
  4. anterior atlanto-axial membrane
  5. tectorial membrane
  6. ligamentum nuchae
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42
Q

name the spinal ligaments

A
  1. ligamentum flavum
  2. anterior longitudinal ligament
  3. posterior longitudinal ligament
  4. supraspinous ligament
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43
Q

describe the structure of the atlanto-occipital articulation

A

convex occiptial condyles articulate with concave superior facets of the atlas

synovial plane joint

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44
Q

describe the structure of the atlanto-axial articulation

A

dens and anterior arch of atlas/transverse ligament - synovial pivot joint

inferior facets of the atlas with superior facets of the axis - biconvex with meniscoids

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45
Q

what is the role of the transverse ligament? What motion does it help limit?

A

prevents anterior displacement of C1 on C2

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46
Q

what is the role of the alar ligament? What motion does it help limit?

A

it becomes taut in neck flexion and during axial rotation

limits lateral flexion and prevents distraction of C1 on C2

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47
Q

What conditions can compromise the integrity of the transverse ligament? What does that result in? What are some possible dangers?

A

RA and Down’s syndrome

instability of C1/C2 joint

C1/C2 can slide and compress the spinal cord and even cause paralysis

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48
Q

describe the orientation of lower cervical facet joints

A

approximately 450 off frontal plane and transverse plane

maximizes motion

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49
Q

what osteokinematic motions occur at the cervical spine?

A
  1. Flexion/Extension
  2. Lateral flexion
  3. Rotation
  4. Protraction/Retraction
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50
Q

what produces protraction at the cervical vertebrae

A

combo of

lower C-spine flexion and upper C-spine extension

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51
Q

what produces retraction at the cervical vertebrae?

A

combo of

extension in lower C-spine and flexion in upper C-spine

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52
Q

what is the primary osteokinematic motion at the atlanto-occipital joint?

A

flexion/extension

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53
Q

describe the arthrokinematics at the atlanto-occipital joint?

A

convex (occipital condyle) on concave (superior facets of atlas)

opposite roll and glide/slide

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54
Q

T/F: movements in the transverse plane are limited at the atlanto-occipital joint?

A

TRUE

limited by deep joint congruency

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55
Q

Atlanto-occpital flexion = occipital condyle roll ______ and glide ________

Atlanto-occipital extension = occipital condyle roll _____ and glide _______

A
  1. anterior; posterior
  2. posterio; anterior
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56
Q

what is the primary osteokinematic motion that occurs at the atlanto-axial joint?

A

rotation

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57
Q

describe the arthrokinematics at the atlanto-axial joint

A

inferior facet of atlas/superior facet of axis

gliding → ipsilateral posterior glide with contralateral anterior glide

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58
Q

what limits rotation at the atlanto-axial joint?

A

alar ligaments

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59
Q

what limits movement in the sagittal plane at the atlanto-axial joint?

A

inferior facet of atlas/superior facet of axis → no gliding

limited by transverse ligament

atlanto-axial joint tilt instead

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60
Q

what limits tilting of the axis at the atlanto-axial joint with flexion?

A

transverse ligament

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61
Q

what coupling motion occur in the lower cervical spine?

A

lateral flexion with rotation coupled in the same direction

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62
Q

what would occur if either lateral flexion or rotation was done in isolation rather than in a coupling motion?

A

the facet joints would come into contact with one another blocking the motion

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63
Q

describe the arthrokinematics that occur during flexion/extension of C3-C7

A

flexion = inferior facet (of superior vertebrae) glides anterior and superior to superior facet (of inferior vertebrae)

extension = inferior facet (of superior vertebrae) slides posterior and inferior to superior facet (of inferior vertebrae)

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64
Q

describe the arthorkinematics that occur during rotation in C3-C7

A

same side as rotation = inferior facet glides posterior and slightly inferior

opposite side as rotation = inferior facet glides anterior and slightly superior

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65
Q

descibe the arthrokinematics that occur during lateral flexion of C3-C7

A

same side - inferior facet glides inferior and slightly posterior

opposite side - inferior facet glides superior and slightly anterior

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66
Q

describe the arthrokinematics of R rotation of C4-5

A

R (ipsilateral) C4 facet glides posterior and slightly inferior on C5 facet

L (contralateral) C4 facet glides anterior and slighly superior on C5 facet

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67
Q

what is the overall function of the cervical spine?

A

stability and protection

C-spine demonstrates most flexibility

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68
Q

what are concerns with muscular imbalance and poor posture?

A

prolonged protraction results in forward head posture

lengthening of deep neck flexors and scapular retractors and tightening of the pecs and upper trap/levator scapulae

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69
Q

what is the benefit of lordotic and kyphotic curves? Drawback?

A

increased ability to resist compressive load

opportunity for shear forces to act, particularly at regions of transition between curves

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70
Q

what is the role of the vertebral body?

A

weight-bearing structure of spinal column, resist compressive loads

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71
Q

what is the role of the pedicles?

A

transmit tension and bending forces from posterior elements to vertebral body

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72
Q

what is the role of the laminae?

A

transmit force from articular, transverse and spinous processes to the pedicles

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73
Q

what is the pars articularis?

A

portion of the laminae between the superior and inferior articular processes

subject to bending forces

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74
Q

what is the role of the articular facet processes?

A

form facet joints and contribute to the articular pillar

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75
Q

what is the role of the spinous process?

A

serve as a muscle attachment and provide mechanical lever

may also serve as boney block to motion

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76
Q

what is the role of the transverse processes?

A

serve as muscular attachment and provide mechanical lever

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77
Q

what are some concerns you may have if someone has a bilaterally pars interarticularis fracture?

A

spondylolisthesis (forward slipping of the vertebrae)

can lead to compression of the spinal cord leading to neurological deficits

most commonly occurs at L5/S1 secondary to angulation of this segment

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78
Q

what is the purpose of the intervertebral discs?

A
  1. increase available motion
  2. transmit load
  3. stabilization of spine
  4. provide space betwen vertebrae and exiting spinal nerves
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79
Q

What are the components of the intervertebral disc?

A
  1. nucleus pulposus
  2. annulus fibrosus
  3. vertebral end plate
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80
Q

what is the annulus fibrosus?

A

fibrous outer ring of the intervertebral disc

60-70% water

collagen and elastin arranged in 15-25 concentric layers

fibers oriented 650 from vertical

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81
Q

what is the role of the annulus fibrosus?

A

helps keep the nucleus pulposus inbetween the vertebrae

capable of resisting distraction, sheer and torsion forces

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82
Q

what is the vertebral end plate?

A

cartilaginous layer covering the S/I surfaces fo the disc

0.6-1 mm of cartilage in adults

strongly attached to annulus fibrosis but not the vertebral body

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83
Q

what can occur with an end plate fracture?

A

nuclues pulposus starts to herniate

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84
Q

T/F: 80% of force is transmitted through the intervertebral disc

A

TRUE

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85
Q

what position increase the pressure on the disc the most?

A

Most = forward bending w/load in front of body

slouching > sitting erect

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86
Q

What motions are available at an interveterbral joint?

A
  1. gliding
    • AP, ML and torsional
  2. distraction and compression
  3. rotation (also called tilt)
    • AP, lateral direction
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87
Q

T/F: zygapophyseal (facet) joints do not contain any fibromeniscoids?

A

FALSE
they do have them

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88
Q

define coupling

A

consistent association of one motion about an axis with another motion around a different axis

lateral flexion with rotation is an example

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89
Q

what influences spinal coupling patterns?

A
  1. spinal posture
  2. spinal curvature
  3. orientation of articulating facets
  4. fluidity/elasticity/thickness of the disc
  5. extensibility of the muscles, ligaments and joint capsules
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90
Q

describe the kinematic role that intervertebral joints have

A
  1. determine magnitude of movement
  2. distribute load
  3. create space for movement and passage of the spinal nerve roots
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91
Q

describe the kinematic role of facet joints

A

determine the direction of the movement

“train tracks”

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92
Q

Spinal osteokinematics decribe the movement based on the direction of what?

A

superior segment’s anterior portion

(front of inferior facet of the superior vertebrae)

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93
Q

what are the arthokinematic motions that occur at the intervertebral joints with each osteokinematic motion?

A
  1. approximation/distraction and gliding
  2. tipping
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94
Q

what are the arthokinematic motions that occur at each facet joint with each osteokinematic movement?

A

approximation/gapping and gliding

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95
Q

what is the overall function of the spinal musculature?

A
  1. control posture
  2. stabilize axial skeleton
  3. protect spinal cord and internal organs
  4. generate intra-thoracic and intra-abdominal pressure
  5. produce torque for movement of the body
  6. mobility of head and neck for optimal place of eyes, ears, and nose
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96
Q

what bones make up the TMJ?

A

mandible and temporal bone

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97
Q

what is the purpose of the articular disc at the TMJ?

A

separate upper and lower articulation

cushions the large repetitive force of mastication

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98
Q

describe the articular surfaces of the TMJ joint

A

articular eminence and mandibular condyle are both convex resulting in incongruent joint

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99
Q

T/F: the TMJ joint is covered in hyaline cartilage

A

FALSE

covered with fibrocartilage

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100
Q

if both articular surfaces of the TMJ are convex, how does it move?

A

articular disc is biconcave to allow both surfaces to remain congruent throughout ROM

result → joint is separated into a S/I joint

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101
Q

describe the articulations of the superior and inferior joint in the TMJ

A

superior ⇒ articular eminence with superior disc

inferior ⇒ condyle with lower disc

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102
Q

what are the attachments of the articular disc at the TMJ?

A
  1. medial and lateral poles of condyle
  2. joint capsule and lateral pyterygoid anterioly
  3. bilaminar retrodiscal pad posteriorly
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103
Q

what does the attachment of the articular disc on the medial and lateral poles of condyle allow for?

A

the condyle to rotate freely on the disc in the AP direction

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104
Q

what does the attachment of the articular disc to the joint capsule and lateral pyerygoid at the TMJ allow for?

A

it restricts posterior translation of the disc

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105
Q

what does the attachment of the articular disc to the bilaminar retrodiscal pad allow for?

A

superior lamina - assists the disc with translating anteriorly with mandibular depression

inferior lamina - limits forward translation

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106
Q

what is the makeup of the joint capsule of the TMJ?

A

capsule in thin and loose AP and relatively firm ML

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107
Q

what is the most common direction of dislocation of the TMJ and why?

A

anterior, due to lack of strength of anteiror capsule and the incongruence of the articular surfaces

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108
Q

name the ligaments of the TMJ and describe their function

A
  1. lateral (TM) ligament
    • stabilize lateral portion of capsule, help guide movement of condyle during opening
  2. Sylomandibular ligament
    • weakest of 3 with questionable function
  3. Sphenomandibular ligament
    • swinging hinge that suspends the mandible
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109
Q

what is the normal resting position of the TMJ?

A

lips closed and teeth several mm apart

maintained by low level activity of the temporalis muscle

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110
Q

what are the osteokinematic motions at the TMJ?

A
  1. elevation/depression
  2. protrusion/retrusion
  3. L/R lateral excursion
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111
Q

how and at which part of the joint does the first part of the mouth opening occur?

A

50% of motion occurs as rolling the lower joint

posterior roll (depression)

disc remains stationary, condyle on temporal bone is where movement occurs

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112
Q

how and at which part of the joint does the second part of the mouth opening occur?

A

50% of motion occurs in the upper joint as gliding

anterior glide in upper portion

disc pulled anteriomedially by lateral pterygoid and then slides along with condyle

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113
Q

how and at which part of the joint does the first part of mouth closing occur?

A

50% motion occurs in the upper joint as a posterior glide

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114
Q

how and at which part of the joint does the second part of mouth closing occur?

A

last 50% of motion occurs in the lower joint as an anterior roll

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115
Q

how and at which part of the joint does protraction of the TMJ occur?

A

anterior and slighlty inferior glide of condyle and disc

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116
Q

how and at which part of the joint does retraction of the TMJ occur?

A

posterior and slightly superior glide of the condyle and disc

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117
Q

T/F: no rotation (or rolling) occurs with protrusion and retraction of the TMJ?

A

TRUE

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118
Q

what occurs on the ipsilateral side during TMJ lateral excursion?

A

primarily side-to-side translation of condyle and disc within the fossa

ipsilateral condyle glides posteriorly (retrusion)

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119
Q

what occurs on the contralateral side during TMJ lateral excursion

A

primarily side-to-side translation of condyle and disc within fossa

anterior glide on the contralateral condyle

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120
Q

what muscles and forces act on the TMJ during opening?

A
  1. primarily gravity
  2. digastric
  3. suprahyoids
  4. inferior lateral pterygoid
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121
Q

what muscles and forces act on the TMJ during closing?

A
  1. temporalis
  2. masseter
  3. medial pterygoid
  4. control of disc vis lateral pterygoid (eccentric control)
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122
Q

what muscles and forces act on the TMJ during protrusion?

A
  1. bilaterally superior masseters
  2. bilaterally M/L pterygoids
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123
Q

what muscles and forces act on the TMJ during retrusion?

A
  1. bilaterally posterior fibers of temporalis
  2. bilateral deep fibers of masseter
  3. bilateral anterior digastric
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124
Q

what muscles and forces act on the TMJ during lateral excursion?

A
  1. contralateral M/L pterygoid (pull condyle forward)
  2. ipsilateral temporalis (pull condyle posterior)
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125
Q

what is the normal ROM for the different motions of the TMJ?

A
  1. opening - 35-55 mm
    • function = 25-35 (2 knuckles)
  2. lateral excursion - 10-15 mm
  3. protrusion - 3-9 mm
  4. retrusion - about 3 mm
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126
Q

what is TMD?

A

a broad/vague term used to describe dysfunctions associated with TMJ

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127
Q

what symptoms are associated with TMD?

A
  1. pain
  2. popping
  3. reduced bite force
  4. reduced ROM w/mouth opening
  5. HA
  6. tinnitus trigger points
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128
Q

what factors are associated with TMD?

A
  1. stress/emotional disturbance
  2. daily oral parafunction habits (teeth grinding)
  3. asymmetric muscle activity
  4. sleep bruxism (teeth clenching during sleep)
  5. chronic forward head posture
  6. C-spine pathology
  7. sensitization of the CNS
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129
Q

describe what is occuring during mouth opening/closing when there is disc replacement with reduction

A

disc sits anterior, not in anatomical position

the disc does not move with the condyle like it normally would, instead it relocates during opening and subluxes during closing

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130
Q

what is a reciprocal click?

A

an click that occurs during jaw opening as the disc relocates

then when the jaw is closing, there is a click as the disc gets squeezed abnormally and subluxes anteriorly

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131
Q

what is occuring during mouth opening/closing when there is disc displacement without reduction?

A

there is a partial displacement or dislocation of the disc in resting position

thus the mandiblar condyle is unable to pass over the posterior border of the disc during opening

since the disc doesn’t relocate it blocks translation and limits motion at durng opening/closing

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132
Q

how does posture and the cervical spine impact the TMJ?

A

head and neck position may affect tension in cervical muscles which can influence the function of the mandible

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133
Q

what makes ribs T1, T10-12 atypical?

A
  1. T1 spinous process is long and prominent
  2. T12 → thoracic-like superior facet, inferior facets are more lumbar-like
  3. have full costal facets rather than demifacets
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134
Q

what is the significance of thoracic vertebral pedicles having a different orientation?

A

they face posteriorly not laterally

results in narrowing of vertebrae canal

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135
Q

what are the available osteokinematic motions at the thoracic spine?

A
  1. flexion/extension
  2. lateral flexion
  3. rotation
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136
Q

what limits flexion in the thoracic spine?

A

tension in several ligaments including:

  1. posterior longitudinal ligament
  2. ligamentum flavum
  3. interspinous ligaments
  4. joint capsule of facets
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137
Q

what limits extension in the thoracic spine?

A

contact of spinous processes, laminae, facet joints and tension from anterior longitduinal ligament, facet joint capsules and abdominal muscles

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138
Q

what limits lateral flexion in the thoracic spine?

A

facets and ribs

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139
Q

what limits rotation at the thoracic spine?

A

rib cage

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140
Q

describe the arthrokinematics for flexion in the thoracic spine at the intervertebral and facet joints

A
  1. facet joint
    • anterior and superior glide bilaterally
  2. intervertebral
    1. anterior tilting of superior vertebrae
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141
Q

describe the arthrokinematics for extension in thoracic spine at the intervertebral and facet joints

A
  1. facets
    • posterior and inferior glide
  2. intervertebral
    1. posterior tilting of superior vertebrae
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142
Q

T/F: flexion and extension are more limited in the lower T-spine than in the upper T-spine

A

FALSE
more limited in upper T-spin (T1-T6) due to rib cage rigidity and facet orientation

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143
Q

describe the arthrokinematics for L sidebending in the thoracic spine at the facet and intervertebral body joints

A
  1. facets
    • contralateral facet → superior glide
    • ipsilateral facet → inferior glide
  2. intervertebral body
    1. lateral tilt to the L
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144
Q

describe the arthrokinematics for R rotation in the upper thoracic spine at the facet and intervertebral body joints

A
  1. facet
    • contralateral side → anterior slide with superio glide
    • ipsilateral side → posterior slide with inferior glide
  2. interbody
    • R rotation
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145
Q

describe the arthrokinematics for L rotation in the lower thoracic spine at the facet and interbody joints

A
  1. facets
    • contralateral → anterior glide with inferior glide
    • ipsilateral → posterior glide with superior glide
  2. interbody
    1. rotate to the L
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146
Q

In the upper Thoracic spine how is rotation and side bending coupled?

A

same direction

R rotation = R side bending

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147
Q

during L rotation in T3-T4, which facet will be gapping and which will be approximating?

A
  1. gapping → contralateral
    • anterior with superior glide
  2. approximation → ipsilateral side
    • posterior with inferior glide
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148
Q

during L rotation in T8-T9, which facet will be gapping and which will be approximating?

A
  1. gapping → ipsilateral side
    1. posterior with superior glide (side bending to R)
  2. approximating → contralateral side
    1. anterior with inferior glide (side bending to R)
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149
Q

what can cause hyperkyphosis?

A
  1. trauma
  2. abnormal growth/development of vertebrae
  3. severe DDD
  4. marked osteoporosis
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150
Q

what kind of joints make up the sacroiliac joint?

A

overall it is a compound joint

  1. anterior portion → synovial planar
  2. posterior portion → syndesmosis
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151
Q

what muscles help reinforce the anterior portion of the pubic symphysis?

A
  1. transversus abdominis
  2. rectus abdominis
  3. internal oblique
  4. adductor longus
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152
Q

describe the arthrokinematics for flexion in the lumbar spine at the facet and interbody joints

A
  1. facets
    1. anterior and superior gliding (gapping)
  2. interbody
    1. anterior tilting
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153
Q

describe the arthrokinematics during extension of the lumbar spine at the facet and interbody joints

A
  1. facets
    • posterior and inferior glide (approximating)
  2. interbody
    1. posterior tilt
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154
Q

where does the greatest amount of motion occur in the lumbar spine?

A

inferior segments for all sagittal plane motions

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155
Q

describe the arthrokinematics during L3-L4 R sidebending at the facet and interbody joints

A
  1. facet
    • contralateral side → superior glide
    • ipsilateral side → inferior glide
  2. interbody
    • R tilt
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156
Q

how is rotation and side-bending coupled in the lumbar spine?

A

it is inconsistent in research

BUT
we know that if you start in a neutral spine, then side-bending and rotation are coupled in the OPPOSITE direction

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157
Q

if you are starting with a neutral Lumbar spine

where would facet gapping occur during L sidebending?

A
  1. gapping → ipsilateral side (L)
  2. approximation → contralateral side (R)
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158
Q

describe the arthrokinematics during L rotation of the L2-L3 at the facets and interbody joints

A
  1. facets
    • contralateral side → anterior slide (approximate if started in neutral)
    • ipsilateral side → posterior slide (gap if started in neutral)
  2. interbody
    • L rotation
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159
Q

where does the greatest amount of motion occur for the Lumbar spine with side bending and rotation?

A

superior lumbar segments

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160
Q

what is lumbo-pelvic rhythm?

A

the relationship of the lumbar spine and the hip joints that occurs with flexion and extension

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161
Q

what is the normal lumbo-pelvic rhythm for flexion?

A

initially lumbar flexion followed by anterior tilting of the pelvis

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162
Q

what is lumbo-pelvic rhythm for extension?

A

posterior tilting of the pelvis followed by lumbar extension

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163
Q

what is a consequence of imparied lumbo-pelvic rhythm?

A

reduced ROM

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164
Q

what are the 2 phases typical to a situp?

A

Trunk flexion phase

hip flexion phase

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165
Q

what is an altered pattern that can occur during a situp?

A

weak abdominals result in early hip flexion due to hip flexors dominance of the activity

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166
Q

what are 3 strategies that should be applied to have better lifting mechanics?

A
  1. reduce velocity of lift
  2. reduce magnitude of external load
  3. reduce length of extensor moment arm
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167
Q

what terms are used to describe the movement of the pelvis (innominate bones)?

A
  1. anterior pelvic tilt → ASIS and pubic move inferiorly
  2. posterior pelvic tilt → ASIS and pubic move superiorly
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168
Q

what terms describe the movement of the sacrum on the pelvis?

A
  1. nutation
  2. counternutation
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169
Q

what is nutation?

A

sacral promontory → moves anteriorly and inferiorly

sacral apex → moves posteriorly and superiorly

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170
Q

what is counternutation?

A

sacral promontory → moves posteriorly and superiorly

sacral apex → moves anteriorly

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171
Q

how does nutation provide stability?

A

it will result in increased compression of the SI joint making it more stable

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172
Q

how does utilizing a lumbar role during sitting postively impact the lumbar spine?

A

without one our lumbar spine flexes more which increase the pressure on the anterior disc causing it shift disc material posteriorly

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173
Q

what type of joint is the SC?

A

functions as a saddle

structurally it is basically a planar

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174
Q

how is the SC joint stabilized?

A
  1. a disc between the clavicle and manubrium improves congruency
  2. Passive stabilizers
  3. Dynamic stabilizers
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175
Q

List the structures that passively stabilize the SC joint

A
  1. fibrous joint capsule
  2. A/P sternoclavicular ligaments
  3. Costoclavicular ligament (posterior and anterior bundle)
  4. interclavicular ligmanet
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176
Q

what motion does the fibrous joint capsule of the SC joint limit?

A

anterior and posterior translation of medial clavicle

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177
Q

what motion does the A/P sternoclavicular ligament limit?

A

Anterior = posterior translation of clavicle

Posterior = anterior translation of clavicle

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178
Q

what are the 2 portions of the costoclavicular ligmanet and what do they limit?

A

Anterior and Posterior bundle

limit elevation of clavicle

contribute to inferior glide of medial clavicle in elevation

shock absorption

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179
Q

what does the interclavicular ligament limit?

A

excessive depression and superior glide of clavicle

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180
Q

List the structures that dynamically stabilize the SC joint

A
  1. SCM
  2. Sternohyoid
  3. Sternothyroid
  4. Subclavius
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181
Q

what osteokinematic motions are available at the SC joint?

A
  1. elevation/depression
  2. protration/retraction
  3. anterior/posterior rotation
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182
Q

describe the arthrokinematics of the SC joint during elevation/depression

A

convex on concave

elevation = lateral clavicle rotates upward (superior roll, inferior glide)

depression = lateral clavicle rotates downward (inferior roll, superior glide)

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183
Q

describe the arthrokinematics of the SC joint during protraction/retraction

A

concave on convex

protraction = lateral clavicle moves anterior (anterior roll and glide)

retraction = lateral clavicle moves posterior (posterior roll and glide)

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184
Q

Describe the SC for the following:

closed pack

open pack

capsular pattern

A

closed pack = full posterior rotation (full arm elevation)

open pack = arm resting at side

capsular pattern = pain at end range with arm overhead

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185
Q

what is the joint type of the acromioclavicular (AC) joint?

A

planar synovial

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186
Q

T/F: an AC joint disc is always present

A

FALSE
it may or may not be there

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187
Q

List the passive structures that support the AC joint

A
  1. weak joint capsule
  2. Superior AC ligament
  3. Inferior AC ligament
  4. Coracoclavicular ligaments
    1. Trapezoid ligaments
    2. Conoid ligaments
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188
Q

what does the Superior Acromioclavicular ligmanet limit at the AC joint?

A

resists anterior clavicular/posterior acromion translation

reinforced by deltoid and trapzeius

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189
Q

what do the coracoclavicular ligmanets limit/resist at the AC joint?

A

limit superior clavicular/inferior scapular translation

and posterior rotation of clavicle

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190
Q

what is the primary function of the AC joint?

A

allow the scapula to rotate during arm movement

increases UE motion

positions glenoid beneath humeral head

maintains congruency of scapula on thorax

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191
Q

what osteokinematic motions are available at the AC joint?

A
  1. internal/external rotation
  2. A/P tilting (tipping)
  3. upward/downward rotation
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192
Q

describe the associated arthrokinematics for the osteokinematic motions at the AC joint

A

none are well defined

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193
Q

how is internal/external rotation of the AC joint important for motion at the scapula?

A

it maintains contact of scapula on curved thorax during protraction and retraction of clavicle

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194
Q

how is A/P tipping of the AC joint important to scapular motion?

A

important for maintaining contact of scapula on curved thorax during elevation and depression of clavicle

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195
Q

what is the significance of upward/downward rotation of the AC joint?

A

important for positioning of glenoid fossa in optimal position

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196
Q

describe the following for the AC joint:

closed pack position

open pack position

capsular pattern

A

closed pack = arm at 90 degrees

open pack = arm by side

capsular pattern = pain at end range with arm overhead

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197
Q

due to the structure of the AC joint, what injury is it susceptible to?

A

dislocation due to slopped nature of the articular coupled w/high probability of receiving large shear forces

can lead to development of posttraumatic OA

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198
Q

T/F: the scapulothoracic joint is a true anatomic joint and has all the assocaited structures expected of a synovial joint

A

FALSE

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199
Q

what osteokinematic motions are available at the scapulothoracic joint?

A
  1. primary
    1. elevation/depression
    2. protraction/retraction
    3. upward/downward rotation
  2. Secondary
    1. anterior/posterior tilting
    2. internal/external rotation
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200
Q

what motions occur at the SC and AC joint to allow for scapulothoracic protraction?

A

SC = protraction

AC = slight IR

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201
Q

what motions occur at the SC and AC joint to allow for scapulothoracic upward rotation?

A

summation of SC elevation and AC upward rotation

202
Q

what is the angle of inclination of the GH joint?

A

130-150 degrees in frontal plane

203
Q

what is the angle of torsion of the GH joint?

A

30 degrees posterior in the transverse plane

204
Q

what is retroversion describing at the GH joint?

A

the posterior orientation of humeral head with regards to the condyles

205
Q

increased humeral retroversion may result in what?

A

increased ER ROM and reduced IR ROM

observed a lot in dominant arm of throwing athletes

206
Q

list the passive structures that support the GH joint

A
  1. Glenoid labrum
  2. Joint capsule
  3. S/M/I GH ligaments
  4. Coracohumeral ligament
207
Q

describe the characteristics of the GH joint capsule

A
  1. significant laxity, minimal stability provided
  2. reinforced by thicker external ligaments
  3. inferior portion is slack in ADD position creating an axillary pouch
208
Q

what is the clincial significance of a tight posterior GH capsule?

A

linked to shoulder impingement

tightness may produces increased anterior humeral head translation which decreases the subacromial space

209
Q

what does the superior glenohumeral ligament limit?

A

ER, anterior and inferior translation at O degrees of abduction

slackens when abducted beyond 35-45 degrees

210
Q

what does the middle GH ligament limit?

A

anterior translation from 45-90 degrees abduction

and extremes of ER

211
Q

what does the inferior GH ligament limit?

A

primary stabilizer beyond 45 degrees of abduction

stabilizes during combing abduction w/rotation

212
Q

what does the coracohumeral ligament limit?

A

downward dislocation

inferior translation and ER of humeral head w/arm hanging at side

213
Q

list the dynamic structures that support the GH joint

A

Rotator cuff

214
Q

what are 2 places the rotator cuff does not reinforce the GH joint?

A
  1. inferiorly
  2. region between subscapularis and supraspinatus (rotator cuff interval)
215
Q

describe the arthrokinematics for each osteokinematic motion at the GH joint

A

convex on concave

(roll and glide will be opposite for every motion)

216
Q

how does shoulder flexion impact the GH joint capsule?

A

causes tension throughout capsule

slight anterior translation may occur at end range flexion due to tension in posterior capsule

217
Q

in order for full GH abduction to occur, what else must occur?

A

ER

218
Q

what is the closed pack position for the GH joint?

A

90 degrees abducted and full ER

OR

full abduction and ER

219
Q

what is the open pack position for the GH joint?

A

abducted 55 degrees, then horizontally adducted 30 degrees with slight ER

220
Q

what is the capsular pattern for the GH joint?

A

ER > ABD > IR

221
Q

what is the ratio of motion in the scapulohumeral rhythm?

A

2 degrees of glenohumeral

to

1 degree of scapular motion

222
Q

what is the ideal shoulder girdle position?

A

slightly elevated and relatively retracted scapula

*results in glenoid fossa facing slightly upward

223
Q

List some pathologies that reduce musclar support of the shoudler

A
  1. Stroke
  2. muscular dystrophy
  3. Guillan-Barre
  4. impinged nerve
224
Q

how does gravity effect scapulothoracic posture?

A

results in depressed, protracted, and excessively downward rotated scapula

225
Q

what is the impact that rounded shoulders can have on an individual’s shoulder complex?

A

can lead to biomechanical stress on SC and GH

slight depression, downward rotation and protraction of scapula

can lead to stressed portions of joint, subluxations at worse and compression of arteries and nerves

226
Q

describe how the rhomboids and traps function together

A

pure retraction

traps tend to elevate scapula and rhomboids tend to depress scapula = neutralized and pure retraction

227
Q

describe how the deltoid and supraspinatus function together

A

work to acheive full abduction

228
Q

if the deltoid is paralyzed, is full abduction of GH possible?

A

yes, but torque is reduced

229
Q

if the supraspinatus is paralyzed is full GH abudction possible?

A

yes but only through compensations and in very specific cases

230
Q

describe how the supraspinatus and mid trap function together

A

middle trap functions to stabilize scapula

while supraspinatus ER the shoulder

231
Q

what would occur if the middle trap was paralyzed?

A

scapular dyskinesis

scapula would move into IR as the GH ER

232
Q

describe how the serratus anterior, upper trap and low trap function together

A

contract simulataneously to produce upward rotation of scapular during GH abduction

233
Q

how does the infraspinatus, teres minor and subscapularis stabilize the GH joint?

A

exert a depressive force on humeral head

234
Q

what is scapular dyskinesia?

A

any abnormal position or movement of the scapula

alters effectiveness of muscle actions and distorts arthrokinematics resulting in stress

235
Q

describe the makeup of the elbow’s joint capsule

A
  1. large loose and weak (A/P)
  2. reinforced laterally by collateral ligaments
236
Q

what is the normal carrying angle of the elbow?

A

8-15 degrees

237
Q

what is the purpose of the carrying angle at the elbow?

A

allows for a person to carry an object away from side of the thigh

238
Q

list the passive structures that reinforce the elbow joint

A
  1. medial (ulnar) collateral ligaments
    1. A/P Transverse
  2. Lateral (radial) collateral ligaments
    1. lateral ulnar collateral ligament
    2. annular ligament
239
Q

what does the A/P transverse ligament do at the elbow?

A

stabilizes against valgus torque at the elbow and limits elbow extension at end ROM

240
Q

what is the role of the annular ligament?

A

stabilizes against varus torque at the elbow and combined varus and supination torques

241
Q

what osteokinematic motions are available at the humeroulnar and humeroradial joint?

A

flexion/extension

242
Q

describe the arthrokinematics at the humeroulnar and humeroradial joint

A

concave on convex

roll and slide in same direction

243
Q

At the humeroulnar joint, what is the:

closed pack position

open pack position

capsular pattern

A

closed = full extension and supination

open = flexed 70 degrees, supinated 10 degrees

capsular pattern = flexion > extension

244
Q

at the humeroradial joint, what is the following:

closed pack position

open pack position

capsular pattern

A

closed = 90 degrees of elbow flexion and 5 degrees of supination

open = full extension and supination

capsular pattern = flexion > extension

245
Q

what types of joints are the proximal and distal radioulnar?

A

synovial pivot

246
Q

how is the arthrokinematics different at the proximal and distal radioulnar?

A

proximal = convex on concave

distal = concave on convex

247
Q

describe the following for the proximal radioulnar joint:

closed pack position

open pack position

capsular pattern

A

closed pack = 5 degrees supination

open = 70 degrees flexion and 35 degrees supination

capsular pattern: supination = pronation

248
Q

describe the following for the distal radioulnar joint:

closed pack position

open pack position

capsular pattern

A

closed = 5 degrees supination

open = 10 degrees supination

capsular pattern: supination = pronation

249
Q

how do we produce the most torque for elbow flexion at the elbow?

A

supinated position

increased flexor moment arm of biceps and brachioradialis when forearm is supinated

250
Q

what is the workhorse of the elbow?

A

brachialis

can produce equal force regardless of position

251
Q

describe the synergy between the triceps and anterior deltoid

A

ant deltoid synergizes with triceps during elbow extension

this will counter shoulder extension potential of triceps

252
Q

what muscle is primarily activated with low level supination?

A

supinator

253
Q

what role does the triceps play during forceful supination?

A

must co-contract to prevent the biceps from actually flexing the elbow and shoulder during supination effort

254
Q

what muscle is primarily activated during low level pronation?

A

pronator quadratus

255
Q

what role does the triceps play during forceful supination?

A

acts as a synergist to counter tendency of biceps brachii to flex elbow

256
Q

what are 2 points of consensus with regards to the wrist complex?

A
  1. structure and biomechanics of wrist and hand vary tremondously from person to person
  2. even subtle variations can produce differences in the way a given function occurs
257
Q

what bones make up the radiocarpal joint?

A

radius with schapoid, lunate, and triquetrum

258
Q

what makes up the 2-joint system in the wrist?

A

radiocarpal joint

midcarpal joint

259
Q

what is the benefit of the 2 joint system in the wrist?

A

permits large ROM w/less exposed articular surface and tighter joint capsules

less tendency for structural pinch at extremes of motion

allows for flatter multi-joint surfaces that are more capable of withstanding imposed pressures

260
Q

what is the function of the TFCC (triangular fibrocartilage complex)?

A

binds distal ends of ulna and radius while allowing radius to rotate around fixed ulna

261
Q

what is beneath the extensor retinaculum?

A

6 fibro-osseus compartments

262
Q

what are the factors that contribute to carpal tunnel syndrome?

A
  1. overcrowding (9 extrinisic flexor tendons + median nerve)
  2. excessive mechanical stress
  3. fibrotic changes of CT
263
Q

what osteokinematic motions are available at the radiocarpal and midcarpal joints?

A

flexion/extension

radial/ulnar deviation

264
Q

describe the arthrokinematics that occur at the radiocarpal and midcarpal joints

A

convex on concave = roll is opposite of slide

265
Q

what is the closed/open pack position and capsular pattern for the radiocarpal joint?

A

closed pack = full extension w/radial deviation

open pack = neutral flexion/extension w/slight ulnar deviation

capsular pattern: flexion = extension , slight radial and ulnar deviation

266
Q

what is the main function of the wrist extensors?

A
  1. position and stabilize wrist in activities that require active flexion of digits (making a fist)
  2. act to counterbalance wrist flexor torque
267
Q

List the joints in the hand

A
  1. CMC
  2. MCP
  3. IP
  4. DIP
268
Q

what osteokinematic motions are available at the 1st CMC joint?

A

flexion/extension

abduction/adduction

opposition/reposition

269
Q

describe the arthrokinematics at the 1st CMC joint

A

flexion/extension = concave on convex (M/L roll with glide)

ADB/ADD = convex on concave

270
Q

what is the open/closed pack position and capsular pattern for the 1st CMC joint?

A

closed pack = full opposition

open pack = midway between flx/ext and abd/add

capsular pattern = abduction

271
Q

what is the open/closed pack position and capsular pattern for 2-5 CMC joints?

A

closed = full flexion

open = midway between flx/ext

capsular pattern = not really defined

272
Q

describe the arthrokinematics at the MCP joints

A

concave on convex

roll and glide same direction

273
Q

describe the arthrokinematics at the IP joints

A

concave on convex

palmar/dorsal roll with anterior/posterior glide

(in same direction)

274
Q

what is the open/closed pack position and capsular pattern for the MCP joints?

A

closed = full flexion

open = slight flexion

capsular pattern: flexion = extension

275
Q

what is the open/closed pack position and capsular pattern for IP joints?

A

closed = full extension

open = slight flexion

capsular pattern: equal loss of flexion and extension

276
Q

what is the function of the flexor mechanism?

A

prevent bowstringing the tendons w/contraction of extrinsic finger flexors

(these refer to the flexor pulleys embedded within fibrous digital sheaths)

277
Q

describe the anatomy of the extensor mechanism

A
  • Distal to wrist they lack digital sheath or pulley system. Tendons become integrated into fibrous extensor expansion
278
Q

What is the normal angle of inclination for the hip?

A

~125°

279
Q

what is coxa valva?

A

pathological increased angle of inclination (>125°)

280
Q

what is coxa vara?

A

pathological decreased angle of inclination (<125°)

281
Q

what are some factors that can contribute to an increased risk of slipped capital femoral epiphysis?

A

high BMI
coxa vara

282
Q

how does a high BMI and coxa vara increase the risk for slipped capital femoral epiphysis?

A

Coxa vara results in the head and neck being closer to a right angle which decreases the dispersion of force resulting in more force coming down onto the head of the femur. A high BMI enhances that because it is even more force coming down.

283
Q

what is considered a normal degree of anteversion at the hip?

A

8-20°

284
Q

excessive anteversion reduces _________

A

hip stability

285
Q

what is excessive anteversion associated with? (mobility)

A

increased hip IR

decreased hip ER

286
Q

excessive retroversion may cause __________

A

hip impingement

287
Q

excess retroversion is associated with what? (mobility)

A

increased hip ER

decreased hip IR

288
Q

List some common acetabular abnormalities

A
  1. acetabular dysplasia
  2. coxa profunda (acetabular over coverage)
  3. anteversion
  4. retroversion
289
Q

what is a CAM lesion?

A

extra bone at anterior-superior region of femoral head and neck junction

290
Q

what is a pincer deformity?

A

abnormal bony extension of anterior lateral rim of acetabulum

291
Q

what motions would provoke an impingement with either a CAM lesion or a Pincer deformity?

A

Hip IR with flexion

292
Q

List structures that support the hip

A
  1. strong joint capsule
  2. iliofemoral ligament
  3. pubofemoral ligament
  4. Ischiofemoral ligament
  5. transverse acetabular ligament
  6. acetabular labrum
  7. ligamentum teres
293
Q

which ligaments of the hip provide protection to blood vessels?

A

transverse acetabular ligament

ligamentum teres

294
Q

what is the trabecular system? Why do we have it?

A

it is a structural adaptation to weight bearing.

it allows us to provide structural resistance to bending force

295
Q

where is the joint capsule strong and weak at the hip?

A

strong = anterosuperiorly

weak = posterior and inferiorly (dislocations are more common in these directions)

296
Q

what is the role of the acetabular labrum?

A

since it is wedge shaped it deepens concavity and improves congruency at the hip

acts as a seal to maintain negative intraarticular pressure

297
Q

what motion can potentially injury the ligamentum teres?

A

excessive ER can strain/potentially tear it

298
Q

describe the arthrokinematics of the hip during an OKC motion

A

Convex on Concave

opposite roll and slide

299
Q

describe the arthrokinematics of hip IR/ER during an OKC motion

A

IR = anterior roll, posterior glide

ER = posterio roll, anterior glide

300
Q

describe the arthrokinematics of the pelvic during an CKC movement

A

Concave on Convex

roll and glide in same direction

301
Q

What osteokinematic movements are available at the pelvis?

A

A/P pelvic tilt

lateral pelvic tilt (pelvic hike/drop)

Forward/backward rotation

302
Q

describe the motion of both the contralateral and ipsilateral femur when the pelvis is hiked to the R

A

ipsilateral (R) = adducted

contralateral (L) = abducted

303
Q

describe the motion of both the ipsilateral and contralateral femur when the pelvis drops to the R

A

ipsilateral (R) = abduction

contralateral (L) = adduction

304
Q

describe the open pack and capsular pattern of the hip joint

A

open pack = 30° flexion, 30° abduction, neutral to slight ER

capsular pattern: equal loss of IR w/flexion and abduction

305
Q

what muscles help with performing an anterior pelvic tilt?

A

hip flexors

back extensors

306
Q

what muscles help with performing a posterior pelvic tilt?

A

abdominal muscles

hip extensors

307
Q

T/F: when performing a single leg raise, your abdominals are not involved. Why/Why not?

A

FALSE

abdominal wall muscles contract to neutralize the hip flexor’s pull on the pelvis into an anterior tilt.

This is important in preventing a lordotic curve in the lumbar spine during a straight leg raise

308
Q

what is the Tredelenberg sign?

A

contralateral hip drop during walking

indicates glute medius weakness on the stance leg

309
Q

in order to maximze a hamstring stretch, what should be done at the pelvis?

A

an anterior pelvic tilt

310
Q

in order to maximze a rectus femoris stretch, what should be done at the pelvis?

A

posterior pelvic tilt

311
Q

what is considered normal for tibiofemoral alignment?

A

femoral shaft 170-175° laterally from tibial shaft

312
Q

what is genu varum?

A

bowlegged

angle is >180°

313
Q

what is genu valgus?

A

knock knees

angle is <165°

314
Q

during genu varum, what tibiofemoral compartment is compressed?

A

medial compartment

315
Q

during genu valgus what tibiofemoral compartment is compressed?

A

lateral compartment

316
Q

what factors can lead to genu valgus?

A
  1. previous injury
  2. genetic predisposition
  3. high BMI
  4. laxity of ligaments
  5. abnormal alignment and muscle weakness at either end of the LE
317
Q

what factos can lead to genu varum?

A
  1. previous injury
  2. genetic predisposition
  3. laxity of ligaments
  4. abnormal alignment and muscle weakness at either end of the LE
  5. thinning of articular cartilage on medial side
318
Q

what might result from genu varum?

A
  1. increased medial compartment loading
  2. greater loss of medial joint space
  3. increased strain on LCL
319
Q

what might result of genu valgum?

A
  1. increased stress on MCL
  2. increased stress on lateral comparment
  3. excessive lateral tracking of patella
  4. increased stress on ACL
320
Q

what is genu recurvatum?

A

tibiofemoral hyperextension greater than 10°

stress is placed on posterior capsule and knee flexors

321
Q

where does the M/L meniscus attach?

A

medial = MCL, ACL, PCL and semimembranosus

lateral = ACL, PCL, popliteus

322
Q

what is the function of the meniscus?

A
  1. distribute weight bearing forces
  2. increase joint congruency
  3. shock absorption
323
Q

what motions does the ACL restrict?

A
  1. anterior translation of the tibia on femur
  2. knee hyperextension
  3. varus and valgus stresses
  4. tibial rotation medially and laterally
324
Q

what motions does the PCL restrict?

A
  1. posterior translation of the tibia on femur
  2. varus and valgus stresses
  3. tibial rotation medially
325
Q

what motions does the MCL restrict?

A
  1. valgus force
  2. lateral tibial rotation
  3. anterior translation of tibia on femur
326
Q

what motions does the LCL restrict?

A
  1. varus stresses
  2. tibial lateral rotation
327
Q

what osteokinematic motions are available at the tibiofemoral joint?

A
  1. flexion/extension
  2. abduction/adduction
  3. IR/ER
328
Q

describe the arthokinematics of the tibiofemoral joint during a CKC motion

A

convex femoral condyle moves on concave tibial plateau

opposite roll and glide

329
Q

describe the arthrokinematics of the tibiofemoral joint during an OKC movement

A

concave tibial plateau moves on convex femoral condyle

roll and glide in same direction

330
Q

what occurs during the screw home mechanism at the knee?

A

10° of tibial ER

needed for terminal knee extension

331
Q

what occurs during the unlocking mechanism of the knee joint?

A

popliteus IR the tibia prior to flexion

332
Q

what is the open pack position and capsular pattern of the tibiofemoral joint?

A

open pack = 25° flexion

capsular pattern = loss of flexion before extension

333
Q

prior to knee flexion, describe the joint congruency of the patella and femur

A

minimal joint congruency as the patella lies in the femoral sulcus during full extension

334
Q

how does the joint congruency of the patella and femur change as the knee flexes?

A

once it gets above 90° the middle portion of the patella isn’t making contact with the femur anymore, its mostly medial and lateral surfaces

335
Q

how is the patella a necessary and significant structure?

A

it functions as pulley for the quad

it increases the internal moment arm of the knee extensor mechanism = we need less force to extend

336
Q

what static structures support the patella?

A
  1. M/L patellofemoral ligament
  2. M/L patellotibial ligament
  3. Trochlear groove
337
Q

describe the motions of the patella

A
  1. S/I glide
  2. M/L glide
  3. M/L tilt
  4. M/L rotation
338
Q

when does S/I glide of the patella occur?

A

superior = knee extension

inferior = knee flexion

339
Q

List from least to greatest, which movements put the greatest amount of compressive force on the patellofemoral joint

A
  1. walking (1.3x BW)
  2. climbing stairs (3.3x BW)
  3. squatting (7.8x BW)
340
Q

what is the Q angle?

A

an estimation of the line of pull of the quads

normal = 13-15°

341
Q

increased Q angle ___ ____ _____on the patell

A

increases lateral force

342
Q

list some local factors that limit lateral pull of the patella

A
  1. raised lateral facet of trochlear groove
  2. quadriceps (VMO in particular)
  3. medial patellar retinaculum fibers
  4. medial passive structures
343
Q

list some local factors that contribute to lateral pull of the patella

A
  1. tight IT band
  2. excession tension in lateral patellar retinacular fibers
  3. excessive tension in lateral passive structures
344
Q

list some global factors that contribute to lateral patellar pull

A
  1. excessive genu valgum increases Q angle
  2. weakness of hip ER or abductor muscles
  3. tightness of hip IR or adductor muscles
  4. excessive pronation of subtalar joint
345
Q

what is a recommendation for weight bearing exercises for someone with patellofemoral pain syndrome?

A

avoid deep flexion

346
Q

what is a recommendation for non-weight bearing exercises for someone with patellofemoral pain syndrome?

A

avoid final 30° of extension

347
Q

what forms the Q angle?

A

line connected ASIS to middle of patella

line connecting tibial tuberosity to middle of patella

348
Q

what stabilizes the proximal tibiofibular joint?

A
  1. joint capsule
  2. anterior tibiofibular ligament
  3. posterior tibiofibular ligament
349
Q

what stabilizes the distal tibiofibular ligament?

A
  1. No joint capsule
  2. A/P tibiofibular ligament
  3. Interosseus membrane
350
Q

what is injured during a high ankle sprain?

A

distal tibiofibular joint

351
Q

what motions are available at the proximal and distal tibiofibular joint?

A
  1. A/P glide
  2. S/I glide
  3. IR/ER
352
Q

what is the open pack position for the tibiofibular joint?

A

10° plantarflexion

353
Q

where is the deltoid ligament and what does it limit?

A

medial ankle

limits eversion/pronation

354
Q

what is the lateral collateral ligament of the ankle made up of?

A

3 ligaments:

  1. anterior talofibular ligament
  2. calcaneofibular ligament
  3. posterior talofibular ligament
355
Q

what does the lateral collateral ligament of the ankle limit?

A

inversion and supination

356
Q

what muscles limit eversion/pronation of the ankle?

A

tibialis posterior

flexor hallucis longus

flexor digitorum longus

357
Q

what muscles limit inversion/supination at the ankle?

A

Fibularis longus and brevis

358
Q

what muscles limit dorsiflexion at the ankle?

A

gastrocnemius and soleus

359
Q

what muscles limit plantarflexion at the ankle?

A

Tibialis anterior

Extensor hallucis longus

Extensor digitorum longus

360
Q

what is the most stable position for the ankle?

A

dorsiflexion (wider base is wedged between the tibiofibular motise)

361
Q

describe the osteokinematics with the arthrokinematics of the talocrural joint

A

Dorsiflexion = anterior roll with posterior glide

Plantarflexion = posterior roll with anterior glide

362
Q

what is the arthrokinematic rule during OKC motion at the talocrural joint?

A

convex talus moves on concave tibiofibular mortise

363
Q

what is the open pack position and capsular pattern for the talocrural joint?

A

open pack = 10º plantarflexion w/neutral inversion/eversion

capsular pattern = loss of plantarflexion greater than dorsiflexion

364
Q

in what position is the foot more stable/mobile?

A

pronation = more mobile

supination = more stable

365
Q

what is the purpose of pronation at the ankle?

A

allows more mobility which allow for:

  1. a decrease in impact from weight-bearing forces
  2. dampen superimposed rotational motions
  3. the ankle to adapt to changes in supporting surfaces and terrains
366
Q

what is the purpose of supination at the ankle?

A

allows the arches to be stable enough to allow for:

  1. distribution of weight through the foot for proper weight bearing
  2. convert the flexible foot to a rigid lever
367
Q

what is the function of the plantar fascia?

A

tightens up when the toes are extended to provide support to the medial longitudinal arch.

aids in the windless effect

368
Q

describe the osteology and joint type of the subtalar joint

A

talus on calcaneus

made up of 3 ovoid synovial joints

369
Q

what moves on what during weight bearing at the subtalar joint?

A

talus moves on calcaneus

370
Q

during weight bearing, what motions couple to allow for supination?

A
  1. calcaneus inverts
  2. talus abducts
  3. talus dorsiflexes
  4. tibiofibular lateral rotation
371
Q

during weight bearing, what motions couple to produce pronation?

A
  1. calcaneus everts
  2. talus adducts and plantarflexes
  3. tibiofibular medial rotation
372
Q

what moves on what during non-weight bearing motions at the subtalar joint?

A

calcaneus moves on the talus

373
Q

during non-weight bearing motions, what movements couple together to produce supination at the subtalar joint?

A

calcaneus adduction, inversion, and plantarflexion

374
Q

during non-weight bearing motions, what movements couple together to produce pronation at the subtalar joint?

A

calcaneus abduction, dorsiflexion and eversion

375
Q

what is a valgus movement at the calcaneus?

A

calcaneal eversion

376
Q

what is a varus movement at the calcaneus?

A

calcaneal inversion

377
Q

how would pronation at the subtalar joint impact the joints higher up?

A

medial rotation of knee and hip

378
Q

how would supination at the subtalar joint impact joints above?

A

lateral rotation of hip and knee

379
Q

what is the open pack position and capsular pattern for the subtalar joint?

A

open pack = mid inversion/eversion and mid plantarflexion/dorsiflexion

no capsular pattern

380
Q

what joints make up the transverse tarsal joint?

A

talonavicular joint

calcaneocuboid joint

381
Q

what is the open pack position for the transverse tarsal joint?

A

midrange of supination/pronation

382
Q

describe the osteokinematics of the MTP joints

A

flexion/extension

abduction/adduction

383
Q

what is the arthrokinematic rule for the MTP joints?

A

Concave on Convex

roll and glide in same direction

384
Q

what is the open pack position and capsular pattern for the MTP joints?

A

open pack = 10° extension

capsular pattern: 1st MTP extension > flexion

2-5 loss of flexion

385
Q

what is hallux limitus

A

Turf Toe

a condition marked by gradual and significant limitation in motion along with articular degeneration and pain

386
Q

what is hallux valgus

A

bunion deformity

progressive lateral deviation of great toe

387
Q

what is the main function of the IP joints?

A

maintain stability by pressing against the ground in standing

388
Q

what is the arthokinematic rule for the IP joints?

A

Concave on Convex

roll and glide in same direction

389
Q

what is pes planus?

A

“flat feet”

abnormally dropped medial longitudinal arch

390
Q

what are some possible causes of pes planus?

A

assocaited with over stretched, torn or weakened plantar fascia, spring ligament, and/or tibialis posterior tendon

391
Q

what is pes cavus?

A

over supination

abnormally raised medial longitudinal arch

392
Q

what are some possible causes for pes cavus?

A

associated with excessive rearfoot varus (inversion)

393
Q

what is the rol of the posterior tibialis tendon during gait?

A

decelerates pronation rearfoot in loading response

this results in gradual and controlled lowering of medial longitudinal arch and absorbs some of the impact from loading

394
Q

describe the arthrokinematics at the atlanto-occipital joint?

A

convex (occipital condyle) on concave (superior facets of atlas)

opposite roll and glide/slide

395
Q

describe the arthrokinematics at the atlanto-axial joint

A

inferior facet of atlas/superior facet of axis

gliding → ipsilateral posterior glide with contralateral anterior glide

396
Q

describe the arthrokinematics that occur during flexion/extension of C3-C7

A

flexion = inferior facet (of superior vertebrae) glides anterior and superior to superior facet (of inferior vertebrae)

extension = inferior facet (of superior vertebrae) slides posterior and inferior to superior facet (of inferior vertebrae)

397
Q

describe the arthorkinematics that occur during rotation in C3-C7

A

same side as rotation = inferior facet glides posterior and slightly inferior

opposite side as rotation = inferior facet glides anterior and slightly superior

398
Q

descibe the arthrokinematics that occur during lateral flexion of C3-C7

A

same side - inferior facet glides inferior and slightly posterior

opposite side - inferior facet glides superior and slightly anterior

399
Q

describe the arthrokinematics of R rotation of C4-5

A

R (ipsilateral) C4 facet glides posterior and slightly inferior on C5 facet

L (contralateral) C4 facet glides anterior and slighly superior on C5 facet

400
Q

what are the arthokinematic motions that occur at the intervertebral joints with each osteokinematic motion?

A
  1. approximation/distraction and gliding
  2. tipping
401
Q

what are the arthokinematic motions that occur at each facet joint with each osteokinematic movement?

A

approximation/gapping and gliding

402
Q

T/F: no rotation (or rolling) occurs with protrusion and retraction of the TMJ?

A

TRUE

403
Q

what occurs on the ipsilateral side during TMJ lateral excursion?

A

primarily side-to-side translation of condyle and disc within the fossa

ipsilateral condyle glides posteriorly (retrusion)

404
Q

what occurs on the contralateral side during TMJ lateral excursion

A

primarily side-to-side translation of condyle and disc within fossa

anterior glide on the contralateral condyle

405
Q

describe the arthrokinematics for flexion in the thoracic spine at the intervertebral and facet joints

A
  1. facet joint
    • anterior and superior glide bilaterally
  2. intervertebral
    1. anterior tilting of superior vertebrae
406
Q

describe the arthrokinematics for extension in thoracic spine at the intervertebral and facet joints

A
  1. facets
    • posterior and inferior glide
  2. intervertebral
    1. posterior tilting of superior vertebrae
407
Q

describe the arthrokinematics for L sidebending in the thoracic spine at the facet and intervertebral body joints

A
  1. facets
    • contralateral facet → superior glide
    • ipsilateral facet → inferior glide
  2. intervertebral body
    1. lateral tilt to the L
408
Q

describe the arthrokinematics for R rotation in the upper thoracic spine at the facet and intervertebral body joints

A
  1. facet
    • contralateral side → anterior slide with superio glide
    • ipsilateral side → posterior slide with inferior glide
  2. interbody
    • R rotation
409
Q

describe the arthrokinematics for L rotation in the lower thoracic spine at the facet and interbody joints

A
  1. facets
    • contralateral → anterior glide with inferior glide
    • ipsilateral → posterior glide with superior glide
  2. interbody
    1. rotate to the L
410
Q

In the upper Thoracic spine how is rotation and side bending coupled?

A

same direction

R rotation = R side bending

411
Q

describe the arthrokinematics for flexion in the lumbar spine at the facet and interbody joints

A
  1. facets
    1. anterior and superior gliding (gapping)
  2. interbody
    1. anterior tilting
412
Q

describe the arthrokinematics during extension of the lumbar spine at the facet and interbody joints

A
  1. facets
    • posterior and inferior glide (approximating)
  2. interbody
    1. posterior tilt
413
Q

describe the arthrokinematics during L3-L4 R sidebending at the facet and interbody joints

A
  1. facet
    • contralateral side → superior glide
    • ipsilateral side → inferior glide
  2. interbody
    • R tilt
414
Q

how is rotation and side-bending coupled in the lumbar spine?

A

it is inconsistent in research

BUT
we know that if you start in a neutral spine, then side-bending and rotation are coupled in the OPPOSITE direction

415
Q

if you are starting with a neutral Lumbar spine

where would facet gapping occur during L sidebending?

A
  1. gapping → ipsilateral side (L)
  2. approximation → contralateral side (R)
416
Q

describe the arthrokinematics during L rotation of the L2-L3 at the facets and interbody joints

A
  1. facets
    • contralateral side → anterior slide (approximate if started in neutral)
    • ipsilateral side → posterior slide (gap if started in neutral)
  2. interbody
    • L rotation
417
Q

during L rotation in T3-T4, which facet will be gapping and which will be approximating?

A
  1. gapping → contralateral
    • anterior with superior glide
  2. approximation → ipsilateral side
    • posterior with inferior glide
418
Q

during L rotation in T8-T9, which facet will be gapping and which will be approximating?

A
  1. gapping → ipsilateral side
    1. posterior with superior glide (side bending to R)
  2. approximating → contralateral side
    1. anterior with inferior glide (side bending to R)
419
Q

describe the arthrokinematics of the SC joint during elevation/depression

A

convex on concave

elevation = lateral clavicle rotates upward (superior roll, inferior glide)

depression = lateral clavicle rotates downward (inferior roll, superior glide)

420
Q

describe the arthrokinematics of the SC joint during protraction/retraction

A

concave on convex

protraction = lateral clavicle moves anterior (anterior roll and glide)

retraction = lateral clavicle moves posterior (posterior roll and glide)

421
Q

describe the associated arthrokinematics for the osteokinematic motions at the AC joint

A

none are well defined

422
Q

how is internal/external rotation of the AC joint important for motion at the scapula?

A

it maintains contact of scapula on curved thorax during protraction and retraction of clavicle

423
Q

how is A/P tipping of the AC joint important to scapular motion?

A

important for maintaining contact of scapula on curved thorax during elevation and depression of clavicle

424
Q

what is the significance of upward/downward rotation of the AC joint?

A

important for positioning of glenoid fossa in optimal position

425
Q

what motions occur at the SC and AC joint to allow for scapulothoracic protraction?

A

SC = protraction

AC = slight IR

426
Q

what motions occur at the SC and AC joint to allow for scapulothoracic upward rotation?

A

summation of SC elevation and AC upward rotation

427
Q

describe the arthrokinematics for each osteokinematic motion at the GH joint

A

convex on concave

(roll and glide will be opposite for every motion)

428
Q

describe the arthrokinematics at the humeroulnar and humeroradial joint

A

concave on convex

roll and slide in same direction

429
Q

how is the arthrokinematics different at the proximal and distal radioulnar?

A

proximal = convex on concave

distal = concave on convex

430
Q

describe the arthrokinematics that occur at the radiocarpal and midcarpal joints

A

convex on concave = roll is opposite of slide

431
Q

describe the arthrokinematics at the 1st CMC joint

A

flexion/extension = concave on convex (M/L roll with glide)

ADB/ADD = convex on concave

432
Q

describe the arthrokinematics at the MCP joints

A

concave on convex

roll and glide same direction

433
Q

describe the arthrokinematics at the IP joints

A

concave on convex

palmar/dorsal roll with anterior/posterior glide

(in same direction)

434
Q

describe the arthrokinematics of the hip during an OKC motion

A

Convex on Concave

opposite roll and slide

435
Q

describe the arthrokinematics of hip IR/ER during an OKC motion

A

IR = anterior roll, posterior glide

ER = posterio roll, anterior glide

436
Q

describe the arthrokinematics of the pelvic during an CKC movement

A

Concave on Convex

roll and glide in same direction

437
Q

describe the arthokinematics of the tibiofemoral joint during a CKC motion

A

convex femoral condyle moves on concave tibial plateau

opposite roll and glide

438
Q

describe the arthrokinematics of the tibiofemoral joint during an OKC movement

A

concave tibial plateau moves on convex femoral condyle

roll and glide in same direction

439
Q

what is the arthrokinematic rule during OKC motion at the talocrural joint?

A

convex talus moves on concave tibiofibular mortise

440
Q

describe the osteokinematics of the MTP joints

A

flexion/extension

abduction/adduction

441
Q

what is the arthrokinematic rule for the MTP joints?

A

Concave on Convex

roll and glide in same direction

442
Q

what is the arthokinematic rule for the IP joints?

A

Concave on Convex

roll and glide in same direction

443
Q

how will a tight capsule impact motion?

A

it will cause early and excessive accesory motion in the opposite direction of the tightness

444
Q

injury to a joint/structures surrounding a joint will often lead to what?

A
  1. pain
  2. loss of motion
  3. excessive motion
445
Q

what does the term open pack position mean?

A
  1. surrounding tissue is as lax as possible
  2. maximal incongruency
  3. intracapsular space is as large as possible
  4. maximal amount of joint play available
446
Q

describe what is meant by the closed pack position

A
  1. joint position where joint is most congruent
  2. surrounding tissue (capsule and ligaments) under maximal tension
  3. maximal stability of joint
447
Q

when assessing joint mobility what 3 things are looked at?

A
  1. gross (quantity of movement)
  2. end-feel (quality of movement)
  3. provocation
448
Q

what is the current classification scale used for joint mobility?

A

hypomobile

normal

hypermobile

449
Q

what is meany by the term hypomobile?

A

the motion stops short of anatomical limit instead it stops at a pathological point of limitation

(can be due to inflammation, pain, spasm, or adhesions)

450
Q

what is meant by the term hypermobile?

A

joint moves beyond its anatomical limit due to laxity of surrounding structures

451
Q

what are some indications for joint mobilizations?

A
  1. break pain cycle
  2. increase joint extensibility
  3. increase extensibility of tendons, muscle, and fascia
  4. increase joint ROM
  5. promote muscle relaxation
  6. improve muscle performance
452
Q

what 3 categories cover the benefits of joint mobilizations?

A
  1. biomechanical improvements
  2. nutritional effects
  3. neurophysiological effects
453
Q

what are the neurophysiological effects of joint mobilizations?

A
  1. stimulates mechanoreceptors to inhibit pain impulses
  2. gate control theory
  3. descending pathway inhibition theory
  4. peripheral inflammation modulation
454
Q

what is the gate control theory?

A

there are large myelinated fibers that synapse onto neurons. If these large fibers are activated they can overwhelm the smaller C fibers transmitting pain sensation

455
Q

what type of joint mobilization is associated with the descending pathway inhibition theory?

A

grave V mobilization

stimulates the PAQ which results in serotonin secretion and decreased pain

456
Q

list some absolute contraindications to joint mobilizations

A
  1. malignancy in area of treatment
  2. infectious arthritis
  3. fusion of joint
  4. fracture at the joint
  5. practioner lack of skill
  6. neurological deterioration
  7. upper cervical spine instability
  8. cervical arterial dysfunction
457
Q

list some relative contraindications for joint mobilizations

A
  1. excessive pain or swelling
  2. arthroplasty
  3. hypermobility
  4. OA
  5. Spondylolisthesis
458
Q

when are joint mobilizations most effective?

A

when they are followed up by a comprehensive treatment plan including strengthening of some kind

459
Q

joint play comes in 3 types of movements. What are they?

A
  1. Compression - perpendicular to joint surface
  2. Traction/Distraction - perpendicular to joint surface
  3. Gliding - parallel to joint surface
460
Q

what are the types of joint mobilizations?

A
  1. Distractions
  2. Oscillation mobilizations
  3. sustained hold mobilizations
  4. mobilizations with no movements
461
Q

what/how many grades are there for distraction mobilizations?

A

Three

  1. Grade I = piccolo (loosen)
  2. Grade II = slack (take up the slack)
  3. Grade III = stretch
462
Q

what is a Grade I Distraction Mobilization?

A

distraction force that neutralizes pressure in the joint w/o producing actual separation of the joint surfaces

no stress on joint capsule

can be used w/gliding mobs to reduce compression forces on articular surfaces

463
Q

what is a Grade II distraction mobilization?

A

slack in joint capsule is reduced through sustained distraction

separates the articulating surfaces and eliminates the play in the joint capsule

can help determine the sensitivity of the joint

464
Q

what is a Grade III distraction mobilization?

A

designed to stretch the joint capsule and soft tissues surrounding the joint to increase mobility

trying to get into the plastic region

465
Q

what region of the stress strain curve do each distraction mobilizations take place?

A
  1. grade 1 = toe region
  2. grade 2 = elastic region
  3. grade 3 = plastic region
466
Q

how many grades are there for oscillation joint mobilizations?

A

5

per Maitland Oscillation Joint Mobilization

467
Q

describe a grade I Maitland Oscillation Joint Mobilization

A

small amplitude technique performed at beginning of available ROM (first 25%)

468
Q

describe a grade II Maitland Oscillation Joint Mobilization

A

large amplitude technique performed in middle of available ROM (middle 50%)

(going from 25-75%, back and forth)

469
Q

what is the goal of Grade I and II Maitland Oscillation Joint Mobilizations?

A

pain and spasm reduction

470
Q

describe a grade III Maitland Oscillation Joint Mobilization

A

large amplitude technique performed at end of availabel ROM (last 50%)

(going from 50-100%, back and forth)

471
Q

describe a grade IV Maitland Oscillation Joint Mobilization

A

small amplitude technique performed at end of availabel ROM (last 25%)

(going from 75-100%, back and forth)

472
Q

what is the goal of Grade III and IV Maitland Oscillation Joint Mobilizations?

A

stretch joint capsule and associated structures

473
Q

what is the theory behind pain reduction from Grades I and II Maitland Oscillation Joint Mobilizations?

A

reduces pain by:

  1. improving joint lubrication and circulation to tissues related to joint
  2. rhythmic oscillations possibly activate articular and skin mechanoreceptors which play a role in pain reduction
474
Q

T/F: Grades I and II influence mechanical nociception?

A

TRUE

475
Q

what are the effects of Grades III and IV Maitland Oscillation Joint Mobilizations?

A
  1. stretches capsule and associated structures
  2. mechanical and neurophysiological effects
  3. may activate inhibitory joint and muscle spindle receptors to aid in reducing restriction of movement
476
Q

Describe a grade V Maitland Oscillation Joint Mobilization

A

high velocity thrust of small amplitude at end of available range but within its anatomical range

movement that exceeds the resistance barrier

477
Q

what are the 5 principles of diagnosis for soft tissue injuries?

A
  1. look for “inherent likelihoods”
  2. look for objective physical signs
  3. Palpation
  4. selective tensionoing: non-contractile vs contractile tissue
  5. The “pain” is the pain for which the pt. is seeking treatment
478
Q

T/F: palpation is helpful but can be unreliable

A

TRUE
some things are just naturally tender to palpate which can often be misinterpreted

479
Q

list different types of contractile tissues

A
  1. tendons
  2. muscles
  3. musculotendinous junction
  4. bone adjacent to attachment of tendon
480
Q

a contractile tissue will have stress with what 3 tests/things?

A
  1. isometric contraction
  2. stretching
  3. palpation
481
Q

List different non-contractile tissues

A
  1. joint capsules
  2. ligaments
  3. bursae
  4. aponeuroses
  5. nerves
482
Q

a non-contractile tissue will have stress with what?

A
  1. stretch
  2. palpation

*no increase in discomfort/stress with isometric contraction

483
Q

when testing active and passive movements, what things should you observe/look for?

A
  1. pain
  2. ROM
  3. quality of movement
  4. willingness to move
  5. compare AROM, PROM, resistance testing and palation between involved and uninvolved side
484
Q

T/F: you do not need to manually test a muscle through it’s full ROM

A

It depends

only to rule out/rule in a suspicous area

485
Q

when palpating a stationary joint what things are you looking for?

A
  1. temperature
  2. swelling
  3. gaps
  4. tenderness
  5. pulsation
486
Q

when palpating a moving joint what things are you looking for?

A
  1. crepitus
  2. clicks
  3. end-feel
  4. hypermobility
  5. hypomobility
  6. willingness to move
  7. pain
487
Q

what can you use to help you make a decision/diagnosis when the pt is in severe or slight pain?

A
  1. pt. history
  2. functional testing - try to recreate their pain in a motion
  3. ask them to return when symptom returns
488
Q

what AROM results should you expect for a muscle/tendon strain, tendonitis or possible small tear?

A

likely limited due to pain and/or weakness

may be able to move through full ROM but with pain

489
Q

what PROM results should you expect from a muscle/tendon strain, tendonitis or possible small tear?

A

if truly passive: should have full pain free motion in all directions

EXCEPT

direction which stretches involved area may be limited due to pain (empty end feel)

490
Q

what isometric/MMT results should you expect from a muscle/tendon strain, tendonitis or possible small tear?

A

likely weak and painful when testing involved area

491
Q

what palpation results should you expect when testing a muscle/tendon strain, tendonitis or possible small tear?

A

involved area painful to palpation

492
Q

what AROM results should you expect from a muscle or tendon complete tear?

A

very limited due to weakness

likely not as much pain as seen w/partial tear, but much more weakness

493
Q

what PROM results should you expect from a muscle or tendon complete tear?

A

if truly passive: full pain free motion in all directions

EXCEPT
direction that stretches involved area, may be limited due to pain (empty end feel) if a muscle is guarding in the area

494
Q

what isometric/MMT results should you expect from a muscle or tendon complete tear?

A

extremely weak

495
Q

what palpation results should you expect from a muscle or tendon complete tear?

A

involved area painful to palpation

496
Q

what AROM results should you expect to see from a joint capsule injury?

A

limited

possibly painful at end ranges

497
Q

what PROM results should you expect to see from a joint capsule injury?

A

limited in same direction as AROM with firm end feel

possibly painful at end ranges

498
Q

what Isometrics/MMT results should you expect to see in a joint capsule injury?

A

if done at mid range - shouldn’t produce sig pain and should be strong

may have pain due to compensation or guarding of surrounding muscles

499
Q

what Palpation results should you expect to see in joint capsule injury

A

depends on depth of joint capsule

most of the time, cannot palpate deep enough to feel joint capsule

surrounding structures may be inflammed and cause discomfort with palpation

500
Q

T/F: if the AROM or PROM loss doesn’t match the capsular pattern for that joint it is prob not an issue with the joint capsule

A

FALSE

can still be the joint capsule even if it doesn’f follow the capsular pattern.

DPT Semester 2 (6 decks)

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