Kinesiology Flashcards
what are Osteokinematics?
large scale movements that we can observe
“flexion of the shoulder”
what are arthokinematics?
the motion that occurs between joint surfaces, we cannot see or observe these
also known as “joint play”
what is the concave-convex rule?
roll and glide is in the SAME direction
what is the convex-concave rule?
roll and glide is in the OPPOSITE direction
T/F: rolls are generally in the same direction as the osteokinematic motion”
TRUE
Describe what movement “roll” is in arthokinematics
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
describe what movement “glide” is in arthorkinematics
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
describe what movement “spin” is in arthrokinematics
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
T/F: : After strain in the elastic region is removed from a tissue it results in a permanent change in tissue length
False,
strain in the plastic region results in permanent change in tissue length
Viscoelastic tissues are dependent on what 2 factors?
time
rate
Define Viscosity
resistance to flow
Define elasticity
ability to return to original length or shape after removal of deforming load
What is creep?
progressive strain of a material when exposed to a constant load over time
describe a first-class lever and give an example of one in the body
classic seesaw
axis is between opposing forces
head and neck extensor muscles is an example
describe a second-class lever and give an example of one in the body
wheelbarrow
axis is located at one end, resistance in the middle, force at the other end
standing on tip toes
describe a third-class lever and give an example of one in the body
axis at one end with force in the middle and resistance at the opposite end
elbow flexion
what is the most common lever type in the human body?
third-class lever
What are Newton’s 3 laws?
- Law of inertia
- Law of acceleration (F = ma)
- Law of action and reaction
Define inertia, what is it directly proportional to?
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
What is mass moment of inertia?
a quantity that indicates resistance to change in angular velocity
what does an electrogoniometer measure?
joint angular rotation during movement
What are 2 non-contractile proteins that make up a muscle?
what do they contribute?
- Titin
- Desmin
stabilization of contractile proteins
provide passive force
what are the most common muscle arrangement?
Fusiform
Pennate
What is a force couple?
When 2 muscles create force in 2 different linear directions that result in a produced torque in the same direction
pelvic tilting
When do we feel passive tension?
when a stretch is placed on connective tissue
T/F: putting a quick stretch on a muscle just prior to contraction will reduce the potential for force generated by that muscle
FALSE
quick stretch = increased potential for force generated
What is passive insufficiency?
limitation in ROM of muscle when that muscle is placed on stretch at both joints it crosses
What is active insufficiency?
limitation in the ability to produce force when a muscle is actively contracting at both joints it crosses
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.
slack
Tenodesis grip is a great example of ___________
passive insufficiency
Force-Velocity Curve
Concentric: velocity is ________ to load
Eccentric: velocity is _______ to load
Concentric: inversely related
Eccentric: proportional
What are the 7 elemental structures that are always present in synovial joints?
- Articular cartilage
- Joint capsule
- Synovial membrane
- Ligaments – protect from excessive movements
- Blood vessels
- Sensory nerves
- Synovial fluid – reduces friction and provide nutrients to the joint
what are the 7 different types of synovial joint?
- Hinge
- Pivot – radioulnar
- Ellipsoid
- Ball and socket
- Plane – intercarpal and intertarsal
- Saddle - CMC
- Condyloid – MCP, tibiofemoral
T/F: the axis of rotation at your joint is a fixed point
FALSE
What are the main components of connective tissue?
- Fibrous proteins
- Ground substance
- Cells
what are the 3 types of periarticular connective tissue?
- Dense connective tissue
- Fibrocartilage
- Articular cartilage
what are the 2 types of dense connective tissue?
- Regular - ligaments and tendons
- Irregular - joint capsule
What is the primary function of Hyaline cartilage and how does it recieve nutrients?
Distribute and absorb joint forces and reduce joint friction
compression results in more synovial fluid which is how it recieves nutrients
what is an example of fibrocartilage?
menisci
labrum
articular discs
what is the primary function of fibrocartilage?
Support and mechanically stabilize joints, dissipates loads across multiple planes and guide complex arthrokinematics
name the craniovertebral ligaments
- posterior atlanto-occipital membrane
- posterior atlanto-axial membrane
- anterior atlanto-occipital membrane
- anterior atlanto-axial membrane
- tectorial membrane
- ligamentum nuchae
name the spinal ligaments
- ligamentum flavum
- anterior longitudinal ligament
- posterior longitudinal ligament
- supraspinous ligament
describe the structure of the atlanto-occipital articulation
convex occiptial condyles articulate with concave superior facets of the atlas
synovial plane joint
describe the structure of the atlanto-axial articulation
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
what is the role of the transverse ligament? What motion does it help limit?
prevents anterior displacement of C1 on C2
what is the role of the alar ligament? What motion does it help limit?
it becomes taut in neck flexion and during axial rotation
limits lateral flexion and prevents distraction of C1 on C2
What conditions can compromise the integrity of the transverse ligament? What does that result in? What are some possible dangers?
RA and Down’s syndrome
instability of C1/C2 joint
C1/C2 can slide and compress the spinal cord and even cause paralysis
describe the orientation of lower cervical facet joints
approximately 450 off frontal plane and transverse plane
maximizes motion
what osteokinematic motions occur at the cervical spine?
- Flexion/Extension
- Lateral flexion
- Rotation
- Protraction/Retraction
what produces protraction at the cervical vertebrae
combo of
lower C-spine flexion and upper C-spine extension
what produces retraction at the cervical vertebrae?
combo of
extension in lower C-spine and flexion in upper C-spine
what is the primary osteokinematic motion at the atlanto-occipital joint?
flexion/extension
describe the arthrokinematics at the atlanto-occipital joint?
convex (occipital condyle) on concave (superior facets of atlas)
opposite roll and glide/slide
T/F: movements in the transverse plane are limited at the atlanto-occipital joint?
TRUE
limited by deep joint congruency
Atlanto-occpital flexion = occipital condyle roll ______ and glide ________
Atlanto-occipital extension = occipital condyle roll _____ and glide _______
- anterior; posterior
- posterio; anterior
what is the primary osteokinematic motion that occurs at the atlanto-axial joint?
rotation
describe the arthrokinematics at the atlanto-axial joint
inferior facet of atlas/superior facet of axis
gliding → ipsilateral posterior glide with contralateral anterior glide
what limits rotation at the atlanto-axial joint?
alar ligaments
what limits movement in the sagittal plane at the atlanto-axial joint?
inferior facet of atlas/superior facet of axis → no gliding
limited by transverse ligament
atlanto-axial joint tilt instead
what limits tilting of the axis at the atlanto-axial joint with flexion?
transverse ligament
what coupling motion occur in the lower cervical spine?
lateral flexion with rotation coupled in the same direction
what would occur if either lateral flexion or rotation was done in isolation rather than in a coupling motion?
the facet joints would come into contact with one another blocking the motion
describe the arthrokinematics that occur during flexion/extension of C3-C7
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)
describe the arthorkinematics that occur during rotation in C3-C7
same side as rotation = inferior facet glides posterior and slightly inferior
opposite side as rotation = inferior facet glides anterior and slightly superior
descibe the arthrokinematics that occur during lateral flexion of C3-C7
same side - inferior facet glides inferior and slightly posterior
opposite side - inferior facet glides superior and slightly anterior
describe the arthrokinematics of R rotation of C4-5
R (ipsilateral) C4 facet glides posterior and slightly inferior on C5 facet
L (contralateral) C4 facet glides anterior and slighly superior on C5 facet
what is the overall function of the cervical spine?
stability and protection
C-spine demonstrates most flexibility
what are concerns with muscular imbalance and poor posture?
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
what is the benefit of lordotic and kyphotic curves? Drawback?
increased ability to resist compressive load
opportunity for shear forces to act, particularly at regions of transition between curves
what is the role of the vertebral body?
weight-bearing structure of spinal column, resist compressive loads
what is the role of the pedicles?
transmit tension and bending forces from posterior elements to vertebral body
what is the role of the laminae?
transmit force from articular, transverse and spinous processes to the pedicles
what is the pars articularis?
portion of the laminae between the superior and inferior articular processes
subject to bending forces
what is the role of the articular facet processes?
form facet joints and contribute to the articular pillar
what is the role of the spinous process?
serve as a muscle attachment and provide mechanical lever
may also serve as boney block to motion
what is the role of the transverse processes?
serve as muscular attachment and provide mechanical lever
what are some concerns you may have if someone has a bilaterally pars interarticularis fracture?
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
what is the purpose of the intervertebral discs?
- increase available motion
- transmit load
- stabilization of spine
- provide space betwen vertebrae and exiting spinal nerves
What are the components of the intervertebral disc?
- nucleus pulposus
- annulus fibrosus
- vertebral end plate
what is the annulus fibrosus?
fibrous outer ring of the intervertebral disc
60-70% water
collagen and elastin arranged in 15-25 concentric layers
fibers oriented 650 from vertical
what is the role of the annulus fibrosus?
helps keep the nucleus pulposus inbetween the vertebrae
capable of resisting distraction, sheer and torsion forces
what is the vertebral end plate?
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
what can occur with an end plate fracture?
nuclues pulposus starts to herniate
T/F: 80% of force is transmitted through the intervertebral disc
TRUE
what position increase the pressure on the disc the most?
Most = forward bending w/load in front of body
slouching > sitting erect
What motions are available at an interveterbral joint?
- gliding
- AP, ML and torsional
- distraction and compression
- rotation (also called tilt)
- AP, lateral direction
T/F: zygapophyseal (facet) joints do not contain any fibromeniscoids?
FALSE
they do have them
define coupling
consistent association of one motion about an axis with another motion around a different axis
lateral flexion with rotation is an example
what influences spinal coupling patterns?
- spinal posture
- spinal curvature
- orientation of articulating facets
- fluidity/elasticity/thickness of the disc
- extensibility of the muscles, ligaments and joint capsules
describe the kinematic role that intervertebral joints have
- determine magnitude of movement
- distribute load
- create space for movement and passage of the spinal nerve roots
describe the kinematic role of facet joints
determine the direction of the movement
“train tracks”
Spinal osteokinematics decribe the movement based on the direction of what?
superior segment’s anterior portion
(front of inferior facet of the superior vertebrae)
what are the arthokinematic motions that occur at the intervertebral joints with each osteokinematic motion?
- approximation/distraction and gliding
- tipping
what are the arthokinematic motions that occur at each facet joint with each osteokinematic movement?
approximation/gapping and gliding
what is the overall function of the spinal musculature?
- control posture
- stabilize axial skeleton
- protect spinal cord and internal organs
- generate intra-thoracic and intra-abdominal pressure
- produce torque for movement of the body
- mobility of head and neck for optimal place of eyes, ears, and nose
what bones make up the TMJ?
mandible and temporal bone
what is the purpose of the articular disc at the TMJ?
separate upper and lower articulation
cushions the large repetitive force of mastication
describe the articular surfaces of the TMJ joint
articular eminence and mandibular condyle are both convex resulting in incongruent joint
T/F: the TMJ joint is covered in hyaline cartilage
FALSE
covered with fibrocartilage
if both articular surfaces of the TMJ are convex, how does it move?
articular disc is biconcave to allow both surfaces to remain congruent throughout ROM
result → joint is separated into a S/I joint
describe the articulations of the superior and inferior joint in the TMJ
superior ⇒ articular eminence with superior disc
inferior ⇒ condyle with lower disc
what are the attachments of the articular disc at the TMJ?
- medial and lateral poles of condyle
- joint capsule and lateral pyterygoid anterioly
- bilaminar retrodiscal pad posteriorly
what does the attachment of the articular disc on the medial and lateral poles of condyle allow for?
the condyle to rotate freely on the disc in the AP direction
what does the attachment of the articular disc to the joint capsule and lateral pyerygoid at the TMJ allow for?
it restricts posterior translation of the disc
what does the attachment of the articular disc to the bilaminar retrodiscal pad allow for?
superior lamina - assists the disc with translating anteriorly with mandibular depression
inferior lamina - limits forward translation
what is the makeup of the joint capsule of the TMJ?
capsule in thin and loose AP and relatively firm ML
what is the most common direction of dislocation of the TMJ and why?
anterior, due to lack of strength of anteiror capsule and the incongruence of the articular surfaces
name the ligaments of the TMJ and describe their function
- lateral (TM) ligament
- stabilize lateral portion of capsule, help guide movement of condyle during opening
- Sylomandibular ligament
- weakest of 3 with questionable function
- Sphenomandibular ligament
- swinging hinge that suspends the mandible
what is the normal resting position of the TMJ?
lips closed and teeth several mm apart
maintained by low level activity of the temporalis muscle
what are the osteokinematic motions at the TMJ?
- elevation/depression
- protrusion/retrusion
- L/R lateral excursion
how and at which part of the joint does the first part of the mouth opening occur?
50% of motion occurs as rolling the lower joint
posterior roll (depression)
disc remains stationary, condyle on temporal bone is where movement occurs
how and at which part of the joint does the second part of the mouth opening occur?
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
how and at which part of the joint does the first part of mouth closing occur?
50% motion occurs in the upper joint as a posterior glide
how and at which part of the joint does the second part of mouth closing occur?
last 50% of motion occurs in the lower joint as an anterior roll
how and at which part of the joint does protraction of the TMJ occur?
anterior and slighlty inferior glide of condyle and disc
how and at which part of the joint does retraction of the TMJ occur?
posterior and slightly superior glide of the condyle and disc
T/F: no rotation (or rolling) occurs with protrusion and retraction of the TMJ?
TRUE
what occurs on the ipsilateral side during TMJ lateral excursion?
primarily side-to-side translation of condyle and disc within the fossa
ipsilateral condyle glides posteriorly (retrusion)
what occurs on the contralateral side during TMJ lateral excursion
primarily side-to-side translation of condyle and disc within fossa
anterior glide on the contralateral condyle
what muscles and forces act on the TMJ during opening?
- primarily gravity
- digastric
- suprahyoids
- inferior lateral pterygoid
what muscles and forces act on the TMJ during closing?
- temporalis
- masseter
- medial pterygoid
- control of disc vis lateral pterygoid (eccentric control)
what muscles and forces act on the TMJ during protrusion?
- bilaterally superior masseters
- bilaterally M/L pterygoids
what muscles and forces act on the TMJ during retrusion?
- bilaterally posterior fibers of temporalis
- bilateral deep fibers of masseter
- bilateral anterior digastric
what muscles and forces act on the TMJ during lateral excursion?
- contralateral M/L pterygoid (pull condyle forward)
- ipsilateral temporalis (pull condyle posterior)
what is the normal ROM for the different motions of the TMJ?
- opening - 35-55 mm
- function = 25-35 (2 knuckles)
- lateral excursion - 10-15 mm
- protrusion - 3-9 mm
- retrusion - about 3 mm
what is TMD?
a broad/vague term used to describe dysfunctions associated with TMJ
what symptoms are associated with TMD?
- pain
- popping
- reduced bite force
- reduced ROM w/mouth opening
- HA
- tinnitus trigger points
what factors are associated with TMD?
- stress/emotional disturbance
- daily oral parafunction habits (teeth grinding)
- asymmetric muscle activity
- sleep bruxism (teeth clenching during sleep)
- chronic forward head posture
- C-spine pathology
- sensitization of the CNS
describe what is occuring during mouth opening/closing when there is disc replacement with reduction
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
what is a reciprocal click?
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
what is occuring during mouth opening/closing when there is disc displacement without reduction?
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
how does posture and the cervical spine impact the TMJ?
head and neck position may affect tension in cervical muscles which can influence the function of the mandible
what makes ribs T1, T10-12 atypical?
- T1 spinous process is long and prominent
- T12 → thoracic-like superior facet, inferior facets are more lumbar-like
- have full costal facets rather than demifacets
what is the significance of thoracic vertebral pedicles having a different orientation?
they face posteriorly not laterally
results in narrowing of vertebrae canal
what are the available osteokinematic motions at the thoracic spine?
- flexion/extension
- lateral flexion
- rotation
what limits flexion in the thoracic spine?
tension in several ligaments including:
- posterior longitudinal ligament
- ligamentum flavum
- interspinous ligaments
- joint capsule of facets
what limits extension in the thoracic spine?
contact of spinous processes, laminae, facet joints and tension from anterior longitduinal ligament, facet joint capsules and abdominal muscles
what limits lateral flexion in the thoracic spine?
facets and ribs
what limits rotation at the thoracic spine?
rib cage
describe the arthrokinematics for flexion in the thoracic spine at the intervertebral and facet joints
- facet joint
- anterior and superior glide bilaterally
- intervertebral
- anterior tilting of superior vertebrae
describe the arthrokinematics for extension in thoracic spine at the intervertebral and facet joints
- facets
- posterior and inferior glide
- intervertebral
- posterior tilting of superior vertebrae
T/F: flexion and extension are more limited in the lower T-spine than in the upper T-spine
FALSE
more limited in upper T-spin (T1-T6) due to rib cage rigidity and facet orientation
describe the arthrokinematics for L sidebending in the thoracic spine at the facet and intervertebral body joints
- facets
- contralateral facet → superior glide
- ipsilateral facet → inferior glide
- intervertebral body
- lateral tilt to the L
describe the arthrokinematics for R rotation in the upper thoracic spine at the facet and intervertebral body joints
- facet
- contralateral side → anterior slide with superio glide
- ipsilateral side → posterior slide with inferior glide
- interbody
- R rotation
describe the arthrokinematics for L rotation in the lower thoracic spine at the facet and interbody joints
- facets
- contralateral → anterior glide with inferior glide
- ipsilateral → posterior glide with superior glide
- interbody
- rotate to the L
In the upper Thoracic spine how is rotation and side bending coupled?
same direction
R rotation = R side bending
during L rotation in T3-T4, which facet will be gapping and which will be approximating?
- gapping → contralateral
- anterior with superior glide
- approximation → ipsilateral side
- posterior with inferior glide
during L rotation in T8-T9, which facet will be gapping and which will be approximating?
- gapping → ipsilateral side
- posterior with superior glide (side bending to R)
- approximating → contralateral side
- anterior with inferior glide (side bending to R)
what can cause hyperkyphosis?
- trauma
- abnormal growth/development of vertebrae
- severe DDD
- marked osteoporosis
what kind of joints make up the sacroiliac joint?
overall it is a compound joint
- anterior portion → synovial planar
- posterior portion → syndesmosis
what muscles help reinforce the anterior portion of the pubic symphysis?
- transversus abdominis
- rectus abdominis
- internal oblique
- adductor longus
describe the arthrokinematics for flexion in the lumbar spine at the facet and interbody joints
- facets
- anterior and superior gliding (gapping)
- interbody
- anterior tilting
describe the arthrokinematics during extension of the lumbar spine at the facet and interbody joints
- facets
- posterior and inferior glide (approximating)
- interbody
- posterior tilt
where does the greatest amount of motion occur in the lumbar spine?
inferior segments for all sagittal plane motions
describe the arthrokinematics during L3-L4 R sidebending at the facet and interbody joints
- facet
- contralateral side → superior glide
- ipsilateral side → inferior glide
- interbody
- R tilt
how is rotation and side-bending coupled in the lumbar spine?
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
if you are starting with a neutral Lumbar spine
where would facet gapping occur during L sidebending?
- gapping → ipsilateral side (L)
- approximation → contralateral side (R)
describe the arthrokinematics during L rotation of the L2-L3 at the facets and interbody joints
- facets
- contralateral side → anterior slide (approximate if started in neutral)
- ipsilateral side → posterior slide (gap if started in neutral)
- interbody
- L rotation
where does the greatest amount of motion occur for the Lumbar spine with side bending and rotation?
superior lumbar segments
what is lumbo-pelvic rhythm?
the relationship of the lumbar spine and the hip joints that occurs with flexion and extension
what is the normal lumbo-pelvic rhythm for flexion?
initially lumbar flexion followed by anterior tilting of the pelvis
what is lumbo-pelvic rhythm for extension?
posterior tilting of the pelvis followed by lumbar extension
what is a consequence of imparied lumbo-pelvic rhythm?
reduced ROM
what are the 2 phases typical to a situp?
Trunk flexion phase
hip flexion phase
what is an altered pattern that can occur during a situp?
weak abdominals result in early hip flexion due to hip flexors dominance of the activity
what are 3 strategies that should be applied to have better lifting mechanics?
- reduce velocity of lift
- reduce magnitude of external load
- reduce length of extensor moment arm
what terms are used to describe the movement of the pelvis (innominate bones)?
- anterior pelvic tilt → ASIS and pubic move inferiorly
- posterior pelvic tilt → ASIS and pubic move superiorly
what terms describe the movement of the sacrum on the pelvis?
- nutation
- counternutation
what is nutation?
sacral promontory → moves anteriorly and inferiorly
sacral apex → moves posteriorly and superiorly
what is counternutation?
sacral promontory → moves posteriorly and superiorly
sacral apex → moves anteriorly
how does nutation provide stability?
it will result in increased compression of the SI joint making it more stable
how does utilizing a lumbar role during sitting postively impact the lumbar spine?
without one our lumbar spine flexes more which increase the pressure on the anterior disc causing it shift disc material posteriorly
what type of joint is the SC?
functions as a saddle
structurally it is basically a planar
how is the SC joint stabilized?
- a disc between the clavicle and manubrium improves congruency
- Passive stabilizers
- Dynamic stabilizers
List the structures that passively stabilize the SC joint
- fibrous joint capsule
- A/P sternoclavicular ligaments
- Costoclavicular ligament (posterior and anterior bundle)
- interclavicular ligmanet
what motion does the fibrous joint capsule of the SC joint limit?
anterior and posterior translation of medial clavicle
what motion does the A/P sternoclavicular ligament limit?
Anterior = posterior translation of clavicle
Posterior = anterior translation of clavicle
what are the 2 portions of the costoclavicular ligmanet and what do they limit?
Anterior and Posterior bundle
limit elevation of clavicle
contribute to inferior glide of medial clavicle in elevation
shock absorption
what does the interclavicular ligament limit?
excessive depression and superior glide of clavicle
List the structures that dynamically stabilize the SC joint
- SCM
- Sternohyoid
- Sternothyroid
- Subclavius
what osteokinematic motions are available at the SC joint?
- elevation/depression
- protration/retraction
- anterior/posterior rotation
describe the arthrokinematics of the SC joint during elevation/depression
convex on concave
elevation = lateral clavicle rotates upward (superior roll, inferior glide)
depression = lateral clavicle rotates downward (inferior roll, superior glide)
describe the arthrokinematics of the SC joint during protraction/retraction
concave on convex
protraction = lateral clavicle moves anterior (anterior roll and glide)
retraction = lateral clavicle moves posterior (posterior roll and glide)
Describe the SC for the following:
closed pack
open pack
capsular pattern
closed pack = full posterior rotation (full arm elevation)
open pack = arm resting at side
capsular pattern = pain at end range with arm overhead
what is the joint type of the acromioclavicular (AC) joint?
planar synovial
T/F: an AC joint disc is always present
FALSE
it may or may not be there
List the passive structures that support the AC joint
- weak joint capsule
- Superior AC ligament
- Inferior AC ligament
- Coracoclavicular ligaments
- Trapezoid ligaments
- Conoid ligaments
what does the Superior Acromioclavicular ligmanet limit at the AC joint?
resists anterior clavicular/posterior acromion translation
reinforced by deltoid and trapzeius
what do the coracoclavicular ligmanets limit/resist at the AC joint?
limit superior clavicular/inferior scapular translation
and posterior rotation of clavicle
what is the primary function of the AC joint?
allow the scapula to rotate during arm movement
increases UE motion
positions glenoid beneath humeral head
maintains congruency of scapula on thorax
what osteokinematic motions are available at the AC joint?
- internal/external rotation
- A/P tilting (tipping)
- upward/downward rotation
describe the associated arthrokinematics for the osteokinematic motions at the AC joint
none are well defined
how is internal/external rotation of the AC joint important for motion at the scapula?
it maintains contact of scapula on curved thorax during protraction and retraction of clavicle
how is A/P tipping of the AC joint important to scapular motion?
important for maintaining contact of scapula on curved thorax during elevation and depression of clavicle
what is the significance of upward/downward rotation of the AC joint?
important for positioning of glenoid fossa in optimal position
describe the following for the AC joint:
closed pack position
open pack position
capsular pattern
closed pack = arm at 90 degrees
open pack = arm by side
capsular pattern = pain at end range with arm overhead
due to the structure of the AC joint, what injury is it susceptible to?
dislocation due to slopped nature of the articular coupled w/high probability of receiving large shear forces
can lead to development of posttraumatic OA
T/F: the scapulothoracic joint is a true anatomic joint and has all the assocaited structures expected of a synovial joint
FALSE
what osteokinematic motions are available at the scapulothoracic joint?
- primary
- elevation/depression
- protraction/retraction
- upward/downward rotation
- Secondary
- anterior/posterior tilting
- internal/external rotation
what motions occur at the SC and AC joint to allow for scapulothoracic protraction?
SC = protraction
AC = slight IR
what motions occur at the SC and AC joint to allow for scapulothoracic upward rotation?
summation of SC elevation and AC upward rotation
what is the angle of inclination of the GH joint?
130-150 degrees in frontal plane
what is the angle of torsion of the GH joint?
30 degrees posterior in the transverse plane
what is retroversion describing at the GH joint?
the posterior orientation of humeral head with regards to the condyles
increased humeral retroversion may result in what?
increased ER ROM and reduced IR ROM
observed a lot in dominant arm of throwing athletes
list the passive structures that support the GH joint
- Glenoid labrum
- Joint capsule
- S/M/I GH ligaments
- Coracohumeral ligament
describe the characteristics of the GH joint capsule
- significant laxity, minimal stability provided
- reinforced by thicker external ligaments
- inferior portion is slack in ADD position creating an axillary pouch
what is the clincial significance of a tight posterior GH capsule?
linked to shoulder impingement
tightness may produces increased anterior humeral head translation which decreases the subacromial space
what does the superior glenohumeral ligament limit?
ER, anterior and inferior translation at O degrees of abduction
slackens when abducted beyond 35-45 degrees
what does the middle GH ligament limit?
anterior translation from 45-90 degrees abduction
and extremes of ER
what does the inferior GH ligament limit?
primary stabilizer beyond 45 degrees of abduction
stabilizes during combing abduction w/rotation
what does the coracohumeral ligament limit?
downward dislocation
inferior translation and ER of humeral head w/arm hanging at side
list the dynamic structures that support the GH joint
Rotator cuff
what are 2 places the rotator cuff does not reinforce the GH joint?
- inferiorly
- region between subscapularis and supraspinatus (rotator cuff interval)
describe the arthrokinematics for each osteokinematic motion at the GH joint
convex on concave
(roll and glide will be opposite for every motion)
how does shoulder flexion impact the GH joint capsule?
causes tension throughout capsule
slight anterior translation may occur at end range flexion due to tension in posterior capsule
in order for full GH abduction to occur, what else must occur?
ER
what is the closed pack position for the GH joint?
90 degrees abducted and full ER
OR
full abduction and ER
what is the open pack position for the GH joint?
abducted 55 degrees, then horizontally adducted 30 degrees with slight ER
what is the capsular pattern for the GH joint?
ER > ABD > IR
what is the ratio of motion in the scapulohumeral rhythm?
2 degrees of glenohumeral
to
1 degree of scapular motion
what is the ideal shoulder girdle position?
slightly elevated and relatively retracted scapula
*results in glenoid fossa facing slightly upward
List some pathologies that reduce musclar support of the shoudler
- Stroke
- muscular dystrophy
- Guillan-Barre
- impinged nerve
how does gravity effect scapulothoracic posture?
results in depressed, protracted, and excessively downward rotated scapula
what is the impact that rounded shoulders can have on an individual’s shoulder complex?
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
describe how the rhomboids and traps function together
pure retraction
traps tend to elevate scapula and rhomboids tend to depress scapula = neutralized and pure retraction
describe how the deltoid and supraspinatus function together
work to acheive full abduction
if the deltoid is paralyzed, is full abduction of GH possible?
yes, but torque is reduced
if the supraspinatus is paralyzed is full GH abudction possible?
yes but only through compensations and in very specific cases
describe how the supraspinatus and mid trap function together
middle trap functions to stabilize scapula
while supraspinatus ER the shoulder
what would occur if the middle trap was paralyzed?
scapular dyskinesis
scapula would move into IR as the GH ER
describe how the serratus anterior, upper trap and low trap function together
contract simulataneously to produce upward rotation of scapular during GH abduction
how does the infraspinatus, teres minor and subscapularis stabilize the GH joint?
exert a depressive force on humeral head
what is scapular dyskinesia?
any abnormal position or movement of the scapula
alters effectiveness of muscle actions and distorts arthrokinematics resulting in stress
describe the makeup of the elbow’s joint capsule
- large loose and weak (A/P)
- reinforced laterally by collateral ligaments
what is the normal carrying angle of the elbow?
8-15 degrees
what is the purpose of the carrying angle at the elbow?
allows for a person to carry an object away from side of the thigh
list the passive structures that reinforce the elbow joint
- medial (ulnar) collateral ligaments
- A/P Transverse
- Lateral (radial) collateral ligaments
- lateral ulnar collateral ligament
- annular ligament
what does the A/P transverse ligament do at the elbow?
stabilizes against valgus torque at the elbow and limits elbow extension at end ROM
what is the role of the annular ligament?
stabilizes against varus torque at the elbow and combined varus and supination torques
what osteokinematic motions are available at the humeroulnar and humeroradial joint?
flexion/extension
describe the arthrokinematics at the humeroulnar and humeroradial joint
concave on convex
roll and slide in same direction
At the humeroulnar joint, what is the:
closed pack position
open pack position
capsular pattern
closed = full extension and supination
open = flexed 70 degrees, supinated 10 degrees
capsular pattern = flexion > extension
at the humeroradial joint, what is the following:
closed pack position
open pack position
capsular pattern
closed = 90 degrees of elbow flexion and 5 degrees of supination
open = full extension and supination
capsular pattern = flexion > extension
what types of joints are the proximal and distal radioulnar?
synovial pivot
how is the arthrokinematics different at the proximal and distal radioulnar?
proximal = convex on concave
distal = concave on convex
describe the following for the proximal radioulnar joint:
closed pack position
open pack position
capsular pattern
closed pack = 5 degrees supination
open = 70 degrees flexion and 35 degrees supination
capsular pattern: supination = pronation
describe the following for the distal radioulnar joint:
closed pack position
open pack position
capsular pattern
closed = 5 degrees supination
open = 10 degrees supination
capsular pattern: supination = pronation
how do we produce the most torque for elbow flexion at the elbow?
supinated position
increased flexor moment arm of biceps and brachioradialis when forearm is supinated
what is the workhorse of the elbow?
brachialis
can produce equal force regardless of position
describe the synergy between the triceps and anterior deltoid
ant deltoid synergizes with triceps during elbow extension
this will counter shoulder extension potential of triceps
what muscle is primarily activated with low level supination?
supinator
what role does the triceps play during forceful supination?
must co-contract to prevent the biceps from actually flexing the elbow and shoulder during supination effort
what muscle is primarily activated during low level pronation?
pronator quadratus
what role does the triceps play during forceful supination?
acts as a synergist to counter tendency of biceps brachii to flex elbow
what are 2 points of consensus with regards to the wrist complex?
- structure and biomechanics of wrist and hand vary tremondously from person to person
- even subtle variations can produce differences in the way a given function occurs
what bones make up the radiocarpal joint?
radius with schapoid, lunate, and triquetrum
what makes up the 2-joint system in the wrist?
radiocarpal joint
midcarpal joint
what is the benefit of the 2 joint system in the wrist?
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
what is the function of the TFCC (triangular fibrocartilage complex)?
binds distal ends of ulna and radius while allowing radius to rotate around fixed ulna
what is beneath the extensor retinaculum?
6 fibro-osseus compartments
what are the factors that contribute to carpal tunnel syndrome?
- overcrowding (9 extrinisic flexor tendons + median nerve)
- excessive mechanical stress
- fibrotic changes of CT
what osteokinematic motions are available at the radiocarpal and midcarpal joints?
flexion/extension
radial/ulnar deviation
describe the arthrokinematics that occur at the radiocarpal and midcarpal joints
convex on concave = roll is opposite of slide
what is the closed/open pack position and capsular pattern for the radiocarpal joint?
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
what is the main function of the wrist extensors?
- position and stabilize wrist in activities that require active flexion of digits (making a fist)
- act to counterbalance wrist flexor torque
List the joints in the hand
- CMC
- MCP
- IP
- DIP
what osteokinematic motions are available at the 1st CMC joint?
flexion/extension
abduction/adduction
opposition/reposition
describe the arthrokinematics at the 1st CMC joint
flexion/extension = concave on convex (M/L roll with glide)
ADB/ADD = convex on concave
what is the open/closed pack position and capsular pattern for the 1st CMC joint?
closed pack = full opposition
open pack = midway between flx/ext and abd/add
capsular pattern = abduction
what is the open/closed pack position and capsular pattern for 2-5 CMC joints?
closed = full flexion
open = midway between flx/ext
capsular pattern = not really defined
describe the arthrokinematics at the MCP joints
concave on convex
roll and glide same direction
describe the arthrokinematics at the IP joints
concave on convex
palmar/dorsal roll with anterior/posterior glide
(in same direction)
what is the open/closed pack position and capsular pattern for the MCP joints?
closed = full flexion
open = slight flexion
capsular pattern: flexion = extension
what is the open/closed pack position and capsular pattern for IP joints?
closed = full extension
open = slight flexion
capsular pattern: equal loss of flexion and extension
what is the function of the flexor mechanism?
prevent bowstringing the tendons w/contraction of extrinsic finger flexors
(these refer to the flexor pulleys embedded within fibrous digital sheaths)
describe the anatomy of the extensor mechanism
- Distal to wrist they lack digital sheath or pulley system. Tendons become integrated into fibrous extensor expansion
What is the normal angle of inclination for the hip?
~125°
what is coxa valva?
pathological increased angle of inclination (>125°)
what is coxa vara?
pathological decreased angle of inclination (<125°)
what are some factors that can contribute to an increased risk of slipped capital femoral epiphysis?
high BMI
coxa vara
how does a high BMI and coxa vara increase the risk for slipped capital femoral epiphysis?
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.
what is considered a normal degree of anteversion at the hip?
8-20°
excessive anteversion reduces _________
hip stability
what is excessive anteversion associated with? (mobility)
increased hip IR
decreased hip ER
excessive retroversion may cause __________
hip impingement
excess retroversion is associated with what? (mobility)
increased hip ER
decreased hip IR
List some common acetabular abnormalities
- acetabular dysplasia
- coxa profunda (acetabular over coverage)
- anteversion
- retroversion
what is a CAM lesion?
extra bone at anterior-superior region of femoral head and neck junction
what is a pincer deformity?
abnormal bony extension of anterior lateral rim of acetabulum
what motions would provoke an impingement with either a CAM lesion or a Pincer deformity?
Hip IR with flexion
List structures that support the hip
- strong joint capsule
- iliofemoral ligament
- pubofemoral ligament
- Ischiofemoral ligament
- transverse acetabular ligament
- acetabular labrum
- ligamentum teres
which ligaments of the hip provide protection to blood vessels?
transverse acetabular ligament
ligamentum teres
what is the trabecular system? Why do we have it?
it is a structural adaptation to weight bearing.
it allows us to provide structural resistance to bending force
where is the joint capsule strong and weak at the hip?
strong = anterosuperiorly
weak = posterior and inferiorly (dislocations are more common in these directions)
what is the role of the acetabular labrum?
since it is wedge shaped it deepens concavity and improves congruency at the hip
acts as a seal to maintain negative intraarticular pressure
what motion can potentially injury the ligamentum teres?
excessive ER can strain/potentially tear it
describe the arthrokinematics of the hip during an OKC motion
Convex on Concave
opposite roll and slide
describe the arthrokinematics of hip IR/ER during an OKC motion
IR = anterior roll, posterior glide
ER = posterio roll, anterior glide
describe the arthrokinematics of the pelvic during an CKC movement
Concave on Convex
roll and glide in same direction
What osteokinematic movements are available at the pelvis?
A/P pelvic tilt
lateral pelvic tilt (pelvic hike/drop)
Forward/backward rotation
describe the motion of both the contralateral and ipsilateral femur when the pelvis is hiked to the R
ipsilateral (R) = adducted
contralateral (L) = abducted
describe the motion of both the ipsilateral and contralateral femur when the pelvis drops to the R
ipsilateral (R) = abduction
contralateral (L) = adduction
describe the open pack and capsular pattern of the hip joint
open pack = 30° flexion, 30° abduction, neutral to slight ER
capsular pattern: equal loss of IR w/flexion and abduction
what muscles help with performing an anterior pelvic tilt?
hip flexors
back extensors
what muscles help with performing a posterior pelvic tilt?
abdominal muscles
hip extensors
T/F: when performing a single leg raise, your abdominals are not involved. Why/Why not?
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
what is the Tredelenberg sign?
contralateral hip drop during walking
indicates glute medius weakness on the stance leg
in order to maximze a hamstring stretch, what should be done at the pelvis?
an anterior pelvic tilt
in order to maximze a rectus femoris stretch, what should be done at the pelvis?
posterior pelvic tilt
what is considered normal for tibiofemoral alignment?
femoral shaft 170-175° laterally from tibial shaft
what is genu varum?
bowlegged
angle is >180°
what is genu valgus?
knock knees
angle is <165°
during genu varum, what tibiofemoral compartment is compressed?
medial compartment
during genu valgus what tibiofemoral compartment is compressed?
lateral compartment
what factors can lead to genu valgus?
- previous injury
- genetic predisposition
- high BMI
- laxity of ligaments
- abnormal alignment and muscle weakness at either end of the LE
what factos can lead to genu varum?
- previous injury
- genetic predisposition
- laxity of ligaments
- abnormal alignment and muscle weakness at either end of the LE
- thinning of articular cartilage on medial side
what might result from genu varum?
- increased medial compartment loading
- greater loss of medial joint space
- increased strain on LCL
what might result of genu valgum?
- increased stress on MCL
- increased stress on lateral comparment
- excessive lateral tracking of patella
- increased stress on ACL
what is genu recurvatum?
tibiofemoral hyperextension greater than 10°
stress is placed on posterior capsule and knee flexors
where does the M/L meniscus attach?
medial = MCL, ACL, PCL and semimembranosus
lateral = ACL, PCL, popliteus
what is the function of the meniscus?
- distribute weight bearing forces
- increase joint congruency
- shock absorption
what motions does the ACL restrict?
- anterior translation of the tibia on femur
- knee hyperextension
- varus and valgus stresses
- tibial rotation medially and laterally
what motions does the PCL restrict?
- posterior translation of the tibia on femur
- varus and valgus stresses
- tibial rotation medially
what motions does the MCL restrict?
- valgus force
- lateral tibial rotation
- anterior translation of tibia on femur
what motions does the LCL restrict?
- varus stresses
- tibial lateral rotation
what osteokinematic motions are available at the tibiofemoral joint?
- flexion/extension
- abduction/adduction
- IR/ER
describe the arthokinematics of the tibiofemoral joint during a CKC motion
convex femoral condyle moves on concave tibial plateau
opposite roll and glide
describe the arthrokinematics of the tibiofemoral joint during an OKC movement
concave tibial plateau moves on convex femoral condyle
roll and glide in same direction
what occurs during the screw home mechanism at the knee?
10° of tibial ER
needed for terminal knee extension
what occurs during the unlocking mechanism of the knee joint?
popliteus IR the tibia prior to flexion
what is the open pack position and capsular pattern of the tibiofemoral joint?
open pack = 25° flexion
capsular pattern = loss of flexion before extension
prior to knee flexion, describe the joint congruency of the patella and femur
minimal joint congruency as the patella lies in the femoral sulcus during full extension
how does the joint congruency of the patella and femur change as the knee flexes?
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
how is the patella a necessary and significant structure?
it functions as pulley for the quad
it increases the internal moment arm of the knee extensor mechanism = we need less force to extend
what static structures support the patella?
- M/L patellofemoral ligament
- M/L patellotibial ligament
- Trochlear groove
describe the motions of the patella
- S/I glide
- M/L glide
- M/L tilt
- M/L rotation
when does S/I glide of the patella occur?
superior = knee extension
inferior = knee flexion
List from least to greatest, which movements put the greatest amount of compressive force on the patellofemoral joint
- walking (1.3x BW)
- climbing stairs (3.3x BW)
- squatting (7.8x BW)
what is the Q angle?
an estimation of the line of pull of the quads
normal = 13-15°
increased Q angle ___ ____ _____on the patell
increases lateral force
list some local factors that limit lateral pull of the patella
- raised lateral facet of trochlear groove
- quadriceps (VMO in particular)
- medial patellar retinaculum fibers
- medial passive structures
list some local factors that contribute to lateral pull of the patella
- tight IT band
- excession tension in lateral patellar retinacular fibers
- excessive tension in lateral passive structures
list some global factors that contribute to lateral patellar pull
- excessive genu valgum increases Q angle
- weakness of hip ER or abductor muscles
- tightness of hip IR or adductor muscles
- excessive pronation of subtalar joint
what is a recommendation for weight bearing exercises for someone with patellofemoral pain syndrome?
avoid deep flexion
what is a recommendation for non-weight bearing exercises for someone with patellofemoral pain syndrome?
avoid final 30° of extension
what forms the Q angle?
line connected ASIS to middle of patella
line connecting tibial tuberosity to middle of patella
what stabilizes the proximal tibiofibular joint?
- joint capsule
- anterior tibiofibular ligament
- posterior tibiofibular ligament
what stabilizes the distal tibiofibular ligament?
- No joint capsule
- A/P tibiofibular ligament
- Interosseus membrane
what is injured during a high ankle sprain?
distal tibiofibular joint
what motions are available at the proximal and distal tibiofibular joint?
- A/P glide
- S/I glide
- IR/ER
what is the open pack position for the tibiofibular joint?
10° plantarflexion
where is the deltoid ligament and what does it limit?
medial ankle
limits eversion/pronation
what is the lateral collateral ligament of the ankle made up of?
3 ligaments:
- anterior talofibular ligament
- calcaneofibular ligament
- posterior talofibular ligament
what does the lateral collateral ligament of the ankle limit?
inversion and supination
what muscles limit eversion/pronation of the ankle?
tibialis posterior
flexor hallucis longus
flexor digitorum longus
what muscles limit inversion/supination at the ankle?
Fibularis longus and brevis
what muscles limit dorsiflexion at the ankle?
gastrocnemius and soleus
what muscles limit plantarflexion at the ankle?
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
what is the most stable position for the ankle?
dorsiflexion (wider base is wedged between the tibiofibular motise)
describe the osteokinematics with the arthrokinematics of the talocrural joint
Dorsiflexion = anterior roll with posterior glide
Plantarflexion = posterior roll with anterior glide
what is the arthrokinematic rule during OKC motion at the talocrural joint?
convex talus moves on concave tibiofibular mortise
what is the open pack position and capsular pattern for the talocrural joint?
open pack = 10º plantarflexion w/neutral inversion/eversion
capsular pattern = loss of plantarflexion greater than dorsiflexion
in what position is the foot more stable/mobile?
pronation = more mobile
supination = more stable
what is the purpose of pronation at the ankle?
allows more mobility which allow for:
- a decrease in impact from weight-bearing forces
- dampen superimposed rotational motions
- the ankle to adapt to changes in supporting surfaces and terrains
what is the purpose of supination at the ankle?
allows the arches to be stable enough to allow for:
- distribution of weight through the foot for proper weight bearing
- convert the flexible foot to a rigid lever
what is the function of the plantar fascia?
tightens up when the toes are extended to provide support to the medial longitudinal arch.
aids in the windless effect
describe the osteology and joint type of the subtalar joint
talus on calcaneus
made up of 3 ovoid synovial joints
what moves on what during weight bearing at the subtalar joint?
talus moves on calcaneus
during weight bearing, what motions couple to allow for supination?
- calcaneus inverts
- talus abducts
- talus dorsiflexes
- tibiofibular lateral rotation
during weight bearing, what motions couple to produce pronation?
- calcaneus everts
- talus adducts and plantarflexes
- tibiofibular medial rotation
what moves on what during non-weight bearing motions at the subtalar joint?
calcaneus moves on the talus
during non-weight bearing motions, what movements couple together to produce supination at the subtalar joint?
calcaneus adduction, inversion, and plantarflexion
during non-weight bearing motions, what movements couple together to produce pronation at the subtalar joint?
calcaneus abduction, dorsiflexion and eversion
what is a valgus movement at the calcaneus?
calcaneal eversion
what is a varus movement at the calcaneus?
calcaneal inversion
how would pronation at the subtalar joint impact the joints higher up?
medial rotation of knee and hip
how would supination at the subtalar joint impact joints above?
lateral rotation of hip and knee
what is the open pack position and capsular pattern for the subtalar joint?
open pack = mid inversion/eversion and mid plantarflexion/dorsiflexion
no capsular pattern
what joints make up the transverse tarsal joint?
talonavicular joint
calcaneocuboid joint
what is the open pack position for the transverse tarsal joint?
midrange of supination/pronation
describe the osteokinematics of the MTP joints
flexion/extension
abduction/adduction
what is the arthrokinematic rule for the MTP joints?
Concave on Convex
roll and glide in same direction
what is the open pack position and capsular pattern for the MTP joints?
open pack = 10° extension
capsular pattern: 1st MTP extension > flexion
2-5 loss of flexion
what is hallux limitus
Turf Toe
a condition marked by gradual and significant limitation in motion along with articular degeneration and pain
what is hallux valgus
bunion deformity
progressive lateral deviation of great toe
what is the main function of the IP joints?
maintain stability by pressing against the ground in standing
what is the arthokinematic rule for the IP joints?
Concave on Convex
roll and glide in same direction
what is pes planus?
“flat feet”
abnormally dropped medial longitudinal arch
what are some possible causes of pes planus?
assocaited with over stretched, torn or weakened plantar fascia, spring ligament, and/or tibialis posterior tendon
what is pes cavus?
over supination
abnormally raised medial longitudinal arch
what are some possible causes for pes cavus?
associated with excessive rearfoot varus (inversion)
what is the rol of the posterior tibialis tendon during gait?
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
describe the arthrokinematics at the atlanto-occipital joint?
convex (occipital condyle) on concave (superior facets of atlas)
opposite roll and glide/slide
describe the arthrokinematics at the atlanto-axial joint
inferior facet of atlas/superior facet of axis
gliding → ipsilateral posterior glide with contralateral anterior glide
describe the arthrokinematics that occur during flexion/extension of C3-C7
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)
describe the arthorkinematics that occur during rotation in C3-C7
same side as rotation = inferior facet glides posterior and slightly inferior
opposite side as rotation = inferior facet glides anterior and slightly superior
descibe the arthrokinematics that occur during lateral flexion of C3-C7
same side - inferior facet glides inferior and slightly posterior
opposite side - inferior facet glides superior and slightly anterior
describe the arthrokinematics of R rotation of C4-5
R (ipsilateral) C4 facet glides posterior and slightly inferior on C5 facet
L (contralateral) C4 facet glides anterior and slighly superior on C5 facet
what are the arthokinematic motions that occur at the intervertebral joints with each osteokinematic motion?
- approximation/distraction and gliding
- tipping
what are the arthokinematic motions that occur at each facet joint with each osteokinematic movement?
approximation/gapping and gliding
T/F: no rotation (or rolling) occurs with protrusion and retraction of the TMJ?
TRUE
what occurs on the ipsilateral side during TMJ lateral excursion?
primarily side-to-side translation of condyle and disc within the fossa
ipsilateral condyle glides posteriorly (retrusion)
what occurs on the contralateral side during TMJ lateral excursion
primarily side-to-side translation of condyle and disc within fossa
anterior glide on the contralateral condyle
describe the arthrokinematics for flexion in the thoracic spine at the intervertebral and facet joints
- facet joint
- anterior and superior glide bilaterally
- intervertebral
- anterior tilting of superior vertebrae
describe the arthrokinematics for extension in thoracic spine at the intervertebral and facet joints
- facets
- posterior and inferior glide
- intervertebral
- posterior tilting of superior vertebrae
describe the arthrokinematics for L sidebending in the thoracic spine at the facet and intervertebral body joints
- facets
- contralateral facet → superior glide
- ipsilateral facet → inferior glide
- intervertebral body
- lateral tilt to the L
describe the arthrokinematics for R rotation in the upper thoracic spine at the facet and intervertebral body joints
- facet
- contralateral side → anterior slide with superio glide
- ipsilateral side → posterior slide with inferior glide
- interbody
- R rotation
describe the arthrokinematics for L rotation in the lower thoracic spine at the facet and interbody joints
- facets
- contralateral → anterior glide with inferior glide
- ipsilateral → posterior glide with superior glide
- interbody
- rotate to the L
In the upper Thoracic spine how is rotation and side bending coupled?
same direction
R rotation = R side bending
describe the arthrokinematics for flexion in the lumbar spine at the facet and interbody joints
- facets
- anterior and superior gliding (gapping)
- interbody
- anterior tilting
describe the arthrokinematics during extension of the lumbar spine at the facet and interbody joints
- facets
- posterior and inferior glide (approximating)
- interbody
- posterior tilt
describe the arthrokinematics during L3-L4 R sidebending at the facet and interbody joints
- facet
- contralateral side → superior glide
- ipsilateral side → inferior glide
- interbody
- R tilt
how is rotation and side-bending coupled in the lumbar spine?
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
if you are starting with a neutral Lumbar spine
where would facet gapping occur during L sidebending?
- gapping → ipsilateral side (L)
- approximation → contralateral side (R)
describe the arthrokinematics during L rotation of the L2-L3 at the facets and interbody joints
- facets
- contralateral side → anterior slide (approximate if started in neutral)
- ipsilateral side → posterior slide (gap if started in neutral)
- interbody
- L rotation
during L rotation in T3-T4, which facet will be gapping and which will be approximating?
- gapping → contralateral
- anterior with superior glide
- approximation → ipsilateral side
- posterior with inferior glide
during L rotation in T8-T9, which facet will be gapping and which will be approximating?
- gapping → ipsilateral side
- posterior with superior glide (side bending to R)
- approximating → contralateral side
- anterior with inferior glide (side bending to R)
describe the arthrokinematics of the SC joint during elevation/depression
convex on concave
elevation = lateral clavicle rotates upward (superior roll, inferior glide)
depression = lateral clavicle rotates downward (inferior roll, superior glide)
describe the arthrokinematics of the SC joint during protraction/retraction
concave on convex
protraction = lateral clavicle moves anterior (anterior roll and glide)
retraction = lateral clavicle moves posterior (posterior roll and glide)
describe the associated arthrokinematics for the osteokinematic motions at the AC joint
none are well defined
how is internal/external rotation of the AC joint important for motion at the scapula?
it maintains contact of scapula on curved thorax during protraction and retraction of clavicle
how is A/P tipping of the AC joint important to scapular motion?
important for maintaining contact of scapula on curved thorax during elevation and depression of clavicle
what is the significance of upward/downward rotation of the AC joint?
important for positioning of glenoid fossa in optimal position
what motions occur at the SC and AC joint to allow for scapulothoracic protraction?
SC = protraction
AC = slight IR
what motions occur at the SC and AC joint to allow for scapulothoracic upward rotation?
summation of SC elevation and AC upward rotation
describe the arthrokinematics for each osteokinematic motion at the GH joint
convex on concave
(roll and glide will be opposite for every motion)
describe the arthrokinematics at the humeroulnar and humeroradial joint
concave on convex
roll and slide in same direction
how is the arthrokinematics different at the proximal and distal radioulnar?
proximal = convex on concave
distal = concave on convex
describe the arthrokinematics that occur at the radiocarpal and midcarpal joints
convex on concave = roll is opposite of slide
describe the arthrokinematics at the 1st CMC joint
flexion/extension = concave on convex (M/L roll with glide)
ADB/ADD = convex on concave
describe the arthrokinematics at the MCP joints
concave on convex
roll and glide same direction
describe the arthrokinematics at the IP joints
concave on convex
palmar/dorsal roll with anterior/posterior glide
(in same direction)
describe the arthrokinematics of the hip during an OKC motion
Convex on Concave
opposite roll and slide
describe the arthrokinematics of hip IR/ER during an OKC motion
IR = anterior roll, posterior glide
ER = posterio roll, anterior glide
describe the arthrokinematics of the pelvic during an CKC movement
Concave on Convex
roll and glide in same direction
describe the arthokinematics of the tibiofemoral joint during a CKC motion
convex femoral condyle moves on concave tibial plateau
opposite roll and glide
describe the arthrokinematics of the tibiofemoral joint during an OKC movement
concave tibial plateau moves on convex femoral condyle
roll and glide in same direction
what is the arthrokinematic rule during OKC motion at the talocrural joint?
convex talus moves on concave tibiofibular mortise
describe the osteokinematics of the MTP joints
flexion/extension
abduction/adduction
what is the arthrokinematic rule for the MTP joints?
Concave on Convex
roll and glide in same direction
what is the arthokinematic rule for the IP joints?
Concave on Convex
roll and glide in same direction
how will a tight capsule impact motion?
it will cause early and excessive accesory motion in the opposite direction of the tightness
injury to a joint/structures surrounding a joint will often lead to what?
- pain
- loss of motion
- excessive motion
what does the term open pack position mean?
- surrounding tissue is as lax as possible
- maximal incongruency
- intracapsular space is as large as possible
- maximal amount of joint play available
describe what is meant by the closed pack position
- joint position where joint is most congruent
- surrounding tissue (capsule and ligaments) under maximal tension
- maximal stability of joint
when assessing joint mobility what 3 things are looked at?
- gross (quantity of movement)
- end-feel (quality of movement)
- provocation
what is the current classification scale used for joint mobility?
hypomobile
normal
hypermobile
what is meany by the term hypomobile?
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)
what is meant by the term hypermobile?
joint moves beyond its anatomical limit due to laxity of surrounding structures
what are some indications for joint mobilizations?
- break pain cycle
- increase joint extensibility
- increase extensibility of tendons, muscle, and fascia
- increase joint ROM
- promote muscle relaxation
- improve muscle performance
what 3 categories cover the benefits of joint mobilizations?
- biomechanical improvements
- nutritional effects
- neurophysiological effects
what are the neurophysiological effects of joint mobilizations?
- stimulates mechanoreceptors to inhibit pain impulses
- gate control theory
- descending pathway inhibition theory
- peripheral inflammation modulation
what is the gate control theory?
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
what type of joint mobilization is associated with the descending pathway inhibition theory?
grave V mobilization
stimulates the PAQ which results in serotonin secretion and decreased pain
list some absolute contraindications to joint mobilizations
- malignancy in area of treatment
- infectious arthritis
- fusion of joint
- fracture at the joint
- practioner lack of skill
- neurological deterioration
- upper cervical spine instability
- cervical arterial dysfunction
list some relative contraindications for joint mobilizations
- excessive pain or swelling
- arthroplasty
- hypermobility
- OA
- Spondylolisthesis
when are joint mobilizations most effective?
when they are followed up by a comprehensive treatment plan including strengthening of some kind
joint play comes in 3 types of movements. What are they?
- Compression - perpendicular to joint surface
- Traction/Distraction - perpendicular to joint surface
- Gliding - parallel to joint surface
what are the types of joint mobilizations?
- Distractions
- Oscillation mobilizations
- sustained hold mobilizations
- mobilizations with no movements
what/how many grades are there for distraction mobilizations?
Three
- Grade I = piccolo (loosen)
- Grade II = slack (take up the slack)
- Grade III = stretch
what is a Grade I Distraction Mobilization?
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
what is a Grade II distraction mobilization?
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
what is a Grade III distraction mobilization?
designed to stretch the joint capsule and soft tissues surrounding the joint to increase mobility
trying to get into the plastic region
what region of the stress strain curve do each distraction mobilizations take place?
- grade 1 = toe region
- grade 2 = elastic region
- grade 3 = plastic region
how many grades are there for oscillation joint mobilizations?
5
per Maitland Oscillation Joint Mobilization
describe a grade I Maitland Oscillation Joint Mobilization
small amplitude technique performed at beginning of available ROM (first 25%)
describe a grade II Maitland Oscillation Joint Mobilization
large amplitude technique performed in middle of available ROM (middle 50%)
(going from 25-75%, back and forth)
what is the goal of Grade I and II Maitland Oscillation Joint Mobilizations?
pain and spasm reduction
describe a grade III Maitland Oscillation Joint Mobilization
large amplitude technique performed at end of availabel ROM (last 50%)
(going from 50-100%, back and forth)
describe a grade IV Maitland Oscillation Joint Mobilization
small amplitude technique performed at end of availabel ROM (last 25%)
(going from 75-100%, back and forth)
what is the goal of Grade III and IV Maitland Oscillation Joint Mobilizations?
stretch joint capsule and associated structures
what is the theory behind pain reduction from Grades I and II Maitland Oscillation Joint Mobilizations?
reduces pain by:
- improving joint lubrication and circulation to tissues related to joint
- rhythmic oscillations possibly activate articular and skin mechanoreceptors which play a role in pain reduction
T/F: Grades I and II influence mechanical nociception?
TRUE
what are the effects of Grades III and IV Maitland Oscillation Joint Mobilizations?
- stretches capsule and associated structures
- mechanical and neurophysiological effects
- may activate inhibitory joint and muscle spindle receptors to aid in reducing restriction of movement
Describe a grade V Maitland Oscillation Joint Mobilization
high velocity thrust of small amplitude at end of available range but within its anatomical range
movement that exceeds the resistance barrier
what are the 5 principles of diagnosis for soft tissue injuries?
- look for “inherent likelihoods”
- look for objective physical signs
- Palpation
- selective tensionoing: non-contractile vs contractile tissue
- The “pain” is the pain for which the pt. is seeking treatment
T/F: palpation is helpful but can be unreliable
TRUE
some things are just naturally tender to palpate which can often be misinterpreted
list different types of contractile tissues
- tendons
- muscles
- musculotendinous junction
- bone adjacent to attachment of tendon
a contractile tissue will have stress with what 3 tests/things?
- isometric contraction
- stretching
- palpation
List different non-contractile tissues
- joint capsules
- ligaments
- bursae
- aponeuroses
- nerves
a non-contractile tissue will have stress with what?
- stretch
- palpation
*no increase in discomfort/stress with isometric contraction
when testing active and passive movements, what things should you observe/look for?
- pain
- ROM
- quality of movement
- willingness to move
- compare AROM, PROM, resistance testing and palation between involved and uninvolved side
T/F: you do not need to manually test a muscle through it’s full ROM
It depends
only to rule out/rule in a suspicous area
when palpating a stationary joint what things are you looking for?
- temperature
- swelling
- gaps
- tenderness
- pulsation
when palpating a moving joint what things are you looking for?
- crepitus
- clicks
- end-feel
- hypermobility
- hypomobility
- willingness to move
- pain
what can you use to help you make a decision/diagnosis when the pt is in severe or slight pain?
- pt. history
- functional testing - try to recreate their pain in a motion
- ask them to return when symptom returns
what AROM results should you expect for a muscle/tendon strain, tendonitis or possible small tear?
likely limited due to pain and/or weakness
may be able to move through full ROM but with pain
what PROM results should you expect from a muscle/tendon strain, tendonitis or possible small tear?
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)
what isometric/MMT results should you expect from a muscle/tendon strain, tendonitis or possible small tear?
likely weak and painful when testing involved area
what palpation results should you expect when testing a muscle/tendon strain, tendonitis or possible small tear?
involved area painful to palpation
what AROM results should you expect from a muscle or tendon complete tear?
very limited due to weakness
likely not as much pain as seen w/partial tear, but much more weakness
what PROM results should you expect from a muscle or tendon complete tear?
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
what isometric/MMT results should you expect from a muscle or tendon complete tear?
extremely weak
what palpation results should you expect from a muscle or tendon complete tear?
involved area painful to palpation
what AROM results should you expect to see from a joint capsule injury?
limited
possibly painful at end ranges
what PROM results should you expect to see from a joint capsule injury?
limited in same direction as AROM with firm end feel
possibly painful at end ranges
what Isometrics/MMT results should you expect to see in a joint capsule injury?
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
what Palpation results should you expect to see in joint capsule injury
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
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
FALSE
can still be the joint capsule even if it doesn’f follow the capsular pattern.
