LECTURE TEST 1 Flashcards
Name the three main types of joints
1) SYNARTHRODIAL—FIBROUS—NONMOVING
2) AMPHIARTHRODIAL – CARTILAGINOUS- SLIGHT MOVEMENT
3) DIARTHRODIAL- SYNOVIAL- FREELY MOVING
Name the three types of Synarthrodial joints and give examples of each
A) synarthrosis or suture joints– example: sutures of the skull
B) syndesmosis or ligamentous joint— example: interrossei jnt between radius/ulna & tibia/fibula
C) gomphosis or Bolting together joint —- example:bolting together of peg(tooth) in socket(upper &lower jaws)
Name the two types of amphiarthrodial joints
A) fibro-example intervertebral disc,symphysis pubis
B) hyaline- example first sternocostal,sternoclavicular jnt.
Name the six types of diarthrodial joints
A)Irregular/plane/irregular/or nonaxial joints – example: intercarpal jnts. B) Hinge/uniaxial joints- flexion/extension only- example: knee/elbow C) Pivot/ uniaxial – rotation only - example atlas/axis, radius/ulna D) Condyloid/ biaxial joints- flex/ext, abb/add – example- wrist,MP joints E) Saddle /biaxial joint - flex/ext, abb/add, some rotation-example- first CMC (thumb) F) Ball and socket /triaxial joints- flex/ext, abb/add, and rotation- example-hip/shoulder
A surface containing all straight lines connecting any two points on it.
PLANE
Name the three planes and how the bisect
Sagittal plane - bisects the body into L & R. (Midsagittal is located centrally)Horizontal (Transverse) - bisects the body into superior and inferiorCoronal (frontal) - bisects the body into anterior and posterior
Movements of the Sagittal Plane
Flexion/Extension
Movements of the Coronal Plane
Motions of Abduction and adduction, lateral bending, hip hiking, ulnar deviation, etc., occur in this plane
Movements of the transverse plane
rotation and pronation/supination of the ulna/radius
Define Cardinal plane
Any plane that intersects at the midline
Center of Gravity
Where all three cardinal planes intersect is the Center of Gravity- Approximately S2 or S1 - Higher in males- COG moves: depends on BOS, load, etc.; moves where weight is concentrated
Axis
<p>A straight line about which an object rotates or may be conceived to rotateA point that runs through the center of a joint around which a part rotates An Axis is Named according to its orientation in space
</p>
Frontal (Horizontal-Lateral) Axis
A line passes side to side horizontally in the frontal/coronal planeMovement around this line is in the sagittal planeFlexion and Extension from anatomical position is permitted
Sagittal (Horizontal anterior posterior) Axis
A line passes anterior to posteriorMovement around this line is in the frontal/ coronal planeAbduction/Adduction or spinal side-bending from anatomical position is permitted
Vertical Axis
- Line runs superior to inferior.- Movement in horizontal plane- Rotation, pronation, supination from anatomical position
4 principles of planes and axes
There are 3 planesEach plane is always perpendicular (at right angles) to the other two planes.
An axis is ALWAYS perpendicular to a plane.
Movement (motion) takes place WITHIN a plane and AROUND an axis
Talk about knee movement
PARTIAL A=Longer medial femoral condyle B=medial rotation of femur during locking in wt. bearing C= external rotation of tibia in locking in open chain
Ankle and foot motions (6)
A=dorsiflexion
B=plantar flexion
C=inversion: raises medial border
D=eversion: raises lateral border
E=adduction
F=abduction
Protraction/Retraction
e.g. scapula
Elevation/Depression
e.g. scapula
Ulnar/Radial deviation
e.g. wrist
Supination/Pronation
e.g. foremarm
Inversion/Eversion
e.g. foot
Plantar/Dorsiflexion
e.g. foot
Oppostion
e.g. thumb at CMC joint
Upward/Downward Rotation
Movement of Scapula
Thumb motions (5)
A= extension B= flexion C=opposition- best to show PAD TO PAD rather than tip to tip D= adduction E= abduction
Metacarpophalangeal Motions
- Flex/Ext
2. Ab/Adduction
Hip Motions
- Anterior pelvic tilt (increases low back curve / “cave”) Back extensors pull up as the hip flexors pull down
- Posterior pelvic tilt (flattens low back) Abdominals pull up and gluteus maximus and hamstrings pull down
- Hip hiking: Lateral tilt of pelvis upward (focus is on the side moving up)
- Pelvic drop: lateral tilt of pelvis downward (focus is on the side moving downward)
Point of reference for lateral hip tilt:
Side that is unsupported
Mandibular movements (5)
A. Elevation (return from depression) B. Depression C. Protraction = protrusion D. Retraction = retrusion E. Lateral deviation
Hyperextension, hyperadduction, hyperflexion, etc
(any joint beyond “normal” or neutral in these directions)
Horizontal Abduction / Adduction
(as at the shoulder when arm moves horizontally from side to side)
Diagonal Flexion
as at shoulder when arm moves from extension / “down” position, across body to flexion / “up” position
3 types of joints
Synarthrodial - Fibrous, unmoving joints
3 types of Fibrous joints
1)Synarthrosis or Suture joint
2)Syndesmosis or Ligamentous joint
3)Gomphosis or Bolting together joint
Amphiarthrodial - Cartilagenous, slightly “moving” joints
e.g., Symphysis pubis and joints between vertebral bodies and disk
Diarthrodial - Synovial joints; freely moving joints
Most appendicular joints
3 types of fiberous joints
Fibrous Joints —three types:
Synarthrodial – has thin layer of fibrous tissue between surfaces like in sutures of the skull— has interlocking surfaces –no movement between bones
Syndesmosis: ligamentous type– there is a great deal of fibrous tissue present, as in the interosseus membrane, to hold joint together.
Gomphosis – e.g.“bolting together” of peg (tooth) in socket (upper and lower jaws)
Two types of cartilageous joints
have either hyaline cartilage or fibrocartilage between two bones: AKA amphiarthrodial joints —allow some compression, twisting (torsion) or bending.
Fibrocartilage type – example is between intervertebral disk and the body of the vertebra
Hyaline cartilage type — example is 1st sternocostal joint— where there is hyaline cartilage connecting between the sternum and 1st rib.
Characteristics of synovial joints
have no direct union between the bones that unite them (aka Diarthrodial jts); these have the following features:
Joint cavity or space is present
Joint capsule uniting bones; capsule has fibrous outer layer and inner synovial membrane.
Smooth articulating bony surfaces
Smooth articulating cartilage
Synovial membrane which secretes synovial fluid to nourish / lubricate joint.
Joint ligaments (attach bone to bone)
Synarthrodial joint
Fibrous, unmoving / non moving joints
e.g., Sutures of the skull
Syndesmosis
a fibrous joint that has a more ligamentous type of relatively unmoving joint.
Between radius and ulna and between tibia and fibula
Amphiarthrodial
Cartilagenous, slightly moving
Between vertebral bodies and disk; Symphysis pubis
Allows motions of compression and torsion
Diarthrodial
Synovial joints; “freely moving”
Includes most joints of the appendages (limbs)
What do all diarthrodial joints hav in common?
a space or cavity between the bones
Classifying Diarthrodial joints (6):
Irregular (plane or gliding) – nonaxial; allows gliding motions only Intercarpal joints
Hinge - uniaxial; allows flexion/extension only elbow, knee
Pivot –uniaxial, allows rotation only. Between atlas/axis; between radius/ulna
Condyloid – biaxial; allows flex/ext, abd/add Wrist, MP joints
Saddle - biaxial, allows flex /ext, abd/add, and some rotation 1st CMC (carpometacarpal joint) = the only “true” example
Ball and Socket - Triaxial (multiaxial), flex / ext, abd / add, and rotation are permitted
Examples are hip and shoulder
Interphalangeal joints are:
Hinge joints
Knuckles are:
Condyloid
Carpometacarpal of thumb is:
Saddle
Carpal joints are:
Gliding, Irregular joints
Wrist (radiocarpal) joint is:
Codyloid
Ankle Joint
Hinge - movment in sagittal plane only!
Distal Radial/Ulnar is:
A pivot joint
Synovial Joint Structure
See slide 66 photo
Joint Capsule
consists of 2 layers, a fibrous outer layer and an inner layer
Synovial membrane
Inner layer of joint capsule - this tissue is highly vascular and secretes synovial fluid
Synovial fluid is a viscous fluid that lubricates the joint AND nourishes the joint cartilage
What reinforces the joint capsule?
Ligaments
Features of a Diarthrodial Joint:
Smooth articulating bony surfaces:
- Smooth head of humerus
- Smooth glenoid fossa
Joint space: Permits free movement at joint
Hyaline (articular) cartilage - Has no blood supply, creates a smooth surface for articulating bones
Two types of fibrocartilage and what they do
Labrum - deepens socket
Menisci - absorb shock and deepen “socket”
Elastic Cartilage
Allows certain amount of flexibility such as seen in the symphysis pubis, and ear
Ligaments - what are they and functions
Fibrous tissues that connect bone to bone
- Ligaments support the joint
Anterior Cruciate and Posterior Cruciate Ligaments (ACL / PCL)
- Medial Collateral and Lateral Collateral Ligaments (MCL / LCL
What are bursae? What do they do? Two types?
These are fluid (synovial) filled sacks found throughout the body near joints, or where muscles attach; they often protect tendons from friction at bony structures
- Trochanteric
- Deltoid
- Pre-patellar
- Natural – Bursae found in places where everyone else has these thin fibrous “sacks”
- Acquired - Formed in response to stress that is unique to the individual
Define Joint Stability
Joint stability: by definition joint stability is the ability of the joint to resist displacement
Factors responsible for joint stability
- Shape of bony structure
- Joint ligaments-arrangement and tautness
- Muscle tension and arrangement
- Fascia and skin (tautness or lack thereof)
- Atmospheric pressure vs pressure within jt. Capsule
The more taut the ligaments the more …
non moving or “stable” the joint is (resistant to displacement)
Muscle tension and joint flexibility
The larger and stronger the muscles and the more they completely surround a joint from many directions the more stable the joint can become.
Or the more the muscles are efficiently positioned, despite being relatively small or moderate in size, the more stable the joint can become. (e.g., the “rotator cuff” muscles at the shoulder.)
Muscle tension can range anywhere from NONE at all in paralyzed muscles to extremely tight in spastic or rigid muscles. The more tight the more stable, the less flexible. A happy medium is what is needed!
Skin an joint flexibility
The tighter the skin the less mobility available at joints, as seen in patients with extensive burn scars that prevent full mobility at joints.
Atmospheric Pressure and joint stability
Pressure outside the joint (atmospheric pressure) is greater than that found inside the joint. (pressure thus “surrounds” the joint, keeping it together from the outside).
The vacuum within the joint actually keeps bones together by a “suction” effect.
The hip joint is especially dependent on this as we do not want the lower extremity to “fall out” of the hip socket each time the “leg” is lifted off the ground!
Factors effecting ROM
Shape of the articulating surfaces Restraining effects of ligaments Controlling action of muscles Body build Heredity Personal exercise habits Current state of physical fitness Age
Define Goniometry
Measurement of joint angles
Indications for Goniometry
Helps determine the extent of disability
Helps in establishing realistic treatment goals
Helps in setting up an appropriate treatment plan, specific to pt.’s needs
Provides objective means of evaluating effectiveness of PT program
Helps determine whether to alter, maintain, progress, or terminate treatment interventions
Motivational Effect: Concrete, Objective Data can affect patient motivation
Aids in seeing what is normal or abnormal in joint motion
Scientific Research: Important in researching effectiveness of various treatment regimes– to seek that which leads to “best practice!”
Contraindications for Goniometry
In the region of a dislocation or unhealed fracture
Immediately after surgery if motion to the part will interrupt healing process
If myositis ossificans or ectopic ossification is suspected or present
Acute pain
Factors effecting joint ROM
Age - young more flexible than elderly
Heredity - flexibility varies
Effects of Disease or injury
spasticity (CNS) vs. paralysis (PNS), systemic RA vs. localized OA , etc.
Occupation or avocation (hobby)
Pain presence or absence
Temperature (room or tissue temp)
Before or after other treatment interventions
Time since last pain medication
Time of day
In Rheumatoid Arthritis, patient is most “stiff” early in AM and best in early PM)
In Multiple Sclerosis and Mysasthenia Gravis, patient fatigues as day progresses
Three parts of Goniometer
lever arms – 2 (corresponds to bony levers)
fulcrum or axis of motion (placed at joint axis or where motion functionally occurs)
protractor - full circle or half circle (most accurate is marked in gradations of 1 0)
Starting position is usually ___ for goniometer measurement
Upright anatomical position
Goniometer should be applied on what side?
Lateral side
Lever arms of the goniometer instrument should be placed_____to the limbs of the anatomical angle.
PARALLEL
“Mechanical axis” of a bone is determined…
from the midpoint of the joint at the distal end of the bone to the midpoint of the joint at the proximal end of the bone
“Mechanical axis” of a bone…
bone makes a straight bone out of one which may not be straight. Example: Knee is made of femur and lower leg, with fibula being lateral.
Variance in goniometer measurements:
More than 3 degrees of variance should NOT be permitted on any 2 measurements. Must repeat if > 3 degrees
Probably need to take at least 2 measurements in order to be certain results are within 30 of each other
What needs to be documented in goniometry?
Date and time of day (to monitor time)
Pt’s name and diagnosis (e.g.,TKR)
Joint or joints tested (e.g., ® knee)
Indicate Active or Passive, and body position
Left knee (normal knee) 00-1500 Active , supine
Right knee (affected knee) 150–950 , Active, sup.
Comments and signature of tester
Explain differences between the following terms structurally and functionally (Begin by listing
characteristics of each.):
a. synovial joints (aka diarthrosis):Indicate the number of planes and axes each type of joint
b. fibrous joints:
- synarthrosis, (suture joint)
- syndesmosis (ligamentous) and
- gomphosis (bolting together) joints, and
c. cartilaginous joints (aka amphiarthrosis):
A. Synovial (Diarthrodial) - freely moving joints, mostly appendicular. They have no direct union with uniting bones. Have a joint cavity/space. Joint cavity has a fibrous layer on the outside and a synovial membrane layer on the inside.
See Book for 6 types.
FIBROUS (Synarthrodial)
B - Synarthrosis - This layer of fibrous tissue. Interlocking surface, no movement, (e.g. sutures of the skull).
- Syndesmosis - Fibrous tissue (interosseous membrane) hold together. Examples would be distal tibia and distal radius/ulana
- Gomphosis - fibrous, peg-in-socket. Tooth in the socket of the jaw.
C. CARTILIGINOUS (Amphiarthrodial)
- Have either fibrous or hyaline cartilage between joints. Slightly moving (pubkic symphisis).
Describe/list synovial joints according to shape (e.g, irregular, hinge, ball and socket). and indicate
the motion/s permitted at each type as well as the specific planes and number of axes each utilizes.
Irregular Hinge Pivot Condyloid Saddle Ball-in-socket
Define joint stability
The ability to resist displacement
Factors that contribute to joint stability
- Shape
- Ligament arrangement and tautness
- Muscle Tension
- Fascia/Skin
- Atmospheric pressure
The more axes in motion, the __________ the joint
less stable
Define joint flexibility
The ability to complete the full range of motion
List and explain factors which contribute to joint flexibility or ROM. Relate these to
joint stability.
Factors: Age, heredity, disease/inury, occupation/avocation.
More flexibility = less stability. Too much of either stability or flexibility can lead to compensated motion.
Methods of assessing joint range of motion
Active Range of Motion (AROM) and Passive Range of Motion (PROM)
Define and identify the anatomical position
Body erect, arms at side, palms forward
Skeletal System Functions (5):
- Protection
- Gives Rigidity to the body
- Attachment for muscles (that provide
movement and stability) - Attachment for ligaments (that provide
flexibility and stability) - Factories for manufacture of blood
cells - Store houses for minerals & chlorides
Structural Classification of Bone
according to Shape (5):
- Long bones
- Short bones
- Flat bones
- Irregular bones
- Sesamoid bones
Long Bones (about) and examples
Form principle part of skeleton; bones which are LONG in relation to their WIDTH; long shaft with knobby ends
examples: femur, tibia humerus, radius ulna, phalanges, metacarpals
Short Bones:
Relatively small, chunky bones
with approximately the same
dimensions in all directions.
Examples:
Carpal bones
Tarsal bones
Flat Bones:
Flat, with a layer of spongy bone sandwiched in between two layers of compact bone.
Examples:
Skull, Sternum
Scapula, Ribs
Irregular Bones:
Includes all bones which DO
NOT fit in the other categories.
Examples:
vertebrae, sacrum, coccyx
Sesamoid Bones:
Small rounded bones (shaped like a sesame seed) which develop within a tendon to PROTECT the tendon and
CHANGE the angle of pull of muscles.
Examples:
Patella of knee
Sesamoid bones of thumb and great toe
Axial Skeleton:
mainly protective part and part which
forms body cavities
examples: skull, spinal column, lower
jaw, ribs and sternum
Appendicular Skeleton:
part forming the limbs; serve as levers for
action of muscles
examples: bones of girdles, UE & LE
Allows MOTION: locomotion and manipulation
Selected Bony Landmarks to be identified in PHT 1121 lab Be able to locate, palpate, and /or recognize the significance of the following landmarks Skull • Frontal bone • Temporal bone • Parietal bone • Occipital bone • Maxilla • Mandible • Zygomatic bone and arch • Mastoid process • Occipital condyle • Foramen magnum
Look up answers
How many of each vertebra are there in the spinal column?
7 cervical vertebrae 12 thoracic “ 5 lumbar “ 5 sacral “ (fused) 2-5 coccygeal “ (fused)
What is the biggest tuberosity?
Trochanter
What is the difference between a condyle and an epidcondyle?
Condyle is a capsule in a joint (can’t palpate).
Epicondyle - above the condyle and you can palpate
What makes the ends of bones shiny?
Hyaline cartilage
What is the function of intervertebral disks?
–Function as shock absorbers,
and spacers between vertebrae
–Help in maintaining appropriate
anterior posterior curves of spine
Structural features of the intervertebral disk:
The nucleus pulposus is the central gelatinous part ofteh intervertebral disk enclosed in several layers of cartilaginous laminae called the annulus.
Disks don’t slip, they rip and NP gel hits a nerve. Never get rid of rip, just move NP.
Kids have a lot of fluid in disks, but they dry up with age (why elderly are shorter).
Vertebral structures • Vertebral bodies (anteriorly positioned) • Vertebral Arch (posteriorly positioned) –Pedicle – Lamina –Spinous process –Transverse processes –Facets and Demifacets – Intervertebral foramina • Spinal canal=vertebral canal
Look up picture locations
Normal AP curves of spine
– Concavity posteriorly in cervical region
– Concavity anteriorly in thoracic region
– Concavity posteriorly in lumbar region
– Concavity anteriorly in sacral and coccygeal
region
Abnormal AP (and lateral) curves
Abnormal AP curves
– Kyphosis-Hump back
– Lordosis - Sway back
• Abnormal Lateral curve
– Scoliosis: C or S curve
Primary curve
Anterior Concavity
– Posterior Convexity
Secondary curves
Posterior Concavity
– Anterior Convexity
Kyphosis:
“Humpback” or “hunchback”
Exaggerated A/P curve in Thoracic spine
– Anterior Concavity
– Posterior Convexity
Note how breathing could be compromised due to the compressed chest area!
• Lordosis:
Exaggerated A/P Curve in lumbar area
–Posterior Concavity
–Anterior Convexity
Where does spinal cord begin and end?
from foramen magnum to approximately L1 or L2
• In the fetus the spinal cord is as long as the spinal canal
• Below L1 or L2 the long spinal roots known as cauda equina extend within spinal column (within fluid filled sac)
• Spinal nerve roots exit spinal column by means of intervertebral foramina
How are bony and spinal cord injuries referred to?
Bony Injuries are indicated by the areas
and the number of the vertebra/e
– e.g. compression fractures of T12 or L4-5
• Spinal Cord Injuries are named according
to the last functioning level
• Spinal nerve injuries, as from disc
protrusion, are named according to the
spinal nerves affected
How many pairs of each type of rib?
12 total pairs of ribs
• 10 sets of ribs attach at sternum in front
and the thoracic vertebrae in back
(“attached” ribs)
• 2 pair of ribs are not attached in front, but
only in the back (“floating” ribs)
• As long as all curves of the spine are
normal then the ribs will move in “rotary”
fashion (up and out, with diaphragm
down) to allow efficient exchange of air
during breathing
Talk about sternum parts and function
“Breast” bone
• Protection for the heart and the aorta-
• Can be palpated easily mid chest from just
below neck
– Manubrium- top end; “handle”
–Sternal notch - at top of manubrium
–Clavicular notch (where clavicle meets
sternum)
–Body - use this when applying CPR
–Xiphoid process- “sword” avoid during CPR!
Talk about clavicle parts
“Collar” bone • An S shaped bone which is part of the pectoral girdle • Can be palpated easily from sternum to shoulder –Sternal end –Acromial end
Scapula: 3 borders and 3 angles
• Three Borders –Vertebral border = Medial border –Axillary Border = Lateral border –Superior Border • Three Angles –Superior angle –Inferior angle –Lateral angle = Glenoid angle
Scapula, lateral view
Locate: • Scapular spine • Acromion process • Corocoid process • Glenoid fossa • Lateral border • Inferior angle • Lateral angle • Supra-glenoid tuberosity • Infra-glenoid tuberosity
Spine of Scapula-posterior • “root” of scapular spine-medial • Acromion process-lateral • Coracoid process-anterior • Glenoid fossa-lateral • Supraspinous fossa • Infraspinous fossa • Subscapular fossa
Look up pictures
Scapular motions
• Elevation: upward movement of entire scapula • Depression: downward movement • Abduction = protraction: forward movement away from spine • Adduction = retraction : backward movement toward spine Upward rotation: upward movement of lateral angle • Downward rotation: downward movement of lateral angle • Scapular tilt: outward movement of inferior angle
Humerus – “arm” bone • Head • Anatomical Neck • Surgical Neck • Greater tubercle or tuberosity • Lesser tubercle or tuberosity • Bicipital groove or intertubercular groove • Deltoid tuberosity 1 Humerus – “arm” bone • Medial epicondyle • Lateral epicondyle • Medial condyle (trochlea) • Lateral condyle (capitulum) • Medial supracondylar ridge • Coronoid fossa • Olecranon fossa
Look up picture
Radius • Head • Neck • Tuberosity • Interosseous border • Styloid process • Ulnar notch of Radius (receives ulna)
Look up picture
Ulna • Olecranon process • Trochlear notch / semilunar notch • Coronoid process • Radial notch (receives radius) • Interosseous border • Head • Styloid process
Look up pictures
How many carpals? How are they arranged? Which one is palpable?
eight (8) bones arranged
in 2 rows of 4 bones each; be able
to locate pisiform
What are metacarpals
Metacarpals:
5 long bones
numbered from thumb (#I) to little
finger (#V) –Head (distal end) –Shaft –Base (proximal end)
How many phalanges? How named?
• Phalanges: 14 total bones in each hand with 2 in the thumb and 3 in each of the remaining fingers; identified by their position –Proximal phalanx –Middle phalanx (not found in the thumb) –Distal phalanx
What 3 bones make of the pelvis?
What makes up the pelvic girdle? The bony pelvis?
Composed of 3 bones that become fused: ilium, ischium and pubis • Right OR Left pelvic bone makes up a pelvic girdle • Right AND Left pelvic bone, PLUS the sacrum and coccyx make up the bony pelvis
What is the sacroiliac joint?
The acetabulum?
Union of Sacrum and Ilium at the sacroiliac joint is the point where the spinal column connects with the pelvic bone • Union of the pelvic bone with the femur at the hip joint is the acetabulum (a deep socket formed from all three pelvic bones)
Ilium • Iliac crest: top ridge • Iliac fossa • Anterior superior iliac spine • Anterior inferior iliac spine • Posterior superior iliac spine • Posterior inferior iliac spine • “Auricular” surface (“ear-like” . . . posteriorly positioned - accepts sacrum) • Iliac tuberosity (posteriorly positioned, by PSIS) • Greater sciatic notch • Ilium contributes to acetabulum
Look up photos
Ischium • Ischial tuberosity (“sitting bone”) • Ischial spine (separates greater sciatic notch from lesser sciatic notch) • Lesser sciatic notch • Ramus of ischium (leads from ischial tuberosity to ischial spine) • Contributes to obturator foramen • Ischium contributes to acetabulum
Look up photos
Pubis • Pubic symphysis (connects Right and Left pubic bones at midline) • Body of pubis • Superior ramus (iliopubic ramus) • Inferior ramus (ischiopubic ramus) • Contributes to obturator foramen • Pubis contributes to acetabulum
Look up photos
Where does femur take weight from pelvic bone?
What are common fracture sights?
Femur (look up photos)
Takes weight from pelvic bone at acetabulum)
• Head (greater sphere than on humerus)
• Neck (often fractured)
• Greater trochanter
• Lesser trochanter
• Intertrochanteric ridge: raised area between
trochanters; (common fracture area)
• Intertrochanteric line (common fracture area)-
shows outline of joint capsule attachment
Femur - where is linea aspera?
Popliteal surface?
Patellar surface?
• Linea aspera: raised line on back of femur, resulting from pull of concentrated attachment of 2 “quad” muscles • Popliteal surface ( back of knee area) • Patellar surface
Parts of femur - which condyle has longer articulating surface?
Femur continued - look up photos • Medial condyle of femur (has longer articulating surface) • Lateral condyle of femur • Medial epicondyle of femur • Adductor tubercle • Lateral epicondyle of femur
•In weight bearing, when the
knee locks, the femur __________
rotates medially on the tibia to lock the knee. (closed chain)
•In open chain, the tibia rotates _______
externally on the femur to lock the knee.
What bone receives the weight from the femur?
Tibia - MEDIAL BONE
Tibia
• Medial condyle of tibia • Lateral condyle of tibia • Medial epicondyle of tibia (outer
surface medially
• Lateral epicondyle of tibia (outer
surface laterally
• Tibial tuberosity (insertion for quadriceps
femoris)
• Shin (sharp anterior border)
• Interosseous border (connection for
interosseous ligament)
• Medial malleolus-”knob” at medial ankle
Look up photos
The tibia distributes weight to what?
Talus (tarsal bone).
TNT - Tibnia oN Talus
Fibula
Location?
Weight?
Function?
Fibula – lateral bone of the leg • Located below the knee joint • Does not contribute to weight bearing at the knee • Function is to allow for muscle attachment and act as a pulley for changing the angle of pull of a muscle • Acts to help protect and stabilize the ankle joint laterally
Parts of the fibula
• Does not act in any significant weight bearing at the ankle • Head (found at proximal end) • Interosseous border (connection for interosseous membrane) • Lateral malleolus (found at distal end)
How many tarsals?
7 tarsals
Name and location tarsals?
- Talus: takes weight directly from the tibia ( T with T!)
- Calcaneous is the heel bone • Navicular bone is directly in front of talus medially
• Cuneiform bones:
1st, 2nd and 3rd are directly in front of (distal to!) navicular bone going from medial to lateral
• Cuboid is the tarsal bone in front of (distal to)
the calcaneus and aligned directly against the
bases of the two lateral metatarsal
Look up picture
How many metatarsals? Components? How they are named?
5 metatarsal bones (long bones) are
located in the foot
• “Named” according to the one aligned
with the great toe being Metatarsal I
and the one aligned with the small toe
as being Metatarsal V
• Base (at proximal end) • Shaft • Head: (at distal end) forms “knuckles
How many phalanges in foot? How named and structure?
• 14 phalanges (long bones) are located in the foot • An individual bone is a phalanx and consists of: –Base (at proximal end) –Shaft –Head: (at distal end)57 Phalanges • 2 phalanges found in the great toe –Proximal phalanx –Distal phalanx • 3 phalanges each are found in the 4 lateral toes –Proximal phalanx –Middle phalanx (not found in great toe) –Distal phalanx
Palpation: LE anterior • Palpation of boney landmarks of lower extremity anterior view
See Handout
Palpation: LE posterior • Palpation of boney landmarks of lower extremity Posterior view
See Handout
Skull website
homes.bio.psu.edu/faculty/strauss/anatomy/skel/skeletal.htm
Vertebral column
homes.bio.psu.edu/faculty/strauss/anatomy/skel/skeletal.htm
Thoracic Bones
homes.bio.psu.edu/faculty/strauss/anatomy/skel/skeletal.htm
Upper Limb Bones
homes.bio.psu.edu/faculty/strauss/anatomy/skel/skeletal.htm
Lower Limb bones
homes.bio.psu.edu/faculty/strauss/anatomy/skel/skeletal.htm
General Skeleton
homes.bio.psu.edu/faculty/strauss/anatomy/skel/skeletal.htm
Epiphysis:
Ends - mostly spongy bone
Diaphysis:
Shaft with hollow cavity
Epiphyseal Plate:
Permits growth in length in growing bone
Smooth, Slippery, porous, malleable, insensitive, bloodless
Articular cartilage
Fibrous, cellular, vascular, highly sensitive sheath around a bone.
Periosteum
What allows growth in diameter of a bone and healing for fractures of any age?
Osteoblastic cells in the perisosteum
spongy bone made of trabeculae – with spaces filled with
red or yellow marrow. Laticce work responds to stresses; allows reorientation, construction and destruction
Cancellous bone
Dense bone forming cortex and shaft
Compact Bone
Major supplier of oxygen and nutrients to the long bone
Nutrient artery
Hollow inner part containing marrow, red in young, mainly yellow in adult
Medullary Cavity
Gel-like; composed of red and white blood cells and specialized capillaries
Red marrow
Fatty connective tissue that no longer produces blood cells
Yellow Marrow
What contributes to hip joint stability?
Deep acetabulum, and labrum
which grasps femoral head,
both contribute to hip joint
stability.
What is the angle of inclination?
The angle of inclination is the angle formed
by joining a line through the center of the
length of the shaft of the femur and one
through the center of “shaft” of the neck and
head. This angle determines where the
condyles of the femur will sit on the condyles
of the tibia. The angle changes, normally,
from the pressure of weightbearing from
infancy (when it is approx. 145 degrees), to
adulthood ( about 126 degrees), through old age (to
approx. 120 degrees).
Talk about Coxa Varus, Coxa Valga
With Vara or varus,the distal segment, in this case the femur, will move medially from its normal position.
With Valgaor Valgus,the distal segment moves laterally from its normal position. In this case the femoral
shaft moves outward.
What is Genu Rectus? What leads to it?
Normal angle of inclinationLeads to Genu Rectus . . .
With: Equal pressure over tibial plateau and Equal length of ligaments
What does coxa varus lead to?
Genu Valgum . . .
With:
Lateral condylar compression and ligament shortening
Medial ligament stretch and joint separation
Genu valgum is
a. k. a.
“knock-kneed”
What does Coxa Valga lead to?
Leads to Genu Varus . . .
With:Medial condylar compression and ligament shorteningLateral ligament stretch and joint separation
Genu varus is called
“bow-legged”
Genu Recurvatum:
Genu Recurvatum is known as “Back kneed”
Backwards bowing of the “knee,” often compensates for Lumbar Lordosis
Discuss the need for using a standardized system of measurement
All about Reliability and Validity.
Validity - Validity is “the degree to which an instrument measures what it is supposed to measure” Measurements must be accurate because the results, taken to be valid representations of actual joint angles, are used to plan treatment and determine treatment effectiveness, patient progress, and degree of disability.
Reliability - Reliability is “the extent to which the instrument yields the same measurement on repeated uses either by the same operator (intraobserver reliability) or by different operators (interobserver reliability).
Reliability indicates the consistency or repeatability of a measurement. The therapist measures ROM and compares measurements taken over time to evaluate treatment effectiveness and patient progress. It is important for the therapist to know that joint position and ROM can be measured consistently (i.e., with minimal deviation due to measurement error). If this is possible, then in comparing ROM measurements, the similarity or divergence between the measures can be relied on to indicate when a true change has occurred that is not due to measurement error or lack of measurement consistency.
List some factors that might be standardized to make sure goniometer measurements are reliable and valid
•Reading the wrong side of the scale on the goniometer (e.g., when the goniometer pointer is positioned midway between 40° and 50°, reading the value of 55° rather than 45°). •
A tendency to read values that end in a particular digit, such as zero (i.e., “_0°”).
•Having expectations of what the reading “should be” and allowing this to influence the recorded result. For example, the patient has been attending treatment for 2 weeks and the therapist expects and sees an improvement in the ROM that is not actually present.
•A change in the patient’s motivation to perform.
•Taking successive ROM measurements at different times of the day.
•Measurement procedure error: Make sure sources of error do not occur or are minimized so that ROM measurements are reliable and the patient’s progress will be accurately monitored.
RELIABILITY
•The same therapist should assess the ROM. •Assess the ROM at the same time each day.
•Use the same measuring tool.
•Use the same patient position.
•Follow a standard measurement protocol.59
•Treatment may affect ROM; therefore, assess the ROM in a consistent manner relative to the application of treatment techniques.
If upper or lower extremity ROM is measured by the same therapist, a 3° or 4° increase in the ROM indicates improvement. If different therapists measure the ROM, an increase of more than 5° for the upper extremity and 6° for the lower extremity would be needed to indicate progress.
Identify the starting and ending positions for goniometry, including the scale and degrees used.
- When it is possible to begin the movement at the 0° start position, the ROM is recorded by writing the number of degrees the joint has moved away from 0°—for example, right shoulder elevation through Flexion (i.e., shoulder flexion) 160° or 0°–160°, right knee flexion 75° or 0°–75°, right knee extension 0°.
- When it is not possible to begin the movement from the 0° start position, the ROM is recorded by writing the number of degrees the joint is away from the 0° at the beginning of the ROM, followed by the number of degrees the joint is away from 0° at the end of the ROM—for example, the patient cannot achieve 0° right elbow extension due to a contracture (abnormal shortening) of the elbow flexor muscles; the end feel is firm. More specifically, the right elbow cannot be extended beyond 10° of elbow flexion and can be flexed to 120°. The ROM would be recorded as right elbow flexion 10°–120°.
- For a joint that is in a fixed position or ankylosed, this is recorded on the chart along with the position of the joint.
A fibrous joint that has a more ligamentous type of relatively unmoving joint.
What is a
Syndesmosis joint?
Example-between
Radius and Ulna
What type of joint is cartilaginous, slightly moving, and allows motions of compression and torsion? Examples?
Amphiarthrodial
Examples-Between
The vertebral bodies and disk ;
Symphysis pubis
What type of joint moves freely and is the most common in the human body?
Diarthrodial – a.k.a. Synovial joints, includes most joints of the appendages(limbs)
What is a LE Diarthrodial/Synovial, triaxial,ball and socket joint and it’s motions?
The hip joint
motions- flex/ext , ab/add, and rotation(IR/ER)
What is an UE Diarthrodial/Synovial, pivot-uniaxial (rotation only) joint and it’s motion?
The Radial-Ulnar Joint.
Motions-pronation and supination
What are the anatomical planes?
Anatomical Planes
Sagittal plane - bisects the body into
L & R.
(Midsagittal is located centrally)
Horizontal (Transverse) - bisects the
body into superior and inferior
Coronal (frontal) - bisects the body
into anterior and posterior
What are the anatomical Axes?
AXIS definition: A point that runs through the center of a joint around which a part rotates- note 3 axes below. A.Sagital Axis or horizontal anterior posterior axis
B. Frontal Axis or Horizontal Lateral Axis
C. Vertical Axis
What is the plane and
axis for flexion and extension motions?
Flexion and Extension:
Movements that takes place WITHIN a sagittal plane (or median plane) and AROUND a frontal axis (also known as a “horizontal lateral axis” or a “lateral axis”).
Seen in motions of the elbow, knee and neck, trunk etc.
What is the plane and
axis for abduction and adduction motions?
Abduction and Adduction:
Movements that takes place WITHIN a frontal plane (or coronal plane) and AROUND a sagittal axis (also known as a horizontal anterior-posterior axis).
Seen in abduction / adduction of the hip, shoulder, wrist and in lateral bending of the trunk
What is the plane and
axis for rotational motions?
Rotation:
Movements that takes place WITHIN a horizontal plane (or transverse plane) and AROUND a vertical axis
Seen in rotation to the R or L in the neck, trunk and in internal/ external rotation of the hip, shoulder ; seen in pronation and supination of forearm
How will this information you just reviewed help a PTA have better clinical decision making skills?
By understanding basic concepts of Anatomy and Kinesiology, a PTA will understand what is NORMAL for the human body and be able to use this information to progress someone to their highest level of functioning post an injury in the rehabilitation plan!
Why is it important for
PTA’s to know
Types of joints and motions of the body?
Knowing what NORMAL joints are and their motions will assist in knowing what the goal is for someone with a disability!
Why is it important for
PTA’s to know
Planes and Axes in the human body?
Understanding Planes and Axis will help you understand movement and assist with understanding therapeutic exercise in Rehabilitation!
What are the principles of Planes & Axes?
- There are 3 planes
- Each plane is always perpendicular (at right angles) to the other two planes.
- An axis is ALWAYS perpendicular to a plane.
- Movement (motion) takes place WITHIN a plane and AROUND an axis
Why is it important for PTAs to know bony landmarks?
Knowing boney landmarks will assist in knowing where muscle and tendons are attached to body
Functions of synovial fluid
which lubricates the joint
and nourishes the cartilage.
T/F Plane joints can move by themselves
False
What does a joint capsule do
surrounds and encases the joint and protects the articular surfaces of the bones
Tendon
Connects muscle to bone
aponeurosis
Broad, flat tendinous sheet.
Aponeuroses are found in several places where muscles attach to bones.
Bursae
Small, padlike sacs found around most
joints. They are located in areas of excessive friction, such as under tendons and over bony prominences.
Lined with synovial membrane and filled with a clear fluid, bursae reduce friction between moving parts.
Can be natural or acquired - acquired often occur at places other than joints and disappear once activity has stopped (e.g. student’s bursae from writing).
Sprain
Partial or total tearing of ligament fibers - strain is over stretching of these fibers
-itis
INFLAMMATION - many joint pathologies are name + itis.
a muscle cell is called what?
A muscle fiber
Sarcolemma
Cell wall or cell membrane of single muscle cell
Sarcoplasm
Specialized protoplasm
Myofibrils
contractile proteins of which
myosin and actin form cross bridges -
actin moves within myosin
Define endomysium, perimysium, and epimysium
• Endomysium: Connective Tissue (CT) covering one muscle cell (muscle fiber) around the sarcolemma -
• Perimysium: CT covering a bundle of muscle fibers (encloses fasciculus) – Encloses Fasciculi
(bundle of muscle cells) – Separates + protects
single muscle fibers
• Epimysium: CT covering entire muscle, – Covers the whole muscle
T/F: • Size of muscle cell can increase
but not the number of cells
TRUE
What is a constant and a variable when it comes to muscle cells?
• There is a constant number of muscle cells within a muscle
• Number of muscle cells responding within a muscle can
vary at any one time
Muscle functional properties (4):
- Irritability: ability to “notice” and respond to stimuli
- Contractility: ability to contract or shorten-unique to muscle tissue
- Extensibility: ability to stretch beyond its resting length when force is applied
- Elasticity: ability to return to a resting length or shape or configuration once a disturbing force is removed
“Excursion”: muscle length changes
a.k.a.“Amplitude” of a muscle’s action
- Contracted length-can shorten to ½ resting muscle length
- Resting length: muscle length at rest
- Extensible or stretched length: length can increase ½ beyond resting length – be stretched passively beyond its resting length
Describe how muscle contraction happens
• The Myofibril is the working unit of the muscle cell
• With contraction, the myofibrils shorten, thus cells shorten, bringing two ends of muscle closer together
• Two contractile proteins are found within the
myofibril : actin and myosin. Actin slides between myosin to cause shortening of the contractile unit.
• If enough myofibrils are active, the contraction is strong, and body parts move.
Define: Z-line I-band A-band H-zone M-line
- Z-line -where sarcomeres meet
- I-band (isotropic) -thin myofilaments
- A-band (anisotropic) -Thick myofilaments
- H-zone - only thick myofilaments (myosin)
- M-line - Where thick myofilaments meet
Difference in thin and thick myofilaments
- Thin myofilaments contain mostly actin
* Thick myofilaments have cross bridges with actin binding sites
Describe the sliding filament theory:
• Thin myofilaments slide toward the H-zone
– Myosin cross-bridges connect with actin in
thin myofilaments, working like the oars of a
boat
• H-band gets smaller, I-band gets smaller
• Thick and Thin myofilaments stay the same length,
but slide over each other, pulling the z-lines together
• At full contraction H and I bands may disappear.
The z-lines separated by the A-band
• Afterward, ATP breaks down the myosin cross
bridges so the myofilaments will slide back to
resting position
Slow twitch fibers:
Red muscle
–These are highly vascular fibers, adapted for aerobic activity
• Strong, lots of stamina
Fast twitch fibers:
White muscle
–full of glycogen, adapted for anaerobic activity
• Fast, fatigue quickly
• Sprinting muscles
Relationship between training and muscle fibers
Training and use can develop more of either kind of fiber
Facts on red and white fibers:
Where is one more predominant? What are we born with?
• Most muscles have a mix of red and white fibers.
–Postural muscles are mostly red
–Arm muscles are typically mostly white
• People are born with unique mixtures of red and white fibers, predisposing them to certain activities (e.g., sprinters vs. marathoners)
Describe the parts of the motor unit (see picture)
Motor Unit (SEE PICTURE)
• Axon
• Axon branch
• Synaptic terminal
– “End” of motor axon
• Motor end plate
– Found on muscle
cell membrane
• Muscle cell / fiber
Define Recruitment:
The process by which the number of Motor Units is increased
• Recruitment is asynchronous, so that the muscle does not fatigue
Muscle tension is controlled by:
The number of active motor units (MUs).
Define a motor unit
• A single motor neuron, combined with all
of the muscle fibers it stimulates
– 1:500 for gross motion (e.g. gastrocnemius,
biceps brachii)
– 1:10 for eye muscles (some as low as 1:4!)
What is the motor end plate
–Axon terminal and the specific muscle fiber
(cell) it stimulates
–Acetylcholine (ACh) - is the neurotransmitter at the myoneural synapse/ junction
What works on the the all-or-none principle and what does not?
Nerve and muscle fibers work on the all-or-none principle, not muscles!
What is AChE and what does it do?
• AChE (acetylcholinesterase) is released to stop the firing of sarcomeres after contraction
Name the four periods of muscle contraction and what happens during each.
• Latent Period -–The time between introduction of
stimuli and contraction
• Contraction Period -–builds to full contraction
• Relaxation Period -–from contraction to rest
• Refractory period -–Time needed for muscle to “reset”
before it can fire again
Name the three different qualities of a muscle contraction
• Twitch -– Rapid, jerky response to a single stimulus
• Tetany - – Response to several stimuli with delayed introduction –Only partial relaxation occurs – Contraction is smooth and sustained
• Treppe - when a muscle reacts more forcefully to same strength stimuli after repeated contractions
– rationale for “warming up”
What are the components of the all-or-none law?
• An individual muscle cell contracts completely or not at all • All of the myofibrils within that cell respond or not at all OR refers to: • A motor neuron supplying a number of muscle cells: all of the muscle cells attached to it will respond or not at all
What is the difference between a strong or a weak contraction?
• Strong contraction is a result of a greater number of muscle cells or MUs responding within a muscle
• Weak contraction is a result of
few cells or MUs responding
• Each fiber or MU, however, will respond 100% if it responds
What does the strength of a muscle contraction depend on?
- Depends on the number of fibers present in the muscle (small, large)
- Shape of the muscle (broad, thin, pennate, fan, etc)
- Arrangement (good or bad) for leverage (e.g. patella improves angle of pull of quadriceps femoris)
What is a tendon and what are its features?
• Tendon: a round cord or flat band that attaches muscle to bone
• The deep fascia combines at the ends of muscles into tendons
• These attach into bone via the periosteum
– Tendons are cord – like, rather than flat sheets (which is an aponeurosis)
• Tendons and ligaments have no contractility; have only extensibility and elasticity
What is an aponeurosis?
• Aponeurosis: fibrous sheet attaching muscle to bone
e.g., lumbodorsal fascia
• An aponeurosis can also connect two muscles
–Frontalis / Occipitalis
–Oblique abdominus muscles on one side with those of the other side
Other then tendons and aponerosis, what is an additional way muscle can be attached to a bone?
• Attachments can also be by way of the fleshy part of the muscle to periosteum of the bone
What are the two types of muscle attachments?
- Origin: generally considered the beginning or proximal/superior or stable attachment
- Insertion: generally considered the end or distal/inferior or moveable attachment.
• Most commonly, insertion (more movable bone), toward origin (more stable bone)
When a muscle contracts, does it move in any one direction?
No - it simply shortens
What happens in reversal of muscle action?
Origin moves toward insertion.
Muscles cross joints, so USUALLY…
Muscles cross joints so USUALLY joint
angles change as muscles contract
What are the 6 ways muscles are named and what are some examples?
• For Shape – Deltoid –Serratus Anterior • For Attachments –Sternocleidomastoid • For Action –Supinator –Pronator Teres Naming Muscles continued: • Number of Heads (divisions) –Triceps Brachii –Biceps Femoris • Direction of Muscle Fibers –Internal Oblique Abdominis • For Position –Rectus Abdominis –Serratus Posterior
What are the features of fibers that are parallel to the longs axis of the muscle vs those that are oblique to the muscle?
• Fibers Parallel to the long axis of the muscle – Longer – Greater range of motion potential • Fibers Oblique to the long axis of the muscle – Shorter – More numerous fibers per given area • Greater strength potential • Smaller range of motion potential
What is a longitudinal muscle and what are some examples?
Longitudinal: long strap- like muscles whose fibers lie parallel to its long axis • Examples: Sartorius, Rectus Abdominis
What is a quadrate or quadrilateral muscle and what are some examples?
Quadrate or Quadrilateral: usually four sided and usually flat • Examples: Pronator quadratus (rectangular) • and Rhomboid Major and Minor (rhombus shaped)
What is a triangular or fan-shaped muscle and what are some examples?
Triangular or fan shaped: relatively flat type whose muscle fibers radiate from a narrow attachment at one end • Examples: Iliacus and Pectoralis Major
What is a fusiform or spindle shaped muscle and what are some examples?
Fusiform or spindle shaped:
usually a rounded muscle which
tapers at either end.
• Examples: brachialis and brachioradialis
What is a penniform or pennate muscle and what are some examples?
Penniform or pennate: series of short parallel fibers extend diagonally from the side of each long tendon (makes it look like a wing feather) • Examples: Extensor digitorum longus and Tibialis posterior of the LE
What is a bipenniform or bipennate muscle and what are some examples?
Bipenniform or bipennate: double penniform with short fibers extend diagonally in pairs from either side of a central tendon (symmetrical tail feather like) • Examples: Rectus femoris, flexor hallucis longus
What is a multipenniform or multipennate muscle and what are some examples?
Several tendons with muscle fibers running diagonally between each of those tendons
• Example: middle portion of the Deltoid muscle
Define coordination. What is coordination a result of?
Purposeful, effective movement of the body or its parts:
• Coordinated movements results
from muscles cooperating
• Muscles must have a stable base
• Muscles cannot voluntarily choose to effect one of its movements and not the other
What are the three muscle roles and what do each do?
- Movers or Agonists: directly responsible for the movement
- Antagonists: Groups performing movement opposite the agonist
- Synergists: group contributing to either steady, stabilize or fixate parts for the agonists, or neutralize unwanted activity of the agonists
Co-contraction:
Simultaneous contraction of the agonists and their antagonists—working together to stabilize a part
• Number of joints a muscle crosses has effect on its role (e.g., one or two or multi joint muscles)—usually cannot work fully at all joints
What are the 3 types of contractions?
Isometric
Isotonic
Isokinetic
What is an isometric contraction?
Same length - no joint motion(same length—focus is length)
– Tension is built up in the muscle, but no change in length or joint movement takes place
What is an isotonic contraction?
– Joint angle changes but tone of contraction is same;
contraction is smooth during movement
• Concentric-shortening contraction
• Eccentric- “braking” action against gravity or against a
force greater than that being produced by muscle–allows
lengthening from a shortened state
What is an isokinetic contraction?
Isokinetic (same speed—focus is speed)
– Controlled only by machine: Biodex, Cybex, etc.
–Speed of movement is determined by selecting and setting a speed on the machine; patient must exercise at that selected speed in order to encounter resistance; resistance is variable but the speed of movement must stay the same
– Isokinetic exercise can be performed eccentrically or concentrically
• “Isokinetic”: though controlled best by machine, the concept of focus on the speed of movement is extremely
important even when not using machines: – Tone is the amount of tension in a muscle at any given time
—less tension is able to be developed with fast speeds
–Greater tension is generated at slow speeds – Need to look at pace of every exercise: slow, moderate, or fast pace?
What is muscle tone and how does it happen?
Even at rest some muscle fibers contract to maintain muscle tone
—providing the muscle with “readiness” to potentially fire.
• Muscle spindles are tiny myoneural units in the muscle that monitor the length of muscle cells, giving the Nervous System feedback regarding changes in length in the muscle.
• This feedback to NS may ultimately influence
the intact NS to alter muscle tone.
3 - muscle contractions and their main points
• Isotonic-same tone, smooth movement
– Concentric-shortens relative to resting
–Eccentric-lengthens from shortened state
- Isometric- same length; no joint motion
- Isokinetic- must exercise at same speed of movement for each repetition (in order to experience resistance on a machine); when not using machines, focus must still be on maintaining the speed asked for of the patient – Concentric –Eccentric
Muscles can only pull…
In a direct line with their fibers–Can only pull ends together
• Insertion and origin toward each other
–Multi-joint muscles (most common
type) produce..
different actions depending on which joint is stabilized
A muscle is strongest if…
Put on a slight stretch before contracting.
- example - kicking a ball
–First hyperextend hip and then flex it forcefully (watch goal kickers warm-up!)
–Hyperextending hip first puts hip flexors on stretch before contracting hip flexors
What is active insufficiency and where does it occur?
Example?
When a muscle reaches a point where it cannot shorten any farther
• Occurs to the agonist
• Hamstrings – Two-joint muscles –Extend the hip, flex the knee – Can perform either motion but not fully
simultaneously
• If flex knee while hip flexed, can attain full knee
flexion
• If flex knee while hip extended, hamstring
muscles cannot complete the full range
simultaneously due to being Actively Insufficient
What is passive insufficiency and where does it occur?
Example?
- When a muscle cannot be elongated any farther without damage to the fibers
- Occurs to the antagonist
- Opposite the agonist
- Hamstrings antagonist – Muscle can be stretched over each joint individually but not both
- If you flex your hip with knee flexed, can complete the range
- Can extend knee when hip is extended
- Now, sit with knee extended, flex at hip; note hamstring tightness = hip extensor tightness or Passively Insufficient
Length –Tension Relationship in Stretching:
Agonist usually becomes actively insufficient (cannot contract any farther) before the antagonist becomes passively insufficient (cannot be stretched farther)
What is tendonesis and through what process is it accomplished?
Some opening and closing of the hand is
accomplished through passive insufficiency—used
consciously by those lacking hand function
• A. Active wrist flexion causes passive finger extension
• B. Active wrist extension cause passive finger flexion
Coordination is dependent on
all muscles in an activity working together
ROM - Shoulder Flexion/Extension
0-180 degrees, 0-60 degrees
ROM Shoulder Abduction/Adduction
0-180 degrees, 0-75 derees
Shoulder Internal/External Rotation ROM
0-70 degrees, 0-90 degrees
Shoulder ROM Horizontal Abduction/Adduction
0-45 degrees, 0-135 derees
Elbow Flexion, Elbow Extension ROM
0-150 degrees, 150-0 degrees
Elbow Pronation/Supination ROM
0-80 degrees, 0-80 degrees
ROM Wrist flexion/extension
0-80 degrees, 0-70 degrees
ROM Ulnar Deviation, Radial Deviation
0-30 degrees, 0-20 degrees
Hip Flexion/Extension ROM
0-120 degrees, 0-10 or 30 degrees. Some experts believe that no true hip extension
Hip Abduction/Adduction ROM
0-45 degrees, 0-30 degrees
Hip Internal/External Rotation ROM
0-45 degrees, 0-45 degrees
Knee Flexion/Knee Extension ROM
0-135 degrees, 135-0 degrees
Ankle Dorsiflexion/Plantar flexion ROM
0-20 degrees, 0-50 degrees
Calcaneous Inversion/Eversion ROM
0-5 degrees, 0-5 degrees
Forefoot Inversion/Eversion ROM
0-35 degrees, 0-5 degrees
ROM - Cervical Spine, Flex, Ext, Lateral bending, Rotation
0-45 degrees for ALL
Dorsal Lumbar ROM: Flexion Ext Lateral bending Rotation
0-80 degrees
0-20 to 30 degrees
0-35 degrees
0-45 degrees
Twitch -
– Rapid, jerky response to a single stimulus
Tetany
– Response to several stimuli with delayed introduction
–Only partial relaxation occurs
– Contraction is smooth and sustained
Treppe
- when a muscle reacts more forcefully to same strength stimuli after repeated contractions
– rationale for “warming up”
• Latent Period
-–The time between introduction of stimuli and contraction
• Contraction Period
-–builds to full contraction
• Relaxation Period
-–from contraction to rest
• Refractory period
-–Time needed for muscle to “reset” before it can fire again
Muscles fire like a choir singing rounds
How is the number of MUs related to number of muscle fibers they stimulate
Gross motion has bigger ratio than fine motion
- Bicep 1:500
- Eye 1:10
What does ATP do?
breaks down the myosin cross bridges so the myofilaments will slide back to resting position
What is muscle excursion?
Difference in resting length and stretched length
• Irritability:
ability to “notice” and respond to stimuli
• Contractility:
ability to contract or shorten-unique to muscle tissue
• Extensibility:
ability to stretch beyond its resting length when force is applied
• Elasticity:
ability to return to a resting length or shape or configuration once a disturbing force is removed
