Lecture Test 2 Flashcards
Lower Cross Syndrome
Tight Thoracolumbar Extensors, Weak Abdominals, Weak Glutes, Tight Iliposoas & Rectus Femoris
Common location for Vertebral Artery imingement?
C1 due to sharp medial turn
Atlanto-Occipital Joint Arthro
convex occipital condyles on concave superior facets
AO Osteo
convex occipital condyles on concave superior facets
AO Flexion limited by
Bony contact of dens and foramen magnum
AO Extension limited by
Compression of occiput on sub occipital muscles
Atlantoaxial Joint Artho
pivot joint between dens of C2 and anterior arch of C1/transv
AA Osteo
Flex/Ext, Lateral Flexion, ROTATION!
Intervertebral Joint Arthro
Sliding and tilting superior vertebra on intervertebral discs
Facet Joint Arthro
sliding of inferior facet of the vertebrae above and & SUP facet of the vertebrae below
Intervertebral and Facet Joint Osteo
Flex/Ext, Lat Flex, Rotation
Cervical Facet Orientation
45 degrees in frontal plane
Cervical Flexion ROM
Goni: 45
Inclino: 50
Cervical Lateral Flexion ROM
Goni: 45
Inclino: 45
Cervical Rotation ROM
Inclino: 80
Cervical Extension ROM
Goni: 45
Inclino: 60
Cervical Flexion limited by:
Interspinous ligament, Posterior Longitudinal Ligament, posterior part of annulus fibrosus, ligamentum flavum
Cervical Extension limited by:
Bony contact of facets, Anterior Longitudinal Ligament, anterior part of annulus fibrosus
Cervical Lateral Flexion limited by:
Intertransverse ligaments, vertebral process/bodies, lateral parts of annulus fibrosis
Cervical Rotation limited by:
Annulus Fibrosis
Facet joints limited by:
Synovial joint capsule/capsular ligaments
Upper Cross Syndrome
Inhibited Neck Flexors, Inhibited Rhomboids & Serratus Anterior, Tight Upper Trap & Levator Scapula, Tight Pecs
Thoracic Extension limited by:
Spinous Processes
Thoracic Flexion Arthro
superior vertebrae tilts ant, translates ant, facet joints: inferior facet of superior slides upward on superior facet of inferior
Thoracic Lateral Flexion Arthro
facet downslides on same side and up slides on contralateral
Thoracic Rotation Arthro
superior vertebrae rotates on inferior vertebrae…impact of inferior facet of sup vert on sup facet of inferior vert. on opposite side
Thoracic Flex/Ext Osteo
facets T1-T6 = frontal plane…limited flex and ext
Facet T6-T12 = more sagittal alignment… allows more flex/ext
Thoracic Lat Flex/Rotation Osteo
Ribs restrict in upper/middle thorax
Lumbar Flex Artho
inferior vertebral facet of superior body slides upwards
Lumbar Lat Flex Arthro
inferior vertebral facet on superior slides down towards lat flex, up on other
Lumbar Rot Arthro (left)
right inferior facet of superior body, impacts superior facet of inferior body
Lumbar Flex/Ext Osteo
facet joints in sag plan = more flexion/ext, limits lat flex and rotation
L5-S1 most flexion, little to no rot/lateral flexion
Lumbar Lat Flex/Rot Osteo
Upper L-spine more (L1-L2, L2-L3)
Trunk Flexion ROM
TM: 10cm
Inclino: 60
Trunk Extension ROM
Goni: 35
Inclino: 25 (L-spine)
Trunk Lateral Flexion ROM
TM: 22cm
Goni: 35
Inclino: 25 (L-spine)
Trunk Rotation ROM
Goni: 45
Inclino: 30 (T-spine)
Trunk Flexion Functional ROM: Sit to stand
35 Degrees
Trunk Flexion Functional ROM: Picking up item from floor
60 degrees
TMJ Osteo
depression (mouth opening), elevation (mouth closing), protrusion, retraction/retrusion, and lateral deviation
TMJ Depression/Elevation Arthro
sagittal plane; condylar rotation combined with sliding of the condyles on the inferior surface of the discs
TMJ Protrusion/Retrusion Arthro
bilateral condyles and discs translate together along temporal articular eminences; upper joint; no rotation (more of a glide)
TMJ Lateral Deviation Arthro
one mandibular condyle and disc slide inferior, anterior, & medially; the other rotates and slides within mandibular fossa
TMJ Depression ROM
35-50mm
TMJ Elevation ROM
Teeth contact
TMJ Protrusion ROM
3-7mm
TMJ Lateral Deviation ROM
10-15mm
Hip Stability
Depth of acetabulum; Labrum (negative intracapsular pressure, sealing cartilage layers, and holds fluid in the joint to assist with impact loading); Joint Capsule; Ligamentous support (Iliofemoral (Y lig) pubofemoral, ischiofemoral); Iliopsoas crossing joint
Hip Arthro
Proximal joint surface: concave acetabulum
Distal Joint surface: convex femoral head
Consider proximal on distal vs distal on proximal!
Hip Flex ROM
120 degrees
Hip Ext ROM
30 degrees
Hip ABD ROM
45 Degrees
Hip ADD ROM
30 degrees
Hip ER ROM
45 degrees
Hip IR ROM
45 degrees
HIp End Feel:
Flex & ADD: Soft/firm
EXT, ABD, ER/IR: firm
Hip Capsular Pattern
FLEX > ABD > IR (order can vary)
Hip Flex Functional ROM: sit to stand
98-101 degrees
Hip Flex Functional ROM: Tying shoes
120 degrees
Hip flex during Gait:
30 degrees
Hip Ext during Gait:
10-20 degrees
Hip Flexion Functional ROM: Ascending stairs
67 degrees
Hip Flexion Functional ROM: Descending stairs
36 degrees
THA Posterolateral Precautions
no flex > 60-90, IR, ADD
THA Anterior Precautions
varies by MD; NONE to avoid ER, ADD, ABD
Q-angle
8-14 in men, 15-17 in females
Tibiofemoral joint Arthro
convex medial and lateral femoral condyles articulate with concave medial and lateral condyles of the proximal tibia
Tibiofemoral Joint Flexion
135 degrees
TF Joint Ext
0 up to 10 hyperextension
Screw home mechanism
last 10-15 of knee extension, tibia rotates externally to “lock” the knee in ext (femur internally rotates)
Knee End-feel
Flexion: Firm/Soft
Ext: Firm
Knee Capsular Pattern
Flex>Ext
PF NWB Arthro
concave tibia slides in same direction on convex femur
Patella slides superior in extension & inferior in flexion
PF WB Arthro
FLX: Femur posterior roll and anterior slide…menisci slide posterior
EXT: femur anterior roll and posterior slide…last part of motion, motion halts at lateral femoral condyle but slide continues at medial femoral condyle= screw home mechanism
Knee Flex Functional ROM: Tying Shoes
106 degrees
Knee Flex Functional ROM: Sitting
93 degrees
Knee Flex Functional ROM: Lifting item from floor
117 degrees
Knee Flex Functional ROM: Climbing stairs
83-105 Degrees
Lumbar Plexus
Ventral Rami- T12 L1, L2, L3, L4
Anterior Division: Adductor Musculature
Posterior Division: Hip Flexors and Knee Extensors
Sacral Plexus
Ventral Rami (L4), L5, S1-S3
Superior Gluteal Nerve: Glut Med
Anterior Division: post thigh, post lower leg, plantar foot
Posterior Division- Abductor musculature, hip extension
Peripheral Nerves
Femoral N L1-L4 Saphenous: sensory of medial side of leg Obturator: L(1) 2, 3, 4 Sciatic: L4,5 : S1,2,3 Common Peroneal: L4-S2 Tibial: L4-5 S1-S3
Tibiofibular Joint Arthro
DF: fibular slides superior & posterior
PF: fibula glides distal & slightly anterior
High ankle Sprain
Foot on ground, hit/twisted, and external rotation occurs, torquing the talus; causes pulling apart of the syndesmosis
Talocrural Arthro
concave distal tibia and fibula, convex talar dome
NWB: talus moves posterior w/DF, anterior w/PF
WB: tibia moves anteriorly w/DF, posterior w/PF
Talocrural DF ROM
20 degrees
Talocrural PF ROM
50 degrees
Talocrural Ligamentous support
Medial: Deltoid ligament complex
Tibionavicular, anterior tibiotalar, and posterior tibiotalar
Lateral: ATF, PTF, CF
ATF-most commonly injured ligament with PF/inversion (lateral) ankle sprains
Talocrural End Feel
DF/PF: Firm/hard
Talocrural Capsular pattern
PF>DF
Talocrural DF Functional ROM: rising form sitting
28 degrees
Talocrural DF Functional ROM: descending stairs
21-36 degrees
Talocrural PF Functional ROM: running
32 degrees
Subtalar Arthro
Ant & Middle= convex talar facts, concave calcaneal facets, share joint capsule with talonavicular joint
Posterior: concave talar facet, convex calcaneal facet, own joint capsule
Oblique Axis
42 degrees from horizontal, 16 degrees from sagittal
Subtalar End feel
Inversion: Firm
Eversion: Hard/firm
Subtalar Capsular Pattern
inversion>eversion
Subtalar INV/EV ROM
5 degrees
STJ and TTJ ROM Supination/Pronation
35 degrees each
Transverse Tarsal Joint
Talonavicular: convex talus, concave navicular
Calcaneocuboid: convex-concave calcaneus, convex-concave cuboid
Transverse Tarsal Ligamentous Support
plantar calcaneonavicular (spring), bifurcate (cc, CN), dorsal talonavicular
Transverse Tarsal Osteo
Longitudinal & Oblique Axis (Triplanar motion)
Midfoot supination (inversion) & pronation (eversion)
Adduction/Abduction of the forefoot
Transverse Tarsal Arthro
NWB inversion: navicular slides medially & dorsally on talus; cuboid slides medially (plantar)
NWB eversion: navicular slides laterally (plantar) & cuboid slides laterally (dorsal)
MTP ROM Flex/Ext
1st: Flex 0-45/ Ext 0-70
Toes 2-5: Flex 0-40/ Ext 0-40
MTP end feel
firm
1st MTP Capsular Pattern
Ext > Flex
Supination
Calcaneal inversion, ADD, PF
ABD/DF of talus
ER of tibia
Pronation
calcaneal eversion, ABD, DF
ADD/PF of talus
IR of tibia
3 Arches
Medial longitudinal, lateral longitudinal, transverse
Pes planus
flat foot, pronation
Pes Cavus
HIgh arch, supination
Myotome L2
Hip flexion (Iliopsoas)
Myotome L3
Knee Extension (Quads)
Myotome L4
Ankle DF (anterior tib)
Myotome L5
Great toe extension (EHL)
Myotome S1
Ankle Plantar Flexion (Gastroc), Ankle Eversion (Peroneus Longus/Brevis), Hip Extension (Gluteus Maximus)
Myotome S1-S2
Knee Flexion (Biceps Femoris)
Dermatomes
Inside of knee : L3
Front of Knee: L4
Outside of Knee: L5