Movement Analysis Upper Limb

Question 1

GLENOHUMERAL FLEXION

Answer 1

Flexion at the glenohumeral joint
Sagittal plane and frontal axis
Produced by anterior fibres of deltoid and clavicular head of pectoralis major, synergists= Coracobrachialis and biceps brachii
Isotonic concentric contraction of shoulder flexors, passive lengthening of shoulder extensors
Can get to 110 degrees
Inner range = full shoulder flexion and outer range= full shoulder extension Neutral arms by side is outer to mid range
Mid range is around 45 degrees flexion
Limited by: tension in antagonists (extensors) and rotators cuff muscles to stabilise head of humerus in Glenoid cavity , coracohumeral ligament ligament, 2:1 ratio for Scapulohumeral rhythm so poor scapula movement , lax shoulder joint
Fixators= Fixated by latissimus dorsi which stabilises inferior angle of scapula and trapezius. Middle and posterior fibres of deltoid.

Question 2

GLENOHUMERAL EXTENSION

Answer 2

GLENOHUMERAL joint extension
Sagittal plane and frontal axis
Produced by: Sternocostal head of pectoralis major, posterior fibres of deltoid and latissimus dorsi, synergist is teres major and triceps brachii.
Isotonic eccentric contraction of flexors
OTHERWISE, shoulder flexors work in eccentric isotonic contraction to lower arms down to neutral
Extension can get to 50-70 degrees but neutral is 0 degrees.
Inner range = full shoulder extension. Outer range = full shoulder flexion. So neutral position is outer to mid range
Limited by: tension in antagonists (flexors), GLENOHUMERAL ligaments stretch during extension , probably inferior GH ligament to stretch most
Fixators: Trapezius , anterior and middle deltoid attaches to humerus and keeps steady , clavicular head of pectoralis major stabilises humerus

Question 3

GLENOHUMERAL ABDUCTION

Answer 3

GLENOHUMERAL joint abduction
Frontal plane and sagittal axis
Prime mover is middle fibres of deltoid, synergist is supraspinatus , which would assist
If it’s only small amount then other way round
Isotonic concentric contraction into abduction
Abduction can get to 100-120 degrees
Inner range = full abduction. Outer range= neutral
So slight abduction is outer to mid range
Limited by: tension in antagonists, rotator cuff muscles and inferior GLENOHUMERAL ligament.
Fixators: Subscapularis and infraspinatus , because they will fix the humerus , anterior and posterior deltoid fibres fixating

Question 4

GLENOHUMERAL ADDUCTION

Answer 4

GLENOHUMERAL joint ADDUCTION
Frontal plane and sagittal axis
Produced by: pectoralis major, latissimus dorsi and teres major, synergists are coracobrachialis and triceps brachii.
In GH ADDUCTION, GH abductors work in eccentric isotonic contraction to lower the arm to adduct it
Can get to 30-40 degrees
Muscle range = inner range is full ADDUCTION and outer range is full abduction
Limited by lateral side of body so you’d need some flexion and medial rotation , tension in abductors
Fixators: Anterior and posterior deltoid fibres , rotator cuff lengthens during ADDUCTION

Question 5

GH MEDIAL ROTATION

Answer 5

GH joint medial rotation
Horizontal plane and vertical axis
Produced by: Subscapularis prime mover, synergists are pectoralis major, latissimus dorsi, anterior fibres of deltoid and teres major.
Isotonic concentric contraction
90 degrees maximum
Inner range = full medial rotation and outer range = full lateral rotation
Limited by: tension in lateral rotators , slight soft tissue apposition,
Fixators: Middle and posterior deltoid fibres fixating, trapezius , biceps brachii as crosses GLENOHUMERAL joint

Question 6

GH lateral rotation

Answer 6

GLENOHUMERAL lateral rotation
Horizontal plane and vertical axis
By: Posterior deltoid fibres, infraspinatus and teres minor.
Isotonic concentric contraction
80 degrees max
Inner range = full lateral rotation. Outer range = full medial rotation
Limited: tension in antagonists medial rotators, all GLENOHUMERAL ligaments
Fixators : anterior and middle fibres deltoid , trapezius stabilises

Question 7

ELBOW JOINT FLEXION

Answer 7

Humero ulna and humero radial joint flexion
Sagittal plane and frontal axis
By brachialis, biceps brachii and assisted by brachioradialis
Isotonic concentric contraction
Gets to 140-150 degrees so estimate
Inner range is full elbow flexion and outer range is full elbow extension (for the flexors)
Mid range is about 80 degrees elbow flexion
Mid to inner
Limited by : Apposition of soft tissue of anterior compartment of forearm and biceps brachii of humerus
Tension in antagonists, tension in antagonists
FixTors: Trapezius and rhomboids work isometricslly to fix the scapula, deltoid stabilises the humerus (mainly anterior and posterior) , stabilised by flexor and extensor forearm muscles because most attach at medial and lateral epicondyles

Question 8

ELBOW JOINT EXTENSION

Answer 8

Humero ulna and humero radial joint extension
Sagittal plane and frontal axis
Produced by triceps brachii and synergist is anconeus
Isotonic eccentric contraction of elbow flexors - BBB
Full extension is 0 degrees
Inner range = full elbow extension. Outer range= full elbow flexion Mid range about 80 degrees flexion?
Limits: extension is closed pack so limited by MCL and LCL and olecranon process in olecranon fossa, tension in antagonists
Fixators: same fixators

Question 9

ELEVATION SHOULDER GIRDLE

Answer 9

Elevation of shoulder girdle
Produced by upper fibres of trapezius and levator scapulae
Isotonic concentration contraction
Max is 10cm up
Inner range is full elevation and outer range is normal posture going into depression.
Limiting factors:
Fixators :

First thing I’ve noticed elevated on one side or depression on other side
Due to tightness or weakness

Question 10

DEPRESSION

Answer 10

Depression at shoulder girdle
By pectoralis minor and serratus anterior
Isotonic concentric contraction
Goes down 2cm max
Inner range = full depression and outer range = normal posture
Limited by:
Fixators:

Question 11

Protraction

Answer 11

Protraction of shoulder girdle
By pectoralis minor and serratus anterior
Isotonic concentric
5cm anterior
Inner range is full protraction and outer range is retraction So outer to mid range maybe
Limitations:
Fixators:

Tight in his pec minor and serratus anterior for protraction

Question 12

Retraction

Answer 12

Retraction of shoulder girdle
Rhomboid major and minor and middle trapezius
Isotonic concentric contraction
2cm back
Inner range is full retraction and outer range is full protraction.
Limited by:
Fixators:

Retraction as taking the cup back , isotonic concentric no gravity acting on that

Question 13

Lateral and medial rotation shoulder girdle

Answer 13

Lateral rotation shoulder girdle = upper and lower fibres of trapezius and lower fibres of serratus anterior

Medial rotation shoulder girdle = rhomboids, pectoralis minor and levator scapulae

Scapulohumeral rhythm 2 degrees humeral flexion and 1 degree of lateral rotation of scapula

Question 14

RADIO CARPAL AND MID CARPAL JOINT FLEXION

Answer 14

Radio carpal and mid carpal joint flexion
Sagittal plane and frontal axis
Prime movers : flexor carpi radialis and flexor carpi ulnaris, some synergists are palmaris longus, flexor digitorum superficialis and FDP
Isotonic concentric contraction into flexion
Wrist flexes to 85 degrees, 60% flexion from mid carpal joint and 40% flexion from radiocarpal joint
Inner range is full wrist flexion and outer range full wrist extension
If wrist only slightly flexed the mid to inner range, wrist slightly extended is mid to outer range
Limited by: dorsal radiocarpal ligament , tension in antagonists
Fixators : Pronator quadratus , abductor pollicis longus, FPL , some extensors

Question 15

RADIO CARPAL AND MID CARPAL EXTENSION

Answer 15

RC joint extension
Sagittal plane and frontal axis
By: ECRL, ECRB , ECU and synergists EPL and EPB
Isotonic concentric contraction
Gets to 85 degrees 60% from wrist and 40% mid carpal
Inner range is full extension and outer range full flexion
Limited by: palmar radiocarpal ligament , tension in flexors
Fixators : ED, EDM, EI

Question 16

HOLDING THE CUP

Answer 16

As going to hold the cup, person will slightly abduct their fingers via the dorsal interossei in the hand.

ISOTONIC concentric contraction of FDS and FDP going to hold cup Isometric muscle work to hold cup by flexor digitorum superficilias and FDP

Some opposition of the thumb via opponens pollicis
Slight flexion of thumb = flexor pollicis longus and flexor pollicis brevis
Opposition: opponens pollicis and opponens , synergy FPL, FPB, abductor pollicis brevis and adductor pollicis

Lumbricals isotonic concentric and then isomeric

Question 17

Radial deviate to pick cup up

Answer 17

Radial deviation of the radiocarpal joint
Frontal plane and sagittal axis
All synergists : Flexor carpi radialis, extensor carpi radialis longus and extensor carpi radialis brevis.
Concentric isotonic muscle work
Radial deviation can get to 15 degrees
Mid range - is neutral, full inner = radial deviation and full outer range = ulna deviation
Limiting : Ulna collateral ligament and the buttress of radial styloid process , congruency of joint surfaces , tension in antagonists so ulna deviators
Fixators : Pronator muscles and supinator , FDP, FDS, EDj

Question 18

Ulna deviation

Answer 18

Ulna deviation at radiocarpal joint
Frontal plane and sagittal axis
Synergy; Produced by flexor carpi ulnaris and extensor carpi ulnaris
Isotonic eccentric contraction of radial deviators , into ulna deviation , then rad and ulna deviation work isometrically to keep it there
Ulna deviation can get to 45 degrees , only a small amount of ulna deviation , eccentric contraction of radial deviators so they’re in outer range
Range of muscle work: Inner range = full ulna deviation and outer range = full radial deviation for the ulna deviation muscles
Limited by: Radial collateral ligament , tension in radial deviators , congruency of joint surfaces
Fixators: Pronator and supinators, FDP, FDS, ED keep wrist secure position as ulna deviate

Question 19

Pronation of forearm

Answer 19

Pronation at the superior and inferior radio ulna joints
Horizontal plane and vertical axis
Produced by: Pronator teres, pronator quadratus , synergist is brachioradialis (pronates from supination to mid prone)
If only pronate to mid range, brachioradialis is prime
Isotonic concentric muscles work of pronator teres and quadratus
Pronation can get to 80-90 degrees
Inner range of pronators is full pronation and outer range is full supination
Brachioradialis supinate to mid range outer to inner
Full pronation to mid range outer inner
Limitations : Tension in antagonists, bony contact of radius crossing over ulna, and the dorsal radio ulna ligament , quadrate ligament at superior radio ulna joint
Fixators: long Flexor and extensor cross common flexor and extensor tendons at epicondyles and cross the wrist joint

Question 20

Supination of forearm

Answer 20

Supination at superior and inferior radio ulna joints
Horizontal plane and vertical axis
Produced by supinator, biceps brachii - synergist is brachioradialis
But if only supinating to mid range, brachioradialis is prime mover , with others in synergy
Isotonic concentric contraction of supinators
Supination can get to 90 degrees
Inner range = full supination and out range= full pronation
Limited by: Tension in antagonists and tension in anterior radio ulna ligament , wuadrate ligament tightens
Fixators: same as pronators

Question 21

Intrinsic hand muscles I could mention

Answer 21

Flexor pollicis brevis - flexion of MCP, CMC and medial rotation of thumb

Opponens pollicis- involves abduction, MR, flexion and ADDUCTION

Abductor pollicis brevis - abduction at CMC MCP joints of thumb

Adductor pollicis

Abductor digiti minimi- abduction of little finger and flexion MCP

Flexor digiti minimi- flexes MCP joint little finger

Opponens digiti minimi- slight opposition

Palmaris brevis will steady and corrugate skin to aid grip on the cup

Dorsal interossei ABDUCT
Palmar interossei ADDUCT