MSK Flashcards
What is the CPP of the vertebrae?
Full EXT
What is the CPP of the TMJ?
Maximal RET (clenching teeth)
OR
Mouth maximally open
What is the OPP of the SC joint?
arm resting by the side
What is the CPP of the SC joint?
Arm maximally ELEV
What is the OPP of the AC joint?
arm resting by the side
What is the CPP of the AC joint?
90 degrees ABD
What is the OPP of the GH joint?
55 degrees ABD
30 degrees Horiz. ADD
(Scapular plane)
What is the CPP of the GH joint?
maximal ABD and ER
What is the OPP of the humeroulnar joint?
70 degrees FLX
10 degrees SUP
What is the CPP of the humeroulnar joint?
Full EXT and SUP
What is the OPP of the humeroradial joint?
Full EXT and SUP
What is the CPP of the humeroradial joint?
90 degrees FLX
5 degrees SUP
What is the OPP of the proximal radioulnar joint?
70 degrees FLX
35 degrees SUP
What is the CPP of the proximal radioulnar joint?
5 degrees supination
What is the OPP of the distal radioulnar joint?
10 degrees SUP
What is the CPP of the distal radioulnar joint?
5 degrees SUP
What is the OPP of the radiocarpal and ulnocarpal joints?
neutral with slight UD
What is the CPP of the radiocarpal and ulnocarpal joints?
Full EXT and RD
What is the OPP of the midcarpal joints?
neutral
What is the CPP of the midcarpal joints?
EXT with UD
What is the CPP of the MCP joints?
Full thumb OPP
Full finger FLX
What is the OPP of the hip?
30 FLX
30 ABD
slight ER
What is the CPP of the hip?
Full EXT, ABD, and IR
What is the OPP of the knee?
25 degrees FLX
What is the CPP of the knee?
Full EXT and ER
What is the capsular pattern/restrictive pattern of the AO joint?
FLX > EXT
What is the capsular pattern/restrictive pattern of the AA joint?
ROT
What is the capsular pattern/restrictive pattern of the lower cervical spine (C3-T2)?
Limited in all motions EXCEPT FLX
SB = ROT >EXT
What is the capsular pattern/restrictive pattern of the GH joint?
ER > ABD > IR
What is the capsular pattern/restrictive pattern of the SC and AC joints?
ELEV
What is the capsular pattern/restrictive pattern of the humeroulnar and humeroradial joint?
FLX > EXT
What is the capsular pattern/restrictive pattern of the radioulnar joints?
PRON = SUP
What is the capsular pattern/restrictive pattern of the joints located in the wrist?
FLX > EXT
What is the capsular pattern/restrictive pattern of the midcarpal joints?
equal in all directions
What is the capsular pattern/restrictive pattern of the IP joints in the hand?
FLX > EXT
What is the capsular pattern/restrictive pattern of the T-spine?
SB and ROT > EXT > FLX
What is the capsular pattern/restrictive pattern of the L-spine?
SB and ROT > EXT > FLX
What is the capsular pattern/restrictive pattern of the hip?
IR/FLX > ABD
What is the capsular pattern/restrictive pattern of the knee?
FLX > EXT
What is the capsular pattern/restrictive pattern of the talocrural joint?
PF > DF
What is the capsular pattern/restrictive pattern of the subtalar joint?
INV > EV
What is the capsular pattern/restrictive pattern of the midtarsal joints?
SUP > PRON
What is the capsular pattern/restrictive pattern of the 1st MTP joint?
EXT > FLX
What is the capsular pattern/restrictive pattern of the MTP joints 2-5?
FLX
What is the capsular pattern/restrictive pattern of the IP joints in the foot?
EXT
What muscle substitutions occur when the shoulder abductors are weakened?
use of Scapular stabilizers to initiate shoulder motion (Reverse Scapulothoracic rhythm)
What muscle substitutions occur when hip abductors are weak?
use of Lateral trunk muscles or TFL
What muscle substitutions occur when finger flexors are weak?
use of wrist extensors (Tendonesis)
What muscle substitutions occur when the pec major is weak?
use of LHOB, coracobrachialis, and anterior deltoid
Orientation of the glenoid fossa forms true ABD at ____ degrees ANTERIOR to the frontal plane.
30 degrees anterior to the frontal plane
What portions of the clavicle at the SC joint are convex?
superior and inferior portions
What portions of the clavicle at the SC joint are concave?
anterior and posterior portions
What portion of the GH joint capsule is the least supported?
Inferior
The GH ligaments support what portions of the joint capsule?
anterior and inferior portions
What motions does the superior GH ligament restrict?
ER and inferior translation
What motions does the middle GH ligament restrict?
ER and anterior translation
What motions does the Anterior band of the inferior GH ligament restrict?
ER, anterior translation, superior translation
What motions does the posterior band of the inferior GH ligament restrict?
IR and anterior translation
How much elevation occurs in the GH joint?
The first 30 to 60 degrees of elevation
At approx. 75 degrees of elevation in the UE, what occurs at the GH joint to prevent compression of the greater tubercle on the acromion?
ER
(“Conjunct ROT”)
How are the trochlea and trochlear notch at the humeroulnar joint placed?
anteriorly at a 45 degree angle
What portion of the humerus articulates with the radius at the humeroradial joint?
capitulum
What portion of the humerus articulates with the ulna at the humeroulnar joint?
trochlea
The ulna (PRON/SUP) with elbow EXT
pronates
The ulna (PRON/SUP) with elbow FLX
supinates
The proximal ulna glides (medially/laterally) during elbow extension
medially
The proximal ulna glides (medially/laterally) during elbow FLX
laterally
The 1st metacarpal is concave in what directions?
medial/lateral
The 1st metacarpal is convex in what directions?
anterior/posterior
What does the extensor hood in the hand provide?
Assistance with EXT of the IP joints
What portion of the hand does the ulnar nerve innervate?
hypothenar region
1/2 of 4th digit
What portion of the hand does the median nerve innervate?
remainder of palmar surface not innervated by the ulnar nerve
+
dorsal portions of 2nd, 3rd, and distal 1/2 of 4th digit
During FLX/EXT at the 1st CMC joint, the first metacarpal is (concave/convext), moving on (concave/convex)
concave moving on convex
During ABD/ADD at the 1st CMC joint, the first metacarpal is (concave/convex), moving on (concave/convex)
convex moving on concave
During FLX and ABD at the 1st CMC joint, the 1st metacarpal rotates (radially/ulnarly) on the trapezium
ulnarly
During EXT and ADD at the 1st CMC joint, the 1st metacarpal rotates (radially/ulnarly) on the trapezium
radially
During wrist FLX, which way does the scaphoid/lunate glide in relation to the radius?
dorsally
During wrist EXT, which way does the scaphoid/lunate glide in relation to the radius?
anteriorly
During RD, which way does the proximal row of carpals glide?
ulnarly
During UD, which way does the proximal row of carpals glide?
radially
What is the depression on the femoral head called?
fovea capitis femoris
How is the femoral head oriented?
Superior, medial, anterior
At the hip joint, articular cartilage covers the while femoral head except for where?
fovea
What is the normal angle of inclination at the hip?
115-125
definition: Angle of inclination > 125 at the hip
coxa valga
definition: angle of inclination <115 at the hip
coxa vara
The femoral neck is angled ___ degrees ANTERIORLY to form the anterior antetorsion angle
10-15 degrees anteriorly
What is the orientation of the acetabulum?
lateral, inferior, anterior
(true/false) the acetabulum is fully covered by cartilage
FALSE - horseshoe shaped cartilage and has a fat pad for shock absorption
What portion of the labrum in the hip is thickest?
superior
Where does the iliofemoral ligament (Y Ligament) attach?
AIIS to intertrochanteric line (Medial to distal edge; lateral to proximal edge)
What movements does the iliofemoral ligament resist?
EXT and ER
What movements does the pubofemoral ligament resist?
ABD
Where does the ischiofemoral ligament connect?
ischium/posterior acetabulum to the greater trochanter
What movements does the ischiofemoral ligament resist?
EXT and IR
The MCL runs in the same direction as what other ligament found in the knee complex?
ACL
The meniscofemoral ligament runs with what other ligament?
PCL
–> has common attachment site at the medial femoral condyle
The oblique popliteal ligament inserts into the expansion of what muscular tendon?
semimembranosus
What forms the floor of the popliteal fossa and is in contact with the popliteal anterior artery?
oblique popliteal ligament
What ligament in the knee is a Y-shape?
Arcuate popliteal ligament
What does the arcuate popliteal ligament provide?
strengthens the posterolateral capsule
What does the transverse ligament of the knee provide?
connects the menisci anteriorly
What does the meniscopatellar ligament do?
pulls the menisci forward with EXT
What does the alar fold in the knee do?
Keeps the patella in contact with the femur
What shape is the medial meniscus?
C-shaped
Is the medial or lateral meniscus smaller?
lateral
What is the shape of the lateral meniscus?
O-shape
What separates the LCL and the lateral meniscus?
popliteus muscle tendon
The menisci follow the (tibia/femur) during IR/ER
femur
The medial meniscus is pulled (anteriorly/posteriorly) during FLX
posteriorly
–> due to semimembranosus and ACL
The medial meniscus is pulled (anteriorly/posteriorly) during EXT
anteriorly
–> due to meniscopatellar ligament
The lateral meniscus is pulled (anteriorly/posteriorly) during FLX
posteriorly
–> due to popliteus
The lateral meniscus is pulled (anteriorly/posteriorly) during EXT
anteriorly
–> due to meniscopatellar ligament and meniscofemoral ligament
During knee FLX, the medial femoral condyle has pure rolling during the first __-__ degrees.
10-15
During FLX, the lateral femoral condyle has pure rolling during the first __ degrees.
20
During FLX, the femoral condyles roll (anteriorly/posteriorly)
posteriorly
–> ACL is taut allowing condyles to glide posteriorly
During EXT, the femoral condyles roll (anteriorly/posteriorly)
anteriorly
–> PCL is taut allowing condyles to glide anteriorly
What is the screw-home mechanism?
The extra 5 degrees of tibial ER during terminal knee EXT
What bone is key to the lateral arch of the foot? Why?
cuboid
–> The makes the saddle shape deeper when articulating with the inferior surface of the calcaneus
What metatarsal is the largest and strongest?
1st
Which metatarsal(s) articulate to the cuboid?
4th and 5th
The ligaments at the talocrural joint are thicker ____.
laterally
What are the medial collateral ligaments of the talocrural joint?
“Deltoid ligament”
- deep anterior talotibial
- superficial posterior talotibial
- deep posterior talotibial
- tibiocalcaneonavicular
What are the lateral collateral ligaments of the talocrural joint?
- anterior talofibular
- posterior talofibular
- calcaneofibular
What ligament is called the spring ligament?
Plantar calcaneonavicular ligament
The plantar fascia becomes taut with what movement?
DF of MTP joints
–> ex: during push-off phase
(“windlass effect”)
What does the tightening of the plantar fascia cause?
- SUP of calcaneus
- INV of subtalar joint
During DF –> PF, the talus rotates (medially/laterally)
medially
Slight side-slide gliding and ABD/ADD are permitted when the foot is in (PF/DF) at the talocrural joint
PF
Where are uncinate joints located in the spine?
C3-C7
What do uncinate joints limit?
Lateral Cx movement
The surface of superior and inferior processes are (flat/curved) in cervical and thoracic regions.
flat
The surface of superior and inferior processes are (flat/curved) in the lumbar region.
can be flat or curved
What kind of joint is the SIJ?
Syndesmosis (diarthrosis)
The annulus fibrosis is ___% water.
65%
The Nucleus pulposis is __% water.
70-90%
What makes of 20-33% of the vertebral column’s height?
Nucleus pulposis
What portion of the annulus fibrosis is innervated?
outer 1/3
(true/false) The nucleus pulposis has blood and nerve supply.
FALSE
What does the alar ligament limit?
- FLX
- contralateral SB
- contralateral ROT
What does the anterior longitudinal ligament (ALL) do?
Reinforces the anterolateral portion of the vertebral column.
What does the alar ligament connect?
Dens to occipital condyles
Where does the ALL and PLL run?
C2 to sacrum
What does the PLL do?
limits FLX and reinforces the posterior aspect of the vertebral column.
What is the extension of the PLL once it goes above C2?
Tectorial membrane
What does the tectorial membrane limit?
FLX
What muscles are tested with inspiration?
- diaphragm
- levator costarum
- external intercostals
- anterior internal intercostals
What muscles are tested with forced expiration?
- internal obliques
- transverse abdominis
- external obliques
- posterior internal intercostals
- rectus abdominis
What movement tests the psoas minor?
Trunk FLX
What muscles are tested with spine ROT?
- intertransversarii
- obliques
- transversospinalis
What does the ligamentum flavum attach to?
The lamina of each vertebra below C2
What does the ligamentum flavum limit?
FLX
Costotransverse ligaments support the costotransverse joint capsules of what ribs?
1-10
What does the sacrotuberous ligament limit?
anterior ROT and superior translation of the sacrum
What does the posterior interosseous ligament limit?
motions in all directions
What rami form the cervical, brachial, and lumbosacral plexus?
ventral rami
SB and ROT occur in the (same/different) direction from C2-C7 regardless of whether the spine is in neutral or not.
same direction
Describe lumbopelvic rhythm with flexion.
During spinal flexion, the spine goes through 60-70 degrees of motion and then the pelvis will anteriorly rotate to allow more movement.
–> FLX of the hips will eventually follow
Describe lumbopelvic rhythm with extension.
During EXT, the hips will extend, the pelvis rotates posteriorly, and then the spine begins to extend
definition: describes a movement that involves FLX of the sacrum and posterior ROT of the ilium
nutation
definition: describes a movement that involves EXT of the sacrum and anterior ROT of the ilium
counternutation
What is required to achieve power grip?
Wrist EXT, UD, finger FLX
What nerve injury will affect power grip?
Ulnar nerve
What nerve injury will affect precision grip?
Median nerve
What does the coracoclavicular ligament do?
prevents upward translation of the humerus
What does the coracohumeral ligament do?
regulates inferior translation and ER of the humerus
What functional changes does radial nerve injury result in?
Affects the ability to maintain the functional wrist position and release an object
What positioning of the LE does excessive anteversion cause?
> 15 degrees
IR
can lead to a toe-in gait pattern
The opposite effects will occur with retroversion (< 15 degrees)
In CKC exsc, the iliopsoas tilts the pelvis (anteriorly/posteriorly) and (increases/decreases) lordosis
anteriorly ; increases
What muscle group stabilizes the pelvis during unilateral stance and prevents the contralateral LE from dropping?
ABD muscles
What do the adductor muscles provide during gait?
Assist in EXT and ROT of the femur during swing phase
What muscle does the sciatic nerve run under?
piriformis
Occasionally splits or passes over the muscle
(true/false) HS can be involved in sciatic nerve compression.
true
During CKC activities, the femur locks with (IR/ER)
IR
During OKC activities the tibia locks the knee by moving (medially/laterally)
laterally
What movements unlock the knee?
ER of femur
IR of tibia
What direction do the menisci move to with knee EXT?
anteriorly
What direction do the menisci move to with knee FLX?
posteriorly
Poor activation or strength of what muscle can result in PFPS?
VMO
Other causes: tight ITB or lateral retinaculum
What movement does the biceps femoris cause at the knee?
ER of the tibia
Conrol hip FLX and knee EXT during CKC activities
The fibula moves in what direction during DF?
laterally
What does OKC pronation at the rearfoot consist of?
Eversion, DF, and ABD of the calcaneus
What does OKC supination at the rearfoot consist of?
Inversion, PF, and ADD of the calcaneus
In what direction does the talus glide on the tibia during DF?
posteriorly
In what direction does the talus glide on the tibia during PF?
anteriorly
Subtalar pronation causes tibial ____.
IR
Subtalar supination causes tibial ____.
ER
During WB, supination of the subtalar joint consists of what movements?
Calcaneal inversion with PF
Talar ABD on the calcaneus
During WB, pronation of the subtalar joint consists of what movements?
Calcaneal eversion with PF
Talar ADD on the calcaneus
During Midstance, the posterior tibbialis, FDL, and FHL control what motion?
FWD motion of the tibia
What are the motor features of median nerve paralysis?
- loss of PRON
- loss of thumb OPP, FLX, and ABD
What are the motor features of radial nerve paralysis?
Loss of elbow, wrist, finger, and thumb EXT
What are the motor features of musculocutaneous nerve paralysis?
- loss of forearm FLX when supinated
- weakened SUP
What are the motor features of ulnar nerve paralysis?
- loss of UD
- weak wrist and finger FLX (4th and 5th digits)
- loss of thumb ADD
- loss of most intrinsic muscles (results in claw hand)
What are the features of sciatic nerve paralysis?
- loss of knee FLX
- weak hip ABD
- loss of all motor function distal to the knee
What are the features of femoral nerve paralysis?
loss of hip FLX and knee FLX
What are the features of tibial nerve paralysis?
loss of PF and knee FLX
What are the features of superficial peroneal nerve parlysis?
loss of Eversion
What are the features of deep peroneal nerve paralysis?
- loss of DF
- weakness of dorsal foot intrinsics
Describe coxa vara.
Femoral neck shaft is angled inward (angle of inclination < 125 degrees)
Describe coxa valga.
Femoral neck shaft is angled outward (angle of inclination > 125 degrees)
Describe valgus heel.
Rearfoot is deviated outward resulting in pronated feet
What MMT grading is described below?
Can move in full ROM with no gravity
poor (2/5)
What MMT grading is described below?
can only move into the testing position against gravity and hold
fair (3/5)
What MMT grading is described below?
can move against gravity in a small ROM
poor+
(2+/5)
What test should be performed prior to any manual treatment of the cervical spine and repeated as ROM increases?
Vertebral artery test
Full EXT and ROT to one side and hold the position for 10 seconds
(+) tinnitus, dizziness, nausea, throbbing, confusion, unusual sensation, pupillary constriction/dilation
- notify PCP if (+) and avoid mobilization and cervical spine movments at the ranges that produce symptoms
What are the movements performed by the superficial layer of intrinsic back muscles?
splenius capitis and splenius cervicis
When acting alone: ipsilateral SB and ROT of the head and neck
When acting as a unit: EXT of the head and neck
What are the movements performed by the intermediate layer of intrinsic back muscles?
Erector spinae
- Bilateral EXT (also allows for eccentric FLX)
- ipsilateral SB
What are the movements performed by the deep layer of intrinsic back muscles?
semispinalis, multifidus, and rotatores
- Bilateral EXT
- ipsilateral SB
- Contralateral ROT
What are the movements of the iliopsoas?
hip FLX and ER
Improper closure of the mandible can cause microtrauma and strained structures. A result of this could be dislocation _____ and ____ with altered surface loading
Anterior and medial dislocation
Describe the arthrokinematics of the mouth opening
Disc and mandible translate anteriorly
What is the common direction of TMJ dislocation?
Anterior
yawning or large bites can cause this
Contraction of the ______ may cause the mandibular head to dislocate anteriorly on the articular tubercle- mouth remains stuck in an opened position.
lateral pterygoid
Describe mandibular depression.
- condylar ROT
- head of mandible and articular disc glide anteriorly until the condylar head is inferior to the articular tubercle
What amount of mouth opening is required for functional opening.
40 mm
Describe protrusion of the TMJ.
anterior movement of the mandible with bilateral anterior condylar translation
Describe lateral excursion of the TMJ.
mandible moves laterally with anterior translation of the contralateral side and spinning of the ipsilateral joint