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NPTE-Logan (Musculoskeletal I) > Orthopedic clinical exam (Cleland) Basic Anatomy of TMJ and Shoulder > Flashcards

Orthopedic clinical exam (Cleland) Basic Anatomy of TMJ and Shoulder Flashcards

1
Q

TMJ: Ligaments (3)

A
  1. Temporomandibular
  2. Sphenomandibular
  3. Stylomandibular
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2
Q

Attachment and function of temporomandibular ligament

A
  • Temporomandibular- thickening of anterior joint capsule extending from neck of mandibe to zygomatic arch (strengthens the TMJ laterally)
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3
Q

Attachment an function of Sphenomandibular ligament (TMJ)

A
  • Sphenoid bone to mandible (serve as a fulcrum and reinforcement to TMJ motion)
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4
Q

Attachment and function of Stylomandibular ligament (TMJ)

A
  • Styloid process to angle of the mandible
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5
Q

Temporalis muscle (TMJ)

A
  • Prox- temporal fossa
  • Dist- Coronoid process and anterior ramus of mandible
  • Nerve and segmental level- Deep temporal branches of mandiular nerve
  • Action- Elevate mandible
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6
Q

Masseter

A
  • Prox- Inferior and medial aspects of zygomatic arch
  • Dist- Coronoid process and lateral ramus of mandible
  • Nerve and segmental level- Mandibular nerve via masseteric nerve
  • Action- Elevate and protrude mandible
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7
Q

Medial Pterygoid (TMJ)

A
  • Prox- Medial surface of lateral pterygoid plate and tuberosity of maxilla
  • Dist- Medial aspect of mandibular ramus
  • Nerve and segmental level- Mandibular nerve via medial pterygoid nerve
  • Action- Elevate and protrude mandible
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8
Q

Lateral Pterygoid (TMJ)

A
  • Prox- (Superior head) Lateral surface of greater wing of sphenoid bone/ (Inferior head) Lateral surface of lateral pterygoid plate
  • Dist- Neck of mandible, articular disc, and TMJ capsule
  • Nerve and segmental level- Mandibular nerve via lateral pterygoid nerve
  • Action- Acting bilaterally: protrude and depress mandible. Acting unilaterally: laterally deviate mandible
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9
Q

Digastric muscle (TMJ)

A
  • Prox- (Anterior belly) Digastric fossa of mandible/ (Posterior belly) Mastoid notch of temporal bone
  • Dist- Intermediate tendon of hyoid bone
  • Nerve and segmental level- Mylohyoid nerve (anterior) and Facial nerve (posterior)
  • Action- Depresses mandible, raises and stabilizes hyoid bone
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10
Q

TMJ nerves

A
  1. Mandibular (motor-temporalis, masseter, lateral and medial pterygoid, digastric, mylohyoid/sensory-skin of inferior third of face)
  2. Nerve to mylohyoid (motor- mylohyoid/no sensory)
  3. Buccal (no motor/ sensory-cheek lining of gingiva))
  4. Lingual (no motor/ sensory- anterior tounge and floor of mouth)
  5. Maxillary (no motor/ sensory- skin of middle third of face)
  6. Opthalmic (no motor/ sensory-skin of superior third of face)
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11
Q

TMJ Exam History:

Jaw crepitus and pain during mouth opening and closing

A
  • OA
  • Capsulitis
  • Internal derangement consisting of anterior disc displacement without reduction
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12
Q

TMJ Exam History:

Patient reports jaw clicking and pain during opening and closing of the mouth

A
  • Internal deragement consiting of anterior disc displacement with reduction
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13
Q

TMJ Exam History:

Patient reports limited motion to about 20 mm with no joint sounds

A
  • Capsulitis
  • Internal deragement consiting of an anterior disc displacement without reduction
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14
Q

Shoulder joints (4)

A
  1. Glenohumeral
  2. Sternoclavicular
  3. AC
  4. Scapulothoracic
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15
Q

Shoulder:

Closed packed positions

A
  1. GH- Full abduction and ER
  2. SC- Arm abducted to 90 degrees
  3. AC- Arm abducted to 90 degrees
  4. ST- NA
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16
Q

Shoulder:

Capsular Patterns

A
  1. GH- ER <abd>
    </abd><li>SC- NR</li><li>AC- NR</li><li>ST- NR</li>

</abd>

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17
Q

Shoulder:

Ligaments (8)

A
  1. Glenohumeral
  2. Coracohumeral
  3. Coracoclavicular (trapezoid & conoid)
  4. Acromioclavicular
  5. Coracoacromial
  6. Sternoclavicular
  7. Interclavicular
  8. Costoclavicular
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18
Q

Glenohumeral igament (shoulder)

A
  • Attach- glenoid labrum of humerus
  • Function- reinforce anterior GH joint capsule
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19
Q

Coracohumeral ligament (shoulder)

A
  • Attach- Corocoid process to greater tubercle of humerus
  • Function- strengthen superior glenohumeral joint capsule
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20
Q

Coracoclavicular ligament (shoulder)

A
  • Attach- (trapezoid) superior aspect of coracoid process to inferior aspect of clavicle/ (conoid) coracoid process to conoid tubercle on inferior clavicle
  • Function- Anchor clavicle to corocoid process
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21
Q

Acromioclavicular ligament (shoulder)

A
  • Attach- acromion to clavicle
  • Function- Strengthen AC joint superiorly
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22
Q

Coracoacromial ligament (shoulder)

A
  • Attach- coracoid process to acromion
  • Function- Prevent superior displacement of humeral head
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23
Q

Sternoclavicular ligament (shoulder)

A
  • Attach- clavicular notch of manubrium to medial base of clavicle anteriorly and posteriorly
  • Function- reinforce SC joint anteriorly and posteriorly
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24
Q

Costoclavicular ligament (shoulder)

A
  • Attach- superior aspect of costal cartilage of 1st rib to inferior border of medial clavicle
  • Function- Anchor medial end of clavicle to 1st rib
25
Q

Upper trapezius

A
26
Q

Middle trapezius

A
27
Q

Lower trapezius

A
28
Q

Levator scapulae

A
29
Q

Rhomboids

A
30
Q

Latissimus Dorsi

A
31
Q

Serratus anterior

A
32
Q

Deltoid

A
33
Q

Pectoralis Major

A
34
Q

Pectoralis Minor

A
35
Q

Supraspinatus

A
36
Q

Infraspinatus

A
37
Q

Teres minor

A
38
Q

Subscapularis

A
39
Q

Teres major

A
40
Q

Radial nerve

A

Segmental levels- C5-T1

Sensory- Posterior aspect of forearm

Motor- Triceps brachii, anconeus, brachioradialis, extensor mm of forearm

41
Q

Ulnar nerve

A

Segmental levels- C7, C8, T1

Sensory- Medial hand including medial half of 4th digit

Motor- Flexor carpi ulnaris, medial half of flexor digitorum profundus, and most of small muscles in hand

42
Q

Musculocutaneous nerve

A

Segmental levels- C5, C6, C7

Sensory- Becomes lateral antebrachial cutaneous nerve

Motor- Coracobrahialis, biceps brachii, brachialis

43
Q

Axillary nerve

A

Segmental levels- C5, C6

Sensory- Lateral shoulder

Motor- Teres minor, deltoid

44
Q

Suprascapular nerve

A

Segmental levels- C4, C5, C6

Sensory- No sensory

Motor- Supraspinatus, Infraspinatus

45
Q

Dorsal scapular nerve

A

Segmental levels- ventral rami, C4, C5

Sensory- No sensory

Motor- Rhomboids, levator scapulae

46
Q

Lateral pectoral nerve

A

Segmental levels- C5, C6, C7

Sensory- No sensory

Motor- Lateral and Medial pectoralis

47
Q

Medial pectoral nerve

A

Segmental levels- C8, T1

Sensory- No sensory

Motor- Pectoralis minor

48
Q

Long thoracic nerve

A

Segmental levels- Ventral rami, C5, C6, C7

Sensory- No sensory

Motor- No serratus anterior

49
Q

Upper subscapular nerve

A

Segmental levels- C5, C6

Sensory- No sensory

Motor- Subscapularis

50
Q

Lower subscapular nerve

A

Segmental levels- C5, C6

Sensory- No sensory

Motor- Teres major, Lower subscapularis

51
Q

Medial cutaneous nerve of forearm

A

Segmental levels- C8, T1

Sensory- Medial arm

Motor- No motor

52
Q

Shoulder exam history:
Patient reports lateral/anterior shoulder pain with overhead activities or deomonstration of a painful arc

A
  • possible subacromial impingement
  • possible tendonitis
  • possible bursitis
53
Q

Shoulder exam history:

Patient report of instability, apprehension, and pain with activities most often when shoulder is abducted and externally rotated

A
  • shoulder instability
  • possible labral tear if clicking present
54
Q

Shoulder exam history:
Decreased ROM and pain with resistance

A
  • possible rotator cuff or long head of the biceps tendonitis
55
Q

Shoulder exam history:

Patient reports of pain and weakness with muscle loading, night pain, age >60

A
  • possible rotator cuff tear
56
Q

Shoulder exam history:

Patient complaints of poorly located shoulder pain with occasional radiation into elbow. Pain is usually aggravated by movement and relieved by rest. Age >45. Females often affected more than males.

A
  • possible adhesive capsulitis
57
Q

Shoulder exam history:

Patient reports of a fall on the shoulder followed by pain over AC joint

A
  • possible AC sprain
58
Q

Shoulder exam history:

Patient complaints of UE heaviness or numbness with prolonged postures and when lying on involved side

A
  • possible TOS
  • possible cervical radiculopathy

NPTE-Logan (Musculoskeletal I) (2 decks)

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