Quiz 3 Flashcards
what are the 5 unique mechanical demands of the TMJ?
1) continuous use
2) generalization of significant force
3) generalization of finely-tuned complex motions
4) bilateral motion-when one side moves, the other has to move too
5) location of pain isn’t always the origin of the problem
what kind of jt is the TMJ?
synovial jt with fibrocartilage
what are the 2 joint spaces of the TMJ?
1) superior jt space (gliding jt)- articular eminence and superior disc
2) inferior jt space (hinge jt)-condyle and inferior aspect of the disc
t/f: the periphery of the TMJ disc is vascular and innervated
true
where is the disc attached in the TMJ?
medial lateral poles of condyle of the mandible
anteriorly to lateral pterygoid and capsule
posteriorly to bilaminar retrodistal pad
what fibers keep the disc in place?
sharpeys fibers
what is the oblique portion of the lateral TMJ lig?
suspensory lig from the neck of the condyle to the articular eminence
what is the horizontal portion of the lateral TMJ lig?
lateral pole of the condyle/disc to articular eminence
what is the stylomadibular lig?
styloid process to posterior border of ramus
limits protrusion and produces posterior disc translation during closing
what is the sphenomandibular lig?
sphenoid to ramus
suspends the mandible and limits protrusion
what are the muscles of the TMJ?
masseter, temporalis, medial pterygoid, later pterygoid, suprahyoids, and infrahyoids
what is the strongest muscle in the body?
masseter
what is the main job of the masseter?
elevation and protrusion bilaterally
ipsilateral lateral deviation unilaterally
what is the rule of the jaw?
if a muscle attaches to the external mandible, it creates lateral deviation ipsilaterally
if a muscle attaches to the internal mandible it creates lateral deviation contralaterally
what does the temporalis do?
elevtates bilaterally
posterior fibers retruded
ipsilateral lateral deviation unilaterally
tenses as you close the jaw
jaw deviation to the L creates rotation at the __ condyle and rotation out the TMJ on the __
L, R
what does the medial pterygoid do?
elevates and protrudes bilaterally
contralateral lateral deviation unilaterally
what does the lateral pterygoid do?
contralateral lateral deviation unilaterally
protrusion bilaterally
the superior head controls disc w/closing
the inferior head resists opening ??
what do the suprahyoids do?
depress and retrude the jaw
what do the infrahyoids do?
stabilize the hyoid
what is the normal amount of jaw opening?
40-50 mm (3 finger width)
what is the normal amount of jaw opening during the rotation phase?
25 mm
what is the normal amount of jaw opening during the gliding phase?
15-25 mm
what occurs during the rotation phase of jaw opening?
anterior rotation of the condyle on the disc
occurs within the inferior jt space b/w the disc and condyle
1st phase of jaw opening
what is the 1st phase of jaw opening?
rotation
what occurs during the gliding phase of jaw opening?
translation of the disc-condyle complex
b/w the disc and eminence in the superior jt space
what occurs during mandibular elevation (jaw closing)?
opposite of depression (opening)
translation posteriorly
rotation of the condyle posteriorly on the disc
what occurs during mandibular protrusion?
condyle and disc translate along the articular eminence w/o rotation
superior jt space
glide and translation
retrodistal tissue stretches 6-9 mm to allow motion
what is the normal motion that allows upper and lower teeth to approximate edge to edege?
mandibular protrusion
what occurs during mandibular retrusion?
motion is limited by TM lig and retrodistal tissue
normally about 3 mm
what occurs during L mandibular lateral deviation?
L condyle spine and R condyle ant glide
what is the normal amount of mandibular lateral deviation?
8 mm (width of upper central incisors)
t/f: mandibular lateral deviation allows us to assess one jt motion at the TMJ
true
L lateral deviation tests __ TMJ motion
R
R lateral deviation tests __ TMJ motion
L
what happens at the superior jt of the TMJ?
gliding/translation
what happens at the inferior jt space of the TMJ
hinge
which jt space moves first in jaw opening?
the inferior jt space
what is the primary curve of the spine?
kyphosis (posterior convexity)
what part of the spine has a kyphotic curve?
thoracic spine
what is the secondary curve of the spine?
lordosis (anterior convexity)
what parts of the spine have lordotic curves?
cervical and lumbar spine
what is kypho-lordotic posture?
increased kyphosis and lordosis
increased forward bending in the thoracic spine
increased backward bending in the lumbar spine
LOG posterior to the lumbar spine and anterior to the thoracic spine
what is flat back posture?
decreased thoracic and lumbar curves leading to decreased shock absorption and increased kinetic forces
what is swayback posture?
increased lordosis
trunk offset posterior to hips
what is scoliosis?
lateral curvature of the spine (R and L)
accompanying rotation
what is the largest portion of the vertebrae?
the body
what makes up the anterior portion of the vertebrae?
the body and pedicle
what portion of the vertebrae transmits forces from the body to the posterior components?
pedicle
what part of the vertebrae dictate the type and amount of motion?
the facets
what part of the vertebrae forms a boney ring around the spinal canal?
lamina
what part of the spine had bifid spinous processes?
cervical
what provides passive stability if the spine?
capsuloligamentous complexes (CLC)
what is the role of spinal ligs?
passive tension
mechanoreceptive feedback
at what point in the range are ligaments engaged?
end range only!
at what point in the range are muscles engaged?
mid range
the anterior longitudinal lig increases in depth, breath, support, strength as it goes from ____ to ____
cervical, lumbar
the ant long lig is taught in ____ and slack in ____
extension, flexion
the posterior longitudinal ligament form the ____ wall of the spinal canal
anterior
what ligaments provide segmental stability in the spine?
supraspinous and intertransverse ligs
what does the supraspinous lig limit?
flexion
what does the intertransverse lig limit?
SB and some rot
what does the interspinous lig limit?
flexion
what is the ligamentum flavum?
paired lig from one lamina to the lamina below it
increases % elastin
helps with returning spinal segments to neutral
helps prevent impingement of capsule during triplanar motion
limits end range motions
is the intervertebral disc fibrocartilage or or hyaline cartilage?
fibrocartilage
t/f: the IV disc produces motion
false, it just helps direct and allow motion
what are the zones of the IV disc?
nucleus pulposus
inner nonfibrous annulus
annulus fibrosis
cartilaginous end plate
what is the nucleus pulposus?
decreased water content with age
central portion of the IV disc composed of hydrophilic proteoglycans
what is the annulus fibrosis?
type 1 and 2 CT arranged in concentric rings from oblique to more vertical fiber direction
contains the nucleus
has a good blood supply in peripheral disc
t/f: the IV disc fails from the inside out
true
t/f: pain occurs in the IV disc when it reaches the periphery
true
what are the functions of the IV disc?
allow motion through deformation
limit motion (primarily rotation)
maintains diameter of the IVF
transmits shock to vertebral bodies
what kind of jts are the facet jts?
synovial jt with CLC and menisci
what is the primary purpose of the facet jts?
direct and determines quantity of motion in each plane
t/f: facet jts absorb weight bearing forces
true
what is the orientation of the midcervical facet jts?
45 deg b/w frontal and transverse planes (upward slope)
what is the orientation of the thoracic facet jts?
frontal
what is the orientation of lumbar facet jts?
sagittal
what is the spinal motion segment?
info aspect of sup vertebra, sup aspect of inf vertebra, and everything that lies in b/w them
what happens in the spine during flexion?
compression of ant vertebral body and anterior disc
nucleus moves posterior
facet jts open up and IV foramen opens up
what happens in the spine during extension
closing foramen and facets
nucleus migrates anterior
annulus moves posterior
what is unique about the cervical spinous process?
bifurcated/forked
what is unique about the transverse processes in the cervical spine?
they have transverse foramen for vertebral arteries
what are the features of the atlas?
C1
ring of bone with no vertebral body
anterior arch w/facet for dens
posterior arch w/small bump like spinous process
lateral masses
inferior facets
very concave superior facets
what are the features of the axis?
the first palpable spinous process
dens
inf facet that behaves like the midcervical spine (45 deg b/w frontal and transverse)
what is the orientation of the cervical facet jts?
45 deg b/w transverse and frontal planes
what is the motion at the OA jt?
“yes” and “maybe” jt
sagittal and frontal plane motion
what kind of jt is the OA joint?
plane synovial jt
what are the jt surfaces of the OA jt?
convex occipital condyles and concave C1 superior facets (ball on saucer)
t/f: facets slope in inf direction medial to lateral in cervical facet jts
true
what is the job of the alar and transverse ligaments?
to prevent the dens from coming in contact w/the spinal cord
what is the job of the alar lig?
stability and guides motion
pulls C2 into place when taught
as you SB, it pulls C2 into rot
what motion occurs at the AA jt?
“no” jt
35-50% of all cervical rotation
what are the 3 jts at the AA jt?
2 facet jts (convex articular facets of C1 w/convex articular facets of C2-ball on ball)
1 central pivot jt (ant dens on ant arch of atlas and post dens on transverse lig)
what jt is like a ball on ball?
AA jt
what is the job of the transverse lig?
to keep the dens in close proximity to anterior arch to stop it from going back into neutral structures
what are the 2 components of the cruciform lig?
vertical and transverse components
what motions occur at the midcervical spine?
just up/down glide
what are the “laws” of cervical kinematics?
1) in the MC spine, SB and rotation are coupled and occur ipsilaterally
2) altas always follows the occiput
3) AA will attempt to keep the head facing forward during SB
4) OA will attempt to keep eyes level during rotation
what is functional cervical motion?
SB at MC spine and rotate at SO in the same direction
R SB (MC motion) and rotate R (AA jt)
L SB (MC) and rotate L (AA)
what is non-functional cervical motion?
SB at MC spine and rotate at SO in opposite direction
R SB (MC) and rotate L (AA)
L SB (MC) and rotate R (AA)
how much FB is there in the cervical spine?
80-90 deg
how much BB is there in the cervical spine?
70 deg
how much SB is there in the cervical spine?
20-45 deg
how much rotation is there in the cervical spine?
45 deg
during FB, what happens in the facet jts of the cervical spine?
inf facets slide up and forward on the sup facets
annulus bulges anterior and nucleus bulges posterior
spinal canal lengthens
IVF increases
during BB, what happens in the facet jts of the cervical spine?
inf facets slide back and down on sup facets
annulus bulges posterior, nucleus bulges anterior
IVF narrows
what occurs in the cervical spine with head retraction?
upper cervical flexion
lower cervical extension
what occurs in the cervical spine with head protraction?
upper cervical extension
lower cervical flexion
with R cervical rotation, what occurs in the facets?
R inf facets slide down and back
L inf facets slide up and forward
with L cervical rotation, what occurs in the facets?
L inf facets slide down and back
R inf facets slide up and forward
with R cervical SB, what occurs at the facets?
R inf facets slide down and back
L inf facets slide up and forward
with L cervical SB, what occurs at the facets?
L inf facets slide down and back
R inf facets slide up and forward
what is required for non-functional cervical SB?
need suboccipital and midcervical
what is required for functional cervical SB?
midcervical only
during cervical FB, the occiput rolls ____, glides ____
anterior, posterior
what stops the atlas anteriorly during cervical FB?
transverse ligament
does the atlas glide anteriorly or posteriorly during cervical FB?
anteriorly (follows the occiput)
during cervical BB, the occiput rolls____, and glides ____
posterior, anterior
what stops the atlas posteriorly during cervical BB?
the anterior arch
does the atlas glide posteriorly or anteriorly during cervical BB?
posteriorly
what occurs in non-functional cervical SB?
R SB=R rot (MC) and L rot (SO)
L SB=L rot (MC) and R rot (SO)
what occurs in functional cervical SB?
R SB=R rot (MC) and R rot (SO)
L SB=L rot (MC) and L rot (SO)
what occurs in cervical rotation?
R rot=R SB (MC) and L SB (SO)
L rot=L SB (MC) and R SB (SO)
a decrease in R cervical SB may be due to what 2 things?
decrease in R downglide or L upglide
decrease in L rot at AA
a decrease in R cervical rot may be due to what 2 things?
decrease in R downglide or L upglide
decrease in L SB at OA
what provides dynamic stability of the cervical spine?
muscles!
what muscles are most important for spinal stability?
deep
what role do the larger, superficial muscles play?
large excursion (can contract 1/2 their length)
hypertrophy
what role do the shorter, deeper muscles play?
stabilization!
force transducers
motor recruitment, motor learning, status and position of jt during movement
what are the superficial neck flexors?
SCM (superficial) and scalenes (middle)
which superficial neck flexor does contralateral rotation?
SCM
what are the deep neck flexors?
longus capitis
longus colli
what is the job of the deep neck flexors?
flexes the head on the neck
support of cervical lordosis
ipsilateral SB and rot
what are the superficial neck extensors?
erector spinae (superficial)
splenius capitus (middle layer)
what are the deep neck extensors?
multifidus and rotators (deepest)
semispinalis cervicis and capitus (middle)
what is the orientation of the facet jts in the thoracic spine?
frontal
what are the features of the thoracic spine?
demifacets on lat body
frontal plane facets
facets on transverse processes
what do the demifacets articulate with?
the head of the ribs
what do the facets of the transverse processes articulate with?
the tubercle of the rib
t/f: you can mobilize the ribs to mobilize the vertebrae and vice versa
true
rib 7 articulates with the demifacets of what vertebrae (costovertebral)?
T6 and T7
the costotransverse jt at rib 7 articulates with what vertebrae?
T7
what is Cloward’s sign?
piercing chest pain (like a heart attack) from thoracic IV disc damage
what is the costovertebral jt?
the demifacets of the vertebrae articulating with the rib
what is the costotransverse jt?
the transverse facets of the vertebrae articulating with the rib
what is the chondrosternal jt?
the articulation bw chondral rib and sternum
ribs 1-7
what ribs attach directly to the sternum?
ribs 1-7
what ribs attach indirectly to the sternum?
ribs 8-10
what ribs are floating?
ribs 11-12
what is the interchondral jt?
the articulation b/w cartilage of ribs 8-10
what is the costochondral jt?
the articulation b/w ribs and cartilage
are the spinous processes of T1-3 at the same level, 1/2 level below, or a full level below?
at the same level
are the spinous processes of T4-6 at the same level, 1/2 level below, or a full level below?
1/2 level
are the spinous processes of T7-9 at the same level, 1/2 level below, or a full level below?
full level below
is the spinous process of T10 at the same level, 1/2 level below, or a full level below
full level below
is the spinous process of T11 at the same level, 1/2 level below, or a full level below
1/2 level below
is the spinous process of T12 at the same level, 1/2 level below, or a full level below
same level
what are the “laws” of thoracic spine kinematics?
1) if SB is primary motion=rot in opposite direction
2) if rot is primary=SB in same direction
3) accessory translation=opposite direction of rot
is the pump handle motion of the rib cage in the sagittal, frontal, or transverse plane?
sagittal
does the pump handle motion of the rib cage occur in the upper ribs, middle ribs, or lower ribs?
upper ribs
is the bucket handle motion of the rib cage in the sagittal, frontal, or transverse plane?
frontal
does the bucket handle motion of the rib cage occur in the upper ribs, middle ribs, or lower ribs?
middle (4-10)
is the caliper motion of the rib cage in the sagittal, frontal, or transverse plane?
transverse (open and close motion)
does the caliper motion of the rib cage occur in the upper ribs, middle ribs, or lower ribs?
lower, floating ribs (11-12)
t/f: the diaphragm is utilized for quiet ventilation
true
t/f: there are no primary muscles for expiration bc it’s passive at rest
true
during inspiration, the diaphragm _____, during expiration, the diaphragm ____
flattens, returns to normal
why are respiratory infection common with ribcage pathology?
bc they can’t fully inhale
what is the orientation of the external abdominals?
like hands in pockets
outward of the midline, like hands in a V?
what is the orientation of the internal abdominals?
perpendicular to the external abdominals
in towards the belly bottom, like hands in a triangle pointing up?
t/f: the pelvic girdle is a closed system of interdependent jts
true
what kind of jt is the sacroiliac jt (SI jt)?
synovial anteriorly, syndesmotic (like skull sutures) posteriorly
does the SI jt provide more mobility or stability?
stability
how much motion is there at the SI jt?
4-20 deg motion
.5-7mm motion
where can motion of the SI jt be felt?
PSIS
ppl often use the SI jt for too much motion when?
with tight hips and hamstrings
does more motion at the SI jt occur anteriorly or posteriorly?
anteriorly
what is the form closure of the sacrum?
the wedge structure of the sacrum creates closure for the jt and less motion due to its form
t/f: there is controversy regarding the topography (arrangement) of the SI jt
true
although there is controversy surrounding the axis of rotation of the SI jt, is the motion most likely in the sagittal, transverse, or frontal plane?
sagittal
t/f: the SI jt is a straight jt line
false, it is an auricular shape (like an ear)
t/f: the SI jt likely encapsulates S1-3
true
is the anterior or posterior aspect of the SI jt wider?
the anterior aspect
describe the shape of the sacrum
an inverted triangle
is the base of the sacrum the top or bottom?
the top
is the apex of the sacrum the top or bottom?
the bottom
facets of the sacrum move in what plane?
the frontal plane
what prevents spondylosthesis (frontal slippage) of the sacrum?
the frontal plane motion at the facets
what is the median sacral crest?
the ridge down the center of the posterior sacrum
what is the sacral sulcus?
the dimples just medial to the PSIS
what would prominent sacral sulci be indicative of?
malposition of the sacrum
what is the inferior lateral angle (ILA)?
the edge of the sacrum lateral and superior to the apex
what do the sacrotuberus lig and pelvis form?
the greater sciatic foramen
what do the sacrospinous and sacrotuberus ligs form?
the lesser sciatic foramen
does the piriformis pass through the greater or lesser sciatic foramen?
greater
t/f: the post interosseous SIJ lig combines with the sacrotuberous lig to form a network of stabilization
true
t/f: the long dorsal lig blends with the post interosseous lig and sacrotuberous lig
true
do the posterior or anterior ligaments of the sacrum provide greater support
posterior ligs
what is the pubic symphysis?
amphiarthrodial, cartilagenous jt with a fibrocartilagenous disc and hyaline cartilage covering the articular surfaces
what provides anterior stability at the pubic symphysis?
muscular expansions
t/f: motion at the pubic symphysis occurs through tissue deformation rather than true jt excursion
true
what is a critical structure in maintaining the closure of the pelvis?
the pubic symphysis
what is the role of the pubic symphysis?
to absorb, direct, control, restrict, and stabilize motions
what happens to the lumbo-pelvic-hip complex during flexion?
anterior compression, posterior distraction
some rotation and translation
opens the foramen and facets
posterior glide of nucleus
what happens to the lumbo-pelvic-hip complex during extension?
anterior distraction, posterior compression
closes foramen and facets
anterior glide of nucleus
in what direction do most herniations in the spine occur?
posterolateral
do ppl with disc pathology tend to prefer flexion or extension?
extension
do ppl with arthritis in facet jts tend to prefer flexion or extension?
flexion
what happens in type 1 (non-functional) lumbar SB?
SB/rot to opposite sides with a neutral spine
R SB=L rot
L SB=R rot
t/f: lumbar motions are combined, not coupled bc there are changes based on functional demands
true
what occurs in type 2 (functional) lumbar SB?
SB/rot to same side out of neutral spine
R SB=R rot
L SB=L rot
with R lumbar SB, do the R and L facets open or close?
R closes, L opens
with L lumbar SB, do the R and L facets open or close?
R opens, L closes
with R lumbar rot, do the R and L facets open or close?
R opens, L closes
with L lumbar rot, do the R and L facets open or close?
R closes, L opens
what is the position of max closing R in triplanar in the lumbar spine?
R SB (frontal), L rot (transverse), and extension (sagittal)
what is the position of max closing L in triplanar in the lumbar spine?
L SB (frontal), R rot (transverse), and extension (sagittal)
what is the position of max opening R in triplanar in the lumbar spine?
L SB (frontal), R rot (transverse), flexion (sagittal)
what is the position of max opening L in triplanar in the lumbar spine?
R SB (frontal), L rot (transverse), flexion (sagittal)
what is iliosacral movement?
the illium moving on the sacrum
what is the point of reference for iliosacral motion? (KNOW THIS)
the ASIS!!!!!
what are the 3 rules of iliosacral kinematics? (KNOW THIS)
1) IS motion reference point is ASIS
2) illium is linked to the hip and they move together
3) motion occurs in triplanar fashion w/most motion in the sagittal plane
what is the illium linked to?
the hip
where does most IS motion occur?
in the sagittal plane
what IS motions occur in the sagittal plane?
ant/post rotation (tilt)
in anterior rotation, how does the ASIS move?
ant and inf
when the hip flexors are tight, what sagittal plane IS motion occurs
ant rot
in posterior rotation, how does the ASIS move?
post and sup
when the hamstrings are tight, what sagittal plane IS motion occurs?
post rot
what IS motions occur in the transverse plane?
outflare and inflare
in outflare, how does the ASIS move?
points out
what hip motion is associated with outflare?
ER
in inflare, how does the ASIS move?
points in
what hip motion is associated with inflare?
IR
what IS motions occur in the frontal plane?
upslip and downslip
does the weightbearing side upslip or downslip?
upslip
does the nonweightbearing side upslip or downslip?
downslip
which motion of the hip creates post rot?
hip flexion
which motion of the hip creates ant rot?
hip extension
in gait, what IS motions are coupled on one side while the other side does the opposite?
upslip, outflare, and post rot
what are the 3 rules of sacroiliac (SI) kinematics?
1) landmark of SI movement=base of sacrum looking anteriorly
2) SI is linked to lumbar spine=when lbar spine moves, sacrum moves
3) sacrum moves in reference to S5 (exception in sagittal plane)
when the lumbar spine flexes, what SI motion occurs?
extension
when the lumbar spine extends, what SI motion occurs?
flexion
what is the landmark of SI motion?
base of the sacrum looking anteriorly
what is sacroiliac motion?
the sacrum moving on the ilia
what SI motions occur in the transverse plane?
rotation following the lumbar spine
if the lumbar spine rotates R, what SI motion occurs?
R sacral rotation
if the lumbar spine rotates L, what SI motion occurs?
L sacral rotation
what SI motion occurs in the sagittal plane?
flex/ex
what is torsion?
triplanar motion of the SI jt
what are the axes of torsion?
R oblique axis through R SIJ
L oblique axis through L SIJ
when moving forward on the ROA, what motion happens with the sulcus?
the L sulcus gets deeper
when moving forward on the LOA, what motion happens with the sulcus?
the R sulcus gets deeper
when moving backward on the ROA, what motion happens with the sulcus?
the L sulcus becomes more prominent
when moving backward on the LOA, what motion happens with the sulcus?
the R sulcus becomes more prominent
more than how many mm of pubic symphysis separation is abnormal?
> 3 mm
what is the landmark of pubic symphysis motion?
the anterior pubic ramus
what motions occur at the pubic symphysis?
sup/inf translation
upward/downward rotation
separation
should trunk muscles be activating before or after limb movement? (KNOW THIS)
before !!!!
with LBP, there is ___ abdominal strength and ____ extensor activity
decreased, increased
what is the cycle of pain in LBP?
pain causes a delay in trunk muscles activation which causes even more pain, continuing the cycle
t/f: timing of motor recruitment is the solution to LBP
true
do the lumbar flexors and extensors produce compression or tension forces?
compressive
t/f: the lumbar flexors produce anti-gravity flexion and/or pelvic post rot
true
are the lumbar flexors or extensors active when flexing the trunk from erect standing?
the extensors are active eccentrically
are we better at using our deep or superficial muscles?
superficial
do the thoracic or lumbar extensors have a greater % of type 1 fibers?
thoracic extensors
what motions do the lumbar extensors produce?
trunk extension and increased lordosis
t/f: the lumbar extensors limit anterior translation during forward bending
true
what is the result of increased tension on any wall of the abdomen?
increased internal pressure
how can we activate the transverse abdominals?
pull the belly button up to the ribs
what does pulling the belly button up the ribs do?
engages the pelvis floor and multifidus
creates an environment of stability
how can we engage the multifidus?
by drawing in the transverse abdominals
