WEEK 3: UPPER QUADRANT RANGE OF MOTION

Question 1

Define: physiological movement

Answer 1

Have their own special value in that they combine tests of joint range, control, muscle power, and the patient’s willingness to perform the movement. Observed during active range of motion

Question 2

Define: accessory movement

Answer 2

There is a small ROM that can be obtained only passively by an examiner called an accessory movement

These accessory movements are not under voluntary control

They are necessary, however, for full painless function of the joint and full ROM of the joint

Question 3

Define: sagital plane

Answer 3

• divides the body vertically into left and right
• Movement in the sagittal plane occurs around a transverse axis;

Question 4

Define: frontal plane

Answer 4

• divides the body into front and back
• Movement in the frontal plane occurs around a sagittal axis

Question 5

Define: transverse/horizontal plane

Answer 5

divides the body into top and bottom

Movement in the transverse plane occurs around a vertical axis

Question 6

Define: contractile tissues

Answer 6

Have tension placed on them by stretching or contraction; include the muscles, their tendons, and their attachments into the bone

Question 7

Define: nervous tissues

Answer 7

Includes their associated sheaths also have tension put on them by stretching and pinching

Question 8

Define: inert tissues

Answer 8

Include all structures that would not be considered contractile or neurological, such as joint capsules, ligaments, bursae, blood vessels, and cartilage

Question 9

Define: active range of motion

Answer 9

performed by patient’s voluntary muscles; Contractile, nervous, and inert tissues are involved or moved during active movements

Look for: when onset of pain happens; if pain intensity or type increases, amount of restriction you observe

Question 10

Define: passive range of motion

Answer 10

primarily performed to determine the available anatomical ROM and end feel. With passive movement, the examiner puts the joint through its ROM while the patient is relaxed. A patient with a lesion of inert tissue may experience pain and limitation or excessive movement in some directions but not in others, as in a ligament sprain or local capsular adhesion.

Question 11

Define: capsular pattern

Answer 11

total joint reaction with muscle spasm, capsular contraction, and generalized osteophyte formation being possible mechanisms at fault

Question 12

Define: end feel

Answer 12

when assessing passive movement, the examiner should apply overpressure at the end of the ROM to determine the quality of end feel of each movement

Question 13

Define: resisted range of motion

Answer 13

strong, static voluntary muscle contraction against force

Question 14

Atlanto-occipital joint
- classification
- articular surface
- degrees of freedom
- osteokinematics

Answer 14

• classification: synovial joint
• articular surface: superior articular surfaces of the lateral masses of the atlas and occipital condyles
• degrees of freedom: 1
• osteokinematics: flexion/extension

Question 15

atlanto-axial joint
- classification
- articular surface
- degrees of freedom
- osteokinematics

Answer 15

• classification: lateral atlanto-axial joints - gliding synovial; medial atlanto-axial - pivot joint
• articular surface: Lateral atlanto-axial joints are between the inferior facets of the lateral masses of C1 and the superior facets of C2;Median atlanto-axial joint between the dens of C2 and the anterior arch of the atlas
• degrees of freedom: one
• osteokinematics: rotation

Question 16

joints of the vertebral bodies
- classification
- articular surface

Answer 16

• classification: symphyses
• articular surface: The articulating surfaces of adjacent vertebrae are connected by intervertebral discs; the anulus fibrosus is a fibrous ring consisting of concentric lamellae of fibrocartilage; The nucleus pulposus is the core of the IV disc

Question 17

joints of the vertebral arches
- classification
- articular surface

Answer 17

• classification: plane type synovial joint
• articular surface: The zygapophysial joints (facet joints); These articulations between the superior and inferior articular processes of adjacent vertebrae

Question 18

joints of the intra-cervical region
- capsular pattern
- open pack position:
- close pack position
- degrees of freedom
- osteokinematics

Answer 18

• Capsular pattern: Side flexion and rotation equally limited, followed by extension
• Open packed position: midway between flexion and extension
• Close packed position: full extension
• degrees of freedom: 3
• osteokinematics: flexion/extension; lateral flexion; rotation

Question 19

define: hangmans fracture

Answer 19

a bilateral fracture traversing the pars interarticularis of cervical vertebrae 2 (C2) with an associated traumatic subluxation of C2 on cervical vertebrae 3 (C3)

Question 20

Define: open pack position

Answer 20

position where the ligaments around the joint are most lax

Question 21

Define: close pack position

Answer 21

position where the ligaments around the joint are most taught

Question 22

What are the active movements on the cervical spine

Answer 22

Flexion
Extension
Side flexion left and right
Rotation left and right
Combined movements, repetitive movements, sustained positions (as necessary)

Question 23

What are the passive movements on the cervical spine

Answer 23

Flexion (tissue stretch)
Extension (tissue stretch)
Side flexion right and left (tissue stretch)
Rotation right and left (tissue stretch)

Question 24

What are the restricted movements on the cervical spine

Answer 24

Flexion
Extension
Side flexion right and left
Rotation right and left

Question 25

sternoclavicular joint
- classification
- articular surface
- degrees of freedom
- osteokinematics

Answer 25

• classification: saddle type of synovial joint but functions as a ball and socket joint
• articular surface: sternal end of the clavicle with the manubrium and the 1st costal cartilage
• degrees of freedom: 3
• osteokinematics: elevation/depression; protraction/retraction; rotation

Question 26

acromioclavicular joint

• classification
• articular surface
• degrees of freedom
• osteokinematics
• capsular pattern
• open pack position
• close pack position

Answer 26

• Classification: plane type synovial joint
• Articular surface: acromial end of the clavicle articulates with the acromion of the scapula
• Degrees of freedom: 3
• Osteokinematics: medial/lateral rotation; flexion/extension (tipping of the inferior angle of the scapula); abduction/adduction of the scapula
• Capsular Pattern: Pain at extremes of ROM, especially with horizontal adduction and full elevation
• Open Packed Position: Arm resting by side in normal physiological position
• Closed Packed Position: 90° abduction

Question 27

glenohumeral joint
- classification
- articular surface
- degrees of freedom
- osteokinematics
- capsular pattern
- open pack position
- close pack position

Answer 27

• Classification: ball and socket type synovial joint
• Articular surface: large, round humeral head articulates with the relatively shallow glenoid cavity of the scapula
• Degrees of freedom: 3
• Osteokinematics: flexion/extension; abduction/adduction; medial/lateral rotation
• Capsular Pattern: Lateral rotation, abduction, medial rotation
• Open Packed Position: 40° to 55° abduction, 30° horizontal adduction (scapular plane)
• Closed Packed Position: Full abduction, lateral rotation

Question 28

inferior radio-ulnar joint
- classification
- articular surface
- degrees of freedom
- osteokinematics
- capsular pattern
- open pack position
- close pack position

Answer 28

• Classification: pivot type synovial joint
• Articular surface: rounded head of the ulna articulates with the ulnar notch on the medial side of the distal end of the radius.
• Degrees of freedom: 1
• Osteokinematics: pronation/supination
• Capsular Pattern: Full ROM, pain at extremes of rotation
• Open Packed Position: 10° of supination
• Closed Packed Position: 5° of supination

Question 29

radio-carpal joint
- classification
- articular surface
- degrees of freedom
- osteokinematics
- capsular pattern
- open pack position
- close pack position

Answer 29

• Classification: condyloid type of synovial joint
• Articular surface: The ulna does not participate in the wrist joint; The distal end of the radius and the articular disc of the distal radio-ulnar joint articulate with the proximal row of carpal bones, except for the pisiform
• Degrees of freedom: 2
• Osteokinematics: flexion/extension; ulnar deviation/radial deviation
• Capsular Pattern: Flexion and extension equally limited (works with midcarpal joints)
• Open Packed Position: Neutral with slight ulnar deviation
• Closed Packed Position: Extension with radial deviation

Question 30

Metacarpal and interphalangeal joints
- classificaiton
- articular surface

Answer 30

Classification: condyloid type of synovial joint
Articular surface: heads of the metacarpals articulate with the bases of the proximal phalanges in the MP joints; The heads of the phalanges articulate with the bases of more distally located phalanges in the IP joints

Question 31

Describe: scapular rhythm and the different phases

Answer 31

the kinematic interaction between the scapula and the humerus

Phase 1: humerus - 30 degree abduction; scapula - minimal movement (setting phase); clavicle - 0-5 degree elevation
Phase 2: humerus 40 degree abduction; scapula: 20 degre rotation with minimal protraction or elevation; clavicle: 15 degree elevation
Phase 3: humerus - 60 degree abduction and 90 degree lateral rotation; scapula - 30 degree rotation; clavicle - 30-50 degree posterior rotation up to 15 degree elevation