WEEK 3: UPPER QUADRANT RANGE OF MOTION Flashcards
Define: physiological movement
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
Define: accessory movement
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
Define: sagital plane
- divides the body vertically into left and right
- Movement in the sagittal plane occurs around a transverse axis;
Define: frontal plane
- divides the body into front and back
- Movement in the frontal plane occurs around a sagittal axis
Define: transverse/horizontal plane
divides the body into top and bottom
Movement in the transverse plane occurs around a vertical axis
Define: contractile tissues
Have tension placed on them by stretching or contraction; include the muscles, their tendons, and their attachments into the bone
Define: nervous tissues
Includes their associated sheaths also have tension put on them by stretching and pinching
Define: inert tissues
Include all structures that would not be considered contractile or neurological, such as joint capsules, ligaments, bursae, blood vessels, and cartilage
Define: active range of motion
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
Define: passive range of motion
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.
Define: capsular pattern
total joint reaction with muscle spasm, capsular contraction, and generalized osteophyte formation being possible mechanisms at fault
Define: end feel
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
Define: resisted range of motion
strong, static voluntary muscle contraction against force
Atlanto-occipital joint
- classification
- articular surface
- degrees of freedom
- osteokinematics
- 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
atlanto-axial joint
- classification
- articular surface
- degrees of freedom
- osteokinematics
- 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
joints of the vertebral bodies
- classification
- articular surface
- 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
joints of the vertebral arches
- classification
- articular surface
- classification: plane type synovial joint
- articular surface: The zygapophysial joints (facet joints); These articulations between the superior and inferior articular processes of adjacent vertebrae
joints of the intra-cervical region
- capsular pattern
- open pack position:
- close pack position
- degrees of freedom
- osteokinematics
- 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
define: hangmans fracture
a bilateral fracture traversing the pars interarticularis of cervical vertebrae 2 (C2) with an associated traumatic subluxation of C2 on cervical vertebrae 3 (C3)
Define: open pack position
position where the ligaments around the joint are most lax
Define: close pack position
position where the ligaments around the joint are most taught
What are the active movements on the cervical spine
Flexion
Extension
Side flexion left and right
Rotation left and right
Combined movements, repetitive movements, sustained positions (as necessary)
What are the passive movements on the cervical spine
Flexion (tissue stretch)
Extension (tissue stretch)
Side flexion right and left (tissue stretch)
Rotation right and left (tissue stretch)
What are the restricted movements on the cervical spine
Flexion
Extension
Side flexion right and left
Rotation right and left
sternoclavicular joint
- classification
- articular surface
- degrees of freedom
- osteokinematics
- 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
acromioclavicular joint
- classification
- articular surface
- degrees of freedom
- osteokinematics
- capsular pattern
- open pack position
- close pack position
- 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
glenohumeral joint
- classification
- articular surface
- degrees of freedom
- osteokinematics
- capsular pattern
- open pack position
- close pack position
- 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
inferior radio-ulnar joint
- classification
- articular surface
- degrees of freedom
- osteokinematics
- capsular pattern
- open pack position
- close pack position
- 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
radio-carpal joint
- classification
- articular surface
- degrees of freedom
- osteokinematics
- capsular pattern
- open pack position
- close pack position
- 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
Metacarpal and interphalangeal joints
- classificaiton
- articular surface
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
Describe: scapular rhythm and the different phases
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
