chapter 1 Flashcards
(96 cards)
1
Q
hold bones together but permit movement (Not always!) Point of contact – between 2 bones – between cartilage and bone – between teeth and bones
A
joints
2
Q
is based on the presence or absence of a
synovial (joint) cavity and type of connecting tissue.
Structurally, joints are classified as Solid (fibrous or cartilaginous)
A
Structural classification
3
Q
is based upon movement
A
Functional classification
4
Q
Immovable
A
synarthrosis
5
Q
Slightly movable
A
amphiarthrosis
6
Q
Freely movable
A
diarthrosis
7
Q
Lack a synovial cavity
• Bones held closely together by fibrous connective tissue
• Little or no movement (synarthroses or amphiarthroses)
A
solid joints-Fibrous Joints
8
Q
(Fibrous Joint)Thin layer of dense fibrous connective tissue unites bones of the skull
• Immovable (synarthrosis)
A
Sutures
9
Q
(Fibrous Joint) – bones united by ligament Slightly movable (amphiarthrosis) • Inferior tibiofibular joint and Interosseous membrane
A
Syndesmosis
10
Q
- between tooth and socket of alveolar process(periodontal ligament- keep your tooth the alveolar process
A
Gomphosis
11
Q
Lacks a synovial cavity
Allows little or no movement
Bones tightly connected by fibrocartilage or hyaline cartilage
A
Cartilaginous Joints
12
Q
(cj) Connecting material is hyaline cartilage
- Immovable (synarthrosis)
- Epiphyseal plate or joints between the ribs and costal cartilages
A
Synchondrosis
13
Q
Fibrocartilage is connecting material
o Slightly movable (amphiarthroses)
o Intervertebral discs and pubic symphysis
A
Symphysis
14
Q
reduce injury
cavity separates articulating bones
o Freely moveable (diarthroses)
A
Synovial Joints (Common Features)
15
Q
reduces friction – absorbs shock
A
Articular cartilage
note:– ostheoarthrisis-articular cartilage
16
Q
surrounds joint – thickenings in fibrous
capsule called intrinsic ligaments
A
Articular (fibrous or joint) capsule
17
Q
Lining the capsule from inside
– Secretes synovial fluid
– Synovial fluid brings nutrients to articular cartilage
A
Synovial membrane
18
Q
Nerves to joints are branches of nerves to nearby muscles(t/F)
A
hilton’s law
19
Q
Joint capsule and ligaments contains
A
pain fibers and sensory receptors proprioceptors-sense of space- ability to identify without looking
20
Q
what are two Extrinsic ligaments?
A
- extracapsular ligaments-outside joint capsule
2. intracapsular ligaments-within capsule
21
Q
attached around edges to capsule
– allow 2 bones of different shape to fit tightly – increase stability (e.g. in knee)
A
Articular discs or menisci
22
Q
fluid-filled saclike structure made by connective tissue
– reduce friction between moving structures • skin rubs over bone
• tendon rubs over bone
A
bursa
23
Q
inflammation of the bursa
A
Bursitis
24
Q
Bone surfaces are flat or slightly curved • Nonaxial • Side to side movement only • Rotation prevented by ligaments • These joints are nonaxial give examples
A
Planar Joint
Examples
– intercarpal and intertarsal joints
– vertebrocostal joints
25
1. Convex surface of one bones fits into concave surface of the 2nd bone
• Uniaxial (monoaxial)
examples of hinge joint?movements?
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Hinge Joint
Examples
– Elbow, ankle, interphalangeal joints
Flexion : decreasing the joint angle
– Extension: increasing the joint angle
– Hyperextension: opening the joint beyond the anatomical position
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26
Rounded surface of bone articulates with ring formed by the 2nd bone & ligament
• Monoaxial since it allows only rotation around longitudinal axis
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Pivot Joint
Proximal radio-ulnar joint
• supination
• pronation
– Atlanto-axial joint
• turning head side to side “no”
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27
Oval-shaped projection fits into oval depression
Condyloid or Ellipsoidal Joint
| radio-carpal and metacarpophalangeal joints
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One bone saddle-shaped; other bone fits as a person would be sitting in that saddle
• Biaxial : flex/ext. - abduct/adduct as well as circumduction are possible
Saddle Joint
| Trapezium and 1st metacarpal
29
```
Ball fitting into a cup-like depression
• Multiaxial
– flexion/extension
– abduction/adduction
– Rotation
– Circumduction
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* Ball and Socket Joint
– shoulder joint
– hip joint
30
is the science of the motion of human body.
Kinematics
31
which is concerned with the
| movements of the bones, and
osteokinematics
32
which addresses the movements occurring between joint surfaces.
arthrokinematics
33
Study of forces that produce movement in the human body
Kinetics
34
Each plane has a corresponding axis of movement that lies perpendicular to the respective plane
Body Planes & Movements
35
(anterior/posterior axis)
Divides body into anterior and posterior segments
Abduction and Adduction motions
Frontal (coronal) Plane
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Divides body into right and left sides
| Flexion and Extension motions
Sagittal Plane (medial/lateral axis)
37
Divides body into upper and lower segments
| Medial , Lateral Rotation and Pronation, Supination
Horizontal (transverse) Plane (vertical axis )
38
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Special Cases - hand and wrist (radial & ulnar deviation),
ankle joint (plantar flexion and dorsiflexion), protraction & retraction
and etc.( true or false)
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true
39
The action or process of moving or of changing place or position; movement.
➢ The shape and congruency of articulating joint surfaces determine the movements permitted at various joints.
Motion
40
1. Motion that occurs around a fixed or relatively fixed axis
2. All points adjacent to the joint will follow the arc of a circle.
3. The center of the circle or arc is the axis of the joint.
4. Speed at distal points is more than that at the proximal points
Angular (rotary):
Example: forward and backward swinging of the upper limb at the shoulder joint.
ex shoulder joint and elbow joint
41
All parts move in the same direction with equal velocity
Translatory:
Example: forward and backward swinging of the upper limb at the shoulder joint.-paramedic wheelchairs/stretchers
42
The number of planes in which a joint’s segments move.
o 1 plane = 1 DOF (elbow)
o 2 planes = 2 DOF (radio-carpal)
o 3 planes = 3 DOF (hip and shoulder)
Degrees of Freedom:
43
is possible in joints with 2 or more DOF
Circumduction
44
Several segments connected by several joints (upper / lower limbs)
o In a kinematic chain the more proximal segments can have less movements than the distal segments.
Kinematic Chains
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the proximal segment is anchored with the distal segment moving.
o Reaching or bringing the hand to the mouth.
Open kinematic chain: -distal is moving
| ex; basketball/vollleyball
46
The distal segment is fixed while the proximal segment moves.
o Performing chin-up or sitting down in a chair
Closed kinematic chain: proximal is moving
| stationary
47
is concerned with the movement of the articular surfaces in relation to the direction of movement of the distal end of the bone.
5. Arthrokinematics
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Movement of Joint Surfaces: When a joint moves, 3 motions can occur
A. Rolling/rocking
B. Sliding/gliding
C. Spinning
➢ For most joint movement a combination of all 3 occurs
➢ Allows a larger range of motion to occur
49
The arthorkinematic movement of joint surfaces
relative to the movements of the shaft of the bones
(osteokinematics) follows convex-concave principles.
Convex-Concave principles
50
If the bone with the convex joint surface moves on the
bone with the concavity, the convex surface moves in
the opposite direction to the bone segment.
Convex-Concave principles
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If the bone with the concavity moves on the convex
surface, the concave articular surface will move in the
same direction as the bone segment.
Convex-Concave principles
52
The joint surfaces of ovoid joints match perfectly in only one position.
-2 articular surface are very close to each other-hard to separate-capsule is going to be tight-ligamrnts are tight(most stable position)
Close-Packed
Examples: Full extension of elbow, wrist, hip, and knee joints, dorsiflexion of ankle, and flexion of MCPs.
In 90 degrees flexion of MCPs the abduction and adduction cannot occur (beneficial for gripping) and in standing hip and knee joints are in closed-packed position (little or no muscle contraction).
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all positions other than close-packed position
Open (loose)-packed position:
54
This point of congruency is the close packed position.
In this position:
1. Maximal area of surface contact occurs
2. Ligaments are under tension
3. Capsular structures are taut
4. The joint is mechanically compressed and difficult to distract (separate)
5. Often occurs at one end of range of motion
55
A. In addition to angular motions (Flex. ABD. etc) joints can be moved passively a few millimeters in translatory movements
known as accessory movements.
B. Accessory movements include; distraction, lateral/medial glide, anterior-posterior (AP) glide , posterior anterior (PA) glide
and rotation.
C. Cannot be performed voluntarily but need muscle relaxation and application of passive movement by an examiner.
D. Essential for pain free joint function and used by therapists for examination & treatment.
Accessory motions/ Joint Play
56
Primary Sources of Force
A. Gravity: Weight of body parts and attachments including splints, casts, and weights.
B. Muscles: Produce forces on bone by active contraction or by being passively stretched.
C. Externally Applied Resistance: Exercise pulleys, doors, manual resistance.
D. Friction:
➢ Provide stability if optimum,
➢ Can decrease motion if excessive,
➢ Lead to instability if inadequate.
57
Every object persists to remain in a state of equilibrium unless it is acted upon by other forces. Clinical applications of this law are
found in the lower limb during the swing phase of walking. Not only is a force required to start the thigh moving (hip flexors)
but also to stop the leg (hamstring muscles).
Newton’s Laws of Motion
| Law of Equilibrium
58
Study of forces that produce movement in the human body.
The forces can also stop or modify the motion of the body.
To conceptualize the forces, one can think of a push (compression) or a pull (tension). Such pushing and pulling can be visualized in the tug of war.
Kinetics
59
Acceleration of an object is proportionate to the force imposed on it and inversely proportionate to it’s mass; a=F/m (F=ma). More simply stated, a greater force is required to move (or stop the motion of) a large mass than a small one. When a muscle contracts,it shortens and produces the same amount of force at its origin and insertion. Thus, either one or both segments may move.
2. Law of Mass & Acceleration
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For every action force there is an equal and opposite reaction force.
3. Law of Action & Reaction
61
. is a rigid structure that moves around a fixed point, the fulcrum (F)
is acted on by two different forces:
– resistance (load) (L), which opposes movement
– effort (E) which causes movement .
Lever Systems and Leverage
| lever
62
Bones serve as levers and joints serve as fulcrums.(true or false)
true
63
The muscle whose attachment is farther from the joint will produce the most force (relatively small effort is required to move a large load over a small
distance).
mechanical advantage
64
The muscle attaching closer to the joint has the greater range of motion and the faster the speed it can produce. (a relatively large effort is required to move a small load (but at greater speed).
This is
| called a mechanical disadvantage.
65
Levers are categorized into three types
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First class levers (EFL) e.g. a seesaw – the head on the vertebral column
• Second-class (FLE) e.g. a wheelbarrow
• Third-class (FEL) (Figure 11.1b) e.g. forceps - the elbow joint
```
66
Can produce mechanical advantage or not depending on location of effort & resistance (load)
o If effort is further from fulcrum than resistance (load), then a strong resistance (load) can be moved.
➢ Head resting on vertebral column
o Weight of skull is the resistance.
o Joint between skull & atlas is fulcrum.
o Posterior neck muscles provide effort.
first lever
67
Similar to a wheelbarrow. It always produce mechanical advantage.
o resistance is always closer to fulcrum than the effort.
➢ Sacrifice of speed for force
➢ Raising up on your toes
o Resistance is body weight
o Fulcrum is ball of foot
o Effort is contraction of calf muscles which pull heel up off of floor
Second lever
68
```
Most common levers in the body
➢ Always produce a mechanical
disadvantage
o Effort is always closer to fulcrum
than resistance
➢ Favors speed and range of motion over
force
➢ Flexor muscles at the elbow
o Resistance is weight in hand
o Fulcrum is elbow joint
o Effort is contraction of biceps
brachii muscle
```
third lever
69
The amount of available motion at any joint varies among individuals and is influenced by many factors, including age, gender, previous injury, current injury/pain and whether the ROM is performed actively or passively or resisted.
The normal ‘range of motion’ (ROM):
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(T/F)
➢ Newborns and infants should be compared to age-appropriate norms as they can have very significant differences in specific
joints and/or motions as compared to normal adult values(i.e. infants typically have higher ROM for hip flexion / abduction / lateral
rotation, dorsiflexion, and elbow motion, and comparatively restricted ROM for hip extension, knee extension, and plantar flexion).
(T/F) The vertebral column ROM of older adults will decrease more significantly, between 25% to 50% of their maximal ROM
experienced as young adults.
During pregnancy women demonstrate increases in ROM due to increased ligament laxity (from circulating Relaxin) in
preparation for labour. This may last for up to 6 months post-partum.
true
71
(T/F)
Older adult groups (60+ years of age), as compared to young adults, will tend to experience decreases in ROM with age, but these differences can be different among individuals, for specific joints / motions, and among gender.
For the extremities, losses in ROM for older adults typically are less than 15% as compared to young adu
true
72
The effects of gender on ROM of the extremities and spine also appear to be joint and motion specific.
Many different studies have reported small to medium differences in a variety of ROM’s between women and men. I
deally, to determine if a ROM for an individual is impaired, compare the ROM values to the uninjured side of the body (if
possible) and to ROM norms from a similarly aged and gendered sample.
true
73
Is the amount of joint motion attained by a subject during unassisted voluntary joint motion.
Having a subject perform ___ provides the examiner with information regarding the subject’s willingness to move,
coordination, muscle strength, as well as joint ROM. can be pain limited due to contraction or stretching of ‘contractile’ tissues (muscles & tendons) or due to stretching
or pinching on ‘non-contractile’ tissues (i.e. ligaments, joint capsules, bursa, etc…).
➢ If a subject can easily and painlessly complete an__ then further testing/investigation is probably not needed.
is limited, painful, or awkward, then additional testing needs to be pursued to clarify the problem.
Active ROM
74
➢ Is the amount of joint motion attained by the examiner without assistance from the subject.
➢ Testing____ provides the examiner with information about the integrity of the articular surfaces, joint capsule,
ligaments, and muscles.
➢ If pain occurs during____ it is often due to moving, stretching, or pinching of non-contractile structures.
➢ By comparing which motions cause pain and where the location of the symptoms are, the examiner can
begin to determine which injured tissues are involved.
Consideration of the joint end-feel during ___ also adds information about structures that may be limiting ROM.
Passive ROM
75
Normally, passive ROM is slightly greater than active ROM.Pain at the end of a passive ROM may be due to stretching of contractile as well as non-contractile structures.
Having the examiner perform passive joint play tests and ligament stress tests on the subject can help determine which noncontractile structures are involved.
true
76
Patient performs active ROM against examiners resistance.
| Helps determine strength of muscle contraction through full range.
resisted rom
77
stiff/achy pain during ROM
Muscle
78
electric shock like pain with hypersensitivity
Nerve
79
sharp catching pain at end range
Capsule
80
avascular NO PAIN!
Cartilage
81
The amount of normal passive ROM experienced by a joint can be limited by one or more of a number of structures including: joint
capsules, ligaments, passive muscle tension, or contact of bony surfaces.
-The type of structure limiting passive ROM has a characteristic ‘end-feel’ which is detected by the examiner.
is the feeling experienced or perceived by the examiner as the barrier to further motion at the end of a passive ROM.
End Feel
82
-The type of structure limiting passive ROM has a characteristic ‘end-feel’ which is detected by the examiner.
is the feeling experienced or perceived by the examiner as the barrier to further motion at the end of a passive ROM.( t/F)
(T/F)
Normal end feels are pathologic if they occur when they should not. For example, a bony end feel that occurs in knee flexion because of a bone fragment within the joint Is not normal, nor a soft end feel in elbow extension because of excessive edema
true
83
Occur either at a different place in the ROM than expected or have an end feel that is not characteristic of the joint.
-is a pathologic type denoting pain on motion but absence of resistance. An empty end feel present when the
joint lacks normal soft tissue stability and a supporting structure is not intact, which is indicative of serious joint injury, e.g .
Bursitis.
Pathologic End Fell
84
```
of restriction indicate loss of mobility of the
entire joint capsule from fibrosis,
effusion of inflammation.
➢Restriction always occurs in
same pattern for each joint. E.g.:glenohumeral– lat. rotation >
abduction > med. rotation.
➢Differentiation can be made by
assessing the end feel.
```
CAPSULAR PATTERNS ➢Capsular patterns
85
```
Typically accompany degenerative joint
disease(fibrosis, inflammation &
effusion), prolonged
immobilization of a joint
(fibrosis) or acute trauma to a
joint (effusion).
➢Only in joint controlled by
muscles (i.e. Sacroiliac joint does
not have a capsular pattern)
```
true
86
the measurement of angles created at human joints by the bones of the body
➢Range of motion (ROM) can be defined as the amount of motion that is available at a joint
➢Typically, the starting position for measuring all ROM, except for rotations in the transverse plane, is the anatomical position
➢We will use the most common system, the 0 - 180 notation: 0 starting at the anatomical, or ‘start’, position, and the body angle
increasing towards 180
Goniometry is derived from the Greek gonia – meaning angle, and metron – meaning measure:
87
❑ PROCEDURES
❖ Positioning
➢Important to place the joint in a zero starting position and to help stabilize the proximal joint segment
➢Affects the amount of tension present in soft tissue structures surrounding the joint
➢If any of these structures are taut, ROM will be limited
➢Must be the same for successive measurements of ROM in order to have a basis for comparison (reliability)
➢Occasionally creativity is required to obtain ROM when normal testing positions are not possible (i.e. due to patient injuries,
conditions, etc…); in this case, record precisely the position used in the subject’s records.
❖ Key Points:
➢Starting position = 0
➢Permit a complete ROM
➢Stabilize Proximally
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❖ Stabilization
➢Important to isolate the motion to one joint to ensure that a true measurement is obtained
➢If both distal and proximal joint segments are able to move, it is difficult to determine ROM
➢Examiner may provide additional stabilization manually using hand or body weight
21
❖ Goniometer Alignment
➢Align arms of goniometer with both proximal and distal segments of
the joint
➢Use bony landmarks to accurately visualize the joint segments
➢By using landmarks reliability and accuracy is increased
➢Stationary arm is often aligned parallel to the longitudinal axis of the
proximal segment of the joint and the moving arm is aligned parallel
to the longitudinal axis of the distal segment of the joint. (In some
situations, this may be reversed).
➢Fulcrum of the goniometer is placed over the axis of motion of the
joint
➢Read the goniometer at eye level
➢Understand the scale that you are using and read it correctly (know
the intervals)
❖ Recording
➢Subjects name, age, and gender along with examiners name
➢Date, time and type of goniometer (i.e. full-circle plastic 8”
goniometer)
➢Side of body, joint, and motion (i.e. left knee flexion)
➢Type of motion (active or passive)
➢ROM – usually do 2 measures; if both are close, take the average, if
quite different, measure a 3rd time
➢Subjective (i.e. pain) and objective (i.e. spasm, crepitus) information
➢Description of deviations from ‘normal’ testing positions
❖ Reliability
Reliability of goniometric instruments can be questionable – especially between different examiners
o To maximize reliability always use the same:
1) Goniometer
2) Positioning
3) Procedure
4) Examiner
89
The muscle contracts, produces force, but no gross movement of the muscle occurs. Functionally used to stabilize
joints.
isometric
90
A contraction under which the tension remains constant. The term is often used to describe a contraction causing a joint
to move through some ROM, such as with elbow flexion with a weight in the hand.
isotonic
91
The muscle shortens while contracting. produce acceleration of body segments
Concentric contractions
92
The muscle lengthens while contracting. decelerate body segments and provide shock
absorption, such as when landing from a jump.
Eccentric contractions
93
A contraction under which the rate of movement is constant (i.e. no acceleration occurring) . An advantage is that it allows for maximal muscle output throughout the whole ROM.
isokinetic
94
Principle muscle producing a joint motion or maintaining a posture is referred to as the prime mover
Agonist
95
➢Is the muscle that has the opposite anatomic action of the agonist
➢Usually is a muscle that neither assists nor resists but that passively elongates or shortens to permit the motion to occur
Antagonist
96
The muscle that contracts at the same time as the agonist
➢The action may be identical or nearly identical to the agonist’s
may rule out an unwanted motion of the agonist (e.g. pronator teres resisting supination when biceps brachii is
agonist)
➢May act isometrically at joints far from the primary motion to fixate proximal joints so that distal motion can occur
The synergist
