Exam 2 Flashcards
(267 cards)
1
Q
what joints make up the shoulder complex?
A
- sternoclavicular
- acromioclavicular
- glenohumeral
- scapulothoracic
2
Q
what type of joint is the sternoclavicular
A
saddle joint
3
Q
what does the sternoclavicular joint look like at rest?
A
joint space is wedge shaped and open superiorly
4
Q
what does the sternoclavicular disc do?
A
- creates two joint spaces
- increases joint congruency
- absorbs forces
- helps limit medial movement of clavicle
5
Q
osteokinematics of sternoclavicular joint
A
- elevation/depression
- protraction/retraction
- anterior/posterior rotation
6
Q
in elevation/depression the SC joint moves….
A
convex on concave
7
Q
elevation of SC joint is
A
superior roll, inferior glide
8
Q
depression of SC joint is
A
inferior roll, superior glide
9
Q
in protraction/retraction the SC joint moves….
A
concave on convex
10
Q
protraction of SC joint is..
A
anterior roll and glide
11
Q
retraction of SC joint is
A
posterior roll and glide
12
Q
arthrokinematics of posterior rotation of SC joint
A
the inferior surface turns anteriorly
- also called backward rotation
13
Q
arthrokinematics of anterior rotation of SC joint
A
inferior surface returns to inferior position
14
Q
closed pack position of SC joint
A
full posterior rotation
15
Q
what type of joint is the acromioclavicular joint
A
plane synovial
16
Q
what is the primary function of the AC joint
A
to allow the scapula to rotate during arm movement
17
Q
what are the osteokinematics of the AC joint
A
- internal/external rotation
- anterior/posteror tilting (tipping)
- upward/downward rotation
18
Q
what is the plane of the scapula
A
35 degrees off of the frontal
19
Q
what does internal/external rotation of the AC joint help with?
A
helps to maintain contact of scapula on curved thorax during protraction and retraction of clavicle
20
Q
what does anterior/posterior tilting of the AC joint help with?
A
helps to maintain contact of scapula on curved thorax during elevation and depression of clavicle
21
Q
upward rotation of AC joint is associated with..
A
scapula swings upwardly and outwardly
- component of abduction and flexion
22
Q
what is the closed pack position of the AC joint
A
full upward rotation (in flexion or abduction)
23
Q
what are the primary movements of the scapulothoracic joint
A
- elevation/depression
- protraction/retraction
- upward/downward rotation
24
Q
what are the secondary movements of the scapulothoracic joint
A
- anterior/posterior tilting
2. internal/external rotation
25
what is the combined motion of elevation of the scapulothoracic joint?
combined motion of SC joint elevation and AC joint downward rotation
- shoulder shrug
26
what is protraction of the scapulothoracic joint
combination of SC joint protraction and slight AC joint IR
27
what is upward rotation of the scapulothoracic joint
summation of SC joint elevation and AC joint upward rotation
- observed during flexion/abduction
28
what is the GH angle of inclination
130-150 degrees in frontal plane
29
what is angle of torsion for GH joint
30 degrees posterior in transverse plane
30
retroversion of GH
- same as angle of torsion
| - posterior orientation of humeral head with regards to condyles
31
increased humeral retroversion is associated with...
increased ER ROM and reduced IR ROM
32
glenoid labrum
enhances concavity and increases articular surface
| - attachment for GH ligaments and tendon of biceps long head
33
GH joint capsule
- inf portion is slack in adducted position creating an axillary pouch
34
tightness in posterior shoulder capsule would result in...
increased anterior humeral head translation which will decrease the subacromial space
35
what are the ligaments of the GH joint
1. superior
2. middle
3. inferior GH lig
4. coracohumeral lig
36
what does the superior GH ligament do
limits ER and anterior and inferior translation at 0 degrees of abduction
- slackens when abducted beyond 35-45 degrees
37
what does the middle GH ligament do
limits anterior translation from 45-90 degree abduction and extremes of external rotation
38
what does the inferior GH ligament do
primary stabilizer beyond 45 degrees of abduction or with combined abduction and rotation
39
what are the components of the inferior GH ligament
1. anterior band
2. posterior band
3. axilarry pouch
40
what does the coracohumeral ligament do
limits inferior translation and ER of humeral head with the arm in dependent position
41
what 2 areas foes the rotator cuff not reinforce
1. inferiorly
| 2. region between subs cap and supraspinatus
42
arthrokinematics of GH flexion
superior roll, inferior glide
43
arthrokinematics of GH extension
inferior roll, superior glide
44
arthrokinematics of GH adduction
inferior roll, superior glide
45
arthrokinematics of GH abduction
superior roll, inferior glide
46
arthrokinematics of GH ER
posterior roll, anterior glide
47
arthrokinematics of GH IR
anterior roll, posterior glide
48
closed pack position of GH
90 degrees abducted and full ER or full abduction and ER
49
capsular pattern of GH
external rotation > abduction > IR
50
what is scapulohumeral rhythm
ratio of 2 degrees of GH to 1 degree of scapular motion
51
when the rhomboids and lower trap act together...
results in pure retraction
52
what is the force couple for upward rotation?
serrates anterior
upper trap
lower trap
53
what are the aspects of the joint capsule of the elbow complex
- weak anteriorly and posteriorly
| - fat pads are located between the capsule
54
what is the carrying angle
medial portion of the trochlea projects more distally than the lateral portion
- combo of shoulder ER, elbow extension and forearm supination
- angle varies from 8-15 degrees
55
what does the lateral collateral ligament do
stabilizes agents varus torque and combined varus and supination torques
56
arthrokinematics of elbow flexion
roll anterior, slide anterior
57
arthrokinematics of elbow extension
roll posterior, slide posterior
58
closed pack humeroulnar
full extension and supination
59
closed pack humeroradial
90 degrees elbow flexion and 5 degree supination
60
open pack humeroulnar
flexed 70, supinated 10
61
open pack humeroradial
full extension and supination
62
elbow capsular pattern
flexion > extension
63
in a closed pack position moving into pronation requires what..`
requires ER of the humerus and ulna
64
what is the closed pack position of the proximal radioulnar joint
5 deg of supination
65
what is the open pack position of the proximal radioulnar joint
70 deg of flexion, 35 deg of supination
66
capsular pattern of proximal radioulnar joint
supination = pronation
67
closed pack position of distal radioulnar joint
5 deg of supination
68
open pack position of distal radioulnar joint
10 deg of supination
69
capsular pattern of distal radioulnar joint
supination = pronation
70
what is the law of parsimony
nervous system tends to activate the fewest muscles or muscle fibers possible for the control of a given joint action
71
what is the goal of the law of parsimony?
energy efficiency
72
what joints make up the wrist/hand
1. distal radioulnar
2. radiocarplal, midcarpal
3. carpometacarpal
4. metacarpal
5. interphalangeal
73
what is the wrist joint
condyloid
74
how many tendons go through the carpal tunnel
9
75
arthrokinematics of wrist flexion
anterior roll, posterior glide
76
arthrokinematics of wrist extension
posterior roll, anterior glide
77
arthrokinematics of wrist radial deviation
lateral roll, medial glide
78
arthrokinematics of ulnar deviation
medial roll, lateral glide
79
closed pack position of the wrist
full extension w radial deviation
80
open pack position of the wrist
neutral flexion/extension with slight ulnar deviation
81
capsular pattern
flexion = extension, slight radial and ulnar deviation
82
at what position is max grip?
30 degrees of extension
83
which wrist flexor is the strongest?
flexor carpi ulnaris
84
where is peak wrist flexion torque
40 degrees of wrist flexion
85
what is active wrist extension typically coupled with?
active radial deviation
86
what do the ulnar and radial collateral ligaments do?
stabilize the thumb
87
what are the arthrokinematics of thumb abduction
anterior roll, posterior glide
88
what are the arthrokinematics of thumb adduction
posterior roll, anterior glide
89
what is moving on what in thumb abduction/adduction
convex articular surface of thumb metacarpal moving on concave trapezium
90
what is moving on what in thumb flexion/extension
concave surface of metacarpal moving on convex diameter of trapezium
91
what is moving on what in thumb flexion
medial roll and glide
92
what is moving on what in thumb extension
lateral roll and glide
93
what makes up thumb opposition
abduction, flexion, IR
94
what is moving on what in thumb reposition
adduction, extension, ER
95
what is the closed pack position of the 1st CMC joint
full opposition
96
what is the open pack position of the 1st CMC joint
mid flexion/extension and mid abduction/adduction
97
what is the closed pack position of the 2nd-5th CMC joint
full flexion
98
what is the open pack position of the 2nd - 5th CMC joints
mid flexion/extension
99
what is the capsular pattern of 1st CMC joint
abduction
100
what type of joint are the metacarpophalangeal joints
condyloid
101
what are the arthrokinematics of MCP flexion
anterior roll and glide
102
what are the arthrokinematics of MCP extension
posterior roll and glide
103
what are the arthrokinematics of MCP abduction
roll and glide away from 3rd digit
104
what are the arthrokinematics of MCP adduction
roll and glide toward 3rd digit
105
what is the closed pack position of the MCP
full flexion
106
what is the open pack position of the MCP
slight flexion
107
what is the capsular pattern pattern
flexion = extension
108
what are the arthrokinematics of IP flexion
roll palmar, slide palmar
109
what are the arthrokinematics of IP extension
roll dorsal, slide dorsal
110
what is the closed pack position of the IP joints
full extension
111
what is the open pack position of the IP joints
slight flexion
112
what is the capsular pattern of the IP joints
flexion = extension
113
what is the most prominent feature of the extensor mechanism
dorsal hood
114
how is the neck of the femur angulated?
so it faces medially, superiorly, and anteriorly with respect to femoral shaft and distal femoral condyles
115
what is the normal range for the angle of inclination
110 to 144
| most about 125
116
what is the angle of inclination
between axis through femoral head/neck and longitudinal axis of femoral shaft
117
define coxa valga
> 125 degrees of angle of inclincation
118
define coxa vara
< 125 degrees of angle of inclination
119
what is the goal of the angle of inclination?
serves to optimize joint surface alignment
120
slipped capital femoral epiphysis (SCFE)
coxa vara + high BMI
121
what is the angle of torsion
between axis through femoral head/neck and the distal femoral condyles
122
what plane does the angle of torsion occur in
transverse plane
123
angle of torsion norms
8-20
| 15 deg is optimal
124
excessive anteversion of hip
increased angle of torsion
- associated with increased hip IR and decreased ER
- typically associated with coxa valga
- instability
125
retroversion of hip
decreased angle of torsion
- associated with increased hip ER and decreased IR
- may cause impingement
126
what is the center edge angle
measurement of acetabular depth
127
what is anteversion of the hip
extent to which acetabulum faces anteriorly
128
what is a Cam deformity
extra bone at anterior-superior region of femoral head and neck
- impingement
(maximized impingement with IR and flexion)
129
what is a Pincer deformity
abnormal bony extension of anterior-lateral rim of acetabulum
130
what is the hip's position of maximal congruency in a non-weight bearing position
flexion, abduction, slight ER
131
in the bending moment of the hip
superiorly _____ force
inferiorly _____ force
superiorly: tensile force
inferiorly: compressive force
132
where is the hip capsule thick versus thin
thickened anterosuperiorly
| thin posteroinferiorly
133
iliofemoral ligament
provides anterior stability
| - Controls internal and external rotation
134
pubofemoral ligament
controls external rotation in extension
135
ischiofemoral ligament
primary restraint to internal rotation
| - All tighten with hyperextension
136
transverse acetabular ligament
part of the labrum, no cartilage cells, protects blood vessels
137
acetabular labrum
wedge shaped, deepens concavity. Acts to seal maintain negative intra-articular pressure
138
ligamentum teres
Conduit for blood supply to the femoral head, excessive ER can strain/potentially tear
139
arthrokinematics OKC of hip flexion
superior roll and inferior glide
140
arthrokinematics OKC of hip extension
inferior roll and superior glide
141
arthrokinematics OKC of hip abduction
superior roll and inferior glide
142
arthrokinematics OKC of hip adduction
inferior roll and superior glide
143
arthrokinematics OKC of hip IR
medial roll and lateral glide
144
arthrokinematics OKC of hip ER
lateral roll, medial glide
145
arthrokinematics CKC anterior tilt
anterior roll and slide
146
arthrokinematics CKC posterior tilt
posterior roll and slide
147
in bilateral stance the pelvis can only...
drop
148
arthrokinematics CKC hip abduction
superior roll and slide
149
arthrokinematics CKC hip adduction
inferior roll and slide
150
what plane does forward/backward rotation occur in
transverse
151
arthrokinematics CKC hip forward rotation
anterior roll and slide
152
arthrokinematics CKC hip backward rotation
posterior roll and slide
153
what is the closed pack position of the hip
full extension with slight IR and abduction
154
what is the open pack position of the hip
moderate flexion, slight abduction, neutral rotation
155
what is the capsular pattern of the hip?
IR = flexion = abduction
156
what works together to produce anterior pelvic tilt (pelvic on femoral flexion)
hip flexors and low back extensors
157
what works together to produce posterior pelvic tilt (pelvic on femoral extension)
hip extensors and abdominal muscles
158
in the sagittal plane, hip adductor longus does...
when hip flexed, will contribute to extension
when hip extended, will contribute to flexion
159
what is trendelenburg sign
visualized weakness of glute medius in single leg stance
160
what is genu valgum
less than 165 deg
| "knock knees
161
what is genu varum
greater than 180 deg
| "bow legged"
162
what is the q-angle
line connecting ASIS to middle of patella and line connecting tibial tuberosity to middle of patella
163
what is the normal q-angle
13-15 deg
164
what are the functions of the meniscus
o Distribute weight bearing forces
o Increase joint congruence
o Shock absorption
165
what connects to the medial meniscus
MCL, ACL, PCL, semimembranosus
166
what connects to the lateral meniscus
ACL, PCL, popliteus
167
what is the MOI for meniscus
axial rotation of condyles over flexed and weight-bearing knee
168
what is the function of menisci
increases contact area and reduces joint stress
169
ACL function
primary restraint to anterior translation of tibia on femur
170
PCL function
resists posterior translation of tibia on femur
171
MCL function
resists valgus forces and lateral tibia rotation
172
LCL function
resists varus stresses
173
iliotibial tract function
assists ACL in resisting anterior translation of tibia on femur
174
what are the arthorokinematics of the knee in OKC flexion
posterior roll and glide
175
what are the arthorokinematics of the knee in OKC extension
anterior roll and glide
176
what are the arthorokinematics of the knee in CKC flexion
posterior roll, anterior glide
177
what are the arthorokinematics of the knee in CKC extension
anterior roll, posterior glide
178
what is the screw home mechanism
need 10 deg ER with terminal extension (valgus)
the knee must unlock with popliteus prior to preforming flexion (varus)
179
what is the closed pack position of the tibiofemoral joint
full extension
180
what is the open pack position of the tibiofemoral
25 deg of flexion
181
what is the capsular pattern of the tibiofemoral joint
flexion >> extension
182
what is patellofemoral pain syndrome
abnormal tracking of patella
183
what is the function of the patella
acts as a spacer between the femur and quad
184
what is the talocrural joint
distal tibia fib + talus
185
what is the subtalar joint
talocalcaneal joint
186
what makes up the transverse tarsal joint
talonavicular and calcaneocuboid
187
what makes up the hindfoot
1. talus
| 2. calcaneus
188
what makes up the midfoot
1. navicular
2. cuboid
3. 3 cuneiform bones
189
what makes up the forefoot
1. metatarsals
| 2. phalanges
190
what type of joint is the proximal tibiofibular joint
plane synovial
191
what type of joint is the distal tibiofibular joint
synarthrosis
192
what is the closed pack position of the tibiofibular joint
weight bearing dorsiflexion
| - point of greatest ligamentous tension
193
what motions go along with foot/ankle pronation
1. eversion
2. abduction
3. dorsiflexion
194
what motions go along with foot/ankle supination
1. inversion
2. adduction
3. plantar flexion
195
what type of joint is the talocrual joint
hinge
196
function of the medial collateral (deltoid) ligament
helps to limit eversion/pronation
| - Very strong
197
function of the lateral collateral ligament
helps to limit inversion/supination
| - Weaker and more susceptible to injury
198
what is the main motion of the talcrual joint
dorsi and plantar flexion
199
what are the arthokinematics of talocrural dorsiflexion
anterior roll, posterior glide
200
what are the arthokinematics of talocrural plantarflexion
posterior roll, anterior slide
201
what is the closed pack position of the talocrural joint
weight bearing dorsiflexion
202
what is the open pack position of the talocrural joint
10 deg of plantarflexion with neutral inversion/eversion
203
what is the capsular pattern of the talocrural joint
plantarflexion > dorsiflexion
204
what type of joint is the subtalar joint
three ovoid synovial joint
205
what are the main motions of the subtalar joint
inversion/eversion
| adduction/abduction
206
supination of foot in weight bearing motions
calcaneous inverts
| talus abductions and dorsiflexes
207
pronation of foot in weight bearing
calcaneous everts
| talus adducts and plantarflexes
208
supination of foot in non-weight bearing
calcaneous inverts, adducts, plantarflexes
209
pronation of foot in non-weight bearing
cancaneous everts, abducts, dorsiflexes
210
what is the closed pack position of the subtalar joint
full inversion
211
what is the open pack position of the subtalar joint
mid inversion/eversion and mid plantarflexion/dorsiflexion
212
what type of joint is the transverse tarsal joint
modified ovid
213
what is the function of the transverse tarsal joint in open chain
add to the subtalar range
214
what is the function of the transverse tarsal joint in closed chain
compensate at the forefoot for hind foot pronation
215
what is the closed pack position of the transverse tarsal joint
supination
216
what is the open pack position of the transverse tarsal joint
mid range of supination/pronation
217
what is the capsular pattern of the transverse tarsal joint
limitations in dorsiflexion, plantarflexion, adduction and IR
218
what is the main function of the transverse tarsal joint
functions to regulate position of the forefoot in relation to the weight-bearing surface
- the tarsometatarsal joint will add to this with end-range subtalar motion
219
what is the supination twist
pronation in the hind foot results in supination of the transverse tarsal joint
- if this is not enough the entire foot will supinate
220
what is pronation twise
full subtalar supination results in supination of transverse tarsals as well
the forefoot must pronate in order to maintain contact with the ground
221
what is hallux limitus
posttraumatic condition, gradual and significant limitation of motion, articular degeneration and pain
- Most commonly happens with forceful hyperextension
- Big toe really can't extend, basically fused
222
what is hallux valgus
progressive lateral deviation of great toe (bunion deformity)
- Can lead to lateral dislocation
223
what is the main role of the plantar fascia?
o Supports the medial longitudinal arch in weight bearing
224
what is the windlass effect
o When PF occurs, contraction lifts calcaneous, body weight is transferred over metatarsal heads, causes extension of metatarsophalangeal joints, winding up of plantar fascia supporting medial, longitudinal arch
o Strengthens the midfoot
225
what is pes planus
abnormally dropped medial longitudinal arch
226
what are the implications of pes planus
- This compromises ability to support and dissipate loads
| - Requires significant work from extrinsic and intrinsic muscles that may lead to fatigue and overuse symptoms
227
what is the navicular drop test
o Measurement of distance between navicular tuberosity and ground in subtalar joint neutral and with relaxed foot posture
- 7 mm is normal
228
what role does the posterior tibialis muscle play in stance phase of ambulation?
o Decelerates pronating foot in loading response
o Results in gradual and controlled lowering of medial longitudinal arch
o Supinates rearfoot in mid to late stance to provide a stable foot for toe of
229
sensory perturbation
may be caused by altering visual input
230
mechanical perturbation
displacement causing changes in the relationship of body's CoM to BoS
231
what are fixed support synergies
central organized patterns of muscle activity that occur in response to perturbations of standing postures
232
what are ankle synergies
discrete burts of muscle activity that occur in a distal-to-proximal pattern
233
what are hip synergies
discrete bursts of muscle activity that occur proximally-to-distally
234
define postural sway
constant swaying motion due to inertial and gravitational forces
235
define ground reaction force
force of the ground pushing back on the body in standing
236
what does GRF represent
represents magnitude and direction of loading applied to 1 or both feet
237
define line of gravity
line extending from center of gravity to BoS
238
define center of pressure
point of application of the GRFV
| - located between the feet in bilateral stance
239
large deviations of ideal standing posture will result in..
1. excessive strain on passive structures
| 2. increased muscular activity
240
long term deviations of ideal standing posture will result in..
structural changes
241
ideal standing posture is ______ to the external auditory meatus
through
242
ideal standing posture is ______ to the shoulder
through
243
ideal standing posture is ______ to the center of the hip joint
slightly posterior
244
ideal standing posture is ______ to the axis of the knee joint
slightly anterior
245
ideal standing posture is ______ to the lateral malleolus
slightly anterior
246
the LoG creates what kind of external moment arm at the ankle
dorsiflexion
247
the LoG creates what kind of internal moment arm at the ankle
plantarflexion
248
to maintain ideal posture, what contracts at the ankle
active contraction of soles with contributions from gastrocnemius
(concentric)
- no passive structures
249
the LoG creates what kind of external moment arm at the knee
extension
250
the LoG creates what kind of internal moment arm at the knee
flexion
251
to maintain ideal posture, what contracts at the knee
active contraction of hamstrings and gastrocnemius
- some passive tension from capsule and ligaments
252
the LoG creates what kind of external moment arm at the hip
extension
253
the LoG creates what kind of internal moment arm at the hip
flexion
254
to maintain ideal posture, what contracts at the hip
iliopsoas
| - passive tension from ligaments of hip
255
the LoG creates what kind of external moment arm at the head and neck
flexion of cervical spine
256
the LoG creates what kind of internal moment arm at the head and neck
extension of cervical spine
257
to maintain ideal posture, what contracts at the head and neck
passive tension from ligaments and facet joint capsules
| - active contraction of cervical extensors
258
how much out toeing is normal?
8-10 deg
259
where is the plumb line aligned in side view
anterior to lateral malleolus
260
what is handedness posture
- dominant shoulder lower
- pelvis shifts to dominant side
- dominant hip higher
- non dom foot more pronated
- spine deviation to non-dom side
261
excessive anterior pelvic tilt creates what type of moment?
increased extension moment
262
in forward head posture where is LoG
anterior to cervical joint axes
263
what does forward head posture result in?
- flexion moment
| - constant isometric muscle tension to support head
264
what is present during pet planus
increase calcanea eversion
265
how are scoliosis diagnosis named?
according to direction of convexity and location of the curve
266
excessive genu valgum compresses what?
lateral compression and medial tension/distraction
267
excessive genu varum compresses what?
medial compression and lateral tension/distraction
