Big List for Long-term learning
Latissimus dorsi, pectoralis major, teres major
What muscles insert on the intertubercular groove of the humerus?
Rectus femoris, vastus lateralis, vastus intermedius, vastus medialis
What muscles of the hip/thigh do knee extension?
sartorius, gracilis, biceps femoris, semitendinosis, semimembranosis
What muscles of the hip/thigh do knee flexion?
Housemaid's knee (caused by friction between the skin and the patella)
What name is given to an inflammation of the prepatellar bursa of the knee?
Glenoid labrum
What name is given to the bands of cartilage that circle the edge of the glenoid cavity to make it deeper?
Femoral nerve
What nerve innervates the anterior compartment of the thigh?
Obturator nerve, Pectineus is innervated by both femoral and obturator nerves
What nerve innervates the medial compartment of the thigh? What is one exception?
Recurrant branch of the median nerve
What nerve innervates the thenar muscles?
Radial nerve
What nerve is in danger of being lacerated if the head and neck of the radius are fractured?
Dorsal scapular nerve
What nerve runs with the dorsal scapular artery?
Upper subscapular nerve
What nerve supplies the subscapularis muscle?
Suprascapular nerve
What nerve travels under the acromium?
musculocutaneous, median, and ulnar
What nerves of the brachial plexus form the easily identifiable "M" anterior to the brachial artery?
femoral artery and vein, saphenous nerve
What passes through the adductor canal?
4 tendons of FDS, 4 tendons of FDP, tendon of flexor pollicis longus, median nerve
What passes through the carpal tunnel?
Avascular necrosis
What process is seen after a hip fracture that compromises the blood flow from the medial femoral circumflex?
Axillary nerve, supraspinatous tendon, anterior glenohumeral ligaments and glenoid labrum separation from the articular surface of the anterior neck(Bankhart lesion), posterolateral humerus head defect (Hill-Sack lesion)
What structures can be damaged in an anterior shoulder dislocation?
MRI
Which imaging study is best when looking at joints?
PCL
Which is thicker and stronger: ACL or PCL?
Acromioclavicular ligament
Which ligament attaches the clavicle to the acromion?
Coracoclavicular ligament
Which ligament attaches the clavicle to the coracoid process?
annular ligament
Which ligament attaches the head of the radius to the ulna and *allows for pronation and supination*?
Iliofemoral ligament
Which ligament is the chief preventor of excessive hip extension?
Iliogemoral ligament
Which ligament is the chief preventor of excessive hip extension?
ACL prevents posterior sliding PCL prevents anterior sliding
Which ligament of the knee joint prevents posterior sliding of the femur in relation to the tibia? Which prevents anterior sliding?
Glenohumeral ligament
Which ligaments attach the supraglenoid tubercle to the anatomical neck of the humerus?
Medial (ulnar) and lateral (radial) collateral ligaments
Which ligaments hold the ulna on the radius?
Sartorius
Which muscle is referred to as the tailor's muscle because it flexes and laterally rotates the thigh as well as flexes and medially rotates the leg?
Popliteus
Which muscle unlocks the knee from full extension?
Extensor digitorum longus and brevis Extensor hallicus longus and brevis
Which muscles are responsible for extending the toes?
flexor digitorum longus and brevis flexor hallicus longus and brevis
Which muscles are responsible for flexing the toes?
Tibialis anterior, extensor digitorum longus, extensor hallicus longus
Which muscles are responsible for the dorsiflexion of the foot and toes?
Peroneus longus, brevis and tertius
Which muscles are responsible for the eversion (pronation) of the foot and toes?
Gastrocnemius, soleus, plantaris, tibialis posterior, flexor digitorum longus, flexor hallicus longus
Which muscles are responsible for the planterflexion of the foot and toes?
Peroneus tertius, tibialis anterior, extensor hallicus longus, extensor digitorum longus
Which muscles does the deep peroneal nerve innervate?
Peroneus longus, peroneus brevis
Which muscles does the superficial peroneal nerve innervate?
Gastrocnemius, soleus, plantaris, popliteus, flexor hallicus longus, flexor digitorum longus, tibialis posterior
Which muscles does the tibial nerve innervate?
Gastrocnemius and soleus
Which muscles form the triceps surae which gives rise to the Achilles' tendon?
Superficial Peroneal nerve
Which nerve innervates the muscles of the lateral compartment of the leg?
Superior gluteal nerve
Which nerve is likely damaged when a person exhibits lurching (Trendelenburg) gait in which the pelvic girdle falls from its horizontal position on the side of the lifted leg?
femoral nerve
Which nerve is responsible for cutaneous sensation of the anterior thigh?
saphenous nerve
Which nerve is responsible for cutaneous sensation of the medial thigh?
Sural nerve
Which nerve is responsible for cutaneous sensation of the posterior leg?
posterior femoral cutaneous nerve
Which nerve is responsible for cutaneous sensation of the posterior thigh?
femoral nerve
Which nerve is responsible for knee extension
Sacral plexus
Which nerve is responsible for knee extension?
Arthrokinematic motion (convex vs concave rule)
convex moving = opposite concave moving = same if the joint is convex/concave in shape the concave joint surface will roll and glide in the same direction as osteokinematic motion. If the joint surface is convex, it will roll in the same direction as osteokinematic motion but it will glide in the opposite direction
Myotome for C2
Neck Flexion
Myotome for C3
Neck Flexion
tissue evacuation sign of accomplishment?
The salient sign is swelling decreases, pain decrease (reduced swelling measurements)
Dermatome for C2
Top of Head
plantar grasp
Touch sole of foot, toes curl downwards 29 weeks GA 6-12 months
spinolimbic tract
Trasmit slow pain info to thalamus w/ large receptive fields from entire body & then project to insula, cingulate cortex, amygdala, basal ganglia, & hypothalamus. Emotions, sensory integration, personality, & movement.
mobility deficit
(aka impaired ROM) - less than normal motion. Joint or soft tissue related. Could be due to pain or others
Hypoglossal nerve - CN XII
- motor supply to all muscles of tongue - intrinsic and extrinsic
long axis distraction of tibiofemoral joint (positioning, mobilization, improves?)
- patient prone with knee in loose packed position of 25 degrees flexion (or in short-sitting) - distraction force applied by pulling on distal tibia - pain reduction
What is origin of the medial reticulospinal tract? Decussation? Descent?
- pontine reticular formation in the pons - it does not cross - ipsilateral through whole cord
What two glides + accessory glide will improve knee flexion?
- posterior tibial glide - anterior femur glide - inferior glide of patella (accessory)
lateral corticospinal tract origin? Decussation? Descent?
- primary motor cortex - decussates at pyramids of the lower medulla (88% cross and 10% continues to become medial corticospinal tract) - descends contralaterally
What is treatment focus in inflammatory phase?
- protection of injured tissue - reduction of pain and edema
anterior glide of hip (positioning, mobilization, improves?)
- pt in side-lying, loose packed position. have them brace self from anterior movement - hold pt knee in position - loose packed. - push inferior to ischial tuberostiy on proximal femur in anterior direction - improves extension and ER
Trigeminal nerve - CN V
- sensation of face and teeth - motor supply to 4 mastication muscles - muscle test jaw motions
Vagus nerve - CN X
- sensation to many organs - parasympathetic to many organs and visceral muscle - motor supply for muscles of swallowing/larynx/pharynx
Vestibulocochlear nerve - CN VIII
- special sense: hearing - balance
Olfactory nerve - CN I
- special sensory. Our sense of smell - test by using smell test - nerve of common disorder seen in concussion or coma patients
What are the pathways in the anterolateral column?
- spinaothalamic - divergent pathways (spinolimbic, spinoreticular, spinomesencephalic)
posterior glide of hip (positioning, mobilization, improves?)
- support under femur with one hand; place other hand right inferior to ASIS - pt supine in loose-packed position - push posterior and inferior - improves hip flexion and IR
Wrist flexion
-80 degrees (techn. 1 w/ fulcrum over triquetrum ** the one we need to know norm value of) -60 degrees (techn. 2 w/ fulcrum over capitate)
extensor thrust
-Position: supine, one hip flexed -Stimulus: tactile stimulus to sole of foot on flexed side -Response: extension of hip and knee on test side (pushes examiner away) 20 weeks GA 2-3 months
Medial glide of hip (positioning, mobilization, improves?)
-pt side-lying, loose packed position. - hold pt knee in position. - push inferior to greater trochanter on proximal femur in medial/inferior direction - improves abduction
loose packed position of tibiofemoral joint
25 degrees flexion (30-45 degrees said in class)
muscle strength exercise reps to %1RM
5 rep max = 85-90% of 1 rep max 10 rep max = 75% of 1 rep max 15 rep max = 60% of 1 rep max
What cranial nerves does the corticobulbar tract facilitate?
5, 7, 11, and 12 cranial nerves;
Shoulder complex extension
60 degrees
MTP Joint extension
70 degrees
Wrist Extension
70 degrees
Thumb CMC abduction
70 degrees (Long); 40-50 (Short)
Shoulder Internal Rotation (medial rotation)
70 degrees (purely glenohumeral)
Forearm pronation
80 degrees
Forearm supination
80 degrees
Thumb IP flexion
80 degrees
For fast pain from the face, how does the 1st, 2nd, and 3rd-order neuron travel?
1st) receptors to pons where CN5 drops down ipsilaterally 2nd) in lower medulla, 2nd neuron crosses then travels to thalamus contralaterally 3rd) From VPM to cortex
Thumb IP extension
20
Ankle (Talocrural) Dorsiflexion
20 degrees
Hip extension
20 degrees
Radial Deviation
20 degrees
Thumb CMC extension
20 degrees
Hip adduction
20 degrees (AMA)
S1
On the lateral aspect of the calcaneus
1st degree injury
Majority of fibers intact. Tissue is not compromised. 75% or more of fibers are intact. But pain is present because some inflammation happens. localized, still stable, there is some limitation b/c of swelling. not great risk for reinjury
Extensor digitorum, indicis, digti minimi
Measure: need to maintain fingers in flexion, can use dorsal wrist measures as an alternative to lateral border of the hand (Norm 80) Stabilization/motion: elbow extended, forearm pronated, curlfingers, maximally flex wrist
Triceps (at shoulder)
Measure: shoulder flexion (Norm 180) stabilization/motion: patient supine, flex elbow, flex shoulder
Latissimus Dorsi
Meausre: Compare this measurement distance to distance of shoulder flexion to determine loss of motion due to lat tightness Stabilization/Motion: Patient in Supine, hook lying, shoulder in full ER and slight abduction movement goes into shoulder flexion
Dermatome for T2
Medial Aspect of Arm
Dermatome for L4
Medial Gastroc to Medial Longitudinal Arch
Dermatome for L3
Medial Thigh & Anterior Knee
Tibial nerve
Which nerve allows plantar flexion?
Deep peroneal nerve
Which nerve innervates the anterior compartment of the leg?
Superficial peroneal (fibular) nerve
Which nerve is responsible for the cutaneous sensation of the majority of the top of the foot?
Biceps- C5 Triceps- C7
Which nerve root is responsible for the biceps reflex? The triceps reflex?
Lateral plantar nerve
Which nerves supplies all of the other intrinsic muscles of the foot? (besides the LAFF muscles)
Deltoid ligament
Which of the main ankle ligaments is the strongest?
femoral Nerve, femoral Artery, femoral Vein, Empty space, Lymphatics (and Lacunar Ligament) This makes NAVEL
Which structures are found under and just inferior to the inguinal ligament? List them in order from lateral to medial
Suprascapular artery and transverse cervical artery
Which two arteries form the primary anastomoses with the subscapular artery?
Lesser saphenous vein
Which vein drains into the popliteal vein?
Rooting
a reflex in which a newborn turns its head in response to a gentle stimulus on its cheek 28 weeks GA
compression stress
a squeezing force applied to an object that can make an object shrink
lateral corticospinal tract
controls voluntary fractionated movement of the distal limbs.
mechanotransduction
conversion of mechanical stimulus to an electrical or chemical signal
Goal of stretching/myofascial release?
apply a tensile load to elongate or impact the innervation of the tissue to help it relax
effector response (mechanotransduction)
biochemical signals that influence gene expression in the nucleus and promote intraceulluar processes leading to matric remodeling. Ex. Hypertrophy
protective extension, LE staggering
body displaced forward, sideways and backward legs and feet flex, extend and abduct/adduct to maintain BOS under COG 15-18mo
Neonatal neck on body righting (NNOB)
body will follow head in log-roll fashion 34 weeks GA 4-5 months
postural fixation reactions
brace appropriate groups of muscles to provide support and react against rotational or horizontal forces that would disturb the body's equilibrium Prone - 6 months Supine - 7 to 8 months Sit - 8 to 9 months All 4's - 9 to 12 months Stand - 12 to 21 months
How do pain symptoms relate to tissue resistance in the proliferative phase (subacute phase)?
characterized by pain AT tissue resistance (R1).
decorticate posturing
characterized by upper extremities flexed at the elbows and held closely to the body (think Egyptian mummy preservation) and lower extremities that are extended. occurs when the brainstem is NOT inhibited by the motor function of the cerebral cortex.
subtalar joint arthrokinematics
complicated/unknown - posterior articular compartment is the convex calcaneus is articulating with a concave talus. so opposite
goal of physical stress theory (aka exercise prescription)
provide safe and sufficient volume of physical stress to produce tissue adaptation without causing tissue injury or death.
distal tibiofibular joint arthrokinematics
fibrous joint
lymph node function
filter lymph
What is loose packed position for patellofemoral joint?
full knee extension
What are 'main pumps' of blood that would help prevent DVTs? related exercises?
gastr/soleus and the diaphragm - belly breathing and ankle pumps great prescriptions
term used when referring to cardiopulmonary limitations - the shape a pt is in.
general debilitation/poor aerobic capacity
lateral reticulospinal tract
grossly facilitates FLEXOR muscles and inhibits extensor muscles of proximal extremities. it is unconcious
spontaneous stepping
several reciprocal steps 37 weeks GA 2 months
protective extension reaction, UE, forward
shoulders flex, arms extend and abduct, hands open vistibular O: 6-7mo
tilting reactions
similar to postural fixation, except BOS is displaced under COG Prone - 6 months Supine - 7 to 8 months Sit - 7 to 9 months All 4's - 9 to 12 months Stand - 12 to 21 months
Where does the tectospinal tract decussate? Descend?
immediate decussation at origin level in midbrain. Descends contralaterally to the cervical cord. (blue)
S4 and S5
in the perianal area
Laterally positioned patella may be indicative of... medially positioned patella may be indicative of...
lateral - tight hamstrings, tight IT band, vastus lateralis????? medial - tight vastus medialis +????
galant
lateral flexion of trunk to side of stimulus 32 weeks GA 2 months
When laterally glidding tibia, what part of joint increases space? This helps with valgus/varus pressures?
lateral joint space helps with valgus pressure on lateral meniscus
lymphatic capillaries
small, open-ended lymph vessels act like drainpipes - close to vascular arterioles where fluid initially enters lymphatic system
Which somatosensory tract gives direct unconscious input to the tectospinal tract? (same function)
spinomesencephalic tract
How do pain symptoms relate to tissue resistance in the remodeling phase (chronically)?
stage characterized by pain AFTER tissue resistance
outcome measures
standardized measurements that look at change.
moro
startle reflex when droped - 28 weeks GA
Protective Staggering (LE)
steps to catch self in appropriate direction after push O: 15-18
shear stress
stress that occurs when forces act in parallel but opposite directions, pushing parts of a solid in opposite directions
What MODE do we use prescribe to increase muscle flexibility?
stretching myofascial release/soft tissue mobilization
What MODE do we use prescribe to increase joint range of motion?
stretching joint mobilization
protective extension, LE
legs extend, abduct and externally rotate, feet flex O = 4mo
Proprioceptive placing (of LE and UE)
the placing of hand or foot on table to bear weight if felt 34 weeks GA 2 months
When is an endurance exercise adequate?
the pt should be tired and this evokes change. Therapeutic dose is good if they are tired/exerted well
periaqueductal gray matter
the region of the midbrain surrounding the cerebral aqueduct; nuclei that play a role in pain suppression and fight-or-flight response
intervention ladder (6 steps)
they may be overlapping - but each step is the primary focus to build upon in intervention planning
loose packed position of proximal and distal tibiofibular joint? closed packed position?
loose - 0 degrees of PF closed - full dorsiflexion
What MODE do we use prescribe to reduce extracellular edema?
lymphatic clearance (tissue evacuation)
MVC
maximum voluntary contraction =1 rep max
What do the medial axons of the lateral corticospinal tract associate with? lateral axons?
medial axons - run to the upper extremities lateral axons - run to the lower extremities (opposite dorsal column orientation)
primitive reflex
movements that appear during gestation/at birth and are integrated by 6 months
muscle power deficit/force production deficit
muscle can't create enough force to do task - weakness. MPD vs FPD is ortho focus vs neuro focus respectively
S3
over the ischial tuberosity
with tissue evacuation, what must a PT be hyper-aware of regarding the tissue?
overloading healing/inflamed/injured tissue. evacuation can be used during the early phases of healing as long as the healing tissue can handle the stress of the contraction.
neonatal positive support
partial weight bearing - little jumps sometimes 35 weeks GA 1-2 months
proximal tibiofibular joint arthrokinematics
plane joint - SAME.
Where is the primary somatosensory cortex?
postcentral gyrus of parietal lobe
Decerebrate posturing
posturing in which the neck is extended with jaw clenched; arms are pronated, extended, and close to the sides; legs are extended straight out; more ominous sign of brain stem damage. Most Severe.
muscle endurance target physiological adaptation
to improve the metabolic activity of the muscle. There is an increase in capillary density around the muscle fibers, and increase in mitochondrial density/biogenesis. An increase in glycogen stores and NaKAPTase activity
motor coordination target physiological adaptations
to improve the recruitment of muscle synergies to control and improve the precision of motion to perform or complete a more complex task that requires the coordination. Big picture, we are training the brain (selection and execution/coordination of movement from the CNS
spinoreticular tract
tract that deals with information that influences levels of consciousness, alertness, and sleep. It has multiple terminations along the reticular formation
What is the VPL?
ventral postlateral nucleus of thalamus
Meet- Medial Malleolus Tom- Tibialis Anterior ANd- anterior tibial artery and deep peroneal nerve His- Extensor Hallicus Longus Dog- Extensor Digitorum Longus
What are the structures of the *anterior* compartment in the leg in order form medial to lateral at the ankle?
Flexor retinaculum
What creates the carpal tunnel of the wrist?
postural tone
when weight of body is put on a limb, muscles automatically contract - must be high enough to resist gravity but low enough to permit the intended movement to occur
protective extension reaction, UE, backward
while sitting push them ----- shoulder and arms extend, hands open, support on hands with contact on floor/object 9-10mo
protective extension reaction, UE, sideways
while sitting push them ------ arm in direction of force abducts and extends at elbow and hand O: 7mo
movement coordination dysfunction
you have ability to activate muscle but the pattern activated is not efficient - PT teaches the person how to move/or move efficiently. Like when we teach balance - or teach the stabilizers of the core muscles to act more effective.
Biceps- weak forearm flexion, and forearm supination Coracobrachilalis- weak arm flexion Brachialis- Weak forearm flexion Skin of lateral forearm- loss of sensation of the lateral forearm
What does the musculocutaneous nerve innervate and what is seen if this nerve is damaged?
Axillary sheath
What encloses the brachial plexus as well as the axillary artery and vein?
Torn fibers of ligaments in the ankle
What exactly is a "sprained ankle"?
pectineus, gracilis, adductor magnus, adductor longus, adductor brevis
What muscles are responsible for hip/thigh adduction?
tensor fasciae latae, gluteus medius, gluteus minimus
What muscles does the superior gluteal nerve innervate?
Deep branch of the radial nerve
What nerve innervates all of the forearm extensor muscles?
Median cubital vein
What vein joins the cephalic and basilic veins at the elbow?
It should be given in the upper, outer quadrant so that the sciatic nerve and other nerves are not damaged
When an injection is given in the gluteal region, where should it be given and why?
when it passes the inferior border of teres major
When does the axillary artery become the brachial artery?
after it arches over the 1st rib
When does the subclavian artery become the axillary artery?
tibialis anterior and posterior
Which muscles are responsible for the inversion (supination) of the foot and toes?
What are the two internal feedback tracts? Function?
1) anterior spinocerebellar tract 2) rostrospinocerebellar tract cerebellum is monitoring interneuron activity in spinal cord. Comparing and refining movement information.
What are the 4 clinically significant (testable) tracks?
1) dorsal column 2) spinothalamic 3) discriminative touch from face (CN 5) 4) discriminative pain from face (CN 5)
extrapyramidal
Outside the pyramidal tracts - above the pyramids of the lower medulla
Flexor digitorum profundus, flexor pollicis longus, pronator quadratus
What are the 3 deep flexor muscles of the forearm?
Supinator, abductor pollicis longus, extensor pollicis longus, extensor pollicis brevis, extensor indicis
What are the 5 deep extensor muscles of the forearm?
Thoracodorsal artery
What artery runs with the thoracodorsal nerve?
Deltoid
What muscle is the most powerful abductor of the arm?
Pectineus, gracillis, adductor magnus, longus and brevis
What muscles can be found in the medial compartment?
Sciatic nerve (tibial branch)
What nerve innervates the hamstring muscles?
Great saphenous vein
Which vein is a frequent site of blood clots that travel into the pulmonary circulation and is also a source of replacement vessels in coronary bypass surgery?
muscle strength target physiological adaptations
we want to increase the force production capacity of the muscle. We want to increase the cross sectional area of the muscle fiber 6 to 8 weeks to notice measurable architectural changes in the muscle
Scaphoid and lunate
With what carpals does the radius articulate?
Talus
With which bone do the tibia and fibula articulate?
collagen stress/strain curve: failure region
"Tearing" of many or most fibers. (injury)
collagen stress strain curve: toe region
"Uncrimping "; done regularly maintains length; if not done regularly, tissue will remodel short (ex ROM)
protective extension, UE, downard (parachute)
"drop" arms extend and abduct and hands open 6-7mo
Dermatome for C6
(Palmar) Radial aspect of the Forearm, 1st & 2nd Phalanx
Birth-2 months
(Three Jumping piggies were Cross, but they Withdrew Galantly)
Dermatome for C7
(Volar) Radial Aspect of Forearm, 3rd Phalanx
What are divergent pathways? What are the three specific pathways?
(medial pain system) Carries info from free nerve endings on C axons (slow pain). involves both conscious and unconscious. 3 specific pathways: 1) spinolimbic 2) spinoreticular 3) spinomesencephalic
4-6 months
(then they Grabbed the cannabis, Rolled two joints, and Fell on the Tracks. They felt weird, so they Laid Out and Looked at their 4 or 6 hands)
Birth-4 Months
(they Thrusted by the cannabis Roots)
ACSM stretch prescription for low load long duration stretching
- 1 cycle for 20 minutes 2/3 times/week
Range of motions for hip
- 120 flexion - 20 extension -45 IR and ER
injury grades
- 1st degree - 2nd degree - 3rd degree
Where does the posterior spinocerebellar tract synapse? How does it ascend? Pass through next to cerebellum?
- 1st neuron synapses in the dorsal horn then ascends ipsilaterally - it never crosses - passes through the inferior punducle
ACSM stretch prescription using PNF
- 4 cycles of 6 second isometric contraction followed by 30 second stretch performed 2/3 times/week
Abducens nerve - CN VI
- Eye movement - motor supply to lateral rectus muscle - inward movement of eye with injury
lateral vestibulospinal tract origin. Descussation? Descent?
- LATERAL vestibular nucleus in lower pons/upper medulla - never crosses - ipsilaterally (blue)
What is response of lymphatic clearance to exercise?
- Lymphatic clearance rates are elevated during exercise compared to resting levels Exercise causes an increase in arterial blood pressure and cardiac output which results in increased capillary filtration (though too much intensity may produce more fluid than uptake)
variables PT will direct for therapeutic exercise: exercise prescription
- Mode: - Intensity: (amount of force necessary to achieve the activity) how much stress and type ex. Shear - Frequency: (how often the exercise is performed 1x - Duration: (number of repetitions or time the exercise is performed)
Glossopharyngeal nerve - CN IX
- Motor supply to voice and gag reflex (1 muscle) - special sense: taste of posterior 1/3 of tongue - sensation of pallet
Facial nerve - CN VII
- Special sense - taste of anterior 2/3 of tongue - motor supply of face - parasympathetic of salivary glands - muscle test specific face muscles
Optic nerve - CN II
- Special sensory - the ability to see. vision - test: peripheral field confrontation, and Snellen chart
distal tibiofibular joint glides. (therapeutic for...)
- anterior glide (increase mobility of the mortise) - posterior glide (increase mobility of the mortise)
2 proximal tibiofibular joint glides (therapeutic for...)
- anterior glide (reposition displaced fibular head) - posterior glide
What two glides + accessory glide will improve knee extension?
- anterior tibial glide - posterior femur glide - superior glide of patella (accessory)
medial corticospinal tract origin? Decussation? Descent?
- cerebral cortex - medial axons do not cross (12% continue and 88% dessucates to become lateral corticospinal tract) - ipsilaterally
Oculomotor nerve - CN III
- eye movement - motor supply of 5 eye muscles - autonomic - pupil constriction
Trochlear nerve - CN IV
- eye movement - motor supply to Superior oblique muscle of eye - head may tilt commonly with this injury
Lymphatic system: extrinsic mechanism to transport lymph (for what part of system?, what provides this force?, what changes luman space?)
- for lymphatic capillaries - skeletal muscle contractions, muscle stretch, respiration, pulse - muscle stretch opens luman and muscle contraction compresses luman.
4 patellofemoral joint glides (therapeutic for...)
- inferior glide (flexion) - superior glide (extension) - medial glide (stretches lateral retinaculum) - lateral glide (stretches medial retinaculum)
What information does patellar mobility/positioning testing give us?
- information on the mobility of the retinaculum
Is the dorsal column ipsilateral or contralateral? where does is it's decussation?
- ipsilateral (ascending spinal cord) - decussation in the lower medulla as the internal arcuate fibers
What is the specific pathway of the 1st and 2nd neuron in the dorsal column (if coming from lower extremity)?
1st - fasciculus gracilis 2nd - medial lemniscus
Elbow Extension
0 degrees
PIP extension
0 degrees
Thumb MCP extension
0 degrees
DIP extension in toes
0 degrees (usually not measured if patient can bring toes to normal 0 extension position)
IP joint Extension in toes
0 degrees (usually not measured if patient can bring toes to normal 0 extension position)
DIP extension
0 degrees reported but should have some extension
DIP flexion in toes
0-30 degrees
Flying high two piggies twist and right their bodies - two see home and land safely. Praise the Lord!
1) Landau 2) Neck righting acting on the body (NOB), Body righting acing on body (BOB), 3) Visual placing (UE and LE) 4) protective extension 5) STNR (symmetric tonic neck)
What are the two high fidelity pathways (spinocerebellar tracts)? Function?
1) Posterior spinocerebellar pathway 2) Cuneocerebellar pathway provide proprioceptive info to cerebellum from the UE and LE muscle/tendons/joints
Three jumping piggies were cross but they withdrew gallantly to the little tracks
1) Spontaneous stepping, neonatal positive support, proprioceptive placing 2) crossed extension 3) Flexor withdrawal 4) galant 5) traction (I at 5 weeks)
What are the stages of healing? (three PT treatment descriptors)
1) acute tissue protection phase 2) subacute 3) preparation for return to activity
For the divergent pathways, how does the 1st, 2nd, and 3rd-order neuron travel? What receptors?
1) from FREE-NERVE endings to the dorsal horn. Here INTERNEURONS within the dorsal horn lamina I, II, & V connect to the ascending neurons 2) decussation occurs immediately and ascends contralaterally in anterolateral column 3) SL, SM, and SR end at their respective locations in reticular formation, midbrain, and cortex/brain.
What are the unconscious relay tracts? (2)
1) high fidelity pathways - spinocerebellar tracts 2) internal feedback tracts to the cerebellum
What are the 5 possible responses taht biological tissues have to stress? (physical stress theory)
1) increased stress tolerance 2) maintenance 3) decreased stress tolerance 4) injury 5) death
three steps of mechanotransduction (and description)
1) mechanocoupling (physical to chemical) 2) cell to cell communication (transfer of signal) 3) effector response (cell gene expression and remodeling change - ex. hypertrophy)
What are the nine primary movement impairments?
1) mobility deficits. 2) movement coordination dysfunction. 3) muscle power deficit. 4) referred pain. 5) poor aerobic capacity. 6) sensory selection deficit. 7) fractionated movement deficit. 8) hypokinesia. 9) hypermetria
Consider the following conditions when assessing reflexes: (3)
1) there must be a specific, accurate stimulus given 2) adequate time must be allowed for a response to occur 3) responses may not always be full-blown or readily visible
Stages of healing (time)
1. Hemostasis - day 1 2. Inflammation - 3 to 5 days 3. Proliferation - 2 days to 8 weeks 4. Remodeling - 3 weeks to year+
peduncles of cerebellum
1. Superior- most output; communicates with midbrain (trigeminal and spinal input) 2. Middle- communicates with pons 3. Inferior- almost entirely input, communicates
Knee extension
10 degrees
loose packed position of talocrural joint
10 degrees plantarflexion
PIP flexion
100 degrees
Glenohumeral abduction
110 ish
Glenohumeral flexion
120 degrees
Hip flexion
120 degrees
Knee flexion
135 degrees
Tarsal Joint Total Eversion
15 degrees
Thumb CMC flexion
15 degrees
Transverse Tarsal Joint Eversion
15-21 degrees
Elbow Flexion
150 degrees
Shoulder complex abduction
180 degrees
Shoulder complex flexion
180 degrees
For the dorsal column, where is the cell body for the 1st, 2nd, and 3rd-order neuron?
1st - dorsal root ganglion 2nd - nucleus cuneatus or gracilis 3rd - VPL of thalamus
What is the specific pathway of the 1st and 2nd neuron in the dorsal column (if coming from upper extremity)?
1st - fasciculus cuneatus 2nd - medial lemniscus
Subtalar Joint Eversion (rearfoot)
5 degrees
What may be typical inbibation duration/frequency? examples?
3-5 minutes 3-4 (up to 8) times a day tailgaters, heal slides
Ulnar deviation
30 degrees
Loose-packed position of hip joint
30 degrees of flexion, 30 degrees abduction and slight ER
IP joint Flexion in toes
30-90 degrees (1st toe) 0-30 degrees (lesser 4 toes)
Tarsal Joint Total inversion
35 degrees
Transverse Tarsal Joint Inversion
35 degrees
Hip abduction
40 degrees (AMA)
Hip external (lateral) rotation
45 degrees
Hip internal (medial) rotation
45 degrees
MCP Extension
45 degrees
MTP Joint flexion
45 degrees
Dermatome for C8
4th and 5th Phalanges
DIP flexion
90 degrees
MCP flexion
90 degrees
Shoulder External Rotation (lateral rotation)
90 degrees
Glenohumeral extension
?? degrees
ACL
A football player plants his foot and takes a posterior blow to the tibia. Which ligament is at risk for injury?
joint mobilization
A technique that applies an external force to a patient's joint to generate a passive oscillatory motion or sustained stretch between the joint surfaces. improves osteokinematic motion. ROM. Immediately after treatment dose - there should be a positive difference.
edema. (cause?)
Abnormal accumulation of fluid in extracellular spaces. caused by an imbalance between the hydrostatic and osmotic pressures
proximal tibiofibular joint capsular pattern
Capsular pattern: No noticeable loss of motion, but pain with biceps femoris contraction
collagen stress/strain curve: plastic region
Actual fiber rupture of some fibers; bonds rupture; will not return to original length (injury)
Myotome for L4
Ankle Dorsiflexion
Myotome for S1
Ankle Plantarflexion
ACL
Another football player plants his foot and takes a posterior blow to the femur. Which ligament is at risk for injury?
PCL
Another football player plants his foot and takes a posterior blow to the femur. Which ligament is at risk for injury?
Dermatome for L2
Anterior Thigh
Myotome for T1
Approximation of Fingers
S2
At the midpoint of the popliteal fossa
Subtalar
At which joint does inversion and eversion of the foot occur?
anterior spinocerebellar tract. origin? punducle? decussation?
Axons that transmit information about the activity of spinal interneurons and of the descending motor signals from the cerebral cortex and brainstem; neurons arise in the THORACOLUMBAR spinal cord, decussate immediately, goes up through the SUPERIOR punducle, and end in the cerebellar cortex; information does not reach consciousness and is used to adjust movements.
lymphatic system functions:
Carries fluid and plasma proteins back to the cardiovascular system Function to produce, maintain, and distribute lymphocytes Assist in the regulation of tissue volume, pressure, and aids in immune function
Posterior spinocerebellar tract.
Carries unconscious proprioceptive information from the lower limbs to ipsilateral cerebellum.
cuneocerebellar tract
Carries unconscious proprioceptive information from the upper limbs to the ipsilateral cerebellum.
Medial (anterior) corticospinal tract
Consciously controls neck, shoulder and trunk musculature involved with posture (red)
anterior and middle scalene muscles
Between what 2 muscles does the brachial plexus and axillary artey run?
treatment strategy
Combination of interventions to achieve patient goals and achieve an optimal level of function
exercise induced adaptation
Complex process mediated through changes in muscle cell signaling Determined by training volume, intensity, and frequency in addition to protein half life Specific to mode of training
contractile lymphatics
Contain smooth muscle that undergoes spontaneous, peristaltic contractions
spinothalamic tract
Contains sensory fibers that transmit the sensations of sharp pain, temperature. fast and localized.
coxofemoral joint (hip) arthrokinematics
Convex femoral head articulates/moves on a concave acetabulum. OPPOSITE
talocrurual joint arthrokinematics
Convex talus articulates with a concave mortise. OPPOSITE
Wells Criteria
Criteria for diagnosing a DVT: A point each for (1) localized tenderness, (2) asymmetric pitting edema, and (3) asymmetric calf swelling
When is subacute phase? Acute phase?
During the proliferative (fibroplastic) phase AND early remodeling phase of healing Acute phase of tissue protection is the inflammatory phase.
internal arcuate fibers
Fibers arising from dorsal column nuclei that pass ventrally for a short distance in an arc-like trajectory before crossing over to the contralateral side as the medial lemniscus.
collagen stress-strain curve: Elastic region
Fibers slide; strain on bonds; will return to same length in a few min. or hours (ex Stretch)
Arises from the superior trunk of the brachial plexus Supraspinatous muscle- trouble initiating arm abduction Infraspinatous muscle- weakness in lateral rotation
From where does the suprascapular nerve arise, what does it innervate, and what is seen if its damaged
Common peroneal nerve
Damage to which nerve creates foot drop (loss of dorsiflexion)?
Myotome for C7
Elbow Extension, Wrist Flexion
Myotome for C6
Elbow Flexion, Wrist Extension
tissue stretch target physiological adaptations (3)
Elongation of tissue fibers (fascicles, aponeurosis, collagen through tissue creep), increased tolerance to tensile load (through spindle), architectural changes through potential sarcomere adaptation for muscle and breaking of bonds and realignment of fibers for collagen.
corticobulbar tract
Extension of corticospinal tract. A bundle of axons from the motor cortex to the 5, 7, 11, and 12 cranial nerves; controls muscles of the face, tongue, larynx, pharynx, and SCM/traps
Myotome for L5
Great Toe Extension
Myotome for L1 and L2
Hip Flexion
muscle power exercise prescription
I - between 30% to 60% of the MVC (is about 15-20 reps until exhaustion) D - for 3 to 6 repetitions, for 1 to 3 sets with a 2 to 3 minute rest between sets
muscle endurance exercise prescription
I - between 40% to 60% of the MVC D - is 2 to 3 sets of 15 to 20 reps with a rest period less than a minute (30 sec) between sets. F - can be daily (not as much rest is required for recovery) or twice daily if lower intensity
tissue stretch exercise prescription
I - depends on tissue health. Ranges can be from low load (mild sensation of stretch/barely noticeable; moderate sensation of stretch; to barely tolerable (lots of load D - 4 sets 30 to 60 seconds F - (2-3x maintains, daily to 2xday improves)
Joint mobilization exercise prescription
I - grades 1,2,3,4 (3 and 4 is therapeutic) D - 6 to 10 second hold Repeated 10 times F - each treatment session
motor coordination prescription
I - intense enough to require attention but with good form and no pain. D - as many that can be done correctly - 10 to 15 min, or 45-60 reps F - multiple (3-5) times per day
Proximal to the subscapular artery
If you must tie-off the axillary artery, where is the best place to tie it?
Thumb CMC opposition
Important to document and consistently use the same landmarks on a patient so that progress can be tracked - distance from 5th MCP fold
Pars interarticularis
In a lateral XR of the lumbar spine, a scotty dog can be seen. What structure forms the neck of the dog?
Inversion- sole of the foot opens to the midline (stretch of lateral ligaments) Eversion- sole of the foot opens laterally (stretch of the medial (deltoid) ligaments)
In reference to the foot, what do the terms inversion and eversion indicate?
humerus, ulnar nerve
In what bone is the ulnar groove found, and what can be found there?
Femoral vein
In which vein does the great saphenous vein drain?
What does posterior glide of FEMUR (at knee) improve/indicate?
Increase knee extension Stoped from ACL. Targets Posterior capsule
What does anterior glide of tibia improve/indicate? How to really target capsule?
Increase knee extension Tests ACL integrity more than capsule (To really focus on POSTERIOR capsule we would go to end of range in extension then glide anteriorly)
What does anterior glide of FEMUR (at knee) improve/indicate?
Increase knee flexion Stopped from PCL. targets Anterior capsule.
What does posterior glide of tibia improve/indicate? How to really target capsule?
Increase knee flexion, Tests PCL integrity more than capsule. (To really focus on ANTERIOR capsule we would go to end of range in flexion then glide posteriorly)
Dermatome for L1
Inguinal Crease (anterior) & PSIS (posterior)
2nd degree injury
Injury large enough that the tissue function is impacted. 50ish% of the tissue is impacted. PT notices more give. Healing is longer. PT has to respect the healing phases longer.
flexor withdrawal
It is a sharp, quick pressure stimulus to the sole of the foot or palm of hand 20 weeks GA 1-2 months
crossed extension
Kick um off response! 28 weeks GA 1-2 months
Myotome for L3
Knee Extension
Myotome for S2
Knee Flexion
Dermatome for C5
Lateral Deltoid
Dermatome for L5
Lateral Lower Leg, Dorsum of Foot to Great Toe
rostrospinocerebellar tract. origin? punducle?
Monitors interneurons & descending motor signals from cortex to brainstem. Info from CERVICAL ventral horns. 1st order: CERVICAL ipsilateral straight to cerebellum via inferior & superior cerebellar punducles.
Myotome for T2
N/A
Connected righting reflexes
NBOB and NNOB lead to the start of BOB and NOB. They body has learned to role disegmentally.
Gluteus maximus
Name the main extensor muscle of the thigh that, when damaged, disables a person from getting out of a chair
MTP Joint Abduction and Adduction
No norms (compare asymmetry)
MCP Abduction
None reported
MCP adduction
Not typically measured, more commonly used to assess intrinsic strength and or nerve entrapment
Thumb CMC adduction
Not typically measures, should return to starting position of full abduction
How to understand
Notes: All (but righting and equilibrium reactions) SHOULD be seen by the END of the time listed. If not, it is concerning! They may occur earlier
MCL
Of the MCL and LCL, which is attached to its corresponding meniscus and will tear the meniscus if injured?
Tibia
Of the tibia and the fibula, which is the larger and bears all the weight?
NSAIDs, local PT, dorsiflexion night splint, stretching, heel lifts/padding, and possibly local steroid injections
Plantar fasciitis (inflammation of the plantar aponeurosis/fascia) is a common overuse injury that is more likely to occur with the use of improper footwear. What is the treatment for plantar fasciitis?
Dermatome for S2
Posterior Thigh, Central Gastroc
Dermatome for S1
Posterior Thigh, Lateral Gastroc to Sole of Foot (incl. 5th Phalanx)
Three jumping pigges were cross but they withdrew gallantly to the little tracks.
Primitive reflexes that integrate 2 months after birth - only traction is shorter at 5 weeks
Then they thrusted next to the cannabis roots.
Primitive reflexes that integrate 2-3 months after birth
Finally, the piggies grabbed the cannabis, rolled two joints, and fell down. They felt weird, so they curled up and looked at their 4 to 6 hands.
Primitive reflexes that integrate 4-6 months after birth (ATNR and TLR is tonic)
tensile stress
Pulls and stretches the material
What is 'R1' and 'R2'?
R1 is the first end of motion feel - 2nd is the push through beyond that
lateral vestibulospinal tract
Receives information from vestibular apparatus in regard to gravity and helps us use our limbs for balance (blue)
tissue evacuation target physiological adaptation
Reduce extracellular edema through the stimulation of lymphatic flow using hydrostatic pressure generated through muscle contraction. Controlled movement can also assist in the movement of synovial fluid within the joint to reduce joint pain and swelling associated with synovitis (aka imbibition/sponge)
Myotome for C5
Shoulder Abduction
Myotome for C4
Shoulder Shrug
SAID principle
Specific Adaptations to Imposed Demands
Interossei &Lumbricals
Stabilzaton/motion: with the forearm and wrist in neutral, flex the MCP, PIP and DIP joints (Norm 45)
Dermatome for C3
Supraclavicular Fossa, Occiput
Scaphoid fracture
Tenderness in the anatomical snuffbox is usually indicative of what type of injury?
Why are strength gains are seen within the first 2-4 weeks? how long until architectural changes occur?
The first components (early strength gains) of increased force production come from the nervous system (improved recruitment of the muscle fibers at the motor endplate, and improve recruitment of the muscle synergy (6-8 weeks for architectural changes)
hydrostatic pressure
The pressure of water against the walls of its container. -is dependent on blood pressure and gravity
stress/strain curve
The relationship between the stress and strain that a particular material displays
tissue stretch sign of accomplishment
The salient sign is a measurable within session increase in ROM. If I cannot measure an increase, I did not elongate fibers or adjust tolerance to the load.
muscle power target physiological adaptations
The target adaptation here is shortening of the time it takes to transition from an eccentric to a concentric contraction during the motion
C5-T1
The ventral rami of which spinal cord regions comprise the brachial plexus?
Musculocutaneous- pierces the coracobrachialis muscle Median- runs with brachial artery Ulnar- runs behind medial epicodyle of humerus
What are the landmarks of the musculocutaneous, median, and ulnar nerves?
Flying high two piggies twist and right their bodies - the two see home and land safely. Praise the Lord!
This deals with various righting reactions and equilibrium reactions that originate at 4 months!
Median and ulnar nerves
What are the only 2 nerves that innervate the muscles of the hand?
3rd degree injury
Tissue can't do it's job. Very impacted. Stability comprised. Function impacted. Phases must be respected by PT
ACL- medial portion of the lateral femoral condyle PCL- lateral portion of the medial femoral condyle
What are the origins of ACL and PCL?
What does proliferative phase (fibroblastic phase) treatment focus on?
Treatment focuses on controlled load to stimulate tissue to remodel and minimize the effects of immobilization Goals are to restore ROM and then functional strength
True
True or False: All 3 bones of the hip (ischium, ilium, pubis) compose the acetabulum
False The peroneal pulse is not palpable, therefore, any pulse felt in the peroneal regions is from the posterior tibial artery
True or False? The pulse felt in the peroneal region is from the peroneal artery
False
True or false: Transverse processes and transverse formanina are visible on AP view of the lumbar spine.
True
True or false: the olecranon and elbow joint are not involved in tennis elbow
False ( the radius articulates with the carpals of the wrist)
True or false: the ulna articulates with the carpals of the wrist
joint mobilization target physiological adaptation
Trying to restore the glide portion of arthokinimatic motion. Mainly trying to realign/elongate fibers in the joint capsule through tensile load (similar to stretching).
Roots, Trunks, Divisions, Cords, Branches (Hint: Real Texans Drink Cold Beer)
What are the segments of the brachial plexus?
Dermatome for T1
Ulnar Aspect of Forearm
Dermatome for C4
Upper Trap, Anterior AC jnt
Deltoid and teres minor
What 2 muscles does the axillary nerve innervate?
Radial- abductor pollicis longus Medial- abductor pollicis brevis
What 2 nerves are responsible for thumb abduction and what muscles do they innervate?
Sartorius, gracilis, semitendinosus
What 3 muscles comprise the pes anserinus?
Abductor pollicis longus, extensor pollicis brevis and longus
What 3 tendons form the anatomical snuffbox?
-Plantar aponeurosis -Tendons of the tibialis posterior and anterior -Tendon of the peroneus longus -Plantar calcaneonavicular (spring) ligament
What 4 principle structures help maintain the arch of the foot?
Deep circumflex iliac, inferior epigastric
What are 2 branches off of the external iliac artery before it becomes the femoral artery?
-Anterior leg pain caused by swelling of the tibialis anterior muscle -More specifically, it is inflammation of the muscle insertions at the tibial periosteum (AKA periostitis)
What are shin splints?
trapezoid ligament and conoid ligament
What are the 2 subdivisions of the coracoclavicular ligament?
Lateral pectoral, median nerve, musculocutaneous
What are the 3 branches off of the lateral cord of the brachial plexus?
I: Deltoid tuberosity A: Abducts arm, anterior fibers flex and medially rotate arm, posterior fibers extend and laterally rotate arm BS: posterior humeral circumflex artery NS: Axillary nerve
Where does the deltoid insert, what are its actions, and what is its blood and nerve supplY?
Obturator and tibial nerves
Which 2 nerves innervate the adductor magnus?
Common fibular and tibial nerves (of sciatic nerve)
Which 2 nerves innervate the biceps femoris?
iliofemoral, ischiofemoral, pubofemoral, ligamentum teres
Which 4 ligaments hold the hip joint together?
Medial and lateral circumflex arteries, medial supplies the most
Which arteries supply the head and neck of the femur? Which supplies the most blood?
Myotome for C8
Wrist Ulnar Deviation, Thumb Extension
medial reticulospinal tract
a ventromedial tract that grossly activates limb EXTENSOR muscles, and controls postural musculature
hypokinesia
abnormally decreased muscle function or activity. too little movement. Slow or small movement. Involves more cerebellum.
equilibrium reactions
automatic reactions that use the body to maintain its COG over its BOS; persist throughout life
righting reactions
automatic reactions which bring the head and trunk into normal alignment; integrated over time
What MODE do we use prescribe to increase continuous muscular output?
endurance exercise
hypermetria
excessive movement. coordination and movement can't be scaled appropriately. They will overshoot target. All-or-nothing kind of response
total amount of exercise performed in a single session
exercise volume
rubrospinal tract
extrapyramidal motor tract responsible for unconcious control of upper limb FLEXION
capsular pattern of tibiofemoral joint
flexion > extension
Capsular pattern of hip
flexion, abduction, IR ?????
Neonatal body on body righting (NBOB)
head and upper trunk will follow in log-roll fashion 34 weeks GA 4-5 months
head righting
head assumes normal position in space with mouth horizontal and face vertical
neck righting
head is turned, body realigns with the head
palmar grasp
hold my hand! 10 weeks GA O = 4-6 months
sensory selection deficit/reweighting deficit
how person is able to interpret and integrate sensation into motor response. There is a failure and we have to identify what sensory system is at a deficit.
spinomesencephalic tract. termination area?
involved in turning eyes and head toward source of noxious input. A reflexive tract. terminates in the periaqueductal gray matter.
What MODE do we use prescribe to increase motor recruitment and skill acquisition?
motor coordination training - refine movements; "brain training"
types of righting reactions (4)
neck righting, head righting, body righting, Landau reaction
Fractionated Movement Deficit
neuromuscular deficit where pt can not isolate joint movement - pt moves with big - ex not just elbow flexion but wrist and shoulder with it.
patellofemoral joint (normal patella movement?)
normally patella should be able to move at least 1/3 to 1/2 of the patellar width. - more than 1/2 of it's width is hypermobility
What MODE do we use prescribe to reduce pain?
pain signal modulation
How do pain symptoms relate to tissue resistance in the inflammatory phase (acute phase)?
pain symptoms come BEFORE tissue resistance (R1)
Connected grasp reflexes
palmar grasp leads to plantar grasp
pain signal modulation
process by which the sensation of pain is inhibited or modified
protective extension reactions
protect the upright posture when the body is suddenly displaced by a horizontal or rotational force
motor coordination training
refinement of movement. Person can move better, longer to reduce pain. "brain training". Therapeutic dose good if their movement improves with time
What MODE do we use prescribe to increase muscle force generation?
resistance/strengthening exercise
Medial vestibulospinal tract
responsible for positioning of head and neck in response to vestibular apparatus (green)
body righting
rotational movements which realign the body part if it is displaced in relation to the other body parts
In decorticate posturing, what tract primarily leads to the upper extremity flexion posture?
rubrospinal tract
Landau reaction
superman! During horizontal suspension at the abdomen the head raises and everything else as well. receptors: labyrinths and proprioceptors O: 3-4 months I: 12-24 months
therapeutic exercise
systematic, planned performance of bodily movements, postures, or physical activities
How is stretch intensity defined?
tensile stress defined through both sensation and end feel.
mechanocoupling
the direct or indirect physical perturbation of the cell through shear or compression that is transformed into chemical signals within and among cells (1st step in mechanotransduction)
osmotic pressure
the external pressure that must be applied to stop osmosis. is dependent on the concentration gradient between the blood vessel and the surrounding tissue
traction
the first pullup. 28 weeks GA O = 2-5 weeks
Surgical neck
What is the thinnest part of the humerus?
3 subtalar joint mobilizations (therapeutic for...)
- joint distraction - medial glide (eversion) - lateral glide (inversion)
3 talocrural joint mobilizations (therapeutic for...)
- joint distraction (pain, general mobility) - posterior glide (dorsiflexion) - anterior glide (plantarflexion)
Where does the cuneocerebellar tract synapse? What peduncle does it pass?
- lateral cuneate nucleus - inferior peduncle
What is origin of the lateral reticulospinal tract? Decussation? Descent?
- lateral reticular formation in medulla - it does not cross - ipsilaterally
For discriminative touch from the face, how does the 1st, 2nd, and 3rd-order neuron travel?
1st - receptors to the trigeminal ganglion then the trigeminal main sensory nucleus 2nd - decussation here, then ascends as trigeminal lemniscus to end at VPM in thalamus 3rd - VPM to cortex
For the spinothalamic tract, how does the 1st, 2nd, and 3rd-order neuron travel?
1st - receptors, through DRG, synapses at dorsal horn 2nd - decussation here at anterior white commisure. Ascends anterolaterally all the way to the VPL. 3rd - VPL to the cortex.
Subtalar Joint Inversion (rearfoot)
5 degrees
Ankle (Talocrural) Plantarflexion
50 degrees
Thumb MCP flexion
50 degrees
What is important consideration/limiter when prescribing intensity of tissue stretch?
Need to respect and understand the phases of tissue healing (directly affects how much load can be applied to the tissue - healing tissue does not have the pliability and strength of non-injured tissue).
referred pain/radiating pain
Pain that is felt in a location other than where is originated. - pt is having symptoms coming from the nervous system. We label it like this so we have a clear path - we are treating the nervous system
Synovial sheaths
What is the name of the cellophane-like tubes that surround flexor and extensor tendons?
Palmar aponeurosis
What is the name of the fibrous band that protects the palm of the hand?
Medial meniscus- C Lateral meniscus- O
What is the shape of the medial and lateral menisci?
Arm hangs by the body's side in medial rotation and forearm is extended and pronated Caused by injury to the superior trunk of brachial plexus (C5 and C6 roots) Results from forcefully increasing angle between head and neck and shoulder as in a vehicle accident or delivery
What symptom is characteristic of Erb-Duchenne palsy and what causes this?
Anterior spinal artery and two posterior spinal arteries
What two arteries supply the spinal cord?
Medial- basilic vein Lateral- cephalic vein
What two superficial veins, found medially and laterally on the arm, drain into the axillary vein?
Deep peroneal (fibular) nerve
Which nerve is responsible for the cutaneous sensation of the first web space of the toes?
is the spinothalamic tract ipsilateral or contralateral? where is decussation?
contralateral, decussation at immediate spinal cord level.
tibiofemoral joint arthrokinematics
moving concave tibial plateaus articulate on convex femoral condyles. SAME DIRECTION. (in an open chain!) But if femur is moving (convex moving) - OPPOSITE DIRECTION. (closed chain)
Head of the fibula
What forms the prominent bump on the lateral knee?
What two basic PT requirements are needed to establish therapeutic exercise?
1) assess the patient's current status 2) determine appropriate, relevant, and achievable goals
Then they thrusted next to the cannabis roots. (reflexes)
1) extensor thrust 2) rooting
5 types of glides for hip joint (therapeutic for...)
- long axis distraction/inferior glide (pain modulation) - posterior glide (flexion flexion and IR) - anterior glide (extension, ER) - lateral distraction - medial glide (abduction)
6 Tibiofemoral jont mobilizations (therapeutic for...)
- long axis joint distraction - posterior glide of tibia (flexion) - anterior glide of tibia (extension) - posterior glide of femur (extension) - anterior glide of femur (flexion) - lateral gapping (joint space)
Lymphatic system: intrinsic mechanism to transport lymph (for what part of system?, what provides this force?)
- main mechanism for contractile lymphatics - Spontaneous intermittent smooth muscle contraction
Where does the medial vestibulospinal tract originate? Dessucate? Descent?
- medial vestibular nucleus in the lower pons/upper medulla - Upper medulla but projects bilaterally - projects bilaterally so it is contralateal and ipsilateral (green)
corticobulbar tract origin? Decussation? termination?
- motor cortex - decusstion at level of associated cranial nerve - to cranial nerve nuclei in brainstem
Accessory nerve - CN XI
- only motor supply of SCM and trapezius
rubrospinal tract origin? Decussation? Descent?
- origin in red nucleus of midbrain - ventral tegmental decussation in midbrain (immediately) - contralaterally
7 exercise categories:
- tissue evacuation - tissue stretch - joint mobilization - motor coordination - muscle strength - muscle power - muscle endurance
4 Key patient considerations for establishing an appropriate therapeutic exercise plan:
- tissue quality - symptom severity (pain) - presence of co-morbidity - physical demand of ADLs and occupation
What 4 things maintain balance of hydrostatic and osmotic pressures?
- vascular system - muscle contractions - adequate intake of nutrients (electrolyte balance) - lymphatic system
Finally, the piggies grabbed the cannabis, rolled two joints, and fell down. They felt weird so they curled up and looked at their 4 to 6 hands.
1) palmar grasp 2) Neonatal neck on body righting (NNOB) and neonatal body on body righting (BNOB) 3) Moro 4) Tonic labyrinthine reflex (TLR) 5) Asymmetrical tonic neck (ATNR)
muscle strength exercise prescription
I - more than 60% of 1RM. The safe recommendation for the general public is to train at 60% to 70% of a 1RM for... D - 2-3 sets: 8 to 12 repetitions with a 2 to 3 minute rest between sets F - 2-4 times per week (even daily for lower intensities)
tissue evacuation exercise prescription
I - no overload to muscle D - ex. 30 reps or 2 min F - many times per day
Hip Flexors (Thomas Test)
Measure: Hip Extension Stabilization/Motion: Opp leg flexed; spine in neutral. Test knee extended; leg in midline At the end of testing motion, if subject has restricted hip extension then testing motion needs to be modified and repeated.
Tensor fascia lata (Thomas Test)
Measure: Hip Extension Stabilization/Motion: Opp leg flexed; spine in neutral. Knee flexed to 90 degrees
Rectus Femoris (Thomas Test)
Measure: Hip Extension Stabulization/ Motion: Opp leg flexed, spine in neutral. Knee flexed to 90 degrees then slightly abducted
Hamstring Muscles Proximally- SLR
Measure: Hip FLexion Stabilization/Motion: Problems with limitations to the other side; pelvic stabilzation. Patient Supine, legs straight then raise testing leg straight up
Tensor fascia lata (Ober Test)
Measure: Hip adduction Stabilization/Motion: Side lying; knee bent Ask for the other examiner to take the measurement.
Tensor fascia lata (Modified Ober Test)
Measure: Hip adduction Stabilization/Motion: Side lying;, knee straight, support patella Ask for the assistant to hold leg or take measurement.
Hamstring Muscles Distally- 90/90
Measure: Lack of knee extension Stabilization/Motion: Hip flexed to 90 degrees, knee extension
FDS + FDP
Measure: Need to maintain fingers in extension, can use dorsal wrist measures as an alternative to lateral border of the hand (Norm 70) Stabilization/motion: put elbow in extension, palm to palm then stretch up
Biceps (at shoulder)
Measure: Shoulder extension (Norm 60) stabilization/motion: patient supine, elbow extended, forearm pronated
Biceps (at elbow)
Measure: elbow extension (Norm 0) Stabilization/motion: shoulder into extension, pronate wrist, extend elbow
Triceps (at elbow)
Measure: elbow flexion (Norm 150) Stabilization/motion: Flex shoulder then flex elbow
Palmar
On which side of the wrist are there more ligaments: palmar or dorsal side?
Pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris
What are the 4 superficial flexors of the forearm?
Anterior tibial artery, posterior tibial artery, peroneal artery
What are the 3 main arteries of the leg?
Short head of biceps brachii, coracobrachialis, pectoralis minor
What are the 3 muscles that attach to the coracoid process?
Median Medial antebrachial Medial pectoral Medial brachial cutaneous Ulnar (MMMM and U)
What are the 5 braches off the medial cord of the brachial plexus?
upper Subscapularis Thoracodorsal Axillary Radial lower Subscapularis (HINT: STARS)
What are the 5 branches off of the posterior cord of the brachial plexus?
1st- Superior thoracic 2nd- thoracoacromial and lateral thoracic 3rd- subscapular, posterior humeral circumflex, anterior humeral circumflex (hint: 1 artery in 1st segment, 2 in 2nd, 3 in 3rd)
What are the 6 branches of the axillary artery?
Brachiradialis, extensor carpi radialis longus and brevis, extensor digitorum, extensor digiti minimi, extensor carpi ulnaris, aconeus
What are the 7 superficial extensor muscles of the forearm?
Supraspinatus: initial 15 degrees of arm abduction Infraspinatus: lateral rotation of arm Teres minor: lateral rotation of arm Subscapularis: medial rotation of arm
What are the actions of the 4 rotator cuff muscles?
Circumflex scapular artery and thoracodorsal artery
What are the branches of the subscapular artery?
Popliteal artery and vein
What are the femoral artery and vein called inferior to the adductor hiatus?
-Deltoid liament -lateral collateral ligament -Posterior and anterior talofibular ligament -Calcaneofibular ligament
What are the four main ligaments of the ankle joint?
ACL- anterior intercondylar area of the fibula PCL- posterior intercondylar area of the tibia
What are the insertions of ACL and PCL?
Meet- Medial Malleolus Tom- Tibialis posterior Dick- Flexor Digitorum Longus ANd- posterior tibial artery, tibial nerve Harry- Flexor Hallicus Longus
What are the structure of the *posterior* compartment of the leg in order from medial to lateral at the ankle?
Superficial and deep peroneal nerve
What are the two superficial branches of the common peroneal nerve?
posterior humerus between long and lateral head of the triceps, through supinator muscle
What are two landmarks in the path of the radial nerve?
Ulnar nerve
What artery and nerve are in danger of being damaged in a fracture of the medial epicondyle of the humerus?
Radial nerve and profunda brachii artery
What artery and nerve are in danger of being damaged in a fracture of the shaft of the humerus?
Median nerve and axillary artery
What artery and nerve are in danger of being damaged in a fracture of the supracondyle of the humerus?
Axillary nerve and posterior circumflex artery
What artery and nerve are in danger of being damaged in a fracture of the surgical neck/upper shaft of the humerus?
Brachial plexus and axillary artery
What artery and nerves are in danger if the clavicle is broken?
Superificial palmar arch arising from the ulnar artery
What artery is injured if arterial bleeding ensues from a cut 3/8ths of an inch deep in the hypothenar eminence?
Lateral thoracic artery
What artery runs with the long thoracic nerve?
Brachial artery
What artery runs with the median nerve?
Profunda brachii (deep brachial artery)
What artery runs with the radial nerve?
Suprascapular artery
What artery runs with the suprascapular nerve?
Ulnar artery
What artery runs with the ulnar nerve?
Radial artery, superficial branch of the radial nerve, tendons of extensor carpi radialis longus and brevis
What can be found in the anatomical snuffbox?
Cephalic vein
What can be found in the deltopectoral triangle?
femoral Artery, femoral Vein, Empty space, Lymphatics (and Lacunar Ligament) Think: N-AVEL
What can be found in the femoral shealth?
Valsalva maneuver
What can you ask the patient to do in order to dilate the femoral vein so that you may be able to puncture it easier?
Radial- scaphoid Ulnar- triquetrum
What carpal bone takes the pressure in radial deviation? Ulnar deviation?
Pedicle
What connects the body of a vertebra to the lateral mass?
pectoralis minor covers the 2nd part
What divides the 1st, 2nd, and 3rd parts of the axillary artery?
-Indicates ACL injury -With the patient in supine position and knee slightly flexed, the tibia is pulled anteriorly from under the femur. In an ACL injury, the tibia will move a farther distance anteriorly than normal
What does a positive anterior drawer sign indicate? How is it performed?
Deltoid and teres major- weak arm abduction, flexion, extension, and lateral rotation Skin of lateral shoulder- sensory loss of lateral shoulder
What does the axillary nerve innervate and what is seen if its damaged?
Deltoid and teres minor- weak arm abduction, flexion, extension, and lateral rotation Skin of lateral shoulder- sensory loss of lateral shoulder
What does the axillary nerve innervate and what is seen if its damaged?
Brachial artery and veins, median nerve
What does the bicipitial aponeurosis give a limited amount of protection to?
Sartorius, inguinal ligament, adductor longus muscle
What forms the femoral triangle?
Collateral circulation flows into the subscapular artery and then into the axillary artery to supply the arm and forearm. Essentially, the flow of blood in the subscapular artery reverses
What happens when the axillary artery is tied off proximal to the subscapular artery?
MRI
What imaging study is the first test if there is neurological dysfunction without trauma?
CT
What imaging study is used to detect disc disease, arthritis, and masses in the spine?
It is the progressive shortening, thickening, and fibrosis of the palmar fascia occuring most commonly in men over 50 years old that often results in flexion of the ring and little fingers
What is Dupuytren contracture?
Forceful eversion of the foot Torn medial (deltoid) ligament (often with an avulsion fracture of the medial malleolus) and fracture of the fibula
What is a Pott's fracture-dislocation of the ankle?
Painful bump caused by pressure against the prominence of the medial first metatarsal head (usually associated with hallux valgus)
What is a bunion?
Intermittent claudication- cramping pain induced by exercise that is a results of inadequate blood supply to the affected muscles
What is a common symptom of perivascular disease?
-a bone which lies in a tendon and slides over another bone -Patella
What is a sesamoid bone? What is the largest sesamoid bone?
Median nerve, brachial artery, biceps tendon
What is found under the median cubital vein, from medial to lateral?
Angulation of the great toe, which, in extreme cases, may cause the great toe to overlap the second toe
What is hallux valgus?
Deformity where there is permanent dorsiflexion of the proximal phalanx at the metatarsophalangeal joint and plantarflexion of the middle phalanx at the interphalangeal joint
What is hammer toe?
Painful arthritis of the great toe associated with gout
What is podagra?
- inflammation od the extensor tendon of the lateral epicondyle -AKA lateral epicondylitis, extensor tendinitis, and extensor tendinosis - caused by repetitive stress/overuse, poor mechanics, and insufficient muscle conditioning
What is tennis elbow and what causes it?
A: flexes forearm NS: Musculocutaneous nerve
What is the action and nerve supply of the brachialis?
O- coracoid process I- humerus A- flexes arm NS- musculocutaneous nerve
What is the action, origin, insertion and nerve supply of the coracobrachialis muscle?
O- long head- supraglenoid tubercle short head- coracoid process I- radial tuberosity A- flexes arm, flexes and supinates forearm NS: musculocutaneous nerve
What is the action, origin, insertion, and nerve supply of the biceps brachii?
O- long head- infraglenoid tuberosity lateral head- proximal humerus medial head- posterior humerus I- olecranon process A- extend forearm NS- radial nerve
What is the action, origin, insertion, and nerve supply of the triceps brachii?
Dislocated- head of humerus rotates out of glenoid cavity Separated- clavicle separates from acromion and coracoid process of scapula
What is the difference between a dislocated shoulder and a separated shoulder?
1 cm
What is the distance between the femoral artery and femoral vein?
I: Medial humerus A:Medial rotation, extension, and adduction of arm NS: Lower subscapular nerve
What is the insertion, action and nerve supply of teres major?
Flexor digitorum superficialis
What is the intermediate flexor muscle of the forearm?
Subscapular artery
What is the largest branch of the axillary artery?
deep (profunda) femoral artery
What is the largest branch off of the femoral artery?
Radial nerve
What is the largest nerve branch to come off the brachial plexus?
Glenohumeral joint (shoulder)
What is the most commonly dislocated joint of all the large joints in the body?
Scaphoid
What is the most commonly fractured carpal bone?
Clergyman's knee (caused by friction between skin and tibial tuberosity)
What is the name given to an inflammation of the infrapatellar bursa?
Shoes with wide toe-box, spacer between the 1st and 2nd toes, NSAIDs when indicated, and possibly surgical correction
What is the treatment for a bunion?
-The usual treatment is simply buddy taping to the next toe -Displaced fractures of the great toe MTP joint may require ORIF
What is the usual treatment for a toe fracture? What type of toe fracture may be treated with open reduction and internal fixation (ORIF)?
Hyperextension injury of the great toe metatarsophalangeal (MTP) joint
What is turf toe?
inguinal ligament
What landmark differentiates the external iliac artery before it becomes the femoral artery?
Coracoacromial ligament
What ligament attaches the coracoid process to the acromion of the scapula?
iliopsoas
What muscle group is the chief flexor of the thigh?
Supraspinatus
What muscle's tendon is involved in rotator cuff tears caused by repetitive movements of the shoulder?
Abductor digiti minimi, opponens digiti minimi, flexor digiti minimi
What muscles are considered hypothenar muscles?
Abductor pollicis, opponens pollicis, flexor pollicis brevis
What muscles are considered thenar muscles?
gluteus maximus
What muscles are innervated by the inferior gluteal nerve?
Tensor fasciae latae, gluteus minimus, gluteus medius
What muscles are responsible for hip/thigh abduction?
gluteus maximus, biceps femoris, semimembranosis, semitendinosis
What muscles are responsible for hip/thigh extension?
Iliopsoas, pectineus, sartorius, rectus femoris
What muscles are responsible for hip/thigh flexion?
Gluteus maximus, piriformis, superior and inferior gemillus, obturator internus and externus, quadratus femoris, sartorius
What muscles are responsible for lateral rotation of hip/thigh?
tensor fasciae latae, gluteus medius, gluteus minimus
What muscles are responsible for medial rotation of hip/thigh?
Rectus femoris, vastus lateralis, intermedius, and medialis
What muscles compose the quadratus femorus?
Anterior tibial artery
Which artery becomes the dorsalis pedis artery when it crosses the extensor retinaculum?
None, while the peroneal artery supplies the lateral compartment of the leg, it is located in the posterior compartment
Which artery is located in the lateral compartment of the leg?
Anterior tibial artery Posterior tibial artery
Which artery supplies the anterior compartment of the leg? The posterior?
Profunda femoral artery
Which artery supplies the posterior and medial compartments?
Calcaneus
Which bone forms the heel of the foot to which the Achilles' tendon is attached?
Crural fascia
Which fascia of the leg is continuous superiorly with the fascia of the thigh?
Plantaris
Which feeble muscle in the leg has an extremely long tendonous insertion?
Lumbrical #1 Adductor hallicus Flexor hallicus brevis Flexor Digitorum brevis (hint: LAFF- tickle my foot)
Which foot muscles does the medial plantar nerve innervate?