Kinesiology Test 2

What is the simple test for radial nerve dysfunction?

wrist extension

What is adhesive capsulitis?

-"frozen shoulder" -inflammation of joint capule -loss of normal tissue redundancy -reduction of "joint space" -leads to severe loss of ROM, pain

What is medial epicondylitis?

-"golfer's elbow" -common flexor tendon site -pain on resisted wrist flexion

What is lateral epicondylitis?

-"tennis elbow" -common extension tendon -repetitive wrist extension activities

What is a third class lever?

-Axis, Force, Resistance -good for speed and distance (aka ROM) -most common lever in the human body Ex: screen door

What is a second class lever?

-Axis, Resistance, Force -good for power Ex: -wheelbarrow -plantar flexors lifting the body; metatarsals are the axis, the resistance is the weight of the body pushing down, force is the muscle contraction pulling up -brachioradialis: axis=elbow, resistance=weight of forearm, force=insertion of muscle

What is a first class lever?

-Force, Axis, Resistance Ex: -see-saw -head/neck (relax neck and head drops forward; axis is the top of the neck, head is heavy and acts as resistance; muscles in neck provide input force that allows you to raise your head)

How do you perform ROM in tenodesis?

-NEVER extend DIPs, PIPs, or MCPs when performing wrist extension ROM in tenodesis -think about what tenodesis does and do it yourself--those need to flex to pick stuff up!

What do the biceps, supinator, pronator teres, and pronator quadratus all have in common?

-all insert on the radius

What are the supinator muscles?

-biceps -supinator

Which muscles cross both the GH and elbow joint?

-biceps, both heads -triceps, long head

What is cubital tunnel syndrome?

-compression to ulnar nerve at the elbow -severe compression-atrophy in hand muscles because ulnar nerve innervates a lot of the hand muscles -numbness, tingling over ulnar distribution -severe injury can result in loss of hand function -ulnar nerve can sublux and rub over medial epicondyle -numbness and tingling at middle and ring fingers -ulnar side of hand is "power side"

What causes a compression injury?

-crutches -poor transfers -"saturday night" palsy (laying on arm in a funky way and temporarily lose wrist extension)

When are avulsion injuries most common?

-during a motor vehicle or motorcycle accident when the arm and shoulder are severely stretched during the collision -when this occurs, the nerves of the arm are pulled so hard that the nerves are actually yanked out of the spinal cord -the end result is a partially or completely paralyzed arm

What are the three bones in the elbow joint?

-humerus, ulna, radius

What is an avulsion (traction) injury?

-injury varies -nerve roots -brachial plexus -sensory and motor loss -long thoracic nerve most common

What is an eccentric muscle contraction?

-lengthening contraction -muscle attachments (O/I) move farther away -movement occurs against gravity -deceleration activity (ex: lowering backpack-extension)

What happens with a musculocutaneous nerve lesion?

-loss of biceps and brachialis -elbow flexion is accomplished by brachioradialis, pronator teres, extensor carpi radials longus and brevis -person uses momentum to get flexion started -can only lift light objects

What happens with a medial nerve lesion?

-loss of pronator teres and pronator quadratus -loss of pronation, so can't turn things like keys

What happens with a radial nerve lesion?

-loss of triceps -elbow flexion and extension are performed by concentric and eccentric contractions of biceps -loss of wrist extension

What are the three ligaments at the elbow?

-medial (ulnar), lateral collateral ligaments & annular ligament

How do you treat an avulsion injury?

-most difficult to treat -surgeons can perform nerve transfers -these may or may not take -the expected result is partial elevation of the arm

What is force coupling?

-pair of muscles that act together -may exert pulls in opposite directions to provide rotation

What are the pronator muscles?

-pronator teres -pronator quadratus

What is nursemaid's elbow?

-radial head subluxes out from the annular ligament -sudden traction to young child's arm -children under 5 have undeveloped ligaments -to treat: actively flex elbow, pop right back into place

What are the two joints of flexion and extension at the wrist?

-radiocarpal -midcarpal

What is the scapulohumeral rhythm?

-scapula doesn't really move for the first 30 degrees (pure shoulder joint motion) -scapula will move 1 degree for every 2 degree the glen-humeral joint moves -all joints need to move in order to get good shoulder rhythm -if clavicle doesn't rotate (at the scapuloclavicular joint), then abduction is limited to 110 degrees

What is important to remember about scapular muscles?

-scapular muscles do NOT have redundancy in movement/action -paralysis of one scapular muscle will cause functional limitations

How does subluxation occur?

-secondary to CVA -due to gravity pull on ligaments

What is a concentric muscle contraction?

-shortening contraction -muscle attachments move closer together -movement occurs against gravity (most cases) -acceleration activity

What are age related changes in the scapula?

-stooped posture changes angle of scapula -increased rotator cuff tears/irritation (everytime you lift your arm and scapula can't move, it tears) -degenerative joint changes -loss of ROM -subluxation (secondary to CVA)

How do we know which muscles are doing the work?

-strongest muscle -muscle that can do the work most efficiently -muscle in the best position-line of pull -the amount of resistance that needs to be overcome -need for stability in other areas of the body

What is tendonitis? Where does it occur?

-suprahumeral space (suprahumeral outlet) frequent site of impingement/irritation with repetitive overhead movement -bicipital groove (long head of biceps) subject to wear and tear as well

How does the radius move?

-the radius rotates around the ulna both proximally and distally -the ulna remains stable -a muscle MUST attach to the radius to produce supination or pronation

What are the two prominent bony landmarks at the distal radioulnar joint?

-ulnar styloid (typically more prominent) -radial styloid

What are the two joints at the elbow?

-ulnotrochear and radiocapitular

When the scapula "wings," what shoulder motions would the person be unable to perform?

-upward rotation -protraction

What are common "substitution motions"?

-use of shoulder internal & external rotation to produce appearance of pronation & supination -eccentric contraction of elbow flexors to produce appearance of elbow extension (with gravity only) -will see with spinal cord injury and stroke as well

How do you treat a compression injury?

-wait -if no return of function, tendon transfers may be an option to regain some function -OTs job will be to retrain muscle to do its function after tendon transfer

How long should a forearm arm splint be?

2/3 the length of the forearm

Which elbow muscles cross only the elbow?

Flexors -brachialis -brachioradialis Extensors -medial & lateral (short) head of triceps

What is the Shoulder Joint called? What does it consist of?

Glenohumeral joint -Scapula & Humerus

Your client has weakness in their left shoulder, so you apply a cuff weight to the wrist and ask them to perform flexion 10x. In addition to weakness making this a challenging exercise, which of Newton's laws explains why initiating the exercise is so difficult?

Law of Inertia

What are the ligaments of the wrist? (4)

RC-radial collateral UC-ulnar collateral PR-palmar radiocarpal DR-dorsal radiocarpal

What are all the possible shoulder girdle movements? What muscles are the prime movers of the shoulder girdle?

Retraction - middle traps, rhomboids Protraction - serratus anterior Elevation - upper traps, levator scapula, rhomboids Depression - lower traps, pectoralis minor Upward rotation - upper and lower traps, & serratus anterior Downward rotation - rhomboids, levator scapulae, pectoralis minor Scapular tilt - Pectoralis Minor

What are the 8 bones carpal bones? Remember: SLTPTTCH

Scaphoid Lunate Triquetrium Pisiform Trapezium Trapezoid Capitate Hammate

You are doing an ergonomic evaluation on a delivery person. They complain of difficulty moving the heavy boxes from the truck to their destination. You recommend the use of a hand truck to move the boxes. Which type of lever system are you recommending?

Second Class Lever

Which muscle is paralyzed/weakened when the scapula "wings"?

Serratus Anterior

What is the best order for assessing balance?

Sitting-->Standing-->Walking

Your patient enters the clinic complaining of pain with resisted wrist extension. You might suspect what cause?

Tennis Elbow

What is an antagonist muscle?

a muscle that performs the opposite motion of the agonist

What is the law of inertia?

an object in motion wants to stay in motion, an object at rest wants to stay at rest Ex: ball, seatbelt

What is a closed kinematic chain?

distal chain is fixed Ex: ball against the wall

What is an open kinematic chain?

distal end is free to move in space Ex: weight in hand

What are parallel forces?

forces that occur in the same plane in the same or opposite direction Ex: three point splint

In most cases, what is the axis in the human body?

joint

What two carpal bones articulate with the radius?

lunate and scaphoid

What is an isometric muscle contraction?

no joint movement

What is the true wrist joint called?

radiocarpal (radius, scaphoid, lunate)

Which bone, the radius or ulna, articulates with the wrist?

radius

In what manner do the carpal bones articulate?

slide across each other (plane joints)

What joints allow shoulder girdle motions?

sternoclavicular joint & acromioclavicular joint

What is the law of acceleration?

the amount of acceleration (increasing speed/velocity) depends on the strength of the force applied to the object

What is the force in the human body?

the muscle (the insertion point of the muscle)

If your client demonstrated poor stability with standing and walking, which piece of equipment would be the best option to increase their stability without limiting their abilities?

walker

What is the resistance?

what the lever system is attempting to move; counterbalanced by force

What does ARF stand for?

A=axis; pivot point (in people, this is the joint) R=resistance; what lever system is attempting to move or lift (counterbalanced by force) F=force; primary force behind lever system; this is the insertion of the muscle (in people, this is the muscle contracting)

Your new client enters the clinic complaining of a pain over the medial elbow with numbness in the small finger. Given the anatomy in that area, what might you consider as a potential cause?

Cubital Tunnel Syndrome

What are prime movers?

agonist muscle, causes motion

Which ligament holds the head of the radius in place?

annular

How do we measure subluxation?

by finger length (1 finger width, 2 finger width)

What is an agonist muscle?

causes motion

What type of tissue primarily supports carpal bones?

ligamentous