PTA 150 Lecture Exam 1

Arthrokinematics - accessory motion forces - traction, compression, and shearing - clinical application of using these forces on joints ***short answer about the four types of accessory motion forces 1. traction or distraction 2. compression 3. shear 4. rotary

"3 main types of forces are used to create movement between joint surfaces: traction, compression, and shearing." - Traction Forces = "joint distraction" in which the joint surfaces pull apart from one another. - Compression Forces = "joint approximation" in which the joint surfaces are pushed closer together. - Shearing Forces = "gliding motion" in which the joint surfaces move parallel to one another. - *Rotary Forces = is a combination of forces, resulting in compression forces on the concave side and traction forces on the convex side. Clinical Application - Distraction, Gliding, Bending, and Torsional/Rotary Forces = used to assist in restoring a joint's mobility - Approximation Forces = assist in promoting joint stability

Muscular System - motor neuron - motor unit - size principle

Motor Neuron - cell body on anterior horn of SC - axon extends from cell body to muscle - terminates at the motor end plate (synapse of the neuromuscular junction) - synaptic cleft...ACh carries action potential across - AP travels to motor end plate - Ca++ ions attract the synaptic vesicle and fuse with motor end plate releasing ACh into synaptic cleft - ACh finds receptor site and transmits AP across NMJ - excess ACh is reabsorbed (acetylcholinesterase) Motor Unit - consists of the motor neuron and all of the muscle fibers it innervates - larger the axon = faster the impulse travels (smaller the cell body = control of fine movements / posture .... large cell body = muscles that produce large force and large movements) - size principle = small motor units recruited first and then progressively increase as force increases

The Nervous System - Multiple Sclerosis - CVA -

Multiple Sclerosis - affects myelin sheath of CNS (myelin is lost and replaced with scar tissue) - interferes with normal nerve conduction (Myasthenia Gravis = normal nerve conduction... problem is at neuromuscular junction) - balance problems, dizziness, spasticity (UMN injury), and fatigue (because muscle is firing all the time) CVA (cerebrovascular accident) - life threatening (part of the brain suffers lack of oxygen) - Ischemic CVA = blood clot blocking artery; 80% of CVA accident - Hemorrhage CVA = excessive bleeding within the brain... often due to hypertension - contributing factors = smoking, diabetes, obesity, family history, sedentary, alcohol/drug use Right Side of the Brain CVA - paralysis on the left side of the body - vision problems - Change in behavior - memory loss Left Side of the Brain CVA - paralysis on the right side of the brain - speech/language problems - behavioral change - memory loss Brain Stem - may affect both sides of the body - "locked-in syndrome" = unable to speak or move anything below the neck... can move eyes

The Nervous System Sensory Receptos - muscle spindles - golgi tendon organs - deep tendon reflexes

Muscle Spindles - intrafusal fiber within skeletal muscles belly... responds to muscle stretch and velocity of lengthening... initiates reflexive actions that control the amount of stretch in agonist and antagonist muscles. -***cause muscle contraction in response to a rapid stretch Golgi Tendon Organs (GTO) - receptors in tendons of skeletal muscles... work with muscle spindles to monitor rapid stretch of a muscle/tendon... inhibits muscle contractions -***cause muscle inhibition of muscular contraction in response to stretch... sense muscle is contracting really hard and tell muscle to relax so damage is not done Deep Tendon Reflexes (DTRs) - maintain tone in muscles that allow functional movement; typically observed with reflex hammer - receptors are sensitive to excessive stretch... if muscle stretches quickly the receptors send message to SC causing muscle to contract

Cardiovascular System - pulmonary system - systemic system - Heart Chambers Valves - tricuspid valve - pulmonic/pulmonary valve - bicuspid/mitral valve - aortic valve Lymphatic System - function - components -

Pulmonary System - transports oxygen-depleted blood from the body through the right side of the heart to the lungs via the pulmonary arteries Systemic System - oxygen rich blood is transported from the lungs via the pulmonary veins, and then into the heart out to the rest of the body via the aorta and branching arteries, and then to capillary beds Heart Chambers - four separate chambers (top = atria , bottom = ventricles) - atruim receive blood from the veins, have relatively thin muscular walls, propel blood into the ventricles - ventricles have thicker walls that provide a greater pumping force Valves - four heart valves - two atrioventricular (AV) valves that lie between the atria and ventricles - and two semilunar (SL) valves lie between the ventricles and the arteries leading out of the heart 1. -Tricuspid Valve = the valve between the right atrium and ventricle (has three flaps) 2. - Bicuspid (Mitral) Valve = valve between the left atrium and ventricle 3. - Pulmonic (Pulmonary) Valve = valve located between the right ventricle and the pulmonary arteries leading to 4. - Aortic Valve = the valve between the left ventricle and aorta ***Path through ventricles 1 = tricuspid 2 = pulmonic 3 = bicuspid 4 = aortic Heart Sounds - "lub-dub" - right and left atria contract together, followed by the right and left ventricle contracting together - "lub" = when the ventricle are full, the AV valves (tricuspid and bicuspid) close, making the first sound (lub) - "dub" = when the SL valves (pulmonic and aortic) close to prevent blood from flowing back into the ventricles making the second noise (dub) Blood Vessels - arteries = arterioles = capillaries (gas exchange occurs here) = venules = veins Lymphatic System - Function - 1. collecting lymph from the body's interstitial/intracellular spaces (plays vital role in maintaining normal blood volume and BP within the circulatory system) - 2. filtering the lymph though lymph nodes - 3. detecting and fighting infection in the lymph nodes - 4. returning the lymph to the blood stream (one way route) **lymphatic system dumps into the subclavian veins Components of the Lymphatic System - lymph = interstitial fluid once inside the lymph vessel - lymph capillaries < lymph vessels < lymphatic trunks - lymph nodes = filtration stations in lymphatic vessels... microbes are detected and immune system attacks can be launched by WBC (macrophages and Lymphocytes) ...elastic properties but cannot regenerate if damaged 3 Main Groups of Lymph Nodes - 1. Cervical (neck) - 2. Axillary (upper extremity) - 3. Inguinal (lower extremity) *located at the region of the head of the extremity - lymph is returned from interstitial spaces to the subclavian veins via valves preventing back flow, angion (smooth muscle between each valve), skeletal muscle contraction, and respiratory pump (the act of respiration) Lymph Drainage - from interstitial/intracellular spaces to subclavian viens - right lymphatic duct = smaller duct... only the right side of the head, right UE, and right upper trunk empty here... which then empties into the right subclavian vein - thoracic duct = larger duct... rest of the body empties into this duct (entire left side of the body + right side of the body below the diaphragm)... drains into the left subclavian vein Spleen - largest lymphatic organ - filters blood... does not filter lymph **can be removed.. other organs such as the liver and bone marrow will compensate for its absence... however individual is more prone to infection Thymus Gland - located in upper part of chest... two lobes **can be removed but decreased T-cell production and possible acute susceptibility to infection

MMT - range of motion

Range of Motion - arc of motion - Benefits of ROM - promotes integrity - decrease contracture formation - promote elasticity - increases circulation (AROM > PROM) - promote synovial fluid movement - reduces pain - establishes positive environment for healing - promotes an awareness of movement Limitations of AROM - will not strengthen muscle (resistance must be added) Contraindications for AROM - disrupts healing process - can cause undue harm or stress (recent surgery) AAROM - pt. is able to assist in the desired motion - aid in mechanical or manual means (pulley system) - will not strengthen muscle (resistance must be added) - less effective in promoting integrity of bone and contractile units than AROM PROM - greater ROM than AROM - promotes extensibility of ligaments, muscles, fascia, and skin Limitations - will not stop muscle atrophy, or enhance strength/endurance - not as good as AROM in circulation - pt. may not be able to fully relax

Torque - define - how to increase torque

Torque - define = tendency of force to produce rotation about an axis - increase torque by increasing force, and distance from axis *patella increases distance which in turn makes a more efficient lever and creates more torque

Types of Displacement - transalatory (linear) - rotary (angular) - curvilinear Lecture 1

Transalatory (linear) - occurs in a more or less straight line from one location to another - all parts of the object move the same distance, in the same direction, and at the same time *Rectilinear Motion = movement that occurs in a straight line (example = sledding down a hill) Rotary (angular) - movement of an object around a fixed point (axis) - joints serve as the axis around which angular motion occur - all parts of the object move through the same angle, in the same direction, and at the same time, but the DO NOT move through the same distance - the distal segment travels further than the proximal segment (foot distance > tibial tuberosity distance with knee extension) - most movements in the body are angular; movement outside the body tends to be linear (common to see both movements occur at the same time) - example = walking (the whole body moves in linear motion... whereas the hips, knees, and ankles exhibit angular motion) - example = skateboarder (entire body = linear motion) joints in the body (legs to propel) move in angular motion to push Curvilinear - movement that occurs in a curved path that is not necessarily circular *example = the path a diver takes after jumping off the diving board until entering the water / skier takes coming down a mountain / path of a thrown ball / Earth's orbit around the sun

The Nervous System - ****significance of SC - central nervous system - cerebrum, diencephalon, brainstem, and cerebellum - ventricular system of the brain

***Spinal Cord Level Significance - in Cervical spine the nerves com out above the vertebra (C3 nerve comes out about C3 vertebra ...C8 nerve comes out below C7 vertebra) all other spinal nerves come out below the vertebra - most muscles are innervated by more than one nerve level... so injury at one level may weaken the muscle, but some function will still be present CNS = brain + SC Brain (4 major parts) - 1. Cerebrum = contains cerebral cortex ...thinking/creativity ...contains basal ganglia which is important for muscle coordination (Parkinson's Disease) ...cerebral cortex = layer of grey matter that covers the cerebrum - 2. Diencephalon = contains hypothalamus (regulates hunger, body temp, thirst, sleep cycle, swallowing "autonomic function regulation"), thalamus ("relay station"), and epithalamus (contains choroid plexus which produces CSF in addition to the ependymal cells of lining the ventricles) - 3. Brainstem = regulates HR, RR, swallowing, blinking, and digestion. Divided into pons, MIDBRAIN (contains substantia nigra = dopamine release which regulates movement "Parkinson's Disease"), and medulla oblongata (point at which decussation of the pyramidal tracts cross over). 10 out of 12 cranial nerves exit here. - 4. Cerebellum = posture, learned skill, coordination (input from proprioceptors) Ventricular System of the Brain - lined with ependymal cells that produce CSF (+choroid plexus production in the epithalamus) - hydrocephalus + tumors impede flow of CSF increase pressure in the brain impeding movement

The Nervous System - CNS, PNS, autonomic nervous system - efferent vs afferent - neuron (soma, dendrite, axon) - myelin

- CNS = Central Nervous System = brain + SC - PNS = Peripheral Nervous System = nerves to the rest of the body - Autonomic Nervous System = Sympathetic (stress and stimulation) and Parasympathetic (conserving energy).... both = visceral structure control - Efferent = motor nerves carry messages from the brain to the body - Afferent = sensory nerves carry messages form the body to the brain Neuron - fundamental unit of nerve tissue - main function is transmit signals/impulses throughout body to regulate bodily functions and sensory info to the brain - Soma = cell body - Dendrites = receive messages or impulses - Axon = sends messages onto next neuron, or organ, muscle , or a gland Myelin - nodes of Ranvier - increase speed of impulse - unmyelinated = grey - myelinated = white Action Potential - depolarization is the beginning of an AP - moves in a single direction down the axon - repolarization occurs behind depolarized segment as the sodium-potassium pumps restore ion balance - refractory period = period of time waiting to be repolarized Synapse - point at which impulse is passed from one neuron to another - neurotransmitters propagate impulse

Levers - Lever - Axis (A) - Force (F) - Resistance (R) - Force Arm (FA) - Resistance Arm (RA) 3 Types of Levers - First-Class Lever - Second-Class Lever - Third-Class Lever What is the most common lever in the body? Clinical Relevance to levers

- Lever = rigid and can rotate around a fixed point when a force is applied. *ex: bone in the human body - Axis (A) = the fixed point around which the lever rotates (aka fulcrum) *ex: joint in the human body - Force (F) = sometimes called the effort, which causes the lever to move *ex: muscles - Resistance (R) = sometimes called the load, that must be overcome for motion to occur *ex: the weight of the extremity being moved, the pull of gravity on the part, or an external weight being moved by the part. - Force Arm (FA) = the distance between the force and the axis - Resistance Arm (RA) = the distance between the resistance and the axis 3 Types of Levers First-Class Levers - define = the axis is located between the force and the resistance (if the axis is close to the resistance, the RA will be shorter and the FA will be longer = easy to move / but remember trade off for distance) - by placing the axis near the resistance you have a lever that favors force - by placing the axis near the force you have a lever that favor distance (range of motion) and speed *ex: pencil as axis, book as resistance, and ruler as force *example in the human body = the head sitting on the first cervical vertebra, moving up and down in cervical flexion and hyperextension. The vertebra is the axis, the resistance is the weight on one side of the head, and the force is the muscle pulling down on the opposite side of the head. (the force and resistance change places depending on if the head is forwardly flexed or posteriorly flexed / anterior neck muscles vs posterior neck muscles contract becoming the force with gravity being the resistance. Second-Class Lever - define = the resistance is in the middle, with the axis at one end and the force at the other end. *ex: a wheelbarrow...wheel at the front is the axis, contents are the resistance, and the person carrying the wheelbarrow is the force. *example in the human body = the action of the ankle plantar flexor muscles when a person stands on tiptoe. The axis is the metatarsophalangeal (MTP) joints in the foot, the resistance is the resistance is the tibia and the rest of the body weight above it, and the force is provided by the ankle plantar flexors. *second class levers favor power because a relatively small force can move a large resistance. However, is only raised a very short distance (body from example above) Third-Class Lever - define = the force is in the middle between the axis and resistance *ex: someone pushing at the center of a boat from a dock that is tied at one end (applying the force close to the axis is more difficult...extending the FA makes is more efficient) (pushing close to the axis is harder but rotates the boat out more (distance>force) vs pushing at the opposite end that is not tied down will be easier but distance is traded off (power>distance) *advantage of third class lever is speed and distance *most common lever in the human body *example in the human body: Elbow Flexion. axis is the elbow, the biceps muscles insertion point on the radial tuberosity is the force, and the distal part of the arm is the resistance. Why so many third class levers (which favor speed and distance) and so few second class levers (which favor power) in the body? - because the advantage gained from increased speed and distance is more important than the advantage gained from increased power *ex: biceps brachii (third class lever) and brachioradialis (second class lever) Clinical Relevance to Levers - pt. is doing seated knee extensions with weight cuff on ankle - exercise is too difficult with cuff at ankle...what do you do to increase mechanical advantage? - move the cuff up the leg...reduces the resistance arm therefore increasing the mechanical advantage Advantages to altering exercise and activity by using the principles of mechanical advantage: 1. Allows for higher success rate with performance 2. Reduces risk of injury 3. Helps to psychologically motivate pt. Two general factors govern the movement of a structure 1. The composition of a structure 2. The forces applied to it

Lumbosacral Plexus

- formed by anterior rami of L1-S3 (8 roots total... that divide into upper and lower branches... ***L3 does not divide) - Lumbar Plexus = L1-L4 ...innervates muscle of the thigh - Sacral Plexus = L4-S3 ...innervates muscles of the leg and foot 6 Main Peripheral Nerves - 1. Obturator (anterior - 2. Femoral (posterior - 3. Superior Gluteal (posterior - 4. Inferior Gluteal (posterior - 5. Common Peroneal (make up sciatic - 6. Tibial (make up sciatic ***Sciatic Nerve = made up of the common perineal and tibial nerves by a common sheath

Force - 4 types of forces - linear force - parallel force - concurrent force - resultant force - example anterior and posterior deltoid - FORCE COUPLE - moment arm - stabilizing force - dislocating force - internal vs external force

1. Linear (Transalatory) Force = results when two or more forces are acting along the same line ex: two people pulling rope attached to boat head 2. Parallel Force = occurs when two forces act in the same plane, or in same plane but opposite direction ex: 3 point pressure back brace 3. Concurrent Force = two or more forces must act on a common point but must pull or push in different directions ex: two people pushing at different angles to each other through a common point of application * example = anterior and posterior deltoid contracting simultaneously and creating a concurrent force causing abduction 4. Resultant Force = the overall effect of concurrent forces, produce a force that lies somewhere in between ex: when the concurrent forces of the anterior and posterior parts of the deltoid muscle pull, although in different directions, the resultant force is directly between the two head causing the shoulder to abduct. *Parallelogram Method = a graphical representation of forces (diagonal line represents the resultant force). Force Couple - define = when two or more forces act in different directions, resulting in a turning effect. ex: During upward rotation of the scapula. The Upper Trapezius pulls up and in, the Lower Trapezius pulls Down, and the Serratus Anterior pulls Out. The combined effects cause Scapular Upward Rotation. Independently each muscle performs its on action. When these muscles work in concert with each other they perform a rotational component around about an axis. Additional: Moment Arm = the perpendicular distance from a muscles line of pull and the joints axis of rotation. *torque is greatest when the angle of pull is at 90 degrees, and it decreases as the angle of pull either decreases or increases from that perpendicular position (elbow strongest at 90 degrees) *increasing moment arm increased torque generation Stabilizing Force = when the perpendicular distance between the joint axis and line of pull is very small, causing most of the force generated by the muscle to be directed back into the joint, pulling the two bones together. *ex: some muscles have a much greater stabilizing force than angular force throughout the range and therefore are more effective at stabilizing the joint than moving it...Coracobrachialis is a good example. Angular Force = when the force generated by a muscle is directed at rotating, not stabilizing, the joint (perpendicular "moment arm" is much larger when joint is at 90 degrees, causes this type of force) *ex: the patella increases the angular force of the quadriceps muscles by increasing the moment arm of the quads. *as the muscle increases its angular force it decreases its stabilizing for and vice versa. At 90 degrees the muscle has its greatest angular force...past 90 degrees the stabilizing force becomes a dislocating force Dislocating Force = when a joint extends past 90 degrees or the joints position where it has maximal angular force, the stabilizing force turns into a dislocating force because the force is directed away from the joint. Internal vs External Force - internal = forces such as muscular contraction, ligamentous restraint, or bony support - external = gravity or any externally applied resistance such as weight, friction, and so on Friction Force - a force that is present when there is contact on that object...example = ball rolling across grass - always parallel and have the opposite direction of the potential movement - friction is increased by increasing the perpendicular forces - static friction > kinetic friction > rolling friction (it is harder to initiate dragging an object that to keep one moving) - synovial fluid and cartilage reduces the coefficient of friction in synovial joints

Active vs Passive Insufficiency - active - passive - benefits and drawbacks of Single vs Multijoint muscles (photo on phone)

Active Insufficiency - the point at which a muscle (the agonist) cannot shorten any farther. *example = the hamstrings... asking the hamstrings to flex the knee and extend the hip... the hamstrings are unable to fully flex the knee, with the hip extended, because they are actively insufficient (ran out of ability to shorten). "the muscle will run out of contractibility before the joints run out of range of motion." Passive Insufficiency - when a multi-joint muscle cannot be lengthened any farther without damage to the fibers. - occurs to the antagonist muscle *example = (hamstrings) when the knee is extended and the hip is flexed... the hamstrings are not able to extend any more they are passively insufficient

Laws of Motion - 1st Law of Motion - 2nd Law of Motion - 3rd Law of Motion - moving dumbbell example

1st Law of Motion - define = an object in motion tends to stay in motion - "law of inertia" (inertia = property of matter that causes it to resist any change of its motion in either speed or direction) - directly proportional to mass (more mass = harder to move ... less mass = easier to move) *example = riding in a car... sudden stop causes neck injury * clinical application (energy conservation) 2nd Law of Motion - define = "the law of acceleration" (acceleration = any change in the velocity of an object) the amount of acceleration depends on the amount of force applied to an object... also depends on the mass of an object (mass is inversely proportional to acceleration) 3rd Law of Motion - define = "law of action-reaction" states that for every action there is an equal and opposite reaction. the strength of the reaction is always equal to the force of the action. * example = jumping on a trampoline... ** Ground Reaction Force = the force exerting a reaction force onto the foot Example - person holds a 25lbs dumbell - therefore, muscle must exert a 25lbs force in the opposite direction to achieve equilibrium (1st LAW**) - the harder and faster you lift, the faster the weight moves (2nd LAW)

Muscular System - roles of muscles

Agonist - "main mover" or "prime mover" causing the motion - example = biceps brachii with elbow flexion Antagonist - opposite action of agonist...opposite side...stretched and relaxed while agonist contracts - example = elbow flexion (agonist = biceps brachii / antagonist = triceps ) Synergist - muscles that assist the agonist in providing a desired muscle action - example = elbow flexion (agonist = biceps brachii / synergist = brachioradialis) Stabilizer - sometimes antagonists contract to provide stability to the joint - help to "balance" the body Energy for Muscle Contraction (3 systems) 1 = ATP-Phosphocreatine System - initial energy source 2 = Anaerobic Glycolysis - exercise that lasts 1-5 minutes - glycogen in the liver + skeletal muscles breakdown to provide ATP - without oxygen use - results in formation of lactic acid 3 = Aerobic - requires oxygen - breaks down fats and carbohydrates to form ATP Muscle Strain - over stretching of muscle Grade 1 / Mild = tearing of a small number of fibers but fascia remains intact...only pain Grade 2 / Moderate = tearing of large number of fibers caused by more severe injury....pain with weakness present Grade 3 / Severe = complete rupture and severe bleeding....pain, weakness, and loss of function Ultrasound Grading (used to determine what percentage of muscle strain) Grade 0 = no US features seen Grade 1 = muscle edema only Grade 2a = <33% Grade 2b = 33-66% Grade 2c = >66% Grade 3 = complete tear of muscle

The Nervous System - neuroglia - brain generates 10-12 watts of power

Astrocyte - location = CNS - function = forms Blood Brain Barrier/scar tissue - pathology = astrocytoma / ALS "Lou Gehrig's Disease" Oligodendrocyte - location = CNS - function = myelination of CNS neuron - pathology = MS (multiple sclerosis) Schwann Cells - location = PNS - function = myelination of PNS neuron - pathology = Guillian Barre Syndrome Microglia - location = CNS - function = phagocytes (eat bad things) - pathology = HIV/AIDS hides inside this cell Ependymal Cells - location = CNS - function = Produce CSF - pathology = Hydrocephalus ***"ependymal cells line the ventricles of the brain and produce CSF which bathes and cushions the brain and SC

Skeletal System - bone cells - bone growth (interstitial vs appositional) - types of bones - types of fractures - epiphyseal plate injuries

Bone Cells - osteoblasts = build new bone - osteocytes = mature bone cell - osteoclasts = eats bone Bone Growth - interstitial growth = responsible for increasing the length of bones... occurs in epiphyseal plate in long bones...plate thickness does not increase because growth rate equals cartilage conversion to bone - appositional growth = growth that increases the diameter of long bones...osteoblasts on surface divide and create layer or new bone on surface, while turning into osteoclasts inside bone Types of Bones - long bones = largest in body; example = humerus, femur, clavicle, metacarpals - short bones = increased articular surface; articulate with more than one bone; example = carpals, and tarsals - flat bones = broad, wide, curved example = scapula, skull, sternum, and ribs - irregular bones = mixed shape; example = vertebra, sphenoid, sacrum, coccyx, mandible Types of Fractures - open fracture = compound; soft tissue damage/open wound - stress fracture = overuse injury due to muscles being fatigued and unable to absorb added shock....result from increased activity - spiral fracture - comminuted fracture = crushing injury - oblique fracture = fracture on an oblique line - impacted fracture = squeezing of bone together; collapsing...common with MVA - greenstick fracture = younger population Epiphyseal Plate Injuries (Salter-Harris Classification) - growth plate = weakest area on bone - most common site is lower end of the radius at the wrist - most common mechanism is falling Salter-Harris Classification of Growth Plate Injuries - Type 1 = epiphysis is completely separated from the end of the bone...growth plate is attached to detached epiphysis - Type 2 = most common***....the epiphysis, together with the growth plate, is separated from the metaphysis - Type 3 = rare/usually at lower end of tibia...when a fracture runs completely through the epiphysis, and separates part of the epiphysis and growth plate from the metaphysis - Type 4 = fracture that runs through the epiphysis, across the growth plate, and into the metaphysis (vertically)...most commonly occurs in upper humerus - Type 5 = occurs when end of bone is crushed and the growth plate is compressed...knee and ankle most common...prognosis is poor (new Type 6 = when part of the epiphysis, growth plate, and/or metaphysis is missing)

Muscular System - 4 major functional characteristics - skeletal muscle structure (also label diagram) - structure definitions - reverse muscle function - Sliding Filament Theory - actin - myosin - calcium binding - troponin - tropomyosin - isotonic, isometric, isokinetic

Four Major Functional Characteristics - 1 = contractility - 2 = excitability - 3 = extensibility - 4 = elasticity Skeletal Muscle Structure (smallest to largest) - myofilaments - myofibrils (surrounded by sarcoplasm) - muscle fiber (surrounded by sarcolemma) - fasciculus - muscle belly (largest to smallest) - skeletal muscle (group of fascicles) - fasciculus (group of muscle fibers) - muscle fiber (group of myofibrils) - myofibrils (group of myofilaments) - myofilaments Structure definitions - myofilaments = contractile unit within fiber includes sarcomere, actin, and myosin - myofibrils = "rod-like" structure contains myofilaments (actin and myosin) that give the skeletal muscle the striated appearance - sarcoplasm = specialized cytoplasm of muscle fiber containing multiple nuclei and mitochondria - sarcolemma = membrane surrounding the muscle fiber - muscle fiber = single muscle cell (threadlike in shape) Reverse Muscle Function - define = when the more moveable end (insertion) is stabilized and the more proximal end (origin) is moved toward the insertion - example = pull-up...the biceps contract and flexes the elbow but now the humerus moves toward the forearm..."the origin move toward the insertion" - example 2 = upper trapezius...typical motion is scapular elevation...reverse muscle function is lateral neck flexion Sliding Filament Theory - myofibrils are divided into functional units called sarcomeres which are capable of shortening when stimulated - sarcomeres are separated by z-lines - actin = thinner filaments - myosin = thicker filaments...have myosin heads which are projections - when a muscle receives a stimulus to contract, myosin heads reach out and bind to the actin filaments - once bound, myosin pulls the actin filaments closer together...which causes the sarcomere to shorten - z line = no contractile proteins...line that contract towards each other - m line = contains only myosin...line in center of sarcomere - titin = (connectin) protein that functions as a molecular spring responsible for passive elasticity (on myosin) What to know - action potential travels along muscle fiber and initiates release of Ca++ ions which binds with troponin causing it to reposition the tropomyosin molecules, revealing the myosin receptor sites on the actin... allowing myosin to bind to actin with the use of ATP and tension is developed when cross-bridge is formed - ATP of heads break down to ADP and phosphate causing head to swivel with energy stored in myosin heads for another contraction Length vs Tension tension = the force built up within a muscle. - passive tension = tension build up in a muscle during stretching...like a rubber band - active tension = comes from the contractile units total tension = combination of passive and active tension tone = the slight tension that is present in a muscle at all times, even during resting...state of readiness excursion = the total distance of a muscle from maximum lengthening to maximum shortening Isometric = no length change Isotonic = resistance stays the same; velocity varies Isokinetic = resistance varies; velocity and speed stays the same

Brachial Plexus

Brachial Plexus - formed by anterior rami of C5-T1 spinal nerves - Roots, Trunks, Divisions, Cords, and Branches 5 Roots (made up of the anterior rami) - C5, C6, C7, C8 and T1 3 Trunks - superior trunk (C5 and C6) - middle trunk (C7) - inferior trunk (C8 and T1) 6 Divisions - 3 anterior - 3 posterior 3 Cords (formed by the joining of trunk divisions) - lateral cord (anterior division of the superior and middle trunks) - posterior cord (originates from the posterior divisions of all three trunks) - medial cord (comes from the anterior division of the inferior trunk) 5 Branches - Musculocutaneous - Axillary - Radial - Median - Ulnar ***this arrangement provides muscles with innervation from more than one level. trauma or disease = not all levels of innervation will be involved...would result in muscle weakness but not paralysis

Cardinal Planes of Motion - Sagittal - Frontal - Transverse Axis of Motion - Vertical Axis (y-axis) - Coronal Axis (Frontal) (x-axis) - Anteroposterior (AP) Axis (z-axis) Magnitude of Displacement

Cardinal Planes of Motion Sagittal Plane - divides body into left and right sides motions = flexion, extension, dorsiflexion, plantarflexion, axis = coronal Frontal Plane - divides body into front (anterior/ventral) and back (posterior/dorsal) halves motions = abduction, adduction, ulnar deviation, radial deviation, inversion, eversion axis = AP Horizontal Plane - divides body into upper and lower parts motions = internal rotation, external rotation, axis = vertical Axis of Motion - Vertical Axis (y-axis) * runs up and down in the body * most commonly transverse plane motions - Coronal Axis (Frontal) (x-axis) * runs side to side in the body * most commonly sagittal plane motions (flexion, extension - Anteroposterior (AP) Axis (z-axis) * runs front to back in the body * most commonly frontal plane motions (abduction, adduction Magnitude of Displacement - magnitude of rotary motion of segment is its range of motion (ROM)

Intro to Kinesiology - caudal Lecture 1

Caudal = closer to the feet

Stability - center of gravity (COG) - base of support (BOS) - line of gravity (LOG) 3 States of Equilibrium - stable equilibrium - unstable equilibrium - neutral equilibrium Anatomical Pulley

Center of Gravity (COG) = balance point of an object at which torque is equal on all sides. slightly anterior to S2 position. *COG in the human body is at about the level of the second sacral vertebra (slightly anterior) Base of Support = the part of the body that is in contact with the supporting surface. Line of Gravity = an imaginary vertical line passing through the COG toward the center of the earth 3 States of Equilibrium 1. Stable Equilibrium = occurs when an object is in a position where disturbing it would require its COG to be raised *ex: brick laying on the ground 2. Unstable Equilibrium = occurs when only a slight force is needed to disturb an object *ex: balancing a pencil on its pointed end 3. Neutral Equilibrium = exists when an object's COG is neither raised nor lowered when it is disturbed. *ex: a ball; a person in a wheelchair moving across the floor Anatomical Pulley - often muscle fibers or tendon of a muscle wrap around a bone or are deflected by a bony prominence - example = acromion process and shoulder tubercles altering deltoid abduction by increasing direction and magnitude of resultant force without changing applied force Clinical Application of a Pulley - in the knee the patella acts as a pulley - w/o patella the quads would act more of a joint compressor than joint extensor due to their line of pull

The Nervous System - ***label circle of willis - **know which arteries supply blood to which region of the brain

Circle of Willlis (9 items to label) - anterior cerebral - anterior communicating - middle cerebral - internal carotid - posterior communicating - posterior cerebral - superior cerebellar - basillar - vertebral Blood Supply from each Artery - Anterior Cerebral Artery = supplies the superior border of the frontal and parietal lobes - Middle Cerebral Artery = surface of cerebral hemispheres and the deep frontal and parietal lobes - Posterior Cerebral Artery = occipital and temporal lobes, thalamus, and upper brain stem - Basilar = supplies brain stem and cerebellum

Kinetic Chains (Open vs Closed) - closed - open

Closed Kinetic Chain - the distal segment is fixed (closed) and the proximal segment(s) moves. - joints move in a limited and predictable directions *example = standing from a chair (foot is fixed on the ground), push up, crutch walking, pushing a wheelchair *examples of exercise machines = bench press, rowing machine, stationary bicycle, and stair stepper **increased stability Open Kinetic Chain - the distal segment is free to move while the proximal segment(s) can remain stationary - allows joints to move in many directions... the distal segment is not fixed but is free to move *example = free weights, and resistance machine allowing the hands and feet to move through space **Manual Muscle Testing is almost always open-chain movement (exception = testing gastrocnemius/soleus with a heel raise) ***more specific in targeting specific muscles Treadmill - closed chain during foot on the belt and weight bearing... non-weight bearing portion is open chain

Arthrokinematics - convex vs concave - types of arthrokinematic motion (roll, glide, and spin) - locking-home mechanism - joint surface shape

Convex vs Concave - define = describes how the differences in shapes of bone ends require joint surfaces to move in a specific way during joint movement. - *"A concave joint surface will glide on a fixed convex surface in the same direction as the distal end of the moving bone." (example = elbow...distal portion of the metacarpal is convex, and the proximal portion of the proximal phalanx is concave...finger extension = proximal end of phalanx moves in same direction as distal portion.) - *"A convex joint surface will glide on a fixed concave surface in the opposite direction as the distal end of the moving bone." (example = convex head of the humerus and concave glenoid fossa of the scapula...abduction = humeral head moving inferiorly while distal segment move superiorly) Types of Arthrokinematic Motion *most joint movement involves a combination of all three of these joint motions. - Roll = rolling of one joint surface on another. New points on each surface come into contact throughout the motion...like shoe on floor when walking. - Glide = or slide, is linear movement of a joint surface parallel to the plane of the adjoining joint surface..."one point on the joint surface contacts new points on the adjacent surface." Ice skaters blade going across the ice. - Spin = rotation of the movable joint surface on the fixed adjacent surface. example = a top spinning on a table....or humerus rotating in the glenoid fossa during shoulder medial and lateral rotation. Knee Joint = roll + glide work together to keep the joint surfaces aligned. When standing the convex femoral condyles roll anteriorly on the concave tibial condyles...and glide posteriorly on the tibia. *spin component during the last portion (20 degrees) of knee extension. *Locking-Home Mechanism Joint Surface Shape - Ovoid Joint = has two bones forming a convex-concave relationship. Most synovial joints are ovoid. (example = MCP joint, glenohumeral, and hip joints) - Sellar Joint (saddle-shaped joint) = each joint surface is concave in one direction and convex in another. (example = CMC joint of the thumb, sternoclavicular joint, and talocrural joint) *two pringle potato chips stacked on top of one another

Arthrokinematics - end feel (normal vs abnormal) - arthrokinematic motion

End Feel - define = the type of resistance that a clinician feels when bringing a patient's joint to the end of its passive range of motion, then applying a slight overpressure. Normal = when motion is limited by expected anatomical structures (bone, capsule, ligaments, muscle) Abnormal = when pain, muscle guarding, swelling, or abnormal anatomy stops the joints movement. Normal End Feel (soft tissue approximation) - Soft End Feel = when muscle bulk is compressed (example = elbow flexion...stopped by the approximation of the forearm and arm) - Firm End Feel = *most common...results from tension in the surrounding ligaments, capsule, and/or muscles..."slight give" on overpressure...(example = shoulder medial + lateral rotation, hip and knee extension, and ankle dorsiflexion.) - Hard End Feel (bony end feel) = characterized by a hard and abrupt limit to PROM with no give on overpressure...bone contacts bone...(example = end ROM with elbow extension) Abnormal End Feel - Boggy End Feel = soft tissue edema is present..."soft wet sponge" feel...(example = immediately after a severe ankle sprain) - Muscle Spasm = reflexive muscle guarding during motion...palpation reveals spasm...protective response to acute injury - Empty End Feel = when movement produces considerable pain and the pt. stops the clinician from moving the joint beyond the painful point. - Springy Block = a rebound movement is felt at the end ROM...usually occurs with internal derangement of a joint, such as torn cartilage Arthrokinematic Motion - define = the manner in which adjoining joint surfaces move on each other during osteokinematic joint movement - osteokinematic motion = joint motion - arthrokinematic motion = joint surface motion

Skeletal System - function of the skeletal system - axial skeleton - appendicular skeleton - cancellous bone - compact bone - Wolff's Law - structure of a bone

Function of the Skeletal System - support = weight bearing - protection = protects organs (example = skull and brain, vertebra and spinal cord, ribs and heart & lungs) - movement = skeletal muscle points of attachment, - storage = calcium and phosphorus are stored in the bones...fat stored within bone cavities - blood cell production = cavities filled with bone marrow that produce blood cells and platelets (hematopoesis) Axial Skeleton - skull, hyoid bone, vertebral column, and thoracic cage Appendicular Skeleton - bones of the upper and lower extremity Cancellous Bone - consists of interconnecting rods or plates called trabeculae (little beams) that have a layer of osteoblasts on them Compact Bone - dense, - osteon = structural unit of bone Wolff's Law - states that bone models and remodels in response to the mechanical stresses it experiences so as to produce a minimal weight structure that is 'adapted' to its applied stresses Structure of a Bone - epiphysis (proximal and distal) = osseous; each end of long bone *epiphyseal plate = cartilaginous epiphysis in growing bone...absence of epiphyseal plate indicates bone growth has stopped *pressure epiphysis = located at ends of long bones where pressure is applied...place where growth of long bones occurs *traction epiphysis = located where tendons attach to bones and are subjected to a pulling, or traction force (ex: greater and lesser trochanters of femur) - metaphysis = flared portion where epiphysis transitions into diaphysis and vice versa - diaphysis = main shaft of a long bone - medullary canal = hollow center of a long bone, contains marrow and arteries - endosteum = membrane that lines the medullary canal...contains osteoclasts - periosteum = thin fibrous membrane covering all of bone except articular surfaces which are covered in hyaline cartilage...contains nerves and blood vessels...serves as attachment point for tendons and ligaments....increased number of pain receptors

MMT - goniometry

Goniometry - the measurement of angles created at human joints by the bones of the body - used to determine joint position and total amount of motion available at a joint - important in proving why things work and how much are they working How to increase validity? - visual exam - universal goniometer (big lollipop... `1 degree measurements) Documentation of Findings - active or passive - left or right - motion tested - position - findings *must document starting position on goniometer - hypermobility documentation = -20-0-135 - "edema present" + "pronounced muscle bulk" - "pain limiting ROM" Systemic Hypermobiliy - hypermobile at many joints - often excess at activities which require a lot of flexibility (cheerleading, gymnasts, tumblers) Predisposed to: - ligament rupture - joint dislocation - premature degenerative arthritis - TMJ and cervical dysfunction

Therapeutic Forces (4 major forces of concern) - gravity, muscles, externally applied resistances, and friction

Gravity = weight of body parts and attachments Muscles = produce forces on the bone segments by active contraction or by being passively stretched Externally Applied Resistance = exercise pulleys, manual resistance, doors, windows Friction = provide stability if optimum, retard motion if excessive, and lead to instability if inadequate

MMT - isokinetic testing - documentation - problematic factors effecting test results

Isokinetic Testing - tests strength through full ROM - force plate - does not isolate specific muscles - can get graphical analysis of muscle performance Documentation - position, L vs R, body part tested, motion tested, grade - example = MMT: R shoulder flexion, sitting, 3/5` Problematic Factors Effecting Test Results - possibility of osteoporosis - cognition (document functional status) - age

Articular System - joint classification

Joint Classification - Functional = 3 classes...based solely on amount of movement permitted at a particular joint 1. Synarthrosis (no to slight movement occurs) 2. Amphiarthrosis (slight to little movement occurs) 3. Diarthrosis (wide range of movement occurs) - Structural = structural classification based on two criteria a). whether or not a space or cavity exists between the bones and b). the type of connective tissue that holds the bones together Three Types of Structural Classification: 1. Fibrous - two bones that are united by fibrous connective tissue, little to no movement; three types of fibrous joints - 1 Suture = synarthrotic (no movement), provide shape and strength (example = skull joint sutures) - 2 Syndesmosis = fibrous connective tissue makes up joint (example = interosseus membrane between tibia and fibula...amphiarthrotic (little movement) - 3 Gomphosis (teeth) = synarthrotic 2. Cartilaginous Two Types - 1 . Synchondrosis = joint where articulating surfaces are joined together by hyaline cartilage...amphiarthrotic (example = ribs meeting sternum) (coughing fit = synchondritis which is pain in the cartilage) - 2 . Symphysis = more cartilage present than synchondrosis allowing more movement...pads between bones are compressible (shock absorption)...(example = vertebral joints, knee menisci)...amphiarthrotic 3. Synovial = posses a joint cavity and the bones forming the joint are surrounded by a joint capsule. Synovial fluid present. Synovial joints are defined on the basis of the following anatomical features: a) the shape of the articulating bones, and b) the amount and arrangement of connective and muscle tissues present at the joint - articular cartilage = serves as a shock-absorber and protects bone surfaces (hyaline cartilage) - synovial cavity = a small space between the articulating bone which is filled with synovial fluid...surrounded by a double layered articular capsule...outer layer is composed of a strong fibrous capsule which connects to the periosteum...inner layer is the synovial membrane which produces synovial fluid Classification of Movements of Synovial Joints 1. Monoaxial = occurring in one direction or plane 2. Biaxial = occurring in two directions or planes 3. Multiaxial = occurring in many directions or planes Synovial Joint Classification - Pivot Joint = characterized by the pointed surface of one bone articulating with a ring formed by bone and cartilage...monoaxial (joint motion is rotation) (example = axis and atlas (dens articulation), radius and ulna) - hinge joint = convex surface of one bone fits into the concave surface of another (example = elbow joint)...monoaxial - ball and socket joint = ball like protrusion into rounded socket...multiaxial....(only two examples = glenohumeral joint, and femur in acetabulum) - gliding/plane joint = two flat articulating surfaces...monoaxial...(example = vertebral joints and AC joint) - saddle joint = both articulating surfaces are saddle shaped, one convex one concave...biaxial...(only example = metacarpal of the thumb and trapezium - ellipsiodal joint (condylar) = oval shaped ends of bones fit into each other...biaxial...(example = atlanto-occipital joint and radius-carpal joint)

Joint Congruency - congruent - Loose-Packed vs Close-Packed -

Joint Congruency - define = how well joint surfaces match or fit - congruent = when the joint surfaces have maximum contact with each other, are tightly compressed, and are difficult to distract (separate) Close-Packed Position - when a joint is congruent (maximum congruency) - ligaments and capsule holding the joint together are taut...usually occurs at one extreme of the ROM - position used to test ligamentous and capsular stability and integrity (often in this position when injured)...joint can't be moved in closed pack position when swollen - example = patellofemoral knee flexion, ankle dorsiflexion, MCP flexion, and extension of the elbow, wrist , hip, knee, and interphalangeal joints Open-Packed Position - joint surfaces are incongruent (maximal incongruency) - capsule and ligaments are lax - joint mobilization techniques are best applied in the open-packed position...allow roll, spin, glide - example = picture on phone

Arthrokinematics - joint mobilization - indication + contraindications - manipulation Definitions - self-mobilizations - accessory movements - component motions - joint play - muscle energy

Joint Mobilization - define = 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. - used to restore joint mobility (force applied into direction of restriction...designed to stretch or lengthen pathologically adhered tissue), decrease pain, and as an examination tool - performed in the resting joint position (loose pack position) Joint Mobilization Indications - stretch supporting tissue in order to restore normal joint accessory motion - reduce pain - reduce muscle guarding Joint Mobilization Contraindications - NO NO for stretching (systemic pathologies like lupus...where connective tissue is weak and could damage tissue if stretched) - joint hypermobility - recent fracture - joint effusion (swelling) - inflammation - joint replacement +(maybe not for: RA, osteoporosis, pregnancy (relaxin = hypermobility), dizziness, spondylolisthesis (vertebra that has slipped forward), or degenerative joint disease if acute or producing a bony block Manipulation - define = technique that involves moving the joint with high speed through a very slight and calculated range that is just past where the joint play ends. Definitions - Self-Mobilizations = self stretching techniques that specifically use joint traction or glides that direct the stretch force to the joint capsule (example = TMJ) - Accessory Movements = movements within the joint and surrounding tissues that are necessary for normal ROM but cannot be actively performed by the patient - Component Motions = motions that accompany active motion but are not under voluntary control (example = upward rotation of scapula and rotation of clavicle with active shoulder flexion) - Joint Play = describes the distensibility or "give" in the joint capsule, which allows bones to move - Muscle Energy = use an active contraction of deep muscles that are attached near the joint and whose line of pull can cause the desired accessory motion...requires therapist to provide stabilization to the segment on which the distal aspect of the muscle attaches (example = pt. performs isometric contraction)

MMT - purpose - parameters - 1 joint peak performance - 2 joint peak performance - Muscle Grading

MMT - purpose = to establish or determine the extent and degree of weakness resulting from injury, disease, or disuse Parameters - observation = what you see... abnormalities - palpation = what you can feel ...fasciculation (twitch) with contraction - test postion = preferred position... same position must be used everytime - stabilization/fixation = one hand stabilizes and the other hand is the test hand - Resistance/Pressure/Break Test = refers to the amount of pressure you are able to apply to pts. muscle that is being tested ***1 joint muscles the peak performance is at its fully shortened range ***2 joint muscles the peak performance is at mid-range - movement against gravity = muscle testing done against gravity - gravity eliminated position = muscle test performed in a position where to forces of gravity do not provide resistance - substitution = occurs when a muscle or group of muscles are weak and the pt. uses another muscle to accommodate for weak muscles Muscle Grading - 0 = no muscle contraction observed or palpated - 1 , 1/5 or Trace, T = muscle contraction can be observed or palpated ...but no visible movement of joint - 2 , 2/5 or Poor, P = unable to perform full ROM against gravity... but is able to perform with gravity eliminated ... or partial ROM against gravity - 3 , 3/5 or Fair , F = starting point... when pt. can move through full ROM against gravity - 4 , 4/5 or Good , G = full ROM against gravity taking some resistance - 5 , 5/5 or Normal , N = full ROM against gravity taking full resistance (N >G > F > P > T > 0)

Articular System - Rheumatoid Arthritis (RA) - Osteoarthritis (OA) - Gout - Arthrocentesis - Sprains - Classification of Sprains - High Ankle Sprain

Rheumatoid Arthritis (RA) - chronic inflammation of the synovial membrane - joints = swollen, red, painful, hot - usually effects hand and feet first, symmetry - cause unknown but works via autoimmune factor (pt. has rheumatoid factor in their blood) "systemic" - "ulnar deviation of metacarpophalangeal joints" - "swan neck deformity of fingers" Osteoarthritis (OA) - most common form of arthritis - degenerative disease of the synovial joints... bio-mechanical breakdown of articular cartilage, resulting in swelling, loss of ROM - more common in weight bearing joints (hip, knee) - non symmetrical - severe stiffness ... found on x-ray - Heberden's Nodes in DIP Gout - form of arthrits - characterized by sudden, severe attacks of pain, swelling, redness and tenderness in joints...often the great toe - high levels of uric acid in blood - formation of urate cystals in joint creating inflammation Arthrocentesis - surgical puncture of joint capsule and removal of synovial fluid - used to determine cause of joint swelling - bloody fluid = fracture in joint - clear fluid = OA or collagen deteriation - cloudy, yellow = RA or gout - cloudy, red tinged with pus = bacterial infection / Lyme disease Sprains - after swelling and pain are decreased, ROM and strength still have deficit - decreased proprioception "feels unstable" - balance and coordination activities on unstable surfaces need to be incorporated Classification of Spains - Type 1 = ligaments stretched - Type 2 = ligaments slightly torn - Type 3 = ligaments completely torn High Ankle Sprain - longer healing time - pt. may not progress as rapidly and may continue to have swelling and pain with weight bearing for weeks and sometimes months

The Nervous System - the peripheral nervous system

The Peripheral Nervous System - begins at anterior horn of the SC - Schwann Cell's produce myelin in the PNS Cranial Nerves - 12 pairs of cranial nerves (24 nerves total) Spinal Nerves - 31 pairs of spinal nerves (62 nerves total) - 8 cervical (C1-C7 exit vertebral column above the corresponding vertebra...C8 exits under the C7 vertebra) - 12 thoracic - 5 lumbar - 5 sacral - 1 coccygeal ***all spinal nerves (except C1 pair and the sacral nerves exit the vertebral column through an inter-vertebral (IV) foramen Branches of Spinal Nerves = the anterior (motor) and posterior (sensory) roots join together to form the spinal nerve - Posterior (dorsal) Ramus = branch tends to be smaller than the anterior ramus...innervates the muscles and skin of the posterior trunk - Anterior (ventral) Ramus = a continuation of the spinal nerve... innervate all skin and muscles not innervated by the posterior ramus... anterior and lateral trunk + all extremities ***on exam = tag something that is a ventral rootlet (aka ventral/anterior horn) the nerve without the dorsal root ganlgia

Muscular System - muscle fiber types - muscular achitecture - parallel muscle fibers - connective tissue of muscle

Type 1 (slow oxidative) - slow contractibility - slow rate of fatigue - low excitation threshold (electrical impulse needed for contraction) Type IIA (Fast Oxidative Glycolytic) - fast contractibility - intermediate rate of fatigue - high excitation threshold (electrical impulse needed for contraction) Type IIB (fast glycolytic) - fast contractibility - fast rate of fatigue - high excitation threshold (electrical impulse needed for contraction) Muscular Architecture - Parallel = biceps brachii - Convergent = pectoralis major - Unipennate = extensor digitorum - Bipennate = rectus femoris - Multipennate = deltoid - Circular = orbicularis oris Parallel Muscle Fibers - strap - fusiform - rhomboidal (rhomboid) - triangular (deltoid) Connective Tissue of Muscle - endomysium = surrounds individual muscle fibers - perimysium = surround fasciculi - epimysium = surround muscle belly - tendon = connects skeletal muscle to bone - Fasciae = (plantar and palmar) superficial (directly under the dermis) and deep (attaches to both bone and muscle; forms bands and retinacula) - aponeuroses = dense compact collagen that attach to muscles, bones, and cartilage