Exam 3 Notes
chin-up/pull-up
- subject grasps horizontal bar with palms away from face - from hanging position, subject pulls up until the chin is over the bar - return to starting position - closed-kinetic-chain exercise
What are the four types of motions the wrist can perform as being classified as a condylar-type joint?
Flexion, extension, radial deviation, ulnar deviation
Specificity (SAID)
addressing specific needs in designing an exercise program - exercise program goals should be determined regarding specific areas of the body, preferred time to physical peak and physical fitness needs such as strength, muscular endurance, flexibility, cardiorespiratory endurance, body composition, etc
three palmar interossei
adduct the 2nd, 4th, & 5th phalanges
stance phase
allows athlete to assume a comfortable & balanced body position from which to initiate the sport skill
open kinetic chain
an extremity may be seen as representing an open kinetic chain if the distal end of the extremity is not fixed to any surface - allows any one joint in the extremity to move or function separately without necessitating movement of other joints in the extremity ex. shoulder shrug, deltoid raise, bicep curl, seated hip flexion, knee extension, and ankle dorsiflexion not very functional!
what syndrome results in swelling and inflammation in the hand?
carpal tunnel syndrome
FITT
frequency - increasing the number of times you train per week intensity - increasing the difficulty of the exercise you do time - increasing the length of time that you are training for each session type - increase the difficulty of training you are doing
wrist abductors (radial deviation)
generally cross wrist joint anterolaterally and posterolaterally to insert on radial side of hand - flexor carpi radialis - extensor carpo radialis longus - extensor carpi radialis brevis - abductor pollicis longus - extensor pollicis longus - extensor pollicis brevis
flexor and extensor wrist tendons immediately proximal to wrist
held in place on palmar and dorsal aspects by transverse bands of tissue known as flexor and extensor retinaculum to prevent the tendons from bowstringing during flexion and extension
what is the origin of the flexor policies longus muscles? - middle 1/3 radius and proximal ulna - medial epicondyle - lateral epicondyle - proximal 3/4 of anterior ulna
middle 1/3 radius and proximal ulna
preparatory phase
cocking or wind-up phase used to lengthen the appropriate muscles so that they will be in position to generate more force and momentum when concentrically contract in next phase becomes more dynamic as need for explosiveness increases
wrist adductors (ulnar deviation)
cross wrist joint anteromedially and posteromedially to insert on ulnar side of hand - flexor carpi ulnaris - extensor carpi ulnaris
aggregate muscle grouping activity example
elbow flexors work together as an agonist group to cause flexion in opposition to the triceps brachii and ancones (elbow extensors) - elbow extensor are cooperating in their lengthening to allow the flexors to perform their task
phalangeal extension - agonists
extensor digitorum extensor indicis extensor digiti minimi extensor pollicis longus extensor pollicis brevis
Disruption of the extensor tendon at the DIP results in a Jersey Finger type injury.
false
True or False- The triquetrum is in the distal row
false
True or False: The Extensor Capri Ulnaris muscle is innervated by the Ulnar Nerve
false
True or false- all wrist and hand muscles are innervated from the radial, median, and axillary nerves?
false
True or false- the scaphoid is on the medial side
false
four dorsal interossei
flex & abduct index, middle, & ring proximal phalanxes assist with extension of middle & distal phalanxes of index, middle, & ring fingers
finger movements
flex and extend MCP joints also abduct and adduct
wrist movements
flexion and extension radial deviation and ulnar deviation
functional anatomy to joint actions
flexion, extension, abduction, and adduction of wrist and hand
wrist flexion - agonists
flexor carpi radialis flexor carpi ulnaris palmaris longus flexor digitorum superficialis flexor digitorum profundus flexor pollicis longus
median nerve from C6, C7, C8, T1
flexor carpi radialis palmaris longus flexor digitorum superficialis
wrist adduction - agonists
flexor carpi ulnaris extensor carpi ulnaris
Which two tendons don't pass through the carpal tunnel
flexor carpi ulnaris and palmaris longus
phalangeal flexion - agonists
flexor digitorum superficialis flexor digitorum profundus flexor pollicis longus
which muscle is part of the thenar eminence: - flexor digiti minimi - flexor pollicis brevis - extensor digitorum - flexor carpi radialis
flexor pollicis brevis
True or false: The flexor carpi radialis muscle originates from the medial epicondyle.
true
swan neck deformity
volar plate rupture
posterolaterally at elbow and forearm and posterior at hand
primarily wrist extension - extensor carpi radialis longus - extensor carpi radialis brevis - extensor carpi ulnaris primarily wrist and phalangeal extension - extensor digitorum - extensor indicis - extensor digiti minimi - extensor pollicis longus - extensor pollicis brevis - extensor pollicis longus
anteromedially at elbow and forearm and anterior at hand
primarily wrist flexion - flexor carpi radialis - flexor carpi ulnaris - palmaris longus primarily wrist and phalangeal flexion - flexor digitorum superficialis - flexor digitorum profundus - flexor pollicis longus
jersey finger
rupture of flexor digitorum profundus = inability to flex digit
This bone is the most commonly fractured and misdiagnosed bone in the wrist.
scaphoid
four lumbricals
- flex index, middle, ring, and little proximal phalanxes - extend middle and distal phalanxes of index, middle, ring, and little finger
anterior interosseous nerve from median nerve
- flexor digitorum profundus for index and long finger - flexor pollicis longus - intrinsic muscles - abductor pollicis brevis, flezor polissi brevis (superficial head), opponens pollicis, and 1st and 2nd lumbrical
upper extremity activities
- typical weight room exercises concentrate only on anterior shoulder - without balanced approach may lead to strong and tight anterior muscles with weak ad flexible muscles posteriorly - analysis of exercises is critical to appropriate exercise prescription
triceps extension
- use opposite hand to assist in maintaining full shoulder flexion - subject behind with elbow in full flexion - elbow is extended until fully straight with dumbbell overhead - return to starting position - open-kinetic chain exercise
wrist abduction - agonists
flexor carpi radialis extensor carpi radialis longus extensor carpi rafialis brevis abductor pollicis longus extensor pollicis longus extensor pollicis brevis
ulnar nerve from C8 and T1
flexor digitorum profundis for 4th and 5th fingers flexor carpi ulnaris flexor policies brevis (deep head) adductor policis palmar interossei dorsal interossei 3rd and 4th lumbrical opponens digiti minimi abductor digiti minimi flexor digiti minimi brevis
shoulder pull
maintain attempt to pull interlocked fingers apart for 5 to 20 seconds isometric exercise - antagonist contraction is as strong as the agonist contraction - agonists in right upper extremity are antagonistic to agonists in left upper extremity and vice versa - isometric contractions of wrist, hand, elbow, shoulder joint, and shoulder girdle muscles - strength of contraction depends on angle of pull and leverage of the joint involved
extension
movement of back of hand and/or phalanges toward posterior or dorsal aspect of forearm
flexion
movement of palm of hand and/or phalanges toward anterior or volar aspect of forearm
opposition
movement of thumb across palmar aspect to oppose any or all of the phalanges
retroposition
movement of thumb as it returns to anatomical position from opposition with hand and/or fingers
extensor carpi radialis brevis
origin: lateral epicodyle insertion: base of 3rd MC action: wrist extension, radial deviation, weak elbow flexion innervation: radial nerve
extensor carpi ulnaris
origin: lateral epicondyle insertion: base of 5th MC action: wrist extension, ulnar deviation, weak elbow extension innervation: radial nerve
extensor carpi radialis longus
origin: lateral epicondyle insertion: base of 5th MC action: wrist extension, ulnar deviation, weak pronation from supination, weak elbow flexion innervation: radial nerve
extensor digitorum
origin: lateral epicondyle insertion: middle and distal phalanx digits 2-5 (dorsal) action: extension of 2nd-5th phalange @ MCP, wrist extension, weak elbow extension innervation: radial nerve
flexor carpi radialis
origin: medial epicondyle insertion: base of 2nd and 3rd metacarpal action: wrist flexion, radial deviation, weak pronation innervation: median nerve
palmaris longus
origin: medial epicondyle insertion: base of 2nd and 3rd metacarpalalmar aponeurosis, 2nd-5th MC action: wrist flexion, weak elbow flexor innervation: median nerve
flexor carpi ulnaris
origin: medial epicondyle insertion: pisiform, hamate, base of 5th MC action: wrist flexion, ulnar deviation, weak elbow flexion innervation: ulnar nerve
flexor digitorum superficialis
origin: medial epicondyle insertion: sides of middle phalanx (palmar) action: wrist flexion, flexion of fingers at MCP and PIP, weak elbow flexion innervation: median nerve
flexor pollicis longus
origin: middle 1/3 radius and proximal ulna insertion: base of distal phalanx (palmar) action: flex CMC, MCP, IP, wrist flexion, radial deviation innervation: median nerve
flexor digitorum profndus
origin: proximal 3/4 of anterior ulna insertion: base of 5th MC (dorsal) action: wrist flexion, flexion of fingers at MCP, PIP, and DIP innervation: median nerve - digits 2-3 ulnar nerve - digits 3-4
wrist extensors
origins on posterolateral aspect of proximal forearm and lateral humeral epicondyle with insertions located on posterior aspect of wrist and hand
barbell press
overhead or military press - barbell is held high in front of chest with palms facing forward, feet comfortably spread, back and legs straight - barbell is pushed upward until arms are fully flexed overhead - return to starting position - open-kinetic chain exercise
During a movement where the distal end of the extremity is fixed, it is considered a closed kinetic chain.
true
The flexor pollicis brevis, opponens pollicis, adductor pollicis, and abductor pollicis brevis comprise the Thenar eminence of the hand.
true
key distal bony landmarks for muscles involved in wrist motion
- base of 2nd, 3rd, and 5th metacarpals, pisiform, and hamate
DIP
- distal interphalangeal joint - hinge - flex 80 to 90 degrees from full extension
strength and endurance in shoulder area
- essential for improved appearance and posture - more efficient skill performance - specific conditioning exercises and activities should be intelligently selected
three muscles act on little finger
- opponens digiti minimi causes opposition of little finger metacarpal - abductor digiti minimi abducts 5th metacarpal - flexor digiti minimi brevis flexes 5th metacarpal
wrist flexors
- origins on anteromedial aspect of proximal forearm and medial epicondyle of humerus with insertions on anterior aspect of wrist and hand - median nerve and all flexor tendons except flexor carpi ulnaris and palmaris longus pass through carpal tunnel
PIP
- proximal interphalangeal joint - hinge - full extension to 90 to 120 degrees of flexion
how many hand muscles are intrinsic?
11
intrinsic hand muscles
11 different hand muscles - 4 lumbricals - 3 palmar interossei - 4 dorsal interossei
wrist joint degrees of radial deviation
15-25
wrist joint degrees of ulnar deviation
25-40
how many bones are in the hand?
29
how many bones are there in the wrist and hand?
29
wrist and hand
29 bones more than 25 joints more than 30 muscles - 18 are intrinsic
wrist and hand bones
29 bones, including radius and ulna 8 carpal bone - 2 rows of 4 bones form wrist 5 metacarpal bones - numbered 1 to 5 from thumb to little finger, going the wrist bones 14 phalanges (digits) - 3 for each phalange except the thumb, which only has 2 - proximal, middle, and distal - thumb has a sesamoid bone in its flexor tendon - other sesamoids may occur in joints of finger
6 muscles move wrist but not fingers and thumb
3 wrist flexors - flexor carpi radialis - flexor carpi ulnaris - palmaris longus 3 wrist extensors - extensor carpi radialis longus - extensor carpi radialis brevis - extensor carpi ulnaris
wrist joint degrees of extension
65-85
wrist joint degrees of flexion
70-90
how many carpal bones are there?
8
When should muscular development start?
Early age & continue throughout the school years
scaphoid
FOOSH injury most often injured - from falling on outstretched hand - often dismissed as a sprain - significant problem if not recognized and treated properly - usually long period of precise immobilization or surgery
What is the origin of the Palmaris Longus Muscle?
Medial Epicondyle
8 carpal bones
Proximal row from radial to ulnar side - scaphoid (boat-shaped) or navicular - lunate (moon-shaped) - triquetrum (three-cornered) - pisiform (pea-shaped) Distal row, from the radial to ulnar side - trapezium (greater multangular) - trapezoid (lesser multangular) - capitate (head-shaped) - hamate (hooked)
What does SAID principle stand for?
Specific Adaptations to Imposed Demands
SAID principle
Specific Adaptations to Imposed Demands the body will gradually, over time, adapt very specifically to the various stresses and overloads to which it is subjected to achieve specific benefits, exercise programs must be specifically designed for the desired adaption
Which interossei muscle adducts the middle finger?
Third dorsal Interossei
overload principle
a muscle or muscle group increases in strength in direct proportion to the overload placed on it the amount of overload applied caries significantly based on several factors an untrained person beginning a strength training program will make significant gains in the amount of weight they are able to lift in the first few weeks a well trained person will see relatively minor improvements in the amount of weight that can be lifted over a much longer period of time overload is not always progressively increases in certain periods of conditioning, the overload should actually be prescriptively reduced or increase to improve the total results of the entire program
Which muscles flexes the thumb? a. Flexor pollicis longus b. Flexor digitorum superficialis c. Flexor digitorum profundus d. None of the above
a. Flexor pollicis longus
follow-through phase
deceleration phase begins immediately after climas of movement phase brings negative acceleration of involved limb or body segment body segment velocity progressively decreases over a wide range of motion the greater the acceleration in the movement phase, the greater the length and the importance of the follow-through phase
muscular development
development should start at an early age and continue throughout the school years fitness tests result indicate there is need for considerable improvement in this area adequate muscular strength and endurance are important in the adult yeas for the activities of daily living as well as job-related requirements and recreational needs
radial nerve from C6, C7, C8
extensor carpi radialis brevis extensor carpi radialis longus
valsalva maneuver
holding breath while bearing down to lift heavy weights or trying to exhale against a closed epiglottis (thought to increase lifting ability) causes dramatic blood pressure increase followed by equally dramatic drop - lightheadedness and fainting - complications in heart disease patients do not use valsalve instead breath rhythmically and consistent exhale during lift and inhale during lowering
periodization
intentional variance in a training program at regular intervals done to bring out optimal gains in physical performance designed so that the athlete will be at their peak level during the most competitive part of the season
origin for wrist and finger extensors
lateral epicondyle and lateral supracondylar ridge
origin for wrist and finger flexors
medial epicondyle, medial supracondylar ridge and coronoid process
what nerves pass through the carpal tunnel? - medial nerve - median nerve - ulnar nerve - poster interosseous nerve
median nerve
thenar eminence
muscular pad on palmar surface of 1st metacarpal - abductor pollicis brevis - opponens pollicis - flexor pollicis brevis - adductor pollicis
hypothenar eminence
muscular pad that forms ulnar border on palmar surface - abductor digiti minimi - flexor digiti miimi brevis - opponens digiti minimi
exercise variables which may be manipulated
number of sets per exercise repetitions per set types of exercises number of exercises per training session rest periods between sets and exercises resistance used for a set type of muscle contraction number of training sessions per day and per week
upper extremity
often one of body's weakest areas
four muscles act on the CMC of thumb
opponens pollicis - opposition in thumb metacarpal abductor pollicis brevis & flexor pollicis brevis abduct thumb metacarpal flexor pollicis brevis flexes thumb metacarpal adductor pollicis adducts thumb metacarpal flexor pollicis brevis & adductor pollicis flex proximal phalanx of thumb
intrinsic hand muscles origins and insertions on bones of hand
radial side - 4 muscles of thumb - opponens pollicis - abductor pollicis brevis - flexor pollicis brevis - adductor pollicis ulnar side - 3 muscles of little finger - opposens digiti minimi - abductor digiti minimi - flexor digiti minimi brevis
all wrist and hand muscles are innervated from
radial, median, and ulnar nerves
break down movements into phases
stance phase preparatory phase movement phase follow-through phase recovery phase
intermediate muscles
three palmar interossei four dorsal interossei four lumbrical muscles
the most traumatized nerve in the upper limbs is - median n - ulnar n - posterior interseosseeous n - anterior interseosseeous n
ulnar n
most traumatized upper limb nerve
ulnar nerve contusion - funny bone with painful tingling into ulnar side of forearm and 4th and 5th fingers
closed kinetic chain
when distal end of extremity is fixed as in a push up, dip, squat, or dead lift movement of one joint cannot occur without causing predictable movements of other joints in extremity very functional!
concepts for analysis
- muscle are usually grouped together according to their concentric function - muscles work in paired opposition to an antagonist group
each finger has 3 joints
- Metacarpophalangeal (MCP) joints - Proximal interphalangeal (PIP) joints - Distal interphalangeal (DIP) joints
what are the three joints that each finger has?
- Metacarpophalangeal Joint - Proximal Interphalangeal Joints - Distal Interphalangeal Joints
key bony landmarks for finger muscles
- base of proximal, middle, and distal phalanxes - base of 1st metacarpal, proximal and distal phalanxes of thumb
carpal bones form a three-sided arch
- concave on palmar side - bony arch is spanned by transverse carpal and colar carp - created the carpal tunnel - frequently a source of problems known as carpal tunnel syndrome
wrist joint
- condyloid-type joint - allows flexion, extension, radial deviation, and ulnar deviation - motion occurs primarily between distal radius and proximal carpal row (scaphoid, lunate, and triquetrum) - known as radoiocarpal jt
when viewing an activity
- determine which muscles are performing the movement - know what type of contraction is occurring - know what kind of exercises are appropriate for developing the muscles
9 muscles primary movers of phalanges
- involved in wrist joint actions - weaker in their wrist actions flexors - flexor digitorum superficialis - flexor digitorum profundus - flexor pollicis longus (thumb flexor) extensors - extensor digitorum - extensor indicis - extensor digiti minimi - extensor pollicis longus (thumb extensor) - extensor pollicis brevis (thumb extensor) abductor of thumb and wrist - abductor pollicis longus
MCP
- metacarpophalangeal joint - condyloid - 0-40 degrees of extension 85-100 degrees of flexion
adduction (ulnar deviation)
- movement of little finger side of hand toward medial aspect or ulnar side of forearm - movement of fingers toward middle finger
abduction (radial deviation)
- movement of thumb side of hand toward lateral aspect or radial side of forearm - movement of fingers away from middle finger
dumbbell bent-over row
- subject is knelling on a bench using contralateral arm to support the body - involved arm is free from contact with floor - with dumbbell in hand, arm and shoulder hanging straight to the floor, subject adducts shoulder girdle and horizontally abducts shoulder joint - then slowly lowering dumbbell to the starting position - open-kinetic chain exercise
chest press/bench press
- subject lies supine on exercise bench - subject grasps barbell and presses weight upward through full range of arm and shoulder movement - weight is then lowered to starting position - open kinetic chain exercise
arm curl
- subject stands - barbell is held in hands with palms to front - barbell is curled upward and forward until elbows are completely fixed - return to starting position - open-kinetic chain exercise
middle phalange is reference point to differentiate abduction and adduction
- thumb, index, and middle fingers abduct when they move forward radial side of hand - movements of thumb, index, and middle fingers toward ulnar side of hand is adduction - ring and little finger abduct when they move toward ulnar side of hand - ring and little finger toward radial side of hand is adduction
push-up (fingertip)
-subject lies prone on floor with legs together, palms touching floor, and the hands pointed forward & approximately under the shoulders -keeping back & legs straight, subject pushes up to the up position -return to starting position - closed-kinetic chain exercise
latissimus pull (lat pull)
-subject, sitting, reaches up & grasps a horizontal bar - subject pulls bar down to a position behind the neck & shoulders -bar is returned slowly to the starting position - open-kinetic chain exercise
What is the origin of the extensor digitorum?
Lateral Epicondyle
Which kinetic chain allows a joint in the extremity to move/function separately without affecting movement of other joints in the extremity?
Open kinetic chain
movement phase
acceleration, action, motion, or contact phase the action is part of the skill summation of force is generated directly to the ball, sport object or opponent characterized by near-maximal concentric activity in involved muscles
third dorsal interossei
adducts middle finger
recovery phase
after follow-through to regain balance and positioning to be ready for the next sport demand
the thumb has 2 joints
carpometacarpal (CMC) joint - unique saddle-type joint - 50 to 70 degrees of flexion - flex 15 to 45 degrees and extend 0 to 20 degrees metacarpophalangeal (MCP) joint - full extension into 40 to 90 degrees of flexion - hinge interphalangeal (IP) joint - flex 80 to 90 degrees - hinge
Which of the following is not one of the 9 muscle primary mover of the phalanges a. Flexor digitorum superficialis b. Extensor indicis c.Flexor Carpal Radialis d. Abductor policis longus
c.Flexor Carpal Radialis
wrist extension - agonists
extensor carpi radialis longus extensor carpi radialis brevis extensor carpi ulnaris extensor digitorum extensor indicis extensor pollicis longus extensor pollicis brevis
posterior interosseous nerve from radial nerve
extensor carpi ulnaris extensor digitorum extensor digiti minimi abductor pollicis longus extensor pollicis longus extensor pollicis brevis extensor indicis
mallet finger
distal extensor tendon rupture, or bony avulsion
Wrist extensors typically have their origins on the anterior aspect of the forearm, assuming anatomical position.
false
all of the following muscles are apart of the Thenar Eminence except: - abductor pollicis - opponents digit minimi - flexor pollicis brevis - adductor pollicis
opponents digit minimi
baseball pitch skill analysis
stance phase - when player assumes a position with ball in glove before receiving signal from catcher preparatory phase - pitcher extends throwing arm posteriorly and rotating trunk to the right in conjunction with left hip flexion movement phase - begins with forward movement of arm and continues until ball release follow-through phase - ball release as arm continues moving in same direction established by movement phase until velocity decreases to point that arm can safely change movement direction recovery phase - player repositions to field the batted ball