FABK Final Spring 21

whenever a segment is fixed, the proximal jt does the __________ movement a) opposing b) synergistic

a) opposing this was STATED in the lecture... not written down...

simplified movement at the wrist --> flexion and extension move in ______ directions at the midcarpal and radiocarpal joints a) opposite b) same

a) opposite convex 3rd MC on concave lunate convex lunate on concave radius

AC joint: what kind of joint? Multiaxial... a) plane b) hinge c) saddle d) condyloid

a) plane

radial deviators: ECRL, ECRB, FCR A) primary b) secondary

a) primary secondary = APL, EPL, FPL, EPB In neutral, ECRL/APL produce greatest torque and EPB has greatest IMA and PCSA

Rotator interval capsule is created by the (3): a) superior capsule b) inferior capsule c) middle capsule d) superior GHL e) inferior GHL f) coracohumeral ligament g) coracoacromial ligament

A, D, F

Describe 6 kinematic principles associated with full abduction of shld... HINTS!! 1) 2:1 principle 2) 60 degrees of ST upward rotation is due to simultaneous __________ at the SC joint combined with __________ __________ at AC joint 3) clavicle ________ at SC joint during shld abduction 4) scapula posteriorly _________ & ___________ _________ during full shoulder abduction 5) clavicle posteriorly ___________ around its own axis during shoulder abduction 6) the GH joint ________ _________ during shld abduction

1) 1 degree ST jt upward rotation for every 2 degrees of GH jt abduction 2) elevation at SC & upward rotation at AC 3) retracts 4) posteriorly tilts & externally rotates 5) rotates 6) externally rotates

STJ osteokinematics: upward/downward rotation 1) How does the glenoid move during this movement? 2) secondary movement: rotatory

1) glenoid up or glenoid down 2) up/down rotation @ AC & SC Jt ant/post rotation with elevation and depression

MCP collateral ligaments have two parts, proper and accessory. What are their two functions? HINT: Think of MCP full flexion... (close packed)

1) provide stability through ROM 2) limit add/abd in full flexion

Explain the dart throwing phenomenon osteokinematics. What carpal bone is the axis for the phenomenon? S L T P T T C H

1) radial deviation with extension 2) ulnar deviation with flexion Capitate.

SH Rhythm: if you have 60 degrees of upward rotation at the ST joint, what do you get at the GH joint? no options - think about it!

120 DEGREES

Scapulothoracic jt (STJ) rests: ______ inches from midline Between ribs ______ & _______

2 inches from midline Ribs 2 (superior angle) and R7 (inferior angle)

what is the functional position of the wrist and hand? (4x things) no hint, think of wrestler hands or about to choke someone -- optimization of flexor mm!!!

20 extension and 10 UD at wrist flexed at MCP 45 flexed at PIP 30 DIP slight flexion

SC jt rotation = ______ degrees a) 40 b) 45 c) 50 d) 55

50 degrees (posterior rotation only)

functional arc of horizontal plane of elbow?

50 degrees supination and pronation

UE WB = _____% of compression force transfers through _______. Why? no hints mutha fucca

80, radius Radius is more distal than ulna

what is the typical treatment goal for contracture in elbow? a) < 60 b) < 30 c) < 15 d) full extension

< 30

RUJ gives up stability, so how does the body make up for it? a) many mm that act on the hand attch on humerus b) many mm that act on the hand attch on ulna c) many mm that act on the hand attch on radius

A

Radial collateral ligament and ulnar collateral ligament are parts of the a) lateral collateral ligament complex b) medial collateral ligament complex

A

SC joint closed pack position a) full upward rotation (elevation) b) full downard rotation (depression c) posterior rotation

A

coronoid process approximates with coronoid fossa & rim of radial head within radial fossa a) full flex b) full ext

A

flexion, bicep contracted a) active insufficiency b) passive insufficiency

A

contracture < 30 degrees a) still do ADLs b) limited ADLs (significant!) what contracture is the other answer option?

A B) limited ADLs when contracture is >60 degrees

Clinical sign of winging? Excessive _____ and ______ at AC joint a) ER/IR b) FLX/EXT c) ABD/ADD

A - ER/IR

What limits upward/downward rotation of AC jt? a) coracoclavicular ligament b) superior capsule c) superior GHL d) coracohumeral lig

A) coracoclavicular ligament (trapezoid + conoid ligament)

when MP joint is extended, their action lines pass through coronal axis and interossei serve as good ________/_______ a) abd/add b) flex/ext

A - abd/add

Ulnar notch of radius = ?? a) base of TFCC b) apex of TFCC c) sides of TFCC

A - base

all finger joints combine to give ROM _____________ > ___________ (match/fill in blank) a) ulnarly, radially b) radially, ulnarly

A - more ROM as you get more ulnar

SC jt elevation/depression (SHOULDER SHRUG) a) convex on fixed concave? b) concave on fixed convex? describe?

A - move opposite! elevation: convex clavicular head slides inferior on sternum depression: convex clavicular head slides superiorly

wrist flexors: FCU > FCR > PL a) primary flexors b) secondary flexors

A - primary secondary = FDS, FDP, FPL, APL

_______________ mm attaches to UPPER facet of humerus a) Supraspinatus b) Infraspinatus c) Teres Minor d) Subscapularis

A - supraspinatus

Greater tubercle of the humerus has: a) lower, middle, upper facet b) medial, intermediate, lateral facet c) upper, intermediate, inferior facet

A) lower middle and upper facets

greatest RD/UD rOM is a) neutral b) fully extended c) fully flexed

A) neutral full extension = least ROM full flexion = "almost NONE" because bones are splayed

motion primarily in GH jt, scapula seeks stable position a) setting phase b) early shld abd c) late shld abd

A) setting

CMC joint: Digits 2-3 are ______________ joints. Digits 4-5 are ___________ joints a) synovial plane joints b) synovial saddle joints c) synovial condyloid d) synovial hinge

A) synovial plane - 1 degree (flex/ext) B) synovial saddle (2 deg) (add/abd + flx/ext) (NOTE: some internal rotation)

If you punch something, the carpal bones may translocate __________ due to the tilt of the radius. a) ulnarly b) radially

A) ulnar translocation

Match the associated range of SH rhythm: setting, early shld abd, late shld abd a) 0-30 b) 30-90 c) 90-180

A, B, C

coracoclavicular ligament is made of _____ and the ______ a) conoid ligament b) coronoid ligament c) corocoid ligament a) trapezius ligament b) trabecular ligament c) trapezoid ligament

A conoid C trapezoid

annular ligament connected to the anterior and posterior surfaces of the a) radial notch b) ulnar notch c) trochlear notch d) humeral notch

A radial notch

what features must you have to be considered a pronator or supinator? a) must attach on both sides of axis of rotation b) must be able to withstand compressive forces c) must simultaneously use a synergist mm to prevent the primary action of the surrounding muscles d) mm must produce orce that acts with IMA AROUND axis of rotation

A&D

Scapulohumeral rhythm: distributes the motion among more than one joint (may pick more than one) a) maximize stability b) increase jt congruency c) decrease sheer forces d) promotes optimal length tension relationship e) prevent active insufficiency

A)

ACJ IR + ER --> how does it move the glenoid fossa? a) AP b) ML c) Sup/Inf

A) AP

carpal instability: the proximal row of carpal bones is _________ stable (aka. _______ mobile) a) less, more b) more, less

A) Proximal = less stable, more mobile "rotational collapse of the wrist" - think of the wrist as being sandwiched by two stable structures (forearm and distal row carpal bones)

What movements combine to provide opposition? a) add, flx, IR b) add, flx, ER c) abd, ext, IR d) abd, ext, ER

A) add, flx, IR "NOTE: some ABD at the IMC" according to my notes... don't know what that stands for

FOOSH injury - what prevents superior dislocation of humerus the best? a) coracoacromial arch b) subacromial and subdeltoid bursa c) SITS muscles d) AC joint

A) coracoacromial arch

upward rotation of scapula increases tension on _________________ ligament a) coracoclavicular ligament b) transverse clavicular ligament c) acromioclavicular ligament d) coracoacromial ligament

A) coracoclavicular ligament

Which joint contributes more motion during UD/RD? a) midcarpal b) radiocarpal

a) midcarpal

Two bursa @ GH jt? (pick two) a) subacromial b) suprahumeral c) subdeltoid d) deltoid Are they continuous with each other? (Y/N)

A/C Yes

Match: SC jt osteokinematics (Ex. A1, B2). Hint: trick question... A) posterior rotation B) protraction/retraction C) elevation/depression D) anterior rotation 1) AP axis 2) Vertical axis 3) ML axis 4) horizontal axis

A3, B2, C1 D4 isn't a thing....

what joint has these ligaments? a) SC B) AC C) GH D) scapulothoracic acromioclavicular lig, coracoclavicular lig, coracoacromial lig

AC joint

name extrinsic mm of the thumb, no hints (4)

APL, EPB, EPL (outcroppers), FPL (deep)

Costaclavicular lig (ant/post bundle) is taught in all motions except? a) elevation b) distraction c) compression d) depression What joint has this ligament?

All motions except depression SC joint

Ulnar deviators: FDS, FDP, ED a) primary b) secondary

b) secondary

controls upwardly rotation of scapulothoracic joint during elevation of humerus (prevent winging) a) deltoid rotator cuff force couple b) trapezius serratus anterior force couple

B

elbow closed packed position? a) full flex b) full ext

B

extension, with the tricep stretched a) active insufficiency b) passive insufficiency

B

taut in varus and full flexion a) medial collateral ligament b) lateral collateral ligament c) annular ligament d) oblique cord

B

SCJ function (pick 2) a) maintain dynamic stability b) maintain length/tension relationship c) orients the glenoid for optimal contact during elevation of arm d) protects neurovasculature

B & C

Scapulohumeral Rhythm: maintains GH fossa in optimal position to receive teh head of humerus (may pick more than one) a) maximize stability b) increase jt congruency c) decrease sheer forces d) promotes optimal length tension relationship e) prevent active insufficiency

B & C

purpose of cubitus valgus? a) optimal mm length for flexion b) hand don't hit side of thigh when carrying shit c) decrease stress on humeroulnar and humeroradial joints d) prevent fractures

B - "carrying angle"

________ have no hyperextension due to their LACK of posterior articular surface (decreased hyper extension) a) PIP b) DIP c) MCP d) CMC Choose best answer

B - DIPs have "no hyperextension" NOTE: a) PIPs have "some hyperextension" --> distinguishing factor between DIP and PIP

Of the shoulder girdle, what ligament is HARDEST to dislocate? a) AC B) SC C) GH D) Scapulothoracic

B - SC joint

Which joint take these ligaments? a) AC b) SC c) GH d) Scapulothoracic costoclavicular lig, sternoclavicular lig, interclavicular lig, articular disc?

B - SC joint

What is the function fo the thumb's MCP joint? a) reinforce joint capsule b) add range to thumb c) opposition d) increase grip surface area contact

B - add range to thumb It has limited ROM and is only there for range (flexion only!)

styloid process of ulna a) base of TFCC b) apex of TFCC c) sides of TFCC

B - apex

what athlete puts their GH joint in closed packed position the most often? why? a) basketball player b) baseball pitcher c) football running back d) tennis player

B - close packed is abduction and external rotation of the humerus throwing, pitching, etc

UD/RD = which rule? a) concave on fixed convex? b) convex on fixed concave

B - convex carpals on fixed concave radius/ulna

without active contraction of supraspinatus during abduction, what might happen? a) impingement b) creep c) bone spur e) movement compensation

B - creep

a multidisciplinary approach to optimizing human capabilities within a system? a) FABK b) Ergonomics c) Biomechanics d) anatomy

B - ergonomics

abduction without concurrent _______________ slide causes humeral impingement a) superior b) inferior c) medial d) lateral

B - inferior

_______________ mm attaches to MIDDLE facet of humerus a) Supraspinatus b) Infraspinatus c) Teres Minor d) Subscapularis

B - infraspinatus

For ulnar variance, if the ulna is more proximal, it is considered _____________ a) positive for ulnar variance b) negative for ulnar variance c) fractured/dislocated

B - negative positive = ulna extends distally negative = ulna is more proximal (developmental problem)

Humerus: head is rotated _________ at _________ degrees of normal retroversion a) anterior 30 b) posterior 30 c) anterior 35 d) posterior 35

B - posterior and 30 degrees

fibers that attach to proximal phalanx and to extensor hood a) juncturae tendinae b) proximal wing tendon (interossei) c) distal wing tendon (interossei) d) sagittal bands of extensor hood probably won't be on test... but looks like a vocab word

B - proximal wing tendon probably won't be on test... but looks like a vocab word

this ligament limits spin in supination and pronation, reinforces inferior capsule, and maintains radial head position to radial notch: a) oblique cord b) quadrate ligament c) interosseous membrane d) dorsal radioulnar

B - quadrate ligament

for every 1 degree at __________ jt, you get 2 degrees of motion at the _______ joint a) GHJ b) Scapulothoracic jt c) AC d) SC What does this describe?

B --> A Scapulohumeral rhythm

Humeral head retroversion (posteriorly) a) 20 deg b) 30 deg c) 40 deg

B 30 degrees

Wrist ROM summary: Normal Ext a) 60 b) 70 c) 80 d) 90

B 70

Narrowing from bony changes, spurs, large ligs, improper mechanics: a) FOOSH b) impingement syndrome c) tendonitis d) rotator cuff tear

B- impingement syndrome

maximal grip force occurs at _______ degrees of wrist extension a) 20 b) 30 c) 40 d) 50

B) 30

What range of motion is functionally most critical in sagittal plane elbow osteokinematics? a) 20-120 b) 30-130 c) 40-140 d) 50-150

B) 30-130

Glenoid fossa points _____ degrees superiorly: a) 2-3 b) 4-5 c) 6-7 d) 8-9

B) 4-5

taut IOM transfers force from radius to ulna a) distraction force b) compression force c) pronation force d) supination force

B) compression force

30 deg GH jt abd + 20-25 SC elevation + 5-10 upward rot AC jt a) setting phase b) early shld abd c) late shld abd NOTE: "30 deg GH + 30 deg ST" according to the slide

B) early shld abd

"interconnect carpals to themselves (aka: interosseous or intercarpal" a) extrinsic ligaments of wrist b) intrinsic ligaments of wrist

B) intrinsic

_______ ligaments of the wrist has a relies on synovial fluid for nutrition, _______ ligaments of the wrist rely on blood for nutrition a) extrinsic, intrinsic b) intrinsic, extrinsic

B) intrinsic/extrinsic

_____________ ligaments are stronger and lie within synovium, thus rely on synovial fluid for nutrition a) extrinsic ligaments of wrist b) intrinsic ligaments of wrist

B) intrinsics extrinsics will fail first but have a BETTER CHANCE at healing

these ligaments hold the sesamoid bones of the thumb down (@ MCP joint) EXCEPT a) collateral ligaments b) joint capsule c) intersesamoid ligament

B) joint capsule

Closed packed position for radiocarpal and midcarpal joint a) ulnar deviation b) radial deviation

B) radial deviation

wrist extensors: EI, EDM, EPL, ED a) primary extensors b) secondary extensors

B) secondary Primary: ECRP > ECU > ECRL

FCU & ECU are ___________ in frontal plane, but ___________ in sagittal plane a) antagonists, synergists b) synergists, antagonists

B) synergists, antagonists

FCR & ECRL/B are ______________ in the frontal plane, but _____________ in sagittal plane a) antagonists, synergists b) synergists, antagonists

B) synergists, antagonists (in frontal plane, they cancel out each other's deviation)

what mm produces pronation torque as well as compressive force at the DRUJ? How? a) pronator teres b) pronator quadratus c) perpendicular line of force d) parallel line of force

BC

all are functions of TFCC EXCEPT: a) primary stabilizer of radioulnar joint b) reinforces ulnar side of wrist c) reinforces radial side of wrist d) forms part of concavity of radiocarpal joint e) transfers part of compression force through wrist to forearm (20%)

C - TFCC is NOT on the radial side of the wrist!

Glenoid: faces _________ and _________ at _________ degrees (NOTE: also slightly anterior) a) lateral, inferior, 10 b) lateral, posterior, 5 c) superior, medial, 5 d) superior, lateral 5

C

without the delt/RC force couple, we lose all the benefits EXCEPT: a) loss of rotation due to loss of bony congruence from the SITS mm b) more translation of the humerus than normal (humerus slides) c) lateral pull of inferior angle of scapula on chest wall d) impingement prevention/protection

C after forces are resolved, the SITS mm allow for the convex/fixed concave rule which increases bony congruency and prevents impingement deltoid has more translational force than rotatory. combine the two = elevation

What is the ulnar tilt of the radius? a) 15 b) 20 c) 25 d) 30

C - 25

Rank in order of least ROM to most ROM a) forearm supinated b) forearm neutral c) forearm pronated

C - B - A

attach to lateral bands and central tendon a) juncturae tendinae b) proximal wing tendon (interossei) c) distal wing tendon (interossei) d) sagittal bands of extensor hood probably won't be on test... but looks like a vocab word

C - distal wing tendons probably won't be on test... but looks like a vocab word

Tipping is coupled with? a) rotation b) protraction/retraction c) elevation/depression

C - elevation/depression

axillary pouch is part of the ________ GH ligament. Given your answer, what position tenses the axillary pouch? a) superior b) middle c) inferior

C - inferior extreme abduction/elevation

Cartilaginous filler that fills space of TFCC? a) ulnotriquetral ligament b) ulnolunate ligament c) meniscal homologue d) volar radioulnar ligament e) dorsal radioulnar ligament f) ECU sheath

C - meniscal homologue

what can we use to measure overall body flexibility at the hand? a) forearm muscle length b) grip strength c) passive hyperextension d) UD/RD in neutral position

C - passive hyperextension

what allows 20-25 scapula upward rotation during late shoulder abduction (SH rhythm)? A) SC ELEVATION B) AC UPWARD ROTATION C) POSTERIOR ROTATION CLAVICLE D) UPWARD ROTATION SCAPULA

C - posterior rotation clavicle

palmar and dorsal capsular radioulnar ligaments

C - sides

_______________ mm attaches to LOWER facet of humerus a) Supraspinatus b) Infraspinatus c) Teres Minor d) Subscapularis

C - teres minor

Wrist ROM summary: Normal FLX a) 60 b) 70 c) 80 d) 90

C 80

Palmar plates slide down ________ during flexion to prevent pinching of flexor tendons a) superiorly b) inferiorly c) proximally d) distally

C) proximally

Carpal/proximal transverse arch of the hand is maintained by the _______________ (choose best answer) a) passive tension in intrinsic ligaments b) dynamic stabilization of extrinsic muscles c) shape of carpals d) flexor retinaculum length

C) shape of carpals

There are many palmar arch functions. Which one does NOT fit? a) allows you to grip things by increasing contact with shit b) protects tendons and median nerve (proximal arch) c) enhances mobility of the hand d) increases sensory feedback

C) the palmar arches enhances STABILITY, not mobility. If the arches made the hand more mobile, you can't grip shit hard

T/F: there is less possible tension in the 5th digit than the 1st digit

True. "More loss of tension ulnarly than radially because larger ROM"

Thoracoclavicular ligament of the ___________ bone attaches to (pick 2) a) costal facet b) costal tuberosity c) conoid tubercle d) trapezoid line e) acromial facet

Clavicular ligament C, D - conoid tubercle, trapezoid line

TF: Inferior GHL has anterior and posterior bands If true, after 90 degrees of abduction, how do you make them taut?

True. Anterior = ER Posterior = IR

what might a surgeon cut in order to relieve pressure in the carpal tunnel? (widens the arch) a) flexor retinaculum (TCL) b) transverse intercarpal ligaments (ICL)

a) cut the TCL

forceful downward rotation of UE or forceful upward movement of trunk in relation to fixed UE (reverse action) a) depression/adduction b) elevation/abduction what force couple??

a) depression/adduction rhomboid teres major couple

____________ contributes to the palmar arch system by providing a axis for opposition a) digits 2/3 b) digits 4/5

a) digits 2/3 "cupping the hand"

taut annular ligament, oblique cord, brachioradialis a) distraction force b) compression force c) pronation force d) supination force

a) distraction

pronation elbow is limited by a) biceps brachii b) bone approximation c) tension of PRUJ d) post fibers of MCL elbow e) all of the above

E

what determines flexion torque the most? a) length tension b) architecture of mm c) internal moment arm d) muscle length e) multiple: pick them

E - ABC

Humerus: head faces _________ and _________ at _________ degree angle of inclination a) med, lateral, 130 b) med, superior, 130 c) med, lateral, 135 d) med, superior, 135

D

supination elbow is limited by: a) passive tension of anterior RU ligament b) passive tension of oblique cord c) quadrate ligament d) all of the above

D

what determines extensor torque the most? a) length tension b) architecture of mm c) internal moment arm d) muscle length e) multiple: pick them

D Even tho the moment arm is larger in full extension, extensor torque is greatest at 90 deg flexion

Functions of palmar plates are all the following EXCEPT: a) extends distal articular surface b) increase distal surface tension c) restrict hyperextension d) prevent long finger tendons getting pinched during extension

D Prevent long finger tendons from getting pinched in FLEXION!!!!

head faces medially and superiorly... a) 120 deg b) 125 deg c) 130 deg d) 135 deg

D - 135 degrees

articular disc of distal radioulnar jt is ALL EXCEPT: a) bi-concave b) between the ulnar head and RCJ c) central 80 is avascular d) source of wrist stability and reinforcement

D - FOOSH = source of wrist pain, since 80% is avascular, blood won't heal it

"Ligaments that connect carpals to radius/ulna or MCs" a) extrinsic ligaments of wrist b) intrinsic ligaments of wrist

a) extrinsic

patient walks into a clinic, you notice their shoulder muscles are fucced up, what symptoms do you expect from this boi? a) burning, tingling, radiating pain b) excessive force closure c) inadequate force closure d) pain and instability Why?

D - because of dynamic stability

_________________ SUSPENDS scapula on clavicle a) coracoacromial lig b) acromioclavicular ligament c) conoid ligament d) coracoclavicular ligament

D - coracoclavicular C is only 1/2 of it....

Carpal ligament attaches to all the following EXCEPT: a) pisiform b) hook of hamate c) scaphoid d) lunate c) trapezium ****flexor compartment*****

D - lunate

IP joints have all the following except a) loose capsule b) volar plate c) collateral ligaments (taut in all positions) d) deep transverse ligaments

D - no deep transverse ligament

the wrist adjusts the orientation of the hand to accomplish the following actions EXCEPT: a) grasp b) pinch c) manipulation d) pulling e) all are accomplished with the help of the wrist

D - pulling is a function of GRASP

_______________ mm attaches to LESSER TUBERCLE of humerus a) Supraspinatus b) Infraspinatus c) Teres Minor d) Subscapularis

D - subscapularis

All are palmar arches EXCEPT: a) fixed proximal transverse arch b) mobile distal transverse arch at level of MC heads c) mobile longitudinal arch d) fixed deep transverse arch e) all are palmar arches

D - there is no fixed deep transverse arch

Clavicular plane: _______ posterior to the _________ plane a) 15, sagittal b) 20, horizontal c) 15, vertical d) 20, frontal

D) 20 degrees posterior to frontal plane

Scapular plane: _______ anterior to the _________ plane a) 30, sagittal b) 35, horizontal c) 30, vertical d) 35, frontal

D) 35 degrees anterior to frontal plane

passive components of the extensor exapansion include all the following EXCEPT: a) sagittal bands b) triangular ligament c) oblique retinacular ligament d) MCP joint capsule

D) MCP joint capsule

_______________________ creates the rotator interval capsule a) superior capsule b) superior GHL c) coracohumeral lig d) all of the above

D) all of the above

what adds to static stability of shoulder? a) rotator interval capsule b) airtight seal (negative pressure) c) tilt of glenoid (5 degrees) d) all of the above

D) all of the above

When is elbow most stable? a) flex b) ext c) mid range e) a & b f) b & c

E

distal radioulnar jt is stabilized by all except: a) TFCC b) pronator quadratus c) tendon of ECU d) distal interosseous membrane e) extensor retinaculum of the wrist

E

What is inside the subacromial space? a) rotator cuff tendons b) subacromial bursa c) biceps - long head d) capsule e) all of the above

E - all of the above subacromial space is between coracoacromial arch and head of humerus

To prevent winging and elevate humerus properly, you need all the following except: a) upward rotation of GH b) upward rotation of scapula c) scapula tilts posteriorly d) ER of scapula e) trick question - you need all of those actions

E - serratus anterior!! Without SA, posture will be protracted and depressed

frontal plane movement of supraspinatus does the following: a) causes inferior roll of GH head b) distracts humeral head against glenoid fossa c) restricts inferior translation d) all of the above e) none of the above

E -- all of it is opposite!! superior roll compress humeral head restricts superior translation

all ligaments under tension in neutral but increase tension in UD/RD a) stand up phenomenon b) shrink phenomenon c) dart throw phenomenon d) central column e) double V support system

E- double V support system proximal V = palmar ulnocarpal and radiocarpal ligs distal V = medial and lateral palmar intercarpal ligs

T/F: external rotators of the arm in horizontal plane compress the humeral head If False, what do they do?

F - depresses humeral head

TF: ACJ motions occur along the axes oriented along cardinal planes

F - plane of scapula

The following items provide intrinsic stability to the shld jt complex: a) shape of articulation b) shape of bone c) bony incongruity d) cartilage space e) a & b f) a & c

F - shape of articulation and bony incongruity

T/F: CMC of thumb is a synovial condyloid joint with 2 deg of freedom

F - synovial saddle with 2 deg with some opposition/reposition

Purpose of scapulohumeral rhythm? a) maximize stability b) increase jt congruency c) decrease sheer forces d) promotes optimal length tension relationship e) prevent active insufficiency f) all of the above

F all of the above

Name the two extrinsic finger flexors... No hints here...

FDS and FDP

name all intrinsic thumb mm, no hints (4)

FPB, APB, OP, ADP

T/F: the anti-deformity position (cast) is the same as the functional position

False

T/F: the radial bursa is larger than the ulnar bursa

False ulnar bursa encases FDS/FDP tendons and is continuous with 5th digit radial bursa encases FPL

T/F: there are 5 cruciate ligaments and 3 annular pulleys

False (3 cruciates, 5 pulleys)

T/F: ligament support of the wrist is dedicated to support, movement, and transmission of CONTRACTILE forces

False - the ligaments transmit PASSIVE forces

T/F: all annular pulley floors are bone

False - A1's floor = deep transverse metacarpal ligament A2-A5 floors = bone

T/F: the sheath of FCU has its own sheath within carpal ligament & FCR is outside the tunnel

False - FCR has its own sheath within superficial fibers of carpal ligament & FCU is outside the tunnel

T/F: MCP joints are synovial saddle joints

False - MCP joints are synovial condyloid with 2 degrees

T/F: ROM increases as you move radially within the CMC joints

False - ROM increases as you move ulnarly Ex. 5th digit has up to 10-20 deg flex/add

T/F: slide is always in the same direction at the AC joint because it is a condyloid joint

False - it is in the same direction because it is a PLANE joint hehehehe

T/F: shoulder complex is statically stable

False - not very stable due to incongruence

T/F: GH labrum is just as effective as the Hip labrum

False - shoulder relies on DYNAMIC STABILITY!

T/F: the thumb's MCP joint has a similar ROM compared to the MCP joints of the fingers In patient friendly language, what is the thumb's MCP's ROM?

False!! Flexion ONLY!!! - 50 degrees. - hyperextension "little if any" - add/abd "extremely limited

T/F: there is a cruciate ligament between A1 and A2

False. cruciate ligaments are between: A2/3, A3/4, A4/5

T/F: the clavicle on the sternum is only a CONCAVE on FIXED CONVEX relationship

False: Clavicle: vertically convex, horizontally concave Sternum: vertically concave, horizontally convex

Of the following, what is the most vital measurement to determining if something is gonna mess up your body ergonomically? (choose best) a) force b) repetition c) contact stress d) posture e) vibration f) temperature g) duration in compromised position

G) duration

GHJ average ROM: Flexion GH? Shoulder complex?

GH 100 Shld 180

GHJ average ROM: extension GH? Shoulder complex?

GH 40 SHLD 60

GHJ average ROM: ADDUCTION GH? Shoulder complex?

GH: 0 SHLD: 0

GHJ average ROM: ABDUCTION GH? Shoulder complex?

GH: 120 SHLD: 180

GHJ average ROM: ER GH? Shoulder complex?

GH: 50 SHLD: 90

GHJ average ROM: IR GH? Shoulder complex?

GH: 70 SHLD: 70

resultant force vector between _______________ and the _________ __________ ________ stabilizes the head of humerus on the glenoid fossa HINT!!!! (the answer is not in here) || second hint: "at rest..." a) superior capsule b) inferior capsule c) middle capsule d) superior GHL e) inferior GHL f) coracohumeral ligament g) coracoacromial ligament

Gravity rotator interval capsule

these bones create the __________ compartment of the mid carpal joint head of capitate, apex hamate, scaphoid, lunate, triquetrum a) medial b) lateral

MEDIAL compartment Lateral compartment = scaphoid, trapezium, trapezoid

Of the downward rotation force couple muscles, which stabilizes the scapula for the rest of the mm to do their jobs? a) lat dorsi b) posterior delt c) rhomboid d) teres major e) infraspinatus

Rhomboid stabilizes the scapula so everything can work on the humerus

Functions of shoulder complex: ________ at the expense of __________

Mobility at the expense of stability

T/F: extension of PIP almost always occurs with DIP extension Hint: oblique retinacular ligament

True - try it!

Trapezium is concave in sagittal plane and convex in frontal plane. What does this do to the thumb? Hint: Form follows function... planes....

Movement of the thumb occurs in the plane perpendicular to the fingers

Of the carpal bones, which bone is NOT articulating in the mid carpal joint? S L T P T T C H

Pisiform

Of the carpal bones, which bone does not articulate at the wrist? S L T P T T C H

Pisiform - it is a sesamoid bone

REBA or RULA? Cares primarily about posture... but does not care about repetition

REBA

REBA or RULA? qualitative test to assess work posture and prioritize risk, gives a single score with 5 levels of action/urgency

REBA

REBA or RULA? Used to compare if an ergonomic change decreased/increased risk. can also evaluate outcomes like productivity

RULA

REBA or RULA? rates musculoskeletal loads in tasks through lens of neck/upper limb loading

RULA

STJ osteokinematics: AC or SC? Elevation = _______ jt elevation + _______ jt downward rotation

SC elevation + AC downward rotation

STJ osteokinematics: AC or SC? protraction = ________ jt protraction + _______ jt internal rotation

SC jt pro AC jt IR

GHJ: flex extension ____________ of convex humerus head around glenoid fossa

SPIN

___________ is most typically fractured wrist bone & __________ is most typically dislocated (pick 2, place them) a) scaphoid b) lunate c) triquetrum d) pisiform

Scaphoid = fractured lunate = dislocated

What are phases of SH rhythm? Hint: __________ PHASE, _________ ________ ABD, ________ __________ ABD

Setting phase Early shoulder abduction late shoulder abduction

SC joint (__________ joint) a) ball and socket b) saddle c) hinge

Synovial joint. Saddle

FOOSH injury - what thang thang protects the SC joint the MOST a) costoclavicular lig b) sternoclavicular lig c) interclavicular lig d) articular disc

The articular disc

T/F: vigorous contraction during supination (screwdriver) requires the tricep mm to contract if true, how? a) isometric b) concentric c) eccentric

True, isometric (neutralizes elbow flexion of biceps)

Significance of Foramen of Weitbrecht

Thin zone between Sup and med GHL, common area for anterior humeral dislocations

If inferior angle is moving posteriorly while superior border moves anteriorly, whats happening?

Tipping

what carpal bone does the CMC of the thumb articulate with? S L T P T T C. H

Trapezium

Of the carpal bones, which two bones does the TFCC connect with? (between the ulna and the _________ & _________) S L T P T T C H

Triquetrum & lunate

T/F: IP joints are synovial hinge joints with 1 degree (flex/ext)

True

T/F: MCP joints are incongruent because the proximal head of MC takes up 180 degrees of articular space and the distal proximal phalange has 20 degrees of the surface

True

T/F: No muscles act directly and solely on the radiocarpal joint

True

T/F: force couples act to rotate scapula, position glenoid, maximizes GH congruity in order to maximize joint stability

True

T/F: the IP joint at the thumb is identical to finger IPs in structure and in function

True

T/F: thumb mm are dependent on wrist position for maximal performance

True

T/F: extensors must turn on in order to have the greatest grip force (ex. deadlifting a heavy barbell)

True If the extensors do not turn on, flexors are actively insufficient

T/F: IOM transfers components of mm force to ulna?

True elbow flexors, pronators, supinators - because they have attachments to the radius

T/F: when the distal segment of the arm is free, the concave/convex relationship changes at the elbow examples?

True free: concave radius and ulna on fixed convex humerus - food to mouth fixed: convex humerus rolls on fixed concave radius and ulna - push ups

Wrist ROM summary: Normal UD / RD? (pick 2) a) 10 b) 20 c) 30 d) 40

UD = 30 (C) RD = 20 (B)

Elevators of STJ

UPPER TRAP LEVATOR SCAP RHOMBOIDS

juncturae tendinae is another word for what Kamla calls: a) intertendinous connections b) extensor expansion c) extensor retinaculum d) flexor retinaculum

a) intertendinous connections

Taut in valgus and flex/ext a) medial collateral ligament b) lateral collateral ligament c) annular ligament d) oblique cord

a) mcl

what is the palmar tilt of the radius? a) 10 b) 15 c) 20 d) 25

a - 10 degrees

This muscle is the only mm that attaches to other muscles, so therefore it is dependent on tension from extrinsic mm! a) lumbricals b) interossei c) thenar eminence mm d) hypothenar eminence mm

a - lumbricals

elevates humerus while providing dynamic stability at the GH joint a) deltoid rotator cuff force couple b) trapezius serratus anterior force couple

a)

what makes the serratus anterior so important? a) irreplaceable b) beautiful c) strong d) well developed

a) "no other mm can replace SA - weakness of SA results in severe winging"

@ 100 degrees, humerus a) scapula rotates around __________ joint b) lower trap becomes ________ active as serratus anterior pulls inferior angle ______-_______

a) AC joint b) more active, pulls inferio-laterally

___________ assists/optimizes the length-tension relationship of the hand during max effort grip a) extensors b) flexors

a) ECRB/ECU help with L-T relationship

what protects the top of the head, mm, tendons, and bursae of surrounding the humerus? a) coracoacromial arch b) coracoclavicular arch c) acromioclavicular arch d) scapuloclavicular arch

a) coracoacromial arch "an osteoligamentous vault"

interosseous membrane: a) between ______________ and ___________ b) maintains ___________ between the two bones c) provides ________ for PRUJ and DRUJ d) maintains transverse stability during _______________ load transfer

a) radius and ulna b) space c) stability d) compressive

@ < 100 degrees of humeral elevation: a) scapula ___________ around SC joint b) upper trap ________ ________ the acromion c) serratus anterior ____________ the scapula and pulls the inferior angle ________-__________

a) rotates b) upward rotates c) protracts & antero-medially

Tear of this ligament may result in an unstable lunate bone a) scapholunate b) scaphotrapezial c) ulnolunate d) lunotriquetral

a) scapholunate

during UD, the scaphoid _________ a) stands up b) shrinks

a) stands up Remember: radial deviation is closed packed, so it gets "tucked in" during RD

What is the clinical sign of someone who injures their annular pulleys? a) trigger finger b) de quervain's c) claw hand

a) trigger finger (hard to flex/ext finger)

AC ligament of the AC joint is taut in ___________ translation between clavicle and acromion a) upward b) downward c) compression d) distraction

a) upward

functions of shoulder: individual joints ____________ provide _________ than by themselves a) collectively, more stability b) collectively, less stability c) individually, more stability d) individually, less stability

a, collectively, more stability

What is the point of the "pistol grip" of certain objects? No hints!

accounts for the loss of tension in the fingers as you move ulnarly (limit loss of tension due to active insufficiency"

Name the four "joints" of the shoulder complex A... S... S... G...

acromioclavicular sternoclavicular scapulothoracic glenohumeral

Shoulder flexors? (4x) Hints: 1) deltoid... 2) one of the components of the pec.... 3) deep to the short head of something.... 4) the brother of the "something" mentioned in 3....

anterior delt pec major clavicular head coracobrachialis biceps brachii long head

muscular force couples stabilize the shoulder complex during movement: a) static stability b) dynamic stability

b

active movement of bringing the arm overhead a) abduction b) elevation c) upward rotation d) lateral flexion

b - elevation

which bone ends more distally at the wrist? a) ulna b) radius

b - radius

Normal angle of cubitus valgus? a) 10 b) 15 c) 20 d) 25

b 15

when MP joint is flexed, the interossei become effective ___________ but cannot _____/______ the fingers because their tendons become anterior to the COR a) extensors, abd/add b) flexors, abd/add c) abductors, flex/ext d) adductors, flex/ext

b) flexors, abd/add

what joint in the elbow experiences spin, whether it the hand is fixed or not? a) humero ulnar jt b) humero radial jt

b) radial

coracoclavicular ligament of AC joint is taut in upward rotation of __________ and an inferior/medial force to ____________ (pick 2) a) acromion b) scapula c) clavicle d) sternum

b) scapula a) acromion

base of TFCC is on the _______________ notch of the ___________ a) radial notch of ulna b) ulnar notch of radius apex of TFCC is on the styloid process of the ___________ a) styloid process of ulna b) styloid process of radius

b) ulnar notch of radius a) styloid process of ulna

Functions of Shoulder: __________ for UE motion

base

prevent longitudinal displacement/distraction of radius (2) a) medial collateral ligament b) lateral collateral ligament c) annular ligament d) oblique cord

c - annular d - oblique cord Yes they do the same thing

best elbow position for bicep supination torque? a) 30 b) 60 c) 90 d) 120

c 90 think about a screwdriver

force sharing between radius and ulna occurs from the a) oblique cord b) articular disc c) interosseous membrane d) quadrate ligament

c) IOM

Dynamic stability: ____________ is coupled to the rotator cuff at the GH joint a) serratus anterior b) trapezius c) deltoid d) rhomboids e) teres major f) rotator cuff

c) deltoid

ACJ IR is coupled with ___________? ER? a) flex b) ext c) protraction d) retraction

c) protraction d) retraction

SITS muscles: all EXCEPT: a) supraspinatus b) infraspinatus c) teres major d) subscapularis

c) teres major --> teres minor!!!

SC jt pro/retraction: a) convex on fixed concave? b) concave on fixed convex? describe?

concave moves on fixed convex retraction: concave articular surface of clavicle rolls and slides POSTERIORLY on convex surface of sternum protraction: concave articular surface of clavicle rolls and slides ANTERIORLY on convex surface of sternum

GHJ: ER/IR ____________ humeral head moves on concave _____________ __________

convex glenoid fossa

GHJ abduction/adduction: ____________ humerus rolls on fixed ___________ glenoid

convex humerus concave glenoid

central 80% of the TFCC is _________________ a) ossified b) concave c) convex d) avascular

d - avascular

if subacromial bursa is inflamed, what tendon is effected (pain)? a) biceps brachii tendon b) musculocutaneous nerve c) deltoid tendon d) supraspinatus tendon

d supraspinatus tendon

Radioulnar joint = decreases ______________ in order to increase ____________ a) stability b) mobility c) function d) elasticity

decrease stability to increase function

action of these muscles will bring the humerus down... "shunt muscle"? What is the reverse action? a) elevators b) depressors c) protractors d) retractors

depressors torso goes up

shld mm that originate on scapula and clavicle and insert onto humerus or forearm? two mm examples? a) proximal stabilizers b) distal mobilizers 1) Biceps 2) Trap 3) SA 4) Deltoid

distal mobilizers biceps and deltoids

Segment free supination: concave radius rolls and slides in same direction on convex/fixed ulna

distal radioulnar

what forearm joint is notorious for causing pain @ triangular fibrocartilage complex? a) humeroradial b) humeroulnar c) proximal radioulnar jt d) distal radioulnar jt

distal radioulnar joint?

___________ ___________ = when a segment or set of segments are more dependent on muscles than on joint structures or maintenance of integrity a) static stability b) dynamic stability c) static mobility d) dynamic mobility

dynamic stability

if the __________ are paralyzed, scapula will be downward rotated and protracted? a) elevators b) depressors c) protractors d) retractors

elevators

Dynamic stability: Deltoid is coupled to the ____________ ____________ at the GH joint a) serratus anterior b) trapezius c) deltoid d) rhomboids e) teres major f) rotator cuff

f) rotator cuff

when the lunate is dislocated and faces dorsally? a) DISI b) VISI

faces DORSAL = DISI faces PALMAR = VISI

What does FOOSH stand for?

falling on out stretched hand

T/F: reposition is a function of the intrinsic thumb mm

false - opposition is intrinsic. reposition is for extrinsic mm

T/F: movement of thumb occurs in plane parallel with fingers

false. PERPENDICULAR!

Palmar plates are firmly attached to the ___________ and not at the __________ (match) a) proximal phalange b) Distal head of MC Hint: Form follows function!

firmly attached to A (prox phalange) not firmly attached at distal head of MC

At the radiocarpal joint, RANK the following ROMs from greatest to smallest: 1) extension 2) flexion 3) ulnar deviation 4) radial deviation

from greatest ROM to smallest: Flexion > extension & ulnar ROM > radial deviation overall: flex/ext > ulnar/rad deviation

at same force production, which mm produces greatest/smallest flexion torque? a) brachialis b) biceps brachii c) brachioradialis

greatest = brachioradialis (longest IMA) least = brachialis (shortest)

Hip is to _____ stability and _____ mobility Shoulder is to _____ stability and _____ mobility

hip: high stab, low mobility shld: low stab, high mobility

what joints allow supination pronation?

humeroradial distal/proximal RUJ

Four joints of the elbow and stuff? what types of joints? a) arm to the thing that doesn't move during supination/pronation b) arm to the thing that moves during supination/pronation c) close joint bt bones of forearm d) far joint bt bones of forearm

humeroulnar jt -- modified hinge humeroradial -- modified hinge proximal radioulnar -- pivot distal radioulnar -- pivot

horizontal plane movers of the arm: ER (2x) a) a SITS mm b) major or minor

infraspinatus teres minor

functions of shoulder: allows for ______________ with our environment

interaction

The lumbricals can put the FDP tendon on SLACK. When the lumbricals are paralyzed, what clincal sign do you see? a) intrinsic plus hand b) intrinsic minus hand

intrinsic minus hand note: lumbrical grip = intrinsic + hand (DIPs are extended)

trap/SA couple: pulls down on medial end of spine of scapula a) upper trap b) middle trap c) lower trap d) serratus anterior

lower trap

depressors of STJ

lower trap lat dorsi pec minor subclavius

retractors STJ

middle trap rhomboids lower trapezius

________________ ______________ can retract on its own __________ and the __________ __________ combine to be secondary retractors Hint... big muscles

middle trapezius rhomboids & lower trapezius

Significance of loose capsule of the glenohumeral joint? what is the cost? Hint: capsule is twice the size of the humeral head

need extra space for mobility... at the cost of decreased stability dynamic stability

You need shoulder ___________ to properly get elbow extension (ex. pushing a door open) a) extension b) abduction c) adduction d) flexors why?

need shoulder flexors (synergist) if shoulder flexors were not working, the triceps would work on the shoulder instead of elbow

GHL assist in maintaining a ____________ intra-articular pressure a) negative b) positive

negative

In a resting position, what resists inferior dislocation at the shoulder?

passive tension of rotator interval capsule If you guessed muscles: WRONG! mm are silent at rest

adductors of arm hint: a) the other head of the pec.... b) big mm but not the traps

pec major sternocostal head lat dorsi

anterior tilters of STJ

pec minor subclavius

shld extensors (x4) hints: 1) deltoid.... 2) big as hell, acts at the arm 3) tricep... 4) theres a major and a minor

posterior delt lat dorsi tricep long head teres major

Tension on coracoclavicular ligament causes ____________ ____________ of clavicle during upward rotation of clavicle no options - think about it!

posterior rotation

STJ osteokinematics: protraction/retraction primary: translation second: rotation

primary: translates side side second: int/ext rotation @ AC pro/retract @ SC

Segment free supination: convex radius rotates on concave ulna

proximal radioulnar

shoulder muscles are split into proximal ______________ and distal _____________ (pick 2) a) stabilizers b) pulleys c) force couples d) mobilizers

proximal stabilizers distal mobilizers

shld mm that originate on spine, ribs, cranium? two mm examples? a) proximal stabilizers b) distal mobilizers 1) Biceps 2) Trap 3) SA 4) Deltoid

proximal stabilizers traps and serratus anterior

FOOSH injury... what nerve might be hurt if the humerus is fractured? a) axillary n b) radial n c) posterior interosseous nerve c) musculocutaneous nerve

radial nerve - it lies in the radial groove.

horizontal plane movement at the forearm.... what bone moves? ROM? a) radius b) ulna c) 85 supination to 75 pronation d) 80 supination to 70 pronation

radius moves C - 85 sup to 75 pron

Dynamic stability: __________ is coupled to the teres major at the ST joint a) serratus anterior b) trapezius c) deltoid d) rhomboids e) teres major f) rotator cuff

rhomboids

downward rotators of STJ

rhomboids pec minor levator scap

What are the 3 rotatory motions of STJ? 2 translatory motions? No options on purpose

rotatory: upward/downard rotation, IR/ER, A/P tipping translatory: elevation/depression, protraction/retraction

STJ osteokinematics: AC or SC? upward rotation = _______ jt elevation + _______ jt upward rotation

sc jt elevation ac jt upward rotation

Dynamic stability: trapezius is coupled to the ____________ ____________ at the ST joint a) serratus anterior b) trapezius c) deltoid d) rhomboids e) teres major f) rotator cuff

serratus anterior

Protractors of STJ

serratus anterior

the long moment arm of the __________ ___________ from the vertical axis of rotation at the SC leads to PROTRACTION

serratus anterior

trap/SA couple: pulls laterally on inferior angle of scapula on chest wall a) upper trap b) middle trap c) lower trap d) serratus anterior

serratus anterior

upward rotators of STJ

serratus anterior upper trap lower trap

functions of the SC joint articular disc? (pick 2) a) shock absorption b) shock reduction c) increase joint congruity d) decrease joint congruity

shock absorb and increase jt congruity

Patient recently had a stroke, what might happen to their shoulder connective tissue?

since the supraspinatus is deteriorated, the CT will change and the GHJ would lose stability Subluxation

Name the four "bones" of the shld complex S C S H

sternum clavicle scapula humerus

T/F: extrinsic finger extensors do not have pulleys or bursa dorsally why?

true - because they have less ROM - no need

What INITIATES shoulder abduction from a resting position?

supraspinatus

shld abductors (x2) hints: 1) initiates movement... 2) fires after initial elevation from (1)

supraspinatus middle deltoid

GHJ - superior capsular ligament is taught when the ____________ mm pulls on humerus during abduction a) infraspinatus b) subscapularis c) supraspinatus d) teres minor

supraspinatus pulls on SCL

Rotator cuff mms: SITS muscles?

supraspinatus, infraspinatus, teres minor, subscapularis

sternoclavicular lig and interclavicular ligament are taught in? a) elevation b) depression c) compression d) distraction what joint? which is the bigger ligament?

taut in depression SC joint, the sternoclavicular lig is biggest

Dynamic stability: rhomboids is coupled to the ____________ ____________ at the ST joint a) serratus anterior b) trapezius c) deltoid d) rhomboids e) teres major f) rotator cuff

teres major

horizontal plane movement: internal rotators (x4) hint: a) major or minor... b) big as hell c) has two heads d) one of the SITS

teres major lat dorsi pec major subscapularis

T/F: extrinsic mm of the hand can only flex/extend the fingers

true. ED = extension only FDS/FDP = flexion only

STJ osteokinematics: elevation and depression? HINT: primary translation with 2ndary rotation

translation up/down rotation: tipping and slight downward rotation @ AC and SC

Dynamic stability: ____________ is coupled to the serratus anterior at the ST joint a) serratus anterior b) trapezius c) deltoid d) rhomboids e) teres major f) rotator cuff

trapezius

T/F: CMC capsule of thumb is relatively weak (close packed position is in extremes of add/abd)

true

T/F: annular ligament and head of radius are both covered in articular cartilage

true

T/F: radial and ulnar bursa have synovial-like fluid (reduce friction)

true

T/F: AROM < PROM at the elbow what are the degrees? MATCH for AROM/PROM a) 135-145 b) 140-155 c) 145-160 d) 150-160 why?

true AROM: 135-145 PROM: 150-160 bicep and soft tissue gets in the way of full flexion...

T/F: intrinsic mm of the fingers can extend the DIP and flex the PIPs

true (lumbricals)

trap/SA couple: lifts up lateral clavicle and acromion process a) upper trap b) middle trap c) lower trap d) serratus anterior

upper trap

the articular disc at the? a) elbow b) wrist what joint?

wrist distal radioulnar jt