Kinesiology, The Shoulder, The Hand

Diathrosis (synovial)

- joints that move freely in the absence of pathology Adjoining bones are separated by a space called the joint cavity; the entire joint is encased in a fibrous capsule 6types of synovial joints

Internal and external rotation

- transverse plane. Aka medial and lateral rotation, respectively. In UEs and Les, movement of the anterior surface of the extremity toward the midline of the body is IR, movement away from midline is ER

AC Joint Pathology: ___% of acute injuries to the shoulder girdle, __% of shoulder girdle injuries in athletes. Two types: _________ - FOOSH or sports related injuries ________ - arthritis, infection, spontaneous subluxation due to laxity Clinical presentation Traumatic - With an AC joint injury pain is often felt radiating to the ______ and ______. The AC joint may also become swollen, the upper extremity often held in ________ with the acromion depressed, which may cause the clavicle to be _________ Atraumatic - c/o pain and _____ that increases with palpation and shoulder ________; crepitus (OA), bilateral symptoms and other joints affected (RA) Diagnostic Procedures: radiographic evaluation, resisted AC joint extension test

10 40 Traumatic Atraumatic neck deltoid adduction elevated swelling abduction

Glenohumeral Joint (GH): Ball and socket joint ___ Degrees of freedom - roll, slide, spin Function: Large head of humerus on smaller, shallow _______ fossa About _______% of humeral head is in contact with glenoid Allows for wide range of ______ (which inherently means it is less ______) Relies on both static and dynamic _______ forces to provide stability Movements: Flexion/________ ER/_______ Abduction/__________ Roll & Slide occur in ___________ direction Abduction: Roll: ______ Slide:_______ Adduction: Roll: ________ Slide: _______ Closed Packed Position: Full _______ and _______ rotation

3 glenoid 25-30 motion stable stabilizing Extension Internal Rotation Adduction OPPOSITE Superior Inferior Inferior Superior abduction external

Strength Assessment of the Hand •Generally, each finger is acted upon by ____ muscles: Three extrinsic: two long flexors and one extensor Three intrinsic: dorsal and palmar interosseous and lumbrical muscles The IF and SF each have an additional ________ extensor

6 extrinsic

Rockwood Classification: How many grades?

6 Grades

Scapulohumeral Rhythm: Pathology _________ becomes Weak & limited Aka "winged scapula" Scapula positioned in _________ rotation ________ may occur Adaptive ________ shortening may occur Typically results from ____________ injury, which can be caused by repetitive use or traumatic injury. Winging is also observable with rhomboid weakness.

Abduction downward Elevation rhomboid Long Thoracic Nerve

____Number of Joints crossed by the Muscle: One-joint muscles (triceps) and two-joint or multijoint muscles (biceps) _______________________: When multi-joint muscle is shortened to a length where it can no longer apply sufficient force to complete a ________ [3] Example: Fully extending the hip _________ ability of hamstrings to flex knee ____________: When a multi-joint muscle is tightened over both joints at the same time Inability to achieve full PROM because the ________ muscle can't be lengthened farther [3] Example: Passive knee flexion allows greater passive hip flexion

Active Insufficiency movement decreases Passive Insufficiency antagonist

Location of Muscle and Axis: ________: Prime mover __________: Against (opposite) the prime mover _________: Along with prime mover Neutralizing or Counteracting (wrist ext with digits flexed) Conjoining (ecrl + ecrb + ecu during wrist extension) Stabilizing or fixating (RC during shoulder elevation)

Agonist Antagonist Synergist

SC Joint: Image on Slide 7 Protraction: Roll: ______ Slide: _______ Retraction: Roll: ___________ Slide: ________ Roll and Slide occur in the _______ direction (concave-on-convex) for protraction and retraction

Anterior Anterior Posterior Posterior SAME

____________: Motion you "feel" Unobservable accessory motions between adjacent surfaces Roll, glide, spin Take place with ____ PROM & AROM and are necessary to achieve full motion If restricted, can limit physiological movement of a joint

Arthrokinematic all

What is the clinical significance of Osteokinematic and Arthrokinematic?

Arthrokinematic motion can be generated passively by a clinician to a client during intervention to increase ROM

Presence of a joint cavity: "This fluid-filled space is the site at which the articulating surfaces of the bones contact each other." [3] Walls of the space are formed by ________________ Fibrous connective tissue structures that attach to each of the articulating bones Bones of these joints articulate within the capsule and joint cavity ________ Cartilage: thin layer covering the entire articulating surface of each bone [3] Hyaline Cartilage Do not connect with each other. Act more as "gliding surface" ____________: Lines inner surface of articular capsule. [3] Secretes synovial fluid __________: Thick fluid that provide lubrication to joint [3] Also provides nutrition to the articular cartilage (non-vascularized)

Articular Capsule Articular Synovial Membrane Synovial Fluid

_________: "a thin connective tissue sac filled with lubricating liquid." [3] Reduce friction by separating structures that tend to rub together 3 Types: Classified by location ___________: Between skin and underlying bone (ex: olecranon) ________: Between muscle and bone (ex: trochanteric) ___________: Between tendon and bone (ex: subacromial) [3]

Bursa (Bursae, plural) Subcutaneous Submuscular Subtendinous

Saddle Joint

CMC joint (thumb). joint components fit like a rider on a saddle. Two degrees of movement. CMC joint (thumb). Plane or gliding - between carpal bones. Ball and socket - shoulder, hip. Spherical head at the end of one bone fits into and moves within a cup-like concavity in the bone with which it articulates.

Factors Influencing ROM and Strength

Client factors: genetics, health status, age and gender, pain Psychological/psychosocial factors Environmental factors Skeletal factors, muscular factors Methodological factors

Intrinsic Plus/Minus Intrinsic Plus: Using intrinsic muscles (_______ packed) Intrinsic Minus: NOT using intrinsic muscles (_______ packed) •Intrinsics - supplied by median and _______ nerves; originate distal to wrist •Extrinsics - supplied by _______, ulnar, and median nerves; originate in forearm, tendons are held in place by the palmar carpal ligament and flexor retinaculum THINK ABOUT + AND - SIGNS FOR THIS

Closed Open ulnar radial

interphangeal joints Articulations of the phalanges with each other: 4 PIP joints, 4 DIP joints, one IP joint Note: the IP joint of thumb functions like the ________ joints of digits 2-5 Functions: flex/ext. Flex>ext due to ligamental restrictions Joint type: synovial, ________ Closed Packed Position: full ________ Degrees of Freedom: _____ Movements: Roll and slide in _______ direction

DIP hinge extension 2 same

Hand Pathology Hand deformities ___________ contracture: progressive shortening and thickening of the palmar fascia on the ulnar side of the hand and palmar aponeurosis, often B hands affected, most common in men over 50. treated with xiaflex injections or z-plasty. _______ hand: indicative of ulnar nerve injury, causes extensive motor and sensory loss to hand Vasomotor changes _______ disease: constricted digital arteries cause disrupted blood flow, digits turn white due to lack of blood flow, then blue due to lack of oxygen, then red as blood flow returns; associated with sclerdoma, exacerbated by stress Arthritis, common sites ______ joint: basilar arthritis, common in women ages 50+, limiting to firm grip, painful

Dupuytren's Claw Raynaud's CMC

_________:The sensation felt by examining clinician at the end point of available ROM How to Assess End Feel: Move patient to end range of PROM, then apply _________; repeat as indicated 5 Main Types: ________ (bony): Motion stops when bone meets bone. Normal for some joints (elbow extension) but abnormal if there are bone fragments or calcifications present. _____: Motion stops when soft tissues are compressed. Normal in many joints (elbow flexion). Abnormal if it feels "boggy", which may indicate edema. _______ (Springy): Motion stops when soft tissues have reached their max stretch (end range). Limited ROM with a firm end feel may indicate tissue shortening. __________: Motion is stopped by the patient, not by biomechanical limits (apprehension or pain). Abnormal. _________: Muscle contraction and pain at end range. Abnormal.

End Feel overpressure Hard Soft Firm Empty Spastic/Spasm

How do Newton's laws apply to rehabilitation?

Forces and resistance, such as gravity, resisted weights, rehabilitation machines and changes in muscle strength, ROM, and balance, all affect the decision-making process of an individual. Knowing how these laws apply to rehabilitation makes for a safer, and possibly more effective, recovery from an injury

Radial and ulnar deviation occurs in the ________ plan - radial deviation hand moves _____ from the body (towards thumb), ulnar deviation hand moves ______ body (towards little finger)

Frontal away towards

Lateral flexion (sideways movements of trunk and neck) occurs in what plane?

Frontal Plane

Client Factors (ROM & Strength) _______ - predisposed to hyper- or hypomobility, strength/weakness _________ - joint disease, decreased activity causing muscle atrophy or muscular imbalance _____ and ______ - normal age-related changes include: loss of extensibility of CT and decreased tensile strength of muscles. Females generally have more flexible joints with greater ROM than men; this is true across the lifespan _______ - limits ROM and strength. complex - merits its own assessment and intervention.

Genetics Health status Age gender Pain

Arthrokinematic Motions: _____ "Sliding" of one surface on another One constant point of one surface contacts new points on the other surface Occurs when the two surfaces are ______ and flat or congruent and curved ______ to the plane of adjoining surface Example: a box being pushed up a ramp Also known as __________

Glide congruent Parallel translation

Scapulothoracic Joint: _______ Mechanism Has ____ bony attachments to the axial skeleton other than through AC and SC joints Stability & Position: axioscapular muscles to include: (Name 5 muscles) ___ muscles attach to or originate from the scapula Function: Allows increased shoulder _____ Approx. 1 degree of scapulothoracic _______ for every 2 degrees of GH _______ Provides ______ base for humeral head articulation with glenoid ________ the UE during functional tasks and movements

Gliding NO Trapezius, serratus anterior, rhomboid major/minor, levator scapulae 17 Movements elevation elevation stable Positions

Extrinsics: ______ Force •_________ of extrinsic flexion muscles (FDP & FDS) •Also causes some flexion ______ to wrist •Activation of Wrist _________ •Keeps wrist in neutral (blocks flexion) •Allows for optimal length of digit flexors to effectively flex fingers

Grip Contraction torque Extensors

six types of synovial joints

Hinge Pivot Condyloid Saddle Plane or gliding Ball and socket

Types of Muscle Contractions ________: No change in muscle length (no movement occurs) ________: Change in muscle length _________: The muscle shortens during contraction _____________: The muscle lengthens during contraction ___________: Muscles contract and shorten at a constant speed Directly proportional to the _________ produced by a muscle at all points of ROM

Isometric Isotonic Concentric Eccentric Isokinetic torque

_______________:Defined as how well joint surfaces fit together ______- packed maximum tightness, no further ROM For example, full flexion of the knee ______-packed or loose-packed (clinically, a resting position; joint surfaces do not fit perfectly together) Some of the ligaments and other CT are lax ________ motion is available; ________ motion is movement in surrounding joints that accompanies active motion in primary joint and is essential for ______ ROM (shoulder abd or flex is a great example - humeral movement affects scapula and clavicle) Joint _______ is available in open-packed positions. It is the extensibility of joint capsule or "give" that occurs when joints are passively distracted. there are specific joint mobilization techniques in which a clinician can be trained. Joint mobilizations are used to restore joint play.

Joint Congruency Close Open Accessory accessory full "play"

___________Strong bands of connective tissue Fibrous Strengthen and stabilize the joint by anchoring bones together Prevent excessive joint movement by limiting the range of movement [3] 3 Types of Synovial Ligaments: ________ Ligament: Located outside the articular capsule ________ Ligament: Incorporated into the wall or fused to the articular capsule _____________ Ligament: Located inside the articular capsule [3]

Ligaments Extrinsic Intrinsic Intracapsular

Types of Motion: ______- all parts move in same direction for the same distance a the same time Angular EX: a gymnast Everyday motions are generally a combination of the two

Linear

Condyloid joint

MCP joints (hand). Oval or egg-shaped convex surface fits into a reciprocally shaped concave surface, allowing concave surface to slide over convex surface in two direction. What are the 2 directions the MCP joints move in? Flexion and extension Medial and lateral rotation

Hand PAthology Tendons _______ finger - avulsion of EDP at DIP resulting in a drop in DIP _______ finger - thickening of (or nodes on) the flexor tendon sheath resulting in tendons sticking as they pass through the A1 pulleys. Most common in MF and RF. Formally known as stenosing tenosynovitis. _______ neck deformity - common in RA, stretching of volar plate to allow PIP extension, pathology of finger flexor apparatus Sprains ________ thumb - forceful hyperextension and abduction at MCP leading to sprain of UCL or fracture or displacement of proximal P1 of thumb Volar plate injuries due to PIP forced hyperextension or forceful ulnar/radial deviation Muscular Muscle wasting or atrophy at the hypothenar eminence, interossei and medial lumbricals due to median nerve damage/compression Muscle loss: intrinsic loss resulting in _________ position of the hand (MP hyperextension and DIP flexion) as the extrinsics overpower. Known as intrinsic minus. Ligament Incomplete injuries at PIP most common. Usually do not result in dislocation due to capsular support

Mallet Trigger Swan Skier's clawed

_____________ - variables may include assessments and instruments used, knowledge and experience of examiner, etc. ____________ - very important to have accuracy in your own skills. also important to make sure your methodology aligns with others with whom you will be sharing info (i.e. fellow practitioners in facility, referring physicians, etc.

Methodology Clinical significance

Both the __________ cord and the ___________ membrane function to transfer force from _______ to Ulna and reinforces proximity of ___________ to Ulna

Oblique Interosseous Radius Radius

________ - distal end moves freely. Examples: person swinging leg while sitting on bench. Bicep curl Typically occurs in one axis when one moving segment, thus isolating the muscles engaged __________ - distal end is stationary (or moves very little). examples: person rises from sit to stand with feet planted throughout the motion. Squats (movement at the knees requires movement at the hips and ankles) Typically involve multiple joints in a kinetic chain Many purposeful activities would be a combination of ______ (i.e. placing grocery items in cabinets)

Open chain Closed chain both

______________: Motion at the joint you can see Observable movements of bones in space (the discussion of how bones and joints move in a plane and around an axis)

Osteokinematic

Extensor intersection syndrome: •___________ of thumb or wrist causing inflammation of _____ and EPL in ______ forearm where they cross each other •Common in weight-lifters and paddlers DeQuervain's tendonitis: •Overuse of thumb or wrist, nicknamed "_______ thumb" •Tendonitis of APL and EPL as they pass through _______ compartment TFCC damage •__________ injury or overextension and rotation of the wrist •Common in sports

Overuse APL upper mommy first FOOSH

Distal Radioulnar Joint Uniaxial _____ joint ___ degree of freedom closed-packed position is 5 degrees of __________ Extremely stable: articular disc, TFCC, interosseous membrane, and pronator quadratus Arthrokinematics: _________ on ___________ (concave ulnar notch of distal radius with convex portion of the head of the ulna); roll and slide in same directions

Pivot 1 supination concave-on-convex

Components of the Hand Arches __________ transverse arch - due to shape of carpal bones with flexor retinaculum as "roof" ________ transverse arch - MCP level ___________ arch—runs from wrist to fingertips with apex along the row of metacarpal heads Clinical significance: weakness or atrophy of intrinsic hand muscles will lead to loss of ________; most notable with median or ulnar nerve damage Palmar arches provide the function of palmar _________, thus enabling the hand to conform to the object being held

Proximal Distal Longitudinal arches cupping

Arthrokinematic Motions: _____ Rolling movement of one joint surface on another New points on one surface come into contact with new points on another surface Example: wheel on the road or shoe on the floor while walking ABduction and ADduction of the Humerus ABduction: Roll is _________, Slide is ___________ ADduction: Roll is __________, Slide is _________ ***Only occurs when the two articulating surfaces are __________

Roll incongruent Superior Inferior Inferior Superior

When the Convex Surface is stationary: the concave joint surface slides in the ______ direction as the bone movement If the concave surface is moving (mobile) on a STATIONAIRY (fixed) convex surface: Glide occurs in _____ direction as Roll ROLL & GLIDE are in the ________ DIRECTION! (ex: MP joints) The more congruent the joint surfaces = the more ______ occurs The more incongruent the joint surfaces = the more ____ occurs

SAME SAME SAME glide roll

Ball and socket - shoulder, hip. Spherical head at the end of one bone fits into and moves within a cup-like concavity in the bone with which it articulates.

Saddle Joint

Plane or gliding - between carpal bones.

Saddle joint

_________________ consists of integrated movements of the glenohumeral, __________, acromioclavicular, and _________ joints occurring in sequential fashion to allow full functional motion of the shoulder complex." 3 Purposes: Allows _______shoulder range of motion (ROM) Allows optimal _______ between humeral head and glenoid fossa Assists in maintaining an optimal ___________ relationship of the GH muscles

Scapulohumeral rhythm scapulothoracic sternoclavicular maximum contact length-tension

Arthrokinematic Motions: _____ "Rotation" of a movable joint surface on the fixed adjacent surface Single point of contact around longitudinal, stationary mechanical axis Example: Top spinning Proximal ________ Joint Atlantoaxial joint Rarely occurs in isolation

Spin Radioulnar

What joints are a part of the shoulder complex?

Sternoclavicular (SC) Acromioclavicular (AC) Scapulothoracic (Gliding Mechanism) Glenohumeral

What bones make up the shoulder?

Sternum Clavicle Scapula Humerus

GH Joint pathology: _____________Syndrome Impingement of the supraspinatus at the acromion process Rotator Cuff Tear _______ is the most commonly torn RC muscle, may be chronic or acute Subluxation/dislocation Most commonly occur in ______ and ______ (anterior/inferior) Adhesive Capsulitis AKA: Frozen Shoulder Capsular ______ (idiopathic (dont know cause) or secondary)

Subacromial Impingement Syndrome Supraspinatus External Rotation Abduction restriction

GH Joint: Rotator Cuff Muscles: (Name the 4) All of the tendons of the RC muscles blend intricately with the _____________ Contraction of the Rotator Cuff results in concavity-___________ Centers the humeral head; important ________ mechanism __________: Muscle action lines contribute to dynamic stabilization of GH joint Tendons of subscapularis, infraspinatus, teres minor pull _________ Supraspinatus pulls ________ Forces offset & pull humeral head into the ______ fossa

Subscapularis Infraspiantus Supraspinatus Teres Minor fibrous capsule compression stabilizing Force Couple inferiorly superiorly glenoid

SC Joint: Image on Slide 6 Elevation: Roll: _________ Slide: __________ Depression: Roll: _________ Slide: _________ Roll and Slide occur in the __________ direction (convex-on-concave) for Elevation and Depression

Superior Inferior Inferior Superior OPPOSITE

____________ Similar to Bursae except smaller Connective tissue sac that surrounds a muscular tendon Located where tendon crosses a joint Contains fluid that smooths movement during muscle contractions and joint movements [3]

Tendon Sheath

______: External force causes joint surfaces to pull apart _______: External force causes the joint surfaces to be pulled together Example: rotator cuff approximates humeral head and glenoid cavity __________: Occur parallel to the joint surfaces and result in a gliding motion at the joint Important concept: Traction assists in joint ______, while Approximation assists with joint _____

Traction Approximation Shear Force mobility stability

SC Joint Pathology Rare Two types: __________ - range from minor dislocation to full subluxation; typically occur during falls, sports-related injuries, or MVA. __________ dislocation is more common than posterior ___________ - arthritis, infection, spontaneous subluxation due to laxity Clinical presentation _________ - c/o swelling and pain, visible "step-off" deformity. In _________ disclocations, more severe sx may be present (pneumothorax, severe swelling, numbness) __________ - c/o pain and swelling that increases with palpation and shoulder abduction; crepitus (OA), bilateral symptoms and other joints affected (RA) Diagnostic Procedures: radiographic evaluation

Traumatic Anterior Atraumatic Traumatic posterior Atraumatic

Cubital Tunnel: Space located on dorsal medial elbow where _______ Nerve passes around the elbow Bordered medially by the _________ epicondyle and laterally by the __________ process Common point of the ulnar nerve entrapment in the UE

Ulnar Medial Olecranon

Associated movements of Scaoulohumeral Rhythm: Scapular _______ Rotation: Shoulder flexion & abduction Scapular ______ Rotation: Shoulder extension & adduction Scapular -_______: Shoulder hyperextensions Scapular __________ (Adduction): Shoulder horizontal abduction Scapular __________(Abduction): Shoulder horizontal adduction

Upward Downward Elevation Retraction Protraction

RCL functions to resist ____ stress AL functions to hold head of radius in the radial notch of the ulna and allow forearm to sup/pro UCL function to resist ______ stress

Varus Valgus

Velocity of Contraction: _________ is proportional to muscle fiber length Muscles with _______ fibers produce greater excursion and velocity As velocity increases, force ___________ Does not indicate that a muscle cannot generate a ______ force at fast speed, as maximum force can also be generated by ________ more muscle fibers Clinical relevance: slow, steady contractions will produce the greatest ______ and allow for more controlled muscle _______

Velocity longer decreases strong recruiting force isolation

SC Joint: Arthrology and Kinematics Closed Packed Position: Arm _________ to 90 degrees Degrees of Freedom: ____ Movements: ___________: Similar to scapular elevation and depression _______________: Strongly associated with scapular protraction/retraction ___________ rotation: Occurs during GH abduction and flexion

abducted 3 Elevation/depression Protraction/retraction Posterior

ROM Assessment of the Hand: Total Active Motion (TAM) Compares tendon excursion (_______) & joint mobility (________) MP + PIP + DIP Flexion minus incomplete active extension Measured while making a fist Used for a single digit Example: MP joint flexion is 85 w/full ext PIP flex is 95 and lacks 20 extension DIP flexion is 65 w/full ext TAM = 85 + 95 + 65 - 20 = 225 Total Passive Motion (TPM) Calculated the same way as TAM, only PROM is used Compare to: Same digit on the opposite hand Subsequent measurements of same digit.

active passive

Psychological/psychosocial Factors: (ROM & Strength) Client participation is essential to ______ movement Understanding client's _______ on means of the limitations, as well as fear of injury/re-injury _______ and stress can cause muscle guarding, tightness in tissues, or inactivity Cognition is a variable as well, with depression, anxiety, or inability to ______ attend to a task all contributing to overall cognitive abilities

active perspective Anxiety cognitively

Pivot

atlantoaxial joint, humeroradial joint. Connection between a ring opening and a component that rotates within it.

SC (Sternoclavicular) Joint Functions: Acts as only bony attachment of the upper extremity (UE) to the _______ skeleton Allows for elevation, depression, protraction and retraction of ________ Axial rotation with shoulder ________ Generally moves with the _________ Allows the scapula to position itself to optimally articulate with humeral ______ Considered the "base of _______" _______ Joint (Double Plane)

axial clavicle elevation scapula head operation Saddle

Skeletal Factors Affecting ROM ROM is facilitated by the shape of the______ and the characteristics of the tissue around the _____ Four types of tissue in the body, each has an impact on ROM: ________ (skin) _________ (fibrous tissues, cartilage, bone). passive element of the musculoskeletal system _______ (striated, unstriated, cardiac) _____ (afferent and efferent) CNS and PNS

bones joint Epithelial Connective Muscle Nervous

Pisotriquetral Joint Separate joint - does not take part in other _______ movements __________ bone forms an articulation in the pisiform with the triquetrum Capable of ________ movement Functions: increase ________ force of FCU (muscle), attachment for _________ carpal ligament Palpable "bump" at proximal ulnar "corner" of palm

carpal Sesamoid slight contraction transverse

Midcarpal Joints Compound articulations between the proximal and distal rows of ______ bones (except for pisiform bone); ______ and ____ motions possible, as well as some ________ Closed-packed position is _______ with ______ deviation Arthrokinematics: Shapes of the carpal bones vary, thus within this compound joint, there are convex-on-concave and concave-on-convex relationships. HOWEVER, on the whole, the joint functions under the ________ on _________ relationship rules; roll and slide is in same direction Due to the movement at the carpal bones, there is __________ ROM produced by only moderate movements of either the radiocarpal or midcarpal joints

carpal flexion ext rotation extension ulnar concave-on-convex significant

Intersection of all 3 planes is

center of gravity (COG) or center of mass (COM)

Environmental Factors (ROM & Strength): Temperature of room, noise level, general environment can affect ______of client and ROM and strength (in testing scenarios) Time of day can affect joint extensibility. For example: Clients with RA general experience greater joint stiffness _____ in the day as compared to later in the morning Clients with MS generally experience greater joint extensibility earlier in the morning as compared to later in the afternoon due to ______

comfort early fatigue

and scapular abduction (protraction) describes

describes movement of the scapula away from the vertebral column

Creases of the Hand Easily to visualize Helpful in _________/"landmarking" Correlate to underlying structures, for example: ________ wrist crease is location of upper margin of flexor retinaculum and midcarpal joint motion Distal ___________ crease of palm lies over heads of 4th and 5th metacarpals Fingers also have named creases: proximal, middle, distal

documentation Distal transverse

Tendinitis: pain and swelling in ______ region, pain and weakness in _________; caused by repeated or excessive use or poor biomechanics Common extensor tendon = ______ epicondylitis or tennis elbow Common flexor tendon = _______ epicondylitis or golfer's elbow

elbow wrist lateral medial

Hinge joint

elbow, knee. Connection between convex and concave surfaces. Moves in flexion and extension.

Synarthrosis (fibrous)

essentially no motion Joined by dense fibrous CT Suture joints of skull syndesmosis joints of the DRUJ, SI joint, interosseous membrane

Distal biceps tendon rupture: overuse or FOOSH with elbow _____ and forearm _______ (can also rupture proximally - look for "Popeye's sign")

ext supination

Intercarpal Joints Articulations between individual bones of the two (proximal and distal) rows. _________ joints, multiaxial Close-packed position is _______ These joints are bound by ligaments and are capable of _________ movements

gliding extension slight

MCP Joint of Thumb Functions: flex/ext of thumb. Joint type: synovial, ________ Closed Packed Position: full ___________ Degrees of Freedom: _______ (though abd/add considered an accessory motion by some authors) Movements: convex head of first metacarpal and concave proximal phalanx of thumb Stability: ulnar and radial collateral ligaments _________.

hinge extension 1 present

Hand Pathology Neurological Peripheral nerve injuries of radial, median, or ulnar nerve or their branches Radial nerve palsy Weakness and pain/tingling in hand, ulnar side>radial side; potential loss of function common in _______ fracture due to radial nerve's course around the distal shaft of humerus Median nerve compression CTS Anterior interosseous nerve syndrome - abnormal "____" sign Ulnar nerve palsy Weakness and pain/tingling in hand, ulnar side>radial side; potential loss of function Complex regional pain syndrome - chronic symptoms (6+ mos) typically following a traumatic injury that exceed the typical pain symptoms of that injury; believed to be a result of ________ and central nerve system dysfunction

humeral OK peripheral

Scaphoid fracture: •Scaphoid may be ______ between capitate and radius •High incidence in young athletes in contact sports •Point tenderness in the anatomical ______ box and hx of hyperextension •Slow healing is common due to poor _______ supply Rheumatoid arthritis: •Commonly effects wrists ____________ •In advanced stages, some or all of the following deformities may present: volar subluxation of triquetrum in relation to ulna, volar displacement of ECU tendon, subluxation of carpals causing __________ deviation Carpal tunnel syndrome: •Typically considered an _________ injury, however, the carpal tunnel can become restricted due to many conditions •Symptoms: numbness/tingling in fingers supplied by _______ nerve, motor weakness with prolonged impingement

impinged snuff blood bilaterally radial overuse median

Flexion and extension occur in what plane?

in sagittal plane

downward rotation

includes downward movement of the glenoid fossa and medial movement of the inferior angle of the scapula

Mobility and stability are ___________ related: the more mobility a joint has, the less stability it has. The less mobility a joint has, the more stability it has. Clinical significance: joints with less stability (_________) are more prone to injury than those with more stability (______)

inversely shoulder Skull

MCP Joints of the Fingers Metacarpals articulate into shallow cavities of the proximal ends of the proximal phalanges (with exception of thumb) Informally: "_________" Functions: __________ of hand to objects and tasks, substantial accessory movement when MCPs are extended (ant/post glide and distraction), significant axial rotation of RF and SF also permitted Joint type: synovial, ________ Closed Packed Position: full __________ Degrees of Freedom: ____ Movements: flex/ext abd/add Rotation Each has a slightly different shape, but generally the concave phalange articulates on the convex metacarpal head; roll and slide in ________ direction Stability- _________ stability is crucial, each joint has fibrous joint capsule (lax in ext., taut in flex.) ________ collateral and ulnar collateral ligaments: each have a cord and accessory palmar ligament (or volar plate): dense, fibrous CT that prevents hyperextension Deep transverse ligaments (3): connect metacarpals 2-3, 3-4, 4-5

knuckles shaping condyloid flexion 3 same mechanical radial

CMC Joints of fingers Articulation of digits 2-5 with the carpal bones, as well as with the adjacent metacarpal bone; all are united by the dorsal, palmar, and interosseous ____________ Functions ROM _________ from radial to ulnar side ________ROM on digits 2 and 3 allows for enhanced function of the radial wrist flexors and extensors can move, thus CMCs of digits 2 and 3 serve as a ________ axis for the 1st, 4th, and 5th metacarpals to move. More ROM on digits 4 (10-15° and 5 (25-30°) allows for hand to curve anteriorly or ________ Joint type: ______ joints, only gliding movements possible Closed Packed Position: fully _______ Degrees of Freedom: 1 -- flex/ext Movements: when metacarpals flex (as with cupping the hand), metacarpals slide on carpals _______, creating increased transverse arch Convex metacarpals on concave carpals - roll and slide in _______ direction Stability: CMC joints are surrounded by fibrous articular capsules and dorsal, palmar, and interosseous ligaments

ligaments increases Less fixed cup plane flexed anteriorly same

Scapular adduction (retraction) describes

movement of the scapula towards the vertebral column,

Planes that do not align with any of the 3 cardinal planes

oblique planes

Design of intervention and HEPs Shoulder: Historically _____ chain Easy to administer & most athletic or functional tasks involve open chain movement of the UE Research has shown that _____ chain can be more beneficial (initially): Emphasize co-contraction forces around the scapula and GH joint Allow the Rotator Cuff to work as a "_________ cuff" Require grading, co-coordination, sequential muscle activation, and proprioceptive feedback Early Shoulder Rehab: _______ chain exercises are less desirable because they cause a greater shear force and require greater ROM Combining scapular stabilization & _______ chain exercises provides a stable base and RC strength necessary to advance to ______ chain exercises (Hyde 2007)

open closed compressed Open closed open

When the concave surface is stationary: the glide occurs in the _________ direction as the bone movement If the convex surface is moving (mobile) on a stationary (fixed) concave surface: Glide occurs in opposite direction as ______ ROLL & GLIDE occur in the _________ directions. (ex shoulder)

opposite Roll opposite

Transverse (aka horizontal)

oriented horizontally, divides body into upper and lower sections, movements are typically rotational Examples: turning head from side to side, twisting at the waist, internal and external rotation of the upper and lower extremities while in anat position

Sagittal

oriented vertically, extends front to back and divides the body into right and left sides, movements are anterior-posterior or posterior-anterior Examples: flexion and extension of trunk, flex/ext of shoulder, elbow, wrist, fingers while in anat position

Frontal (aka Coronal

oriented vertically, extends side to side and divides body into front and back, movements in this plane are right-left or left-right Examples: moving in trunk in a side-to-side fashion, abduction and adduction of the shoulders and hips

Pronation

palm down (posterior

supination

palm up (anterior)

Intermetacarpal Joints Functions: 4 proximal intermetacarpal joints as metacarpals articulate with one another at their bases and three distal intermetacarpal joints as metacarpals 2-5 articulate with eachother at their metacarpal heads Joint type: synovial _________ Movements: slight nonaxial ________ motions. First and fifth are most ________

plane gliding mobile

Acromioclavicular Joint (AC) Degrees of Freedom: 3 Allows scapula "freedom to fine-tune its ________ on the thorax" _________ Position: Arm abducted to 90 degrees Movements: Upward/downward _________ _________ plane: "rotational adjustment" ______ plane: "rotational adjustment"

position Closed Packed rotation Transverse Sagittal

Muscular factors affecting strength: Angle of pull A muscle's action is dependent on its line of ______ relevant to the _____ it crosses Fibers can be oriented in any of the ____ planes, or in multiple planes Muscles with fibers in one plane (i.e. brachialis) produce _____ movement (elbow flexion) Muscles with fibers in multiple planes (i.e. Flexor Carpi Ulnaris) produce _______ movements (sagittal plane - elbow flexion; frontal plane - ulnar deviation)

pull joint 3 one multiple

TFCC Components of the TFCC: _________ articulating disc (triangular fibrocartilage), meniscus homolog (lunocarpal), and ulnocarpal ligament (consisting of the ulnolunate and ulnotriquetral ligaments), dorsal and volar radioulnar ligaments, and ECU sheath Functions as a major __________ of the DRUJ and contributes to __________ stability ________ portions prevent dorsal displacement of ulna and are taut in _________ _________ portions prevent volar displacement of the ulna and are tight in supination

radioulnar stabilizer ulnocarpal Volar pronation Dorsal

Length of Muscle: A muscle is capable of generating max force at/near _______ length _______ - moderate tension _________ - minimal tension (max # of cross-bridges formed, no additional tension available) Clinical relevance: development of strengthening programs, stretching of muscles and soft tissues

resting Lengthened Shortened

Horizontal abduction and adduction

shoulder movements in the transverse plane

Amphiarthrosis (cartilaginous)

slight motion Joined by fibrocartilage or hyaline cartilage Symphysis joints of the manubrioalsternal joint, intervertebral discs Synchondrosis joints of the physeal plate (growth plate) and sphenooccipital joint. These are replaced with bony union when skeletal maturity is reached.

Bones and Joints of the Hand Bones Metacarpals - first-fifth Phalanges Proximal - first-fifth Middle - second-fifth (not in _________) Distal - first-fifth Joints Carpometacarpal joints of the fingers Carpometacarpal joint of thumb Metacarpophalangeal joints of the fingers Metacarpophalangeal joint of the thumb Interphalangeal joints Intermetacarpal joints Applies to both Metacarpals & Digits: Digit 1 (I): Thumb Digit 2 (II): Index Finger (IF) Digit 3 (III): ______ Finger (MF) Digit 4 (IV) ______ Finger (RF) Digit 5 (V): ______ Finger (SF)

thumb Middle Ring Small

Pronation and supination of the forearm refers to rotation of the forearm in the

transverse plane around the vertical axis of the arm

Rotation of head, neck, trunk, or pelvis

transverse plane. Described by R or L rotation. Also described at CW or CCW rotation.

CMC Joint of Thumb Articulation is formed by the ___________ and base of the first metacarpal Functions: reach, grasp, pinch, etc. involved in almost all prehensile patterns; loss of thumb at any level has an effect on a person's ________ ability that is disproportionate to it's small size. The thumb is so valuable to function that, in it's absence or malformation, the IF will be moved to the thumb position in a process called ____________ Joint type: _________, saddle Closed Packed Position: full ___________ Degrees of Freedom: _________ Movements: many movements, thumb has own "movement vocabulary," see below. Circumduction is also available and is a combination of abd/flex/add/ext. In flex/ext: convex trapezium articulates on concave metacarpal; roll and slide are in __________ direction In abd/add: concave trapezium articulates on convex metacarpal; roll and slide in ____________ directions

trapezium functional pollicization synovial opposition 3 same opposite

Interosseous Membrane Connects ______ and ______ "The IOM serves several important biomechanical functions. Transmits load from the ____ to the _____ Transfers load from the _____ to the _____ Maintains forearm stability Helps maintain DRUJ stability" [1]

ulna and radius wrist to elbow radius to ulna

Cubital tunnel syndrome (CBTS): ________ nerve entrapment Second most common compression neuropathy (CTS is first) Uncomfortable and limiting to function; in extreme cases can lead to loss of function in the hand Pain or parasthesia in the fourth or fifth finger and pain in the ________ elbow Risk factors: overhead throwing, work which involves prolonged periods of elbow flexion

ulnar medial

Elevation and depression of the scapula describes the

upward and downward movement of the scapula

Upward rotation of the scapula is described as

upward movement of the glenoid fossa and lateral movement of the inferior angle of the scapula;

Radiocarpal Joint Commonly referred to as the ______ Biaxial _______ and synovial joint, ___ degrees freedom (wrist flex/ext, wrist radial and ulnar deviation; also - circumduction, a combination of all four movements) closed-packed position is wrist ______ with slight _____ deviation Arthrokinematics:_________ on ___________ (convex carpals on concave radius); roll and slide is in opposite directions The joint itself is formed by the radius and radioulnar disc (TFCC) proximally and by the scaphoid, lunate, and triquetrum distally

wrist condyloid 2 extension ulnar convex-on-concave