UE Kinesiology Combo
Sternocleidomastoid (SCM)
ACTION: -When lying down - flexes neck (gravity does it otherwise) -Contralateral rotation (bulges out) -Ipsilateral flexion -Extends neck at AO joint -Acts as accessory muscle of respiration (elevating sternum and clavicle
7. Abductor Pollicis Longus
ACTION: Abducts thumb and extends it at carpometacarpal joint PROX: Posterior surfaces of ulna, radius and interosseous membrane DISTAL: Base of 1st metacarpal INNERVATION: Posterior interosseous nerve, continuation of deep branch of radial nerve
Rhomboids (82TG)
ACTION: Adduct, elevate and downwardly rotate scapula. ORIGIN: Minor: Nuchal ligament and spinous processes of C7/T1 Major: Spinous processes of T2-T5. INSERTION: Medial border of scapula from level spine of inferior angle. Rhomboid major: Thin and flat. 2x wider than minor. Superiorly located.
Teres Major (71TG)
ACTION: Adducts and medially rotates arm (IR). ORIGIN: Dorsal surface of inferior angle of scapula INSERTION: Medial lip of intertobercular groove of humerus INNERVATION: Lower subscapular nerve (C6/C7) Important stabilizer of humeral head in glenoid cavity. Teres minor and major hold humeral head in place against pull of deltoid during abduction.
Pectoralis Major (411)
ACTION: Adducts and medially rotates humerus, flexes shoulder, Proximal: Clavicular head- Anterior surface of medial half of clavicle Sternocostal head- Anterior surface of sternum, superior 6 costal cartilage and aponeurosis of external oblique muscle Distal: Lateral lip of intertubercular groove of humerus Innervation: C5-T1 (Lateral and medial pectoral nerves; clavicular head)
Deltoid (67TG)
ACTION: Anterior-flexion, horizontal adduction, weak IR middle-abducts arm, posterior-helps lat extend arm and laterally rotates arm Acts as a shunt muscle - resisting inferior displacement of head of humerus from glenoid cavity or when lifting heavy suitcases. First 15 degrees of abduction assisted by supraspinatus** ORIGIN: Lateral third of clavicle, acromion, and spine of scapula INSERTION: Deltoid tuberosity INNERVATION: Axillary nerve (C5/C6)
2. Anconeus (139TG)
ACTION: Assists triceps in extension of forearm *More stability for RU joint. Pulls capsule out of way at full extension. ORIGIN: Lateral epicondyle of humerus INSERTION: Lateral surface of olecranon and superior part of posterior surface of ulna INNERVATION: Radial Nerve (C7, C8, T1)
Rectus Capitis Posterior Major
ACTION: Bilaterally extends head, unilaterally - ipsilateral rotation ARISE: SP of C2 ATTACH: Inferior nuchal line (lateral) of occipital bone DOESN'T CROSS AA JOINT
Rectus Capitis Post Minor
ACTION: Bilaterally extends head, unilaterally- ipsilateral rotation ARISE: Tubercle of SP on Atlas (C1) ATTACH: Medial inferior nuchal line
1. Triceps Brachii (97TG)
ACTION: Chief extensor of elbow. ORIGIN: Long head: Infraglendoid tubercle of scapula (only one that stabilizes head - shunt muscle) Lateral head: Posterior surface of humerus, superior to radial groove Medial head: Posterior surface of humerus, inferior to radial groove INSERTION: Proximal end of olecranon process of ulna and fascia of forearm INNERVATION: Radial Nerve (C6-C8)
Oblique Capitis Inferior
ACTION: Contributes to rotation of head ARISE: Posterior tubercle of C2 (axis) ATTACH: TP of C1 *DOESN'T ATTACH TO HEAD
Pectoralis Minor (412)
ACTION: Depress downward rotation, a little protraction (stabilizes scapula by drawing inferiorly and anteriorly against thoracic wall) Proximal: 3rd-5th ribs near costal cartilages Distal: Medial border and superior surface of coracoid process
Subclavius (406, 412)
ACTION: Depresses clavicle/Downward rotation (Stabilizes SC joint) Proximal: Junction of 1st rib and costal cartilage Distal: Inferior surface of middle third of clavicle Innervation: C5-C6 (nerve to subclavius)
Interossei
ACTION: Dorsal 1-4: Abduct digits from axial line, and act with lumbricals to flex MCP joints and extend IP joints PROXIMAL: Dorsal 1-4: adjacent sides of 2 metacarpals (bipennate muscle) Palmar 1-3: Palmar surfaces of 2nd, 4th and 5th metacarpals (unipennate muscles) DISTAL: Dorsal 1-4: Extensor expansions and bases of proximal phalanges 2-4 Palmar 1-3: Extensor expansions of digits and bases of proximal phalanges of digits 2, 4 and 5. Palmar 1-3: Adduct toward axial line and assist lumbricals in flexing and extending. INNERVATION: Ulnar Nerve - Deep Branch TEST: Dorsal - Abduct fingers against resistance Palmar: Adduct fingers to keep paper between fingers.
Trapezius (168, 68TG)
ACTION: Elevates, retracts and rotates scapula; superior fibers elevate, middle fibers retract, inferior fibers help in superior rotation of scapula. ORIGIN: Medial third of superior nuchal line; EOP (external occipital protuberance), nuchal ligament and spinous process of C7-T12 INSERTION: Lateral third of clavicle, acromion, and spine of scapula
2. Extensor Carpi Radialis Brevis
ACTION: Extend and abduct hand at wrist joint PROX: Lateral epicondyle DISTAL: Base of 3rd metacarpal INNERVATION: Deep branch of radial nerve -Covered by ECRL. -Acts with ECRL to stead wrist dusting flexion of 4 digits.
1. Extensor Carpi Radialis Longus (ECRL) (135TG, 432N)
ACTION: Extend and abduct hand at wrist joint PROX: Lateral supracondylar ridge of humerus DISTAL: Base of 2nd metacarpal INNERVATION: Radial nerve -Indespensible when clenching fist (along with ECU)
5. Extensor Indicis
ACTION: Extends 2nd digit and helps to extend hand PROX: Posterior surface of ulna and interosseous membrane DISTAL: Extensor expansion of 2nd digit INNERVATION: Posterior interosseous nerve, continuation of deep branch of radial nerve -Can act alone or together with extensor digitorum to extend index finger (pointing).
6. Extensor Digiti Minimi
ACTION: Extends 5th digit at metacarpophalangeal and interphalangeal joints Medial portion of Extensor Digitorum. PROX: Lateral epicondyle of humerus DISTAL: Extensor expansion of 5th digit INNERVATION: Posterior interosseous nerve, continuation of deep branch of radial nerve
3. Extensor Carpi Ulnaris
ACTION: Extends and adducts hand at wrist joint PROX: Lateral epicondyle and posterior border of ulna DISTAL: Base of 5th metacarpal INNERVATION: Posterior interosseous nerve, continuation of deep branch of radial nerve
7. Extensor Pollicis Longus
ACTION: Extends distal phalanx of thumb at carpometacarpal and interphalangeal joints PROX: Posterior surface of middle 1/3 of ulna and interosseous membrane DISTAL: Base of distal phalanx of thumb INNERVATION: Posterior interosseous nerve, continueation of deep branch of radial nerve
4. Extensor Digitorum
ACTION: Extends medial 4 digits at metacarpophalangeal joints (principal extensor); extends hand at wrist joint PROX: Lateral epicondyle DISTAL: Extensor expansions of medial 4 digits INNERVATION: Posterior interosseous nerve, continuation of deep branch of radial nerve
Latissimus Dorsi (71TG)
ACTION: Extends, adducts and IR, GH depression, downward rotator of scapula ORIGIN: SP T7-L5, thoracolumbar fascia and iliac crest INSERTION: Intertubercular groove of humerus INNERVATION: Thoracodorsal nerve (C6-C8)
Oblique Capitis Superior
ACTION: Extension of head, lateral flexion ARISE: TP of C1 ATTACH: Occipital bone between superior and inferior nuchal lines
Coracobrachialis (99TG)
ACTION: Flex and adduct arm ORIGIN: Tip of coracoid process (in name) INSERTION: Middle third of medial surface of humerus INNERVATION: Musculocutaneous Nerve (C5/C6)
Lumbricals
ACTION: Flex digits at MCP joints and extend at IP joints PROXIMAL: 1-2 Lumbricals: Lateral 2 tendons of flexor digitorum profundus (unipennate muscle) 3-4 Lumbricals: Medial 3 tendons of flexor digitorum profundus (bipennate muscle) DISTAL: Lateral sids of extensor expansions of digits 2-5 INNERVATION**: Lumbricals 1-2: Median nerve Lumbricals 3-4: Ulnar nerve TEST: Flex MP joints while keeping IP joints extended against resistance.
Longus Capitis
ACTION: Flex head at AO joint, Lateral flexion SUPERIOR: Basilar aspect of occipital bone, anterior to occipital condyle INFERIOR: Anterior tubercles of TP C3-C6
1. Flexor Carpi Radialis (430N)
ACTION: Flexes (with flexor carpi ulnaris) and abducts hand (with extensor carpi radialis longus and extensor carpi radialis brevis) ORIGIN: Medial epicondyle INSERTION: Base of 2nd metacarpal INNERVATION: Median nerve
2. Flexor Carpi Ulnaris (430N)
ACTION: Flexes and adducts hand (simultaneously) ORIGIN: Humeral head: medial epicondyle Ulnar head: olecranon and posterior border INSERTION: Pisiform bone, hook of hamate and 5th metacarpal INNERVATION: Ulnar nerve** (exception to flexor-pronators innervated by median nerve)
4. Flexor Digitorum Profundus (431N)
ACTION: Flexes distal phalanges at distal interphalangeal joints; assists with flexion of hand ORIGIN: 3/4 of medial and anterior surfaces of ulna and interosseous membrane INSERTION: Base of distal phalanges of medial four digits (2-5) INNERVATION: Medial part- Ulnar nerve** (1/2 - digits 4/5) Lateral part- Median nerve (digits 2/3)
3. Brachioradialis
ACTION: Flexes elbow (NOT WRIST) *Mainly shunt muscle* PROX: Prox 2/3 of lateral supracondyle ridge of humerus DISTAL: Lateral surface of distal end of radius INNERVATION: Radial nerve
3. Palmaris Longus (430N)
ACTION: Flexes hand and tightens palmar aponeurosis ORIGIN: Medial epicondyle INSERTION: Distal half of flexor retinaculum and palmar aponeurosis INNERVATION: Median nerve -14% of people don't have it.
Rectus Capitis Anterior
ACTION: Flexes head at AO joint SUPERIOR: Base of skull, naterior to occipital condyle INFERIOR: TP of C1?
Rectus Capitis Lateralis
ACTION: Flexes head, lateral flexion, stabilize SUPERIOR: Superior Jugular process of occipital bone INFERIOR: TP of C1
5. Flexor Digitorum Superficialis (431N)
ACTION: Flexes middle phalanges (not distal*), also flexes proximal phalanges at metacarpophalangeal joints and hand. ORIGIN: Humoulnar head- medial epicondyle, ulnar collateral ligament, coronoid process Radial head- Superior half of anterior border radius INSERTION: Bodies of middle phalanges of medial 4 digits (2-5) INNERVATION: Median nerve -Largest superficial muscle in forearm
6. Flexor Pollicis Longus (431N)
ACTION: Flexes phalanges of thumb (only one that flexes thumb) ORIGIN: Anterior surface of radius and adjacent to interosseous membrane INSERTION: Base of distal phalanx of thumb INNERVATION: Anterior interosseous nerve from median nerve.
Supraspinatus (75TG)
ACTION: Initiates/assists deltoid with abduction, stabilize head of humerus ORIGIN: Supraspinous fossa INSERTION: Superior facet on greater tuberosity of humerus INNERVATION: Suprascapular nerve (C4-C6)
Infraspinatus (75TG)
ACTION: Laterally rotate arm (ER), stabilize head of humerus ORIGIN: Infraspinous fossa of scapula INSERTION: Middle facet on greater tuberosity INNERVATION: Suprascapular (C5/C6)
Teres Minor
ACTION: Laterally rotate arm (ER); stabilizes head of humerus. ORIGIN: Superior part of lateral border of scapula INSERTION: Inferior facet on greater tuberosity of humerus INNERVATION: Axillary nerve (C5/C6) - along with deltoid. -Completely hidden by deltoid.
2. Brachialis (132TG)
ACTION: Major flexor of forearm ORIGIN: Distal half of anterior surface of humerus INSERTION: Coronoid process and ulnar tuberosity INNERVATION: Musculocutaneous Nerve (C5/C6) -Steadies eccentric movement from flexed to extended. -Lies posterior to biceps brachii.
Subscapularis
ACTION: Medially rotates arm (IR), stabilizes head of humerus. ORIGIN: Subscapular fossa INSERTION: Lesser tuberosity of humerus INNERVATION: Upper and lower subscapular nerves (C5-C7)
Longus Colli
ACTION: Neck flexion and rotation (contralateral rotation) SUPERIOR: Anterior tubercle C1, bodies C1-C3, TPs of C3-C6 INFERIOR: Bodies of C5-T3 NO SKULL ATTACHMENT
Splenius Capitis (203TG)
ACTION: Rotate, laterally flex and extend head/neck PROXIMAL: Inferior 1/2 of nuchal ligament and SP of C7-T4 DISTAL: Mastoid process and lateral portion of superior nucal line. INNERVATION: Dorsal rami of spinal nerve
Splenius Cervicis (203TG)
ACTION: Rotate, laterally flex and extend head/neck PROXIMAL: Spinous processes of T3-T6 DISTAL: Transverse processes of C1-C3 INNERVATION: Dorsal rami of spinal nerve DOESN'T CROSS AO JOINT
Anterior/Middle/Posterior Scalenes
ANTERIOR -Elevate 1st rib with deep breath -Lateral neck flexion -Rotation MIDDLE Elevate 1st rib POSTERIOR -Elevate 2nd rib with inhalation -Lateral neck flexion ALL SUPPORT CERVICAL SPINE
Active/Passive Insufficiency
Active insufficiency: Simultaneously shortened over joints it is acting on EXAMPLE: Biceps - flex at elbow and shoulder Passive insufficiency: Simultaneously lengthened over joints it's acting on. EXAMPLE: Biceps - extend at elbow and shoulder
4. Glenohumeral Joint
Ball and socket synovial joint MOTIONS: 1. Flexion (180) / Extension (45-60) in x axis/sagittal 2. Abduction/Adduction (180) z-axis/frontal 3. IR (70) / ER (90) y axis/transverse 4. Horizontal adduction (140) / Horizontal abduction (45) y axis/transverse - arm up at 90 degrees and move forward/backward Articulation: Large head of humerus and smaller glenoid fossa.
1st CMC Joint
Biaxial plus joint, Saddle joint 1. Abduction/Adduction in sagittal plane around x axis -Convex on concave 2. Flexion/Extension in frontal plane around z axis -Concave on convex Opposition/Reposition
1. Synarthrodial Joints
Bones connected by either fibrous or cartilaginous connective tissue. NEARLY IMMOVABLE Fibrous joints: Sutures - in skull Gomphoses - peg in a hole (tooth into mandible) Syndesmoses - 2 bones joined by ligament, fibrous cord or aponeurotic membrane (tibia and fibula connected by interosseous membrane)
Wrist Complex
Both complex (has disk) and compound (radius, ulna and carpal bones) Consists of 2 compound joints: 1. Radiocarpal joints 2. Midcarpal joints Varies tremendously person to person Subtle variations = big differences Biaxial: 1. Extension/Flexion in sagittal plane around x axis (60-85°) 2. Ulnar/Radial Deviation in frontal plane around z axis (20-45° / 15-21°)
Synergy: Deltoid/RC Muscles
Deltoid raises shoulder RC muscles hold and steer shoulder down
Example of Solving for Torque
Diane abducts the shoulder to 90 degrees. Her arm weighs 10 lbs (with COG at 7" from shoulder). She is holding a 2 lb weight which is 15" from the shoulder. The abductor muscle inserts at a 20 degree angle 3" from the shoulder joint. Calculate: 1. External torque 2. Internal Torque 3. Rotary Force 4. Total Force 5. Stabilizing Force
Temporomandibular Joint
Diarthrodial Modified hinge joint Articulation of condyle of mandible and eminence of temporal bone. Contains biconcave disc NORMAL ADULT: 2-3 IP at full opening
Muscle Movement
Elevation (closing) = Temporalis, masseter and medial pterygoid Depression (opening) = Suprahyoid muscles + Lateral Pterygoid
3. Diarthrodial (Synovial) Joints
Ends of bones free to move in relation to one another because no CT directly connects them. They are indirectly connected by joint capsule that encloses joint. FREELY MOVEABLE 1. Joint capsule composed of 2 layers 2. Joint cavity enclosed in capsule 3. Synovial tissue that lines inner surface of capsule 4. Synovial fluid that forms film over joint surfaces 5. Hyaline cartilage that covers surfaces of bones
Open Packed vs. Closed Packed Position
Close-Packed - Joint surfaces are maximally congruent and ligaments and capsule are maximally taut. Usually at extreme end of ROM. Greatest stability and least amount of joint play Open-Packed - Most amount of joint play possible
1. Radiocarpal joints
Formed by: -Radius -Radioulnar disc -Scaphoid, Lunate and Triquetrium
3. Hyaline (articular) cartilage
Forms relatively thin covering on ends of bones in SYNOVIAL JOINTS. -Provides low-friction surface that can distribute weight. AVASCULAR -When loaded, fluid released and when fluid flows back it carries nutrients from synovial fluid that supply chondrocytes (only source of nourishment)
2. Elastic cartilage (Yellow)
Found in ears and epiglottis. Has more elastin than white fibrocartilage
Transverse Ligament of the Atlas (23)
Posterior aspect holding dens against anterior arch of atlas. Alar ligaments run from dens to lateral mardins of foramen magnum. -Provide restriction of excessive rotation of head. -Combined flexion/rotation may tear alar ligaments.
2. Midcarpal joints
Proximal carpals and distal carpals (NOT pisiform)
Calculating Torque
R = weight of forearm Ra = distance from joint W = weight of weight being lifted Wa = Distance of weight from joint Fr = rotary force Fa = Distance of muscle insertion from joint External torque = (R x ra)+ (W x Wa) Internal torque = (Fr x Fa) Can set these 2 equal to each other to solve
Joint Excursion?
ROM Goniometer Angles PROM AAROM AROM Resisted ROM>
MCP Joint Ligaments
Radial and Ulnar ligaments of MCP joints composed of 2 parts: 1. Collateral ligament proper (loose in extension) 2. Accessory collateral ligament (loose in flexion)
Synergy: Scapular Downward rotation
Rhomboids Levator Scapula Pectoralis Minor Latissimus Dorsi
Synergy: Rhomboids/Teres Major
Rhomboids/Teres Major stabilize against upward rotation of scapula
1. Fibrocartilage (white)
Little motion -IV discs -glenoid and acetabular labra -TMJ -SI joint
2. Amphiarthrodial Joints
SLIGHTLY MOVEABLE Cartilaginous Joints: -Symphyses - covered by hyaline cartilage and joined by fibrocartilage in form of discs or pads (IV joints, manubrium/sternum, pubis) -Synchondroses - Connected by hyaline cartilage between 2 ossifying centers.
TMJ Muscles (Secondary)
SUPRAHYOID = Digastric, Mylohyoid, Geniohyoid and Stylohyoid INFRAHYOID = Omohyoid, Sternohyoid, Sternothyroid and Thyrohyoid
Synergy: Thumb
Need FCU and ECU to contract to prevent radial deviation
Carrying Angle
Normal is 5-15°. Excessive = Cubital Valgus.
4. Pronator Teres (428N)
ORIGIN: Medial epicondyle of humerus and coronoid process of ulna INSERTION: Middle/Lateral surface of radius ACTION: Pronates and flexes elbow INNERVATION: Median nerve (C6/C7)
C2 (Axis) (19)
Odontoid process is pivot. Dens has anterior facet that articulates with facet of anterior arch of atlas. Dens has groove containing a posterior facet which articulates with transverse ligament of atlas. Facets covered by hyaline cartilage.
Kinematic Chain (open vs. closed)
Open - distal part of extremity free to move Closed - Distal part of extremity fixed
Joint Degrees of Freedom (Synovial Joints)
UNIAXIAL: One plane around one single axis -Hinge Joints - Elbow -Pivot Joints - Atlanto-axial joint BIAXIAL: 2 planes around 2 axes -Condyloid Joints - Concave/Convex surfaces (MCP joint) -Saddle Joints - Convex in one plane, concave in the other (CMC joint) TRIAXIAL/MULTIAXIAL: 3 planes, 3 axes -Plane Joints - Permit gliding between bones (Carpal bones) -Ball & Socket Joints - Ball-like convex surface on concave socket (GH joint)
Statics and Dynamic Support of Shoulder Girdle
Upper Trapezius - holds up against gravity Supraspinatus - Holds up glenohumeral head Shoulder subluxation - means more subhumeral space
Synergy: Deltoid/Upper Trapezius
Upper Trapezius prevents depression of shoulder girdle Deltoid raises shoulder
Sternoclavicular Disc
Upper portion of disc attached to posterosuperior clavicle and lower portion to manubrium and first costal cartilage. During elevation, disc acts like hinge/pivot point for medial end of clavicle
Ligaments of Wrist Complex
VOLAR (Palmar) = thicker/strong -Radiotriquetrium -Radiocapitate -Ulolunate -Ulnocapitate DORSAL = Thin/weaker -Radiolunate -Radiotriquetrium (doubled???) COLLATERAL -Radial collateral (scaphoid) -Ulnar collateral (triquetrium, pisiform, 5th MC) Extrinsic ligaments - Connect carpals to radius/ulna proximally or metacarpals distally Intrinsic ligaments - Connect carpals to themselves.
Joint Capsule (90)
Vary depending on forces Shoulder = thin, loose and redundant (mobility over stability) Hip = thick, dense (stability over mobility) Composed of 2 layers 1. Startum fibrosum (outer layer) - aka fibrous capsule composed largely of dense fibrous tissue. Poorly vascularized but richly innervated by joint receptors 2. Statum synovium (inner layer) - Lining tissue. Composed of 2 layers: intima (layer of cells that lines joint space) and subsynovial tissue (highly vascularized fibrous CT).
Synergy: Finger flexors
Wrist extensors provide stabilization to prevent active insufficiency
4. Synergy
Wrist flexion but not flexion at IP joints - Recruit extensors (lumbricals, ED)
Motion of RU Joint
Supination/Pronation in Transverse plane around y axis Measure with elbow flexed at 90° to limit shoulder motion. Supination = 90° Pronation = 80° Radial head spins in radial notch of ulna Ulnar notch moves on ulnar head ADL - keys, tools.
Glenoid Labrum
Surrounds and is attached to periphery of glenoid fossa. -Enhances depth of concavity by approx. 50%. Consists of densely packed fibrous CT covered by mesh consistent with cartilaginous tissue. PURPOSE: 1. Resist humeral head translations 2. Protection of bony edges of labrum 3. Reduction of joint friction 4. Dissipation of joint contact forces Serves as attachment site for glenohumeral ligaments and long head of biceps brachii.
Torque
Torque = Force x Distance Distance = Moment Arm (MA)
MOTION: Translatory / Rotary
Translatory - movement of segment in straight line. Pure translatory motions rare. CLOSEST EXAMPLE: Anterior drawer test - tibia moves straight forward. Rotary - Movement of segment around a fixed axis in a curved path. DOESN'T HAPPEN - None of body segments move around truly fixed axe. All joints shift at least slightly during motion because segments aren't sufficiently constrained to produce pure rotation.
Motions of Sternoclavicular Joint
Triplanar joint 1. Elevation / Depression, in frontal plane around z axis (Average: 48° / 15°) 2. Protraction / Retraction, in transverse plane around y axis (20° / 30°) 3. Anterior/Posterior Rotation, in sagittal plane around x axis (10° / 50°)
Motions of Acromioclavicular Joint
Triplanar joint 1. Internal (medial) / External (lateral) Rotation - transverse plane, y axis (30° combined) 2. Anterior / Posterior Tipping - sagittal plane, x axis (20-40°) - prevents inferior angle from hitting ribs during ER 3. Upward / Downward Rotation - frontal plane, z axis (30° / 17°) MOVEMENT ORIENTED TO PLANE OF SCAPULA
Movement at Elbow Joint
Trochlear groove spirals obliquely around trochlea and divides it into medial and lateral portions. Medial portion projects distally more than lateral portion = valgus angulation called CARRYING ANGLE. FULL FLEXION (150°) Coronoid fossa receives Coronoid Process Radial Fossa receives Rim of radial head FULL EXTENSION (Hyperextension = 10°) Olecranon Fossa receives Olecranon Process
Role of Muscles
-Agonist: Most responsible for movement -Antagonist: opposes movement -Synergist: Contributes to movement but not primary mover -Spurt: Designed for mobility. Typically insertion close to joint axis (greater rotary component - biceps brachii) -Shunt: Stabilizer. Insertion further from joint. (greater stabilizing component - brachioradialis)
Lever Systems
-Based on where axis is...(37?)
First-Class Lever System
-Effort arm may be greater than resistance arm, smaller than RA or equal to RA, as long as they are on opposite sides of the lever axis. INFREQUENT Fulcrum in the middle EXAMPLE: AO Joint is pivot, Weight of head is resistance, Neck muscles provide effort
Characteristics of Muscle (109)
-Excitability -Contractility -Extensibility
Muscle Orientation
-Fusiform (longitudinal) muscle - fibers longer but cross-sectional area less - allows for further movement (sartorius) -Pennate - fibers shorter but cross-sectional area greater - allows for more power (deltoid = multipennate)
Types of Prehension
-Power grip - in palm of hands -Precision handling - between fingers
Distal RU Joint
-Ulnar notch of radius -Articular disc -Head of Ulna
2 Characteristics for Muscle Function
1. Muscle fiber length 2. Physiological Cross-Sectional Area (PCSA)
Ligaments of Acromioclavicular Joint
1. Superior Acromioclavicular ligament - limits movement from anterior forces 2. Inferior Acromioclavicular ligament 3. Coracoclavicular ligament - unites clavicle and scapula and provides inferior stability DIVIDED into Conoid ligament (medial portion and more vertically oriented) and Trapezoid ligament (lateral portion - nearly horizontally oriented.)
Primary Wrist Extensors
1. ECRL 2. ECRB 3. ECU 4. ED 5. EI 6. EDM 7. EPL
Math (look at drawing too)
1. External torque = (R x ra)+ (W x Wa) (10 x 7) + (2 x 15) = 100 2. Internal torque = (Fr x Fa) 3. SET External and Internal equal to each other 100 = Fr x 3 Fr = 33.333 lbs 4. Total force -> Sin(angle) = Fr/Ft Sin20 = 33.333/Ft Ft = 97.9 lbs 5. Cos(angle) = Fs/Ft Cos(20) = Fs/97.9 Fs = 92 lbs
Radial Deviators
1. FCR 2. ECRL 3. ECRB 4. FPL 5. EPL 6. EPB 7. ABPL
Primary Wrist Flexors
1. FCR 2. FCU 3. Palmaris Longus 4. FDP 5. FDS 6. FPL 7. ABPL
Ulnar Deviators
1. FCU 2. ECU 3. EDM
Atlanto-axial Joint (AA) (23)
3 articulations: 2 lateral atlanto-axial joints= facets of C1/C2 (synovial) 1 median atlanto-axial joint (pivot joint) 50-70% of C-spine motion comes from AO and AA
Internal/External Forces
??
1. Supinator
ACTION: Prime mover in supination of forearm (for slow, unopposed. Otherwise biceps more powerful) PROX: Lateral epicondyle, radial collateral and annular ligaments, supinator fossa and crest of ulna DISTAL: Lateral, posterior and anterior surfaces of proximal 1/3 of radius *Can isolate w/ elbow extension or flexion (eliminates biceps) INNERVATION: Deep branch of radial nerve
1. Pronator Quadratus
ACTION: Pronates forearm at radioulnar joints; deep fibers bind radius/ulna together TEST: Pronation with fully flexed or extended elbow PROX: Distal fourth of anterior surface of ulna DISTAL: Distal fourth of anterior surface of radius
Serratus Anterior (412) "Boxer's Muscle"
ACTION: Protracts scapula (upward rotation) and holds it against thoracic wall; rotates scapula (prevents winging - push-up test) Proximal: External surfaces of lateral parts of 1-8 ribs Distal: Anterior surface of medial border of scapula Innervation: C5-C7 (Long thoracic nerve)
1. Biceps Brachii (95TG)
ACTION: Supinates forearm and then flexes forearm ORIGIN: Short head (medial): Coracoid process Long head (lateral): Supraglenoid tubercle of scapula INSERTION: Tuberosity of radius and forearm via aponeurosis of biceps brachii (distributes weight - lessens pressure on tendon) INNERVATION: Musculocutaneous nerve (C5/C6)
Levator Scapulae (83TG)
ACTION: Elevates scapula and tilts glenoid cavity inferiorly by downwardly rotating scapula, (flexes neck laterally, rotates head) ORIGIN: Posterior tubercles of transverse process of C1-C4 INSERTION: Superior part of medial border of scapula
Scapulohumeral Rhythm
Combination of movement from glenohumeral joint and scapulothoracic in a ratio of 2/1. 90° abduction =60° from glenohumeral and 30° from scapulothoracic motion. During this process, AC joint = 25°, SC joint = 5°
Ligament (74)
Connect one bone to another (usually near joint). -Often blend with joint capsule and make it appear thicker. Composed of: -10-20% cells (mainly fibroblasts) -80-90% extracellular matrix (mainly type I collagen). Collagen fibers run in many directions allowing resistance in multiple directions.
1. Medial (Ulnar) Collateral Ligament
Consists of Anterior, Posterior and Transverse bundles. Anterior bundle is primary ligamentous restraint of valgus stress from 20-120° elbow flexion Posterior bundle - limits elbow extension
Motor Unit
Consists of: -Alpha motor neuron (cell body of neuron in anterior horn site) -Muscle fibers it innervates
2. Physiological Cross-Sectional Area (PCSA)
Measure of cross-sectional area of muscle perpendicular to orientation of muscle fibers. -Amount of force is proportional to # of sarcomeres aligned side by side (or parallel)
Resting Length of Multi-Joint Muscles
Measured in anatomical position
Movement at Wrist Complex (Radial/Ulnar Deviation)
ULNAR DEVIATION (35°) -Distal row of carpals moves ulnarly (frontal) -Proximal row moves radially (Frontal) -Scaphoid extends slightly (Saggital) RADIAL DEVIATION (28°) -Distal row of carpals moves radially (frontal) -Proximal row moves ulnarly (frontal) -Scaphoid flexes slightly (saggital)
Number of Joints Muscles Cross
Uni-joint (brachialis - elbow) Multi-joint (biceps - shoulder, elbow, radio-ulnar)
Synergy: Scapular Upward Rotation
Upper/Lower traps Serratus Anterior
Solving for Torque
R = 10 lbs ra = 7" W = 2 Wa = 15" Fa = 3" Angle = 20 degrees
Muscles Used in Grip Pic
1. FDP, FDS, FPL 2. FPL, FDP 3. Proximal portion of phalanges; FDP, FDS 4. Thenar eminence 5. Dorsal interossei, OP (for abduction), FDP, FDS (for more tension)
Causes and Effects of Shoulder Impingement
-Bone spurs -Wear and tear of supraspinatus (like rope back and forth) -Weak RC muscles EFFECTS -Inflammation of soft tissue -Congested Suprahumeral space -Lack of scapula movement
Movement of TMJ
-Mandibular depression (opening) / Mandibular elevation (closing) -Lateral/Medial deviation -Protraction/Retraction (also called Protrusion/Retrusion)
2. Sternoclavicular Joint
-Only joint that attaches shoulder to trunk -Complex joint - has Sternoclavicular disc in between.
TMJ Muscles (Primary)
-Temporalis -Masseter -Medial pterygoid
Proximal Radioulnar Joint
-Ulnar radial notch -Annular ligament - encircles rim of head of radius -Head of radius -Humeral capitulum
Hypothenar Muscles
1. Abductor Digiti Minimi 2. Flexor Digiti Minimi Brevis 3. Opponens Digiti Minimi
Types of Joints
1. Synarthrodial 2. Amphiarthrodial 3. Diarthrodial -Simple -Compound -Complex
Muscle Fiber Types
1. Type 1 (slow) aerobic 2. Type IIA (intermediate) 3. Type IIB (fast) anaerobic Tonic - Stabilizing (I) Phasic - quick contraction (II)
RU Ligaments
1. Annular ligament (not fully formed in children - don't yank) 2. Quadrate ligament 3. Oblique ligament (1-3 keep radial head in radial notch) 4/5. Anterior/Posterior RU Ligament 6. Interosseous Membrane - shortened in pronation, lengthened in supination.
Group 2: Shoulder Girdle to Humerus
1. Coracobrachialis 2. Supraspinatus 3. Deltoids 4. Infraspinatus 5. Teres Minor 6. Subscapularis 7. Teres Major
Ligaments of Sternoclavicular Joint
1. Costoclavicular 2/3. Anterior and Posterior Sternoclavicular 4. Interclavicular - spans manubrium and attaches both clavicles
CMC Motions
1st is most mobile 5th is next most mobile 2nd-4th = Less mobile Allows for gripping/cupping
MCP Joints
2nd-5th are Biaxial: 1. Flexion/Extension in sagittal plane around x axis (90-110° / 30°) 2. Abduction/Adduction in frontal plane around z axis (greater on ulnar side) 1st is Uniaxial 1. Flexion/Extension -Convex head of MC on concave proximal portion of phalange -Closed pack position = full flexion
Thenar Eminence (Thumb Muscles)
4 Extrinsic -FPL (attaches to elbow) -EPL (above snuff box) -EPB (below snuff box) -APL (below EPB) 4 Intrinsic -APB -Adductor Pollicis -FPB -Opponens Pollicis
Movement at Wrist Complex (Flexion/Extension)
80° to neutral= distal row of carpals move on proximal row at midcarpal joint 0-45° extension = Midcarpal and scaphoid movement. Lunate and triquetrium fixed. 45-70° = Radiocarpal movement (ALL carpal bones)
Concave-Convex Rule
Concave joint surfaces generally roll and slide in the SAME direction -Translatory and rotary in same direction
Bursa
Flat sacs of synovial membrane that separate: -tendon/bone (subtendinous bursae) -bone/skin (subcutaneous bursae) -muscle/bone (submuscular bursae) -ligament/bone
Types of Contractions
1. Isometric - same length 2. Concentric - shorten length 3. Eccentric - lengthen
2. Lateral Collateral Ligamentous Complex
1. Lateral (Radial) Collateral Ligament - Provides reinforcement for humeroradial articulation, offers some protection against varus stress and asists in providing resistance to longitudinal distraction 2. Lateral Ulnar Collateral Ligament - assists LCL in resisting varus stress and assisting in providing lateral support 3. Annular Ligament
Group 3: Trunk to Humerus
1. Latissimus Dorsi 2. Pectoralis Major
JOINTS OF SHOULDER GIRDLE
1. Scapulothoracic - pseudo-joint. 2. Sternoclavicular 3. Acromioclavicular 4. Glenohumeral
Group 1 Muscles: Trunk to Shoulder Girdle
1. Serratus Anterior 2. Trapezius (upper/middle/lower) 3. Rhomboids (minor/major) 4. Levator Scapulae 5. Pectoralis Minor 6. Subclavius
3. Acromioclavicular Joint
Attaches acromion of scapula to clavicle. Plane synovial joint. Primary function: Allow scapula to rotate in 3 dimensions to increase UE motion Contains joint capsule, 2 major ligaments, and might have joint disc.
Support for Glenohumeral Joint (Capsule/Ligaments/RC)
Capsule - Tightens when humerus abducted and laterally rotated making it close-packed position for GH joint. -Superior, Middle and Inferior Glenohumeral Ligmaments -Coracohumeral ligament -Rotator Cuff muscles and their tendons provide reinforcement to capsule
Types of Cartilage
Composed mainly of Type II collagen 1. Fibrocartilage (white) 2. Elastic cartilage (Yellow) 3. Hyaline (articular) cartilage
Layers of Bone
Composed of hard CT LAYERS -Periosteum is outer layer membrane that covers outer surface (helps in healing because houses cells that are precursors to osteoblasts - build bone /osteoclasts - bone resorption) -Cortical (compact) - outer layer -Cancellous (spongy) - inner layer - calcified tissue forms thin plates (trabeculae) that are laid down in-line with stresses place on bone.
Elbow Joint
Compound joint - 3 bones Loose Hinge joint - X axis in sagittal plane (some axial rotation around ulna during flex/extension)
Tendon
Connect muscle to bone and transmit forces developed by muscles to bony attachments. Contain slightly more type I collagen than ligaments because dealing with stronger forces.
C1 (Atlas)
Contains facet on posterior surface for odontoid process (dens). Facet covered by hyaline cartiage. Holding dens to C1 anterior arch is transverse ligament of atlas.
Atlanto-Occipital Joint
Convex condyles, concave superior facets -Biaxial condyloid joint MOVEMENT 1. Flexion/Extension 2. Lateral flexion
Carpometacarpal (CMC) Joints
Distal carpal rows with metacarpals -Trapezium with 1st MC -Trapezoid with 2nd MC -Capitate with 3rd MC -Hamate with 4th and 5th MC
Synergy: Extension at IP Joints
Extensor digitorum puts extension in dorsal head to work with intrinsics (lumbricals/interossei) to get good EXTENSION
CMC 2-5 Flexors/Extensors
FLEXION 1. FCU 2. FCR 3. FDP 4. FDS EXTENSION 1. ECU 2. ECRL 3. ECRB 4. ED 5. EI
Hand Muscles (2-5 Digits)
FLEXORS -FDP -FDS -Lumbricals -Interossei EXTENSORS -ED -EDM -EI -Lumbricals -Interossei
Flexors/Extensor/Pronator/Supinator Muscles
FLEXORS 1. Biceps 2. Brachialis 3. Brachoradialis 4. Pronator Teres EXTENSORS 1. Triceps Brachii 2. Anconeous PRONATOR 1. Pronator Quadratus 2. Pronator Teres SUPINATOR 1. Supinator
1. Muscle Fiber Length
Fiber length (or # of sarcomeres along fiber) determines amount of shortening/lengthening of fiber. -Long muscle fiber with more sarcomeres is capable of shortening over greater distance than short muscle fiber. EXAMPLE: If muscle fibers can shorten to 50% of resting length, one with length of 6cm can shorten to 3cm, but one of 4cm can only go to 2cm.
PIP/DIP Joints
Hunge joints (Uniaxial): Flexion/Extension -DIP: Flexion=80-90°, Extension=10° -PIP: Flexion=100-130°, Extension=Back to neutral -Concave moving on convex -Swan-neck deformity: flexion of DIP and hyperextension of PIP
Normal ROM - Hypomobility vs. Hypermobility
Hypermobile - When joint exceeds normal ROM limits Hypomobile - When ROM is less than normal -ALWAYS compare to uninvolved side "Normal" will vary based on body type, sex, age, occupation/activities
Joint Mobilization
In order to have "joint play" the joint should have sufficient amount of movement but not excessively lax to be unstable.
1. Scapulothoracic Joint
Movements from this joint come from a combo of other 3 joints. MOTION: 1. Elevation/Depression 2. Abduction/Adduction (or Protraction/Retraction) 3. Upward (inferior angle to right)/Downward Rotation (IA left)
Muscle Composition
Muscle fiber surrounded by Endomysium Groups of muscle fibers (Fascicles) surrounded by Perimysium Muscle surrounded by Epimysium
Third-Class Lever System
Muscle force lies closer to joint axis than does gravitational force -Effort arm is always smaller than resistance arm. -Effort in the middle EXAMPLE: Biceps is effort, elbow is pivot, weight in hand is resistance
Second-Class Lever System
Muscles most commonly act on second-class levers when gravity or another external force is the effort force ("winner") and muscle is resistance force. -Effort arm is always larger than resistance arm. -ROM sacrificed to gain force Resistance in the middle EXAMPLE: Calf lift - MTP is pivot, Gravity is resistance, Effort is calf
Planes/Axes of Motion
Sagittal Plane (L/R) - Rotation of body segment around the x-axis occurs in sagittal plane EXAMPLE: Flexion/extension of elbow Transverse Plane (Top/Bottom) - Rotation of body segment around y-axis occurs in transverse plane. EXAMPLE: Pronation/Supination (in anatomical position) Frontal Plane (Front/Back) - Rotation of body segment around z-axis occurs in frontal plane. EXAMPLE: Abduction/Adduction of arm/leg
Retinaculum
Thickenings of fascia that form loop attached at both ends of bone -Form tunnel that retain or prevent tendons from bowing out of position during muscle action
Convex-Concave Rule
When a convex joint surface moves on a concave surface, the bone typically rolls in one direction and glides (moves) in the OPPOSITE direction in order to maintain optimum contact. -Translatory and rotary movements in opposite directions
