Exam 3 Notes

chin-up/pull-up

- subject grasps horizontal bar with palms away from face - from hanging position, subject pulls up until the chin is over the bar - return to starting position - closed-kinetic-chain exercise

What are the four types of motions the wrist can perform as being classified as a condylar-type joint?

Flexion, extension, radial deviation, ulnar deviation

Specificity (SAID)

addressing specific needs in designing an exercise program - exercise program goals should be determined regarding specific areas of the body, preferred time to physical peak and physical fitness needs such as strength, muscular endurance, flexibility, cardiorespiratory endurance, body composition, etc

three palmar interossei

adduct the 2nd, 4th, & 5th phalanges

stance phase

allows athlete to assume a comfortable & balanced body position from which to initiate the sport skill

open kinetic chain

an extremity may be seen as representing an open kinetic chain if the distal end of the extremity is not fixed to any surface - allows any one joint in the extremity to move or function separately without necessitating movement of other joints in the extremity ex. shoulder shrug, deltoid raise, bicep curl, seated hip flexion, knee extension, and ankle dorsiflexion not very functional!

what syndrome results in swelling and inflammation in the hand?

carpal tunnel syndrome

FITT

frequency - increasing the number of times you train per week intensity - increasing the difficulty of the exercise you do time - increasing the length of time that you are training for each session type - increase the difficulty of training you are doing

wrist abductors (radial deviation)

generally cross wrist joint anterolaterally and posterolaterally to insert on radial side of hand - flexor carpi radialis - extensor carpo radialis longus - extensor carpi radialis brevis - abductor pollicis longus - extensor pollicis longus - extensor pollicis brevis

flexor and extensor wrist tendons immediately proximal to wrist

held in place on palmar and dorsal aspects by transverse bands of tissue known as flexor and extensor retinaculum to prevent the tendons from bowstringing during flexion and extension

what is the origin of the flexor policies longus muscles? - middle 1/3 radius and proximal ulna - medial epicondyle - lateral epicondyle - proximal 3/4 of anterior ulna

middle 1/3 radius and proximal ulna

preparatory phase

cocking or wind-up phase used to lengthen the appropriate muscles so that they will be in position to generate more force and momentum when concentrically contract in next phase becomes more dynamic as need for explosiveness increases

wrist adductors (ulnar deviation)

cross wrist joint anteromedially and posteromedially to insert on ulnar side of hand - flexor carpi ulnaris - extensor carpi ulnaris

aggregate muscle grouping activity example

elbow flexors work together as an agonist group to cause flexion in opposition to the triceps brachii and ancones (elbow extensors) - elbow extensor are cooperating in their lengthening to allow the flexors to perform their task

phalangeal extension - agonists

extensor digitorum extensor indicis extensor digiti minimi extensor pollicis longus extensor pollicis brevis

Disruption of the extensor tendon at the DIP results in a Jersey Finger type injury.

false

True or False- The triquetrum is in the distal row

false

True or False: The Extensor Capri Ulnaris muscle is innervated by the Ulnar Nerve

false

True or false- all wrist and hand muscles are innervated from the radial, median, and axillary nerves?

false

True or false- the scaphoid is on the medial side

false

four dorsal interossei

flex & abduct index, middle, & ring proximal phalanxes assist with extension of middle & distal phalanxes of index, middle, & ring fingers

finger movements

flex and extend MCP joints also abduct and adduct

wrist movements

flexion and extension radial deviation and ulnar deviation

functional anatomy to joint actions

flexion, extension, abduction, and adduction of wrist and hand

wrist flexion - agonists

flexor carpi radialis flexor carpi ulnaris palmaris longus flexor digitorum superficialis flexor digitorum profundus flexor pollicis longus

median nerve from C6, C7, C8, T1

flexor carpi radialis palmaris longus flexor digitorum superficialis

wrist adduction - agonists

flexor carpi ulnaris extensor carpi ulnaris

Which two tendons don't pass through the carpal tunnel

flexor carpi ulnaris and palmaris longus

phalangeal flexion - agonists

flexor digitorum superficialis flexor digitorum profundus flexor pollicis longus

which muscle is part of the thenar eminence: - flexor digiti minimi - flexor pollicis brevis - extensor digitorum - flexor carpi radialis

flexor pollicis brevis

True or false: The flexor carpi radialis muscle originates from the medial epicondyle.

true

swan neck deformity

volar plate rupture

posterolaterally at elbow and forearm and posterior at hand

primarily wrist extension - extensor carpi radialis longus - extensor carpi radialis brevis - extensor carpi ulnaris primarily wrist and phalangeal extension - extensor digitorum - extensor indicis - extensor digiti minimi - extensor pollicis longus - extensor pollicis brevis - extensor pollicis longus

anteromedially at elbow and forearm and anterior at hand

primarily wrist flexion - flexor carpi radialis - flexor carpi ulnaris - palmaris longus primarily wrist and phalangeal flexion - flexor digitorum superficialis - flexor digitorum profundus - flexor pollicis longus

jersey finger

rupture of flexor digitorum profundus = inability to flex digit

This bone is the most commonly fractured and misdiagnosed bone in the wrist.

scaphoid

four lumbricals

- flex index, middle, ring, and little proximal phalanxes - extend middle and distal phalanxes of index, middle, ring, and little finger

anterior interosseous nerve from median nerve

- flexor digitorum profundus for index and long finger - flexor pollicis longus - intrinsic muscles - abductor pollicis brevis, flezor polissi brevis (superficial head), opponens pollicis, and 1st and 2nd lumbrical

upper extremity activities

- typical weight room exercises concentrate only on anterior shoulder - without balanced approach may lead to strong and tight anterior muscles with weak ad flexible muscles posteriorly - analysis of exercises is critical to appropriate exercise prescription

triceps extension

- use opposite hand to assist in maintaining full shoulder flexion - subject behind with elbow in full flexion - elbow is extended until fully straight with dumbbell overhead - return to starting position - open-kinetic chain exercise

wrist abduction - agonists

flexor carpi radialis extensor carpi radialis longus extensor carpi rafialis brevis abductor pollicis longus extensor pollicis longus extensor pollicis brevis

ulnar nerve from C8 and T1

flexor digitorum profundis for 4th and 5th fingers flexor carpi ulnaris flexor policies brevis (deep head) adductor policis palmar interossei dorsal interossei 3rd and 4th lumbrical opponens digiti minimi abductor digiti minimi flexor digiti minimi brevis

shoulder pull

maintain attempt to pull interlocked fingers apart for 5 to 20 seconds isometric exercise - antagonist contraction is as strong as the agonist contraction - agonists in right upper extremity are antagonistic to agonists in left upper extremity and vice versa - isometric contractions of wrist, hand, elbow, shoulder joint, and shoulder girdle muscles - strength of contraction depends on angle of pull and leverage of the joint involved

extension

movement of back of hand and/or phalanges toward posterior or dorsal aspect of forearm

flexion

movement of palm of hand and/or phalanges toward anterior or volar aspect of forearm

opposition

movement of thumb across palmar aspect to oppose any or all of the phalanges

retroposition

movement of thumb as it returns to anatomical position from opposition with hand and/or fingers

extensor carpi radialis brevis

origin: lateral epicodyle insertion: base of 3rd MC action: wrist extension, radial deviation, weak elbow flexion innervation: radial nerve

extensor carpi ulnaris

origin: lateral epicondyle insertion: base of 5th MC action: wrist extension, ulnar deviation, weak elbow extension innervation: radial nerve

extensor carpi radialis longus

origin: lateral epicondyle insertion: base of 5th MC action: wrist extension, ulnar deviation, weak pronation from supination, weak elbow flexion innervation: radial nerve

extensor digitorum

origin: lateral epicondyle insertion: middle and distal phalanx digits 2-5 (dorsal) action: extension of 2nd-5th phalange @ MCP, wrist extension, weak elbow extension innervation: radial nerve

flexor carpi radialis

origin: medial epicondyle insertion: base of 2nd and 3rd metacarpal action: wrist flexion, radial deviation, weak pronation innervation: median nerve

palmaris longus

origin: medial epicondyle insertion: base of 2nd and 3rd metacarpalalmar aponeurosis, 2nd-5th MC action: wrist flexion, weak elbow flexor innervation: median nerve

flexor carpi ulnaris

origin: medial epicondyle insertion: pisiform, hamate, base of 5th MC action: wrist flexion, ulnar deviation, weak elbow flexion innervation: ulnar nerve

flexor digitorum superficialis

origin: medial epicondyle insertion: sides of middle phalanx (palmar) action: wrist flexion, flexion of fingers at MCP and PIP, weak elbow flexion innervation: median nerve

flexor pollicis longus

origin: middle 1/3 radius and proximal ulna insertion: base of distal phalanx (palmar) action: flex CMC, MCP, IP, wrist flexion, radial deviation innervation: median nerve

flexor digitorum profndus

origin: proximal 3/4 of anterior ulna insertion: base of 5th MC (dorsal) action: wrist flexion, flexion of fingers at MCP, PIP, and DIP innervation: median nerve - digits 2-3 ulnar nerve - digits 3-4

wrist extensors

origins on posterolateral aspect of proximal forearm and lateral humeral epicondyle with insertions located on posterior aspect of wrist and hand

barbell press

overhead or military press - barbell is held high in front of chest with palms facing forward, feet comfortably spread, back and legs straight - barbell is pushed upward until arms are fully flexed overhead - return to starting position - open-kinetic chain exercise

During a movement where the distal end of the extremity is fixed, it is considered a closed kinetic chain.

true

The flexor pollicis brevis, opponens pollicis, adductor pollicis, and abductor pollicis brevis comprise the Thenar eminence of the hand.

true

key distal bony landmarks for muscles involved in wrist motion

- base of 2nd, 3rd, and 5th metacarpals, pisiform, and hamate

DIP

- distal interphalangeal joint - hinge - flex 80 to 90 degrees from full extension

strength and endurance in shoulder area

- essential for improved appearance and posture - more efficient skill performance - specific conditioning exercises and activities should be intelligently selected

three muscles act on little finger

- opponens digiti minimi causes opposition of little finger metacarpal - abductor digiti minimi abducts 5th metacarpal - flexor digiti minimi brevis flexes 5th metacarpal

wrist flexors

- origins on anteromedial aspect of proximal forearm and medial epicondyle of humerus with insertions on anterior aspect of wrist and hand - median nerve and all flexor tendons except flexor carpi ulnaris and palmaris longus pass through carpal tunnel

PIP

- proximal interphalangeal joint - hinge - full extension to 90 to 120 degrees of flexion

how many hand muscles are intrinsic?

11

intrinsic hand muscles

11 different hand muscles - 4 lumbricals - 3 palmar interossei - 4 dorsal interossei

wrist joint degrees of radial deviation

15-25

wrist joint degrees of ulnar deviation

25-40

how many bones are in the hand?

29

how many bones are there in the wrist and hand?

29

wrist and hand

29 bones more than 25 joints more than 30 muscles - 18 are intrinsic

wrist and hand bones

29 bones, including radius and ulna 8 carpal bone - 2 rows of 4 bones form wrist 5 metacarpal bones - numbered 1 to 5 from thumb to little finger, going the wrist bones 14 phalanges (digits) - 3 for each phalange except the thumb, which only has 2 - proximal, middle, and distal - thumb has a sesamoid bone in its flexor tendon - other sesamoids may occur in joints of finger

6 muscles move wrist but not fingers and thumb

3 wrist flexors - flexor carpi radialis - flexor carpi ulnaris - palmaris longus 3 wrist extensors - extensor carpi radialis longus - extensor carpi radialis brevis - extensor carpi ulnaris

wrist joint degrees of extension

65-85

wrist joint degrees of flexion

70-90

how many carpal bones are there?

8

When should muscular development start?

Early age & continue throughout the school years

scaphoid

FOOSH injury most often injured - from falling on outstretched hand - often dismissed as a sprain - significant problem if not recognized and treated properly - usually long period of precise immobilization or surgery

What is the origin of the Palmaris Longus Muscle?

Medial Epicondyle

8 carpal bones

Proximal row from radial to ulnar side - scaphoid (boat-shaped) or navicular - lunate (moon-shaped) - triquetrum (three-cornered) - pisiform (pea-shaped) Distal row, from the radial to ulnar side - trapezium (greater multangular) - trapezoid (lesser multangular) - capitate (head-shaped) - hamate (hooked)

What does SAID principle stand for?

Specific Adaptations to Imposed Demands

SAID principle

Specific Adaptations to Imposed Demands the body will gradually, over time, adapt very specifically to the various stresses and overloads to which it is subjected to achieve specific benefits, exercise programs must be specifically designed for the desired adaption

Which interossei muscle adducts the middle finger?

Third dorsal Interossei

overload principle

a muscle or muscle group increases in strength in direct proportion to the overload placed on it the amount of overload applied caries significantly based on several factors an untrained person beginning a strength training program will make significant gains in the amount of weight they are able to lift in the first few weeks a well trained person will see relatively minor improvements in the amount of weight that can be lifted over a much longer period of time overload is not always progressively increases in certain periods of conditioning, the overload should actually be prescriptively reduced or increase to improve the total results of the entire program

Which muscles flexes the thumb? a. Flexor pollicis longus b. Flexor digitorum superficialis c. Flexor digitorum profundus d. None of the above

a. Flexor pollicis longus

follow-through phase

deceleration phase begins immediately after climas of movement phase brings negative acceleration of involved limb or body segment body segment velocity progressively decreases over a wide range of motion the greater the acceleration in the movement phase, the greater the length and the importance of the follow-through phase

muscular development

development should start at an early age and continue throughout the school years fitness tests result indicate there is need for considerable improvement in this area adequate muscular strength and endurance are important in the adult yeas for the activities of daily living as well as job-related requirements and recreational needs

radial nerve from C6, C7, C8

extensor carpi radialis brevis extensor carpi radialis longus

valsalva maneuver

holding breath while bearing down to lift heavy weights or trying to exhale against a closed epiglottis (thought to increase lifting ability) causes dramatic blood pressure increase followed by equally dramatic drop - lightheadedness and fainting - complications in heart disease patients do not use valsalve instead breath rhythmically and consistent exhale during lift and inhale during lowering

periodization

intentional variance in a training program at regular intervals done to bring out optimal gains in physical performance designed so that the athlete will be at their peak level during the most competitive part of the season

origin for wrist and finger extensors

lateral epicondyle and lateral supracondylar ridge

origin for wrist and finger flexors

medial epicondyle, medial supracondylar ridge and coronoid process

what nerves pass through the carpal tunnel? - medial nerve - median nerve - ulnar nerve - poster interosseous nerve

median nerve

thenar eminence

muscular pad on palmar surface of 1st metacarpal - abductor pollicis brevis - opponens pollicis - flexor pollicis brevis - adductor pollicis

hypothenar eminence

muscular pad that forms ulnar border on palmar surface - abductor digiti minimi - flexor digiti miimi brevis - opponens digiti minimi

exercise variables which may be manipulated

number of sets per exercise repetitions per set types of exercises number of exercises per training session rest periods between sets and exercises resistance used for a set type of muscle contraction number of training sessions per day and per week

upper extremity

often one of body's weakest areas

four muscles act on the CMC of thumb

opponens pollicis - opposition in thumb metacarpal abductor pollicis brevis & flexor pollicis brevis abduct thumb metacarpal flexor pollicis brevis flexes thumb metacarpal adductor pollicis adducts thumb metacarpal flexor pollicis brevis & adductor pollicis flex proximal phalanx of thumb

intrinsic hand muscles origins and insertions on bones of hand

radial side - 4 muscles of thumb - opponens pollicis - abductor pollicis brevis - flexor pollicis brevis - adductor pollicis ulnar side - 3 muscles of little finger - opposens digiti minimi - abductor digiti minimi - flexor digiti minimi brevis

all wrist and hand muscles are innervated from

radial, median, and ulnar nerves

break down movements into phases

stance phase preparatory phase movement phase follow-through phase recovery phase

intermediate muscles

three palmar interossei four dorsal interossei four lumbrical muscles

the most traumatized nerve in the upper limbs is - median n - ulnar n - posterior interseosseeous n - anterior interseosseeous n

ulnar n

most traumatized upper limb nerve

ulnar nerve contusion - funny bone with painful tingling into ulnar side of forearm and 4th and 5th fingers

closed kinetic chain

when distal end of extremity is fixed as in a push up, dip, squat, or dead lift movement of one joint cannot occur without causing predictable movements of other joints in extremity very functional!

concepts for analysis

- muscle are usually grouped together according to their concentric function - muscles work in paired opposition to an antagonist group

each finger has 3 joints

- Metacarpophalangeal (MCP) joints - Proximal interphalangeal (PIP) joints - Distal interphalangeal (DIP) joints

what are the three joints that each finger has?

- Metacarpophalangeal Joint - Proximal Interphalangeal Joints - Distal Interphalangeal Joints

key bony landmarks for finger muscles

- base of proximal, middle, and distal phalanxes - base of 1st metacarpal, proximal and distal phalanxes of thumb

carpal bones form a three-sided arch

- concave on palmar side - bony arch is spanned by transverse carpal and colar carp - created the carpal tunnel - frequently a source of problems known as carpal tunnel syndrome

wrist joint

- condyloid-type joint - allows flexion, extension, radial deviation, and ulnar deviation - motion occurs primarily between distal radius and proximal carpal row (scaphoid, lunate, and triquetrum) - known as radoiocarpal jt

when viewing an activity

- determine which muscles are performing the movement - know what type of contraction is occurring - know what kind of exercises are appropriate for developing the muscles

9 muscles primary movers of phalanges

- involved in wrist joint actions - weaker in their wrist actions flexors - flexor digitorum superficialis - flexor digitorum profundus - flexor pollicis longus (thumb flexor) extensors - extensor digitorum - extensor indicis - extensor digiti minimi - extensor pollicis longus (thumb extensor) - extensor pollicis brevis (thumb extensor) abductor of thumb and wrist - abductor pollicis longus

MCP

- metacarpophalangeal joint - condyloid - 0-40 degrees of extension 85-100 degrees of flexion

adduction (ulnar deviation)

- movement of little finger side of hand toward medial aspect or ulnar side of forearm - movement of fingers toward middle finger

abduction (radial deviation)

- movement of thumb side of hand toward lateral aspect or radial side of forearm - movement of fingers away from middle finger

dumbbell bent-over row

- subject is knelling on a bench using contralateral arm to support the body - involved arm is free from contact with floor - with dumbbell in hand, arm and shoulder hanging straight to the floor, subject adducts shoulder girdle and horizontally abducts shoulder joint - then slowly lowering dumbbell to the starting position - open-kinetic chain exercise

chest press/bench press

- subject lies supine on exercise bench - subject grasps barbell and presses weight upward through full range of arm and shoulder movement - weight is then lowered to starting position - open kinetic chain exercise

arm curl

- subject stands - barbell is held in hands with palms to front - barbell is curled upward and forward until elbows are completely fixed - return to starting position - open-kinetic chain exercise

middle phalange is reference point to differentiate abduction and adduction

- thumb, index, and middle fingers abduct when they move forward radial side of hand - movements of thumb, index, and middle fingers toward ulnar side of hand is adduction - ring and little finger abduct when they move toward ulnar side of hand - ring and little finger toward radial side of hand is adduction

push-up (fingertip)

-subject lies prone on floor with legs together, palms touching floor, and the hands pointed forward & approximately under the shoulders -keeping back & legs straight, subject pushes up to the up position -return to starting position - closed-kinetic chain exercise

latissimus pull (lat pull)

-subject, sitting, reaches up & grasps a horizontal bar - subject pulls bar down to a position behind the neck & shoulders -bar is returned slowly to the starting position - open-kinetic chain exercise

What is the origin of the extensor digitorum?

Lateral Epicondyle

Which kinetic chain allows a joint in the extremity to move/function separately without affecting movement of other joints in the extremity?

Open kinetic chain

movement phase

acceleration, action, motion, or contact phase the action is part of the skill summation of force is generated directly to the ball, sport object or opponent characterized by near-maximal concentric activity in involved muscles

third dorsal interossei

adducts middle finger

recovery phase

after follow-through to regain balance and positioning to be ready for the next sport demand

the thumb has 2 joints

carpometacarpal (CMC) joint - unique saddle-type joint - 50 to 70 degrees of flexion - flex 15 to 45 degrees and extend 0 to 20 degrees metacarpophalangeal (MCP) joint - full extension into 40 to 90 degrees of flexion - hinge interphalangeal (IP) joint - flex 80 to 90 degrees - hinge

Which of the following is not one of the 9 muscle primary mover of the phalanges a. Flexor digitorum superficialis b. Extensor indicis c.Flexor Carpal Radialis d. Abductor policis longus

c.Flexor Carpal Radialis

wrist extension - agonists

extensor carpi radialis longus extensor carpi radialis brevis extensor carpi ulnaris extensor digitorum extensor indicis extensor pollicis longus extensor pollicis brevis

posterior interosseous nerve from radial nerve

extensor carpi ulnaris extensor digitorum extensor digiti minimi abductor pollicis longus extensor pollicis longus extensor pollicis brevis extensor indicis

mallet finger

distal extensor tendon rupture, or bony avulsion

Wrist extensors typically have their origins on the anterior aspect of the forearm, assuming anatomical position.

false

all of the following muscles are apart of the Thenar Eminence except: - abductor pollicis - opponents digit minimi - flexor pollicis brevis - adductor pollicis

opponents digit minimi

baseball pitch skill analysis

stance phase - when player assumes a position with ball in glove before receiving signal from catcher preparatory phase - pitcher extends throwing arm posteriorly and rotating trunk to the right in conjunction with left hip flexion movement phase - begins with forward movement of arm and continues until ball release follow-through phase - ball release as arm continues moving in same direction established by movement phase until velocity decreases to point that arm can safely change movement direction recovery phase - player repositions to field the batted ball