Formative exam 2
To strengthen the elbow extensors in a closed chain, you have the patient perform push-ups, using body weight as the source of resistance. Which of the following variations of push-ups provides the greatest amount of resistance to the elbow extensors?
Bilateral push-ups while in a fully prone position on the floor with weight on the hands and toes
Regional interdependence
"The concept that seemingly unrelated impairments in a remote anatomical region may contribute to, or be associated with, the patient's primary complaint Focus is on impairments present in proximal or distal segments Impairment-based treatment approach
What would you do in order to improve flexion at the ulnohumeral joint?
Do a distraction technique
Proposed patellofemoral joint kinematics (weight bearing)
Femur moves relative to the stationary patella -Closed chain - patella is stationary and the femur is moving. (Ex. Feel the patella while doing mini squats and the patella should stay facing forward throughout the entire motion) Femoral internal result in relative lateral displacement of patella
Metacarpalphalangeal ROM
Finger flexion: 90 Finger extension: 45
Radiocarpal ROM
Flexion: 70 Extension: 70 Radial deviation: 20 Ulnar deviation: 30
Ulnohumeral capsular pattern
Flexion>extension
Which of the following muscles helps to support the medial collateral ligament when exposed to large valgus forces?
Flexor carpi ulnaris
Which of the following muscles is the primary finger flexor of digits two through five?
Flexor digitorum profundus (FDP)
Low load long duration stretch dose
Frequency: 2x/day Intensity: <2/10 pain at elbow region symptoms Time: 5-15 minutes Type: LLLD Important to ensure pain does not exceed 2/10 because the flexors will turn on the the patient will guard the whole time and won't make any gains in muscle length Dumbell and moist heat can help facilitate the stretch as well
Radiohumeral open packed position
Full extension and full supination
Which of the following best represents the closed pack position of the wrist?
Full wrist extension
Which of the following muscles act as strong interphalangeal (proximal interphalangeal [PIP] and distal interphalangeal [DIP]) extensors and weak metacarpophalangeal (MCP) flexors?
Lumbricales
Which of the following statements is true regarding the extensor mechanism of the fingers?
Lumbricales and interossei allow active metacarpophalangeal (MCP) joint flexion, and proximal interphalangeal (PIP) and distal interphalangeal (DIP) joint extension.
Forearm supinator stretch
Place pressure on the radius Compensation adduction
Forearm pronator stretch
Place pressure on the ulna Compensation Internal rotation
Distal radioulnar convex/concave
concave on convex
Metacarpalphalangeal convex/concave
concave on convex
Tibiofemoral joint is
concave on convex in open chain and convex on concave in closed chain.
Radiocarpal convex/concave
convex on concave
Extension of the metacarpophalangeal (MCP) joint of the second digit results in a ____________________ roll and a ____________________ glide of the proximal phalanx on the metacarpal.
dorsal, dorsal
Ulnohumeral closed packed position
extension
Radiocarpal closed packed position
extension with radial deviation
Radiocarpal capsular pattern
fexion=extension
Interphalangeal capsular pattern
flexion>extension
Metacarpalphalangeal closed packed position
full extension
Interphalangeal closed packed position
full flexion
Carpometacarpal closed packed position
full opposistion
Hip hike
-Adducted on the way down -Abducted on the way up -Pelvis is moving over the femur -You are using pelvic movement to get adduction -Concentric contraction of glute med When would you choose this exercise? More functional Stance limb control Compensation: Side bending
Elbow ROM
0-150 degrees
Distal radioulnar open packed postion
10 supination
Discuss how to modify exercise based on patient's MMT grade
3/5 and up Exercises are done in a gravity resisted position 2+/5 Gravity eliminated: patient can move through full ROM and can accept resistance 2/5 Gravity eliminated: patient can move through full ROM 2-/5 Gravity eliminated: patient can move through partial ROM and no resistance 1/5 Trace: patient has a visible contraction at the muscle. 0/5 Zero: no visible contraction of the muscle
Distal radioulnar closed packed postion
5 degrees of supination
Proximal radioulnar closed packed position
5 degrees of supination
Ulnohumeral open packed position
70 degrees of flexion and 35 degrees of supination
Proximal radioulnar open packed position
70 of flexion and 35 of supination
Proximal radioulnar ROM
80 for both pronation and supination
Distal radioulnar ROM
80 pronation and supination
"W" sitting position is most associated with
ANTEVERSION at the hip
What would you do in order to improve flexion at the radiohumeral join?
An anterior glide due to the head of the radius being concave on a convex humerus
How to improve proximal radioulnar supination?
Anterior glide
Which of the following elbow flexors produces the greatest amount of compression in the elbow joint and therefore is a stabilizer of the elbow?
Brachioradialis
Carpometacarpal capsular pattern
CMC1: retroposition; CMC 2: 5 fan/fold
Interphalangeal convex/concave
Concave on convex
Radiohumeral convex/concave rule
Concave on convex
Ulnohumeral Convex/concave rule?
Concave on convex
Proximal radioulnar concave/convex rule
Convex on concave
Radiohumeral closed packed position
Elbow flexed 90 degrees and forearm supinated 5 degrees
What is a sign of quad weakness during a SLR?
Extensor Lag- Leg starts completely straight but once the pt begins to perform the SLR they are unable to keep the leg straight and it bends or it begins to bend after a few reps due to fatigue
Which of the following muscles is the only muscle capable of extending the metacarpophalangeal (MCP) joint of the digits?
Extensor digitorum
Your patient has an "extensor lag" of the MCP joint. The exercise of choice to remediate this problem is:
Have the patient move actively from the full fist position of the hand to the hook fist (claw hand) position.
Each of the following is true about the use of early controlled motion after tendon repair in the hand and forearm EXCEPT:
It is used more often after extensor tendon repair than after flexor tendon repair.
Superior glide of the patella is associated with
KNEE EXTENSION
Inferior glide of the patella is associated with
KNEE FLEXION
Metacarpalphalangeal capsular pattern
MP 2-5: flexion>extension
Which of the following structures is the primary stabilizer of elbow to valgus stress between 20° and 120° flexion?
Medial collateral ligament
Thinking about injuries at the elbow, the most common ligament to be injured is the
Medial collateral ligament due to the valgus forces placed on it
Main nerves of the elbow, wrist, and hand
Median Ulnar Radial
Carpometacarpal open packed position
Midway between abduction-adduction and flexion-extension
RAdiohumeral capsular pattern
No true pattern, possibly equal pronation and supination
Interphalangeal ROM
PIP Ext: 0 PIP fex: 100 DIP Ext: 0 DIP Flex: 90
Which of the following would you consider to be a limiter of motion when a patient cannot achieve full elbow extension?
Passive tension of the flexor muscles
Proposed patellofemoral joint kinematics (non weight bearing)
Patella moves relative to stationary femur -Open chain LAQ - the patella moves with segment
2 general principles for designing a therapeutic exercise program to address proximal impairments related to knee injury
Pelvis and trunk stability -Improve lumbopelvic proprioception -Iumbopelvic neuromuscular control Dynamic hip joint control -Improve muscle performance of gluteus maximus and gluteus medius
How to improve proximal radioulnar pronation?
Posterior glide
During the subacute stage of soft tissue healing after injury and repair of the flexor tendons of the hand or forearm, each of the following is an important intervention except:
Progressive resistance exercise.
Which of the following muscles works to dynamically support the distal radioulnar joint?
Pronator quadratus
Signs of short biceps
Protracted scapula Arms internally rotated Arms flexed at the side
How do you know the pt is performing the SLR correctly?
The calf will make contact with the table before the heel as they bring the leg back down..
Discuss Regional Interdependence and Clinical Decision Making
The patient's local area of primary complaint should be examined initially and treated as indicated in accordance with current best evidence Screen the regions above and below the area of primary dysfunction
Each of the following is true about flexor tendon-gliding exercises EXCEPT:
To perform these exercises, the therapist passively moves the patient's fingers into five different positions in a particular sequence.
What are some compensations for Bridging?
Use of Paraspinals and/or hamstrings
Using a handheld weight as the source of resistance, which of the following positions to strengthen the elbow extensors begins with the long head of the triceps brachii fully lengthened?
With the patient standing or sitting in a chair, begin with the elbow fully flexed and the arm elevated overhead and stabilized to maintain the shoulder in as much flexion as possible.
Ex. of Regional interdependence
Your patient has low back pain. Your patient demonstrates hypomobility of both hips and bilateral weakness of the gluteus maximus. In addition to treating impairments in the lumbar spine region, your interventions will be directed at improving hip mobility and gluteus maximus strength. Analysis 1. Patient has to much lumbar flexion and limited hip flexion. This could be a contributing factor to their back pain. 2. Glute max eccentrically lowers the body bending forward and concentrically pulls you back up.
The range and direction of motion at the first carpometacarpal (CMC) joint produces opposition of the thumb. Opposition is sequentially ____________________.
abduction, flexion, and adduction of the first metacarpal
How to improve proximal Distal radioulnar pornation?
anterior glide
The ____________________ radioulnar joint has a disc that is also known as ____________________.
inferior, triangular fibrocartilage complex (TFC)
Radiocarpal open packed position
neutral with slight ulnar deviation
Proximal radioulnar capsular pattern
no true pattern, possibly equal pronation and supination
How to improve proximal Distal radioulnar supination?
posterior glide
During elbow extension from 90° flexion at the humeroradial joint, the radial head rolls in a(n) ____________________ direction and glides in a(n) ____________________ direction on the capitulum at the humeroradial joint.
posterior/caudal, posterior/inferior
Interphalangeal open packed position
slight flexion
Metacarpalphalangeal open packed position
slight flexion
To achieve terminal knee extension
you are most likely going to want to stretch the gastrocnemius muscle NOT THE HAMSTRING.
