NPTE Musculoskeletal chapter from IER

338 terms by Marmite22 

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1st class lever - definition and example in the body

Force and resistance on opposite sides of the fulcrum (see-saw).

Triceps action at elbow.

2nd class lever - definition and example in the body

Force and resistance on same side of the fulcrum with resistance closer to the fulcrum (wheel barrow).

Push-ups and toe-raises. (Few examples in body).

3rd class lever - definition and example in the body

Force and resistance on same side of the fulcrum with force closer to the fulcrum.

Shoulder abduction, elbow extension. (Most common lever-type in the body).

Osteo/arthrokinematics: Interphalangeal joints
Shape of moving bone articular surface
Opposite/Same direction

Concave
Same

Osteo/arthrokinematics: Metacarpophalangeal joints
Shape of moving bone articular surface
Opposite/Same direction

Concave
Same

Osteo/arthrokinematics: Radiocarpal
Shape of moving bone articular surface
Opposite/Same direction

Convex
Opposite

Osteo/arthrokinematics: Distal radio-ulnar
Shape of moving bone articular surface
Opposite/Same direction

Concave
Same

Osteo/arthrokinematics: Proximal radio-ulnar
Shape of moving bone articular surface
Opposite/Same direction

Convex
Opposite

Osteo/arthrokinematics: Humeroradial
Shape of moving bone articular surface
Opposite/Same direction

Concave
Same

Osteo/arthrokinematics: Humeroulnar
Shape of moving bone articular surface
Opposite/Same direction

Concave
Same

Osteo/arthrokinematics: Glenohumeral
Shape of moving bone articular surface
Opposite/Same direction

Convex
Opposite

Osteo/arthrokinematics: Sternoclavicular
Shape of moving bone articular surface
Opposite/Same direction

Elevation/Depression: Convex, opposite
Protraction/Retraction: Concave, same

Osteo/arthrokinematics: Acromioclavicular
Shape of moving bone articular surface
Opposite/Same direction

Concave
Same

Osteo/arthrokinematics: Subtalar
Shape of moving bone articular surface
Opposite/Same direction

Anterior & middle calcaneus: Concave, same
Posterior calcaneus: Convex, opposite

Osteo/arthrokinematics: Talocrural
Shape of moving bone articular surface
Opposite/Same direction

Convex
Opposite

Osteo/arthrokinematics: Distal Tibiofibular
Shape of moving bone articular surface
Opposite/Same direction

Convex
Opposite

Osteo/arthrokinematics: Proximal Tibiofibular
Shape of moving bone articular surface
Opposite/Same direction

Concave
Same

Osteo/arthrokinematics: Knee
Shape of moving bone articular surface
Opposite/Same direction

Concave
Same

Osteo/arthrokinematics: Hip
Shape of moving bone articular surface
Opposite/Same direction

Convex
Opposite

Osteo/arthrokinematics: TMJ
Shape of moving bone articular surface
Opposite/Same direction

Convex
Opposite

Osteo/arthrokinematics: Atlanto-occipital
Shape of moving bone articular surface
Opposite/Same direction

Convex
Opposite

Osteo/arthrokinematics: Facet joints
Shape of moving bone articular surface
Opposite/Same direction

Concave
Same

Close/Loose-Packed position: Vertebral

Close: Maximal extension
Loose: Midway between flexion and extension

Close/Loose-Packed position: TMJ

Close: Maximal retrusion (teeth clenched) or maximal anterior position (mouth maximally opened)
Loose: Jaw slightly open

Close/Loose-Packed position: Sternoclavicular

Close: Maximal shoulder elevation
Loose: Arm resting at side

Close/Loose-Packed position: Acromioclavicular

Close: Shoulder abducted 90 degrees
Lose: Arm resting at side

Close/Loose-Packed position: Glenohumeral

Close: Maximal abduction and external rotation
Loose: 55-70 degrees abduction; 30 degrees horizontal adduction; neutral rotation

Close/Loose-Packed position: Humeroulnar

Close: Maximal extension and supination
Loose: 70 degrees flexion; 10 degrees supination

Close/Loose-Packed position: Humeroradial

Close: 90 degrees flexion; 5 degrees supination
Loose: Maximal extension and supination

Close/Loose-Packed position: Proximal/distal radioulnar

Proximal:
Close: 5 degrees supination; maximal extension
Loose: 70 degrees flexion; 35 degrees supination
Distal:
Close: 5 degrees supination
Loose: 10 degrees supination

Close/Loose-Packed position: Radiocarpal

Close: Maximal extension; radial deviation
Loose: Neutral; slight ulnar deviation

Close/Loose-Packed position: Midcarpal

Close: Maximal extension
Loose: Neutral; slight flexion; slight ulnar deviation

Close/Loose-Packed position: Carpometacarpal (2-5)

Close: Maximal opposition
Loose: Midway between flexion/extension

Close/Loose-Packed position: Trapeziometacarpal

Close: Maximal opposition
Loose: Midway between flexion/extension and adduction/abduction

Close/Loose-Packed position: 1st Metacarpophlangeal

Close: Maximal extension
Loose: Slight flexion

Close/Loose-Packed position: Metacarpophalangeal 2-5

Close: Maximal flexion
Loose: Slight flexion; ulnar deviation

Close/Loose-Packed position: Proximal interphalangeal (hand)

Close: Maximal extension
Loose: 10 degrees flexion

Close/Loose-Packed position: Distal interphalangeal (hand)

Close: Maximal extension
Loose: 30 degrees flexion

Close/Loose-Packed position: Hip

Close: Ligamentous: Maximal extension; maximal abduction; maximal internal rotation
Bony: 90 degrees flexion; slight abduction; slight external rotation

Loose: 30 degrees flexion; 30 degrees abduction; slight external rotation

Close/Loose-Packed position: Knee

Close: Maximal extension; maximal external rotation of the tibia
Loose: 25 degrees flexion

Close/Loose-Packed position: Talocrural

Close: Maximal dorsiflexion
Loose: Midway between inversion/eversion; 10 degrees plantarflexion

Close/Loose-Packed position: Subtalar

Close: Maximal inversion
Loose: Midway between extremes of ROM; 10 degrees plantar flexion

Close/Loose-Packed position: Midtarsal

Close: Maximal supination
Loose: Midway between extremes of ROM; 10 degrees plantar flexion

Close/Loose-Packed position: Tarsometatarsal

Close: Maximal supination
Loose: Midway between supination/pronation

Close/Loose-Packed position: Metatarsophalangeal

Close: Maximal extension
Loose: Neutral (10 degrees extension)

Close/Loose-Packed position: Interphalangeal (foot)

Close: Maximal extension
Loose: Slight flexion

Soft end-feel

Soft tissue approximation

Firm end-feel

Ligament/capsular stretching

Hard end-feel

Bone/cartilage approximation

Boggy end-feel

Edema; joint swelling

Firm end-feel with decreased elasticity

Soft tissue fibrosis

Rubbery end-feel

Muscle spasm

Empty end-feel

Loose at first then very hard: Muscle guarding to preventing entering painful ROM

End-feel at later time than opposite side

Hypermobility

Muscle substitution for weak shoulder abductors

Scapular stabilizers

Muscle substitution for weak hip abductors

Lateral trunk; TFL

Muscle substitution for weak finger flexors

Wrist extensors

Muscle substitution for weak pectoralis major

Long head of biceps; corocobrachialis; anterior deltoid

Muscle substitution for weak hip extensors

Low back extensors; adductor magnus; QL

Muscle substitution for weak hip flexors

Lower abdominals; lower obliques; hip adductors; latissimus dorsi

Capsular pattern: TMJ

Limitation of mouth opening

Capsular pattern: Occipitoatlantal joint

Forward bending more limited than backward bending

Capsular pattern: Atlantoaxial joint

Restricted rotation

Capsular pattern: C3-T2

Lateral flexion and rotation, extension

Capsular pattern: Sternoclavicular

Full elevation, pain at extremes of movement

Capsular pattern: AC joint

Full elevation, pain at extremes of movement

Capsular pattern: Glenohumeral

External rotation, abduction, internal rotation

Capsular pattern: Humeroulnar

Flexion, extension

Capsular pattern: Humeroradial

Flexion, extension

Capsular pattern: Proximal radioulnar

Pronation and supination

Capsular pattern: Distal radioulnar

Pronation and supination

Capsular pattern: Wrist

Flexion and extension

Capsular pattern: Midcarpal

Equal in all directions

Capsular pattern: Trapeziometacarpal

Abduction, extension

Capsular pattern: Carpometacarpals 2-5

Equal in all directions

Capsular pattern: MCPs and IPs (hand)

Flexion, extension

Capsular pattern: Thoracic spine

Lateral flexion and rotation, extension, flexion

Capsular pattern: Lumbar spine

Lateral flexion and rotation, extension, flexion

Capsular pattern: Sacroiliac, symphysis pubis, sacrococcygeal

Pain when stressed

Capsular pattern: Hip

Flexion and internal rotation, abduction, adduction and external rotation (add/ER limitation = little to none)

Capsular pattern: Tibiofemoral

Flexion (++), extension (minor)

Capsular pattern: Tibiofibular

Pain when stressed

Capsular pattern: Talocrural

Plantarflexion, dorsiflexion

Capsular pattern: Subtalar

Increasing limitation of varus. When fixed in valgus: Inversion, eversion

Capsular pattern: Midtarsal

Supination, pronation (with limited DF, PF, Add and IR)

Capsular pattern: 1st Metatarsophalangeal

Extension (++), flexion (minor)

Capsular pattern: Metatarsophalangeal 2-5

Variable, usually flexion restriction

Capsular pattern: Interphalangeal (foot)

Usually extension restriction

Angles of head of humerus

20-30 degrees retroversion
Longitudinal axis of head is 135 degrees from axis of neck

Scapula position

2nd to 7th ribs

Glenoid fossa position and shape

At lateral angle
Pear-shaped
Faces anteriorly, laterally and superiorly
Places true abduction at 30 degrees anterior to frontal plane

Corocohumeral ligament: Attachments and function

Base of coracoid to greater and lesser tubercles of the humerus.
Reinforces biceps tendon and superior capsule
Prevents caudal dislocation
(Taut with external rotation)

Glenoid labrum attachments

Superior and inferior capsule, long head of biceps attachment

Scapulothoracic & Glenohumeral rhythm

At 75 degrees shoulder flexion, humerus external rotates to prevent compression of greaster tuberosity on acromion.

180 degrees abduction: 2:1 movement ratio
1st 30-60 degrees at GHJ
120 degrees of total movement occurs at GHJ
60 degrees of total movement occurs at scapulothoracic joint

Joint movements during shoulder flexion

Humerus glides inferiorly and external rotates
Clavical rotates at sternoclavicular joint
Scapula abducts and laterally rotates

Elbow 'Screw home' mechanism

Ulna pronates slightly with extension and supinates slightly with flexion
Proximal ulna glides medially during extension and laterally during flexion

Radiocarpal joint articulations

Lunate and scaphoid with radius
Triquetrum with ulna

Volar Plate

Thickening of capsule on palmar aspect of MCP, PIP and DIP joints.
More mobile at MCPs than IPs.

Finger ligs: Collateral

From lateral condyle to distal phalanx and lateral volar plate.
Tighten with flexion.
Volar fibers also tighten with extension.

Finger ligs: Accessory

From condylar head to volar plate

Finger ligs: Transverse

Link MCPs
Reinforce anterior capsule

Digit rotation during flexion/extension

Phalanges and metacarpals rotate radially during flexion

1st CMC movement

Rotated position of trapezium places plane of flexion/extension of 1st CMC perpendicular to other digits.

Flexion/Abduction 1st CMC rotates ulnarly
Extension/Adduction 1st CMC rotates radially

Head of femur orientation

Anteriorly, medially, superiorly

Normal head of femur angle of inclination

115-125 degrees

Head of femur coxa valga angle

>125 degrees

Head of femur coxa vara angle

<115 degrees

Head of femur normal anteversion angle

10-25 degrees

Head of femur anterversion angle

>25 degrees

Head of femur retroversion angle

<10 degrees

Bursae Locations: Prepatellar

Between skin and distal patella

Bursae Locations: Superficial Patellar

Anterior to patella ligament

Bursae Locations: Deep infrapatellar

Between patellar ligament and tibial tuberosity

Bursae Locations: Suprapatellar

Between patella and tibiofemoral joint

Bursae Locations: Popliteal

Posterior knee (often connected to synovial cavity)

Bursae Locations: Semimembranosus

Between semimembranosus and femoral condyle

Bursae Locations: Gastrocnemius

One under each head

Bursae Locations: Pes anserine bursa

Between pes anserinus and MCL

Bursae Locations: Subtendinous iliac

Between hip and os pubis

Bursae Locations: Iliopectineal

Between tendon of illiopsoas and capsule (close to femoral nerve)

Bursae Locations: Ischiofemoral

Between ischial tuberosity and gluteus maximus

Bursae Locations: Deep trochanteric

Between gluteaus maximus and posterior lateral greater trochanter (may cause pain on hip flexion and internal rotation due to compression of gluteus maximus)

Bursae Locations: Superficial trochanteric

Over greater trochanter

Bursae Locations: Subacromial

Under deltoid, extending under acromion and coracoacromial arch above the joint capsule

Bursae Locations: Olecranon

Posterior aspect of elbow over olecranon process

Knee 'screw home' mechanism

At terminal extension the tibia externally rotates 5 degrees due to:

Lateral femoral condyle has a longer articular surface than medial (20 deg femoral roll laterally; 10-15 deg medially)
Medial meniscus attached to MCL which restricts medial gliding
Twisted cruciate ligaments
Lateral pull of quads

Talocrural osteokinematics

Open Chain Plantarflexion: Talus glides anteriorly on mortise and medially rotates slightly. (opposite for DF)

Closed Chain Plantarflexion: Tibia glides posteriorly on talus and laterally roates slightly. (opposite for DF)

Subtalar osteokinematics

Open Chain Inversion: Calcaneus adducts, supinates and plantarflexes on fixed talus. (opposite for eversion)

Closed Chain Inversion: Talus glides laterally, abducts and dorsiflexes. Produces external rotation of tibia. (opposite for eversion).

Talonavicular osteokinematics

Open Chain Inversion: Navicular plantarflexes, adducts and externally rotates on the talus. (opposite for eversion).

Closed Chain Inversion: Talus glides dorsally, abducts and internally rotates on navicular. (opposite for eversion)

Thoracic Spine "Rule of 3"

T1-T3 spinous processes even with transverse processes
T4-T6 spinous processes found 1/2 level below transverse processes
T7-T9 spinous processes at level of transverse process of vertebra below
T10 at level of vertebra below
T11 1/2 level below
T12 level with it's own transverse processes

Cervical Spine Coupled Movement Direction (rotation/side flexion)

Occiput/C1: Opposite
C2-C7: Same
Lumbar/Thoracic (in Neutral or extension): Opposite
Lumbar/Thoracic (in flexion): Same
(differs among individuals, should be tested prior to any manual technique)

Manual Grading of Accessory Joint Motion: 0

Ankylosed

Manual Grading of Accessory Joint Motion: 1

Considerable hypomobility

Manual Grading of Accessory Joint Motion: 2

Slight hypomobility

Manual Grading of Accessory Joint Motion: 3

Normal

Manual Grading of Accessory Joint Motion: 4

Slight hypermobility

Manual Grading of Accessory Joint Motion: 5

Considerable hypermobility

Manual Grading of Accessory Joint Motion: 6

Unstable

Imaging uses: X-Ray

Bone dysfunction/disease

Imaging uses: CT

(Enhanced X-rays)
Complex fractures, spinal stenosis, facet dyfunction, disc disease, poor quality imaging of soft tissues

Imaging uses: Discography

(Radiopaque dye injected into disc)
Specific technique to identify internal disc disruptions or the nucleus or annulus

Imaging uses: MRI

(uses magnetic field rather than radiation)
Two types:
T1: Visualizes fat within tissues - used for bones
T2: Surpresses fat - used for soft tissues

(CI: Claustrophobia, metal implants)

Imaging uses: Arthrography

(Inject water-soluble dye into joint)
Identify joint abnormalities eg - tendon rupture

Imaging uses: Bone Scan

(Radioactive chemicals injected, isotope settles in area of high metabolic activity)
Identify stress fractures, RA, bone cancer, bone infection

Imaging uses: Ultrasound

(Real-time dynamic images)
Soft-tissue imagin

Imaging uses: Myelography

(Water-soluble dye injected into vertebral canal)
To assess discs and stenosis
(not used much as MRI/CT generally better and have less side-effects)

Neuro/Musculo screen (root origins of peripheral nerves): Musculocutaneous

C5-C7 (lateral cord)

Neuro/Musculo screen (root origins of peripheral nerves): Lateral pectoral

C5-C7 (lateral cord)

Neuro/Musculo screen (root origins of peripheral nerves): Median

C5-T1 (lateral and medial cords)

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