Kinesiology Study guide exam 2 PDF

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This is the study guide of all information from lectures 4-6 that we used for the second exam....

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Kinesiology Study Guide

Week 4 Scapula:

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Anterior side is deep Superior border is difficult to palpate, aligned parallel with the spine of the scapula, covered by muscle. The spine of the scapula separates fossa’s – superior to spine = supraspinous fossa, inferior to spine = infraspinous fossa. On the lateral side the subscapular fossa is under the superior border. Can palpate the coracoid process from the front but it’s tender.

Scapular ROM: Abduction/adduction = protraction/retraction Elevation/depression Upward/downward rotation [Protraction - laterally and anterior Retraction - medial borders move closer to thoracic spine, pinch of back]

Muscles of the Scapula:

(Levitator Scapulae = deep to traps)

Anterior View

Posterior View

Lateral View

Serratus Anterior

Origin ● Ribs 1-9 Insertion ● Anterior surface of the entire medial border of the scapula Action ● Upward rotation o Protraction Innervation ● Long thoracic nerve (C5, 6, 7)

Upper Trapezius

Origin ● ● ● ●

External occipital protuberance The medial 1/3 of the superior nuchal line of the occiput The nuchal ligament Spinous process of C7

Insertion ● Lateral 1/3 of the clavicle ● Acromion process of the scapula Action ● Elevation o Retraction o Upward rotation Innervation ● Accessory nerve (C3,4)

Middle Trapezius

Origin ● Spinous process of T1-T5 Insertion ● Acromion process ● Spine of scapula Action ● Retraction o Upward rotation Innervation ● Accessory nerve (C3,4)

Lower Trapezius

Origin ● Spinous process of T6-T12 Insertion ● Tubercle at the root of the spine of the scapula Action ● Depression o Retraction Innervation ● Accessory nerve (C3,4)

Rhomboids

Origin ● Spinous process C7-T5 Insertion ● Medial border of the scapula from the root of the spine to the inferior angle of the scapula Action ● Retraction o Downward rotation Innervation ● Dorsal Scapular Nerve (C5)

Week 5 The Shoulder Complex The shoulder is made up of: 20 muscles 3 articulations (joints) Best mobility of any joint in the body Anchors the upper extremity to the trunk Shoulder is not a stable joint

Bones Sternum ● Manubrium o Clavicular notch o Jugular notch o 1st costal notch Where we see secure of the upper extremity to the axial skeleton

Clavicle ● Sternal end ● Humeral end Find jugular notch and you will feel the sternal end of clavicle

Scapula ● Borders o Medial o Lateral o Superior ● Angles o Inferior ● Glenoid fossa (most lateral) o Glenoid labrum ● Spine o Supraspinatus fossa o Infraspinatus fossa ● Acromion process ● Coracoid process Labrum dense fibrous connective tissue that surrounds the glenoid fossa expanding depth to increase joint congruency and to decrease stress/forces by increasing surface area 50%.

Humerus ● Humeral head ● Greater tubercle ● Lesser tubercle ● Bicipital groove ● Surgical neck The head of the humerus sits in the glenoid fossa

Anterior view :

Joints 3 synovial joints: Sternoclavicular (sternum and clavicle) Acromioclavicular (scapula and clavicle) Glenohumeral (scapula and humerus)

Scapulothoracic joint = Not a true joint/not synovial, it’s the scapula gliding around thorax to allow other joints of shoulder to move.*

Sternoclavicular joint Saddle joint ● Only joint that connects the UE to the axial skeleton * ● 3 degrees of freedom* ● Stabilizing structures o Articular disc o Sternoclavicular ligament (ant. &post.) ▪ Resists ant./post. Gliding of the clavicle. ▪ Prevent ant./post. stresses o Interclavicular ligament ▪ Resists traction between the two clavicles across the sternum (laterally), sup./inf. displacement o Costoclavicular ligament ▪ Resists elevation, rotation ▪ Attaches clavicle to first rib ➢ Medial end of clavicle and where it connects to the manubrium and the medial end of the first rib ➢ Ligaments- They cannot be regenerated, will not heal itself . ➢ Limit mobility and prevent certain motions all together. ➢ When the ligament does its job it becomes tight (taught). Absorb forces. ➢ Elevation/ depression, protraction/retraction and rotation ➢ Also protected by the sternocleidomastoid muscle fibers ➢ Articular disc: Fibrocartilaginous disc allowing for motion ➢ Disc allow smoother movement ➢ But not too much to allow pop out or anything

Acromioclavicular Joint ● ● ●

Synovial joint 3 degrees of freedom Stabilizing structures (limited by two strong ligaments) o Acromioclavicular ligaments ▪ Resists ant./post. Displacement of clavicle and acromion o Coracoclavicular ligaments ▪ Resists elevation/depression of clavicle on scapula

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Elevation & depression, upward &downward rotation, protraction and retraction Medical side of acromion and lateral side of clavicle Primary action of AC joint: To maintain contact with thorax throughout movement. Also allows glenoid fossa to keep aligned to GH head.

Glenohumeral Joint ● ● ●

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Ball-and-socket joint 3 degrees of freedom Stabilizing structures o Coracohumeral ligament ▪ Limits upward and posterior movement of humeral head ▪ Primary force against gravity’s downward pull at rest o Glenohumeral ligament ▪ Resists external rotation and abduction of humerus Flex & ex, abb & add, int & ext rotation Resting in glenoid fossa, humeral head is twice size as fossa. (Down to the surgical neck), lined Filled with synovial fluid - lubrication for movement Joint relies on tendons, tissue, ligaments… = joint capsule

Capsular ligaments from glenohumeral head to the capsule ● Weakness between superior and middle glenohumeral ligament and this sight becomes a place for ant displacement of the glenohumeral joint. ● Bursa can become inflamed, causing more fluid, feel inflammation causing discomfort and pain.

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Coracohumeral ligament holds bicep tendon in bicipital groove

GH Movements ● ● ● ● ● ●

Flexion (0-180*) Extension (0-50/60*) Abduction (0-180*) ER (0-90*) IR (0-70*) Combined motions: o Horizontal abduction & adduction o Scaption o Circumduction

Scapulohumeral Rhythm

Why we have so much movement allowing for the motion we have at that joint, especially add and abd of shoulder Acromion- Can block so we have scapulohumeral rhythm (movement of scapula so we can flex, abd and add the shoulder.)

GH joint First 30 degrees of abduction GH First 45-60 degrees of flexion Then after we will see scapular movement Decrease shearing forces at joint ●

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Movement of the scapula across the thorax in relation to the humerus o 120* of flexion & 120* of abduction comes from the GH joint o 60* of flexion & 60* of abduction comes from scapulothoracic (AC & SC joints) Flexion: coupled with scapular protraction & upward rotation Abduction: coupled with scapular upward rotation

Muscle Overview

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Muscles that cross the GH joint o Anteriorly = typically f lex the arm o Posteriorly = typically extend the arm o Laterally/superiorly = typically abduct the arm o Medially/inferiorly = typically adduct the arm Muscles that wrap medial to lateral and cross anterior to the GH joint = typically i nternally rotate the arm Muscles that wrap medial to lateral and cross posterior to the GH joint typically e xternally rotate the arm

Muscles of the shoulder complex

Pectoralis Major

Pectoralis Minor

Latissimus Dorsi

Teres Major

Deltoid

Coracobrachialis

Rotator Cuff Group – SITS ➢ Primarily internal and external rotation of shoulder. ➢ If hurt: We will see a reduction of the motion they do. ➢ Decrease of shoulder stability with any functional activity.

Supraspinatus

Infraspinatus ➢ Closest to the scapula ➢ Covering Teres minor

Teres Minor ➢ Lateral border of scapula ➢ Infraspinatus works together but innervated by other nerves

Subscapularis ➢ Usually traumatic in nature if it happens

Biceps Brachii

Triceps Brachii

Shoulder Mobilization & Stability

Humerus and scapula are intimately tied together to produce effective upper limb movement Muscle force coupling o Muscles working in seemingly counteractive directions to create movement ➢ Can help with stability and/or mobility. ➢ Might not help through the entire ROM. ➢ Just know that muscle coupling happens and that they increase stability or mobility. * ● ●

➢ None will extend past T1 and none will go past C5. ➢ The nerves that innervate the muscle TERMINAL BRANCH: ➢ Spinal nerve root it comes off before it joins the brachial plexus (C5-T1)

➢ Important to know nerve root and nerve branch because that depends if it is a peripheral nerve injury or a spinal nerve injury.

Brachial Plexus and the UE

Nerve Innervation

Myotomes & Dermatomes

Clinical Relevance These diagnosis revolve around: Muscle, nerve, artery and tendon Diagnosis: ● Frozen shoulder – Stiffness of the shoulder, loss ROM, usually scapula ● Shoulder instability ● Shoulder impingement – Tendons of the rotator cuff muscles (get stuck under acromion) become inflamed or irritated ● Brachial plexopathy - Peripheral neurotrophy (decreased sensation) starting with tingles then complete loss of sensation. Damage to the brachial plexus - seen in babies sometimes with awkward birth, or swinging kids arms

Thoracic outlet – Compression of nerves/blood vessels as they run between the space of the clavicle and first rib. ● Tendonitis - Inflammation of the tendon Effects of immobilization Effects of hypermobility Functional Reaching ➢ Important to understand what's going on but most worried about functional reach. *** ●

Week 6 Analysis of the Elbow & Forearm Bones of the Elbow & Forearm Humerus Ulna Radius

Humerus ● Medial Epicondyle - attachment for pronator Teres, ulnar ligament, and wrist/finger flexors ● ● ● ●

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Lateral Epicondyle Attachment to wrist, finger, and thumb extensors, forearm supinator attach. sites Lateral Supracondylar Ridge – attachment site for wrist flexors Trochlea – separated by the trochlear groove – where ulnar head sits and where the distal humerus articulates with the ulna Capitulum - proximal radius articulates with humerus Coronoid fossa - Coronoid process of ulna moves into when elbow flexes Radial fossa - Just superior to the capitulum, radial head slips into during elbow flexion Olecranon fossa - Deep and stable articulating surface in extension

Ulna & Radius

Ulna (olecranon process, coronoid process, trochlear notch, ulnar tuberosity, radial notch) Ulna is medial forearm ● Ulna is going to play a big part in elbow and little role wrist ● Ulnar nerve runs between medial epicondyle and olecranon process ● Coronoid process gives stability in flexion, moves into when elbow flexes ● Trochlear notch is a concave notch that articulates with the humorous ● The radial notch - the ulna articulates with the radius to form the proximal radial ulnar joint Radius (radial head, radial neck, radial tuberosity) Radius is lateral forearm ● Radius is little role at elbow but big role at wrist ● Radial head articulates with the capitulum to form the - radial humeral joint ● Radial head is a common fracture site for fractures. ● Radial head rotates around trochlea during pronation and supination but during elbow flexion it sits in radial fossa ● Radial tuberosity is the attachment site of the biceps. ● Just inferior to the coracoid notch is the radial tuberosity, the attachment site for the brachioradialis

Joints of the Elbow

Ulnohumeral joint Radiohumeral joint Proximal radioulnar joint (1 degree of freedom - pronation and supination) ➢ At elbow we will see most of the movement occur at the ulnohumeral joint but it does work with the radiohumeral joint creating a bilateral hinge joint ➢ Elbow joint is strong and stable providing open chain movements but also the makeup of a supportive closed chain movements ➢ A lot of muscles cross at the elbow providing stability and ligament system. ➢ 120-160 we see active forearm less when elbow is supinated

Ulnohumeral joint Articulation between the ulna and humerus o Trochlea of the distal humerus ▪ Trochlear notch on the ulna o Coronoid process of the ulna ▪ Coronoid fossa of the humerus o Olecranon process of the ulna ▪ Olecranon fossa of the humerus ● Hinge joint ● valgus position is 10-20 degrees – in extension & reduced in flexion ● Flexion/extension of elbow ●

Radiohumeral Joint ● ● ➢ ➢ ➢

Articulation between the radius and humerus Capitulum of the humerus –> radial head of the radius Because of the way the head sits on the capitulum, it allows for rotation. In radial extension there's not contact between the radius and the humorous But in flexion it slides into the radial fossa.

Soft tissue of the Ulnohumeral & Radiohumeral Joints

➢ UCL has 3 parts – ant./post./transv. ➢ UCL primary stabilizer of elbow ➢ UCL limits excessive motion laterally – anterior fibers limit extension and posterior fibers limit flexion ➢ UCL prevents subluxation of ulnohumeral articulation ➢ Ulnar and radial stabilize the capsule medial and laterally. ➢ RCL limits excessive stress that would cause the forearm to move medially ➢ RCL prevents subluxation of the radiohumeral joint ➢ Annular ligament is the anterior posterior and transverse ➢ AL Prevents radial extraction (dislocation) ➢ AL Maintains articulation of proximal radioulnar joint

Radioulnar Joint

Radial Rotation

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Radial head is rotating and when it turns it is going to flip the distal head over Supination = bones are parallel Pronation = bones crossed RADIUS IS PIVOTING AROUND A STATIONARY ULNA Attached to ulna = nothing to do with pronation and supination The hand and wrist really only connect via radius. Hand is following radius. Radius can move around fixed ulna. Supination is stronger 150-180 degrees people can range up to 70-90 degrees of pronation/ supination 80-90 degrees

Proximal Radioulnar Joint

Middle Radioulnar Joint

➢ Interosseous membrane absorbs forces ➢ Takes force off radius because that’s where all the forces come through

Distal Radioulnar Joint

➢ Distal radial joint is pivoting of the radius

Muscles of the Elbow and Forearm

➢ 24 muscle cross at the elbow joint. ➢ Most are capable of producing more than one movement at most three (crossing at elbow wrist and finger) ➢ Branches of the brachial plexus c7-c7 musculocutaneous nerve roots

Brachialis

➢ Prime elbow flexor when palm is down or pronated ➢ Only crossing the elbow ➢ Deep to bicep

Biceps Brachii

Brachioradialis

➢ Beer drinking muscle

Triceps Brachii

Aconeus

Supinator

Pronator teres

➢ Common extensor tendon - medial epicondyle ➢ Common flexor tendon - lateral epicondyle

Pronator Quadratus

➢ Only connects ulnar and radius so only function is pronation

Putting it all together ➢ Pronator's medially rotate the forearm ➢ Supinator's laterally rotate the forearm

Multijoint Muscles

➢ Aren't really functional movements so you probably won’t put someone in active insufficiency (will see it in hand and finger though)

Analyzing how the 3 Main Elbow Flexors Create Elbow Flexion

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ONLY 3rd CLASS LEVER SYSTEM The longer the force arm the greater the mechanical advantage MC= if the ratio is 1=1 neutral Brachialis = most efficient All ratios will be less than 1 so we are seeing which will be more mechanically advantageous MA = closer to 1

Elbow Flexors ● The longer the force arm, the greater the mechanical advantage for that muscle around the axis ● Brachioradialis has the longest force arm, therefore the greatest MA ➢ Multi muscles crossing multi-joints = look at longer force arm more MA ➢ One muscle = least amount of joints will be more efficient ➢ Longer force arm = more MA, but does not mean most efficient

Week 7 Analysis of the Wrist 29 bones in wrist

Primary forearm bone at elbow - ulna Primary forearm bone at wrist - radius Fibrocartilaginous disk between bones Flexion/extension/ulnar deviation/radial deviation Distal Ulna ● Head ● Ulnar Styloid Process - Attachment for ulnar _ collateral ligament ● Fovea – Depression, providing attachment site for fibro cart disk ● Pole - Ulnar articulation with fibrocartilaginous disc Distal Radius ● Tubercle of the Radius - Lies 1/3 of the wrist width from radial styloid ● Radial Styloid Process - Attachment site for radial carpal collateral ligaments ● Ulnar Notch – (Sigmoid notch) Head of ulna sits in to make distal humeral joint ➢ Distal surface is where we see articulation with scaphoid and lunate ➢ Dorsal area = extensor muscles

Carpal Bones ➢ Their volar and dorsa surfaces = rough because attachment sites of wrist ● Scaphoid - Most radial side of the proximal row Pal. Distally to the radial styloid in ulnar dev prom. In rad. Dev. Recede (the scaphoid and trapezium is the floor anatomical snuff box, extensor pollicus longus and brevis tendon. It is in articulation with the radius ● Lunate - Moving distally under the radial tub. Flex it sticks out and extends it goes back in and it is the most dislocated bone in wrist ● Triquetrum - is difficult to pal. But you can on the… ● Pisiform - Final on in proximal row. Pal. On palmer side of hand. Come up from ulna. (volar portion) ● Trapezium - Next row = trapezium, if you bend thumb in (opposition in middle of palm) you can feel it on base of first metacarpal. ● Trapezoid - difficult to palpate. Lies distally from the scaphoid and medial to .. Lateral to.. ● Capitate - Center position of wrist. Come down middle finger best palpated on dorsum of wrist ● Hamate - Most ulnar carpal bone of the distal carpal row.

Joints of the Wrist ● ●

Radiocarpal Joint Midcarpal Joint o Mobility and stability of hand o Ellipsoidal joint with 2 degrees of freedom o But in reality, it is a complex joint with 15 bones 17 joints and complex movements

Radiocarpal Joint

Midcarpal Joint

Other Joints Acting on the Wrist ●

Ulnacarpal Articulation o Functional Articulation o Triangular Fibrocartilage Complex (TFCC)

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Proximal carpal row is bound to the ulna More flexible in ulnar deviation because nothing really stopping it Could get hurt and painful especially in pronation and supination Sometimes surgery is needed. Could be a lasting injury

Ligaments of the Wrist ● ●

Extrinsic Ligaments o Connect the radius, ulna, or metacarpals to the carpal bone Intrinsic Ligaments o Run between the carpal bones only ➢ Stabilize, promote and limit joint motion, preventing dislocation of carpal bones ➢ Dorsal volar radial and ulnar

Extrinsic Ligaments of the Wrist

➢ In pronation the dorsal radial carpal ligament is going to move with the radius and we will see this

Extrinsic Ligaments of the Wrist Cont.

➢ In supination the dorsal radial carpal ligament is going to move with the radius and we will see this

Intrinsic Ligaments of the Wrist

Flexor Retinaculum

➢ 1-2 mm thick ➢ 1-2 cm wide ➢ Attaches to hook of hamate and pisiform on ulnar side. Radial side it attaches at trapezium and ulnar styloid ➢ Carpal tunnel: ➢ Inside tunnel we see the FDP the FDS the FCR a...