Podcast
Questions and Answers
Which of the following is a myotome for shoulder abduction?
Which of the following is a myotome for shoulder abduction?
C8 is responsible for thumb extension.
C8 is responsible for thumb extension.
True
What is the innervation of the Deep Neck Flexors?
What is the innervation of the Deep Neck Flexors?
Cervical primary rami
The _______________ is a muscle that restricts occipital-atlantal flexion and is associated with cervicogenic headaches.
The _______________ is a muscle that restricts occipital-atlantal flexion and is associated with cervicogenic headaches.
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Match the following muscles with their primary functions:
Match the following muscles with their primary functions:
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Which muscle is innervated by CN XI and is involved in shoulder elevation?
Which muscle is innervated by CN XI and is involved in shoulder elevation?
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What muscle restricts scapular movement and is innervated by the dorsal scapular nerve?
What muscle restricts scapular movement and is innervated by the dorsal scapular nerve?
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C7 is responsible for elbow flexion and wrist extension.
C7 is responsible for elbow flexion and wrist extension.
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The ___________ muscle originates from TPs of C3-C7 and inserts on the 1st rib.
The ___________ muscle originates from TPs of C3-C7 and inserts on the 1st rib.
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What is the primary purpose of Grade III joint mobilization?
What is the primary purpose of Grade III joint mobilization?
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Which joint mobilization grade is characterized by small amplitude movements at the R2 and beyond?
Which joint mobilization grade is characterized by small amplitude movements at the R2 and beyond?
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In the context of mandibular motion, which muscle is the primary mover for mandibular elevation?
In the context of mandibular motion, which muscle is the primary mover for mandibular elevation?
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What does a C curve during assessment indicate regarding TMJ mobility?
What does a C curve during assessment indicate regarding TMJ mobility?
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Which scenario does NOT comply with the rules of Mulligan mobilizations with movement?
Which scenario does NOT comply with the rules of Mulligan mobilizations with movement?
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What is the primary action of the Latissimus Dorsi muscle?
What is the primary action of the Latissimus Dorsi muscle?
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Which muscle is involved in shoulder flexion and is innervated by the Axillary nerve?
Which muscle is involved in shoulder flexion and is innervated by the Axillary nerve?
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Which of the following muscles is innervated by the Long Thoracic nerve?
Which of the following muscles is innervated by the Long Thoracic nerve?
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What is the action associated with the Multifidus muscle during movement?
What is the action associated with the Multifidus muscle during movement?
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Which muscle restricts external rotation and is innervated by the Upper and Lower Subscapular nerves?
Which muscle restricts external rotation and is innervated by the Upper and Lower Subscapular nerves?
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Study Notes
Musculoskeletal Physical Therapy Overview
- Focus on assessing and treating musculoskeletal conditions through various physical therapy techniques.
Upper Quarter Screen
- Peripheral Joint Scan includes assessments for cervical flexion, extension (no overpressure), rotation, side bending, and shoulder abduction as well as functional external/internal rotation.
Myotomes
- Key muscle functions associated with cervical spinal levels:
- C1-C3: Cervical rotation
- C4: Scapular elevation
- C5: Shoulder abduction, internal rotation, external rotation
- C6: Elbow flexion, wrist extension
- C7: Elbow extension, wrist flexion
- C8: Thumb extension
- T1: Finger abduction
Dermatomes
- Sensory distributions for cervical spinal levels:
- C3: Side of neck
- C4: Supraclavicular region
- C5: Lateral aspect of the arm
- C6: Thumb
- C7: Digits 2 and 3
- C8: Ulnar border of the hand
- T1: Medial aspect of the arm
Muscle Stretch Reflexes (MSRs)
- Key reflexes tested at cervical levels:
- C5: Biceps reflex
- C6: Brachioradialis reflex
- C7: Triceps reflex
Key Muscles and Their Details
-
Deep Neck Flexors
- Origin: Vertebral bodies
- Insertion: Transverse processes (TPs, anterior)
- Innervation: Cervical primary rami
- Relevance: Weakness associated with forward head posture; assessed using pressure biofeedback method.
-
Suboccipitals
- Origin: Spinous processes (SPs) and TPs of C1/C2
- Insertion: Occiput
- Innervation: C1 dorsal rami
- Relevance: Restricts occipital-atlantal flexion; relevant for cervicogenic headaches.
-
Levator Scapulae
- Origin: TPs C1-C4
- Insertion: Superior/medial scapula
- Innervation: Dorsal scapular nerve (C5)
- Relevance: Attention for contralateral scapular assistance and C1-C4 dysfunction.
-
Trapezius
- Origin: Medial ⅓ superior nuchal line, nuchal ligament, SPs T1-T7
- Insertion: Acromion, spine of scapula, lateral ⅓ clavicle
- Innervation: CN XI and cervical nerves C3, C4
- Relevant tests include MMT for upper, middle, and lower trapezius with specified body positions and actions.
-
Sternocleidomastoid (SCM)
- Origin: Sternum, medial ⅓ clavicle
- Insertion: Mastoid process
- Innervation: CN XI, C2, C3
- Relevance: Important for assessing occipital-atlantal (OA) flexion; techniques include chin tucks and contralateral side bends.
-
Scalenes
- Origin: TPs C3-C7
- Insertion: 1st rib
- Innervation: Spinal nerves C3-C8
- Relevance: Stuck open positioning; vital to assess for thoracic outlet syndrome.
-
Latissimus Dorsi
- Origin: Inferior 3-4 ribs, SPs T6-T12, posterior iliac crest, thoracolumbar fascia
- Insertion: Floor of intertubercular groove
- Innervation: Thoracodorsal nerve (C6-C8)
- Relevance: Key for thoracic spine assessment; MMT performed prone with arms at the side.
Muscles and Their Attachments
- Latissimus Dorsi: Originates from the inferior 3-4 ribs, SPs T6-T12, posterior iliac crest, TL fascia, and inferior angle of scapula. Innervated by thoracodorsal nerve (C6-C8).
- Serratus Anterior: Attaches to lateral ribs 1-8, inserting on the medial scapula. Innervated by long thoracic nerve (C5-C7). Associated with muscle imbalance and restriction in flexion.
- Multifidus: Originates from superior SPs and inserts on inferior TPS. Innervated by dorsal rami, involved in contralateral rotation and flexion.
- Rhomboids (Major/Minor): Attachments from SPs C7-T5 to the medial scapula, controlled by dorsal scapular nerve (C5).
- Teres Major & Minor: Major attaches to lateral scapula and intertubercular groove (C5-C6). Minor attaches near the greater tubercle; both have no specific muscle testing.
- Pectoralis Minor: Arises from ribs 3-5 to coracoid process; tightness linked with TOS and forward head posture.
- Pectoralis Major: Has two heads (sternal/costal and clavicular) with different points of insertion and tightness issues related to TOS.
- Supraspinatus: Originates from the supraspinous fossa, inserts on the superior facet of the greater tubercle (C5-C6).
- Infraspinatus: Located in the infraspinous fossa, inserts on the middle facet of the greater tubercle (C5-C6).
- Deltoid: Divided into anterior, middle, and posterior sections with attachments to the acromion and clavicle, innervated by the axillary nerve (C5-C6).
Muscles Responsible for Arm Movements
- Subscapularis: Originates from the subscapular fossa and inserts on the lesser tubercle, innervated by upper and lower subscapular nerves (C5-C6).
- Biceps Brachii: Includes long (supraglenoid tubercle) and short head (coracoid process) elements, innervated by musculo-cutaneous nerve (C5-C6). Used in elbow flexion with supination.
- Brachialis: Sources from the distal anterior humerus to the coronoid process, also innervated by musculo-cutaneous nerve (C5-C6).
- Brachioradialis: Runs from the lateral supracondylar line to the radial styloid process, involved in neutral elbow flexion (C5-C7).
- Triceps Brachii: Comprised of three heads (long, lateral, medial) with specific origins; crucial for elbow extension.
Forearm Muscles
- Pronator Teres: Located on the medial supracondylar line, assisting in forearm pronation (Median, C6-C7).
- Supinator: Connects lateral epicondyle with the proximal third of the radius, countering forearm pronation (Deep radial, C7-C8).
- Pronator Quadratus: Attached to the distal ulna and radius, facilitates forearm pronation (AIN, C8-T1).
Range of Motion (ROM) Values
- Cervical Spine: Flexion at 45 degrees, extension 45 degrees, lateral flexion 45 degrees, rotation 60 degrees.
- Thoracic Spine: Flexion 60 degrees, extension 10 degrees.
- Shoulder: Flexion 180 degrees, extension 60 degrees, abduction 180 degrees, IR 70 degrees, ER 90 degrees.
- Elbow: Full flexion at 150 degrees, with a slight hyperextension range 0-10 degrees.
Mobilization Techniques
- Mobilization Direction: Should be towards the direction of restriction.
- Grades of Mobilization: Ranges from I (small amplitude) to V (high velocity), commonly used for pain and ROM improvement.
- The Mulligan Technique: Involves pain-free, weight-bearing movements with specific blocking or SNAG protocols.
Exercise Guidelines
- Strength Training: Target intensity over 84% 1RM, performing 2-6 sets of 1-1 reps with short rests.
- General Fitness: Utilize 65-80% 1RM for 2 sets of 8-15 reps.
TMJ Biomechanics
- Articulation: TMJ comprises a synovial, bilateral moving hinge joint between the mandibular condyle and temporal bone, divided by a fibrocartilaginous disc.
- Mandibular Movements: Includes depression, elevation, protrusion, and lateral deviation. Normal ROM for opening is 35-55 mm.
Assessment and Treatment of TMJ Conditions
- Hypomobility: Characterized by reduced opening (< 35 mm) and C curve toward the affected side, often due to disc displacement or degeneration.
- Hypermobility: Identified by excessive motion (> 50 mm) typically caused by habitual behaviors.
- Management of Inflammation: Utilizing modalities, protected motion, and soft foods.
- Joint Hypomobility Treatment: Includes mobilization, active ROM exercises, and strengthening.
Cervical Spine Safety Tests
- Stability Tests: Assess for cervical instability and ligament integrity through tests like the Anterior Shear or Alar Ligament tests.
- Imaging Techniques: CT for bone assessment, MRI for soft tissue analysis, and measuring spinal curvature via Cobb or Pedicle methods for scoliosis evaluations.### Dysfunction and Pain
- Dysfunction can cause pain when deep breathing, rotating, sneezing, or coughing.
- Structural dysfunction often involves subluxations from force.
- Torsional dysfunction is characterized by retention in internal or external rotation.
- Respiratory dysfunction is frequently linked to poor posture.
Common Chest Deformities
- Pigeon Chest: Abnormal protrusion of the sternum.
- Funnel Chest: Indentation of the chest wall, also known as pectus excavatum.
- Barrel Chest: Increased anteroposterior diameter of the chest, often associated with respiratory conditions.
Assessment Methods
Respiration Screening
- Observation: Look for rib flare, lateral mobility of the rib cage, and prominent accessory muscles like SCM and scalenes.
-
Breath Hold Test:
- Measure functional residual capacity post-normal exhale (normal > 25 seconds).
- Measure total lung capacity post-full inhale (normal > 35 seconds).
- Hi-Lo Test: Assess movement of the sternum and upper abdomen during breathing, checking for paradoxical breathing.
- MARM Assessment: Palpation from behind to evaluate lower rib cage and abdomen with breathing.
- Costovertebral Expansion: Measure expansion with an inhale after a full exhale, normal expansion is 3-7 cm at T4, Axilla, T8, and T10.
Biomechanical Assessment
- Palpation can occur posteriorly, anteriorly, and laterally to assess intercostal spacings and depth.
- Note tenderness in intercostal muscles or iliocostalis.
- Rib Motion and Thoracic Excursion: Evaluate motion between transverse processes and rib during flexion/extension.
- Rib Spring Test: Apply posterior-anterior pressure with the thumb over the rib, assessing for pain which indicates rib dysfunction.
- If no pain is present during rib springing, it may indicate a facet joint issue.
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Rib Maneuver for Costal Sprain:
- Laterally flex away from the painful side.
- Raise the arm of the painful side overhead.
- Perform caudal and cranial glides on the involved rib:
- Pain increases with stretching and decreases with compression indicates a costal strain.
Manual Therapy
- Rib Elevation (Inhalation) Mobilization: Targeting ribs that are stuck in a depressed position through accessory motion techniques.
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Description
Explore the essentials of Musculoskeletal Physical Therapy with a focus on upper quarter screening techniques and myotomes. This quiz will cover various assessments including cervical flexion and shoulder abduction, providing a comprehensive understanding of physical therapy practices. Perfect for beginners and those looking to refresh their knowledge.
