Questions and Answers
Which of the following is a myotome for shoulder abduction?
C8 is responsible for thumb extension.
True
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.
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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?
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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.
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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?
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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?
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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?
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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?
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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?
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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
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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.
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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.
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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.
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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.
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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.
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Scalenes
- Origin: TPs C3-C7
- Insertion: 1st rib
- Innervation: Spinal nerves C3-C8
- Relevance: Stuck open positioning; vital to assess for thoracic outlet syndrome.
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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.
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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.
