Study Guide: Shoulder & Elbow Complex PDF

Study Guide: Shoulder Complex Objectives 1. Identify key osteologic features of the shoulder complex. 2. Analyze arthrokinematic motions that occur within the shoulder complex at various joints. Overview of the Shoulder Complex Bones Involved: ○ Humerus ○ Clavicle...

Study Guide: Shoulder Complex Objectives 1. Identify key osteologic features of the shoulder complex. 2. Analyze arthrokinematic motions that occur within the shoulder complex at various joints. Overview of the Shoulder Complex Bones Involved: ○ Humerus ○ Clavicle ○ Scapula ○ Sternum ○ Ribs Joints Involved: ○ Glenohumeral joint ○ Acromioclavicular (AC) joint ○ Sternoclavicular (SC) joint ○ Scapulothoracic joint (not a true joint) Osteology Joint Descriptions Sternoclavicular Joint: ○ Irregular saddle joint. ○ Connects the appendicular skeleton (clavicle) to the axial skeleton (sternum). ○ Stability provided by extensive periarticular connective tissue. Clavicle Osteokinematics: ○ Movements in three degrees of freedom: Elevation/Depression (frontal plane) Protraction/Retraction (transverse plane) Rotational component motion with elevation. Arthrokinematics of Clavicle: ○ Elevation: Superior roll and inferior slide. ○ Depression: Inferior roll and superior slide. ○ Protraction/Retraction: Roll and slide occur in the same direction due to concave surface. Acromioclavicular Joint Articulation between the distal end of the clavicle and acromion of the scapula. Characteristics: ○ Planar joint; surfaces are relatively flat. ○ Primarily upward/downward rotation. ○ Secondary internal/external rotation and anterior/posterior tilting. Scapulothoracic Joint Not a true joint; contact between scapula and thorax. Muscles involved: Subscapularis and serratus anterior. Movements include elevation, depression, protraction, retraction, upward/downward rotation. Kinematics Scapulohumeral Rhythm Concept: For full shoulder motion, the ratio of movement between the scapulothoracic joint and the glenohumeral joint is approximately 2:1 after the first 30 degrees of abduction. ○ For 180 degrees of abduction: 120 degrees from glenohumeral joint, 60 degrees from scapulothoracic joint. Glenohumeral Joint Characterized by a large humeral head fitting into a shallow glenoid fossa. Size Mismatch: ○ Humeral head is approximately 1.9 times larger longitudinally and 2.3 times larger transversely than the glenoid fossa. ○ This allows for a large range of motion but also increased instability. Motion Types Abduction/Adduction: ○ Convex surface (humeral head) rolls superiorly and slides inferiorly. Flexion/Extension: ○ Humeral head spins within the glenoid fossa. Internal/External Rotation: ○ Convex surface rolls and slides in opposite directions (e.g., external rotation rolls posteriorly and slides anteriorly). Clinical Relevance Impingement Syndrome: ○ Occurs if there’s inadequate inferior slide during abduction, potentially pinching the supraspinatus tendon. Importance of Joint Functionality: ○ Healthy function in the SC and AC joints provides redundancy in shoulder movements, essential for activities of daily living. Study Guide: Elbow and Forearm Complex Objectives 1. Identify key osteologic features of the elbow and forearm. 2. Analyze arthrokinematic motions at the elbow and forearm. Key Bones and Joints Bones 1. Humerus ○ Features: Trochlea: Articulates with ulna. Capitulum: Articulates with radius. Medial and Lateral Epicondyles: Palpable on the inner arm. 2. Ulna ○ Features: Olecranon Process: Located at the proximal end. Trochlear Notch: Articulates with humeral trochlea. Head of Ulna: Convex structure located distally. 3. Radius ○ Features: Head of Radius: Proximal and articulates with the capitulum of the humerus. Fovea: Concave surface for articulation with the capitulum. Joints 1. Humeroradial Joint: Between humerus and radius. 2. Humeroulnar Joint: Between humerus and ulna. 3. Proximal Radio-Ulnar Joint: Allows rotation between radius and ulna. 4. Distal Radio-Ulnar Joint: Allows additional rotation of the forearm. Arthrokinematics Humeroulnar Joint Type: Modified hinge joint. Flexion/Extension: ○ Arthrokinematics: Roll and slide occur in the same direction. ○ Mechanics: Concave trochlear notch of the ulna rolls on convex trochlea of the humerus. ○ Requires extensibility of anterior structures (e.g., skin, biceps, anterior capsule). Humeroradial Joint Type: Part of elbow joint. Flexion/Extension: ○ Arthrokinematics: Roll and slide occur in the same direction. ○ Mechanics: Fovea of the radius (concave) articulates with the capitulum (convex) of the humerus. Radio-Ulnar Joints (Proximal & Distal) Allow for supination and pronation. Supination: ○ Proximal Joint: Rotation occurs without slide due to the annular ligament. ○ Distal Joint: Roll and slide occur in the same direction. Pronation: ○ Proximal Joint: Similar rotation without slide. ○ Distal Joint: Roll and slide in the same direction. Closed Chain Position When the hand is fixed (e.g., on a surface), the ulna rotates around a fixed radius. Associated movements: ○ Pronation: External rotation of the humerus. ○ Supination: Internal rotation of the humerus. Muscle Attachments Pronator Quadratus: Attaches on the radius; facilitates pronation. Supinator Muscle: Attaches to the radius; facilitates supination. Clinical Significance Degeneration Studies: More degeneration observed at the humeroradial joint than the humeroulnar joint. Functional Importance: Activities like typing and throwing involve significant pronation and supination. Visual Aids Diagrams: Include labeled diagrams of the elbow and forearm, highlighting bones, joints, and muscle attachments. Motion Arrows: Illustrate arthrokinematic movements (roll, slide, rotation). Study Tips Anatomical Terms: Familiarize yourself with anatomical terminology (e.g., trochlea, fovea). Visual Learning: Use anatomical models or diagrams to visualize the complex relationships between bones and joints. Practice Questions: Create flashcards for key terms and concepts for self-testing. Study Guide for Wrist Anatomy and Kinematics Objectives 1. Identify key osteologic features of the wrist (carpus). 2. Analyze arthrokinematic motions from various joints in the wrist. Overview of the Wrist The wrist, or carpus, consists of 8 carpal bones: ○ Proximal row: Scaphoid, Lunate, Triquetrum, Pisiform ○ Distal row: Trapezium, Trapezoid, Capitate, Hamate Joints of the Wrist Distal Radioulnar Joint Radiocarpal Joint Midcarpal Joint Movements of the Wrist Flexion and Extension Radial and Ulnar Deviation Key Features of the Wrist Bones of the Forearm Radius: Larger distal end; contains a prominent tubercle that separates tendons. Ulna: Smaller distal end; notable features include: ○ Ulnar Styloid Process ○ Head of the Ulna Angulation and Motion Ulnar Tilt: Facilitates greater ulnar deviation due to the larger styloid process blocking radial deviation. Palmar Tilt: Provides more flexion (approximately 80°) compared to extension (approximately 70°). Radial Deviation: ~20° Ulnar Deviation: ~30° Carpal Bones 1. Scaphoid: ○ Greek for "boat." ○ Articulates with 5 bones, including the radius. ○ Palpable in the anatomical snuff box. 2. Lunate: ○ Latin for "moon." ○ Most commonly dislocated carpal bone; lacks muscular attachments. 3. Triquetrum: ○ Triangular in shape; palpable just distal to the ulnar styloid. 4. Pisiform: ○ Small, located on the palmar surface; serves as an attachment site for muscles and ligaments. 5. Hamate: ○ Contains a hook for ligament attachment; located beneath the 4th and 5th metacarpals. 6. Capitate: ○ Largest carpal bone; serves as the central pillar of the wrist, articulating with seven bones. 7. Trapezoid: ○ Fits snugly between trapezium and capitate. 8. Trapezium: ○ Asymmetrical shape; located beneath the thumb. Joints and Forces Radiocarpal Joint Force Distribution: ~80% of forces travel through the radius; ~20% through the ulnar side. Most common fractures occur at the radius. Midcarpal Joint Comprises medial and lateral compartments. Most arthrokinematic motions occur here. Kinematics Osteokinematics Flexion and Extension: Around a medial-lateral axis; occurs primarily at the capitate. Ulnar and Radial Deviation: Around an anterior-posterior axis; mainly through the capitate. Arthrokinematics Extension: Convex lunate rolls dorsally on concave radius; palmar slide. Flexion: Palmar roll and dorsal slide at lunate and capitate. Deviation Mechanics Ulnar Deviation: Proximal row rolls ulnarly and slides radially; limited by scaphoid against the radius. Radial Deviation: Opposite action occurs; approximately 85% of radial deviation happens at the midcarpal joint due to scaphoid limitations. Conclusion Understanding wrist anatomy and its movements is crucial for evaluating wrist function and diagnosing injuries. Prepare for discussions and application of this knowledge in practical settings. Study Guide: Osteology and Arthrokinematics of the Hand Objectives  1. Identify key osteologic features of the hand. 2. Analyze arthrokinematic motions of the joints of the hand. Terminology Key Joints Carpometacarpal (CMC) Joints: Joints between carpals and metacarpals. Metacarpophalangeal (MCP) Joints: Joints between metacarpals and proximal phalanges. Interphalangeal (IP) Joints: Includes: ○ Proximal Interphalangeal (PIP): Between proximal and middle phalanges. ○ Distal Interphalangeal (DIP): Between middle and distal phalanges. Numbering of Fingers Thumb: 1 Index Finger: 2 Middle Finger: 3 Ring Finger: 4 Little Finger: 5 Rays A ray refers to the metacarpal and its associated phalanges (e.g., fifth ray includes the fifth metacarpal and both phalanges). Osteologic Features Bone Structure Distal Head of Metacarpals: Convex. Proximal Base of Phalanges: Concave. Thumb: Unique with one IP joint and two phalanges (compared to two IP joints in fingers). Orientation of Thumb Flexion: Thumb moves across the palm (medially).  Dorsal Surface: Lateral side of the thumb. Palmar Surface: Anterior for fingers, medial for the thumb. Unique Structures Proximal and Distal Transverse Arches: Support hand function. ○ Proximal Transverse Arch: CMC joints; keystone is the capitate. ○ Distal Transverse Arch: MCP joints; keystone is the second and third rays. ○ Longitudinal Arch: Runs along the length of the hand between the second and third rays. Arthrokinematics of Hand Movements General Movements Flexion: Bringing fingers together. Extension: Straightening fingers. Abduction: Spreading fingers apart (relative to the third ray). Adduction: Bringing fingers together. Thumb Movements Opposition: Thumb moves across the palm to touch the pads of the fingers. Reposition: Returning the thumb to anatomical position. Specific Arthrokinematic Details 1. First CMC Joint (Saddle Joint): ○ Abduction: Convex base of the metacarpal moves on the concave trapezium (roll anterior, slide posterior). ○ Flexion/Extension: Concave base of metacarpal on convex trapezium (roll and slide in the same direction). ○ Opposition: Two phases: abduction (convex on concave) followed by flexion/medial rotation (concave on convex). 2. MCP Joints (Fingers II-IV): ○ Flexion/Extension: Concave proximal phalanx moving on convex metacarpal (roll and slide in the same direction). ○ Abduction/Adduction: Affected by the position of the fingers (more limited when flexed due to collateral ligament tightening). 3. IP Joints: ○ PIP and DIP Joints: Primarily allow flexion/extension; central ridge prevents rotation.  4. First IP Joint (Thumb): ○ Similar to fingers but only one IP joint; concave moving on convex (roll and slide in the same direction). Study Guide: The Hip Joint Objectives 1. Identify key anatomical features of the hip. 2. Describe femoral anteversion and common compensatory techniques. 3. Define the closed-pack position of the hip and its significance. 4. Analyze osteokinematic and arthrokinematic motions of the coxofemoral joint. 1. Key Anatomical Features of the Hip Pelvis: Components: ○ Ilium: Largest part, forms the superior portion. ○ Pubis: Anterior bone, contributes to the pelvic front. ○ Ischium: Posterior bone, known as the sitting bone. Pelvic Ring: Formed by the fusion of ilium, pubis, and ischium. Connections: ○ Anterior: Pubic symphysis connects the two innominate bones. ○ Posterior: Ilium articulates with the sacrum. Muscle Attachments: Key muscles attach to the pelvis, impacting movement and stability. Rectus Abdominis: ○ Attaches distally on the pubis, influencing pelvic tilt. ○ Facilitates posterior pelvic tilt when contracted. Innominate Bone Anatomy: Palpable Landmarks: ○ ASIS (Anterior Superior Iliac Spine): Easily felt on the anterior pelvis. ○ AIIS (Anterior Inferior Iliac Spine): Harder to palpate due to muscle coverage. ○ PSIS (Posterior Superior Iliac Spine): Located on the posterior side.  ○ PIIS (Posterior Inferior Iliac Spine): Less emphasized in the lecture. Crest of Ilium: ○ When palpated, thumbs point to approximately the L4 vertebra. Acetabulum: Formed by contributions from the ilium, ischium, and pubis (approximately 25% each). 2. Femoral Anteversion Definition: Anterior rotation of the femoral head within the acetabulum. Normal Range: ○ Newborns have about 40 degrees, which typically resolves as they grow. Excessive Anteversion: ○ Occurs when normal resolution does not happen (20-40 degrees). ○ May necessitate surgical correction, especially in conditions like cerebral palsy. Compensatory Technique: ○ Toeing In: Medial rotation of the foot, leading to internal rotation of the tibia and femur. ○ Consequences: Potential shortening of internal rotators, impacting external rotation abilities over time. 3. Closed-Pack Position Definition: Position where joint surfaces are maximally congruent and ligaments are taut. Positioning: ○ Extension: Hip is extended. ○ Abduction: Limb is moved away from the midline. ○ Internal Rotation: Hip is internally rotated. Importance: ○ Unique among joints; involves ligament orientation rather than just bone congruency. Clinical Relevance: ○ In pediatrics, a pavlik harness may be used to maintain this position for hip dysplasia prevention, allowing proper bone development. 4. Osteokinematic and Arthrokinematic Motions Osteokinematics:  Sagittal Plane: ○ Flexion/Extension: Movement around a horizontal axis. ○ Pelvic Motion: Can be described as anterior or posterior pelvic tilting. Frontal Plane: ○ Abduction/Adduction: Movement away from or toward the midline. Horizontal Plane: ○ Internal/External Rotation: Rotation of the femur relative to the pelvis. Arthrokinematics: Concave-Convex Rule: ○ Movements should be analyzed based on whether the concave surface (acetabulum) is moving on a convex surface (femoral head) or vice versa. Key Movements: ○ Fill in the specific motions for different movements (flexion, extension, abduction, adduction, internal/external rotation). Study Guide: Knee Joint Anatomy and Function Lecture Objectives 1. Identify Key Osteologic Features of the knee joint bones. 2. Analyze Motions guided by the soft tissue around the knee joint (muscles, ligaments). 3. Differentiate Osteokinematic and Arthrokinematic Motions. 4. Evaluate Torque Demands on the knee at various phases of knee flexion. 5. Apply Knowledge to Clinical Decision-Making in exercise prescription as a physical therapist. 1. Key Osteologic Features of the Knee Joint Bones of the Knee Patella: The largest sesamoid bone; aids in knee extension. ○ Anterior Surface: Base (top) and Apex (bottom).  ○ Posterior Surface: Covered in articular cartilage for smooth movement against the femur. ○ Patellar Tendon: Attaches to the tibial tuberosity. Femur: ○ Distal End: Contains the medial and lateral epicondyles. ○ Condyles: Articulate with the tibia. Tibia: ○ Proximal End: Contains the medial and lateral condyles. ○ Tibial Tuberosity: Attachment point for the patellar tendon. 2. Soft Tissue Anatomy Around the Knee Meniscus Function: ○ Stabilizes the joint by increasing contact area. ○ Reduces compression forces. Blood Supply: ○ Outer third is vascularized; inner two-thirds is avascular, leading to poor healing after injury. Ligaments Medial Collateral Ligament (MCL): ○ Resists valgus forces (forces coming from the outside). ○ Intertwined with the medial meniscus, often injured together. Lateral Collateral Ligament (LCL): ○ Resists varus forces (forces coming from the inside). Anterior Cruciate Ligament (ACL): ○ Resists anterior-posterior shear forces. ○ Poor blood supply; commonly injured. Posterior Cruciate Ligament (PCL): ○ Resists posterior translation of the tibia. ○ Also has a poor blood supply; injury often requires surgical intervention. 3. Motions of the Knee Osteokinematics  Sagittal Plane: Flexion and extension. ○ Tibial-on-Femoral Motion: Tibia moves on the femur (open chain). ○ Femoral-on-Tibial Motion: Femur moves on the tibia (closed chain). Arthrokinematics Open Chain (Tibial-on-Femoral): ○ Rolling and sliding occur in the same direction. Closed Chain (Femoral-on-Tibial): ○ Rolling occurs anteriorly while sliding occurs posteriorly. Axial Rotation Knee Flexed to 90°: ○ Tibial-on-Femoral rotation involves the tibial tuberosity moving relative to the femur. Knee Flexed to 30°: ○ Changes in tibial and femoral rotation direction need to be noted. 4. Torque Demands on the Knee Torque Comparison Torque demands vary between open and closed chain movements: ○ Open Chain: Torque demands increase with extension. ○ Closed Chain: Highest torque demands occur at 90° of flexion, decreasing toward 0°. Clinical Implications Understanding torque demands aids in selecting appropriate exercises for patients: ○ Patellofemoral Pain: Exercises in the range of 45°-90° flexion are critical. ○ Different Approaches for Patients: Consider whether to use open or closed chain exercises based on patient conditions. 5. Clinical Decision-Making Case Application  For a 46 y/o male with patellofemoral pain and a 21 y/o female recovering from a broken arm: ○ Determine if exercise should be in closed or open chain based on their conditions and the knee’s torque demands at varying angles of flexion. Discussion Points Prepare for discussions in class about how biomechanics influences exercise prescription. Study Guide: Foot and Ankle Anatomy and Kinematics Lecture Objectives 1. Identify key osteologic features of the foot and ankle. 2. Differentiate between fundamental and applied foot and ankle movements. 3. Analyze osteokinematic and arthrokinematic motions of foot and ankle joints. 4. Identify primary movements contributing to pronation and supination across the three major ankle joints. Key Osteologic Features of the Foot and Ankle Major Joints 1. Talocrural Joint (Ankle Joint) ○ Intersection of the talus with the tibia and fibula. ○ Often referred to as the ankle joint. 2. Subtalar Joint ○ Located below the talocrural joint, involving the talus and calcaneus. 3. Transverse Tarsal Joint ○ A combination of the calcaneocuboid and talonavicular joints. Bones of the Foot Seven Primary Bones:  1. Calcaneus 2. Talus 3. Navicular 4. Cuboid 5. Medial Cuneiform 6. Intermediate Cuneiform 7. Lateral Cuneiform Additional bones: Metatarsals and Phalanges. Foot Sections 1. Rearfoot: Talus and Calcaneus 2. Midfoot: Tarsal bones (except talus and calcaneus) 3. Forefoot: Metatarsals and Phalanges Movement Terminology Fundamental Movements Occur around three axes: 1. Medial-Lateral Axis: Plantar Flexion: Movement downwards. Dorsiflexion: Movement upwards towards the shin. 2. Anterior-Posterior Axis: Inversion: Movement inward. Eversion: Movement outward. 3. Vertical Axis: Abduction: Movement away from the midline. Adduction: Movement towards the midline. Applied Movements Pronation: Combination of eversion, abduction, and dorsiflexion. Supination: Combination of inversion, adduction, and plantar flexion. Osteokinematics of the Talocrural Joint Oblique Axis of Rotation: ○ Axis runs through the talus and the tips of the malleoli. ○ Lateral malleolus is inferior to the medial malleolus, creating an oblique angle. Movement Contributions: ○ Pronation: Involves dorsiflexion, slight abduction, and eversion. ○ Supination: Involves plantar flexion, slight inversion, and adduction. Arthrokinematics of the Talocrural Joint Dorsiflexion: Posterior slide with anterior roll. Plantar Flexion: Anterior slide with posterior roll. Subtalar Joint and Transverse Tarsal Joint Subtalar Joint Involves articulation between the talus and calcaneus. Pronation: Eversion and abduction. Supination: Inversion and adduction. Arthrokinematics of the Subtalar Joint Open Chain: Calcaneus moves on a fixed talus. Closed Chain: Tibia and talus move relative to a fixed calcaneus. Transverse Tarsal Joint Composed of: 1. Talonavicular Joint 2. Calcaneocuboid Joint Allows for opposing movement directions between the forefoot and rearfoot. Provides flexibility and stability. Arthrokinematics of the Transverse Tarsal Joint Movement involves simultaneous roll and slide in the same direction. Summary Understanding the anatomy and movement mechanics of the foot and ankle is crucial for analyzing gait, diagnosing injuries, and developing rehabilitation protocols. Remember the relationship between fundamental and applied movements, especially in the context of pronation and supination, which are critical for overall foot function. Important Notes Be prepared to identify the primary fundamental movements contributing to pronation and supination at each joint. Recognize the clinical relevance of observing calcaneal movement for diagnosing pronation or supination. This study guide serves as a comprehensive overview of the foot and ankle's anatomy, joints, movements, and biomechanics, crucial for further studies in kinesiology, physical therapy, or sports science. Study Guide: Sacroiliac Joint (SI Joint) Objectives 1. Identify the basic osteologic features of the SI joint. 2. Understand the two primary functions of the SI joint. Overview of the SI Joint Location and Structure The SI joint is the key connection between the axial skeleton (spine) and the appendicular skeleton (lower extremities). It is formed by: ○ The ilium (part of the pelvis) ○ The sacrum The joint itself cannot be palpated directly but can be approximated through anatomical landmarks: ○ PSIS (Posterior Superior Iliac Spine): A bony protuberance felt when standing and marching in place. Importance of the SI Joint Estimated to be a source of chronic low back pain in about 25% of individuals. Its stability is critical for bipedal movement, particularly during activities involving unilateral forces (e.g., running, jumping). The Pelvic Ring  The pelvic ring comprises: ○ Sacrum ○ SI joints ○ Ilium ○ Pubis ○ Ischium (sitting bones) ○ Pubic symphysis Sacrum is the keystone, while the SI joints serve as areas of pressure release. Motion of the SI Joint Key Terms 1. Nutation: ○ Defined as the relative anterior tilt of the sacral promontory relative to the innominate. ○ Can occur as: Sacral on iliac motion Iliac on sacral motion 2. Counternutation: ○ The opposite of nutation; the promontory moves posteriorly while the ilium moves anteriorly. Functions of the SI Joint 1. Stress Relief Provides relief during: ○ Gait and Running: Due to the interaction of descending gravity forces and ascending ground reaction forces, the SI joint accommodates torsion, preventing injury. ○ Pregnancy: Increased ligament laxity in the last trimester allows for greater nutation, enlarging the pelvic outlet for childbirth. 2. Stability Maintains stability during: ○ Standing: The body’s center of mass is affected by gravity, causing joint reaction forces through the acetabulum, leading to nutation. Close-packed position during nutation provides greater stability to the joint. ○ The stability from nutation can also be influenced by posterior tilting of the innominate on the sacrum due to ground reaction forces.