PT 8361 Introductory Concepts 2024 PDF

Introductory Concepts PT 8361 Fall 2024 Dr. Hiser, PT, DPT, PhD Thanks to Dr. Maring for original slides. Session Objectives 1. Discuss Introductory Concepts planes and axes of movement joints – classifications relate joints to planes and a...

Introductory Concepts PT 8361 Fall 2024 Dr. Hiser, PT, DPT, PhD Thanks to Dr. Maring for original slides. Session Objectives 1. Discuss Introductory Concepts planes and axes of movement joints – classifications relate joints to planes and axes of movement 2. Review UE and LE movements 3. Introduction to palpation skills Let’s begin with Anatomical Position adopted worldwide for giving anatomical descriptions standing erect; head, eyes, toes anterior (forward) upper limbs by sides; palms facing anteriorly (forward) lower limbs parallel, toes facing anteriorly (forward) movements and relationships typically described as if the patient is in the anatomical position. So – when you indicate whether someone is flexing/extending/abducting/adducting/rotating – all movements are described assuming the anatomical position as the starting point. Let’s Practice: Stand up and assume anatomical position Planes and Axes The body may be divided into several planes and several axes. Generally - movements take place in planes around an axis. (Sometimes movement is more complex with planes that slide over each other or surfaces that may pivot, etc.) Oblique movements and circumduction movements (combination of planes) are possible but for our initial purposes we will primarily (but not exclusively) describe movements within the primary planes. Anatomical Planes Sagittal Plane: imaginary vertical plane passing longitudinally front to back dividing it into right and left portions. The Median Plane is a sagittal plane that divides the body into equal right and left halves. Horizontal or Transverse Plane: imaginary planes passing through the body at right angles to both the median and coronal plane; divides the body into superior (upper) and inferior (lower) parts. (www..davedraper.com) Coronal or Frontal Plane: imaginary vertical plane passing through the body at right angles to the median plane dividing it into Axes Axes are lines around which a movement takes place. Movement of joints takes place around an axis within a plane. Frontal/coronal axis Sagittal/anterior-posterior axis Longitudinal/superior-inferior/cephalo-caudal/ vertical axis www.hmmmedia.com Axes and Planes Combination Practice Stand up in anatomical position Bring your arm/UE straight forward by moving the shoulder. In what plane did you move and around what axis? Resume anatomical position. Move your leg/lower extremity straight out to the side by moving the hip. In what plane did you move and around what axis? Resume anatomical position. Shake your head no. In what plane did you move and around what axis? Terms to Describe Anatomical Relationships Anterior: nearer to the front of the body; aka ventral; for hands it is known as palmar surface Posterior: nearer to the back of the body; aka dorsal Superior: nearer to the head; aka cranial & cephalic Inferior: towards the feet or lower part of the body; aka caudal. Medial: toward the median plane Lateral: farther away from the median plane Combined terms: (e.g.)inferomedial; posterolateral Comparative Terms Proximal: nearest to the trunk or point of origin Distal: farthest from the trunk or point of origin Superficial: nearer to or on the surface Deep: farther from the surface Internal: toward or in the interior of an organ or cavity External- toward or on the exterior of an organ or cavity Ipsilateral- on the same side of the body Clinically Oriented Anatomy. Moore, Dalley, Agur. 8th Ed. 2018. Contralateral- on the opposite side of the body Practice Point to a body part that is inferior to the knee. In anatomical position is the thumb medial or lateral to the little finger? List one joint that is proximal and one joint that is distal to the elbow. Which structure is deeper when looking at someone from the dorsal view – the calf muscle (triceps surae) or the tibia? Joint Classification Systems There are several ways we classify a joint. 1. Amount of movement 2. Material 3. Number and Shape of Articulating Surfaces 4. Degrees of freedom (DOF; in how many planes can the joint move?) 1. Amount of Movement Synarthrosis-joint that permits no movement (ex. sutures of the skull) Amphiarthrosis-joint that allows slight movement (ex. Intervertebral disks of the spine; pubic symphysis of pelvis) Diarthrosis-joint that is freely movable (ex. Shoulder, elbow, wrist, etc) 2. Material I. Fibrous (Synarthrosis)-dense connective tissue Suture- fibrous connective tissue uniting 2 opposing surfaces Syndesmosis-2 surfaces bound together by an interosseous ligament Gomphosis- peg & socket joint (ex. tooth) II. Cartilaginous (Amphiarthrosis)-hyaline cartilage and/or fibrocartilage Epiphyseal plate (junction via hyaline cartilage) Fibrocartilaginous (ex. pubic symphysis or intervertebral disc) III. Synovial (Diarthrodial) Articular cartilage lines the ends of the bone Freely moveable or diarthrodial joints True joint space filled with synovial fluid surrounded by joint capsule Suture- fibrous connective tissue uniting 2 opposing surfaces NETTER PLATES 4th ed: 07 5th ed: 09 Syndesmosis-2 surfaces bound together by an interosseous ligament (e.g. inf tib fib joint) NETTER PLATES 4th ed: 525 5th ed: 513 Gomphosis- peg & socket joint (eg, tooth) NETTER PLATES 4th ed: 15 5th ed: 17 Epiphyseal plate Fibrocartilagino us (ex pubic symphysis or intervertebral disc) Synovial (Diarthrodial) Joints Types of Classification: 1. Number of articulating surfaces 2. Shape of articular surfaces 3. Number of axes and degrees of freedom (DOF) 3. Synovial Joints: According to # of Articulating Surfaces A. Simple- just 2 articulating surface B. Compound- a joint possessing more than 2 articulating surfaces C. Complex- may have 2 or more articulating surfaces, but also has an intracapsular disc, meniscus, or labrum present 3. Synovial Joints: According to shape of articular surfaces Ball and Socket – ex. shoulder and hip Condyloid (Ovoid) - ex. metacarpal phalange (MCP) Ginglymus (Hinge) – ex. elbow, interphalangeal (IP) Planar – ex. scapula Saddle (sellar) – ex. carpometacarpal (1st CMC) 4. Synovial Joints: According to DOF Each (diarthrodial) joint can also be described in terms of “degrees of freedom”. This describes the number of planes in which the joint can move. For example: in how many planes can the elbow move? In how many planes can your hip move? Try it and report. For this task, remember to think in terms of the planes and not combination of planes (oblique and circumduction-type movements). Synovial Joints: According to # of Axes & DOF 1. uni-axial 1 degree of freedom (DOF) 2 directions of motion 2. bi-axial 2 degrees of freedom (DOF) 4 directions of motion 3. tri-axial 3 degrees of freedom (DOF) 6 directions of motion 1. So how would you classify the ball and socket joint? 2. What about the MCP joint of fingers 2 through 5? 3. What about the IP joints? Movement Terms Flexion- bending or decreasing the angle between body parts Extension- straightening or increasing the angle between body parts. Abduction- moving away from the median plane Adduction- moving toward the median plane Rotation- medial (internal) and lateral (external) movements around a long or vertical axis Circumduction and oblique movements- circular movements combining flexion, extension, abduction, adduction, rotation Relate DOF to shape and articulating surfaces Hinge: 1 DOF; 2 movements. Elbows and interphalangeal: flex and extend. Condyloid/ovoid: 2 DOF; 4 movements. 2nd-5th MCP: flexion, extension, abduction, adduction. Saddle/sellar: usually 2 DOF ; 4 movements. 1st MCP joint flex, extends, adducts and abducts. Ball and socket: 3 DOF and 6 movements. The shoulder and hip flex, extend, abduct, adduct, internally and externally rotate. Planar/Gliding: depends on the number of planes and articulations. Will talk about the scapula more specifically later. Review again the movements and planes - for each identify the movement, axis and plane Flexion Extension Abduction Adduction External Rotation Internal Rotation Other Terms of Movement Eversion-moving the sole of the foot away from the median plane Inversion-moving the sole of the foot toward the median plane Dorsiflexion-bending the toes and foot toward your shin Plantarflexion-pointing your toes and foot towards the ground Supination-rotating the forearm and hand laterally so the palm is anterior Pronation-rotating the forearm and hand medially so the palm is posterior Opposition-movement by which the first digit pad is brought to another digit pad Elevation-raising or moving a part superiorly Depression-lowering or moving a part inferiorly Horizontal abduction and adduction Eversion Inversion supination pronatio n Horizontal Abduction and Adduction Scapular Motions elevation/depression- scapula moves along a vertical path retraction-the scapula moves so that the medial border of scapula approaches the spine (adduction of scapula) (squeeze shoulder blades together) protraction-scapula moves anteriorly along the chest wall; the reverse of retraction upward rotation- causes the glenoid cavity of scapula to face upward; the inferior angle of scapula moves laterally and upwards downward rotation- the reverse of upward rotation-the What is happening here? glenoid cavity moves in a downward direction http://moon.ouhsc.edu/dthompso/NAMICS/gifiles/scapmove.gif http://www.maitrise-orthop.com/corpusmaitri/orthopaedic/112_kelly/kelly-fig03.jpg Practice 1) Describe 4 ways to classify joints 2) Classify the hip joint in as many different ways as possible: http://www.reshealth.org/images/greystone/em_0244.gif Review Movements of the UE Cervical flexion/extension lateral flexion rotation Shoulder flexion/extension abduction/adduction internal (medial)/external (lateral) rotation horizontal abduction/adduction Scapular elevation/depression abduction (protraction)/ adduction (retraction) upward/downward rotation Review Movements of the UE Elbow Thumb flexion/extension flexion/extension abduction/adduction Forearm opposition pronation/supination Fingers Wrist flexion/extension flexion/extension abduction/adduction abduction (radial deviation)/adduction (ulnar deviation) Review Movements of the LE Hip flexion/extension abduction/adduction external and internal rotation Knee flexion/extension Ankle and foot dorsiflexion/plantarflexion Inversion/Eversion; Supination/Pronation (these terms are used different depending on whether you are talking about MMT or goniometric measurement) Toes flex and extend Description of Movements Clinically Oriented Anatomy. Moore, Dalley, Agur. 8th Ed. 2018. Intro to palpation (Trail Guide) Reference your Trail Guide to the Body Text Pages 4-17 provides detailed hints and study tools for palpation. - making contact - working hard vs working smart - less is more - rolling and strumming - movement and stillness - movement as a palpation tool - textural differences bw structures (muscle, skin, bone, tendon, ligament, fascia, retinaculum, aa, vv, bursa, nn, lymph nodes) Review these techniques prior to palpation lab Intro to palpation (Trail Guide) Making contact – responsive and relaxed Adapt based on size of structure (fingertips vs whole hand) Closing eyes periodically helps your awareness. The deeper you move the slower and softer your touch. Keep your hands still to feel movement - move hand to determine the outline of structures. Use active (even resisted) movement performed by patient/partner to locate a structure. Self-palpate first when appropriate and helpful MOVE SLOW AVOID TOO MUCH PRESSURE STAY FOCUSED