OSU Kinesiology
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- What type of joint is the scapulothoracic?
- It\'s not a true joint; there\'s no fibrous tissue connection
- Where does the scapula sit at the scapulothoracic joint?
- Between the 2nd and 7th ribs
- What movements are allowed at the scapulothoracic joint?
- Elevation/Depression, protraction(abduction)/retraction(adduction), upward & downward rotation
- What movement requires rotation of the scapula?
- Abduction
- What type of joint is the glenohumeral joint?
- Ball-and-socket
- What is the positioning of the glenoid fossa and the humeral head at the GH joint?
- The glenoid fossa points up, while the humeral head points up and back
- What structures support the GH joint?
- Rotator cuff muscles, capsular ligaments, coracohumeral ligament, scapular tilt
- Which structures at the GH joint provide the most stability?
- Soft tissues (connective tissue, muscles, etc)
- Which muscles make up the rotator cuff?
- Supraspinatus, infraspinatus, teres minor, subscapularis
- Which soft tissue structures are more prone to disruption, those at the shoulder, or those at the hip?
- Shoulder; trades stability for mobility
- How many planes of motion are allowed at the GH joint, and what are they?
- 3; abduction/adduction, flexion/extension, internal & external rotation
- What is the scapular plane\'s role in GH abduction.
- The scapular plane is about 35 degrees anterior to the frontal plane, and it allows for full abduction of the GH joint. Full abduction at the frontal plane is not possible due to interference from the acromion.
- What is scapulothoracic rhythm?
- A natural kinematic rhythm or timing of GH joint abduction in the frontal plane occuring simultaneously with scapular upward rotation
- What is the ratio for scapulohumoral rhythm?
- 2 degrees of GH abduction : 1 degree of scapulothoracic upward rotation
- When are roll and slide in the same direction?
- When the concave surface is moving relative to the fixed bone.
- When are roll and slide in opposite directions?
- When the convex surface is moving relative to the fixed bone.
- What is the purpose of the coracoclavicular ligament?
- Prevents dislocation from an upward motion (such as a person falling on their shoulder in a way that would push the scapula inward and down)
- How many planes of motion are allowed at the AC joint, and what are they?
- 3; Upward & downward rotation, horizontal plane \"rotational adjustments\", sagittal plane \"rotational adjustments\"
- Which motions at the AC joint act to \"fine tune\" the position of the scapula against the thorax?
- Horizontal plane movement and sagittal plane movement
- What are the relative ROM for each action at the sternoclavicular joint?
- More elevation than depression; about 15-30 degrees of protraction; about 45 degrees of axial (posterior) rotation
- What type of joint is the acromioclavicular joint?
- Plane joint
- What are the three major ligaments of the AC joint?
- Superior acromioclavicular, inferior acromioclavicular, coracoclavicular.
- Four bones that make up the Shoulder
- Sternum, Clavicle, Scapula, Proximal Humerus
- 4 joints of the shoulder
- Sternoclavicular, Scapulothoracic, Glenohumeral, Acromioclavicular
- What type of joint is the sternoclavicular?
- Condylar (convex clavicle, concave sternum)
- Name the 3 major ligaments of the sternoclavicular joint.
- Anterior sternoclavicular, posterior sternoclavicular, costoclavicular
- What is the purpose of the costoclavicular ligament?
- It prevents upward dislocation and fast downward movement of the rib
- What actions are permitted at the sternoclavicular joint, and how many planes of motion are there?
- Elevation/Depression, Protraction/Retraction, Posterior rotation; 3 planes of motion
- What motion is best performed with the help of internal rotation of the humerus?
- GH flexion
- What are the relative ROM for GH flexion/extension and GH internal/external rotation?
- Greater flexion than extension, and greater internal (medial) rotation than external (lateral) flexion
- Describe roll and slide for GH internal & external rotation
- Internal rotation: anterior roll, posterior slide; external rotation: posterior roll, anterior slide
- Name the elevators of the shoulder, and state which is the prime mover
- Upper trapezius (prime mover), levator scapulae, rhomboids
- When do the rhomboids act as scapulothoracic elevators?
- When rotation is neutralized
- Which parts of the trapezius (I, II, III, IV) are responsible for what action?
- I & II: elevators III: adduction IV: depressors/rotators
- Name the scapulothoracic depressors
- Lower trapezius, latissimus dorsi, pectoralis minor, subclavius
- Which of the scapulothoracic depressors does not insert on the scapula?
- Latissimus dorsi
- What roles can the pectoralis minor play at the scapulothoracic joint?
- Can be either an elevator or a depressant. By itself, it\'s an elevator. When activated with a posterior muscle, it acts as a sling to depress.
- Name the scapulothoracic protractors
- Serratus anterior
- \"Winging\" of the scapula is the result of which weak muscle, and about which joint does it happen?
- Weak serratus anterior; AC joint
- Name the scapulothoracic retractors
- Middle trapezius, rhomboids, lower trapezius
- Which scapulothoracic retractors act as neutralizers/synergists?
- Rhomboids and lower trapezius
- Which muscles are responsible for GH abduction, and which is the main abductor?
- Deltoid (main abductor), supraspinatus
- Why is GH abduction a weak action?
- Because of long resistance arm and short force arm; it\'s very mechanically disadvantaged
- Name the GH flexors
- Anterior deltoid, coracobracialis, biceps brachii (long head)
- What other action does GH flexion tend to be coupled with?
- Trunk rotation
- Which muscle can flex both the shoulder and elbow?
- Biceps brachii (long head)
- Describe the concept of a force couple in GH abduction.
- The deltoid and rotator cuff muscles act simultaneously to rotate the head of the humerus.
- Name the GH adductors/extensors, and indicate which ones are the main adductors
- Latissimus dorsi & pectoralis major are the main adductors; also included are teres major, long head of triceps, posterior deltoid, infraspinatus, and teres minor
- How does the pectoralis major act as both an adductor and an abductor at the GH joint?
- When the clavicular head of the pec major rises above the axis of rotation, that portion acts as an abductor
- Why is there weak abduction torque when the shoulder is extended?
- It\'s due to the joint axis and the pull of the muscle
- Which GH adductor/extensor does whatever action the latissimus dorsi does?
- Teres major
- Name the GH internal rotators
- Subscapularis, anterior deltoid, teres major, latissiumus dorsi, pec major
- Which sports rely on internal rotation?
- Softball, javelin, etc
- Name the GH external rotators
- Supraspinatus, infraspinatus, teres minor, posterior deltoid
- Which are smaller, GH internal or external rotators?
- External rotators
- Which GH external rotator creates the most torque?
- Infraspinatus
- If someone obtains a rotator cuff tear, which group of muscles is often torn?
- GH external rotators, especially the infraspinatus
- Is stabilization of the shoulder joint by the rotator cuff muscles an active or passive process?
- Active
- What is the osteology of the elbow and forearm complex?
- Distal humerus, ulna, radius
- What are the two joints of the elbow?
- Humeroulnar & humeroradial
- What type of joint is the humeroulnar, and how many planes of motion are permitted?
- Hinge; 1 plane of motion
- Describe the humeroradial joint
- The radius is pulled to the humerus during muscle contraction, but there is no bony support. It is held in place by the joint capsule and soft tissue
- What is the valgus angle of the elbow?
- Due to the trochlear asymmetry of the humerus, the forearm bends away from the body at about 15 degrees
- Do males or females have a greater valgus angle of the elbow?
- Females
- Describe what a varus angle of the elbow would be
- Varus is the opposite of valgus. A varus angle is a 5 degree positioning of the forearm towards the body when in anatomical position
- What does cubitis mean?
- Elbow
- Which elbow ligament is under great stress as a result of the elbow\'s valgus angle?
- Medial collateral
- What are the two large ligaments of the elbow?
- Medial collateral and lateral collateral
- Which ligament of the elbow has anterior and posterior fibers, medial or lateral collateral?
- Medial collateral
- What is the purpose of the medial and lateral collateral ligaments of the elbow?
- They resist varus and valgus forces
- What is \"Tommy John\" surgery, and which athletes might experience this?
- Another ligament is stitched into the place of the medial collateral ligament. This is a common surgery for baseball pitchers and jav throwers
- What limits elbow extension?
- Olecranon of ulna
- True or false: the larger your biceps are, the less elbow flexion you can have.
- True
- What can happen at the elbow joint if the anterior joint capsule is loose?
- You can hyperextend your elbow
- What structures limit elbow flexion?
- Posterior joint capsule and musculature
- What are the joints of the forearm?
- Proximal radioulnar, distal radialulnar
- True or false: proximal movement of the forearm is reflected in distal movement
- True
- What role does the interosseous membrane play in force transmission in the forearm?
- Because of it\'s orientation away from the radius, the force that travels across the radiocarpal joint gets transferred to the ulna as it progresses proximally up the forearm
- How much compressive force does the IOM receive?
- 80 percent
- What is the path that force takes in the forearm?
- Hand to radius to IOM to ulna to humerus
- Is force transmission through the IOM passive or active?
- Passive
- What happens in terms of force transmission when you carry the handle of a suitcase?
- The bracioradialis actively pulls the radius to the humerus to transmit the force up the arm. This is fatiguing.
- What are the two ligaments at the proximal radialulnar joint, and what purpose do they serve?
- Annular ligament, which holds the radius against the ulna; quadrate ligament, which does not give much support, runs from radius to ulna
- What can cause annular ligament dislocation, and what population commonly sees this injury?
- Sharp pull to the hand; children
- What connective tissue is seen at the distal radioulnar joint?
- Dorsal radioulnar ligament, palmar radioulnar ligament, triangular fibrocartilage (articular disc)
- Which ligament stabilizes pronation of the forearm?
- Dorsal radioulnar ligament
- Which ligament stabilizes forearm supination?
- Palmar radioulnar ligament
- Which has slightly less ROM, forearm pronation or supination?
- Pronation
- Which ligament is stretched during forearm supination?
- Palmar radioulnar
- Which ligament is stretched during forearm pronation?
- Dorsal radioulnar
- When the hand is fixed, what characterizes forearm pronation and supination? (Think of the actions of the radius and ulna)
- Supination: internal rotation of humerus Pronation: External rotation of humerus
- Name the elbow flexors, and state which are most responsible for elbow flexion
- Bracialis & Biceps brachii are most responsible; also bracioradialis
- Which elbow flexor has the largest PCA and is stronger than the biceps?
- Bracialis
- Which elbow flexor has the largest mechanical advantage, and only acts in lifting heavy objects?
- Brachioradialis
- Which elbow flexor functions best with shoulder extension?
- Biceps brachii
- Which elbow flexor requires more neutralizers, and why?
- Biceps, because it crosses multiple joints
- What is the law of parsimony?
- As force increases, small one-joint muscles are recruited first, then larger two-joint muscles are recruited second
- What is the result of the law of parsimony?
- It minimizes the muscle fibers activated, and it minimizes the neutralizers that must be activated
- Name the elbow extensors
- Triceps brachii, anconeus
- In what order are the triceps bracii activated?
- Medial first because it\'s smallest, then lateral, then long
- Which head of the triceps also contributes to shoulder extension and is recruited for high work production?
- Long head
- What does the anconeus act to do, since it is a weak elbow extensor?
- Holds the elbow joint together
- When pushing open a door, which muscle creates a greater torque than the long head of the triceps? Why?
- Anterior deltoid; it is the result of lever arm length as the anterior deltoid neutralizes the long head of the tricep
- Name the forearm supinators
- Supinator, biceps brachii
- True or False: forearm supination is weak
- False; it is very powerful
- How does the bicep act as a supinator?
- Because it inserts on the radius, as the forearm is pronated, the biceps tendon wraps around the radius. Active contraction of the biceps can spin the radius sharply into supination.
- When is the bicep most efficient as a supinator?
- 90 degrees
- Where does the supinator originate and insert?
- Originates on lateral epicondyle, inserts on radius
- When is supination weaker?
- When the elbow is extended
- Name the forearm pronators and state which is most active
- Pronator quadratus (most active), pronator teres
- Which muscle provides compressive tension for the DRU joint and supports the distal radioulnar joint by contraction?
- Pronator quadratus
- Which forearm pronator is activated first, pronator quadratus or pronator teres?
- Pronator quadratus
- Which forearm pronator is high power and larger?
- Pronator teres
- Which forearm pronator requires tricep activation? Why?
- Pronator teres; Because the pronator teres contributes to elbow flexion, tricep neutralization is necessary arm is just pronating
- What are the secondary actions of arm extensors and flexors? Why?
- Supination is a secondary action of extensors because they arise on the lateral epicondyle; Pronation is secondary action of flexors because they arise on medial epicondyle
- Name the carpals, lateral to medial and proximal row to distal row
- Scaphoid, lunate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate
- Name the two joints of the wrist
- Radiocarpal and metacarpal (midcarpal)
- What is the natural position of the hand in anatomical position?
- Ulnar deviation (25 degrees) and slight anterior tilt (10 degrees)
- How is the midcarpal joint divided? Which part experiences less movement?
- Medial and lateral compartments; lateral compartment has less movement
- Name the extrinsic ligaments of the wrist
- Radial collateral, palmar radiocarpal, palmar ulnocarpal, dorsal radiocarpal, dorsal ulnocarpal, ulnar collateral
- Name the intrinsic ligaments and their purposes
- Short: stabilizes the proximal row of carpals; long: provides transverse stability
- Which bones make up the central column?
- Radius, Lunate, Capitate, 3rd metacarpal
- What is the relative ROM for wrist flexion and extension?
- More flexion than extension (10-15 degrees more)
- Describe the roll and slide of the lunate and capitate bones during wrist flexion
- The lunate slides dorsally & stretches the DRC ligament; the capitate rolls ventrally and slides dorsally
- What is the relative ROM for ulnar and radial deviation?
- More ulnar than radial deviation (15-20 degrees more).
- What are the roll and slide actions during ulnar deviation?
- Proximal row slides laterally; capitate rolls medially and slides laterally
- Which ligaments resist ulnar deviation? Radial deviation?
- Ulnar deviation: palmar ulnocarpal ligament and lateral palmar intercarpal ligament; radial: palmar radiocarpal ligament and medial palmar intercarpal ligament
- Name the wrist extensors
- Extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris
- What is the secondary action of the wrist extensors?
- Supination
- True or false: Finger extensors may also act as wrist extensors
- True
- Name the wrist flexors
- Flexor carpi radialis, flexor carpi ulnaris, palmaris longus
- What is the secondary action of the wrist flexors?
- Pronation
- True or false: Finger flexors may also flex the wrist
- True
- When does the wrist allow for greatest grip strength?
- 30 degrees of extension
- What role do the wrist extensors play when the finger flexors make a fist?
- The wrist extensors counteract the flexion torque of finger flexors; they act as neutralizers.
- Which are stronger, radial deviators or ulnar deviators?
- Radial
- What is the osteology of the hand?
- Metacarpals, phalanges
- Name the 3 joints of the hand
- Carpometacarpal, metacarpophalangeal, interphalangeal
- What do DIP and PIP stand for?
- DIP = distal interphalangeal PIP = proximal interphalangeal
- Name the three arches of the hand
- Proximal transverse, distal transverse, longitudinal
- What are the properties of the proximal transverse arch of the hand?
- Rigid; keystone is the capitate
- What are the properties of the distal transverse arch of the hand?
- Flexible; keystone is between the 2nd and 3rd MCP joints
- What are the properties of the longitudinal arch of the hand?
- Keystone is between 2nd and 3rd MCP joints
- Which CMC joints are rigid? Flexible? Why is this important?
- 2nd and 3rd MCP joints are rigid, while the peripheral MCP joints are flexible; this allows us to pick up small objects
- What are the properties of the first CMC joint (thumb)?
- Saddle joint; each articulating surface has both convex and concave components
- How many degrees of freedom are at the CMC joints? Name the motions allowed
- 2 true planes of motion, kind of three; flexion/extension, abduction/adduction, opposition (aka hyperadduction, allows thumb to touch pinky)
- What ligaments are found at the MCP joints?
- Radial/ulnar collateral ligaments, palmar plates, flexor tendon \"pulley\"
- When is flexion close-packed at the MCP joint?
- 70 degrees
- What limits hyperextension at the MCP joints?
- Palmar plate, passive structures
- When is adduction/abduction less at the MCP joint?
- When the MCP joints are flexed
- How many sesamoid bones are located inside the thumb MCP joint? What is their purpose
- 2; increase the flex force possible by increasing mechanical advantage
- True or false: hyperextension of the MCP joint of the thumb is not limited
- False; hyperextension is mostly due to the CMC joint of the thumb
- How much abduction/adduction is there at the MCP joint of the thumb?
- Minimal; mostly at CMC joint
- At what joint does most thumb movement occur?
- CMC
- What ligaments are found at the PIP and DIP joints?
- Radial/ulnar collateral ligaments, palmar plates, \"check-rein\" ligaments (only at PIP)
- How are \"check-rein\" ligaments of the PIP joints damaged?
- Hyperextension
- What is the purpose for \"check-rein\" ligaments?
- Prevent hyperextension of the PIP joint
- Name the two types of flexor tendon sheaths of the interphalangeal joints. Which is less robust and gives less resistance?
- Annular (A2,A3,A4) and cruciate (C1,C2,C3); cruciate is weaker
- How are flexor tendon sheaths of the interphalangeal joints damaged? What is a condition of this called?
- When force is applied to a flexed finger; can lead to \"bowstringing\"
- Regarding the hand, what does A1 refer to, a flexor tendon pulley, or a flexor tendon sheath?
- Pulley
- What is an example of the length-tendon principle in the hand?
- Abduction of fingers is better when MCP joint is extended rather than flexed
- What is the difference between extrinsic and intrinsic finger flexion?
- Extrinsic flexion is flexing only your intercarpal joints, while intrinsic flexion flexes your MCP joint
- What structures affect extrinsic finger flexion? Where do the muscles originate?
- DIP, PIP joints; flexor digitorum superficialis, flexor digitorum profundus; the muscles originate on the forearm
- Where does the flexor digitorum superficialis insert?
- On middle phalange
- Where does flexor digitorum profundus insert?
- Distal phalange
- Which muscles are responsible for intrinsic finger flexion?
- Lumbricals and interossei
- Where do the lumbricals arise from?
- Flexor digitorum profundus tendon
- Name the extensors of the fingers, and state which is the main extensor
- Extensor digitorum communis (main), extensor digiti minimi, extensor indicis, lumbricals, extensor retinaculum
- Which finger extensors are redundant?
- Extensor digiti minimi, extensor indicis
- Which interossei are responsible for finger abduction? Finger adduction? At which joint do they act?
- Dorsal interossei abduct the fingers, palmar interossei adduct the fingers; Only acts at MCP joint
- What are the thumb flexors? At which joints do they act?
- Flexor pollicis longus (all joints); flexor pollicis brevis (CMC, MCP joints)
- What are the adductors of the thumb?
- Oppenens pollicis; adductor pollicis
- What are the extensors of the thumb? At which joints do the act?
- Extensor pollicis longus (all joints), extensor pollicis brevis (MCP and CMC joints)
- What is the abductor of the thumb?
- Abductor pollicis longus
- Where are the thenar muscles located? The hypothenar? What part of the hand consists of these muscles?
- Thenar are closer to the thumb, hypothenar are closer to pinky; these are palmar muscles