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Anatomical Position

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- Person stands erect - feet flat on floor and pointed forward - arms at sides - palms, eyes and face facing forward - standard frame of reference for anatomical descriptions and dissection

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Above other structures, towards the head

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superior

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below other structures away from the head

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inferior

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toward the front of the body

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back of the body

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posterior

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toward the midline

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medial

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away from the midline

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lateral

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nearest to the point of attachment to the trunk

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proximal

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farthest from the point of attachment to the trunk

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distal

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toward the surface at the body

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superficial

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aaa from the body surface

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deep

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on the other side

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contralateral

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on same side

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ipsilateral

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lying on your back

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supine

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lying face down

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prone

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lying on your right side

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right lateral recumbent

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Human movements are described in 3 dimensions based on a series of ______ - imaginary flat surfaces passing through the body

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planes

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The three planes are perpendicular to each other they are known as

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sagittal frontal and transverse

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divides the body into right and left parts

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sagittal

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passes directly through the midline of the body. cuts the body into equal halves

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mid-sagittal plane

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Any plane parallel to the mid-sagittal plane (unequal parts)

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Parasagittal plane

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In a sagital plane the axis is oriented ________

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LEFT TO RIGHT

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_____ and ______ movements occur in the sagittal plane

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flexion and extension

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Divides the body into anterior and posterior parts

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frontal plane

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The axis of the frontal plane is oriented ______

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front to back

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______ and ______ occur in the frontal plane

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abduction and adduction

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Divides the body into superior and inferior parts

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Transverse (horizontal) plane

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The axis of the transverse plan is oriented in an

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up to down position

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_______ ________ and________ movements occur in the transverse (horizontal) plane

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horizontal abduction, adduction, and rotation

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When organs are sectioned along the transverse plane the sections are called

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cross sections

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Flexion extension Hypersextension Dorsiflexion Plantar flexion are all movements in what plane?

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Sagittal

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Decreases the angle at the joint brings the articulating bones closer together

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Flexion

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Increases the angle at the joint Brings the articulating bones farther together

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Extension

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Extension past the anatomical postion

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Hyperextension

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Moving the dorsum (top) of the foot toward the anterior surface of the tibia - decreasing the angle at the talocrural (ankle joint)

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Dorsiflexion

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Moving the dorsum (top) of the foot away from the anterior surface of the tibia - increasing the angle at the talocrural (ankle) joint

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Plantar Flexion

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In the sagittal plane a ____ occurs at the pelvis and scapula

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Tilt

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The ASIS moves in an anterior and caudal direction

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Anterior pelvic tilt

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The ASIS movews in a posterior and cranial direction

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Posterior pelvic tilt

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The coracoid process moves in an anterior and caudal direction while the inferior angle moves in a posterior and cranial direction

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Anterior tilt of the scapula

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The coracoid process moves in a posterior and cranial direction while the inferior angle moves in an anterior and caudal direction

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Posterior tilt of the scapula

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Abduction, adduction, elevation, depression, lateral flexion, inversion, eversion, shoulder girdle elevation, shoulder girdle depression, shoulder girdle upward/outward rotation, shoulder girdle downward/inward rotation, and lateral pelvic tilt are all movements of what plane?

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Frontal Plane

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movement of a limb away from the midline body

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Abduction

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movement of a limb toward the midline of the body

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adduction

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moving a body part superiorly

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elevation

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moving an elevated body part inferiorly

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depression

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bending the vertebral column to the side

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lateral flexion

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turning the plantar surface of the foot so that it faces medially

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inversion

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turning the plantar surface of the foot so that it faces laterally

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eversion

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movement of the scapula and lateral end of the clavicle in a cranial direction

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shoulder girdle elevation

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movement of the scapula and lateral end of the clavicle in a caudal direction

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shoulder girdle depression

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moving the scapula so that the glenoid cavity faces superiorly

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shoulder girdle upward/outward rotation

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moving the scapula so that the glenoid cavity faces inferiorly

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shoulder girdle downward/inward rotation

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movement of the ipsilateral iliac crest in either a cranial or caudal direction

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lateral pelvic tilt

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Horizontal adduction (flexion), horizontal abduction (extension), protraction, and retraction. Rotation- right, left, medial/internal/inward, lateral/external/outward, supination, and pronation are all movements of the

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transverse plane

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Movement of the humerus or femur, in the horizontal plane, toward the midline of the body or in the anterior direction

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horizontal adduction (flexion)

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Movement of the humerus or femur in the horizontal plane, away from the midline of the body or in the posterior direction

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Horizontal abduction (extension)

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Moving a part of the body anteriorly in the horizontal plane. example: mandible, scapulae

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Protraction

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Moving a part of the body posteriorly in the horizontal plane example: mandible, scapulae

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Retraction

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Turning a bone along its own long axis

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rotation

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Turning at your spine

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Right/left rotation

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movement of the anterior surface of a limb toward the midline of the body

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medial/internal/inward rotation

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movement of the anterior surface of a limb away from the midline of the body

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lateral/externla/outward rotation

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rotating the forearm so the palm faces anteriorly

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supination

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rotating the forearm so the palm faces posteriorly

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pronation

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Opposition reposition and circumduction are considered special movements in what type of plane

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multiplanar

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movement of the thumb to touch the tips of the fingers on the same hand. Occurs at the carpometacarpal joint of the thumb

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opposition

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Moving the fingers out of opposition

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reposition

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movement of the distal end of a body part in a circle. A combination of flexion, abduction, extension and adduction

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Circumduction

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Movement in the plane of the scapula. The scapular plane is approx 30 to 45 degree anterior to the frontal plane.

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Scaption

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The body and bony segments move through planes of motion and around axes of motion. An axis is the point around which rotation occurs. The axes are at a _____ degree to the plane of motion

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90 degree

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The net effect of the forces applied on a common point of attachment on a bony segment. - the line passing through the point of application of the force in the direction in which the force is exerted

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line of pull of a muscle

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The relationship between the line of pull of a muscle and the axis of rotation of a joint determines the movement that occurs at the

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joint

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Some normal anatomical factors affecting joint range of motion are

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connective tissue muscle bulk bony structures body fat and joint structure

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tendons, ligaments, fascia, joint capsules and skin are considered

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connective tissue

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muscle size may affect ROM

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muscle bulk

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bony prominences can stop movements at normal end points in the range

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bony structures

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can act as a wedge between lever arms

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body fat

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the structure of a joint will affect joint ROM. For example a ball and socket joint verses a hinge joint

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Joint structure

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The number of axes or planes in which a joint can move

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degrees of freedom

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Movement along one axis (plane)

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Uniaxial

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Movement along two axes (planes)

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Biaxial

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Movement along three axes (planes)

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Triaxial

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The greater the degree of freedom the greater the mobilty and less

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stability

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the axis for movements in the sagittal plane

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medial lateral axis

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the axis for movements in the frontal plane

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anterior posterior axis

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the axis for movements in the transverse plane

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superior inferior axis

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Muscles with a line of pull _______ to the medial lateral axis of rotation of a joint will produce flexion in the sagittal plane examples: biceps brachii, anterior deltoid

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Muscles with a line a of pull _____ to the medial lateral axis of rotation of a joint will produce extension in the sagittal plane examples: triceps brachii, posterior deltoid

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Posterior

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Muscles with a line of pull _______ or _______ to the anterior posterior axis of rotation of a joint will produce abduction in the frontal plane example: middle deltoid

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Superior or lateral

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Muscles with a line of pull ______ or ______ to the anterior-posterior axis of rotation of a joint will produce adduction in the frontal plane example: latissimus dorsi

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inferior or medial

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Muscles with a line of pull _______ to the superior inferior axis of rotation of a joint will produce internal rotation in the transverse plane example: subscapularis

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muscles with a line of pull ______ to the superior inferior axis of rotation of a joint will produce external rotation in the transverse plane example: Infraspinatus

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Posterior

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Degree of movement that occurs at a joint

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Range of motion ROM

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The joint is moved through a ROM by the examiner with no assistance from the patient

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Passive ROM

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The ROM through which a patient can actively move without assistance a joint using the adjacent muscles

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Active ROM

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Contractile tissues can have stress placed on them by ____________ they include muscle and tendons

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stretching or contracting

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Non contractile tissues can have stress placed on them by ___________ they include joint capsule, ligaments, cartilage, fascia, skin, and bursae

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stretching or pinching

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If AROM and PROM are painful and liminted in the same direction lesion is in the

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non contractile tissues

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If AROM and PROM are painful and limited in the opposite direction lesion is in the

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contractile tissues

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Stresses the contractile and passive tissues of a joint. Evaluates coordination of movement, muscle strength, and joint ROM. All movements permitted at the joint being evaluated should be tested

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Active Range of Motion

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Limitation in AROM may be due to restricted joint _______ muscle ________ and muscle ________ or ________

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mobility weakness and tightness or pain

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ROM is evaluated using a ________ which is the most common instrument for measuring joint angles or ROM in the clinical setting. It is a 180 or 360 protractor with one axis that joins two arms, one arm is stationary and the other arm is moveable around the axis or fulcrum of the protractor.

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goniometer

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Joint movement is measured by placing the gonimeter directly over the _____ of the joint. Aligning the arms of the goniometer with the two musculoskeletal segments connected to the joint

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axis

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When using a goniometer the movement is generally measured with the proximal segment ____ and distal segment ______

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fixed moving

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The ROM is recorded in

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degrees

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Pure motion is measured in onle one plane sagittal plane = __________________ frontal plane = ____________________ transverse plane = ________________

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flexion and extension abduction and adduction rotation

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Observing an individual performing functional tasks can provide important information as to their abilities and limitations. - The findings will help the OT determine what testing should be completed in order to properly evaluate the client - if deficiencies are noted, OT can the proceed to -- ___________ --____________

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range of motion testing and manual muscle strength testing

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ROM testing should begin with ________

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active ROM testing

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If less than normal active ROM is observed the following testing should be performed -______________ -______________ -______________

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passive ROM measurement of range of motion with goniometer and manual muscle strength testing

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When doing active ROM movement should be performed _______ one at a time and symmertical

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bilaterally

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When doing active ROM the OT should observe - effort - ______ of movement - signs of ______ or ______ and the angle at which they occur - if there is _______ in any joint other than the one being tested

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fluidity pain or restriction movement

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The joint is moved through a ROM by the examiner with no assistance from the client. Evaluated the integrity of the joint and extensibility of the joint capsule, ligaments, muscles and soft tissue

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Passive range of motion

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PROM is generally ______ than AROM because of limitations in the extensibility of contractile tissue related active movement and the amount of movement that is under voluntary control

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greater

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The difference between AROM and PROM helps to protect the integrity of the joint by allowing for the absorption of

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external forces

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when AROM and PROM produce pain for the same joint action, _________ are usually the cause

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passive tissues

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A client with supraspinatus tendonitis may present with limited AROM due to pain. To rule out adhesive capsulitis of the glenohumeral joint, ______ should be performed

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PROM

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With adhesive capsulitis ________ is painful and limited

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AROM AND PROM

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The sensation the examiner feels in their hands as the joint reaches the end of the PROM

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End feel

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The sensation the examiner feels when there is normal ROM and the normal anatomical structures of the joint stop the movement

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Normal end Feel

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Normal end feels consist of

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soft end feel, firm end feel, and hard end feel

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A soft compression sensation - the limitation in PROM when soft tissues approximate each other - a soft compression of tissue examples: knee flexion and elbow flexion

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soft end feel

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The limitation in PROM due to resistance in stretching of muscles, join capsule or ligaments

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Firm end feel

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This occurs in firm end feel - firm or spongy sensation that has some give when muscle is stretched - muscle tension limits the movement Example: hip flexion with straight knee --> hamstrings limit joint movement Example: Ankle dorsiflexion with straight knee --> gastrocnemius muscle limits joint movement

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Muscular stretch (soft tissue stretch)

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This occurs in a firm end feel - Firm leathery feeling (slight give) when non-contractile tissues are stretched - Joint capsule or ligament tension limits the movement Examples: - external rotation of the shoulder - Extension of the MCP joints of the fingers (limited by tension in the anterior capsule) - Supination of the forearm (limited by the radioulnar ligament)

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Capsular stretch

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An abrupt hard bony sensation - the limitation in PROM when bone contacts bone - an abrupt hard stop to movement Example: elbow extension contact between the olecranon process of the ulna and the olecranon fossa of the humerus

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Hard end feel

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The sensation the examiner feels when there is a decrease or increase in joint PROM or normal PROM but structures other than the normal anatomy stop joint movement

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Abnormal end feel

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soft end feel firm end feel hard end feel empty end feel can all be considered

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abnormal end feels

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A boggy sensation This sensation occurs during PROM - sooner than typical or - in a joint that normally has a firm or hard end feel - Suggestive of: soft tissue edema and synovitis

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Soft end feel

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A springy or firm sensation This sensation occurs during PROM - Sonner than typical or - in a joint that normally has a soft or hard end feel - Suggestive of hpertonicity of muscle tissue or capsular ligamentous or muscular shortening - Example: limited elbow extension due to biceps brachia spasticity

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Firm End Feel

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An abrupt, hard, bony sensation. An abrupt hard stop to movement. This sensation occurs during PROM - sooner than typical or - in a joint that normally has a soft or firm end feel - Suggestive of: oesteoarthritis, loose bodies in the joint, fracture, chondromalacia, and myositis ossificans

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Hard end feel

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No end feel is reached because of pain, preventing reaching end of PROM - Suggestive of: acute joint inflammation, Bursitis, Fracture, Psychogenic disorder

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Empty end feel

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An increase in PROM beyond normal values for the movement being tested at a specific joint - Possible causes: laxity of ligaments, joint capsule and muscles, abnormal joint surfaces, joint trauma, certain connective tissue disorder such as mar fan syndrome and rheumatic diseases, and down syndrome (hypotonia)

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Hypermobility

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Females have greater flexibility then men due to structural and ________ differences - older adults are generally less flexible due to -- muscle fibrosis -- reduced _________ -- degnerative _______ -- sedentary lifestyle

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hormonal muscle strength joint disease

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Contraindictions to PROM testing includes - dislocation of a ______ - diagnosis of - unhealed

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joint myositis ossificans fracture

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Precautions should be taken if ______ testing is performed on a client with - presence of an infection or inflammatory process in a joint - recent surgical procedure - region of marked osteoporosis - carcinoma of the bone or any fragile bone condition - significant hyper mobility - significant pain - hemophilia - region of hematoma acute muscular injury

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PROM

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The nervous system consists of the

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CNS- Brain: cerebrum, cerebellum, and brain stem & Spinal Cord PNS- Cranial and Spinal Nerves

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receives sensory information and processes to produce body responses (movement) - there are two hemispheres

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cerebrum

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- A thick band of nerves that divides the cerebrum into left and right hemispheres - connects the left and right sides of the brain allowing for communication between both hemispheres - transfers motor, sensory, cognitive info between the brain hemispheres

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Corpus callosum

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Generally each hemisphere receives sensory information from and controls movement on the _________ side of the body

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opposite

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The __________ forms the outer layer of the cerebrum and processes information for tasks that require conscious thought

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cerebral cortex

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Motor neurons run from the _____ to the _____

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CNS to the PNS

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These motor neuron cells bodies are located in the motor area of the cerebral cortex. - They synapse in motor neclei of the brainstem or the anterior gray born of the spinal cord with a LMN - They do NOT leave the CNS

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Upper Motor Neurons (1st order neurons)

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These motor neuron cell bodies are located in the motor nuclei of the brainstem or the anterior gray horn of the spinal cord. - Innvervate skeletal muscle fibers - They are cranial and spinal nerves - These axons LEAVE the CNS

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Lower motor neurons (2nd order neurons)

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Regulates muscle tone, balance, and coordinates voluntary motor acts

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Cerebellum

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Connects the cerebrum to the spinal cord

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Brain stem

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- Carries information between the brain and body - Sensory signals travel from the body to the brain - Motor signals travel from the brain to the body

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Spinal Cord

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- Extends from the CNS - PNS neerve fibers carry impulses to and from the CNS

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PNS

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In the PNS- collections of nerve cell bodies that lie outside the brain or spinal cord

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Ganglia

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Carry nerve impulses from receptors or sense organs of the PNS to the CNS

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Afferent fibers

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Carry nerve impulses form the CNS to the PNS (muscles and glands)

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Efferent fibers

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Carry impulses to and from muscles

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somatic

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carry impulses to and from organs and glands

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Visceral

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extend outward from the spinal cord - 31 pairs

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spinal nerves

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- 12 pairs - branch off the brain and brain stem - Are either sensory, special sensory, motor, or mixed

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cranial nerves

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All cranial nerves, except ______ innervate structures in the head and neck

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CN 10 vagus nerve

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CN 10 is _______ - innervates organs another structures in the thorax and abdomen

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mixed (sensory and motor)

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Divisions of the PNS =

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Sensory and Motor Division

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Somatic and visceral sensory nerve fibers are part of what division

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Sensory (afferent) division

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- Motor fibers are part of what division

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Motor efferent division

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Divisons of the motor system =

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Somatic nervous system and Autonomic nervous system

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- Somatic motor (voluntary) - Impulses from CNS to skeletal muscles

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Somatic nervous system

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- Visceral motor (involuntary) - Impulses from CNS to cardiac muscle, smooth muscle and glands

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Autonomic Nervous System

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Branches of the autonomic nervous system =

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Sympathetic and parasympathetic nervous system

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- Also known as the thoracolumbar division - Mobilizes body systems during activity - Kicks in during periods of exertion, stress or emergency - Fight or flight

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Sympathetic Nervous System

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- Also known as the craniosacral division - Conserves energy (to calm the body) - Predominates under resting conditions

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Parasympathetic nervous system

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The nervous system controls _________ Movement occurs either by conscious intention or unconsciously in response to sensory impulses received from sensory receptors in the skin, muscles or related tissues

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movement

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Automatic responses to change in environment

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Reflexes

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Reflexes Occur over neural paths called reflex

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arcs

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Components of a Reflex Arc: Step 1: a _______ is stimulated Step 2: _________ carry the signal to the CNS (integration center) Step 3: integration center processes and transfers the nerve signal to a _______ - polysynaptic reflexes involve one or more _______ and monosynaptic reflexes don't involve any. Step 4: Motor neurons carry impulses to an _________ Step 5: ________ responds

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Receptor Sensory neurons Motor Neuron Interneurons Effector Organ Effector Organ

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Classified by complexity of neural circuit Involves only one synapse Sensory neuron synapses directly onto motor neuron Example: stretch reflex

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Monosynaptic Reflex

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Classified by complexity of neural circuit Involves multiple synapses and interneurons At least one interneuron between sensory neuron and motor neuron Example: Withdrawal Reflex

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Polysynaptic Reflex

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Classified by site of information processing it is where Integration occurs in the gray matter of the spinal cord

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Spinal Reflexes

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Classified by site of information processing it is where integration occurs in the brain stem

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Cranial Reflexes

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- A monosynaptic reflex - Monitors and regulates skeletal muscle length - When a stimulus results in the stretching of a muscle, the muscle reflexively contracts

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Stretch Reflex

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In a stretch reflex The stretch in a muscle is monitored by a stretch receptor called a

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muscle spindle

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An example of a stretch reflex is the

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patellar reflex

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The receptors in stretch reflexes - Bundles of small, specialized intrafusal muscle fibers innervated by sensory and motor neurons - Surrounded by extrafusal muscle fibers which maintain tone and contract muscle - Prevent injury from over stretching because muscle contracts when it is stretched - Provide information regarding muscle length and rate of change in muscle length

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Muscle Spindles

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When a muscle lengthens (stretches), muscle spindle intrafusal muscle fibers are stretched the deformation of the muscle spindle sends signals to the spinal cord along the afferent nerve fibers where they synapse with the _________. The nerve signals exit the spinal cord via the efferent nerve fibers which innervate the extrafusal muscle fibers of the same muscle causing the muscle to_________ This helps to reduce the chance of muscle damage due to_________

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motor neurons contract overstretching

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Stretch activates the

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muscle spindle

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Sensory neurons synapse directly with motor neurons in the ________. Motor neurons cause the stretched muscle to contract

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spinal cord

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Stretch reflexes are monosynaptic and

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ipsilateral

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When the stretched muscle contracts, antagonistic muscles that oppose the contraction relax this is called __________

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Reciprocal inhibition

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Reciprocal inhibition is when the sensory fibers stimulated by the muscle spindle synapse with interneurons in the spinal cord that inhibit the _________ of antagonistic muscles Example: in the Latella reflex, the stretched muscle (quadriceps) contracts and the antagonists (hamstrings) relax

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motor neurons

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Consist of sensory receptors located in tendons or near a musculotendinous junction - Provide information on amount of tension in a muscle and tendon - Prevent contracting muscles from applying excessive tension to tendons

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Golgi Tendon Organs

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Sensory organs in the golgi tendon organs (GTO) transmit nerve impulses to ________ in the spinal cord which inhibit motor neurons in the same muscle - This helps to control muscle tension by causing muscle relaxation to help prevent tendon damage

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interneurons

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Motor Neurons supplying the contracting muscles are _________ and the antagonist muscles are ________ - This is reciprocal activation

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inhibited (relax) activated (contract)

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Reflexes that are processed in the brain stem =

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cranial reflexes

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Righting reflex is an example of a

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cranial (brain stem) reflex

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This reflex - Helps regulate skeletal muscle responses to gravity acting on the body - Regulate head movements that affect the entire body - A neuromuscular response to restore the body to its normal upright position when it has been displaced - Stimulation of the proprioceptors of the labyrinth causes changes in tone of the neck muscles which bring the head into its natural position in space

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Righting Reflex

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Body movement occurs at joints (articulations) where two bones meet

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Articulations

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Joint structure determines ______ and _______ of movement (ROM)

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direction and distance

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There is an inverse relationship between joint _______ and ______

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mobility and stability

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Two methods of joint classifications =

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functional and structural

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Functional joint classification is based on joint ________ - Synarthrosis= _________ - Amphiarthrosis= ______ - Diarthrosis =__________

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ROM immovable joint slightly moveable joint freely moveable joint *** what we will focus on (functional classifications)***

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Structural joint classification is based on ________ of the joint - Fibrous - Cartilaginous - Bony - Synovial

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Anatomical organization

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- Immovable joints - Fibrous or cartilaginous connections - May fuse over time Examples include - Sutures of the skull - Between the teeth/jaw - Epiphyseal cartilage of long bones

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Synarthrodial Joints

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Slightly movable joints Fibrous or cartilaginous connections

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Amphiarthrodial Joints

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Two types of amphiarthorodial joints =

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Symphysis and Syndesmosis

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The bones are joined by fibrocartilage Examples: - Pubic symphysis - Intervertebral discs

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Symphysis (cartilaginous) joints

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Bones are connected by ligaments, cords or a bands of fibrous sheets (interosseus membrane) Example: - Interosseous membrane between radius and ulna

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Syndesmosis (fibrous) joints

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Also called synovial joints - Permit a wide range of motion - Articulating bones are separated by a fluid-containing joint cavity surrounded by a fibrous articular capsule - A synovial membrane lines the walls of the articular cavity - Hyaline cartilage lines the articulating surfaces of the bones - Typically located at the ends of long bones Examples include - Shoulder, knee, hip, ribs, wrist, ankle, elbow and toes

answer

Diarthrodial Joints

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In diarthrodial joints the classification is based on the _______ of the articulating surfaces Examples: Plane (Gliding) Hinge Pivot Condylar (Ellipsoidal) Saddle Ball and Socket

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Shape

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Flattened or slightly curved faces - Limited motion (mainly monaxial) - Intercarpal Joints - Intertarsal Joints

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Plane (gliding) joints

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Angular motion in a single plane (monaxial) - Elbow - Knee - PIP and DIP joints

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Hinge Joints

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Rotation only (monaxial) - Atlas/axis - Proximal radio-ulnar joint

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Pivot Joints

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Oval articular face within a depression in the opposing surface - Motion in two planes (biaxial) - MCP 2 - 5; flexion/extension, abduction/adduction

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Condyloid (ellipsoid) joints

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Concave surface articulates with a convex surface - Motion in two planes (biaxial) - CMC joint of the thumb; flexion/extension, abduction/adduction, opposition/reposition and circumduction

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Saddle Joints

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Round articular face in a depression - Motion in three planes (triaxial) Shoulder, hip

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Ball and socket joints

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Three types of muscle tissue include

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cardiac, smooth, and skeletal muscle tissue

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Involuntary Only found in the heart Consists of small striated cells Pushes blood through the circulatory system

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Cardiac Muscle

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Involuntary Found in the walls of hollow organs Consists of small elongated cells that are not striated Pushes fluids and solids along the digestive tract Regulates the diameter of blood vessels

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Smooth Muscle

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Voluntary Associated with the bony skeleton Consists of large striations cells Attach to the skeletal system and allow us to move

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Skeletal Muscle

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Skeletal muscle can be strengthened which results in _______ fibers, not an increase in the number of fibers. Strength depends on the _______ of the muscles cross section

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thicker Thickness

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In skeletal muscles the number and type of fibers that make up a muscle is determined

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genetically

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In skeletal muscle muscle fibers contract (______)and relax (______)

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shorten lengthen

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Generally muscle fibers can contract or stretch _____ of their resting length. - Skeletal msucles vary in shape and fiber arrangement

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50%

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Connective tissue of skeletal muscles consist of

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Epimysium Perimysium and Endomysium

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- Dense irregular connective tissue layer that surrounds the entire muscle - A muscle consists of bundles of muscle fibers called fascicles

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Epimysium

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Connective tissue layer that surrounds each fascicle

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Perimysium

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Flexible, elastic connective tissue that surrounds individual muscle fibers

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Endomysium

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Muscle attachments may be _____ or ______

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direct or indirect

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The epimysium of the muscle fuses to the periosteum of the bone or perichondrium of a cartilage

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Direct (fleshy) attachment

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The collagen fibers of the endomysium, perimysium, and epimysium extend beyond the muscle and come together to form either a bundle called a tendon or a broad sheet called an aponeurosis, which attach skeletal muscle to bone

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Indirect attachment

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All skeletal muscles consist of ________, bundles of fibers.

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fascicles. Fascicle arrangments vary- result in muscles with different shapes and functional capabilities

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four patterns of fascicle organization include

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circular convergent parallel and pennate

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The amount of tension a muscle can develop depends on total number of _______ in a cross sectional area

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myofibrils

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A type of fascicle arrangement where - fascicles are _____ to the long axis of mucles - Most muscles of the body are ______ muscles Example: biceps brachii - There are some variations - When a ______ muscle contracts It shortens and increases in diameter - Located in positions requiring longer movements with less power or faster movements

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Parallel (fuisform) muscles

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A type of fascicle arrangement where - Fascicles form an angle with the tendon - Do not move as far as parallel muscles because the fascicles are at an angle to the tendon - Contain more muscle fibers per cross-sectional area than parallel muscles - Therefore, develop more tension than parallel muscles - Few muscles have an angle of pen nation greater than 15 degrees

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Pennate muscles

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Types of pennate muscles

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unipennate bipennate and multipennate

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Fibers on one side of tendon Example: tibialis anterior

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Unipennate

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Fibers on both sides of tendon Example: rectus femoris

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Bipennate

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Tendon branches within muscle Example: deltoid

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Multipennate

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Skeletal muscles are composed of fibers that have markedly different _________ (form and structure) and _________ (function) characteristics. The differences have lead to several different systems of classifications.

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morphological physiological

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One approach to classifying muscle fibers is by twitch time, fibers in this category are

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Fast twitch (type II) fibers which have type IIx and type IIa and there are also slow twitch (type 1) fibers.

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These fibers reach a peak tension in 0.01 seconds or less

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fast twitch (type II) fibers

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these fibers are - fast glycotic fibers (FG) - Generate ATP mainly be anaerobic cellular metabolism - Fast because ATP is hydrolyzed rapidly

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Type II-x fibers

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These fibers are - fast oxidative glycotic fibers (FOG) - generate ATP by aerobic and anaerobic cellular metabolism - ATP is hydrolyzed 3 to 5 times faster than in slow twitch fibers - have characteristics of type I and type IIx fibers

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Type II-a (intermediate fibers) Fibers

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Fibers take three times as long to reach peak tension - Slow oxidative fibers (SO) - Generate ATP mainly by aerobic cellular metabolism - Slow, because ATP is hydrolyzed relatively slowly and the contraction cycle proceeds slower than fast-twitch fibers

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Slow-twitch (type I) fibers

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Different fibers allow a muscle o efficiently perform a wide variety of tasks. Most skeletal muscle consist of more than one fiber type but are composed of predominately one type

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Info on Skeletal muscle fibers

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Postural muscles such as the erector spine and soles are continually active for long periods of time and therefore, have a high percentage of

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Type I fibers

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Muscles of the shoulders and arms are used to produce large or quick burst of tension and are composed of a high percentage of

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type IIx fibers

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Some muscles of the legs are used for support, walking, and running and therefore have a large number of

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type I and Type II-a fibers

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A functional unit of neuromuscular system. Consists of a motor neuron and all of the muscle fibers it innervates, within it all of the muscle fibers are the same type. Varies in size form just a few muscle fibers per ________ to a few thousand fibers - this allows a muscle to vary its level of force output according to the demands of the specific task. When stimulated all the fibers of a _________contract simultaneously and maximally (all or none principle)

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Motor Unit

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The muscle fibers of a motor unit are or are not adjacent to each other?

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are not adjacent

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Control of movements depends on the _______ of muscle fibers within each motor unit

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number

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muscles that control precise movements consist of many _______ motor units

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small

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Muscles that are responsible for producing large forces without fine control consist of motor units that innervate as many as ______ muscle fibers per motor neuron

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1000

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Muscles that control eye movements may have motor units with as few as ______ muscle fibers per motor neuron

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5 or 10

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Gastrocnemius muscle has motor units that have as many as ________ muscle fibers per motor neuron

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2000 to 3000

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In a motor unit The level of force produced is dependent on the _____ of the stimulus

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intensity

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Force produced by a muscle is affected by - number of _____ activated - Motor unit ______ and - Rate of ________

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motor units size firing

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The process in which the number of motor units activated increases - the different motor units of a muscle are not all stimulated to contract together - motor units are recruited in order of small to large

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Recruitment

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This is needed for muscle contraction

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Adenosine triphosphate (ATP)

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Aerobic metabolism occurs in

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mitochondria

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Anaerobic metabolism occurs in

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cytosol

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sustained muscle contraction uses a lot of ______ energy

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ATP

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Muscles store only enough energy to start contraction (approx. 4-6 secs worth) - muscle fibers must manufacture more ATP as needed to maintain the contraction - ATP is generated at the same rate it is being used

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ATP and muscle contraction

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There are several types of skeletal muscle contractions - muscle tension ; load (external resistance) - muscle shortens

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Concentric contraction

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Muscle tension ;load (external resistance) - muscle lengthens - helps protect the pint form being forced into rapid changes in the joint position

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Eccentric contraction

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In general we can lower more weight (_______) that we can hold (_______) and hold more weight than we can lift (_______)

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eccentric isometric concentric

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Muscle tension = load (external resistance) - a contraction in which the muscle length does not change - body movement does not occur

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isometric contraction

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a contraction in which muscle tension remains constant - a muscle length changes and body movement occurs

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isotonic contraction

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a contraction of a muscle moving the joint through a ROM at a constant velocity

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Isokinetic contraction

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Typical strength training involves moving a weight through a ROM - the amount of force a muscle generates to move the weight varies due to the mechanical advantage of the joint This type of training is often referred to as

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isotonic training

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However other than isotonic training, _____________ training better describes a type of strength training in which the weight lifted does not change during the concentric and eccentric phases of an exercise

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Dynamic constant external resistance

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functional classifications of muscles =

answer

agonist antagonist synergist co contraction

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Prime mover - muscle/muscle group that provides the major force for the specific movement

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Agonist

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A muscle/muscle group that can slow down or stop a movement - has the opposite action of the agonist - must relax before the agonist can contract

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antagonist

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a muscle/muscle group that assists the agonist to produce specific movement - also contract at the same time as the agonist

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synergist - muscles can provide synergistic actions in different ways

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Contraction of the agonist and antagonist to help stabilize a joint

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co contraction

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Three types of synergists include

answer

conjoint synergists neutralizing or counteracting stabilizing or fixating

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Provide identical or nearly identical activity to that of the agonist Example brachioradialis contracts with the brachial is during elbow flexion

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conjoint synergists

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Prevent an unwanted movement of the agonist Many muscles have more than one action - They can pull in more than one direction (line of pull) - Therefore, when such a muscle contracts the desired and undesired movements can occur simultaneously

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neutralizing or counteracting synergists

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Neutralizing synergists act to pull against and cancel out an unwanted line of pull from the ________ A neutralizing synergist prevents the undesired movement. Example - The biceps brachii can perform elbow flexion and forearm supination - To prevent supination during elbow flexion, the pronator trees contracts

answer

agonist

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Many muscles cross more than one joint and therefore, can cause movement at more than one joint - These act to prevent movement at one of the joints the muscle crosses while allowing movement at the other joint Example: - The biceps brachii crosses the elbow joint (attaching to the radius) and shoulder joint (attaching to the scapula) - The biceps brachii can cause elbow flexion and shoulder flexion - When the biceps brachii contracts, in order to just perform elbow flexion, stabilizing synergists must isometrically contract to prevent movement at the glenohumeral (shoulder extensors) and scapulothoracic joints (rhomboids, trapezius)

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Stabilizing or fixating synergists

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The maximal amount of tension or force a muscle or muscle group can generate in one maximal effort (1RM) at a specific velocity

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Muscle Strength

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The ability of a muscle or muscle group to perform repeated contractions against a resistance or maintain an isometric contraction for a period of time

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muscular endurance

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The tendency of a force (muscle tension) to cause a lever to rotate around an axis of rotation (joint)

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Torque

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Ways muscle strength can be tested =

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force gauges manual muscle testing MMT

question

grip and pinch strength dynamometers are used in what type of muscle strength measure

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force gauges

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The application of graded resistance for the evaluation of the function and strength of muscle groups responsible for pure motion and single muscles when possible - is based on effective performance of movement in relation to the forces of gravity and manual resistance

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Manual muscle testing

question

when performing muscle testing, the OT must consider the effect of gravity on the client because of its effect on movement - the OT must be able to position the client in a _________ and _________ position - some practitioners have questioned the subjectivity and consistency of MMT scoring - some studies show reliability while others have not

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gravity-eliminated and against gravity

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Movement of the body part perpendicular to the floor

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against- gravity position

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movement of the body part parallel to the floor - this can be performed with the OT supporting the body part using a roller board, powder board or other support

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gravity eliminated position

question

Shoulder flexion done while standing the client raises their arm into shoulder flexion is an example of ___________ and Shoulder flexion done while client lying on their side (non test side down) the OT supports the arm while the client moves their arm parallel to the floor is an example of ___________

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against gravity gravity eliminated

question

Manual grading of muscle strength is based on three factors known as

answer

evidence of contraction gravity as a resistance and amount of manual resistance

question

Grade 0: (zero) no palpable or visible muscle contraction Grade 1: (trace) palpable or visible muscle contraction no joint motion Grade 2: (poor) Full available ROM with gravity eliminated and no manual resistance are apart of what muscle grading factor

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evidence of contraction

question

Grade 3: (fair) full available ROM against gravity, no manual resistance is apart of what muscle grading factor

answer

gravity as a resistance

question

Grade 4: (Good) Full available ROM against gravity and moderate manual resistance Grade 5: (normal) full available ROM against gravity and maximal manual resistance is apart of what muscle grading factor

answer

Amount of manual resistance

question

+ or - can be added to whole grades to further describe muscle ability. If a patient has a joint limiting condition he/she can only perform within their available ROM therefore their available ROM is the full ROM for that patient at that time This would be the ROM used during

answer

muscle testing

question

MMT Procedures - The OT uses the ________ - metacarpophalangeal joints are flexed - Interphalangeal joints held in extension - Thumb is either adducted or relaxed in slight extension

answer

lumbrical grip

question

OT applies ___________ - To the segment into which the muscle being tested is inserted - to the segment distal to the joint - using one hand while the other hand stabilizes the joint and prevents recruitment of muscles not being tested - in the opposite direction the client is moving

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Manual resistance

question

MMT Procedures - The client positions the segment to near mid-range of the joints available AROM - With the client performing an isometric contraction in this fixed position, the tester gradually applies an increasing __________ - The client is instructed to not allow the tester to move the segment - The highest grade a client can perform is the grade assigned: the magnitude of the force applied is scored as mild, moderate, or maximal

answer

resistance

question

The normal tension and firmness of a muscle at rest This is because some motor units are always active, even at rest, can be assessed by observation and palpation

answer

Muscle Tone

question

Reduced muscle tone The muscle will feel soft and mushy and will give in to sustained resistance

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Hypotonia

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Complete loss of muscle tone

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Flaccid

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Increased muscle tone The muscle will feel very firm will cause increased resistance to passive stretching

answer

Hypertonia

question

A velocity dependent (speed) resistance to movement felt by the examiner when stretching a muscle/muscle group - Due to hyper-excitability of the stretch reflex - Assessed by palpation of the muscle being stretched - Moving the segment fast causes a sudden and marked resistance to PROM followed by relaxation of the muscle

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Spasticity

question

Causes resistance to quick stretching in the first third of the ROM

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Severe spasticity

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Causes resistance to stretching in the second third of the ROM

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Moderate spasticity

question

Causes resistance to stretching in the last third of the ROM

answer

Mild spasticity

question

Uncontrollable resistance throughout a ROM - Resistance to stretch that is not velocity-dependent

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Rigidity

question

Hypertonic and hypotonic states will ______ MMT grading

answer

invalidate

question

Any disease process that affects the musculoskeletal or nervous systems will affect __________ The effect on the ROM will vary based on the specific condition and the individual

answer

movement

question

Damage to the _______ will affect voluntary and involuntarymovements - Head trauma - Cerebral Vascular Accident (CVA)

answer

cerebrum

question

Pathological conditions that affect one cerebral hemisphere will generally affect movement on the ________ side of the body

answer

opposite

question

Damage to the ________ will affect muscle tone and coordination - The _______ is involved in the coordination of voluntary motor movement, balance and equilibrium and muscle tone

answer

cerebellum

question

Spinal cord damage affects motor and sensory function ______ the level of the lesion

answer

below

question

Damage to _________ will affect individual muscles and dermatomes

answer

peripheral nerves

question

A localized area of skin that is innervated via a single spinal nerve root

answer

Dermatome

question

Peripheral nerve fibers have the ability to ________, unlike CNS structures If the nerve cell body remains intact after injury, recovery of muscle use and sensation often occurs

answer

regenerate

question

Metabolic problems, trauma and disease can affect the

answer

musculoskeletal system

question

An abnormal lateral curvature of the vertebral column which can affect spinal mobility If severe, it can affect the function of the heart, lungs and other organs

answer

Scoliosis

question

Diseases that alter bone development can have an effect on movement. - A congenital disease that can cause loose joints and muscle weakness - It is frequently caused by defect in the gene that produces type 1 collagen, an important building block of bone; Causes extremely fragile bones

answer

Osteogenesis imperfecta

question

Fracture or trauma to the ______________ in growing children may disrupt or halt bone growth

answer

epiphyseal plates

question

Damage to a bone's blood supply can lead to _____________ and bone deterioration Can lead to arthritis, muscle spasm and pain

answer

avascular necrosis

question

A metabolic bone disease leading to weak, porous bones that can result in a fracture - Defined by the World Health Organization (WHO) as a bone mineral density that is 2.5 standard deviations or more below the mean peak bone mass (average of young, healthy adults) as measured by DXA scan

answer

Osteoporosis

question

Damage to a joint may limit ROM - Fractures that cross the joint can affect ROM after the fracture has healed _________ damage may cause - chronic joint instability - predispose the joint to joint stiffness and reduced ROM from subsequent osteoarthritis

answer

Ligament

question

Postions to avoid after hip arthroplasty - Flexion of the hip past ____ - Adduction of the leg past the ______ of the body - Combined extension of the hip joint with external rotation of the lower extremity - Flexion with ________

answer

90 degree midline internal rotation

question

Autoimmune disease Attacks the cartilage and joint lining Causes swelling, pain and loss of function May lead to Joint instability Joint subluxation Ulnar deviation of the fingers

answer

Rheumatoid Arthritis

question

Deformity of the hand/finger Findings Flexion of the PIP joint Hyperextension of the DIP joint Due to rupture/avulsion of central slip of extensor digitorum tendon at the PIP joint Causes: trauma, RA

answer

Boutonniere Deformity

question

Deformity of the hand/finger Findings Hyperextension of PIP joint Flexion of the DIP joint Due to disruption of the lateral bands of the extensor tendons at the PIP joint and flexor digitorum profundus at the DIP joint Cause: RA

answer

Swan Neck deformity

question

A hand deformity which results in the proximal phalanx becoming displaced towards the palmar side

answer

Volar Subluxation

question

A hand deformity which results in fingers becoming displaced towards the ulnar side

answer

Ulnar drift

question

- Inflammation in the MCP joints which can lead to laxity of the joint capsule and surrounding ligaments - Tendons in the fingers shift to the ulnar side causing the proximal phalanx to migrate in the ulnar direction Cause: RA

answer

Volar subluxation and ulnar drift are due to

question

A push or a pull Causes objects to deform or move Muscles produce force

answer

Force

question

Types of Forces =

answer

Compressive Force Tensile Force Shearing Force Torsional Force Bending Force

question

Force that pushes two surfaces closer together

answer

Compressive Force

question

Force that pulls two surfaces apart

answer

Tensile Force

question

Force that act parallel to the surface area

answer

Shearing Force

question

Force that causes a rotation or twisting action

answer

Torsional Force

question

Force that causes asymmetric loading Produces tension on one side of the longitudinal axis and compression on the other side

answer

Bending Force

Chapter 2 Kin. The study of human movement – Flashcards

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