Kinesiology - after midterm

Metacarpals

from transverse arches that enhance grasp and hand manipulation

longitudinal arch allows for radial and ulnar aspects of palm to come together

Phalanges

proximal, middle, distal

thumb- proximal, distal

Metacarpophalangeal (MCP) joint

Interphalangeal (IP) joint

hinge - flexion and extension

PIPs important for power grips and DIPs smaller and less movement

Cylindrical grasp

flexion around a tube shaped object

steering wheel

Spherical grasp

flexion around an object thats round

hold a ball

Hook grasp

simultaneous flexion of the PIPs and DIPS with extension of MCPs

carrying a briefcase or basket

Composite grasp

maximal flexion of all digits

ring and pinky finger generate more force than radial digits

Tip pinch

distal tips of thumb and index finger

threading a needle

three jaw chuck

tip of thumb against index and middle fingers

writing with pen/pencil

Lateral (key) pinch

pad of thumb pressed against radial side of index finger

turning key, presenting credit card

trigger finger

finger becomes lodged in a flexed position; can be caused by high repetition activities or high vibration

interventions: surgical release, activity modification, preventing prolonged flexion

Boutonniere Deformity

PIP flexion with DIP hyperextension - damage to the central slip

interventions: orthoses, splints

Swan neck deformity

PIP hyperextension and DIP flexion - laceration volar plate or damage to terminal tendon

interventions: orthoses, splint

Dupuytren’s contracture

abnormal thickening of palmar aponeurosis leading to contracture of ring and small finger

interventions: surgical release, injection, splinting, post op rehab, scar management

DeQuervain’s tenosynovitis

(texting thumb) CTD of the tendons of the first dorsal compartment

occurs from extended ulnar deviation and rapid thumb movement

osteoarthristis

common in fingers and thumbs

interventions: conservative movement, modalities splints, activity modification, adaptive equipment

tenodesis

fingers relaxed and wrist extended - causes fingers to flex - fist is created by passive tension

provides functional grasp for people with SCIs at C6

saddle joint

thumb - flexion/extension, palmar adduction/abduction, radial adduction/abduction

CMC arthritis

pain from repetitive use

De Quervains Tenosynovitis

irritation of 1st dorsal compartment

APB and APL at extensor retinaculum

spinal column

cervical -7

thoracic - 12

lumbar -5

sacral -5

coccygeal -4

spinal column characteristics

spine acts as a spring - curves shrink and expand with exerted forces

provides stability for functional movement

anterior and posterior curves

anterior - kyphosis

posterior - lordosis

Atlanto-occipital joint

interface between skull and spinal column

C1-atlas - initial movements for flexion and extension

“yes” joint - nodding head yes

Atlantoxial joint

joint between C1 and C2

supplies much of the movement for rotation

“no” joint - shakes head no

Radiculopathy

nerve root compression resulting from narrowing of intervertebral forearm

can occur with fractures, OA, or thinning of intervertebral disks

leads to sensorimotor deficits in muscles or dermatomes in nerve roots

Rib fractures

mild fractures heal on own as intercostal muscles holds

severe fractures can impact lungs or other vital organs and requires surgery

Core stability

important motor component of occupational engagement - seating and stability

infant - crawling

adult - heavy objects

older adult - functional mobility

Hemiparesis

can occur from CVA or TBI

abnormal muscle tone, weakness, paralysis

can lead to vestibular, visual, or somatosensory issues

Spinal injuires

can occur from improper lifting, traumatic injury, age related changes

interventions: fusion, laminectomy

Spinal cord injury

high impact trauma - MVA, diving

injury blocks transmission of neurological signals from brain to body

Pelvis charactistics

stable base of support for head, arms, and trunk

requires balance to maintain symmetry of entire body

anatomical position = tilted anteriorly

Sacroiliac joint (SI)

designed to stabilize pelvis and has limited mobility

Acetabulum

socket for femoral head

illium, ischium, pubis

connect SI joint and pubic symphysis

Ischial tuberosity

primary point of pelvis contact with a seating surface

SITS bones - can feel when sit on hands

worry about them breaking down from repetitive sitting

pelvic floor

controlled by surrounding sphincter muscles that regulate urination and defecation

damage to these muscles can lead to incontinence and issues relating to sexual intimacy

Incontinence

stress incontinence - involuntary leaking of bowel/bladder due to increased abdominal pressure

urge incontinence- inability to control bowel/bladder until an appropriate time for elimination

Pelvic organ prolapse

pelvic floor weakness leads to herniation of the uterus, recum, or vagina

lots of causes: heavy lifting, vaginal delivery, coughing

lots of symptoms: bulging/pressure in vag, pelvis pressure, UTI

intervention: surgical, pelvic floor exercise

Cystocoele

bladder falls into uterus

uterine prolapse

uterus drops into vagina

vaginal vault prolapse

top of vagina falls into vaginal canal

enterocoele

small bowel pushes against vagina

rectocele

rectal prolapse

Ankylosing spondylitis

inflammatory condition of the spine that can lead to fusion of skeletal structures

lots of immobility

intervention: compensatory strategies, medication, rehab

Sciatica

compression of sciatic nerve - caused by tightness in piriformis - compression of back of leg

intervention: stretching, activity modification

Pelvic alignment

tilted anteriorly in anatomical position

want to look at tilt, rotation, and obliquity (one hip higher than other)

important for positioning

Pelvic fractures

bladder, intestines, and kidneys can be affected due to close proximity

Intervention: severe cases surgery, period of non weight bearing

femur characteristics

longest bone - femoral head pairs with acetabulum to form hip joint

greater trochanter - axis for flexion and extension

medial and lateral epicondyle- attachment points for tendons and ligaments

Tibia characteristics

primary weight bearing bone of lower leg

medial malleolus- axis for ankle plantar flexion

Fibula characteristics

bears little weight, proximally articulates with tibia

lateral malleolus-

Patella characterstics

largest sesamoid bone in body

stabilizes knee during flexion - attached to quadriceps tendon which then turns into patellar ligament

Hip joint

ball and socket - flexion/extension, abduction/adduction, internal/external rotation

formed by head of femur and acetabulum- more surface area/more stability

supported by iliofemoral, ischiofemoral, and pubofemoral - internally supported by round ligament

Knee joint

Tibiofemoral - hinge - flexion/extension

ACL/PCL limit anterior/posterior gliding and rotation

LCL/MCL prevent genoveraum/valgus

IT band syndrome

repetitive strain of IT band

interventions: rest, activity modification, stretching, anti-inflammatory medication

Hip fractures

most involve proximal femur

require internal fixation to repair and acute care OT

Hip arthroplasty (replacement)

replaces femoral head and acetabulum

hemiarthroplasty- replaces femoral head

no hip flexion past 90, no internal rotation, no crossing legs

collateral ligament injury

(ACL tear) - causes instability of knee

includes surgical repair and then post op therapy

osteoarthritis

none or limited precautions - acute OT - outpatient PT

lower limb amputation

occurs from traumatic injury, PVD, diabetes

managing edema, joint contractures, shaping residual limb

lower limb amputation: Prosthetic

prosthetic phase- facilitating functional mobility, transfers, ADL participation

prosthetic training- can take up to a year, donning (put it on)/doffing (take off) prosthetic, bearing weight, increasing tolerance

Genu varum and genu valgum

Tibia is not aligned with femur in straight line- can create imbalance of forces between femur and tibia

varum- bow leg

valgum- knock knee

Stability

the ability to maintain control of the position or movement of your body

depends on: vision, vestibular system, proprioception, tactile sensation

Base of Support (BoS)

parts of body or mobility devices that come into contact with ground - distance between those points

more points of contact + larger distance = better BoS

Center of Gravity (CoG)

focal point where gravity acts; where the weight of object is evenly distributed

COG lowers = stability increases

COG in anatomical: S2

bony landmarks that could wear away when bed bound

scapula, calcaneus, acromion etc

posture

relative position of body segments in response to demands of activity

depends on: sensory and motor input, voluntary and involuntary, lighting workspace and environment

Ergonomics

fitting the workplace to the worker

lumbar spine supported, hips knees and elbows at 90, wrist neutral, monitor 18-24 inches away, head and neck neutral

functional mobility

moving from one position/place to another such as bed mobility, w/c mobility, and transfers

Bed mobility

use of logrolling, bridging, trapeze bar (SCI)

pain, generalized weakness, lack of mobility can lead to skin break down

Gait

step: heel strike to heel strike

step width: width between heals (BOS determined)

cadence: steps per minute

stance phase

heel strike

foot flat

midstance

heel off

toe off

swing face

acceleration

midswing

deceleration

trendelenburg

weakness in gluteus medius

causes lateral lean to affected side to compensate weakness

circumduction gait

muscle weakness in legs causes trunk and pelvis to compensate by laterally swinging leg to the side of the body to propel it forward

hemiplegia, OA of knee, general muscle weakness

foot drop

weakness or paralysis of ankle dorsiflexors impair heel strike

toes come into contact with ground before heel - dragging foot

stroke or tbi

hemiplegic gait

paralysis of one side of the body resulting from stoke, CVA, CP

hip is adducted and knee locked in extension

arm is flexed at the elbow and wrist is held against body - limits balance

Parkinsonian gait

affected by impaired perception and modulation of motor movements

shuffling feet with small forward movements and limited elevation of legs

weight is placed on heels with flexion of trunk

scissor gate

narrowing or crossing over of the legs during ambulation

associated with CP and other neurolgical diagnoses

ataxic gait

unique gait where strength and ROM are not compromised but coordination is

neurological impairment of the cerebellum

Tibia and Fibula

lateral and medial malleolus

Hindfoot

Talus- surface for ankle joint

Calcaneus- heel of foot

Midfoot

stabilized by plantar ligaments and plantar aponeurosis

stabilize and support weight

Proximal and Distal Tibiofibular joint

contribute to stability of ankle - interosseous membrane binds tibia and fibula together

Talocrural joint

hinge - dorsiflexion/plantar flexion

talus held between distal tibia and fibula

Subtalar joint

formed by calcaneus and inferior aspect of talus

provides inversion and eversion

MTP and IP

MTP allows flexion/extension and some abduction/adduction

IP flexion and extension

Typical ROM for inversion and eversion

Inversion - 35

Eversion - 15

Neurological Impairment of LE

joints and skin of foot are sending info to brain

assist in stabilizing uneven surfaces

consider how numbness/weakness may affect gait/mobility

Foot drop

inability to actively dorsiflex foot - foot may drag

innervation: AFO - holds foot in passive position to restore modified gate pattern

Plantar fascititis

inflammation of plantar aponeurosis - pain when bearing weight on foot

Intervention: rest, orthotics, modalities, stretching

Neck ROM

Flexion/extension - 45

Rotation- 45

Lateral flexion- 60