Kinesiology Practical Questions

cervical spine CPP

full extension

cervical spine LPP

flexion/slight flexion

cervical flexion and extension expected value for tape measure

none

cervical flexion end feel

firm

cervical flexion limiting structures

posterior longitudinal ligament, ligamentum flavum, interspinous and supraspinous ligaments

erector spinae, suboccipital, splenius capitis, upper trapezius

cervical spine arthrokinematics

atlanto-occipital (concave on convex) joint anterior roll, posterior glide

cervical extension end feel

firm

cervical extension limiting structures

anterior longitudinal ligament

sternocleidomastoid, scalenes, longus capitis, longus colli, annulus fibrosus

extreme extension - spinous processes running into each other

cervical extension arthrokinematics

atlanto-occipital (concave on convex), posterior roll, anterior glide

cervical flexion/extension goni placement

fulcrum: C7

proximal arm: perpendicular to floor

distal arm: occipital protuberance

cervical lateral flexion tape measure

mastoid process to lateral acromion process

cervical lateral flexion expected value (tape measure)

none

cervical lateral flexion end feel

firm

cervical lateral flexion limiting structures

intertransverse ligaments, annulus fibrosus

sternocleidomastoid, scalenes, longus capitis, longus colli on contralateral side

cervical lateral flexion arthrokinematics

cervical side bend same, body goes in same direction as side bend

spinous process goes opposite

rolls same side (ipsilateral), glides opposite (contralateral)

cervical rotation goni placement

fulcrum: top of head lining up with the mastoid process

proximal arm: tip of acromion

distal arm: tip of nose

cervical rotation tape measure placement

tip of chin to lateral acromion

cervical rotation tape measure expected value

none

cervical rotation end feel

firm

cervical rotation limiting structures

alar ligament

contralateral SCM, longus colli, longus capitis, scalenes

cervical rotation arthrokinematics

facets have posterior-inferior glide on same side and anterior-superior glide on opposite side

cervical rotation has a bit of lateral flexion

thoracolumbar flexion patient position

standing, stabilize hips from moving

thoracolumbar flexion goni placement

none

thoracolumbar flexion tape measure landmarks

C7-S2

take difference between measures flexed and neutral

thoracolumbar flexion tape measure landmarks

tip of middle finger to floor

thoracolumbar flexion expected value (fingertip to floor)

none

thoracolumbar flexion end feel

firm

thoracolumbar flexion limiting structures

posterior longitudinal ligament, ligamentum flavum, supraspinous ligament, interspinous ligament

annulus fibrosus

erector spinae and multifidus if tight

thoracolumbar flexion arthrokinematics

motion increases as you move down the spine because lumbar facet orientation becomes medial/later

patient position for thoracolumbar extension

standing, patient self-stabilizes with hand on hips

thoracolumbar extension goni placement

no goni measurement

thoracolumbar extension tape measure placement

C7-S2

difference between extension and neutral measurement

thoracolumbar extension expected value (tape measure)

none

thoracolumbar extension end feel

firm (may be hard in very flexible individuals)

thoracolumbar extension limiting structures

anterior longitudinal ligament, annulus fibrosus

rectus abdominis, external/internal obliques

spinous process in extreme flexibility (hard end feel)

thoracolumbar extension arthrokinematics

motion increases as you move down spine because of lumbar facet orientation

thoracolumbar lateral flexion patient position

standing, stabilize hips

thoracolumbar lateral flexion goni placement

fulcrum: S2

proximal arm: perpendicular to ground

distal arm: C7

thoracolumbar lateral flexion tape measure position

tip of middle finger to floor or tip of middle finger to mark on thigh

difference between neutral and lateral flexion measurements

thoracolumbar lateral flexion end feel

firm

thoracolumbar lateral flexion limiting structures

intertransverse ligaments, annulus fibrosus, thoracolumbar fascia

external oblique, erector spinae, serratus posterior inferior, multifidus, contralateral intercostal muscles, possibly ribs

thoracolumbar lateral flexion arthrokinematics

generally good due to facet orientation, increases slightly at end of T spine and beginning of L spine

lower thoracic and lumbar side bend opposite, body goes to side of convexity and spinous process goes to concavity

thoracolumbar rotation goni placement

fulcrum: none

proximal arm: in line with hips

distal arm: line of shoulders

thoracolumbar end feel

firm

thoracolumbar rotation limiting structures

annulus fibrosus, supraspinous ligament, interspinous ligament, abdominal muscles, tight multifidus or rotatores

thoracolumbar rotation arthrokinematics

most rotation at T1, decreases caudally until lL5/S1

sudden increase at L5,S1 which is at risk for injury

lumbar-only flexion patient position

standing, pelvis stabilized

lumbar-only flexion tape measure placement (modified schober)

Find L5/S1

measure 10 cm up and 5 cm down

result = end length - 15 cm

lumbar-only flexion tape measure placement (modified-modified schober)

Find S2

measure 15 cm above

result = end length -15 cm

lumbar-only flexion double inclinometers placements

T12 and S2

adjust both to 0 before motion, then take differencel

lumbar-only flexion end feel

firm

lumbar-only flexion limiting structures

annulus fibrosus, supraspinous ligament, interspinous ligament, abdominal muscles, tight multifidus or rotatores

lumbar-only flexion arthrokinematics

facets arranged to benefit flexion

motion increases from L1 to L5

lumbar-only extension patient position

prone on plinth

lumbar-only extension goni placement

no goni measurement

lumbar-only extension limiting structures

anterior longitudinal ligament, annulus fibrosus, abdominal muscles

extreme extension: spinous processes (hard end feel)

lumbar-only extension arthrokinematics

facets arranged to benefit extension

motion increases from L1-5

glenohumeral joint CPP

abduction with external rotation

glenohumeral joint LPP

90º flexion with 45º abduction

glenohumeral flexion patient position

supine with knees bent

glenohumeral flexion goni placement

fulcrum: lateral acromion

proximal arm: midline of torso

distal arm: midline of humerus

glenohumeral flexion end feel

firm

glenohumeral flexion limting structures

sternoclavicular ligament and capsule, costoclavicular ligament

muscle tightness in lats, pec major and minor, and rhomboids

glenohumeral flexion arthrokinematics

convex on concave, spin

glenohumeral flexion muscles

anterior deltoid, coracobrachialis

subacromial space contents

supraspinatus tendon, subacromial bursa, long head of biceps tendon, joint capsule

glenohumeral extension patient position

prone, face turned away from shoulder being measured, arm bent at elbow

glenohumeral extension goni placement

fulcrum: lateral acromion

proximal arm: parallel to mid-axillary line

distal arm: midline of humerus

glenohumeral extension limiting structures

sternoclavicular ligaments and capsule, tight serratus anterior, anterior deltoid

subscapularis muscles stabilizes shoulder to prevent anterior dislocation

glenohumeral extension arthrokinematics

convex on concave, spin

glenohumeral extension muscles

posterior deltoid, lats, triceps,teres major

glenohumeral abduction patient position

supine palms supinated

glenohumeral abduction goni placement

fulcrum: anterior aspect of acromion

proximal arm: parallel to midline of sternum

distal arm: midline of humerus

glenohumeral abduction limiting structures

sternoclavicular ligament, costoclavicular ligament and capsule

interfior fibers of GH capusle, tight lats, pec major, pec minor, rhomboids

glenohumeral abduction arthrokinematics

convex on concave, superior roll, inferior glide

glenohumeral internal rotation patient position

supine with arm abducted and flexed 90º

towel roll under arm to align humerus to socket

hand in neutral position

glenohumeral internal/external rotation isolation technique

thumb on clavicle, fingers on scap spine, feel for movement and press into shoulder to prevent scap from moving

glenohumeral internal and external rotation goni placement

fulcrum: olecranon process

distal arm: ulnar styloid process

proximal arm: perpendicular/parallel to floor

glenohumeral internal rotation limiting structures

posterior GH joint capsule, infraspinatus, posterior delts, teres minor

glenohumeral internal/external rotation arthrokinmeatics

anterior roll, posterior glide; posterior roll, anterior glide

glenohumeral internal rotation muscles

lats, teres major, anterior delt, pec major, subscapularis

glenohumeral external rotation limiting structures

teres major, anterior deltoid, anterior capsule, pec major, lats, subscap

glenohumeral ligament, coracohumeral ligament

glenohumeral external rotation muscles

posterior delts, infraspinatus, teres minor

humeroulnar joint CPP

extension and supination

humeroulnar joint LPP

flexion to 45º

humeroradial joint CPP

flexion (70º) with pronation (45º)

humeroradial joint LPP

extension with supination

proximal radioulnar joint CPP

extension with supination

distal radioulnar joint CPP

5º supination

distal radioulnar joint LPP

10º supination

elbow flexion/extension goni placement

fulcrum: lateral epicondyle of humerus

proximal arm: midline of humerus

distal arm: radial styloid process

elbow flexion end feel

soft, can be firm or hard

elbow flexion limiting structures

soft: biceps meeting forearm muscles

firm: triceps, anconeus, or posterior capsule tightness

hard: coronoid process meeting coronoid fossa or radial head meeting radial fossa

elbow flexion arthrokinematics

humeroulnar: concave ulna on convex humerus, anterior roll, anterior glide

humeroradial: concave radius on convex humerus, anterior roll, anterior glide

humerus: rolls and glides same distal end of humerus, bulges 45º

anteriorly: allows more motion

elbow flexion muscles

biceps, brachioradialis, brachialis, pronator teres

secondary movers: ECRB, ECRL, FCU

elbow flexion/extension patient position

supine, palm toward ceiling, towel under humerus

elbow extension end feel

hard

elbow extension limiting structures

olecranon on olecranon fossa

elbow extension arthrokinematics

humeroulnar: posterior roll posterior glide

humeroradial: posterior roll posterior glide

distal end of humerus bulges 45º to allow for more motion

elbow extension muscle

primary: triceps

secondary: anconeus