Everything for Kines Unit 2 Slides

What is coupled to help produce jaw function (eating, talking, bite)

Left and Right TMJs

Articulations of TMJ

Mandible→convex

Skull→concave

Occlusion→ closing of teeth to form “3rd” joint surface

Movements at TMJ

Elevation/depression (35-50 mm)

Protraction/retraction (5 mm)

Lateral deviation (shift) (10-12 mm)

Depression of TMJ arthros

First phase (mandible on meniscus): inferior compartment→posterior roll/anterior glide

Second phase (disc on temporal bone): superior compartment→ anterior roll/glide

Elevation of TMJ arthros

First phase (meniscus on temporal bone): superior compartment→ posterior roll and glide

Second phase (mandible on meniscus): inferior compartment→ anterior roll/posterior glide

Protraction of TMJ arthros

Superior compartment: Anterior roll/glide

Retraction of TMJ arthros

Superior compartment: posterior roll and glide

Lateral deviation TMJ arthros

Superior compartment:

Contralateral TMJ→ medial roll/glide, anterior roll/glide

Ipsilateral TMJ→ lateral roll/glide, posterior roll/glide, posterior spin

Muscles that elevate mandible

Masseter

Temporalis

Medial Pterygoid

Muscles that depress mandible

Suprahyoid

Infrahyoid

Lateral pterygoid

Muscles that retract mandible

Posterior temporalis

Muscles that protract mandible

Lateral pterygoid

Muscles that laterally shift the mandible

OS lateral and medial pterygoids

SS Posterior temporalis

SS masseter

TMJ dysfunctions (4)

1. Disc subluxations→ clicking, hyper mobility; potential for open or closed locks

2. Dislocation→ mandibular condyle passes under and anteriorly to articular eminence

3. Muscular hypertonicity→ clenching, grinding

4. Capsular tightness→ less than 20% of patients

TMJ resting position and muscular function is influenced by

Position of cervical spine (POSTURE!)

What are the joints of the shoulder girdle

Sternoclavicular (SC)

Acromioclavicular (AC)

Glenohumeral (GH)

Scapulothoracic articulation (NOT A TRUE ANATOMICAL JOINT; helps increase ROM in complex)

Clinical Pearl: Restriction of SC/AC/GH joints will result in

ABNORMAL KINEMATICS of the rest of the chain (thoracic spine)

What helps stabilize the SC joint

Interclavicular lig

Anterior/posterior SC ligs

Costoclavicular lig

SC disc (congruency)

SCM/sternothyroid/sternohyoid muscles

Movements at SC Joint

Elevation (coupled with Posterior Rot)

Depression (coupled with Ant Rot)

Protraction/retraction

SC Joint Type

Saddle

Elevation of SC arthros

Superior roll/inferior glide

Coupled with posterior rotation (posterior roll/spin)

Depression of SC arthros

Inferior roll/superior glide

Coupled with anterior rotation (anterior roll/spin)

Protraction SC arthros

Anterior roll/glide

Retraction SC arthros

Posterior roll/glide

AC joint articulations

Acromion process moving on clavicle (CONCAVE ON CONVEX DUE TO DISC ON CLAVICLE)

Elevation AC arthros

Superior roll/glide

Depression AC arthros

Inferior roll/glide

Scapular upward/lateral rotation AC arthros

Superior roll/glide

Scapular downward/medial rotation AC arthros

Inferior roll/glide

Protraction AC joint

Anterior roll/glide

Retraction AC arthros

Posterior roll/glide

Movements of AC joint

Elevation/depression

Scap upward/downward rotation

Protraction/retraction

GH joint movements

Flexion/extension

Abduction/Adduction

IR/ER

Abduction GH arthros

Superior roll/inferior glide

Adduction GH arthros

Inferior roll/superior glide

Flexion GH arthros

Primary arthro→ anterior roll/posterior spin

Secondary arthros→

• Phase 1: anterior roll/posterior glide (0-90)

• Phase 2: superior roll/inferior glide (90-180)

• Phase 3: posterior roll/anterior glide (>180)

Extension GH arthros

Primary arthro→ posterior roll/anterior spin

Secondary arthro→

• Phase 1: posterior roll/anterior glide

• Phase 2: superior roll/inferior glide

IR Anatomical Position GH Arthros

Anterior roll/posterior glide

IR 90 degree shoulder flexion GH arthros

Primary arthro→ anterior roll/spin

Secondary arthro→ anterior roll/posterior glide

ER anatomical position GH arthros

Posterior roll/anterior glide

ER 90 degree shoulder flexion GH arthro

Primary arthro→ posterior roll/spin

Secondary arthro→ posterior roll/anterior glide

What price do we pay for having ROM capability in the shoulder complex?

Excessive mobility/potential instability

What muscles/structures help stabilize GH joint

RC muscles (supraspinatus, infraspinatus, subscapularis, teres minor)

GH joint capsule

Coracohumeral lig

Long head triceps brachii

Glenoid labrum

What type of complex is scapulothoracic articulation

“muscle-bone-muscle complex” (not a true anatomical joint complex)

Scapulothoracic Rhythm

• smooth continuous motion of SCAPULA moving on THORAX in response to movement of HUMERUS at GH JOINT

What is the predictable ratio of movement of scapulothoracic rhythm?

1:2 in the frontal plane; less predictable in transverse plane

Advantages of scapulothoracic rhythm

Spreads out movement over several joints

What happens when scapulothoracic rhythm is absent or impaired

Increased stress/strain

Kinematics of Scapulohumeral rhythm

SC: 30 degrees

AC: 30 degrees

GH: 120 degrees

Scapulothoracic: 60 degrees

• GH and ST add up to 180 (1:2 ratio)

Muscles that create force couples for scapulothoracic and humeral elevation

Trap (all fibers)

Deltoid

Serratus Anterior

GH Joint force couple muscles

RC muscles

Deltoid

What needs to happen in order to reach full humeral elevation (flexion or abduction)?

ABDUCTION

• allows for external rotation to posteriorly rotate greater tubercle for more ROM access “hitch hiker rule” (thumb pointed to sky)

• upward rot of scapula

What 3 bones make up the elbow and forearm

Humerus

Radius

Ulna

4 joints of elbow/forearm complex

HU

HR

PRU

DRU

Ligaments of the elbow

Medial/ulnar collateral lig

Lateral/radial collateral lig

Annular lig

Function of Medial/ulnar collateral lig

Limits extensive valgus forces and Flexion

Function of Lateral/radial collateral lig

Limits extensive virus forces and flexion

Function of annular lig

Prevents dislocation of radius

How many degrees of freedom does HU joint have

4

How many degrees of freedom does HR joint have

6

How many degrees of freedom does PRU joint have

4

How many degrees of freedom does DRU joint have

4

HU Arthros

Modified Hinge

• Flexion: anterior roll/glide COUPLED with Adduction: medial roll/lateral glide (big dog gotta eat)

• Extension: posterior roll/glide COUPLED with Abduction: lateral roll/medial glide

Carrying angle for normal cubitus valgus

18 degrees

Carrying angle for excessive cubitus valgus

30 degrees

Carrying angle for cubitus varus

-5 degrees

HR Arthros

• Flexion: anterior roll/glide

• Extension: posterior roll/glide

• Pronation: anterior rotation (anterior roll/spin)

• Supination: posterior rotation (posterior roll/spin)

PRU Arthros

Convex on concave

• Pronation: anterior roll/posterior glide

• Supination: posterior roll/anterior glide

DRU Arthros

Concave on Convex

• Pronation: anterior roll/glide

• Supination: posterior roll/glide

What movements at PRU and DRU have to occur during with compression/distraction or supination/pronation

Superior and Inferior motions

What are the primary elbow flexors

Biceps brachii

Brachialis

Brachioradialis

What are the primary elbow extensors

Triceps brachii

Anconeus

Primary supinators

Supinator

Biceps Brachii

Secondary Supinators

Radial wrist extensors (ext radialis longs/brevis)

Extensor Indicis

Brachioradialis (from pronated position)

Primary Pronators

Pronator teres

Pronator Quadratus

Secondary Pronators

Flexor carpi radialis

Palmaris longus

Brachioradialis (from supinated position)

What has to happen during forceful supination and pronation to keep biceps brachii from maximally flexing the elbow?

Max supination will cause co-contraction of elbow extensors to not allow full elbow Flexion from biceps

How many bones in the hand are there

27

• 8 carpals

• 5 metacarpals

• 14 phalanges

What is the most stable point/keystone of proximal transverse arch?

Capitate

What is the most stable point/keystone of Distal transverse arch?

2nd and 3rd MCP

What is the most stable point/keystone of longitudinal arch?

2nd and 3rd MCP

What makes the roof of the carpal tunnel?

Transverse carpal lig/flexor retinaculum

What makes the floor of the carpal tunnel

Carpal bones and deep velar radiocarpal/volar radiocarpal interosseous ligs

What are the contents for carpal tunnel

Median N

Flexor digitorum superficialis

Flexor digitorum profundus

Flexor digitorum longus

Excessive pressure and or/compression of median nerve with ulnar may lead to…

Carpal tunnel syndrome (CTS)

Articulations of RC joint

Scaphoid/lunate with radius, triquetrum with TFC)

Articulation of Midcarpal joints

Proximal/distal row of carpals

What is the role of the wrist complex joints (RC and MC)

Control length-tension relationships of multi-articular hand muscles

Permit adjustments in grip and prehensile activity

RC joint arthros

Convex on concave

• Flexion→ ant roll/post glide

• Extension→ post roll/ant glide

• Radial deviation→ lat roll/med glide

• Ulnar deviation→ med roll/lat glide

MC Joint Arthros

Convex on Concave

• Flexion→ anterior roll/posterior glide

• Extension→ posterior roll/anterior glide

• Radial deviation→ lateral roll/medial glide COUPLED with Trapezii extension

• Ulnar deviation→ medial roll/lateral glide

Trapezii Group on Scaphoid Arthros

Concave for Flex/extend

• Flexion→ anterior roll/glide

• Extension→ posterior roll/glide COUPLED with MC radial deviation

Convex for radial/ulnar deviation

• Radial deviation→ lateral roll/medial glide

• Ulnar deviation→ medial roll/lateral glide

Why must MC radial deviation be coupled with Trapezii group Extension?

Helps to clear radial styloid process for full radial deviation

Radial deviation is less than ulnar deviation why?

Due to ligamentus tightening

Normal carpal mobility is essential for…

Normal wrist/hand function

T or F: Individual carpal mobility will channel ADDITIONAL mobility to remaining carpals

True! #checkthosecarpals

CMC 2-5 Arthros

Concave on Convex

• Flexion→ anterior roll/glide COUPLED with medial rot (med roll/spin) digits 4-5

• Extension→ posterior roll/glide COUPLED with lateral rot (lateral roll/glide) digits 4-5

• Radial deviation→ lat roll/glide

• Ulnar deviation→ medial roll/glide

1st CMC Arthros

Concave: flex/extend

• Flexion: medial roll/glide

• Extension: lateral roll/glide

Convex: abduct/adduct

• abduction: ant roll/post glide

• Adduction: post roll/ant glide

Opposition: flex/abduct/med rot

• medial roll/glide

• Anterior roll/post glide

• Medial roll/spin

MCP Arthros

Concave

• Flexion: anterior roll/glide COUPLED with med rot (med roll/spin) digits 4-5

• Extension: posterior roll/glide COUPLED with lateral rot rot (lat roll/spin) digits 4-5

• Abduction: lat roll/glide

• Adduction: medial roll/glide

IP arthros

Concave

• Flexion: anterior roll/glide

• Extension: posterior roll/glide

What the the function of collateral ligaments (MCP)

Help stabilize volar plates

• slack in MCP extension

• Taut in MCP Flexion

• Explains why MCP abduction/adduction is limited in MCP flexion compared to extension