Intro to exercise physio exam 3

What are the 5 bones that make up the shoulder complex

sternum (manubrium), scapula, humerus, clavicle, dorsal surface area of the ribs

What is the shoulder complex

made up of 4 articulations, most proximal link of the upper extremity to the axial skeleton

What is the most mobile joint and the problem with it

glenohumeral joint but its laxity (freely movable, hypermobile) can lead to injury

Plastic deformation of the glenohumeral joint causes what

hyper mobility

What are the 4 joints of the shoulder complex

glenohumeral, acromioclavicular, sternoclavicular, scapulothoracic

What is the shoulder girdle (pectoral girdle)

the bony ring formed by the scapulae, clavicles (posterior), and the manubrium of the sternum (anterior)

What is the labrum of the glenohumeral joint

the fibrocartilaginous structure that encircles the glenoid fossa

What does the labrum do

nearly doubles the depth of the glenoid fossa, may increase glenoid/humeral head surface area, acts as a valve with the humeral head and creates a seal against atmospheric pressure (decreases atmospheric pressure, decreases joint instability)

What happens to the shoulder if the labrum is damaged

it will hang lower

What are the 3 anatomic basis to stabilize the shoulder

bursa, ligaments, labrum

Theres only what between the head of humerus and glenoid cavity (labrum)

incidental contact that allows high movement and is completely dependent on ligaments

A FOOSH damages what

the labrum

Glenoid labrum is torn away from the glenoid fossa causes what

high mobility in shoulder

What is the primary reason for recurrent shoulder dislocation

labral tear

What does SLAP stand for

superior labrum anterior and posterior

What is bankart lesion

labrum is torn on inferior boarder

What is a SLAP tear

a tear on top of the labrum

What is the difference between a SLAP tear and bankart lesion

location of tear

What is the acromioclavicular joint

synovial joint particularly susceptible to degenerative and inflammatory conditions, osteoarthritis especially common in weight lifters and those with labor-intensive jobs (thin cartilage wears), pain commonly arises with reachs and/or loaded overhead activities

The SC joint is not problematic to what

the heart just for internal bleeding

A dislocation of the AC joint is called

shoulder separation

What is the anatomical basis for shoulder speration

its some rupture or some disruption in ligaments

What is the sternoclavicular joint

mostly a saddle-shaped, diarthrodial synovial joint, relatively incongruent articulation so heavily reliant on ligamentous support, dislocation is rare (more often the clavicle just fx), only skeletal articulation upper limb and axial skeleton (weak link)

What happens when the sternoclavicular joint dislocates posteriorly

immediate emergency because of the nerve and vascular structures deep to this joint (life threatening)

What is the scapulothoracic joint

articulation of the broad, flat triangular scapula and the posterolateral aspect of the thorax and ribs (backside of scapula, no synovial fluid, no bone connection, in proximity of each other), usually considered to be a pseudojoint

What is the rotator cuff

Network of 4 muscles that come together as tendons to form a covering around the head of the humerus (anterior and posterior aspect of the shoulder)

What are the 4 muscles that make up the rotator cuff

supraspinatis, infraspinatis, teres minor, subscapularis

What causes an injury of the rotator cuff and what sx do you have

excessive throwing/rotating, pain/weakness when lifting, lowering, rotating arm

What is the debridement procedure

cuts off dead tissue- stops inflammatory response (have to go through rehibilitation)

What are the 3 bones of the elbow

humerus, ulna, radius

What are the 3 articulations of the elbow

humeroulnar, humeroradial, radioulnar (proximal)

Should you try and reduce elbow dislocations in the field

no do in OR because of nerves and blood vessels could get trapped

What is interosseous membrane

provides structural integrity, allows ulna and radius to function as one and allows them to rotate and provide shock absorption when they rotate (rotation at wrist/elbow)

Little League is a what

traction apophysitis of the medial epicondyle of the humerus that leads to osteochondritis dissecans

What are the common flexor tendons in little league elbow

palmaris longus, flexor carpi ulnaris, pronator teres, flexor carpi radialis

When does little league elbow occur

in a younger individual (growth plate, like osgood schlatters), acute or gradual pain at the medial elbow, medial pain

How to stop little league elbow

pitch counts (overuse injury), RICE treatment

Avulsion fx of the apophysis can suggest what

abuse

What is the difference between little league elbow and tennis elbow

age and location

What is tennis elbow

lateral epicondylitis or tendinosis of the wrist extensor tendons, prevalent in 40-50% of tennis players age 30-60, backhand stroke most often the trigger, repetitive movement, overuse injury

Sx of tennis elbow

pain begins and slowly worsens over weeks and months, weak grip strength, usually no specific injury associated with the start of sx

Treatment of tennis elbow

get better racket, better instruction, not well treated

What is Tommy John surgery

repair of a torn ulnar collateral ligament (UCL)

How can a UCL tear

partially or completely, gradually or acutely

Which way do fibers run of the UCL

in direction of the force

How long is rehabilitation for tommy john surgery

12-18 months

Can you retear your UCL after surgery

yes

Why do baseball players want tommy john surgery even without tearing their UCL

the surgery can make biomechanical changes and proper rehabilitation making them better

What biomechanical changes can tommy john surgery make

increase torque, may change the moment arm of applied force

How many bones make up the wrist and hand

29 bones- carpals, metacarpals, phalanges

How many articulations in the wrist and hand

multiple articulations, distal widening of the radius

Metacarpals have what

hyaline cartilage (body can attack it causing rheumatoid arthritis)

What is rheumatoid arthritis

less common, autoimmune disease, causes disfigured out-bony formation (ulnar deviation), can take anti-inflammatory drug

What is a scaphoid fx

most common carpal fx, lateral wrist pain, often mis-diagnosed as sprained wrist, FOOSH injury, under and misdiagnosed, can fx it and not know it, want to tell radiologist about it to get proper xray of it

What can happen if you fx your scaphoid bone

avascular necrosis because the blood supply becomes asymmetric

What is carpal tunnel syndrome

occurs when the median nerve, which runs from the forearm into the palm of the hand, becomes pressed or squeezed at the wrist by connective tissue (flexor retinaculum covering carpal tunnel), overuse injury (assembly work)

When do sx start for carpal tunnel syndrome

usually start gradually, with frequent burning, tingling, or itching numbness in the palm of the hand and the fingers, especially the thumb and the index and middle fingers

What are test you can do to test for carpal tunnel syndrome

phalen test and flick test

What is phalen test

put back of wrists together with fingers pointing down if positive pt will be in pain

What is the flick test

have pt flick their wrist pain will get better- usually already doing this

How to treat carpal tunnel

stop continuation of activty, shave the connective tissue-not very successful may be back after about a year to have it done again

What are the 5 muscles of the abdomen

external oblique, internal oblique, transversus abdominis, rectus abdominis, pyramidalis (small muscle more in pelvis, absent in 20% of us)

What is the order of abdominal muscles from superficial to deep

external oblique, internal oblique, transversus abdominis, rectus abdominis

How to strengthen your core

move in fiber orientation of muscles

Abdominal muscles are what and anchored by what

thin, tightly with connective tissue (tendons)

Can abdominal muscles partially contract

yes because of inscribed by tendons, can contract them from multiple directions

Subcutaneous tissue is in front of what

abdomen muscles

How to see abs

be mindful of the exercise and direction that your opposing force, have to get rid of subcutaneous fat to show abs more (be lean- genetics), exercise in way of fibers

What is the valsalva maneuver

increase of pressure in a chamber- impacts blood flow, muscle contraction (can put pressure on heart- be careful of older pt or unexperienced lifters)

What is abdominal hernia

protrusion of the intestine through an opening, area of weakness in the abdominal wall, “sports” hernia (athletic pubalgia) think oblique muscle/tendon tear, most require surgical repair, connective tissue in abdominal wall tears

What are the 2 types of hernias

ventral and groin

What is ventral hernia

upper abdominal wall

What is groin hernia

lower abdominal wall

What is the most common hernia in males

inguinal- in scrotum

Are males or females more likely to do pelvic floor rehabilitation

females- childbirth and pregnancy (pelvic muscle repair, pelvic tissue repair, strengthen it for childbirth)

What does the care consist of according to Stuart McGill

proximal stiffness occurs between the ball and socket joints, it involves all of the muscles on the torso, they function primarily to stop motion and they should be trained this way, the core also involves the muscles that cross the ball and socket joints that have distal connections

The core transmits what between what and provides what

forces, upper/lower body, spinal stability

What percentage of fibers do abdominal muscles consist of

55-58% type I, 15-23% type IIa, 21-22% type IIb

Abdominal muscles are more active in what then what

trunk-raising activities than in double leg-raising activities

What engages the hip flexors to a higher degree

bent-knee positions

Altering leg position between a bent or straight leg does not what

change total muscle activity by much

What is the best exercise for all of the abdominals

no one single best exercise

Was 6 weeks of abdominal exercise training alone sufficient to reduce abdominal subcutaneous fat and other measures of body composition

no

What are the most effective exercises in activating abdominal musculature as well as the most effective in activating extraneous musculature

the power wheel (pike, knee-up and roll-out), hanging knee-up with straps, and reverse crunch inclined 30 degrees

Abdominal musculature are what

smaller intrinsic muscles

How many vertebrae are there and # of spinal nerves

24 articulating vertebrae, 9 nonmovable vertebrae, 31 pairs of spinal nerves

What does the spine provide

rigid support and flexibility connecting the upper and lower extremities

How many curves of the spine facilitate this support and springlike response to loading

4

What are vertebral bone pathologies

pars interarticularis, spondylolysis, spondylolisthesis

What are the 4 natural curves in the vertebral column

cervical, thoracic, lumbar, sacral

What is kyphosis

think thoracic spine, curving of the spine that causes a rounding of the back, arthritis, disk degeneration, (osteoporotic) fx, spondylolisthesis

What is treatment for kyphosis

depends on cause, surgery is needed if neurological symptoms or persistent pain develop

What are complications for kyphosis

think respiratory system

What is lordosis

think lumbar spine, inward curve, achondroplasia (dwarfism), spondylolisthesis

Faulty alignment leads to

faulty movement patterns (swimmer with tight internal shoulder rotators, shoulder impingement)

Postural faults can cause

muscle imbalance, crossed syndromes (muscles can either be tight (tonic) or weak (phasic))

When muscles are tonic they have what

a lowered activation threshold and can bring about abnormal movement

What does the chain concept consist of

open, closed

Not every activity can be classified totally as what

either open- or closed-chain, for example running includes both open and closed movements

In open-chain the distal end of extremity is what

free