Module 2

in the upper body the boney alignments and muscle synergist allow for what?

- Extensive ROM
- Manipulation of Objects
- Coordination and controlled movements

True or False: The Should Complex is made up of the SC joint, the AC, the Glenohumeral joint and the scapulothoracic joint?

True

True or False: The Scapulothoracic joint is a true joint?

False (Not a true joint does no articulate with other bones but rather a point of contact between The anterior surface of the scapula and the posterior-lateral wall of the thorax)

Why is it important that the the humeral head be retroverted 30˚?

- Allows for articulation between the Scapulas glenoid cavity and the humeral head
- allows for ROM of the arm

The head of the humerus face in what directions?

Medial, Superior and slightly posteriorly

What articulations from the Sternoclavicular joint?

- The medial end of the clavicle
- The clavicular facet on the sternum
- The superior border of the cartilage of the first rib

Where does the sternoclavicular joint get its stabilization?

Ligaments provide Passive stabilization
Muscles provides Active stabilization

True or False: the sternoclavicular joint is the most proximal joint?

True

What is significant about the SC joint?

- Attachment site for Axial and appendicular skeleton
- The joint must be firmly attached while simultaneously allowing considerable range of movement

What kind of joint is the SC joint?

Saddle joint; both opposing surfaces have both convex & concave surfaces

Acromioclavicular joint articulates between what?

Acromial end of the clavicle and the acromion of the scapula

True or False: You must name the the arthrokinematics of the AC joint?

False (you do not name arthrokinematics)

What type of Joint is the AC joint?

A plantar joint

Where does the Acromioclavicular joint get its stabilization?

Ligaments provide Passive stabilization
Muscles provides Active stabilization

What is the angle of inclination of the humeral head at the glenohumeral joint?

130˚

True or False: The glenohumeral joint is not a stable joint and does not allow for extensive ROM?

False (The glenohumeral joint is a stable joint being stabilized by ligaments and muscles, this stability allows for a large ROM)

What acts as the boney bridge above the subacromial space?

Acromion

The Scapular plane relates to the position of what joint?

Scapulothoracic joint!

What is the importance of the way the Scapulothoracic joint is position relative to the scapular plane?

The thorax is not flat but rather has a convex shape due to the ribs! if the scapula laid flat on the thorax we would lose a significant amount of ROM. With the position its able to move around the thorax

What is the position of the scapular plane?

10˚ of Anterior tilt
5-10˚ of Upward Rotation
~35˚ of Internal Rotation

True or False: The humeroulnar joint does not provide major stability in the elbow

False (provides major stability)

What joints allow for pronation and supination?

Distal and proximal radioulnar joints

What is the normal valgus angle?

~13˚±6˚

Why is does everyone have a valgus angle?

M/L axis at elbow has an upward tilt due to distatal length of the trochlea so its not perfect

Why is the valgus angle important?

allows for hands to swing past our hips

What is excessive valgus?

An angle greater than 20-25˚ is considered excessive valgus

What does varus mean?

points toward the midline

what does valgus mean?

points away from the midline

What is the ulnar tilt at the wrist?

25˚ upward tilt towards the ulna

Why does it matter that that the ulna is tilted 25 in the upward direction towards the ulna?

Allows for greater ulnar deviation

What is the palmar tilt at the wrist?

10˚ of upward tilt toward the palm

Why does it matter that the palm is tilted 10˚ toward the palm?

allows for greater flexion in comparison to extension

True or False: Changes in ulnar or palmar tilts will NOT effect the length tension curve?

False: Changes in tilts will affect the length tension curve

How many tendons run in the carpal tunnel?

9

What tendons run through the carpal tunnel?

(4) FDS, (4) FDP,(1) FPL

What nerve runs through the carpal tunnel?

median nerve

what makes up the carpal tunnel?

(roof) transverse carpal ligament and proximal transverse arch a.k.a distal carpals (floor)

What does the carpel tunnel do?

provides passage for the extrinsic hand muscles tendons and median nerve

What is significant about the transverse carpal ligament

prevents bowstringing of tendons when grasping

What is carpal tunnel syndrome?

compression of the median nerve in the tunnel

Where is the longitudinal arch found on the hand?

Along 3rd ray of the hand

True or False: The longitudinal Arch is very mobile at the distal end but very stable at the proximal end?

True

Where can you find the proximal transverse arch of the hand?

the distal carpal bones

What's the keystone of the proximal transverse arch?

Capitate

True or False: The proximal transverse row is a loose and unfixed arch

False (its a static ridge arch)

Whats the Key stone of the Distal transverse Arch?

MCP joints

True or False: The Distal transverse Arch has mobile sides?

True

How many Linear and angular DOF does the sternoclavicular joint have?

Linear: 3
Angular: 3

how many total DOF does the sternoclavicular joint have?

6

What are the motions at the sternoclavicular joint? Name them and the associated plane?

Protraction and Retraction (Transverse plane: S/I Axis)
Elevation and Depression (Frontal plane: A/P Axis)
Posterior rotation (Sagittal plane: M/L Axis)

How many Linear and angular DOF does the Acromioclavicular joint have?

Linear: 3
Angular: 3

How many total DOF does the Acromioclavicular joint have?

6

What are the motions at the acromioclavicular joint? Name them and the associated plane

Internal and external rotation (Transverse plane: S/I axis)
Upward and downward rotation (Frontal plane: A/P axis)
anterior and posterior tilt (Sagittal plane: M/L axis)

How many Linear and angular DOF does the Scapulothoracic joint have?

Linear:3
angular: 3

How many total DOF does the Scapulothoracic joint have?

6

What combination of SC + AC motions create Scapular Elevation?

SC elevation + Slight AC Downward rotation

Why does the AC downwardly rotate during scapular elevation?

In order to stabilize the scapula during the elevation and allows the scapula to remain nearly vertical throughout the elevation

What combination of SC + AC motions create Scapular Depression?

SC depression + slight AC Upward rotation

What combination of SC + AC motions create Scapular Protraction?

SC protraction + AC internal rotation

What combination of SC + AC motions create Scapular Retraction?

SC rectraction + AC External rotation

What combination of SC + AC motions create Scapular Upward Rotation?

SC elevation + AC upward rotation

What combination of SC + AC motions create Scapular Downward Rotation?

SC depression + AC downward rotation

Why is AC motion important when considering Scapulothoracic motion?

Additional adjustments at the AC joint help to keep the scapula flush with the slightly changing curvature of the thorax

True or False: Since scapulothoracic protraction occurs as a composite of motions at the SC and AC joints a decrease in motion at one joint can be partially compensated for by an increase at the other?

True

What coupled rotations are essential for the full 60 degrees of upward rotation at the scapulothoracic joint?

SC elevation + AC Downward Rotation

True or False: The AC and SC joints do not have the mobility to adjust and choose to only pick one path that the scapula follows during elevation of the arm

False (Normally the AC and SC joints have the mobility to adjust to the virtually infinite number of paths that the scapula may take during elevation of the arm)

What are the motions at the Glenohumeral joint? Name them and the associated plane

Flexion and Extension (Sagittal: M/L axis)
Abduction and Adduction (Frontal: A/P axis)
Internal and External rotation (Transverse: S/I axis)

How many linear and angular DOF does the Glenohumeral joint have?

Linear: 3
Angular: 3

How many total DOF does the Glenohumeral joint have?

6

What are the 6 kinematic principles of shoulder abduction?

- 2:1 scapulohumeral rhythm
- 60˚ of upward rotation is a result of AC and SC movement
- Clavicle retracts at SC joint
- Scapula posteriorly tilts and externally rotations
- Clavicle posteriorly rotates around its axis
- Glenohumeral joint externally rotates

What is scapulohumeral rhythm?

relationship that states that after the first 30˚ of abduction fpr every 2˚ of glenohumeral abduction you get 1˚ of Scapulothoracic abductions

During scapulohumeral rhythm how much motion do you get from the glenohumeral joint? How about the Scapulothoracic joint?

120˚ from Glenohumeral joint
60˚ from Scapulothoracic joint

What ROM would you get if the Scapulothoracic was immobilized during abduction?

you would get 120

Motions at the humeroulnar joint? Name plane and axis associated with them

flexion and extension (sagittal: M/L axis)

how many linear and angular degrees of freedom does the humeroulnar joint?

linear: 1
angular: 1

how many total degrees of freedom does the humeroulnar joint?

2

What motions occur at radioulnar joint?

pronation and supination

what happens during pronation?

radius crosses over ulna

what happens during supination?

radius and ulna are parallel

What motions occur at radiocarpal? name the plane and and axis associated to them

Flexion and extension (sagittal plane: M/L axis)
ulnar + radial deviation (frontal plane: A/P axis)

what is the typical ROM of wrist Flexion and extension?

Flexion: 70-85
Extension: 60-75

what is the typical ROM of radial and ulnar deviation?

Ulnar Deviation -35-40˚
Radial Deviation - 15-20˚

What kind of joint is the 1st CMC joint?

saddle joint

What motions are at the 1st CMC joint? name the plane and axis associated to the motions

Adduction and abductions (Sagittal plane: axis M/L)
Flexion and extension (Frontal plane: axis A/P)

What is the convex-concave pairing going top to bottom for the 1st CMC joint?

1st metacarpal top to bottom: convex
Trapezium top to bottom: concave

What is the convex-concave pairing going front to back for the 1st CMC joint?

1st metacarpal front to back: concave
Trapezium front to back: convex

Name the arthrokinematics of the 1st CMC joint during abduction? What is the pairing?

(convex on concave) palmar roll and dorsal slide of the 1st metacarpal on the trapezium

Name the arthrokinematics of the 1st CMC joint during adduction? What is the pairing?

(convex on concave) dorsal roll and palmar slide of the 1st metacarpal on the trapezium

Name the arthrokinematics of the 1st CMC joint during flexion? What is the pairing?

(Concave on convex) medial roll and slide of the 1st metacarpal on the trapezium

Name the arthrokinematics of the 1st CMC joint during extension? What is the pairing?

(Concave on convex) lateral roll and slide of the 1st metacarpal on the trapezium

What two motions make up opposition?

combination of 2 osteokinematic motions
1st) 1st CMC abduction
2nd) 1st CMC flexion w/medial rotation

Name the arthrokinematics of the glenohumeral joint during abduction? What is the pairing?

(convex on concave) superior roll and inferior glide of the humeral head on the glenoid cavity of the scapula

Name the arthrokinematics of the glenohumeral joint during adduction? What is the pairing?

(convex on concave) inferior roll and superior glide of the humeral head on the glenoid cavity of the scapula

Name the arthrokinematics of the glenohumeral joint during flexion? What is the pairing?

Spin of the humeral head on the glenoid cavity

Name the arthrokinematics of the glenohumeral joint during extension? What is the pairing?

Spin of the humeral head on the glenoid cavity

Name the arthrokinematics of the glenohumeral joint during external rotation (in anatomical position) ? What is the pairing?

(convex on concave) posterior roll and anterior glide of the humeral head on the glenoid cavity of the scapula

Name the arthrokinematics of the glenohumeral joint during internal rotation (in anatomical position)? What is the pairing?

(convex on concave) anterior roll and posterior glide of the humeral head on the glenoid cavity of the scapula

What is the convex-concave pairing going top to bottom for the sternoclavicular joint?

Sternal end of the clavicle top to bottom: convex
Sternum top to bottom: concave

What is the convex-concave pairing going front to back for the sternoclavicular joint?

Sternal end of the clavicle front to back: concave
Sternum front to back: convex

Name the arthrokinematics of sternoclavicular elevation? What is the pairing?

(Convex on concave) Superior roll and inferior glide of the clavicle on the sternum