Untitled Flashcards Set

Chapter 7: The ankle and the foot 

Bones of the feet

·      Calcaneus

·      Talus

·      Navicular

·      Cuboid

·      3 Cuneiforms

o   Lateral (3^rd)

o   Intermediate (2^nd)

o   Medial (1^st)

·      This Circus Needs More Interesting Little Clowns

·      Metatarsals

·      Phalanges

o   Proximal

o   Distal

o   Middle (except hallux)

Sections of the foot

·      Rearfoot

·      Midfoot

·      Forefoot

Bony land marks

·      Tuberosity of the 5^th metatarsal

·      Medial and lateral malleolus

·      Tubercle of the navicular

Ankle joint

·      Formed with the distal ends of tibia and fibula and the talus

·      Ankle bones

o   Medial malleolus- tibia

o   Lateral malleolus- fibula

·      Classified as a hinge joint

o   Dorsiflexion- flex

o   Plantar flexion- pointing

·      Mortise tenon joint

Other joints

·      Metatarsophalangeal (MTP) joint

o   Condyloid joint of the forefoot

o   Creates the “ball" of the foot to stand on

o   Toe flexion/ extension and aBduction/adduction

Hallux

·      Big toe

·      Has 2 phalanges instead of 3

·      2 sesamoid bones under the head of the first metatarsal

o   Help muscles create effective force

o   Protect the flexor hallucis longus

Medial collateral ligaments

·      AKA deltoid ligament

·      4 parts that fan out from the medial malleolus

·      Very strong- sometimes the bone will break before the ligament is torn

·      Medial stability

o   What kinds of movements would this protect against?

Lateral collateral ligaments

·      Composed of 3 bands at distal end of fibula

·      Provides lateral stability

o   What kinds of movements would this protect against?

Arches of the foot

·      Anterior transverse arch

·      Lateral longitudinal arch

·      Medial longitudinal arch

Arch Deviations

·      Pes cavus

o   High arched feet

o   Aesthetically desired in dance

o   Limited shock absorbency

·      Pes planus

o   Flat foot

o   talus drops

o   Pronation

Anterior Muscles

·      Action dorsiflexion

·      Tibialis anterior

o   Primary dorsiflexor

o   Also, inversion

o   Palpate flexed and inversion

·      What injury occurs here

o   Shin splints

o   Stress feactures

·      Extensor hallucis longus

o   Hallux extension

o   Palpate lift the big toe off the ground

·      Extensor digitorum longus

o   Extension of the phalanges

o   Also, eversion

Posterior Muscles

·      Plantar flexion

·      Gastrocnemius

o   Inserts into Achilles tendon

o   Attaches above knee

o   Knee flexion

o   Fast twitch fibers

·      Stretching mechanics

·      Soleus

o   Slow twitch fibers

o   Inserts to Achilles tendon

·      Plantaris

o   Absent in 10% of individuals

o   Calf muscles=gps

Posteromedial Muscles

·      Actions inversion and plantarflexion

·      Run deep into calf muscles

o   Tibialis posterior

§  Primary inverter

§  Support of which arch

§  Medial longitudinal

o   Flexor hallucis longus

§  Hallux flexion

§  Runs underneath the first metatarsal and hallux

§  Push off force

o   Flexor digitorum longus

§  Flexion of phalanges 2-5

§  Push off/ grounding in running and jumping

§  Supports lateral longitudinal arch

Lateral Muscles

·      Actions foot eversion

o   Peroneus longus

§  Prevents excessive inversion

§  Supports the transverse arch

o   Peroneus brevis

§  Shorter of the two

Dorsal intrinsic muscles

·      Intrinsic: proximal and distal attachments are within the foot

·      Function:

o   Small movements of the toes

o   Supporting the arches

o   Stabilization of the feet

Plantar intrinsic muscles

Tibial torsion

·      Excessive tibial torsion means the feet can turnout further than the knee

·      Actively pulling the knees up and back so they don’t drop inwards

Weight bearing mechanics

·      Ideal even weight across the triangle of the arches with 50% at the heel and 50% over the metatarsals

·      Working towards this ideal may

o   Control knee hyperextension

o   Anterior-posterior stability

o   Quick rise to releve/agility

Stirrup muscles

·      Tibialis anterior

·      Peroneus longus

·      Tibialis posterior

Pointing technique

·      Emphasize stretci

Imbalances of the ankle

·      Pronation- the head of the first metatarsal falls lateral to a line described by the tuberosity of the navicular and the medial aspect of the calcaneus

·      Observe: look at these three bony land marks

o   Medial aspect of the head of first metatarsal

o   Tuberosity of the navicular

o   Medial aspect of the calcaneus

o   Also alignment of the Achilles tendon (posterior)

·      Cause- weak intrinsic muscles of the foot and weak low leg muscles over rotation

·      Supanation: the head of the first metatarsal medial to the line described by the tuberosity of the navicular and the medial aspect of the calcaneus

·      Observe: look at these bony landmadks

o   Medial aspect of the head of the first metatarsal

o   Tuberosity of the navicular

o   Medial aspect of the calcaneus

o   Also alignment of the Achilles tendon (posterior)

·      Cause- weight transmitted to the lateral side of the foot, weak lower leg muscles

Chapter 7

The upper extremity

Bones of the shoulder girdle

·      Scapula

·      Clavicle

·      Humorous

·      Sternum

Joints

·      Sternoclavicular joint

·      Acromioclavicular joint

·      Glenohumeral joint

Bony landmarks of the scapula

·      Superior, lateral and inferior angles

·      Glenoid cavity, coracoid process, acromion process, spine

·      Superior, medial and lateral boarders

Scapula actions

·      Adduction (retraction)

·      aBduction (protraction)

·      upward rotation

·      downward rotation

·      depression

·      elevation

Bony landmarks of the humerus

·      head

·      greater and lesser tubercle

·      intertubercular groove

·      deltoid tuberosity

Glenohumeral actions

·      flexion/ extension

o   on the sagittal plane

·      aBduction/adduction

o   on the frontal plane

o   approx. frontal plane but actually in scapular plane

·      internal/external rotation

o   in the transverse plane

Specialized structures

·      glenoid labrum

o   equivalent to acetabular labrum

o   stability, reduce friction

·      Coracoacromial arch

o   Protects against trauma to top

o   Site of shoulder impingement

Muscles of the back and shoulder

·      Trapezius

o   Scapular adduction, upward rotation, elevation, depression

o   Activate to bring shoulders away from ears in fifth position

·      Deltoids (anterior, middle, posterior)

o   Shoulder flexion/extension, internal/external rotation, aBduction

·      Pectoralis Major

o   Shoulder flexion, extension, internal rotation, adduction

o   Pushing, throwing, punching movements

·      Latissimus dorsi

o   Shoulder extension, adduction, internal rotation

o   Broadest muscle of the back

o   Keeping shoulders depressed, inversions lowering

Rotator Cuff muscles (sits)

·      Supraspinatus- shoulder aBduction

·      Infraspinatus- shoulder external rotation

·      Teres minor- shoulder external rotation

·      Subscapularis- shoulder internal rotation

·      Which may be easily compressed?

o   Supraspinatus

Other shoulder muscles

·      Levator scapulae- scapular elevation, downward rotation, adduction

o   Contour of the neck

·      Serratus anterior- scapular aBduction, upward rotation, and depression

o   Strengthening to help winged scapula

Scapulohumeral rhythm

Injuries and misalignments

·      Rolled shoulders

o   Excessive scapular protraction and internal rotation of the humerus

o   Strengthen trapezius, rhomboids, infraspinatus, posterior deltoid

o   Rows, shoulder shrugs, external rotation

·      Winged Scapula

o   Medial boarder or bottom tip protrudes

o   Strengthen serratus anterior and trapezius

o   Push up plus, face pulls with cable, farmer’s carry

·      Acromioclavicular sprain

o   Ligament injury around the joint

o   Mild stretching to complete tear

o   Cause- falling on outstretched arm on top of the shoulder

o   Recovery- rest, sling, limiting ROM, strengthen traps and delts

·      Shoulder Dislocation

o   95% in anterior position

o   Cause- trauma during protraction and external rotation

o   Result in excess laxity in the joint with recurrence of dislocation

o   Strengthening rotator cuff muscles

·      Shoulder impingement

o   Pinching of soft tissues, typically supraspinatus tendon

o   Pain with overhead movements between 45-120 degrees

o   Strengthening scapular depressors and upward rotators

Elbow

·      Humerus

o   Medial and lateral epicondyle

·      Hinge joint

o   Flexion and extension

o   Humeroulnar joint

Muscles of the upper arm

·      Biceps brachii- elbow flexion, radioulnar supination, shoulder flexion

o   Max force in supination  

·      Brachialis- elbow flexion

·      Triceps brachii- elbow extension, shoulder extension  

Lower arm

·      Bones: radius (lateral) and ulna (medial)

·      Radioulnar joint- proximal, middle, distal

·      Pivot joint- supination and pronation

Muscles of the lower arm

·      Brachioradialis- elbow flexion, pronation/supination

·      Pronator teres and pronator quadratus- pronation

·      Supinator- supination

Wrist and hand

·      Bones- carpals, metacarpals, phalanges

·      Pollex= thumb with 2 phalanges

·      Radiocarpal joint

o   Wrist joint

Condyloid joint- flexion/extension and abduction/adduction