-
Anaerobic System
- does not require oxygen
- uses carbohydrates
- 30-40 seconds of muscle contraction
- forms lactic acid, resulting in muscle fatigue
-
Aerobic System
- low intensity, high duration
- yields by far the most ATP
- will provide energy as long as there are nutrients to utilize
-
Classes of Levers
- Class 1: axis of rotation (fulcrum) is between the effort (force) and resistance (load)
- Class 2: resistance (load) between the axis of rotation (fulcrum) and the effort (force)
- Class 3: effort (force) between the axis of rotation (fulcrum) and the resistance (load)
-
Joint Classification
- Fibrous: sutures (skull-immovable), syndesmosis (interosseous membrane), gomphosis (teeth)
- Cartilaginous:synchondrosis (rib articulation), symphysis (pubic symphysis)
- Synovial: uniaxial, biaxial, multi-axial
-
Glenohumeral joint
- convex moving on concave
- loose packed: 55' abduction, 30' horizontal adduction
- capsular pattern: ER, abduction, IR
-
Shoulder flexion
- anterior deltoid
- coracobrachialis
- pec major
- biceps brachii
-
shoulder extension
- latissimus dorsi
- posterior deltoid
- teres major
-
shoulder abduction
- middle deltoid
- supraspinatus
-
shoulder adduction
- pec major
- latissimus dorsi
- teres major
-
shoulder external rotation
- teres minor
- infraspinatus
- posterior deltoid
-
shoulder internal rotation
- subscapularis
- teres major
- pectoralis major
- latissimus dorsi
- anterior deltoid
-
Labrum, jt. capsule, subacromial/subscapular bursa (shoulder)
- glenoid labrum: deepens the fossa and increases the size of the articular surface
- jt. capsule: blends with the muscles of the rotator cuff
- subacromial bursa: extends over supraspinatus- involved with impingement
- subscapular bursa: over the subscapularis muscle
-
Radiohumeral jt
- concave on convex
- loose packed: full extension, supination
- close packed: 90' flexion, 5' supination
-
Ulnohumeral jt
- loose packed: 70' flexion, 10' supination
- close packed: extension
-
Proximal radioulnar
- concave ulna, convex radius
- loose packed: 70' flexion, 35' supination
- close packed: 5' supination
-
elbow flexion
- biceps brachii
- brachialis
- brachioradialis
-
-
Ligaments of elbow
- Radial (lateral) Collateral Ligament: prevents adduction of elbow, reinforcing radiohumeral articulation
- Ulnar (medial) Collateral Ligament: prevents excessive abduction of elbow
- Annular ligament: surrounds head of radius, allowing it to rotate and stay in contact with ulna
- Anterior ligament: capsular in nature
- Posterior ligament: blends with collateral ligaments
-
Radiocarpal
- convex moving on concave
- loose packed: neutral with slight ulnar deviation
- close packed: extension with radial deviation
-
Ligaments of Wrist
- Dorsal Radiocarpal: limits wrist flexion
- Palmar Radiocarpal: limit wrist hyperextension
- Radial Collateral Ligament: limit ulnar deviation
-
Ileofemoral
- convex on concave
- loose packed: 30' flexion, 30' abduction, slight ER
- capsular pattern: flexion, abduction, IR
-
hip flexion
- iliopsoas
- sartorius
- rec fem
- pectineus
-
hip extension
- glut max
- glut med
- semitendinosus
- semimembranosus
- biceps femoris
-
hip abduction
- glut med
- glut min
- piriformis
- obturator internus
-
hip adduction
- adductor magnus
- adductor longus
- adductor brevis
- gracilis
-
Hip medial rotation
- TFL
- glut med
- glut min
- pectineus
- adductor longus
-
hip lateral rotation
- glut max
- obturator externus
- obturator internus
- piriformis
- gemelli
- sartorius
-
Ligaments of hip
- Iliofemoral ligament: strongest ligament in the body, prevent excessive hip extension and maintains upright posture, Y ligament
- Pubofemoral ligament: prevent excessive abduction and limits hip extension
- Ischiofemoral ligament: reinforces articular capsule
- Inguinal ligament: forms tunnel for muscles, arteries, veins
- (acetabular labrum reinforces depth of acetabulum)
-
Tibiofemoral
- Loose packed: 25' flexion
- Close packed: full extension, ER of tibia
- Capsular pattern: flexion, extension
-
Ligaments of Knee (how they're injured)
- Anterior cruciate: noncontact twisting, hyperextension and varus/valgus stress (anterior drawer, lachmans, lateral pivot shift, slocum)
- Posterior cruciate: tibia is struck while the knee is flexed (posterior draw, posterior sag sign)
- Medial collateral: pure valgus load without rotation (valgus stress test), common with ACL and medial meniscus
- Lateral collateral: pure varus load without rotation (varus stress test), come in with PCL or ACL
-
Talocrural Joint
- synovial hinge joint
- loose packed: 10' PF, neutral inversion/eversion
- capsular pattern: PF, DF
-
Subtalar joint
- three articulations between talus and calcaneus
- inversion/eversion
-
Plantarflexion
- tibialis posterior
- gastroc
- soleus
- fibularis longus/brevis
- plantaris
- flexor hallucis
-
Dorsiflexion
- tibialis anterior
- extensor hallucis longus
- extensor digitorum longus
- fibularus tertius
-
Inversion
- tib posterior
- tib anterior
- flexor digitorum longus
-
Eversion
fibularis longus/brevis/tertius
-
Hip coxa valga/cara, and anteversion/retroversion
- Angle of inclination normal: 115-125
- coxa valga: >125'
- coxa vara: <115'
- Femoral neck angle normal: 10-15'
- anteversion: >25-30'
- retroversion: <10'
-
Ankle Ligaments
- Anterior talofibular: taut during PF, resists inversion
- Calcaneofibular: extracapsular, resisting inversion
- Posterior talobfibular: resists posterior displacement
- Deltoid: provides medial ligamentous support by resisting eversion
-
Menisci of Knee
- Function: increase congruency, provides stability, provides shock absorption, reduces friction, improves weight distribution
- Medial meniscus: C shaped, attach to MCL and fibrous capsule, semimembranosous attaches to it
- Lateral meniscus: circular shaped, separated from LCL and lateral capsule by popliteus tendon
-
Screw Home Mechanism
- 5' tibial external rotation occuring at terminal knee extension
- unlocking occurs primarily through popliteus
-
Plantar Fascia
- dense band of longitudinally arranged collagen fibers
- tightens with DF of MTP during push off (windlass effect)
- tightening causes supination of calcaneus & inversion of subtalar jt- creating rigid lever for push off
-
Type I vs. Type II Muscle Fibers
- Type I: aerobic, red, tonic, slow twitch, slow-oxidative, large # of mitochondria, extensive blood supply, high capillary density
- Type II: anaerobic, white, phasic, fast twitch, fast-glycolytic, high fatigability, less blood supply, fewer mitochondria, low capillary density
-
Types of muscle contractions (concentric, ect)
- concentric: muscle shortens
- eccentric: muscle lengthens
- isometric: tension develops but not lengthening difference
- isotonic: resists a constant load
- isokinetic: constant speed, resistance may change
-
Exercise Programs
- Oxford Technique: start at 100% max for first set and then 75% and 50% for third set
- DeLorme: opposite, start at 50% and work to 100% max
-
Body Composition Measurements
- Hydrostatic weighing: body fat determined by amount of water displaced
- plethysmography: density of body determined by amount of air displaced
- skinfold measurements: abdominal, triceps, biceps, chest, medial calf, midaxillary, subscap, suprailliac, thigh
- BMI: heigh/weight
- Bioelectrical Impedance: small current measures the resistance to the current flow (lots of requirements before getting measured, urinating before, no alcohol consumption or excessive water)
-
Plumb Line for proper alignment
- posterior to coronal suture
- through external auditory meatus
- through axis of odontoid process
- midway through tip of shoulder
- through lumbar vertebres
- posterior to hip jt
- anterior to axis of knee
- anterior to lateral malleolus
-
Close packed vs loose packed positions in general
- loose packed: minimal stress on jt, minimal jt. congruency, great laxity
- close packed: maximal stress on jt, full jt. congruency, full ligament tightness
-
End feels
- Normal: firm (stretch), hard (bone to bone- elbow ext.), soft (tissue approximation- elbow flexion)
- Abnormal: firm (increased tone, capsule tightening), hard (fracture, osteophyte), soft (edema), empty (pain generally)
-
Manual Muscle Testing
- Zero: no palpable muscle contraction
- Trace: palpable contraction, no movement
- Poor: completes ROM in gravity eliminated position
- Fair: completes ROM against gravity
- Good: completes ROM against moderate resistance
- Normal: completes ROM against maximal resistance
-
Muscle Insufficiency
- Active: 2 jt. muscle contracts across both joints
- Passive: 2 jt muscle lengthened over both joints
-
Gait Cycle- standard and ranchos
- Stance phase:
- heel strike - initial contact
- foot flat - loading response
- midstance - midstance
- heel off - terminal stance
- toe off - preswing
- Swing phase:acceleration - initial swing
- midswing - midswing
- deceleration - terminal swing
-
ROM requirements for gait
- hip motion: 10-0-30
- knee motion: 0-60
- PF to DF: 20-0-10
-
Gait terminology
- cadence: # of steps (avg 110-120 per minute)
- degree of toe out: avg. 7'
- pelvic rotation: avg is total of 8' degrees
- step length: right heel strike to left heel strike (avg. 28")
- stride length: right heel strike to right heel strike (avg. 56")
-
Abnormal Gait Patterns
- antalgic: protective gait pattern
- ataxic: staggering/unsteadiness, wide BOS
- cerebellar: staggering gait pattern
- circumduction: insufficient hip/knee flexion or DF
- equine: high step, excessive gastroc activity
- festinating: walks on toes like being pushed
- parkinsonian: forward flexion of trunk and knees, gait is shuffling
- spastic: stiff movement
- tabetic: high stepping, ataxic, slap the ground
- trendelenburg: glut med weakness, lat trunk flexion & and weight shifting over stance limb
- vaulting: elevation of pelvis and PF of stance leg
-
Shoulder dislocation tests
- apprehension test for anterior shoulder dislocation
- apprehension test for posterior shoulder dislocation
-
Rotator cuff pathology special tests
- drop arm test: slowly lower from 90' abduction
- hawkins-kennedy: flex to 90' and IR
- neer impingement: elevate arm through flexion
- supraspinatus: empty can test-ish
-
thoracic outlet syndrome
- adson (vascular): diminished radial pulse
- allen (vascular):ER/abd/elbow flexion and rotate head away, monitor radial pulse
- costoclavicular syndrome (vascular): military posture-monitor radial pulse
- Roos test: open and close hands x 3 minutes
- Wright test (vascular): abduct arm- monitor radial pulse
-
Miscellaneous shoulder special tests
- glenoid labrum tear test: passively abduct & ER arm (clunk)
- upper limb neural tension test
-
Elbow ligamentous instability special test
- varus stress test: 20-30' elbow flexion
- valgus stress test: 20-30' elbow flexion
-
Elbow epicondylitis special tests
- cozen's test: fist, pronate, RD, and extend wrist against resistance- lateral epicondyle pain
- lateral epicondylitis: extend 3rd digit against resistance
- medial epicondylitis: passive supination, extension of wrist/elbow
- mill's: passive pronation, wrist flexion, elbow extension- lateral epicondyle
-
Elbow Neuro dysfunction special tests
tinels sign: between olecranon and medial epicondyle
-
wrist/hand special tests
- ulnar collateral ligament stability test: thumb in extension & apply valgus force (gamekeepers)
- allen test (vascular): open and close hand- radial & ulnar artery
- bunnel-littler test: intrinsic/capsular tightness
- tight retinacular ligament: retinacular ligament or capsular
- froments (neuro): ulnar nerve- paper between thumb and index
- phalens (neuro): median nerve compression
- tinels (neuro): volar aspect of wrist- carpal tunnel
- finkelstein: deQuervains
- grind: compression at metacarpal
- murphy: dislocated lunate- 3rd metacarpal same height
-
Hip contracture/tightness special tests
- elys: prone- rec fem contracture
- obers: sidelying- TFL contracture
- piriformis: sidelying
- thomas: supine, knee to hip, contralateral hip flexion
- tripod: sitting- HS tightness when straighten one leg
- 90-90: HS tightness
-
Hip pediatric special tests
-
Hip miscellaneous special tests
- craigs test: prone, anteversion- 8-15 normal
- faber/patricks test: iliopsoas, SI, or hip jt issues
- quadrant scoring: AVN or osteochondral defect- flex adduct and knee flexed w/ compressive force
- trendelenburg: glut med weakness
-
Knee ligamentous special tests
- anterior drawer: 90' ACL
- lachman: 20-30' ACL
- lateral pivot shift test: anterolateral instability
- posterior drawer: 90' PCL
- posterior sag sign: 90' PCL
- slocum: 90' anterolateral or anteromedial instability
- valgus stress test: 20-30' MCL
- varus stress test: 20-30' LCL
-
Knee Menisci special tests
- apleys: prone, knee flexed, IR/ER tibia with force
- bounce home: maximally flex knee then passively extend
- mcmurray: supine, knee flexed IR/ER tibia
-
Knee swelling special test
- brush test: effusion of knee (medial border of patella)
- patellar tap test: tap over patella- joint effusion
-
Knee Miscellaneous special tests
- clarkes sign: patellofemoral dysfunction, knees extended contract quad with hand over patella
- hughston's plica test: medial plica popping out
- noble compression test: ITB friction over lateral epicondyle, flexed hip/knee then sactively extend
- patellar apprehension test: patellar sublux, apply lateral force to patella
-
Ankle ligamentous instability special test
- anterior drawer: anterior talofibular ligament, 20' PF and draw talus forward on mortise
- talar tilt: calcaneofibular ligament sprain, tilt talus into abd/add- excessive adduction
-
Miscellaneous ankle special test
- Thompson test: ruptured achilles, absense of PF when squeezing gastroc
- tibial torsion test: normal 12-18'
- true leg length discrepancy: >1 cm difference
-
Mobilization indications/contraindications
- indications: restricted jt mobilty, restricted accessory motion, desired neurophysiological effects
- contraindications: active disease, infection, advanced osteoporosis, hypermobility, fracture, acute inflammation, muscle guarding, jt. replacement
|
|
