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  1. Anaerobic System
    • does not require oxygen
    • uses carbohydrates
    • 30-40 seconds of muscle contraction
    • forms lactic acid, resulting in muscle fatigue
  2. Aerobic System
    • low intensity, high duration
    • yields by far the most ATP
    • will provide energy as long as there are nutrients to utilize
  3. 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)
  4. Joint Classification
    • Fibrous: sutures (skull-immovable), syndesmosis (interosseous membrane), gomphosis (teeth)
    • Cartilaginous:synchondrosis (rib articulation), symphysis (pubic symphysis)
    • Synovial: uniaxial, biaxial, multi-axial
  5. Glenohumeral joint
    • convex moving on concave
    • loose packed: 55' abduction, 30' horizontal adduction
    • capsular pattern: ER, abduction, IR
  6. Shoulder flexion
    • anterior deltoid
    • coracobrachialis
    • pec major
    • biceps brachii
  7. shoulder extension
    • latissimus dorsi
    • posterior deltoid
    • teres major
  8. shoulder abduction
    • middle deltoid
    • supraspinatus
  9. shoulder adduction
    • pec major
    • latissimus dorsi
    • teres major
  10. shoulder external rotation
    • teres minor
    • infraspinatus
    • posterior deltoid
  11. shoulder internal rotation
    • subscapularis
    • teres major
    • pectoralis major
    • latissimus dorsi
    • anterior deltoid
  12. 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
  13. Radiohumeral jt
    • concave on convex
    • loose packed: full extension, supination
    • close packed: 90' flexion, 5' supination
  14. Ulnohumeral jt
    • loose packed: 70' flexion, 10' supination
    • close packed: extension
  15. Proximal radioulnar
    • concave ulna, convex radius
    • loose packed: 70' flexion, 35' supination
    • close packed: 5' supination
  16. elbow flexion
    • biceps brachii
    • brachialis
    • brachioradialis
  17. elbow extension
    • triceps brachii
    • aconeus
  18. 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
  19. Radiocarpal
    • convex moving on concave
    • loose packed: neutral with slight ulnar deviation
    • close packed: extension with radial deviation
  20. Ligaments of Wrist
    • Dorsal Radiocarpal: limits wrist flexion
    • Palmar Radiocarpal: limit wrist hyperextension
    • Radial Collateral Ligament: limit ulnar deviation
  21. Ileofemoral
    • convex on concave
    • loose packed: 30' flexion, 30' abduction, slight ER
    • capsular pattern: flexion, abduction, IR
  22. hip flexion
    • iliopsoas
    • sartorius
    • rec fem
    • pectineus
  23. hip extension
    • glut max
    • glut med
    • semitendinosus
    • semimembranosus
    • biceps femoris
  24. hip abduction
    • glut med
    • glut min
    • piriformis
    • obturator internus
  25. hip adduction
    • adductor magnus
    • adductor longus
    • adductor brevis
    • gracilis
  26. Hip medial rotation
    • TFL
    • glut med
    • glut min
    • pectineus
    • adductor longus
  27. hip lateral rotation
    • glut max
    • obturator externus
    • obturator internus
    • piriformis
    • gemelli
    • sartorius
  28. 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)
  29. Tibiofemoral
    • Loose packed: 25' flexion
    • Close packed: full extension, ER of tibia
    • Capsular pattern: flexion, extension
  30. 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
  31. Talocrural Joint
    • synovial hinge joint
    • loose packed: 10' PF, neutral inversion/eversion
    • capsular pattern: PF, DF
  32. Subtalar joint
    • three articulations between talus and calcaneus
    • inversion/eversion
  33. Plantarflexion
    • tibialis posterior
    • gastroc
    • soleus
    • fibularis longus/brevis
    • plantaris
    • flexor hallucis
  34. Dorsiflexion
    • tibialis anterior
    • extensor hallucis longus
    • extensor digitorum longus
    • fibularus tertius
  35. Inversion
    • tib posterior
    • tib anterior
    • flexor digitorum longus
  36. Eversion
    fibularis longus/brevis/tertius
  37. 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'
  38. 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
  39. 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
  40. Screw Home Mechanism
    • 5' tibial external rotation occuring at terminal knee extension
    • unlocking occurs primarily through popliteus
  41. 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
  42. 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
  43. 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
  44. 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
  45. 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)
  46. 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
  47. 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
  48. 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)
  49. 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
  50. Muscle Insufficiency
    • Active: 2 jt. muscle contracts across both joints
    • Passive: 2 jt muscle lengthened over both joints
  51. 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
  52. ROM requirements for gait
    • hip motion: 10-0-30
    • knee motion: 0-60
    • PF to DF: 20-0-10
  53. 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")
  54. 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
  55. Shoulder dislocation tests
    • apprehension test for anterior shoulder dislocation
    • apprehension test for posterior shoulder dislocation
  56. 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
  57. 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
  58. Miscellaneous shoulder special tests
    • glenoid labrum tear test: passively abduct & ER arm (clunk)
    • upper limb neural tension test
  59. Elbow ligamentous instability special test
    • varus stress test: 20-30' elbow flexion
    • valgus stress test: 20-30' elbow flexion
  60. 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
  61. Elbow Neuro dysfunction special tests
    tinels sign: between olecranon and medial epicondyle
  62. 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
  63. 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
  64. Hip pediatric special tests
    • barlow
    • ortolani
  65. 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
  66. 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
  67. 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
  68. Knee swelling special test
    • brush test: effusion of knee (medial border of patella)
    • patellar tap test: tap over patella- joint effusion
  69. 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
  70. 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
  71. 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
  72. 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
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2013-01-09 15:06:52
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