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111 Cards in this Set
- Front
- Back
Elbow joint axis
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lateral
(through the Medial and Humeral Lateral Epicondyles) |
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Elbow joint movments
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Flexion/Extension
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close packed position of elbow
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extension
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Radio-ulnar joint axis
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oblique line that connects the superior and inferior radio-ulnar joints
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radio-ulnar joint motion
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pronation/supination
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Humero-Ulnar Joint in an Open Chain
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The concave ulnar surface rolls and glides in same direction on convex humeral surface.
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Humero-Ulnar Joint in a Closed Chain
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The convex humeral surface rolls and glides in opposite directions on the concave ulnar surface
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arthrokinematics during Open Chain Elbow Extension
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The ulna rolls and glides posteriorly on humerus while
radius moves distally ulna and radius spread apart ulna and radius pronate with respect to each other. |
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arthrokinematics during Open Chain Elbow Flexion
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The ulna rolls and glides anteriorly on humerus while
radius moves proximally ulna and radius move closer together ulna and radius supinate with respect to each other |
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elbow flexors
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Extensor Carpi Radialis Longus
pronator teres flexor carpi radialis palmaris longus biceps brachialis Brachioradialis |
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elbow extensors
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triceps
anconeus |
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forearm pronators
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Pronator Quadratus
Pronator Teres Flexor Carpi Radialis |
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forearm supinators
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Supinator
Biceps (Extensor Pollicis Longus) (Extensor Indicis) |
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Carpal muscles that act at the wrist and, in some cases, the elbow
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EXTENSOR CARPI RADIALIS LONGUS
EXTENSOR CARPI RADIALIS BREVIS EXTENSOR CARPI ULNARIS FLEXOR CARPI RADIALIS FLEXOR CARPI ULNARIS PALMARIS LONGUS |
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Extrinsic hand mm that act on the second through fourth digits:
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EXTENSOR DIGITORUM
EXTENSOR INDICIS (PROPRIUS) EXTENSOR DIGITI MINIMI (PROPRIUS) FLEXOR DIGITORUM SUPERFICIALIS FLEXOR DIGITORUM PROFUNDUS |
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Extrinsic thumb muscles that act on the first digit:
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FLEXOR POLLICIS LONGUS
EXTENSOR POLLICIS LONGUS EXTENSOR POLLICIS BREVIS ABDUCTOR POLLICIS LONGUS |
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Intrinsic hand muscles that act only on the digits
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THENAR MUSCLES and ADDUCTOR POLLICIS
HYPOTHENAR MUSCLES LUMBRICALES DORSAL INTEROSSEI PALMAR INTEROSSEI |
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close packed position of wrist
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extension
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Radial and Ulnar Deviation occur around an axis through
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through the head of the capitate
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Wrist flexion and extension occurs around an axis that
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migrates distally during extension. Although your text states (obviously correctly) that the axis passes through the capitate, we will use the scaphoid as our landmark during labs as it is palpable and marks the more distal component of the capitate
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during open chain wrist flexion
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The scaphoid/lunate roll anteriorly (toward palm) and glide posteriorly (toward dorsum)
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during open chain wrist extension
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The scaphoid/lunate roll posteriorly(toward dorsum) and glide anteriorly (toward palm).
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during ulnar deviation arthrokinematics
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The scaphoid/lunate roll toward ulna and glide toward radius
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during radial deviation arthrokinematics
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The scaphoid/lunate roll toward radius and glide toward ulna.
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5 pillars of the wrist
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1. Extensor Carpi Radialis Longus (ECRL)
2. Extensor Carpi Radialis Brevis (ECRB) 3. Extensor Carpi Ulnaris (ECU) 4. Flexorr Carpi Radialis (FCR) 5. Flexor Carpi Ulnaris (FCU) (Palmaris Longus is the sixth man) |
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shared fxn of wrist pillars
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These wrist muscles are responsible for stabilizing the wrist during all hand and finger movements, and allowing fine motor activity in the fingers
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wrist pillars that extend wrist
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extensor carpi radialis longus
extensor carpi radialis brevis extensor carpi ulnaris |
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wrist pillars that flex wrist
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Flexor Carpi radialis
Flexor Carpi Ulnaris palmaris longus |
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wrist pillars ulnar deviators
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flexor carpi ulnaris
extensor carpi ulnaris |
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wrist pillars radial deviators
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flexor carpi radialis
extensor carpi radialis longus extesnor carpi radialis brevis |
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What is the role of the wrist extensors (ECRB, ECRL, ECU) when you make a tight fist or firmly grab an object?
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Maintain appropriate length and tension (force) in finger flexors so they can produce strong grip
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Open your fingers forcefully and observe that the wrist flexes automatically…WHY??
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The role of the wrist flexors (FCU, FCR) is to maintain appropriate length and tension in finger extensors they can forcefully open the hand.
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Palpate the Extensor Carpi Ulnaris as you quickly move the thumb away from the second digit. Why is the ECU active during this maneuver?
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-Abductor Pollicis Longus and Extensor Pollicis Brevis move thumb but also radially deviate wrist;
-The Extensor Carip Ulnaris thus acts as a true synergist in that it ulnarly deviates the wrist. |
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Carpal tunnel contains
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-Flexor Carpi Radialis tendon
-Flexor Pollicis Longus tendon -Median Nerve -tendons of Flexor Digitorum Superficialis and Flexor Digitorum Profundus -Vascular structures |
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What causes carpal tunnel syndrome?
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-Repetitive motion can produce a tenosynovitis in the tendon sheaths of the long flexor muscles.
-This, in turn, can increase hydrostatic pressure in the tunnel, causing compression damage to median nerve |
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carpal tunnel syndrome's impairments
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-pain and paresthesia in the distribution of the median nerve.
-weakness of muscles innervated by the median nerve, the thenar muscles, and the first and second lumbricales |
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CMC joint close packed position
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You cannot passively rotate the CMC when you place it in full opposition or full reposition; these are the CMC joint's close packed positions. In these positions, the capsular fibers are maximally elongated and taut, and so prevent CMC rotation
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extensor mechanism of the thumb receives fibers from
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-abductor pollicis brevis (median nerve)
-adductor pollicis (ulnar nerve) -ulnar head of flexor pollicis brevis / first palmar -interosseous (ulnar nerve) -extensor pollicis longus (radial nerve) |
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tendons which make up anatomical snuff box
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The Abductor Pollicis Longus and the Extensor Pollicis Brevis (radial border).
The Extensor Pollicis Longus (ulnar border) |
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3 thenar muscles and basic fxn
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Abductor Pollicis Brevis
Flexor Pollicis Brevis Opponens Pollicis Position thumb for grasping |
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abductor pollicis brevis action and insertion
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Abducts the CMC and MCP joint
extends the IP joint of the thumb via extensor expansion Attaches to the trapezium and to base of the first proximal phalanx; crosses MCP and CMC joints |
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flexor pollicis brevis action and insertion
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Proximal phalanx of thumb
Flex metacarpaphalangeal and carpometacarpal joints of the thumb Assists in opposition. |
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opponens pollicis action and insertion
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shaft of first metacarpal
Crosses only CMC joint; its oblique fibers abduct, flex, and rotate the CMC to oppose thumb to other digits. |
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adductor pollicis action
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Adducts first MP joint by approximating 1st and 3rd metacarpals
Depending on the CMC's initial position, the Adductor Pollicis can flex the MP joint Can assist with IP extension through its attachment to the thumb's extensor mechanism |
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flexor pollicis longus action and insertion
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Base of distal phalanx of thumb
flexion to the IP, MCP, CMC, and wrist radial abduction |
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extensor pollicis longus attachments and actions
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-attaches proximally to ulna, and crosses wrist, CMC, MP, and IP joints.
-The extensor pollicis longus extends the IP, MCP, and CMC joints of the thumb. Because the muscle passes dorsal to the medial lateral axis of the CMC joint, it also causes adduction at that joint. -radial deviation/wrist extension |
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Extensor pollicis brevis attachment and action
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Attaches proximally to radius, its tendon passing through common sheath with that of APL, then attaches to base of proximal phalanx
extends the MCP and the CMC joints of the thumb radially deviate wrist/wrist flexion |
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abductor pollicis longus insertion and actions
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Base of 1st metacarpal – radial side
a prime abductor of the CMC joint can also extend CMC joint radial abduction and wrist flexion |
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Rapid flexion of the thumb's IP joint involves the flexor pollicis longus (FPL), and is often accompanied by palpable activity in the abductor pollicis longus. The first CMC joint may even abduct. Why is the APL active?
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The APL activity counters FPL's tendency to flex the CMC joint in the plane of the palm
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Rapid extension of the thumb's IP joint involves the extensor pollicis longus (EPL), and is often accompanied by palpable activity in the thenar muscles. The first CMC joint may even flex in the plane of the palm. Why does this cause the opponens pollicis to activate?
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Activity in the opponens pollicis counters the EPL's tendency to extend the first CMC joint or adduct it in a plane perpendicular to the palm.
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The extensor carpi ulnaris is often active when the abductor pollicis longus is in use. Why?
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Since the APL also produces radial deviation of the wrist, the extensor carpi ulnaris (ECU) may also act to prevent wrist motion.
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power grasp definition and examples
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In a power grasp the adductor pollicis stabilizes an object against the palm; the hand's position is static.
Ex: grabbing a ball in palm, carrying a suitcase, pinching a floppy disc |
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precision grasp definition and examples
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Muscles are active that abduct or oppose the thumb; the hand's position is dynamic.
Ex: holding a pencil, key-grip |
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3 arches of the hand
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1. Proximal Transverse Arch (rigid)
2. Distal Transverse Arch (flexible, maintained by activity in the hand's intrinsic muscles) 3. Longitudinal Arch (same as #2) |
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hand arches purpose
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The arches provide a balance between stability and mobility for grasping. For instance, we produce the so-called "chuck grasp" by using the more stable second and third metacarpals, instead of the more mobile fourth and fifth metacarpals.
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close packed position MP joint
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1st: extension
2 – 5: Flexion |
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PIP and DIP close packed position
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extension
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MP joints arthrokinematics
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Because the proximal joint surface is convex and distal surface is concave…
Roll and glide occur in same direction anterior glide occurs with MP flexion posterior glide occurs with MP extension. |
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IP joints arthrokinematics
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Because the IP proximal joint surface is also convex and the distal surface is concave…
roll and glide occur in same direction anterior glide occurs with IP flexion posterior glide occurs with IP extension |
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2 muscles responsible for finger flexion
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Flexor digitorum profundus and flexor digitorum superficialis
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5 structures that compose extensor mechanism
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1. Muscle – The Extensor Digitorum Communis tendon (EDC)
2. central band (or "slip“, or “tendon”) of EDC (not contractile tissue) 3. two lateral bands 4. oblique retinacular ligaments (ORL) 5. The dorsal hood (aka dorsal aponeurosis or aponeurotic sleeve) |
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Extensor Digitorum Communis tendon (EDC) fxn
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extends the metacarpophalangeal joints.
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central band fxn
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tension is placed into this central tendon or slip, that tension can extend the PIP joint
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lateral bands fxn
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tension in the lateral bands extend the DIP joints.
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oblique retinacular ligaments fxn
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purpose is to coordinate movement between the PIP and DIP joints
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dorsal hood fxn
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The lumbricales and interossei attach into the
extensor mechanism via the oblique and transverse fibers of the dorsal hood and assist the EDC with extension of the PIP and DIP joints |
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Dorsal interossei actions
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The dorsal interossei produce MP abduction and, in certain instances, MP flexion. Because they attach to the extensor mechanism, they can also produce PIP and DIP extension
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palmar interossei actions
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They produce MP adduction and, in certain instances, MP flexion. They also produce PIP and DIP extension when they introduce tension into the extensor mechanism.
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indirect effect of hand opening of interossei
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: The production of a flexion torque at the MCP joint. This prevents the extensor digitorum from hyperextending the MCP joint – which is an action that would prematurely dissipate most of its contractile force.
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lumbricales action
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Acting alone, the lumbricales produce MP flexion, PIP and DIP extension, by introducing tension into the extensor mechanism.
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2 ways extensor mechanism works
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-activity in the intrinsic muscles that attach to the extensor mechanism always produces DIP and PIP extension.
-Passive flexion of the MP joint (try it yourself!) elongates the extensor mechanism and extends the PIP and DIP joints |
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why are wrist flexors active during active finger extension?
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-maintain the optimal length of the EDC during active finger extension
-offset the large extension moment of the EDC at the wrist – thus allowing its action at the MCP joints instead. |
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lordosis typically found in what spinal regions?
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cervical and lumbar
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kyphosis typically found in what spinal regions?
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thoracic and sacrococcygeal
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fryette's law #1
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lateral flexion and rotation occur in opposite directions (neutral mechanics- facets are not engaged or locked)
Only applies to lumbar and thoracic |
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fryette's law #2
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if segments are fully engaged in flexion/extension then lateral flexion and rotatio occur in the same direction.
This always applies to cervical spine |
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fryette's law #3
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if motion is reduced in one plane, motion in the other planes is reduced
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3 erector spinae muscles
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spinalis
longissimus iliocostalis |
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3 transversospinalis muscles
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multifidi
rotatores semispinalis |
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side bending right muscles contributions
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Initiated concentrically with right rectus abdominis, right internal oblique, right external oblique, right erector spinae group (superficial muscles) and right deep group (transversospinalis group)
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side bending left muscles contributions
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Initiated concentrically with left rectus abdominis, left internal oblique, left external oblique, left erector spinae group (superficial muscles) and left deep group (transversospinalis group)
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right rotation muscle contributions
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Initiated concentrically with right internal oblique, left external oblique, right erector spinae group (superficial muscles) and left deep group (transversospinalis group)
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left rotation muscle contributions
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Initiated concentrically with left internal oblique, right external oblique, left erector spinae group (superficial muscles) and right deep group (transversospinalis group
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trunk flexion muscle contributions
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Initiated concentrically with right and left rectus abdominis, right and left internal oblique, right and left external oblique
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trunk extension muscle contributions
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Initiated concentrically with right and left erector spinae group (superficial muscles) and right and left deep group (transversospinalis group)
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anterior pelvic tilt done using
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uses hip flexors and spinal extensors – therefore it increases lumbar lordosis.
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posterior pelvic tilt done using
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uses the hip extensors and abdominals - therefore it decreases the pelvic tilt – causing lumbar FLEXION
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When rolling to the right in an open chain (leading with your shoulders, moving the left shoulder forward and off the floor to rotate towards the right) gravity is resisting this motion by producing leftward rotation. Which muscles are used?
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concentrically use your use the: Right internal oblique, left external oblique, right erector spinae group (superficial muscles) and left deep group (transversospinalis group), and eccentrically use left internal oblique, right external oblique, left erector spinae group (superficial muscles) and right deep group (transversospinalis group
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Roll moving the pelvis first: When performing leftward rotation in a closed chain (the left side of the pelvis moves forward while the shoulders remain fixed on the bed), gravity produces backward rotation on the pelvis. Which muscles are used?
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Muscles that produce leftward rotation act concentrically. We know this activity occurs largely from the abdominals….however the trunk extensors also assist with rotation….so we use the: left internal oblique, right external oblique, left erector spinae group (superficial muscles) and right deep group (transversospinalis group), and the opposite groups of muscles eccentrically.
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While in a supine position, elevate your left lower extremity by flexing the left hip. If you palpate your anterior trunk muscles (abdominals), you'll note that they become active. Explain this muscle activity
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When you are supine and flex your left hip your pelvis is also brought into an interior pelvic tilt by your hip flexors. You need something that posteriorly tilts the pelvis for stability as a stabilizing synergy. You can use the abdominals to do so, or you can use the OTHER (left) hip extensor – which also produces a poster pelvic tilt
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While lying on the right side, abduct the left hip. You can palpate in the lower trunk muscle activity that is similar to what you observed in the previous problem. Explain this muscle activity
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When performing open chain hip abduction while side lying the hip abductor muscles are also pulling the pelvis caudally. Lateral abdominal muscles (probably mostly internal and external obliques on the abducting hip side) must act as stabilizers isometrically in order to counter the effects of the hip abductors on the pelvis
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How is scoliosis named? (left vs. right scoliosis)
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1) Scoliosis is named for the side of the convexity as well as for the location. For example, left thoracic socoliosis is a right lateral flexion in the thoracic spine.
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side of rib hump for scoliosis
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2) The posterior rib hump that develops from a thoracic scoliosis is always on the side of the rotation. So a left lateral flexion (right scoliosis) prodices a right rotation with a posterior rib hump on the right side of the back.
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"S" shaped curve cause
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3) Many times a curve in one side of the back is compensated for by a curve in another part of the back. This results in an “S” shaped curve
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Triceps activity during forceful pronation/supination
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In addition to pronation and supination, the pronator teres (a radio-ulnar pronator) as well as the biceps (a radio-ulnar supinator) also have lines of pull of application for elbow flexion. The triceps activate in order to prevent elbow movement from occurring
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2 purposes of wrist extensors during a firm grip
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1. Maintain the wrist in extension so that the finger flexors do not flex it
2. Maintain an appropriate length-tension relationship of the long finger flexors by elongating them over the wrist joint so that they can develop more tension in the fingers. |
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The metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints are all slightly flexed when the hand is relaxed.
Why? |
Because the resting lengths of the long finger flexors (the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) are shorter than the resting lengths of the long extensors (extensor digitorum communis, extensor indicis, and extensor digiti minimi).
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Passive wrist extension increases flexion in the MCP, PIP, and DIP. Why?
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Because wrist extension elongates the FDP and FDS. This change in length increases passive force in the FDP and FDS, so they produce finger flexion.
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c. Passive wrist flexion extends (decreases flexion) in the MCP,PIP,and DIP. Why?
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Because wrist flexion shortens the FDP and FDS. This change in length decreases passive force in the FDP and FDS, decreasing their contribution to finger flexion. Wrist flexion also elongates the extensor digitorum. This change in length increases passive force in that muscle, producing finger extension
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Activity in the triceps brachii during forceful gripping
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the extensor carpi radialis works to extend the wrist to maintain a forceful grip. While doing so it causes elbow flexion. The triceps counters this elbow flexion
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Why does the wrist flex during forcefull finger extension?
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The flexor carpi radialis and the flexor carpi ulnaris are active with forceful finger extension to prevent over shortening of the extensor digitorum by elongating this muscle over the wrist joint
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3 ways lumbricales contribute to hand opening
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1. Producing tension into the central tendon (extends the PIP joint) and the lateral bands (extends the DIP joint).
2. produce MP flexion which counters the extensor digitorum’s tendancy to hyperexted the MP joints. 3. create slack into the distal part of the flexor digitorum profundus – making finger extension easier. |
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interossei contribution to forceful hand opening
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by producing tension into the extensor mechanism and adding to MP joint flexion. In addition, the dorsal interossei abduct the fingers – useful in forceful hand opening and dropping dangerous objects from the hand.
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interossei contribution to forceful fist making
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We use the Interosseous muscles in hand closure, even though they can contribute to PIP and DIP extension because once the MP joints are flexed, these muscles have lines of application to assist in MP flexion. In addition, when making a tight fist the palmar interossei aid in holding the fingers together (adduction) for a tighter grip. Without them the grip is weak
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Consider a person whose grasp is so weak that he or she cannot grip a spoon to eat or a pen to write. How might you modify implements like eating utensils or tools to facilitate this person's function
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Building up handles elongate the muscles of the hand, particularly the Flexor Digitorum Profundus and Superficialis. When a muscle is weak, it can develop more force when it is elongated
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To move the thumb without also moving the wrist, the "snuffbox" muscles must act in a synergy with what carpal muscles?
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Extensor carpi ulnaris, flexor carpi ulnaris – however – if wrist flexion or extension is also desired, of course only one of the “pillars of the wrist” can be used.
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In which extrinsic thumb muscle does passive force develop as a result of the wrist extension?
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Flexor Pollicis Longus
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IN which extrinsic finger muscles does passive force develop as a result of the wrist extension?
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Flexor Digitorum Profundus and Superficialis
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What kinds of patients might need to use a passive or tenodesis grip?
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Specifically patients with C6 quadriplegia whose wrist extensors are innervated, but their fingers and thumb are not! In fact, the extensor carpi radialis longus is the ONLY muscle innervated distal to the elbow. However, this strategy can enhance any patient who has a weak grip.
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which wrist muscles are required for tenodesis grip?
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Extensor Carpi Radialis longus - if the patient has innervation to them the extensor carpi radialis brevis and extensor carpi ulnaris can also help!
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thumb extension- primary muscles
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the extensor pollicis longus extends the IP joint of the thumb directly assisted by the abductor pollicis brevis via the extensor mechanism
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