Lecture-Notes-Lectures-Week-1-Week-4-6-Week-9-11 (PS1001) PDF

lOMoARcPSD|3108808
Lecture notes, lectures WEEK 1, week 4-6, week 9-11
Introduction to Physiotherapy (James Cook University)
StuDocu is not sponsored or endorsed by any college or university

Downloaded by Harry Chung (harry47282005@hotmail.com)
lOMoARcPSD|3108808
PS1001: WEEK ONE REVISION NOTES

LEARNING OUTCOMES:
 Students will have an understanding of:
- The physiotherapy profession
- The role of the physiotherapist with regards to health
- Other health professionals
ROLE OF PHYSIOTHERAPIST  Assess- context; impact
 Develop a problem list
 Provide intervention
 Evaluate effectiveness
ANATOMICAL POSITION  Standing
 Facing forwards
 Palms facing forwards
 Arms straightened
 Legs straight
 Feet parallel to one another
 Universally accepted positon.
SUPERIOR (CRANIAL)  Nearer to head

INFERIOR (CAUDAL)  Nearer to feet
ANTERIOR (VENTRAL)  Nearer to the front
POSTERIOR (DORSAL)  Nearer to the back
MEDIAL  Nearer to the median plane
(middle)
LATERAL  Father from the median plane
(middle)
PROXIMAL  Nearer to trunk/ point of origin
DISTAL  Further from trunk/ point of origin
SUPERFICIAL  Nearer to/ on surface
DEEPT  Farther from the surface.
MASSAGE:
Learning objectives:
 Understand the foundations of massage and relevance to the physiotherapy
profession.
 Understand the suggested physiological effects of massage.
 Understand the general indications and contraindications of massage.
 Practical application

lOMoARcPSD|3108808
MASSAGE  The manipulation of the soft

tissues of the body by a trained
therapist as a component of a
holistic therapeutic intervention
(Holey and Cook 2003).
PHYSIOLOGICAL EFFECTS OF  EFFECTS:
MASSAGE - Circulatory system and tissues
- lymphatic system
- muscle
- connective tissue
- pain and sensation
- autonomic effects
CIRCULATORY SYSTEM AND  Vasodilation is caused by the

TISSUE EFFECTS release of histamine and other
chemical mediators (increased
capillary permeability)
 Heat supplied from friction.
 Increased blood flow
EFFECTS ON LYMPHATIC SYSTEM  Causes a flushing affect which

removes chemical irritants and
waste products.
EFFECTS ON MUSCLE  Muscle recovery:
- Promotes lactate removal
following exercise
- reduces muscle spamming
 Effects reflex output through
influencing cutaneous
mechanoreceptors & pressure
receptors.
 Reduces spinal and motor
neurone excitability
 Improves delayed onset pain
following exercise where the
muscle is mostly lengthened.
eccentric exercise
 Increases pliability in the
connective tissue around the
muscle fasciculi.
CONNECTIVE TISSUE EFFECTS  Mechanical force disrupting /
stretching fibrous adhesions
 Promotes remodelling
(organisation) of fibres in a more
organised fashion
AUTONOMIC EFFECTS  Can be positive or negative.
PAIN AND SENSATION EFFECTS  Leads to the removal of pain
mediating chemicals.

lOMoARcPSD|3108808
 Can affect pain threshold and

sensitivity.
PSYCHOLOGICAL EFFECTS  Relaxation
 Reduced anxiety
TYPES OF MASSAGE
 Stroking & Flat Hand Techniques
- Slow stroking – to sedate, decrease muscle tone
- Fast stroking – to stimulate
- Facilitates regression of sensory analgesia
- Usually applied from proximal to distal
 Effleurage
- Relaxation/decreased muscle spasm
- Aids venous and lymphatic flow
- Aids removal of chemical irritants
- Long, slow strokes proximally towards lymph nodes


lOMoARcPSD|3108808
PS1001, WEEK FOUR-

PS1001 WEEK 4, LECTURE ONE: MECHANICAL PROPERTIES OF MUSCLE
Muscle fibre Types:
Type one (slow-twitch): better for posture control and for long distance running use.
- greater oxygen carrying/ metabolising ability
Type 2 (fast twitch muscle fibres): - Have greater anaerobic metabolic bias
- Fibres more suitable for short duration contractions
In humans the proportions of type one and 2 fibres differ from muscle to muscle. Also
changes due to age and lifestyle.
Muscle action
Agonist: the muscle or muscle group that is most directly related to the initiation and
execution of a particular movement
Antagonist: the muscle/ muscle group that is considered to have the opposite action of a
particular agonist. Its movement is inhibited.
Synergist: a pair of muscles are considered synergists when they cooperate during the
execution of a particular movement. A pair of muscles worki g together whe you do ’t
expect them to be to produce a particular movement.
 Length- tension factors:

-Myosin and actin form cross bridges, overlapping their length, resulting in a
shortening of the muscle
-The amount of force that can be developed is proportional to the number of cross
bridges formed.
Force production and stretch
-When muscle is short, there is maximum overlap, no further cross bridging available-
inrange of muscle
-When lengthened beyond resting, decrease contact between actin and myosin- outerange
of muscle
Resting range: muscle works at its best- midrange of muscle
The force produced by the muscle is dependent on the length of muscle
Whole muscle: optimal length is the length at which a skeletal muscle in the body can
produce maximal active/ contractile tension. This tends to be somewhere around the
middle of the range of joint movement.

lOMoARcPSD|3108808
Speed of muscle contraction

-concentric is when muscle is shortening
- Eccentric contraction is when muscle elongates
isometric- moveme t of uscle does ’t cha ge
- Eccentric contraction is stronger than isometric and concentric.
Effect of exercise on muscle
- Resistance training results in an increase in muscle bulk and strength
- related to a growth of muscle cells rather than a significant increase in number of cells as
well as the recruitment of muscle cells.
Low resistance and high repetition training

-Increase in the number of mitochondria in the active muscles improved muscle
endurance
Neural adaptations: increased recruitment in no. of firing motor units as well as increased
firing rate and synchronisation of firing leading to muscle working more efficiently and
effectively
Effect of disuse on muscle

- results in a decrease in strength (30-60% loss of strength with 5-52 weeks in bed)
- decrease cross-section area of muscle (muscle atrophy or wastage)
Due to either: - a decrease in muscle fibre numbers
- a loss of myofibrils
Type one slow twitch
- fatigue resistance
- develop less strength
Type 2 fast twitch

- contract more rapidly and forcefully but
- fatigue quickly
Type one slow twitch muscle fibres atrophy more quickly than type 2.
Effect of immobilisation on muscle length

Immobilised in shortened position
- leads to adaptive muscle shortening
- A decrease in the number of sarcomeres in series- sarcomeres lost from each end of
muscle.
- The remaining sarcomeres will lengthen slightly and as a result the muscle will become
weaker.
- decreased extensibility of connective tissue present in muscle

lOMoARcPSD|3108808
Immobilised in lengthened position

- muscles immobilised in lengthened position will gain sarcomeres and an increase in length
and extensibility.
Immobilisation of joint
- increased stiffness in most connective tissues surrounding joint
- causes reduced range of motion and increased stiffness (resistance to movement through
range)
- some ligaments become less still which results in increased joint laxity (decreased support)
Effect of injury on muscle
- rapid muscle atrophy due to cellular response to pain, inflammation and immobility
- persistent pain alone will cause muscle weakness due to decreased neural output
- Joint effusion, however small, also lead to reflex inhibition of surrounding muscles.
BASIC BIOMECHANICAL PRINCIPLES

LEARNING OUTCOMES:
 Review basic biomechanical terminology
 Review the basic math, force and moment definitions and levers required for
basic biomechanical concepts
 Review rotary & stabilising/ dislocating components of muscle movement
 Describe the difference between 2 &3 dimensional planes of motion (degrees
of freedom).
TERM DEFINITION/ EXPLANATION

LEVERS  Rigid body or rod with two externally applied forces (generally
on by a muscle and one by contract with the environment or
gravity) and a point of rotation (the joint).
 First, second and third class levers
 Forces on either same side or different sides of the centre of
rotation (COR).

lOMoARcPSD|3108808
LEVERS: FIRST  Forces are on different sides of the COR

CLASS LEVERS
 E.g. the head sitting on top of the cervical spine.

Spine is the fulcrum (COR), weight of head is the load
(tipping head forwards) and the force is the muscle holding the
head in place to prevent it from tipping further.
LEVERS: SECOND  The forces are on the same side of the COR
CLASS LEVERS  E.g. a wheelbarrow with the COR being the wheel itself, load is
the contents inside the barrel and the force is lifting of the
handles upwards.
The longer the force arm, the less strength required to move a lever.
LEVERS: THIRD  Forces are on the same side of the COR where the force is
CLASS LEVERS closer to the COR and the load is further away.
 E.g. and elbow joint: resistance of load is the weight of the
forearm and hand, force is produced by muscles required to lift
the forearm which are closer to the COR (elbow joint).
 The longer the lever, the greater velocity.
MECHANICAL  MA = EFFORT ARM/ LOAD ARM

ADVANTAGE  EFFORT ARM: resistance arm, gives mechanical advantage of
all levers.

lOMoARcPSD|3108808
FACTORS THAT  Strength= force of a muscle

INFLUENCE A  Force produces a moment/ torque (tendency to rotate.
MUSCLES  M = F x d (Moment = Force x moment arm).
STRENGTH  Primary factors: muscle size, muscle moment arm, stretch of
muscle, contraction velocity, fibre types, level of muscle fibre
recruitment.
 Force must be applied away from fulcrum (COR)
 Effectiveness of force depends on strength and how far the
forces are applied from the COR.
ANATOMICAL  Muscles apply force via their tendons to rigid rods (bone) that
LEVERS move around fixed points called fulcrums (joint centres).
 Resistance is based on the weight of the segment (plus an
object).
MOMENT ARM  Perpendicular distance from an axis to the line of action of a

force.
A MUSCLE WITH A LONG MOMENT ARM MUST SHORTEN MORE

TO PRODUCE THE SAME ANGULAR DISPLACEMENT (ROM) AS A
MUSCLE WITH A SHORT MOMENT ARM.
SHORTER MUSCLE: MUCH GREATER ROM

lOMoARcPSD|3108808
TORQUE  Creates the movement of the lever system (bones).

 The greater the torque a muscle can produce, the greater the
movement it will produce on the body’s levers.
 It is a force applied over a distance (lever arm) that causes
rotation about a fulcrum/ axis of rotation.
Fg: gravitation force

Fy: Torque (rotary force)
Fx: compression force
TORQUE:  Patella increases the amount of torque the quadriceps can

QUADRICEPS create due to the increased angle of insertion and moment arm.
 Torque is the driving force for human movement and is greatest
when applied at 90 degrees angle to its lever.

lOMoARcPSD|3108808
ROTARY &
STABILISING
COMPONENTS
DURING ELBOW
FLEXION
PLANES
DEGREES OF  3 MAIN CATEGORIES:

FREEDOM - Uniaxial Joints: movement in one plane around one axis
 Hinge or Pivot joint
- Biaxial: movement in two planes around two axis
 Condyloid or saddle joint
- Multiaxial: movement in three planes around three axis.
 ball and socket joints
JOINT MOTION  Accessory movements are integral to physiological movements
 Translatory movements: Roll, spin and glide.
 SPIN: pure rotation about a fixed axis
 Roll: rotation about a moving axis (rotation + translation)

lOMoARcPSD|3108808
 SLIDE/ GLIDE: pure translocation of the articulating surface

(no rotation).
 The direction of roll is OPPOSITE the direction of Glide.
 The direction of Roll is in the SAME direction as the movement
of the distal end of the limb.
 Therefore, the direction of glide is the OPPOSITE to the
movement of the distal end of the limb.
 REALISTICALLY: MOVEMENTS OF THE HUMAN BODY AND
JOINTS RESULTS IN BITS OF EVERYTHING.
INSTANTANEOUS  Joints may either:
CENTRE OF  Exhibit pure rotation: movement about a fixed axis.
ROTATION (ICR)  Exhibit rotation while simultaneously gliding (rotate about
an axis that moves in space).
 Is a theoretical axis of rotation for a given joint position
 Joints that exhibit pure rotation (Constant ICR, e.g. elbow joint).
 Joints that exhibit rotation while simultaneously gliding (Multiple
ICRs).
 Need to consider the ICR in order to correctly position a
goniometer.
CONGRUENT  Similar surfaces
 Ball and socket joints
INCONGRUENT  Dissimilar surfaces
 E.g. the knee

lOMoARcPSD|3108808
PS1001 WEEK FIVE REVISION

LEARNING OBJECTIVES: SUBJECTIVE ASSESSMENT
 Be able to state the components of a subjective assessment and how to gain
information.
 Understand the purpose and relevance of information obtained in a subjective
examination.
SUBJECTIVE EXAMINATION PURPOSE:
 Gain information from the patient (and others
if appropriate) on the condition ad possible
structures involved.
 Identify goals/ expectations of patient
 Build trust/ rapport with patient
 Establish contraindication/ precautions to
objective examination or treatment.
 Identify red flags (serious pathology)
 Identify yellow flags (psychosocial risk
factors).
 SUBJECTIVE EXAMINATION WILL:
- Assist in the development of a plan for
objective examination
- Assist in formation of: Provisional diagnosis,
differential diagnosis and prognosis.
EXAMINED:
 Biographical
- Name
- Age
- Birth date
- Address
- Occupation
- Phone number
 History of present condition
- Cause/ factors
- mechanism of injury
- Onset
- Duration
- Investigations (A&E, GP, X-ray)
- Any interventions- results
- Behaviour of problem since onset.
 Body chart
- Pain sites  including pins & needles,
numbness
- Severity- VAS
- Irritability
- Aggravate/ ease- be specific Visual analogue
scale (VAS) No paint worst pain

lOMoARcPSD|3108808
OR Scale of 1-10, how bad?

- 24 hour pattern- general and specific
- Sleep: position
 Special questions
- T.H.R.E.A.D.S & C.O.D.F.I.S.H & R
- CERVICAL SPINE: 5 D’s
- LUMBAR SPINE: Difficulty controlling
bladder? Incontinence?
Saddle anaesthesia loss of feeling to
buttocks and thigh area?
- ALL SPINE: bilateral parenthesis?
 Past medical history
-General health
- Operations
- Fractures
- Illnesses
- Same area/ problem
- Previous relevant investigations
- Relevant family history
 Drug history
- For current problems
- Others
 Social history
- Accommodation
- Employment
- Home situation
- Activities of daily living
- Assistance/ support available

lOMoARcPSD|3108808
RED FLAGS  Serious pathology or for any health state that

would constitute a precaution or
contraindication to any examination or
treatment strategy.
YELLOW FLAGS  Attitudes and beliefs about presenting

problem: especially back pain
 Behaviours
 Compensation issues
 Diagnostic and treatment issues
 Emotions
 Family
 Work
CLINICAL REASONING  Using clinical reasoning you can:
- Develop a plan for objective examination
- Formulate a provisional diagnosis
- Develop a problem list and management
plan.
LEARNING OBJECTIVES: OBJECTIVE ASSESSMENT

 Be able to state the components for objective assessment of ROM and muscle strength
 Have knowledge of clinical tools used to measure joint ROM (goniometers,
inclinometers, tape measures).
 Understand the purpose and relevance for the findings of ROM and muscle strength
testing.
READINGS:
- Clarkson, H. (2009) Musculoskeletal Assessment: Joint Range of motion and manual
muscle strength. Chapter one.
OBJECTIVE ASSESSMENNT  Observation
- Posture
- Contours
- Gait
- Walking aids
- Splints/ POP/ dressings etc.
- Deformities
- Muscle atrophy/ hypertrophy
- Facial expressions
 Functional activities
- Gait
- Sit- stand- sit
- Standing
- Sitting
- Dressing/ undressing

lOMoARcPSD|3108808

Inspection
- Skin: colour, bruising, sutures, scars,
sweating, quality
- Muscle tone: atrophy, hypertrophy
- Oedema
- Deformities
 Palpation
- Heat
- Oedema
 Eliminate other joints
- Check active range of movement
(AROM)
 Movements
- Active Range of movement (AROM) 
ROM pain
- Passive range of movement (PROM)
ROM, end feel, pain.
- Accessory movements: Pain, end- feel.
 Muscle strength
- Isometric muscle testing
- Manual muscle testing
 Joint integrity
- Ligaments
- Muscles
 Special tests
 Neurological tests if indicated.
- sensory testing
- proprioception and joint movement
PRINCIPLES OF ROM AND  Visual observation
MUSCLE STRENGTH TESTING  Palpation
 Therapist posture
 Movement description- AROM or PROM
 Anatomical knowledge of joints & their
classifications
 Knowledge of movement planes and axes
 Knowledge of movement terminology
 Muscle testing terminology: type of
contraction, torque, strength,
classification.
AROM & PROM SAFETY DO NOT DO IF:
 It is in a region of dislocation or unhealed
fracture
 If movement is likely to disrupt healing
 If Myositis ossificans or ectopic
ossification is suspected or present.
BE CAUTIOUS OF:
 Inflammatory of infectious processes
 Bone fragility or newly united fractures

lOMoARcPSD|3108808

In the presence of hypermobility or
subluxation
 Patients who are taking pain or muscle
relaxants
 Conditions where assessment may
aggravate
 Haemophilia + Haematoma
 Bony ankyloses
 Initial stages of acute injury with soft
tissue disruption
 Prolonged period of immobilisation.
ACTIVE MOVEMENT TESTS DETERMINES
 Ability and willingness of the patient to
move
 Active range of movement available at the
joint
 Quality of movement
 Movements that cause pain or are stiff
 Ability of patient to follow instructions
 Levels of pain
 Where symptoms may originate from
 End feel of the joint (when overpressure is
applied)
 type of structure causing joint
restriction.
TO EXAMINE AROM:
 The part being examined must be exposed
 Starting position of the patient (stable,
reproducible, allow full ROM)
 Patient symptoms prior to
commencement?
 Instructions: Clear and concise
 Painful movements done last
 Initially patient to perform without manual
or verbal correction.
OBSERVE:
- Compare unaffected to affected side first
- Quality
- Range
- Pattern or trick movement: effects of altering/
correcting?
- observe patient from front, back and side
- Observe the return to the neutral position
SYMPTOMS DURING OR AFTER?
PERFROM GONIOMETRY AFTER ALL

PREVIOUS OBSERVATIONS AND
QUESTIONS.

lOMoARcPSD|3108808
OVERPRESSURE Passive force applied at the end of

available AROM.
 Determines End feel of joint
 Assesses if the application of a force at the
end of range reproduces the patients
problem (Ask patient what they feel and
where).
 Not routinely undertaken if AROM is
painful
 Not used in cases of irritable joint.
PASSIVE MOVEMENT TESTS  Joint movements completed by the
physiotherapist while the patient relaxes
 Passive movement tests are used to
determine:
- Comparison with AROM
- Comparison with PROM on unaffected
side
- Quality of the joint movement
- End Feel- Type of resistance at end of
range
- What the patient feels
TO EXAMINE PASSIVE MOVEMENT:
- Same as AROM but with the following:
- Monitor the patients symptoms throughout the
movement
- The patient must be RELAXED
- Therapist position muscle be stable.
END FEEL  The feeling transmitted to the therapists
hands when overpressure is applied at end
of AROM or PROM
 3 NORMAL TYPES:
- Bone to bone: hard
- Soft tissue approximation: Soft/ mushy
feeling.
- Tissue Stretch: firm/ springy
- Elastic is softer
- Capsular is harder
 5 ABNORMAL TYPES:
- Muscle spasm (early or late): jerky,
sudden, hard and pain.
- Capsular: Like tissue stretch but thinker
at end of ROM
- Bone to bone: hard resistance prior to
normal end ROM
- Springy: like tissue stretch with rebound
effect at end of ROM.

lOMoARcPSD|3108808
RECORDING AROM/ PROM &  Visual estimate

OVERPRESSURE  Manual measure (goniometer,
inclinometer)
 Pain:
- P1: point in range where
pain first occurs
- P2: The point in range of
maximum intensity of
pain.
 DURING OVERPRESSURE:
- R1: Point when resistance is first felt by
therapist
- R2: point at which maximum resistance
is felt by therapist

FINDING MEANING OF AROM, 
AROM < PROM: muscle weakness/
PROM problem
 AROM > PROM: yellow flags
 AROM = PROM: end feel to indicate
structure likely causing restricting
 Limited PROM: ligament or capsule
problem.
ISOMETRIC STRENGTH  Muscle contraction against resistance
TESTIN when the muscle length stays the same.
 Primarily indicates if musculotendinous
structures are a t fault.
 Tests a group of muscles
 Is a quick assessment of strength
 NO movement should occur at the joint of
non-contractile tissue will be implicated.
PROCEDURE:
 Test unaffected side first
 Mid position of joint range
 Patient supported + area exposed
 Therapist in a stable position
 Use longest lever for resistance and apply
smoothly & constantly
 Explain: meet me don’t beat me, don’t let
me move you
 Resistance applied muscle stop the
movement
 Assess effect on pain
 Assess alternative ranges depending on
findings
 Record P1 area of pain and point in
range tested.

lOMoARcPSD|3108808
FINDINGS MEANING:
 STRONG AND PAINFREE: no muscle,
tendon or nerve supply lesions.
 STRONG AND PAINFUL: lesion of
tendon or muscle
 WEAK AND PAIN FREE: rupture of
tendon/ muscle, nerve lesion
 WEAK AND PAINFUL: pain inhibition,
sever injury.
MANUAL MUSCLE TESTING  Assesses strength of a specific muscle:
- specific for each muscle, not joint
movement.
 HELPS PROVIDE:
- Differential diagnosis
- Prognosis
- Provides a baseline/ outcome measure
- Assists progress and treatment
monitoring.
 PROCEDURE:
- Optimal Test position:
- Supine, side lying, prone, sitting
- Test unaffected then affected side.
- Test gravity eliminated or against
position first
- Resistance: applied at 90 to the limb,
gradually and smoothly. Less than
isometric.
 GRADING SYSTEM METHOD:

- 0= No contraction palpated
- 1= trace- flicker/ no joint movement
- 2= gravity eliminated position Full
AROM achieved
- 3= Full AROM against gravity
- 4= Full AROM with moderate force
against gravity
- 5= Full AROM against gravity with
maximal force (equal to unaffected side).
 Command: Push against my resistance for
Grade 4 &5.
 Monitor patient before, during and after
the test.
 Record Grade.

lOMoARcPSD|3108808
WEEK SIX REVISION NOTES

LEARNING OBJECTIVES
 Describe & explain the variations in spinal vertebrae
 Understand the normal curves of the spine
 Explain the structure & function of the IV disc
 Understand the basic components of the Spine:
Bones and articulations
– regional

SPINE  72-75cm in length
 ¼ of height accounted for by intervertebral discs.
 Protects the spinal cord and nerve roots
 Serve as attachment site for muscles of the pectoral and pelvic girdles
 Allows movement of the torso, head and neck
 Transmits movements across the upper and lower limbs
 Provides attachment for the muscles that move the vertebral column and
maintain balance and erect posture.
 Carries and supports the thoracic cage
 Supports body weight
 Provides shock absorption via its curvatures and intervertebral discs
 Stores bone marrow.
 33 vertebrae
 7 cervical
 12 thoracic
 5 lumbar
 5 sacral (fused)
 4 coccygeal (fused)
CURVATURES
 Cervical lordosis: out
 Thoracic kyphosis: in
 Lumbar lordosis: out
 Sacro-coccygeal kyphosis: in
 Slight scoliosis due to arm dominance.

lOMoARcPSD|3108808
COMPONENTS OF A TYPICAL VERTEBRA
- costal facet, foramen transversarium)

lOMoARcPSD|3108808

lOMoARcPSD|3108808

lOMoARcPSD|3108808

SPINAL MOVEMENTS  Movements between vertebral joints- facet joints and
symphysis are interrelated there, both move.
 Range will be different at different levels
 At any one level small range of movement- composition of
all movements lead to gross movement
 Gliding at facet joints
 Joints of vertebral bodies- traction/ compression/ rotation.
 Affected by disc height and direction of facet joints
 Thoracic region- ribs- all movements limited except
rotation.

lOMoARcPSD|3108808
TERM DEFINTION/ EXPLANATION

FUNCTIONS OF 1. Act as fulcrum for intervertebral movement
INTERVERTEBRAL 2. Distributes mechanical stresses equally
DISC 3. Acts as a shock absorber
4. Plays a major role in the fluid and nutrition exchange
between the disc and the vertebra.
FUNCTIONS OF THE 1. Plays a major role in vertebral stability
ANNULUS 2. Allows normal movement between vertebrae as the
spinal arrangement of its elastic fibres are altered in
the direction
3. Acts as a check ligament
4. Acts as an envelope to retain the nucleus
5. Acts as a shock absorber.
FUNCTIONS OF THE 1. Protects vertebral bodies
CARTILAGE END 2. Allows fluid exchange between the discs and vertebral
PLATES blood vessels
3. Serves as growth plate for vertebra

lOMoARcPSD|3108808
SPINAL FLEXION  Frequently over estimated: masked by movement of

head on neck and hips and pelvis.
 Anterior part of disc compressed, posterior part of
disc tractioned.
 Inferior facet glide upwards on superior facet on
vertebra below.
 Limited by: posterior longitudinal ligament,
ligamentum flavum, and supraspinous and
interspinous.
 In cervical region flexion is free movement due to the
direction of the facets, deep discs.
 Thoracic flexion limited because have narrow discs
and facets follow vertical arrangement.
 Lumbar Flexion: free movement, deep discs, facet
direction doesn’t inhibit movement.
SPINAL EXTENSION  Posterior part of disc is compressed, anterior part
tractioned
 Inferior facet of vertebra above glides downwards on
superior facet of vertebra below.
 Limitation: anterior longitudinal ligament.
 Large range of movement in cervical region.
 Thoracic spine: very slight: used in mechanics of
respiration to increase thoracic diameter.
 Lumbar extension very free, very large range.
SPINAL LATERAL  Compression of side to which bending other side will
FLEXION be tractioned.
 On flexing side: inferior facet of vertebra above glides
down on superior facet of vertebra below.
OPPOSITE MOVEMENT ON OTHER SIDE
 When side flex automatically have a degree of
rotation in the joints due to arrangement of discs and
facets.
 Cervical movement: quite free but facets not in ideal
position
 Thoracic movement: limited due to ribs, facets and
discs.
 Lumbar movement: most movement, occurs higher
up.
SPINAL ROTATION  Tortion of disc, lamellae move on one another to give

rotation of disc- half set of fibres taut some fibres
relaxed due to oblique nature.
 Gliding movement at facets- sideways.
 Cervical spine: at atlantoaxial joint mostly.
 Thoracic spine: movement relatively free- facets in
ideal position for rotation.
 Lumbar spine: limited tends to occur in upper lumbar.

lOMoARcPSD|3108808
PS1001 WEEK NINE REVISION

LECTURE TWO: THE ELBOW COMPLEX
LEARNING OBJECTIVES:
 Understand and describe the functions and structure of the elbow
complex in terms of movement and stability.
 Understand and describe normal range of movement at the elbow.
 Understand the structure, function and relationship of muscles and
ligaments for the elbow complex.
ELBOW JOINT
 Shortens and lengthens upper limb.
 Uniaxial: flexion and extension, sagittal axis, frontal plane.
 Complex joint: 3 separate articulations which share a common synovial
cavity.
 FLEXION AND EXTENSION is achieved by the joints between the
trochlear notch of the ulna and the trochlea of the humerus AND between
the head of the radius and the capitulum of the humerus.
 PRONATION AND SUPINATION OF THE FOREARM involves the
joint between the head of the radius and the radial notch of the ulna
(proximal radio-ulna joint).
 Articular surfaces of the bones are covered with hyaline cartilage.
 Synovial hinge joint

lOMoARcPSD|3108808
ELBOW JOINT CONT.

 Synovial membrane of the elbow joint
originates
from the edges of the articular cartilage
and lines
the radial fossa, the coronoid fossa, the
olecranon
fossa, the deep surface of the joint
capsule, and the
medial surface of the trochlea.
 Synovial membrane is separated from
the fibrous
membrane of the joint capsule by pads
of fat in regions
overlying the coronoid fossa, olecranon fossa and the radial fossa.
 Fat pads accommodate the related bony processes during flexion
and extension.
 ATTACHMENTS: brachialis and triceps brachii muscles attach to the
joint capsule overlying these regions. The muscles pull the attached fat
pads out of the way when the adjacent bony processes are move into
depression, hollow parts.
 Fibrous membrane of the joint capsule overlies the synovial membrane,
it encloses the joint.
 IS THICKENED MEDIALLY AND LATERALLY TO FORM
COLLATERAL LIGAMENTS which support flexion and extension
movements.
 External surface of the joint capsule is reinforced laterally where is
‘cuffs the head of the radius’ with a strong annular ligament of the
radius allows the radial head to slide against the radial notch of the
ulna and pivot on the capitulum during pronation and supination.

lOMoARcPSD|3108808
THE ELBOW REGION

 Comprised of the lower end of the humerus and he upper ends of the
radius and ulna.
 LOWER END OF HUMERUS:
- composed of a medial and lateral condyle (rounded prominence at
the end of the
bone).
- Has 2 articular surfaces: the trochlea and the capitulum (Are two
fossae: coronoid medially and the radial laterally).
- Posteriorly: larger depression- the olecranon fossa.
- Lateral condyle: lateral prominence (LATERAL EPICONDYLE
WHICH LIES AT THE END OF THE LATERAL
SUPRACONDYLE RIDGE).
 RADIUS UPPER END:

- Composed of a head (articular on upper surface and medial third of
rim)
- Neck: cylindrical, joins head to upper end of shaft,
Bicipital tuberosity on base of neck projects from its medial
side.

lOMoARcPSD|3108808
ELBOW AND FOREARM MOVEMENTS
DISTAL END OF HUMERUS & PROXIMAL END OF ULNA

 Distal end of humorous articulating with ulna
 Head of radius comes into contact with the capitulum during flexion
movements only.

lOMoARcPSD|3108808
RADIOGRAPHS OF DEVELOPMENT OF ELBOW COMPLEX
ELBOW COMPLEX ARTICULATIONS

Humerus with radius and ulna:
 Trochlea & trochlea notch of ulna
 Capitulum and head of radius
 Synovial hinge joint
 Two planes of movement
PROXIMAL END OF RADIUS

 Quite round: allows it to spin within a ligament (to hold into contact with
ulna).

lOMoARcPSD|3108808
DISTAL RADIO ULNA JOINT

 Head of ulna on the opposite end of the radius.
 Articulates with distal end.
 Fibres allow rotation between two bones.
 Fate pads: protect tendons running along anterior aspect of joint.
 Each Fossae (coronoid, olecranon & radial) has fat pads.

lOMoARcPSD|3108808
JOINT CAPSULE AND LIGAMENTS

 Joint capsule encloses whole of joint
 Angular ligament reinforces capsule
 Thick in middle: attachment of the Brachioradialis (pulls capsule and
associated fat pad out in flexion).
 Thin posteriorly: attachment of some triceps fibres pulls capsule and
associated fat pad out during extension
LIGAMENTS OF THE ELBOW COMPLEX

 Ulna Collateral Ligament (UCL): 3 parts= anterior, posterior &
intermediate.
 Anterior and posterior portions are thick
 Intermediate forms transverse bands between anterior and posterior
portions.
 Forms triangular shape

lOMoARcPSD|3108808
RADIAL COLLATERAL LIGAMENT (RCL)

- Triangular blends with annular ligament
ANNULAR LIGAMENT:
- Flexible, circles head of radius to allow
radial head to rotate
- Upper part fibrocartilage: lower part synovial
membrane.
- forms 4/5 of joint surface.
Prevents downwards movement of radius.
QUADRATE LIGAMENT
- Assists support
- Criss-cross pattern: always some
fibres in tension
(mostly in pronation and supination).
- Square shape
LATERAL STRESS AT THE ELBOW

 Major Stabiliser: bony shape of the trochlea resists lateral forces
 Collateral ligaments

lOMoARcPSD|3108808
BICEPS BRACHII
 ORIGIN: long head- Supraglenoid tubercle
Short head- Apex of coracoid process
 INSERTION: Long Head- Radial Tuberosity
Short Head- Bicipital Aponeurosis
(merges into the deep fascia of the
forearm, providing an indirect
attachment to the
subcutaneous border of the ulna).
 MOVEMENTS: - Powerful elbow flexor.
- Long head assists with Glenohumeral flexion.
BRACHIALIS
ORIGIN: Lower half of the anterior surface of humerus, medial
and lateral surface &
adjacent intermuscular septa.
INSERTION: Tuberosity of the ulna
MOVEMENT: Powerful flexor of the elbow
BRACHIORADIALIS
ORIGIN: Proximal part of the supracondylar ridge of the
humerus and adjacent intermuscular septum.
INSERTION: Lateral surface of distal end of radius,
radial styloid process.
MOVEMENT: Accessory elbow flexor, will return
forearm to mid position from extreme supination or pronation.

lOMoARcPSD|3108808
TRICEPS BRACHII (posterior aspect of arm)

ORIGIN:
1. Long head: Infra-glenoid tubercle
2. Lateral head: posterior surface of upper 1/3 humerus
3. Medial head: posterior surface of lower 1/3 humerus
INSERTION: Olecranon Process
MOVEMENT: Extension of elbow
Long head also adducts and extend GH
joint.
ANCONEUS
ORIGIN: posterior surface of lateral Epicondyle of humerus.
INSERTION: Lateral surface of olecranon and proximal
lateral surface of ulna.
MOVEMENT: Abduction of the ulna in pronation, accessory
extensor for elbow extension.
ELBOW EXTENSION
 The moment of triceps is
improved by the
olecranon: anatomical
pulley.
 Increased internal moment
arm of triceps brachii
changes with altered
ROM:
- When extended (0 degrees) the distance from the axis of rotation and
the perpendicular intersection with the line of force of the triceps brachii
(Increased MA).
 The longer the movement arm: the more force required.

lOMoARcPSD|3108808
MUSCLES OF THE RADIO- ULNAR JOINTS

PRONATORS
Pronator Teres:
ORIGIN: Medial epicondyle of the humerus (humeral head)
and the olecranon and posterior border of ulna (ulnar head).
INSERTION: Roughening on lateral surface of midshaft of radius.
Pronator Quadratus:
ORIGIN: Linear ridge on distal anterior surface of ulna
INSERTION: Anterior surface of distal ¼ of radius.
BRACHIORADIALIS
ORIGIN: Proximal part of supracondylar ridge of humerus
and adjacent intermuscular septum.
INSERTION: Radial styloid process.
MOVEMENT: Assists elbow flexors, with forearm in
midposition of pronation and supination; returns arm to mid
prone position from extreme supination or pronation.

lOMoARcPSD|3108808
ELBOW COMPLEX STABILITY

 ELBOW (due to bone surfaces): trochlear ridge fits snugly with trochlear
groove helped by ligaments and muscles.
 Greatest stability at 90 degrees flexion, in mid pronation/ supination
 When elbow is extended, the head of the radius is not in contact with the
capitulum.
 Superior RU joint (small articular contact): more mobile to allow
increased hand movement.
MULTI-JOINT MUSCLES AND STABILITY

 Wrist and finger extensors attach to lateral epicondyle of humerus:
- Assist in stabilising joint against tension forces and lateral forces.
 Wrist and finger flexors attach to medial epicondyle of humerus
- Assist in stabilising the joint against tension forces and medial forces.

lOMoARcPSD|3108808
TERMINOLOGY: VALGUS vs. VARUS

 Valgus: lateral deviation of a distal segment compared
to the segment proximal to it.
 Varus: medial deviation of a limb segment compared
to the proximal segment.

lOMoARcPSD|3108808
HUMEROULNAR ALIGNMENT- CARRYING ANGLE:

 The lateral orientation of the ulna with respect to the humerus
 10-15 degrees for males
 20-25 degrees for females.
FORCE TRANSFER THROUGH INTEROSEOUS MEMBRANE

 Between radius and ulna
 If weight load onto upper extremity.
 Fibre direction transfers forces placed directly onto distal
radius through the ulna (sharing force load and reducing
stress at the humeroradial joint).
 Weight bearing load is transmitted from the hand to
radius radius to ulna (via the interosseous membrane).
Tensile force transfer through interosseous membrane

If we hold a heavy load (such as a suitcase), it causes a distracting Force.
Most force is to the radius which causes the interosseous
membrane to slacken, resulting in a need for other structures
to support the load
 Brachioradialis
 Annular ligament, and oblique cord

lOMoARcPSD|3108808
PS1001, WEEK 1O
LECTURE ONE: THE WRIST COMPLEX
LEARNING OBJECTIVES:
 Understand and describe the function of the wrist
 Understand the articulations, ligaments and muscles
 Understand and describe the functions of the muscles
 Understand the accessory movements of the wrist
 Understand the carpal tunnel- instability
DISTAL RADIO-ULNAR JOINT

 Articulation between the head of the ulna and
ulnar notch of the radius.
 Articular disc: triangular, fibrocartilaginous,
unites radius and ulna.
Disc: makes joint more congruent and
enables movement
 Loose weak fibrous capsule
because of the movement of the
radius around the ulnar
 Movements: rotation of the lower end of
radius around the head of the ulna
(pronation and supination).
 Interosseous membranes help hold
bones together and assist with rotation,
limit extreme movements

lOMoARcPSD|3108808
THE CARPALS, METACARPALS AND PHALANGES

 8 small bones form the carpals of the wrist.

THE WRIST JOINT  NOT a single joint:
- Radiocarpal Joint (forearm and carpus
- Intercarpal Joints (Carpal bones).
PROXIMAL ROW:
 Scaphoid:
- Articulates: with the radius, trapezius and capitate.
- Common site of fracture
- Marks the inferolateral corner of the carpal tunnel.
 Lunate:
- Articulates with the radius and articular disc proximally
and with the capitate and triquetral distally.
 Triquetral:
- articulates with lunate
- Sits between lunate and hamate
 Pisiform:
- Rests on top of the triquetral
- In ulnar deviation: enters the radial carpal joint
- Is a sesamoid bone, doesn’t fully articulate with any
other bone
- Forms the inferior medial corner of the carpal tunnel.
DISTAL ROW:
 Trapezium:
- Next to the thumb
- Irregular bone
- Articulates with the scaphoid and trapezoid but main
articulation is with the first metacarpal (forming a saddle

lOMoARcPSD|3108808
joint)
- Marks the superolateral joint of the carpal tunnel.
 Trapezoid:
- Small and irregular
- Articulates with the scaphoid, trapezium and capitate as
well as the second metacarpal.
 Capitate:
- Articulates with the trapezoid
- Is the largest of the carpal bones
- Central bone
- Articulates with scaphoid and lunate cavities and with
the 3rd metacarpal as well as a small amount of the second
and third metacarpal.
- Is often palpable during flexion.
 Hook of Hamate:
- Large palpable bone
- Superomedial corner
- Distal base articulates with the fourth and fifth
metacarpal..

lOMoARcPSD|3108808
FLEXOR RETINACULUM
 Attaches on four bony points: tubercle of the scaphoid, ridge of trapezius, pisiform
and hook of hamate. Rectangular shaped
 Holds flexor tendons in shape,
 Medial nerve passes under
 Very compressed space, if inflamed at all can affect median nerve which leads to
numbness of tingling.
CARPAL INSTABILITY
 Loss of function due to alteration of normal
anatomical alignment and biomechanics.
 TWO COMMON TYPES:
1. Rotational collapse: zig-zag deformity
2. Translocation of carpus: subluxed, move
out of alignment
 If compressive forces, either the palmer,
radial collateral or dorsal ligaments can tear.
 Limits ROM

lOMoARcPSD|3108808

JOINTS OF THE WRIST: Located just proximally to the wrist joint. It is an
DISTAL RADIO ULNAR articulation between the ulnar notch of the radius, and
the ulnar head.
In addition to anterior and posterior ligaments

strengthening the joint, there is also a fibrocartilaginous
ligament present, called the articular disk. It serves
two functions:
 Binds the radius and ulna together, and holds

them together during movement at the joint.
 Separates the distal radioulnar joint from the
wrist joint.
Like the proximal radioulnar joint, this is a pivot joint,

allowing for pronation and supination. The ulnar notch
of the radius slides anteriorly over the head of the ulnar
during such movements.
Pronation: Produced by the pronator quadratus and

pronator teres
Supination: Produced by the supinator and biceps

brachii
JOINTS OF THE WRIST:  Joint between the radius and proximal row
RADIO-CARPAL carpus
 Synovial
 ARTICULAR DISC:
- Stabilises distal radio Ulna joint
- Cushions between ulna and carpus
- Allows axial loading of ulna aspect of forearm
- Articular surface of carpus
- Stabilises ulna side of carpus
 Movement on two axis, flexion/ extension and
ulnar/ radial deviation.
 Articulation with the distal end of the radius and

the articular disc (on the distal end of the ulnar)
and the scaphoid, lunate and triquetral.
JOINTS OF THE WRIST:  The midcarpal joint is formed by the eight

MID CARPAL carpal bones that make up the carpus.
 From lateral to medial, the proximal row of
carpal bones is made up of the scaphoid, lunate,
triquetrum and pisiform bones.

lOMoARcPSD|3108808
 The distal row is made up of the trapezium,

trapezoid, capitate and hamate bones (from
lateral to medial).
 The midcarpal joint is the articulation between
the proximal row of carpal bones and the distal
row of carpal bones.
 At the lateral portion of the joint, the scaphoid
articulates with the trapezium and trapezoid.
Centrally, the scaphoid and lunate articulate
with the capitate with the lunate also articulating
with the hamate. The hamate also articulates
with the triquetrum of the proximal row.
 Series of synovial gliding joints between the
proximal and distal rows of carpal bones
 Lined with hyaline cartilage and the joint cavity
is encompassed in a fibrous capsule lined with
synovial membrane.
 It also extends out to the distal surfaces of the
distal row of carpal bones to the proximal
surfaces of the proximal bones, but it does not
blend with the wrist joint cavity due to the
intercarpal or interosseous ligaments
 LIGAMENTS:
Intercarpal ligaments - link some adjacent
carpals
•Palmar intercarpal ligament – anteriorly,

extends from the proximal row of the carpal
bones to mainly the head of the capitate
(sometimes known as the radiate capitate
ligament or palmar ligament)
•Dorsal intercarpal ligament – posteriorly,

projects from the proximal to distal row of
carpal bones
•Radial collateral ligament - a strong ligament

that is a continuation of the radial collateral
carpal ligament from the wrist joint that extends
from the scaphoid bone to the trapezium
•Ulnar collateral ligament – Like the radial

collateral ligament, the ulnar collateral ligament
is an extension. It is a prolongation of the ulnar
collateral carpal ligament and it connects the
hamate bone to the triquetrum

lOMoARcPSD|3108808
WRIST JOINT CAPSULE  ORIGIN:

-Anterior & Posterior: distal edges of the radial
and ulnar
- Medial & lateral: radial and styloid processes.
 INSERTION:
- Anterior & Posterior: anterior and posterior
margins of the articular surfaces of the proximal
row of carpal bones.
- Medial: medial side of the triquetral
- Lateral: lateral side of the scaphoid.
 Anterior and posterior sections are thickened
and blend with the collateral ligaments to
strengthen.
 Capsule reinforced by ligaments.
DORSAL RADIOCARPAL  ORIGIN: posterior edge of the lower end of the

LIGAMENT radius
 INSERTION: posterior surface of the scaphoid,
lunate and triquetral.
 Fibres run inferiorly and medially
 Become taut in flexion.
PALMAR RADIOCARPAL  FIBRES ORIGIN: anterior edge of radius and

LIGAMENT radial styloid.
 INSERTION: proximal row of carpus
anteriorly.
 Fibres run inferiorly and slightly medially.
 Become taut in extension
PALMAR ULNOCARPAL  FIBRES ORIGIN: ulnar styloid and articular
LIGAMENT disc
 INSERTION: proximal row of carpal anteriorly
 Fibres run inferiorly and laterally
 Fibres become taut in extension

lOMoARcPSD|3108808

RADIAL COLLATERAL  ORIGIN: radial styloid
CARPAL LIGAMENT  INSERTION: lateral side of scaphoid and trapezium
 Helps stabilise during deviations of the wrist.
ULNA COLLATERAL  ORIGIN: ulnar styloid

CARPAL LIGAMENT  INSERTION: base of the pisiform and the medial/
posterior surface of the triquetral below.
 Blends with the carpal tunnel
 Rounded cord

lOMoARcPSD|3108808
MID CARPAL JOINT  Articulation of proximal and distal rows of carpal

bones
 LATERAL: trapezium/ trapezoid with scaphoid
 CENTRAL: capitate articulates with scaphoid/
lunate.
 MEDIAL: hamate articulates with triquetal.
 Pisiform sits on top and doesn’t fully articulate
LIGAMENTS OF THE MID  Intercarpal- Palmar and dorsal

CARPAL JOINT  Collateral- Radial (scaphoid- trapezium) and
ulnar (triquetal- hamate).
 Interosseous: (between bones) Capitate- scaphoid.
CARPAL BONES AND ATTACHMENTS

SCAPHOID:
 Articulates with the radius, trapezium and capitate
 Common site of fracture
 Marks inferolateral corner of carpal tunnel
LUNATE:
 Articulates with radius and articular disc proximal as well as capitate and triquetral.
TRIQUTRAL:
 Sits between lunate and hamate

lOMoARcPSD|3108808
PISIFORM:
 Sits on top of triquetral
 Sesamoid bone: found within flexor carpi ulnaris
 Forms inferior medial tunnel of carpal tunnel
TRAPEZIUM:
 Articulates with scaphoid and trapezoid and base of the first metacarpal of thumb to
form a saddle joint
 Tubercle marks superolateral corner of carpal tunnel;
TRAPZEZOID:
 Small and irregular, articulates with scaphoid, trapezium and capitate and base of 2 nd
MC
CAPITATE:
 largest, rounded, articulates with lunate and scaphoid and 3rd as well as small amount
of 2nd and 4th MC
HAMATE:
 Forms superomedial corner, Articulates with fourth and fifth MC

lOMoARcPSD|3108808
LECTURE ONE, PART 2:

MUSCLES THAT MOVE THE WRIST AND FOREARM
 Supinators and Pronators
- Supinator muscle works along with biceps brachii to assist in supination
- Pronator teres and quadratus muscles to occur in the forearm, affecting te ulnar and
radius bones.
Central Column of the Wrist Measuring

 Use styloid process of ulnar to measure flexion and extension
 Use Capitate for radial ulnar deviation

lOMoARcPSD|3108808

WRIST FLEXORS: FLEXOR CARPI  ORIGIN: medial epicondyle of the
ULNARIS humerus
 INSERTION: the hook of hamate
and the base of the 5th metacarpal
WRIST FLEXORS: FLEXOR CARPI  ORIGIN: Medial epicondyle of the
RADIALIS humerus
 Passes under the flexor retinaculum
 INSERTION: base of the 2nd and 3rd
metacarpals.
WRIST FLEXORS: PALMARIS  ORIGIN: medial epicondyle of the
LONGUS: humerus
 INSERTION: superficial surface of
the flexor retinaculum
 Not always present
FLEXOR DIGITORUM SUPERFICIALIS ORIGIN:
 Humero-ulnar head – medial
epicondyle of humerus and adjacent
margin or coronoid process
 Radial head – oblique line of radius
INSERTION:
 Four tendons, which attach to
palmar surfaces of the middle
phalanges of the index, middle, ring
and little fingers
FUNCTION
 Flexes proximal interphalangeal
joints of index, middle, ring and
little fingers; can also flex
metacarpophangeal joints of the
same fingers and the wrist joints
FLEXOR DIGITORUM PROFUNDUS ORIGIN:
 Anterior and medial surfaces of ulna
and anterior medial half of
interosseous membrane
INSERTION:
 Four tendons, which attach to the
palmar surface of the distal
phalanges of the index, middle , ring
and little fingers
FUNCTION
 Flexes distal interphalangeal joints
of the index, middle , ring and little
fingers; can also flex
metacarpophalangeal joints of the
same fingers at the wrist joint

lOMoARcPSD|3108808
FLEXOR POLLICIS LONGUS ORIGIN:

 Anterior surface of radius and radial
half of interosseous membrane
INSERTION:
 Palmar surface of base of distal
phalanx of thumb
FUNCTION
 Flexes interphalangeal joint of the
thumb; can also flex
metacarpophalangeal joint of the
thumb
WRIST EXTENSORS:  ORIGIN: lateral epicondyle of

EXTENSOR CARPI ULNARIS the humerus
 INSERTION: Base of the
posterior 5th metacarpal
WRIST EXTENSORS:  ORIGIN: lateral epicondyle of

EXTENSOR CARPI RADIALIS LONGUS the humerus
 INSERTION: Under the
extensor retinaculum to the first
metacarpal
WRIST EXTENSORS:  ORIGIN: lateral epicondyle of the

EXTENSOR CARPI RADIALIS BREVIS humerus
 INSERTION: 3rd metacarpal base.
WRIST EXTENSORS: ORIGIN:
EXTENSOR DIGITORUM  Lateral epicondyle of humerus and
adjacent intermuscular septum and
deep fascia

lOMoARcPSD|3108808
INSERTION:
 Four tendons, which insert via
extensor hoods into dorsal aspects of
the bases of the middle and distal
phalanges of the index, middle, ring
and little fingers
FUNCTION
 Extends the index, middle, ring and
little fingers; can also extend the
wrist

EXTENSOR INDICIS  Posterior surface of the ulnar (distal
to the extensor Pollicis longus) and
adjacent interosseous membrane
INSERTION:
 Extensor hood of the index finger.
FUNCTION
 Extends index finger.
EXTENSOR POLLICIS LONGUS  Posterior surface of the ulna (distal
to the abductor Pollicis longus) and
the adjacent interosseous membrane.
INSERTION:
 Dorsal surface of the base of the
distal phalanx of the thumb.
FUNCTION
 Extends interphalangeal joint of the
thumb; can also extend
carpometacarpal and
metacarpophalangeal joints of the
thumb.
EXTENSOR DIGITI MINIMI  Lateral epicondyle of humerus and
adjacent intermuscular septum
together with extensor Digitorum
INSERTION:
 Extensor hood of the little finger
FUNCTION
 Extends the little finger
EXTENSOR POLLICIS BREVIS  Posterior surface of the radius (distal
to the abductor Pollicis longus) and
the adjacent interosseous membrane
INSERTION:
 Dorsal surface of the base of the
proximal phalanx of the thumb.
FUNCTION

lOMoARcPSD|3108808
 Extends the metacarpophalangeal

joints of the thumb; can also extend
the carpometacarpal joint of the
thumb.
DORSAL COMPARTMENT OF THE WRIST

lOMoARcPSD|3108808
Flexor Retinaculum
 Helps blend things together
 Forms a tunnel that you can easily see how many muscles are attaching under, over or
into.
ULNAR DEVIATION (ADDUCTION)

 Occurs predominantly at radio-carpal joint (approx.. 45 degrees)
 Flexor Carpi Ulnaris
 Extensor Carpi Ulnaris
 Muscles work synergy
RADIAL DEVIATION (ABDUCTION)

 Predominantly at midcarpal joint (approx. 15 degrees).
 Flexor Carpi Radialis
 Extensor Carpi Radialis Longus
 Extensor Carpi Radialis Brevis
 Assisted by Abductor Pollicis Longus and Extensor Pollicis Brevis.
 Muscles work in synergy (usually work against work together to produce movement)

lOMoARcPSD|3108808
WRIST COMPLEX- ROM

 Pronation & Supination: 80- 90 degrees each direction.
 Extension: 70 degrees
 Flexion: 80 degrees
 Radial deviation: 15- 20 degrees
 Ulnar deviation: 30-45 degrees.
WRIST MOVEMENT
 Combined radiocarpal and midcarpal arthrokinematics
 EXTENSION:
- mostly at radiocarpal joint, occurs with slight radial deviation and pronation.
- Proximal row of carpal bones slide anteriorly while the distal row slides posteriorly
 FLEXION:
- mostly at the midcarpal joint, occurs with slight ulnar deviation and supination.
- Proximal bones slide posteriorly while distal bones slide anteriorly.
 ULNAR DEVIATION: Proximal row slides towards the radial side which causes the
distal Capitate to roll.
 RADIAL DEVIATION: proximal row slides towards the ulnar side which causes the
distal capitate to roll.

lOMoARcPSD|3108808
INCLINATION OF DISTAL RADIUS

 Articulates with scaphoid and lunate.
 Distal articular surface tilts anteriorly 10-15
degrees & in the ulnar direction 15-25 degrees.
 ANGLE OF RADIUS DETERMINES
INCLINATION.
SIGNIFICANCE OF INCLINATION OF DISTAL RADIUS

 Explains the direction of carpal subluxation in the unstable wrist (Rheumatoid
arthritis, excessive loading).
 Anterior tilt downwards puts shear forces on the distal radius during lifting.
 Falls onto outstretched hands which commonly produces a fracture at the distal radius
which disrupts the normal inclination of the wrist.
 ROM is decreased and predisposed to degeneration in the wrist.
ULNAR VARIANCE
 Determined by:
- Age
- Genetics
- Forces at wrist
- Elbow pathology
 Negative ulnar variance: shorter ulna
- ROM during ulna deviation decreased.
-Less stability of lunate
-Increased loading of radial side wrist.
 More than 1mm difference in length:
- Ulnocarpal impaction degeneration ulna
- FC disc & certain carpals.

lOMoARcPSD|3108808
CARPAL TUNNEL

lOMoARcPSD|3108808
MUSCULATURE OF THE FOREARM:
ANTERIOR- SUPERFICIAL
 Flexor Carpi Ulnaris
 Palmaris Longus
 Flexor Carpi Radialis
 Pronator Teres
ANTERIOR- DEEP
 Flexor Digitorum Profundus
 Flexor Poliicis Longus
 Pronator Quadratus
ANTERIOR INTERMEDIATE:
 Flexor Digitorum Superficialis
POSTERIOR- SUPERFICIAL
 Brachioradialis
 Extensor Carpi Radialis Brevis
 Extensor Digitorum
 Extensor Digiti Minimi
 Extensor Carpi Ulnaris
 Anconeus
POSTERIOR- DEEP
 Supinator
 Abductor Pollicis Longus
 Extensor Pollicis Brevis
 Extensor Pollicis Longus
 Extensor Indices

lOMoARcPSD|3108808
LECTURE TWO: HANDS AND FINGERS

OBJECTIVES
 Understand and describe the function of the hand (including bones, joints and
ligaments)
 Understand, describe and measure the normal ROM and movement patterns of the
hand.
 Understand the role of the muscles of the wrist during group and the consequences of
active insufficiency.
 Understand and describe the accessory movement/s of the hand.
 Understand and describe the types of prehension.
JOINTS OF THE HAND

CARPOMETACARPAL JOINTS (2-5)
 Between the distal ends of the carpal bones of the wrist
and the proximal five metacarpal bones.
 Thumb- saddle
 Opposition, synovial
 Other fingers- gliding
 Articulation between distal row of carpals and the
bases of the five metacarpals.
 2nd – 4th: Gliding joints allowing flexion/ extension
 5th: Saddle joint allowing flexion/ extension,
some abduction and adduction, limited opposition.
 1st: Saddle allowing flexion/ extension,
abduction/ adduction, opposition. Conjunct axial rotation.
 Between trapezium and thumb (trapezium next to thumb).
 Flexion across, extension out, abduction lifts away to hand.
 Conjunct axial rotation: when thumb opposes fingers, medial rotation also occurs.

lOMoARcPSD|3108808
GOING TO BE A SHORT ANSWER QUESTION

CONCERNING THE 1ST CMC
Ligaments:
 Anterior oblique ligament
 Posterior oblique ligament
 Radial Carpometacarpal ligament

lOMoARcPSD|3108808
DURING ABDUCTION OF THE 1ST CMC:

 Metacarpal bone rolls and slides on saddle base joint to move
 Stretched adductor Pollicis helps limit movement
ADDUCTION OF THE 1ST CMC:

 Slight medial rotation
 Slide and roll occurs between the metacarpal and trapezium
 Radial ligament becomes taut and the anterior ligament loosens.
FLEXION AND EXTENSION OF THE 1ST CMC:

 Because saddle joint, slide and rolling occurs in the same direction.

lOMoARcPSD|3108808
METACARPOPHALANGEAL JOINTS (MCP)

 Flexion/ Extension
 Gives additional flexion range in opposition: ONLY ADDS FLEXION TO GET
OPPOSITE
 LEARN COLLATERAL LIGAMENTS AND OTHER LIGAMENTS TO KNOW
WHICH ARE GOING TO BE TAUT AND WHEN!
 Ligaments taut in flexion
 Accessory ligaments taut in extension
 Instability: unable to oppose thumb and index finger tip.
 Digits 2-5: flex and extension
 Can get passive rotation to mould fingers to better shapes, assess passive rotation.

lOMoARcPSD|3108808
Deep Transverse Metacarpal Ligament:

 Underneath Flexor Sheets
 Transverse
 Maintains Position Of MCP Joints 2-5.
METACARPOPHALANGEAL JOINTS
 Structure and function 1st- 5th similar, which slight differences in structure.
 ROM flexion increased in 2nd – 5th.
2nd: 90 degrees
5th : 110-115 degrees
 Passive extension: 30-45 degrees
 Abduction/ adduction: 20 degrees (> 2nd & 5th).
 Supporting structures: capsule, collateral ligaments, volar (palmer) plates,
surrounding tendons and soft tissue.

lOMoARcPSD|3108808
INTERPHALANGEAL JOINTS
 Hinge, one degree of freedom: Flexion/ Extension
 ROM: Flexion PIP: 100-120 degrees.
 DIP allows: 70-90 degrees.
 Flexion increase from radial to ulnar digits.
 Hyperextion PIP (PROXIMAL INTERPHALANGEAL JOINT) minimal, DIP
(DISTAL INTERPHALANGEAL JOINT): approx. 30 degrees.
 Stability: Collateral and accessory ligaments and volar plate.
 Axis is oblique so when flex fingers move towards the thumb side, grip will be
facilitated.
 Thumb IP: Active flexion is approx. 70 degrees.
Passive Hyperextension: approx. 20 degrees (increases with age).
PROXIMAL INTERPHALANGEAL JOINTS:

 Support and limit amount of flexion
 Have palmer ligaments, have collateral ligaments
 Prevents too much rotation and gliding
 Are hinge joints: flexion and extension

lOMoARcPSD|3108808
COLLATERAL LIGAMENTS: IPJ

 FLEXION: Collateral ligament tension, stable grasp.
 EXTENSION: Collateral ligament lax permits abduction by interossei: necessary for
opening the hand to grasp.
Volar plates/ PALMER: Ligamentous like structures: thick discs of fibrocartilage
which adds to the stability.
Amount of flexion increases from the radial aspect to the ulna.
Hyper extension depends on laxity of ligaments
IMMOBILISATION OF THE HAND:

 Close: packed position= MCP flexion 60-70 degrees.
 Immobilise in CP: collateral ligament extrinsic extensor muscles relatively elongated
and taut: prevents shortening. ALLOWS MOVEMENT POST INJURY REHAB.

lOMoARcPSD|3108808
ZONES OF THE HAND

 ZONE ONE: From middle of middle phalanx
distally (only the tendon of FDP).
 ZONE TWO: From MCP joint to the middle of
the middle phalanx (Tendons of FDS and FDP).
 ZONE THREE: From the distal end of the flexor
retinaculum to the MCP joints (Tendons of FDS & FDP
with the origin of the lumbricals).
VERY IMPORTANT REGION
EXTENSOR HOODS
 The tendons of the Extensor Digitorum and Extensor Pollicis Longus pass onto the
dorsal aspects of the digits and expand over the proximal phalanges to form complex
‘extensor hoods’ or ‘dorsal digital expansions’.
 ATTACH ON PHALANGES?
 WHEN YOU WANT
 PAD: PALMER, ADDUCTION
 DAB: DORSAL ABDUCTION
Each hood is triangular with:

 The apex attached to the distal phalanx
 The central region attached to the middle phalanx (proximal phalanx for the thumb).
 Each corner of the base is wrapped around the sides of the MCP joint for the index,
middle, ring and little fingers and attach mainly to the deep transverse metacarpal
ligaments (in the thumb the hood is attached on each side to muscles).
 Need complex attachments to achieve fine hand movement required.

lOMoARcPSD|3108808
FLEXOR PULLEYS
 Series of ligaments:
- Annular (5) (AROUND) & Cruciate (3 pairs)
(CROSSING OVER) Ligament.
 VARIES PER PERSON.
 Stabilise the flexor tendons.
 Variability amongst individuals

lOMoARcPSD|3108808
ARCHES OF THE HAND

 Proximal transverse arch:
- Distal row of carpals
- RUNS ONE SIDE TO THE OTHER
-Static structure forming carpal tunnel
 Distal transverse arch:
- Through MCP joints
- 1st, 4th, 5th mobile: 2nd & 3rd stable.
 Longitudinal arch:
- Digit length from proximal to distal
- Proximal end stable: distal end mobile.
- Runs right across length of hand
 Which muscles and ligaments stabilise
these arches, which bones make up the arc
HAND FUNCTION:
PROCESS:
 Open in preparation for grasp
 Mould to the shape of the object.
 Hold or manipulate the object.
 Feel the object.
 Need normal ROM & strength
 Must have normal sensation
PREHENSION
 Ability of fingers & thumb to grasp/ seize for holding, securing & picking up objects:
a) Grip: all digits are used
b) Pinch: mainly thumb & index finger
c) Hook: only fingers used.
A) Power: high force without need for exactness of task
B) Precision: high level of exactness & low force.
- Power grip
- Precision grip
- Hook grip
- Power pinch
- Precision pinch
- tripod grip: thumb, index and middle fingers
LINK ARCHES IN RELATION TO

WHICH GRIPS YOU GET

lOMoARcPSD|3108808
PINCH
 Thumb and distal aspect of index and/ or long finger.
 Manipulation of small objects
 Precision
 Many different version.
NECESSARY ELEMENTS OF A POWER GRIP (OR GRASP)

 Generally users all digits of the hand
 Flexion of fingers (particular MCP joints)
 Participation of ulnar side of hand (as oppose pinch-
radial side)
 Contact between object and fingers and palm.
INTRINSIC MUSCLES OF HAND: need to know all and the origins and
insertions.
 Palmaris Brevis
 Dorsal Interossei (4 muscles)
 Palmar Interossei (4 muscles)
 Adductor Pollicis
 Lumbricals (4 muscles)
THENAR MUSCLES: muscles of thumb

 Opponens Pollicis
 Abductor Pollicis Brevis
 Flexor Pollicis Brevis
HYPOTHENAR MUSCLES
 Opponens Digiti Minimi
 Abductor Digiti Minimi
 Flexor Digiti Minimi Brevis

lOMoARcPSD|3108808
TO GET FULL FLEXION NEED TO HAVE WRIST IN SLIGHT

EXTENSION TO ACHIEVE OPTIMAL MUSCLE LENGTH, LOOSENS
EXTENSORS FOR FLEXION.

lOMoARcPSD|3108808
PS1001 WEEK 11 NOTES: MOVEMENT ANALYSIS UPPER

LIMB
Shoulder Complex Joints
 Glenohumeral
 Scapulothoracic
 Acromioclavicular
When assessing movement think about what muscle is producing the
movement but also what limits/ stabilises and the mechanics involved.
LINK FORM TO FUNCTION.
Elbow Complex Joints
 Radiohumeral
 Ulnahumeral
 RADIUS COMING INTO CONTACT WITH THE HUMERUS HEAD
DURING FLEXION (NOT IN CONTACT WHEN EXTENDED).
Forearm Joints
 Superior and inferior Radio-Ulna
 MOVEMENT: SUPINATION AND PRONATION.
 RADIUS ROTATED AROUND THE ULNA.
 Fibreossious: mix of tissue
Wrist Complex Joints
 Radiocarpal
 Intercarpal: how they move in relation to one another and the collateral
ligaments around.
Hand Joints
 Carpometacarpal
 Metacarpalphalangeal
 Interphalangeal
muscles and how they sit in relationship to one another.
Ligaments and how they allow us to have flexion at one joint and
extension at another.
Extensor hoods

lOMoARcPSD|3108808
Cervical spine:
where movement begins and in which area and how it moves down
Mechanics of bones moving in relation to one another.
C1, C2 & C7 are atypical. What that means for movement.
Which muscles produce movements and how the ligaments around the area
limit/ stabilise the movements.
THORACIC SPINE:
orientation of joints lend to rotation.
Remember the direction of the spinous processes
Know which ligaments limit flexion and extension.
NECK:
which muscles working ipsilateral (same side) or cons laterally (affects different
side).
Structuring Movement Analysis
 Movement(s) occurring at joint
 Planes and axes
 Type of muscle contraction
 Muscles producing the movement(s)
 Range of the muscle
 Joint range
Movements to Analyse:
Break into sections and analyse each area of the body. What’s happening at
which joints and what muscles are producing the movements.
 Drinking from a cup
 Brushing/ combing hair
 Pushing/ pulling a door open
 Pushing/ pulling a door shut
 Throwing underarm
 Throwing overarm

Lecture-Notes-Lectures-Week-1-Week-4-6-Week-9-11 (PS1001) PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Lecture-Notes-Lectures-Week-1-Week-4-6-Week-9-11 (PS1001) PDF

Uploaded by

Copyright:

Available Formats

lOMoARcPSD|3108808

Lecture notes, lectures WEEK 1, week 4-6, week 9-11

Introduction to Physiotherapy (James Cook University)

StuDocu is not sponsored or endorsed by any college or university

PS1001: WEEK ONE REVISION NOTES

SUPERIOR (CRANIAL)  Nearer to head

Downloaded by Harry Chung (harry47282005@hotmail.com)

MASSAGE  The manipulation of the soft

CIRCULATORY SYSTEM AND  Vasodilation is caused by the

EFFECTS ON LYMPHATIC SYSTEM  Causes a flushing affect which

Downloaded by Harry Chung (harry47282005@hotmail.com)

 Can affect pain threshold and

Downloaded by Harry Chung (harry47282005@hotmail.com)

PS1001, WEEK FOUR-

 Length- tension factors:

Downloaded by Harry Chung (harry47282005@hotmail.com)

Speed of muscle contraction

Low resistance and high repetition training

Effect of disuse on muscle

Type 2 fast twitch

Effect of immobilisation on muscle length

Downloaded by Harry Chung (harry47282005@hotmail.com)

Immobilised in lengthened position

BASIC BIOMECHANICAL PRINCIPLES

TERM DEFINITION/ EXPLANATION

Downloaded by Harry Chung (harry47282005@hotmail.com)

LEVERS: FIRST  Forces are on different sides of the COR

 E.g. the head sitting on top of the cervical spine.

MECHANICAL  MA = EFFORT ARM/ LOAD ARM

Downloaded by Harry Chung (harry47282005@hotmail.com)

FACTORS THAT  Strength= force of a muscle

MOMENT ARM  Perpendicular distance from an axis to the line of action of a

A MUSCLE WITH A LONG MOMENT ARM MUST SHORTEN MORE

Downloaded by Harry Chung (harry47282005@hotmail.com)

TORQUE  Creates the movement of the lever system (bones).

Fg: gravitation force

TORQUE:  Patella increases the amount of torque the quadriceps can

Downloaded by Harry Chung (harry47282005@hotmail.com)

DEGREES OF  3 MAIN CATEGORIES:

Downloaded by Harry Chung (harry47282005@hotmail.com)

 SLIDE/ GLIDE: pure translocation of the articulating surface

Downloaded by Harry Chung (harry47282005@hotmail.com)

PS1001 WEEK FIVE REVISION

Downloaded by Harry Chung (harry47282005@hotmail.com)

OR Scale of 1-10, how bad?

Downloaded by Harry Chung (harry47282005@hotmail.com)

RED FLAGS  Serious pathology or for any health state that

YELLOW FLAGS  Attitudes and beliefs about presenting

LEARNING OBJECTIVES: OBJECTIVE ASSESSMENT

Downloaded by Harry Chung (harry47282005@hotmail.com)

Downloaded by Harry Chung (harry47282005@hotmail.com)

SYMPTOMS DURING OR AFTER?

PERFROM GONIOMETRY AFTER ALL

Downloaded by Harry Chung (harry47282005@hotmail.com)

OVERPRESSURE Passive force applied at the end of

Downloaded by Harry Chung (harry47282005@hotmail.com)

RECORDING AROM/ PROM &  Visual estimate

Downloaded by Harry Chung (harry47282005@hotmail.com)

 GRADING SYSTEM METHOD:

Downloaded by Harry Chung (harry47282005@hotmail.com)

WEEK SIX REVISION NOTES

Bones and articulations

TERM DEFINITION/ EXPLANATION