Anatomical Position
- Person stands erect
- feet flat on floor and pointed forward
- arms at sides
- palms, eyes and face facing forward
- standard frame of reference for anatomical descriptions and dissection
Above other structures, towards the head
superior
below other structures away from the head
inferior
toward the front of the body
anterior
back of the body
posterior
toward the midline
medial
away from the midline
lateral
nearest to the point of attachment to the trunk
proximal
farthest from the point of attachment to the trunk
distal
toward the surface at the body
superficial
aaa from the body surface
deep
on the other side
contralateral
on same side
ipsilateral
lying on your back
supine
lying face down
prone
lying on your right side
right lateral recumbent
lying on your left side
...
Human movements are described in 3 dimensions based on a series of ______
- imaginary flat surfaces passing through the body
planes
The three planes are perpendicular to each other they are known as
sagittal
frontal and
transverse
divides the body into right and left parts
sagittal
passes directly through the midline of the body. cuts the body into equal halves
mid-sagittal plane
Any plane parallel to the mid-sagittal plane (unequal parts)
Parasagittal plane
In a sagital plane the axis is oriented ________
LEFT TO RIGHT
_____ and ______ movements occur in the sagittal plane
flexion and extension
Divides the body into anterior and posterior parts
frontal plane
The axis of the frontal plane is oriented ______
front to back
______ and ______ occur in the frontal plane
abduction and adduction
Divides the body into superior and inferior parts
Transverse (horizontal) plane
The axis of the transverse plan is oriented in an
up to down position
_______ ________ and________ movements occur in the transverse (horizontal) plane
horizontal abduction, adduction, and rotation
When organs are sectioned along the transverse plane the sections are called
cross sections
Flexion
extension
Hypersextension
Dorsiflexion
Plantar flexion are all movements in what plane?
Sagittal
Decreases the angle at the joint
brings the articulating bones closer together
Flexion
Increases the angle at the joint
Brings the articulating bones farther together
Extension
Extension past the anatomical postion
Hyperextension
Moving the dorsum (top) of the foot toward the anterior surface of the tibia
- decreasing the angle at the talocrural (ankle joint)
Dorsiflexion
Moving the dorsum (top) of the foot away from the anterior surface of the tibia
- increasing the angle at the talocrural (ankle) joint
Plantar Flexion
In the sagittal plane a ____ occurs at the pelvis and scapula
Tilt
The ASIS moves in an anterior and caudal direction
Anterior pelvic tilt
The ASIS movews in a posterior and cranial direction
Posterior pelvic tilt
The coracoid process moves in an anterior and caudal direction while the inferior angle moves in a posterior and cranial direction
Anterior tilt of the scapula
The coracoid process moves in a posterior and cranial direction while the inferior angle moves in an anterior and caudal direction
Posterior tilt of the scapula
Abduction, adduction, elevation, depression, lateral flexion, inversion, eversion, shoulder girdle elevation, shoulder girdle depression, shoulder girdle upward/outward rotation, shoulder girdle downward/inward rotation, and lateral pelvic tilt are all mo
Frontal Plane
movement of a limb away from the midline body
Abduction
movement of a limb toward the midline of the body
adduction
moving a body part superiorly
elevation
moving an elevated body part inferiorly
depression
bending the vertebral column to the side
lateral flexion
turning the plantar surface of the foot so that it faces medially
inversion
turning the plantar surface of the foot so that it faces laterally
eversion
movement of the scapula and lateral end of the clavicle in a cranial direction
shoulder girdle elevation
movement of the scapula and lateral end of the clavicle in a caudal direction
shoulder girdle depression
moving the scapula so that the glenoid cavity faces superiorly
shoulder girdle upward/outward rotation
moving the scapula so that the glenoid cavity faces inferiorly
shoulder girdle downward/inward rotation
movement of the ipsilateral iliac crest in either a cranial or caudal direction
lateral pelvic tilt
Horizontal adduction (flexion), horizontal abduction (extension), protraction, and retraction. Rotation- right, left, medial/internal/inward, lateral/external/outward, supination, and pronation are all movements of the
transverse plane
Movement of the humerus or femur, in the horizontal plane, toward the midline of the body or in the anterior direction
horizontal adduction (flexion)
Movement of the humerus or femur in the horizontal plane, away from the midline of the body or in the posterior direction
Horizontal abduction (extension)
Moving a part of the body anteriorly in the horizontal plane.
example: mandible, scapulae
Protraction
Moving a part of the body posteriorly in the horizontal plane
example: mandible, scapulae
Retraction
Turning a bone along its own long axis
rotation
Turning at your spine
Right/left rotation
movement of the anterior surface of a limb toward the midline of the body
medial/internal/inward rotation
movement of the anterior surface of a limb away from the midline of the body
lateral/externla/outward rotation
rotating the forearm so the palm faces anteriorly
supination
rotating the forearm so the palm faces posteriorly
pronation
Opposition reposition and circumduction are considered special movements in what type of plane
multiplanar
movement of the thumb to touch the tips of the fingers on the same hand. Occurs at the carpometacarpal joint of the thumb
opposition
Moving the fingers out of opposition
reposition
movement of the distal end of a body part in a circle. A combination of flexion, abduction, extension and adduction
Circumduction
Movement in the plane of the scapula. The scapular plane is approx 30 to 45 degree anterior to the frontal plane.
Scaption
The body and bony segments move through planes of motion and around axes of motion. An axis is the point around which rotation occurs. The axes are at a _____ degree to the plane of motion
90 degree
The net effect of the forces applied on a common point of attachment on a bony segment.
- the line passing through the point of application of the force in the direction in which the force is exerted
line of pull of a muscle
The relationship between the line of pull of a muscle and the axis of rotation of a joint determines the movement that occurs at the
joint
Some normal anatomical factors affecting joint range of motion are
connective tissue
muscle bulk
bony structures
body fat and
joint structure
tendons, ligaments, fascia, joint capsules and skin are considered
connective tissue
muscle size may affect ROM
muscle bulk
bony prominences can stop movements at normal end points in the range
bony structures
can act as a wedge between lever arms
body fat
the structure of a joint will affect joint ROM. For example a ball and socket joint verses a hinge joint
Joint structure
The number of axes or planes in which a joint can move
degrees of freedom
Movement along one axis (plane)
Uniaxial
Movement along two axes (planes)
Biaxial
Movement along three axes (planes)
Triaxial
The greater the degree of freedom the greater the mobilty and less
stability
the axis for movements in the sagittal plane
medial lateral axis
the axis for movements in the frontal plane
anterior posterior axis
the axis for movements in the transverse plane
superior inferior axis
Muscles with a line of pull _______ to the medial lateral axis of rotation of a joint will produce flexion in the sagittal plane
examples: biceps brachii, anterior deltoid
anterior
Muscles with a line a of pull _____ to the medial lateral axis of rotation of a joint will produce extension in the sagittal plane
examples: triceps brachii, posterior deltoid
Posterior
Muscles with a line of pull _______ or _______ to the anterior posterior axis of rotation of a joint will produce abduction in the frontal plane
example: middle deltoid
Superior or lateral
Muscles with a line of pull ______ or ______ to the anterior-posterior axis of rotation of a joint will produce adduction in the frontal plane
example: latissimus dorsi
inferior or medial
Muscles with a line of pull _______ to the superior inferior axis of rotation of a joint will produce internal rotation in the transverse plane
example: subscapularis
Anterior
muscles with a line of pull ______ to the superior inferior axis of rotation of a joint will produce external rotation in the transverse plane
example: Infraspinatus
Posterior
Degree of movement that occurs at a joint
Range of motion ROM
The joint is moved through a ROM by the examiner with no assistance from the patient
Passive ROM
The ROM through which a patient can actively move without assistance a joint using the adjacent muscles
Active ROM
Contractile tissues can have stress placed on them by ____________ they include muscle and tendons
stretching or contracting
Non contractile tissues can have stress placed on them by ___________ they include joint capsule, ligaments, cartilage, fascia, skin, and bursae
stretching or pinching
If AROM and PROM are painful and liminted in the same direction lesion is in the
non contractile tissues
If AROM and PROM are painful and limited in the opposite direction lesion is in the
contractile tissues
Stresses the contractile and passive tissues of a joint. Evaluates coordination of movement, muscle strength, and joint ROM. All movements permitted at the joint being evaluated should be tested
Active Range of Motion
Limitation in AROM may be due to
restricted joint _______
muscle ________ and
muscle ________ or ________
mobility
weakness and
tightness or pain
ROM is evaluated using a ________ which is the most common instrument for measuring joint angles or ROM in the clinical setting. It is a 180 or 360 protractor with one axis that joins two arms, one arm is stationary and the other arm is moveable around th
goniometer
Joint movement is measured by placing the gonimeter directly over the _____ of the joint. Aligning the arms of the goniometer with the two musculoskeletal segments connected to the joint
axis
When using a goniometer the movement is generally measured with the proximal segment ____ and distal segment ______
fixed
moving
The ROM is recorded in
degrees
Pure motion is measured in onle one plane
sagittal plane = __________________
frontal plane = ____________________
transverse plane = ________________
flexion and extension
abduction and adduction
rotation
Observing an individual performing functional tasks can provide important information as to their abilities and limitations.
- The findings will help the OT determine what testing should be completed in order to properly evaluate the client
- if deficienc
range of motion testing and
manual muscle strength testing
ROM testing should begin with ________
active ROM testing
If less than normal active ROM is observed the following testing should be performed
-______________
-______________
-______________
passive ROM
measurement of range of motion with goniometer and
manual muscle strength testing
When doing active ROM movement should be performed _______ one at a time and symmertical
bilaterally
When doing active ROM the OT should observe
- effort
- ______ of movement
- signs of ______ or ______ and the angle at which they occur
- if there is _______ in any joint other than the one being tested
fluidity
pain or restriction
movement
The joint is moved through a ROM by the examiner with no assistance from the client. Evaluated the integrity of the joint and extensibility of the joint capsule, ligaments, muscles and soft tissue
Passive range of motion
PROM is generally ______ than AROM because of limitations in the extensibility of contractile tissue related active movement and the amount of movement that is under voluntary control
greater
The difference between AROM and PROM helps to protect the integrity of the joint by allowing for the absorption of
external forces
when AROM and PROM produce pain for the same joint action, _________ are usually the cause
passive tissues
A client with supraspinatus tendonitis may present with limited AROM due to pain. To rule out adhesive capsulitis of the glenohumeral joint, ______ should be performed
PROM
With adhesive capsulitis
________ is painful and limited
AROM AND PROM
The sensation the examiner feels in their hands as the joint reaches the end of the PROM
End feel
The sensation the examiner feels when there is normal ROM and the normal anatomical structures of the joint stop the movement
Normal end Feel
Normal end feels consist of
soft end feel, firm end feel, and hard end feel
A soft compression sensation
- the limitation in PROM when soft tissues approximate each other
- a soft compression of tissue
examples: knee flexion and elbow flexion
soft end feel
The limitation in PROM due to resistance in stretching of muscles, join capsule or ligaments
Firm end feel
This occurs in firm end feel
- firm or spongy sensation that has some give when muscle is stretched
- muscle tension limits the movement
Example: hip flexion with straight knee --> hamstrings limit joint movement
Example: Ankle dorsiflexion with straight
Muscular stretch (soft tissue stretch)
This occurs in a firm end feel
- Firm leathery feeling (slight give) when non-contractile tissues are stretched
- Joint capsule or ligament tension limits the movement
Examples:
- external rotation of the shoulder
- Extension of the MCP joints of the fing
Capsular stretch
An abrupt hard bony sensation
- the limitation in PROM when bone contacts bone
- an abrupt hard stop to movement
Example: elbow extension contact between the olecranon process of the ulna and the olecranon fossa of the humerus
Hard end feel
The sensation the examiner feels when there is a decrease or increase in joint PROM or normal PROM but structures other than the normal anatomy stop joint movement
Abnormal end feel
soft end feel
firm end feel
hard end feel
empty end feel
can all be considered
abnormal end feels
A boggy sensation
This sensation occurs during PROM
- sooner than typical or
- in a joint that normally has a firm or hard end feel
- Suggestive of: soft tissue edema and synovitis
Soft end feel
A springy or firm sensation
This sensation occurs during PROM
- Sonner than typical or
- in a joint that normally has a soft or hard end feel
- Suggestive of hpertonicity of muscle tissue or capsular ligamentous or muscular shortening
- Example: limited e
Firm End Feel
An abrupt, hard, bony sensation. An abrupt hard stop to movement. This sensation occurs during PROM
- sooner than typical or
- in a joint that normally has a soft or firm end feel
- Suggestive of: oesteoarthritis, loose bodies in the joint, fracture, chon
Hard end feel
No end feel is reached because of pain, preventing reaching end of PROM
- Suggestive of: acute joint inflammation, Bursitis, Fracture, Psychogenic disorder
Empty end feel
An increase in PROM beyond normal values for the movement being tested at a specific joint
- Possible causes: laxity of ligaments, joint capsule and muscles, abnormal joint surfaces, joint trauma, certain connective tissue disorder such as mar fan syndrom
Hypermobility
Females have greater flexibility then men due to structural and ________ differences
- older adults are generally less flexible due to
-- muscle fibrosis
-- reduced _________
-- degnerative _______
-- sedentary lifestyle
hormonal
muscle strength
joint disease
Contraindictions to PROM testing includes
- dislocation of a ______
- diagnosis of
- unhealed
joint
myositis ossificans
fracture
Precautions should be taken if ______ testing is performed on a client with
- presence of an infection or inflammatory process in a joint
- recent surgical procedure
- region of marked osteoporosis
- carcinoma of the bone or any fragile bone condition
- s
PROM
The nervous system consists of the
CNS- Brain: cerebrum, cerebellum, and brain stem & Spinal Cord
PNS- Cranial and Spinal Nerves
receives sensory information and processes to produce body responses (movement)
- there are two hemispheres
cerebrum
- A thick band of nerves that divides the cerebrum into left and right hemispheres
- connects the left and right sides of the brain allowing for communication between both hemispheres
- transfers motor, sensory, cognitive info between the brain hemisphere
Corpus callosum
Generally each hemisphere receives sensory information from and controls movement on the _________ side of the body
opposite
The __________ forms the outer layer of the cerebrum and processes information for tasks that require conscious thought
cerebral cortex
Motor neurons run from the _____ to the _____
CNS to the PNS
These motor neuron cells bodies are located in the motor area of the cerebral cortex.
- They synapse in motor neclei of the brainstem or the anterior gray born of the spinal cord with a LMN
- They do NOT leave the CNS
Upper Motor Neurons (1st order neurons)
These motor neuron cell bodies are located in the motor nuclei of the brainstem or the anterior gray horn of the spinal cord.
- Innvervate skeletal muscle fibers
- They are cranial and spinal nerves
- These axons LEAVE the CNS
Lower motor neurons (2nd order neurons)
Regulates muscle tone, balance, and coordinates voluntary motor acts
Cerebellum
Connects the cerebrum to the spinal cord
Brain stem
- Carries information between the brain and body
- Sensory signals travel from the body to the brain
- Motor signals travel from the brain to the body
Spinal Cord
- Extends from the CNS
- PNS neerve fibers carry impulses to and from the CNS
PNS
In the PNS- collections of nerve cell bodies that lie outside the brain or spinal cord
Ganglia
Carry nerve impulses from receptors or sense organs of the PNS to the CNS
Afferent fibers
Carry nerve impulses form the CNS to the PNS (muscles and glands)
Efferent fibers
Carry impulses to and from muscles
somatic
carry impulses to and from organs and glands
Visceral
extend outward from the spinal cord
- 31 pairs
spinal nerves
- 12 pairs
- branch off the brain and brain stem
- Are either sensory, special sensory, motor, or mixed
cranial nerves
All cranial nerves, except ______ innervate structures in the head and neck
CN 10 vagus nerve
CN 10 is _______
- innervates organs another structures in the thorax and abdomen
mixed (sensory and motor)
Divisions of the PNS =
Sensory and Motor Division
Somatic and visceral sensory nerve fibers are part of what division
Sensory (afferent) division
- Motor fibers are part of what division
Motor efferent division
Divisons of the motor system =
Somatic nervous system and
Autonomic nervous system
- Somatic motor (voluntary)
- Impulses from CNS to skeletal muscles
Somatic nervous system
- Visceral motor (involuntary)
- Impulses from CNS to cardiac muscle, smooth muscle and glands
Autonomic Nervous System
Branches of the autonomic nervous system =
Sympathetic and parasympathetic nervous system
- Also known as the thoracolumbar division
- Mobilizes body systems during activity
- Kicks in during periods of exertion, stress or emergency
- Fight or flight
Sympathetic Nervous System
- Also known as the craniosacral division
- Conserves energy (to calm the body)
- Predominates under resting conditions
Parasympathetic nervous system
The nervous system controls _________
Movement occurs either by conscious intention or unconsciously in response to
sensory impulses received from sensory receptors in the skin, muscles or related tissues
movement
Automatic responses to change in environment
Reflexes
Reflexes Occur over neural paths called reflex
arcs
Components of a Reflex Arc:
Step 1: a _______ is stimulated
Step 2: _________ carry the signal to the CNS (integration center)
Step 3: integration center processes and transfers the nerve signal to a _______
- polysynaptic reflexes involve one or more ___
Receptor
Sensory neurons
Motor Neuron
Interneurons
Effector Organ
Effector Organ
Classified by complexity of neural circuit
Involves only one synapse
Sensory neuron synapses directly onto motor neuron
Example: stretch reflex
Monosynaptic Reflex
Classified by complexity of neural circuit
Involves multiple synapses and interneurons
At least one interneuron between sensory neuron and motor neuron
Example: Withdrawal Reflex
Polysynaptic Reflex
Classified by site of information processing it is where Integration occurs in the gray matter of the spinal cord
Spinal Reflexes
Classified by site of information processing it is where integration occurs in the brain stem
Cranial Reflexes
- A monosynaptic reflex
- Monitors and regulates skeletal muscle length
- When a stimulus results in the stretching of a muscle, the muscle reflexively contracts
Stretch Reflex
In a stretch reflex The stretch in a muscle is monitored by a stretch
receptor called a
muscle spindle
An example of a stretch reflex is the
patellar reflex
The receptors in stretch reflexes
- Bundles of small, specialized intrafusal muscle
fibers innervated by sensory and motor neurons
- Surrounded by extrafusal muscle fibers which maintain tone and contract muscle
- Prevent injury from over stretching becau
Muscle Spindles
When a muscle lengthens (stretches), muscle spindle intrafusal muscle fibers are stretched the deformation of the muscle spindle sends signals to the spinal cord along the afferent nerve fibers where they synapse with the _________.
The nerve signals exit
motor neurons
contract
overstretching
Stretch activates the
muscle spindle
Sensory neurons synapse directly with motor neurons in the ________. Motor neurons cause the stretched muscle to contract
spinal cord
Stretch reflexes are monosynaptic and
ipsilateral
When the stretched muscle contracts, antagonistic muscles that oppose the contraction relax this is called __________
Reciprocal inhibition
Reciprocal inhibition is when the sensory fibers stimulated by the muscle spindle synapse with interneurons in the spinal cord that inhibit the _________ of antagonistic muscles
Example: in the Latella reflex, the stretched muscle (quadriceps) contracts a
motor neurons
Consist of sensory receptors located in tendons or near a
musculotendinous junction
- Provide information on amount of tension in a muscle and tendon
- Prevent contracting muscles from applying excessive tension to tendons
Golgi Tendon Organs
Sensory organs in the golgi tendon organs (GTO) transmit nerve impulses to ________ in the spinal cord which inhibit motor neurons in the same muscle
- This helps to control muscle tension by causing muscle relaxation to help prevent tendon damage
interneurons
Motor Neurons supplying the contracting muscles are _________ and the antagonist muscles are ________
- This is reciprocal activation
inhibited (relax)
activated (contract)
Reflexes that are processed in the brain stem =
cranial reflexes
Righting reflex is an example of a
cranial (brain stem) reflex
This reflex
- Helps regulate skeletal muscle responses to gravity acting on the body
- Regulate head movements that affect the entire body
- A neuromuscular response to restore the body to its normal upright position when it has been displaced
- Stimulati
Righting Reflex
Body movement occurs at joints (articulations) where two bones meet
Articulations
Joint structure determines
______ and
_______ of movement (ROM)
direction and distance
There is an inverse relationship between joint _______ and ______
mobility and stability
Two methods of joint classifications =
functional and structural
Functional joint classification is based on joint ________
- Synarthrosis= _________
- Amphiarthrosis= ______
- Diarthrosis =__________
ROM
immovable joint
slightly moveable joint
freely moveable joint
**
what we will focus on (functional classifications)
**
Structural joint classification is based on ________ of the joint
- Fibrous
- Cartilaginous
- Bony
- Synovial
Anatomical organization
- Immovable joints
- Fibrous or cartilaginous connections
- May fuse over time
Examples include
- Sutures of the skull
- Between the teeth/jaw
- Epiphyseal cartilage of long bones
Synarthrodial Joints
Slightly movable joints
Fibrous or cartilaginous connections
Amphiarthrodial Joints
Two types of amphiarthorodial joints =
Symphysis and
Syndesmosis
The bones are joined by fibrocartilage
Examples:
- Pubic symphysis
- Intervertebral discs
Symphysis (cartilaginous) joints
Bones are connected by ligaments, cords or a bands of fibrous sheets (interosseus membrane)
Example:
- Interosseous membrane between radius and ulna
Syndesmosis (fibrous) joints
Also called synovial joints
- Permit a wide range of motion
- Articulating bones are separated by a fluid-containing joint cavity surrounded by a fibrous articular capsule
- A synovial membrane lines the walls of the articular
cavity
- Hyaline cartilage l
Diarthrodial Joints
In diarthrodial joints the classification is based on the _______ of the articulating surfaces
Examples:
Plane (Gliding)
Hinge
Pivot
Condylar (Ellipsoidal)
Saddle
Ball and Socket
Shape
Flattened or slightly curved faces
- Limited motion (mainly monaxial)
- Intercarpal Joints
- Intertarsal Joints
Plane (gliding) joints
Angular motion in a single plane (monaxial)
- Elbow
- Knee
- PIP and DIP joints
Hinge Joints
Rotation only (monaxial)
- Atlas/axis
- Proximal radio-ulnar joint
Pivot Joints
Oval articular face within a depression in the opposing surface
- Motion in two planes (biaxial)
- MCP 2 - 5; flexion/extension, abduction/adduction
Condyloid (ellipsoid) joints
Concave surface articulates with a convex surface
- Motion in two planes (biaxial)
- CMC joint of the thumb; flexion/extension, abduction/adduction,
opposition/reposition and circumduction
Saddle Joints
Round articular face in a depression
- Motion in three planes (triaxial)
Shoulder, hip
Ball and socket joints
Three types of muscle tissue include
cardiac, smooth, and skeletal muscle tissue
Involuntary
Only found in the heart
Consists of small striated cells
Pushes blood through the circulatory system
Cardiac Muscle
Involuntary
Found in the walls of hollow organs
Consists of small elongated cells that are not striated
Pushes fluids and solids along the digestive tract
Regulates the diameter of blood vessels
Smooth Muscle
Voluntary
Associated with the bony skeleton
Consists of large striations cells
Attach to the skeletal system and allow us to move
Skeletal Muscle
Skeletal muscle can be strengthened which results in _______ fibers, not an increase in the number of fibers. Strength depends on the _______ of the muscles cross section
thicker
Thickness
In skeletal muscles the number and type of fibers that make up a muscle is determined
genetically
In skeletal muscle muscle fibers contract (______)and relax (______)
shorten
lengthen
Generally muscle fibers can contract or stretch _____ of their resting length.
- Skeletal msucles vary in shape and fiber arrangement
50%
Connective tissue of skeletal muscles consist of
Epimysium
Perimysium and
Endomysium
- Dense irregular connective tissue layer that surrounds the entire muscle
- A muscle consists of bundles of muscle fibers called fascicles
Epimysium
Connective tissue layer that surrounds each fascicle
Perimysium
Flexible, elastic connective tissue that surrounds individual muscle fibers
Endomysium
Muscle attachments may be _____ or ______
direct or indirect
The epimysium of the muscle fuses to the periosteum of the bone or perichondrium of a cartilage
Direct (fleshy) attachment
The collagen fibers of the endomysium, perimysium,
and epimysium extend beyond the muscle and come
together to form either a bundle called a tendon or a
broad sheet called an aponeurosis, which attach
skeletal muscle to bone
Indirect attachment
All skeletal muscles consist of ________, bundles of fibers.
fascicles.
Fascicle arrangments vary- result in muscles with different shapes and functional capabilities
four patterns of fascicle organization include
circular
convergent
parallel and
pennate
The amount of tension a muscle can develop depends on total number of _______ in a cross sectional area
myofibrils
A type of fascicle arrangement where
- fascicles are _____ to the long axis of mucles
- Most muscles of the body are ______ muscles
Example: biceps brachii
- There are some variations
- When a ______ muscle contracts It shortens and increases in diameter
Parallel (fuisform) muscles
A type of fascicle arrangement where
- Fascicles form an angle with the tendon
- Do not move as far as parallel muscles because the fascicles are at an angle to the tendon
- Contain more muscle fibers per cross-sectional area than parallel muscles
- There
Pennate muscles
Types of pennate muscles
unipennate
bipennate and
multipennate
Fibers on one side of tendon
Example: tibialis anterior
Unipennate
Fibers on both sides of tendon
Example: rectus femoris
Bipennate
Tendon branches within muscle
Example: deltoid
Multipennate
Skeletal muscles are composed of fibers that have markedly different _________ (form and structure) and _________ (function) characteristics. The differences have lead to several different systems of classifications.
morphological
physiological
One approach to classifying muscle fibers is by twitch time, fibers in this category are
Fast twitch (type II) fibers which have type IIx and type IIa and there are also slow twitch (type 1) fibers.
These fibers reach a peak tension in 0.01 seconds or less
fast twitch (type II) fibers
these fibers are
- fast glycotic fibers (FG)
- Generate ATP mainly be anaerobic cellular metabolism
- Fast because ATP is hydrolyzed rapidly
Type II-x fibers
These fibers are
- fast oxidative glycotic fibers (FOG)
- generate ATP by aerobic and anaerobic cellular metabolism
- ATP is hydrolyzed 3 to 5 times faster than in slow twitch fibers
- have characteristics of type I and type IIx fibers
Type II-a (intermediate fibers) Fibers
Fibers take three times as long to reach peak tension
- Slow oxidative fibers (SO)
- Generate ATP mainly by aerobic cellular metabolism
- Slow, because ATP is hydrolyzed relatively slowly and the contraction cycle proceeds slower than fast-twitch fibers
Slow-twitch (type I) fibers
Different fibers allow a muscle o efficiently perform a wide variety of tasks.
Most skeletal muscle consist of more than one fiber type but are composed of predominately one type
Info on Skeletal muscle fibers
Postural muscles such as the erector spine and soles are continually active for long periods of time and therefore, have a high percentage of
Type I fibers
Muscles of the shoulders and arms are used to produce large or quick burst of tension and are composed of a high percentage of
type IIx fibers
Some muscles of the legs are used for support, walking, and running and therefore have a large number of
type I and Type II-a fibers
A functional unit of neuromuscular system. Consists of a motor neuron and all of the muscle fibers it innervates, within it all of the muscle fibers are the same type. Varies in size form just a few muscle fibers per ________ to a few thousand fibers - th
Motor Unit
The muscle fibers of a motor unit are or are not adjacent to each other?
are not adjacent
Control of movements depends on the _______ of muscle fibers within each motor unit
number
muscles that control precise movements consist of many _______ motor units
small
Muscles that are responsible for producing large forces without fine control consist of motor units that innervate as many as ______ muscle fibers per motor neuron
1000
Muscles that control eye movements may have motor units with as few as ______ muscle fibers per motor neuron
5 or 10
Gastrocnemius muscle has motor units that have as many as ________ muscle fibers per motor neuron
2000 to 3000
In a motor unit The level of force produced is dependent on the _____ of the stimulus
intensity
Force produced by a muscle is affected by
- number of _____ activated
- Motor unit ______ and
- Rate of ________
motor units
size
firing
The process in which the number of motor units activated increases
- the different motor units of a muscle are not all stimulated to contract together
- motor units are recruited in order of small to large
Recruitment
This is needed for muscle contraction
Adenosine triphosphate (ATP)
Aerobic metabolism occurs in
mitochondria
Anaerobic metabolism occurs in
cytosol
sustained muscle contraction uses a lot of ______ energy
ATP
Muscles store only enough energy to start contraction (approx. 4-6 secs worth)
- muscle fibers must manufacture more ATP as needed to maintain the contraction
- ATP is generated at the same rate it is being used
ATP and muscle contraction
There are several types of skeletal muscle contractions
- muscle tension > load (external resistance)
- muscle shortens
Concentric contraction
Muscle tension <load (external resistance)
- muscle lengthens
- helps protect the pint form being forced into rapid changes in the joint position
Eccentric contraction
In general we can lower more weight (_______) that we can hold (_______) and hold more weight than we can lift (_______)
eccentric
isometric
concentric
Muscle tension = load (external resistance)
- a contraction in which the muscle length does not change
- body movement does not occur
isometric contraction
a contraction in which muscle tension remains constant
- a muscle length changes and body movement occurs
isotonic contraction
a contraction of a muscle moving the joint through a ROM at a constant velocity
Isokinetic contraction
Typical strength training involves moving a weight through a ROM
- the amount of force a muscle generates to move the weight varies due to the mechanical advantage of the joint
This type of training is often referred to as
isotonic training
However other than isotonic training, _____________ training better describes a type of strength training in which the weight lifted does not change during the concentric and eccentric phases of an exercise
Dynamic constant external resistance
functional classifications of muscles =
agonist
antagonist
synergist
co contraction
Prime mover
- muscle/muscle group that provides the major force for the specific movement
Agonist
A muscle/muscle group that can slow down or stop a movement
- has the opposite action of the agonist
- must relax before the agonist can contract
antagonist
a muscle/muscle group that assists the agonist to produce specific movement
- also contract at the same time as the agonist
synergist
- muscles can provide synergistic actions in different ways
Contraction of the agonist and antagonist to help stabilize a joint
co contraction
Three types of synergists include
conjoint synergists
neutralizing or counteracting
stabilizing or fixating
Provide identical or nearly identical activity to that of the agonist
Example brachioradialis contracts with the brachial is during elbow flexion
conjoint synergists
Prevent an unwanted movement of the agonist
Many muscles have more than one action
- They can pull in more than one direction (line of pull)
- Therefore, when such a muscle contracts the desired and undesired movements can occur simultaneously
neutralizing or counteracting synergists
Neutralizing synergists act to pull against and cancel out an
unwanted line of pull from the ________
A neutralizing synergist prevents the undesired movement.
Example
- The biceps brachii can perform elbow flexion and forearm supination
- To prevent supi
agonist
Many muscles cross more than one joint and therefore, can cause movement at more than one joint
- These act to prevent movement at one of the joints the muscle crosses while allowing movement at the other joint
Example:
- The biceps brachii crosses the el
Stabilizing or fixating synergists
The maximal amount of tension or force a muscle or muscle group can generate in one maximal effort (1RM) at a specific velocity
Muscle Strength
The ability of a muscle or muscle group to perform repeated contractions against a resistance or maintain an isometric contraction for a period of time
muscular endurance
The tendency of a force (muscle tension) to cause a lever to rotate around an axis of rotation (joint)
Torque
Ways muscle strength can be tested =
force gauges
manual muscle testing MMT
grip and pinch strength dynamometers are used in what type of muscle strength measure
force gauges
The application of graded resistance for the evaluation of the function and strength of muscle groups responsible for pure motion and single muscles when possible
- is based on effective performance of movement in relation to the forces of gravity and man
Manual muscle testing
when performing muscle testing, the OT must consider the effect of gravity on the client because of its effect on movement
- the OT must be able to position the client in a
_________ and _________ position
- some practitioners have questioned the subjecti
gravity-eliminated and
against gravity
Movement of the body part perpendicular to the floor
against- gravity position
movement of the body part parallel to the floor
- this can be performed with the OT supporting the body part using a roller board, powder board or other support
gravity eliminated position
Shoulder flexion done while standing the client raises their arm into shoulder flexion is an example of ___________
and
Shoulder flexion done while client lying on their side (non test side down) the OT supports the arm while the client moves their arm pa
against gravity
gravity eliminated
Manual grading of muscle strength is based on three factors known as
evidence of contraction
gravity as a resistance and
amount of manual resistance
Grade 0: (zero) no palpable or visible muscle contraction
Grade 1: (trace) palpable or visible muscle contraction no joint motion
Grade 2: (poor) Full available ROM with gravity eliminated and no manual resistance
are apart of what muscle grading factor
evidence of contraction
Grade 3: (fair) full available ROM against gravity, no manual resistance is apart of what muscle grading factor
gravity as a resistance
Grade 4: (Good) Full available ROM against gravity and moderate manual resistance
Grade 5: (normal) full available ROM against gravity and maximal manual resistance is apart of what muscle grading factor
Amount of manual resistance
+ or - can be added to whole grades to further describe muscle ability.
If a patient has a joint limiting condition he/she can only perform within their available ROM therefore their available ROM is the full ROM for that patient at that time
This would b
muscle testing
MMT Procedures
- The OT uses the ________
- metacarpophalangeal joints are flexed
- Interphalangeal joints held in extension
- Thumb is either adducted or relaxed in slight extension
lumbrical grip
OT applies ___________
- To the segment into which the muscle being tested is inserted
- to the segment distal to the joint
- using one hand while the other hand stabilizes the joint and prevents recruitment of muscles not being tested
- in the opposite d
Manual resistance
MMT Procedures
- The client positions the segment to near mid-range of the joints available AROM
- With the client performing an isometric contraction in this fixed position, the tester gradually applies an increasing __________
- The client is instructed
resistance
The normal tension and firmness of a muscle at rest
This is because some motor units are always active, even at rest, can be assessed by observation and palpation
Muscle Tone
Reduced muscle tone
The muscle will feel soft and mushy and will give in to sustained resistance
Hypotonia
Complete loss of muscle tone
Flaccid
Increased muscle tone
The muscle will feel very firm
will cause increased resistance to passive stretching
Hypertonia
A velocity dependent (speed) resistance to movement felt by the examiner when stretching a muscle/muscle group
- Due to hyper-excitability of the stretch reflex
- Assessed by palpation of the muscle being stretched
- Moving the segment fast causes a sudde
Spasticity
Causes resistance to quick stretching in the first third of the ROM
Severe spasticity
Causes resistance to stretching in the second third of the ROM
Moderate spasticity
Causes resistance to stretching in the last third of the ROM
Mild spasticity
Uncontrollable resistance throughout a ROM
- Resistance to stretch that is not velocity-dependent
Rigidity
Hypertonic and hypotonic states will ______ MMT grading
invalidate
Any disease process that affects the musculoskeletal or
nervous systems will affect __________
The effect on the ROM will vary based on the specific condition and the individual
movement
Damage to the _______ will affect voluntary and involuntarymovements
- Head trauma
- Cerebral Vascular Accident (CVA)
cerebrum
Pathological conditions that affect one cerebral hemisphere will generally affect movement on the ________ side of the body
opposite
Damage to the ________ will affect muscle tone and
coordination
- The _______ is involved in the coordination of voluntary motor movement, balance and equilibrium and muscle tone
cerebellum
Spinal cord damage affects motor and sensory function ______ the level of the lesion
below
Damage to _________ will affect individual muscles and dermatomes
peripheral nerves
A localized area of skin that is innervated via a single
spinal nerve root
Dermatome
Peripheral nerve fibers have the ability to ________, unlike CNS structures
If the nerve cell body remains intact after injury, recovery of muscle use and sensation often occurs
regenerate
Metabolic problems, trauma and disease can affect the
musculoskeletal system
An abnormal lateral curvature of the vertebral column which can affect spinal mobility
If severe, it can affect the function of the heart, lungs and other organs
Scoliosis
Diseases that alter bone development can have an effect on movement.
- A congenital disease that can cause loose joints and muscle
weakness
- It is frequently caused by defect in the gene that produces type 1 collagen, an important building block of bone;
Osteogenesis imperfecta
Fracture or trauma to the ______________ in
growing children may disrupt or halt bone growth
epiphyseal plates
Damage to a bone's blood supply can lead to _____________ and bone deterioration
Can lead to arthritis, muscle spasm and pain
avascular necrosis
A metabolic bone disease leading to weak, porous bones
that can result in a fracture
- Defined by the World Health Organization (WHO) as a
bone mineral density that is 2.5 standard deviations or
more below the mean peak bone mass (average of
young, health
Osteoporosis
Damage to a joint may limit ROM
- Fractures that cross the joint can affect ROM after the fracture has healed
_________ damage may cause
- chronic joint instability
- predispose the joint to joint stiffness and reduced ROM from subsequent osteoarthritis
Ligament
Postions to avoid after hip arthroplasty
- Flexion of the hip past ____
- Adduction of the leg past the ______ of the body
- Combined extension of the hip joint with external rotation of the lower extremity
- Flexion with ________
90 degree
midline
internal rotation
Autoimmune disease
Attacks the cartilage and joint lining
Causes swelling, pain and loss of function
May lead to
Joint instability
Joint subluxation
Ulnar deviation of the fingers
Rheumatoid Arthritis
Deformity of the hand/finger
Findings
Flexion of the PIP joint
Hyperextension of the DIP joint
Due to rupture/avulsion of central slip of extensor digitorum tendon at the PIP joint
Causes: trauma, RA
Boutonniere Deformity
Deformity of the hand/finger
Findings
Hyperextension of PIP joint
Flexion of the DIP joint
Due to disruption of the lateral bands of the extensor tendons at the PIP joint and flexor digitorum profundus at the DIP joint
Cause: RA
Swan Neck deformity
A hand deformity which results in the proximal phalanx becoming displaced towards the palmar side
Volar Subluxation
A hand deformity which results in fingers becoming displaced towards the ulnar side
Ulnar drift
- Inflammation in the MCP joints which can lead to laxity of the joint capsule and surrounding ligaments
- Tendons in the fingers shift to the ulnar side causing the proximal phalanx to migrate in the ulnar direction
Cause: RA
Volar subluxation and ulnar drift are due to
A push or a pull
Causes objects to deform or move
Muscles produce force
Force
Types of Forces =
Compressive Force
Tensile Force
Shearing Force
Torsional Force
Bending Force
Force that pushes two surfaces closer together
Compressive Force
Force that pulls two surfaces apart
Tensile Force
Force that act parallel to the surface area
Shearing Force
Force that causes a rotation or twisting action
Torsional Force
Force that causes asymmetric loading
Produces tension on one side of the longitudinal axis and compression on the other side
Bending Force