Kinesiology Final
Arthrokinematics: (concave on covex = same direction; convex on concave = opposite direction)
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Atlanto-occipital extension: occipital condyles roll POSTERIORLY and slide ANTERIORLY
o Flexion: ANTERIORLY and POSTERIORLY
Atlanto-occipital lateral flexion: roll to CONTRALATERAL side and slide to IPSILATERAL side
C spine extension: inf facets of sup vertebrae slide POSTERIORLY and INFERIORLY
o Flexion: SUPERIORLY an ANTERIORLY
C spine lateral flexion: inf facet of sup vertebra slides POSTERIORLY and INFERIORLY
o C2-C7 also wants to rotate to ipsilateral side during lateral flexion
C spine rotation: inf facet of sup vertebra of ipsilateral sides slide INFERIORLY and POSTERIORLY
o Contralateral side: slides SUPERIORLY and ANTERIORLY
GH abduction: humeral head rolls SUPERIOR and slides INFERIOR
o Add: INFERIOR/SUPERIOR
GH flexion: humeral head SPINS in glenoid fossa
o Extension: SPINS
GH IR: humeral head rolls ANTERIOR and slides POSTERIOR
o ER: POSTERIOR/ANTERIOR
RH/UH flexion: ulna/radius rolls ANTERIOR and slides POSTERIOR
o Extension: POSTERIOR/ANTERIOR
Distal RU supination: radius rolls and slides in SAME direction
o Pronation: SAME
Proximal RU supination: radius SPINS in annular ligament
o Ulna does nothing
o Pronation: SPINS
Wrist flexion: carpals roll PALMAR direction and slide DORSAL direction
o extension: DORSAL/PALMAR
Ulnar deviation: scaphoid, lunate, triquetrum roll ULNARLY and slide RADIALLY
o radial deviation: RADIALLY/ULNARLY
MCP of hand: roll and slide in SAME direction
CMC flexion: roll and slide in SAME direction
CMC abduction: roll and slide in OPPOSITE direction
IP flexion: roll and slide in SAME direction
T spine flexion: inf facets of sup vertebrae slide SUPERIORLY and ANTERIORLY
T spine rotation: inf facets of sup vertebrae slide to CONTRALERAL side
T spine lateral flexion: inf facet of sup vertebrae slide INFERIORLY and POSTERIORLY on ipsilateral side
o Contralateral side: SUPERIORLY and ANTERIORLY
L spine flexion: inf facets of sup vertebrae slide ANTERIORLY and SUPERIORLY
L spine rotation: ipsilateral facet DISTRACTS (separates); contralateral facet APPROXIMATES
Hip abduction: roll SUPERIOR slide INFERIOR if hip moving on trunk
o Roll INFERIOR and slide INFERIOR if trunk moving on hip
Hip IR: roll ANTERIORLY and slide POSTERIORLY if hip moving on trunk
o Roll POSTERIORLY and slide POSTERIORLY if trunk moving on hip
Knee extension (tibia on femur): tibia rolls ANTERIORLY and slides ANTERIORLY
o Menisci are pulled ANTERIORLY by quadriceps muscle
Ankle DF (talus on tibiofibular joint): talus roll ANTERIORLY and slides POSTERIORLY
Ankle DF (tibiofibular joint on talus): tibia roll ANTERIORLY and slides ANTERIORLY
Closed/Loose positions
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Close-packed: contact between the two joint surfaces is maximal and mobility is minimal
o Position of maximal congruency
Loose-packed: less contact between the surfaces in the joint and more mobility between two surfaces
o Position of least congruency
C spine:
o Close: full extension
o Loose: between flexion and extension
Glenohumeral:
o Close: max shoulder abduction and lateral rotation
o Loose: 55 degrees of should abduction and 30 degrees of horizontal adduction
Acromioclavicular:
o Close: shoulder abducted to 30 degrees
o Loose: shoulder in anatomical position
Radio humeral:
o Close: elbow flexed 90 degrees, 5 degrees of supination
o Loose: anatomical position
Ulnar humeral:
o Close: max elbow extension
o Loose: 70 degrees of elbow flexion, 10 degrees of supination
PIP/DIP:
o Close: extension
o Loose: flexed position
MCP:
o Close: 90 degrees of flexion
HIP:
o Close: max extension with max IR of hip
o Loose: 30 degrees of flexion with 30 degrees of abduction and slight (0-5 degrees) of ER
Knee:
o Close: max extension and max ER
o Loose: 25 degrees of knee flexion
Ankle (talocrural joint):
o Close: maximal DF
o Loose: 10 degrees of PF
End Feels
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Neck:
o
o
o
o
Elbow
o
o
o
o
Flexion: firm
Extension: hard
Lateral flexion: firm
Rotation: firm
Flexion: soft (or firm)
Extension: hard
Pronation: firm
Supination: firm
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Wrist
o Flexion: firm
o Extension: firm/hard
o Radial deviation: firm/hard
o Ulnar deviation: firm/hard
Hip
o Flexion: soft or firm
o Extension: firm
o Hip abduction: firm
o Hip adduction: soft or firm
o Hip IR: firm
o Hip ER: firm
Shoulder:
o Extension: firm
o Horizontal abduction: firm
o Horizontal adduction: firm/soft
o IR: firm
o ER: firm
o Elevation through flexion: firm
o Elevation through abduction: firm
Normal AROM
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Neck
o Flexion: 45-60
o Extension: 45-75
o Side bending: 30-45
o Rotation: 60-90
Shoulder
o Flexion: 160-180
o Extension: 50-60
o Abduction: 170-180
o ER: 80-90
o IR: 60-90
o Hor. Add: 130
Elbow
o Pronation: 80
o Supination: 80
o Flexion: 150
o Extension: 0
Hip
o Flex: 110-120
o Extension: 10-20
o Abduction: 30-50
o Adduction: 30
o ER: 40-60
o IR: 30-40
Knee
o Flexion: 130-145
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o
Ankle
o
o
Extension: 0
PF: 50
DF: 15
Joints
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Synarthroses: reinforced by a combination of fibrous and cartilaginous connective tissues; permit slight to
no movement
o Fibrous
 Ex: sutures of the skull, distal tibiofibular joint (syndesmosis), interosseous membrane
o Cartilaginous
 Ex: symphysis pubis, interbody joint of the spine (+ IV disc), manubriosternal joint
Diarthroses: possess a synovial fluid-filled cavity; permit moderate to extensive movement
o Ex: GH joint, apophyseal joint of spine, knee, ankle
Amphiarthroses: between diarthrotic and synarthrotic
o Ex: vertebra
o Term not used in book
6 types:
o Ball and socket: articular cartilage surface of one bone is convex and hemispherical and moves
against a rounded concave cup-like articular cartilage surface on the other bone
 3 axes, 3 DOF
 ex: hip, GH
o Condyloid: One surface of bone is rounded and convex and moves against rounded concave
articular cartilage surface
 2 axes, 2 DOF (flex/ext, abd/add)
 ex: MCP joints, wrist, occipital bone and C1
o Saddle: articular cartilage surfaces of both bones are rounded with both convex and concave
regions
 2 axes, 2 DOF (flex/ext, abd/add)
 Ex: CMC of thumb, sternoclavicular
o Hinge: articular cartilage surface of one bone is relatively cylindrical with a groove or depression
to guide the movement of the articular cartilage surface of the other bone which is trough shaped
with a ridge that fits the groove in the opposite bone
 1 axis, 1 DOF (flex/ext)
 ex: elbow, IP joints, ankle
o Pivot: articular cartilage surface of one bone is rounded and moves against a ring or sleeve-shaped
 1 axis, 1 DOF (rotation)
 ex: dens and atlas, head of radius and radial notch of ulna
o Planar/gliding: articular cartilage surfaces of the adjacent bones are planar and where the joint
capsule and ligaments allow only slight translational, sliding movements
 1 axis, 1 DOF (translational/gliding)
 ex: carpals, facet joints of vertebra, AC
o Knee is often called “modified hinge” or condylar joint
Definitions:
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Strength: maximal amount of tension or force that a muscle or muscle group can voluntarily exert in one
maximal effort
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Endurance: ability of a muscle or group to perform repeated contractions against a resistance or maintain
an isometric contraction for a period of time
Active insufficiency: when a multi-joint muscle reaches a shortened length where it can no longer apply
effective force (cannot shorten anymore-sarcomeres are too shortened and crossbridging can’t happen)
Passive insufficiency: muscle cannot lengthen anymore (antagonist muscle is stretched to a point where it
doesn’t allow agonist to move the joint any further)
Accessory motion: movement that occurs b/n joint surfaces that is produced by forces applied by examiner
Kinematic describes the joint angles or position of the body
Kinetics describes the forces acting on the body
Osteokinematics: position of the body
Arthrokinematics: movement of the joint surfaces (roll, slide, spin)
Types of forces:
o Tension: pulling apart
o Compression: pushing together
o Bending: tension on 1 side and compression on the other side
o Shear: forces opposite in opposite directions towards each other (i.e. scissors)
o Torsion: twisting
Torque: twisting force that tends to cause rotation (rotational/circular)
o Small force with long lever or large force with short lever
Force: strength, power, energy (translational/straight lines)
Levers:
o Type 1: see saw (ex: neck)
o Type 2: wheel barrel (ex: brachioradialis)
o Type 3: crane (ex: biceps/most muscles)
Coxa valga of hip: >135 degrees (head positioned higher than normal)-typical at birth
Coxa vara of hip: <120 degrees (head positioned lower)
Hip anteversion: >15 degrees (reason why kids “w” sit-lack hip ER)
o Normal = 15 degrees of anteversion
Hip retroversion: <15 degrees
Center edge angle: extent to which acetabulum covers top of femoral head
o low center edge angle = increased risk of dislocation and decreased contact with joint
o Normal: 25-39 degrees
o High center edge angle = increased risk of impingement
Anteversion: femoral head fits better in acetabulum when leg is internally rotated (results in “pigeon toe”)
Retroversion: femoral head fits better when leg is externally rotated
Anterior pelvic tilt: iliac crests forward
Posterior pelvic tilt: iliac crest backward
Nutation: top/anterior portion of sacrum is tilted anterior and coccyx is posterior (childbirth)
Counternutation: top/anterior portion of sacrum is tilted posterior and coccyx is anterior (riding horse)
Special Conditions:
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Herniated disc
o Fissure (or break) in the annular fibrosis does not keep the nucleus pulposus inside
o If protrudes into central canal-pt. finds relief in extension (propels disc forward, away from canal)
Torticollis
o Shortened SCM
o SCM laterally flexes to same side, and rotates to opposite side
o If R SCM is tight/shortened, the pt will have head rotated to left and side bent to right
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Colles Fracture: displaced dorsally
Smith’s fracture: displaced palmarly
Murphy’s sign: determines if lunate is dislocated
o Have pt make a fist-if 3rd metacarpal is level with 2nd and 4th, then its dislocated
DISI: lunate dislocates so distal articular surface faces dorsally
VISI: lunate dislocated so distal articular surface faces volarly/palmarly
Zigzag collapse: proximal row of carpals goes one way and distal row goes the other
TFCC: triangular fibrocartilage complex-includes triangular fibrocartilage disc, palmar and dorsal RU
ligaments, ulnocarpal ligaments; securely binds the distal ends of radius and ulna while permitting radius to
freely rotate about fixed ulna
o TFCC compression test: forearm in neutral position with ulnar deviation reproduces symptoms
o TFCC stress test: applying force across ulna w/ the wrist in UD reproduces symptoms
o Press test: patient lifts themselves out of chair using wrists in extended position; pain = pos. test
DeQuervain’s Tenosynovitis: inflammation of tendon’s of EPB and EPL
o Perform Finkelstein’s test: put wrist in UD (EPB and EPL are stretched); pain = pos test
Froment’s sign: test for ulnar nerve compromise-specifically looking at Adductor Pollicis
o Put paper b/en thumb and index finger and examiner pulls paper out
o Pos test = flexing distal IP joint of thumb (using FPL instead to hold on)
Carpal tunnel syndrome
o Median nerve at wrist is injured
o Carpal tunnel: all extrinsic flexors and median nerve go through
 Radial synovial sheath, ulnar synovial sheath
 Transvers carpal sheath (trapezium  pisiform)
 Sits on top of lunate, scaphoid and triquetrum
 Ulnar nerve sits on tom of transverse carpal sheath
 Lumbricals and interossei can crowd it
Colditz pinch test: tearing paper-keep “o” shape with thumb and digit 1
o If not have weak abductor pollicis
Craig’s test: tests femoral torsion (wherever greater trochanter is most lateral)
Lumbar laminectomy: removal of part of vertebra to relieve pressure put on spinal cord and nerves
Boxer’s fracture: 5th metacarpal
o Never external fixate 5th MC (only fixate 2nd and 3rd for more stability)
Skier’s thumb: dislocation of MCP joint
Trigger finger: cutting A1 pulley
Claw hand: injury to ulnar nerve-fixed position at rest, digits 2 & 3 are extended, digits 4 &5 flexed
Ape hand: median n injury at wrist-thenar muscles don’t work; thumb pulled into same plane as digits 2-5
Sign of benediction: median n injury at elbow; when trying to make fist, only digits 4 and 5 flex; when
relaxed hand looks normal
Slipped capital femoral epiphysis: upper end of thigh bone slips at growth plate and does not fit in hip
socket correctly
Legg-calve Pertries disease: decreased blood flow to head of femur which affects bone as seen on x-ray and
MRI of child
Femoral anteversion: knees and feet to turn inward “pigeon toed” appearance
Developmental dysplasia of hip: with development of hip; top of femur does not fit correctly into hip socket
so femur can partially or completely slip out of socket
Scoliosis: Cobb angle >10 degrees, curvature results in side-bending and rotation