Enrico C. Aguila

OTPT 102: Applied Anatomy and Kinesiology

August 19, 2009

• Joints of the upper extremity

• Motions available at each joint

• Muscles responsible for each motion

• Special considerations for each joint• Special considerations for each joint

• Types of muscle contraction

• Concepts related to muscle strength

• Sternoclavicular

• Acromioclavicular

• Scapulothoracic

• Glenohumeral (shoulder)• Glenohumeral (shoulder)

• Elbow

• Radio-ulnar joints (forearm)

• Radiocarpal (wrist)

• Thumb and finger joints

• False/ Functional Joint

• Functions:– Increases the ROM of the arm

– Maintains favorable length-tensionrelationships for the deltoid musclerelationships for the deltoid muscle

– Provides stability to the GH joint

– Provides shock absorption for forcesapplied to the outstretched arm

– Permits elevation of the body for crutch-walking and sitting push-ups

Elevation (600)

Depression (50 – 100)Depression (5 – 10 )

Protraction (scapularabduction)

Retraction (scapularadduction)

Serratus Anterior

Trapezius

Rhomboid major and minor

Pectoralis minorSerratus AnteriorTrapezius

Serratus Anterior

Trapezius

• Sellar joint with 3 degrees offreedom

• Movements

– Elevation (300 - 450)– Elevation (30 - 45 )

– Depression (50 - 100)

– Protraction (150)

– Retraction (150)

– Transverse rotation (400)

• 3 axes and 3 degrees of freedom

• Motions are reflected in scapularelevation, abduction and rotation

– Full arm elevation - 200 of scapular– Full arm elevation - 20 of scapularelevation and 200 of upward rotation

– 80 maximum acromioclavicular motion

• Permit scapular movement so thatthe glenoid fossa may face forward,upward or downward while thecostal surface remains close to thethoraxthorax

• 1st 300 of abduction – variable

• 300 - 1700: 2:1 ratio between the GHand ST joints

•• A regular pattern of scapular rotationA regular pattern of scapular rotation

that accompanies and facilitatesthat accompanies and facilitates

humeral abductionhumeral abductionhumeral abductionhumeral abduction

•• ScapulothoracicScapulothoracic :: glenohumeralglenohumeral jointjoint

movements =movements = 11::22

• Abduction

• Adduction

• Flexion

• Extension• Extension

• Internal Rotation

• External Rotation

• Horizontal Abduction

• Horizontal Adduction

• Flexion

• Extension

• Elbow flexion with shoulderextension

• Elbow extension with shoulderflexionflexion

• Elbow flexors

– Biceps

– Brachialis

– Brachioradialis

• Pronation

• Supination

• Radiocarpal Joint

– Radius + scaphoidand lunate

• Midcarpal Joint

– Proximal and– Proximal anddistal rows ofcarpal bones

• Carpometacarpaljoints (CMC)

• Flexion

• Extension

• Radial deviation (abduction)

• Ulnar deviation (adduction)• Ulnar deviation (adduction)

• Condyloid

• 2 degrees of freedom

• Accessory motions

• Formed by the trapezium and base of1st metacarpal

• Saddle Joint• Movements

– Flexion– Flexion– Extension– Adduction– Palmar abduction– Radial abduction– Opposition

• Flexion

• Extension

• MCP

– Flexion

– Extension

– Adduction

– abduction– abduction

• PIP and DIP

– Flexion

– Extension

• Opposition of little finger

• Tenodesis

• Ligaments

• Stable and mobile components

• Thumb and finger movements• Thumb and finger movements

• Positions of the hand

• Prehension patterns

• Grip and pinch strength

• Synergistic contractions

• Concentric

• Eccentric

• Isometric

Concentric

Quickagainstgravity

Slowagainst

Quickgravity Concentric against

gravity

On gravitydecreased

plane

gravityassisted

Slow

Eccentric

Bringingdown aheavyobject

Eccentric

Position ismaintainedvs. gravity

Isometric

Whenhand isholding

something

Pushingvs.

immovableobject

• Movements against gravity

• Movements in the gravity decreasedplane

• Movements assisted by gravity• Movements assisted by gravity

• Movements against resistance

• Movements against no resistance

• Passive ROM

• Active ROM

• Goniometry

• Functional Testing• Functional Testing

TaskTask

PersonPerson

EnvtEnvt

MovementMovement

TaskTask EnvtEnvt

• Identify the steps of the activity

• Identify the joint motions involved ineach of the steps

• Identify the muscles for each motion• Identify the muscles for each motion

• Describe the effects of gravity and orresistance– Gravity resisted– Gravity assisted– No effect– Against resistance– Against resistance– No resistance

• Identify type of muscle contraction beingperformed by each muscle

• Estimate the range of motion required foreach movement

• Sanding a piece of wood in standing

– Steps• Bringing the sander forward

• Bringing the sander backwards

MotionsMotions Range ofRange ofMotionMotion

PrimaryPrimaryMusclesMuscles

Effect ofEffect ofGravityGravity

ResistanceResistance Minimal StrengthMinimal StrengthRequiredRequired

Type of ContractionType of Contraction

•• AssistedAssisted

•• ResistedResisted

•• No effectNo effect

••NormalNormal

••GoodGood

••Fair plusFair plus

••FairFair

••PoorPoor

••ConcentricConcentric

••EccentricEccentric

••IsometricIsometric

••PoorPoor