OT103: Lec 4

• Shoulder Complex


  • Permits upper extremity movement and weight-bearing for functional activities
  • More mobility over stability
  • Muscles and ligaments
  • Injuries cause problems in movement
• Sternoclavicular Joint

  Closed-pack position: full arm abduction/elevation
• Movements of Sternoclavicular Joint

  1. Elevation-depression

  2. Protraction-retraction

  3. Posterior rotation

  
• Convex-concave Principle

  Principle 1: convex joint moves with concavity (opposite direction)

  Principle 2: concave joint moves with convexity (same direction)
• Motions of SC Joint

  1. Elevation: Superior roll - inferior slide

  2. Depression: Inferior roll - superior slide

  3. Protraction: Anterior roll - anterior slide

  4. Retraction: Posterior roll - posterior slide

  
• Acromioclavicular Joint


  • Maintains contact of scapula with thorax by fine tuning scapular motions mainly provided by SC joint
  • Enables transmission of forces from upper arm to the axial skeleton
  • Plane synovial joint

  
• Movements of Acromioclavicular Joint

  1. Anterior-Posterior Tilting: Accompanied by anterior-posterior rotation of clavicle at both AC and SC joints

  2. Internal-External Rotation: Medial-lateral tilting

  3. Upward-Downward Rotation: UR of scapula-Medial translation
• Scapulothoracic Joint


  • False joint
  • Functional joint
  • Provides shoulder region stability
  • Increases ROM of shoulder
  • Permits elevation of body

  
• Movements of Scapulothoracic Joint

  1. Elevation: depression of scapula moving on the thorax

  2. Protraction

  
• Glenohumeral Joint


  • Most freely moving joint
  • Little bony stability, supports: ligaments and tendons
  • Ball-and-socket joint

  
• Firm end feels


  End range of motion, firm: May lumalaban na firm ligaments & muscles (stretched), Example: When there is external rotation on shoulder; SITS muscles and surrounding ligaments are fully stretched
• Soft end feels


  Example: Shoulder flexion
• Bony-end feels


  Bone-to-bone contact; normal, Example: Knee extension

  
• Movements of Glenohumeral Joint

  1. Flexion-extension

  2. Abduction-adduction

  3. Internal-external rotation (M-L rotation)

  4. Horizontal abduction-adduction

  5. Scaption: Sh abduction in scapular plane (30-40 deg. ant to frontal plane), Most functional shoulder abduction motions occur in scapular plane, Evaluation of sh abduction
• Motion of Humerus


  1. Flexion: Minimal roll, Anterior slide (at higher)

  2. Extension: Posterior roll (spinning on Glenoid fossa), Anterior slide (post. at higher)

  3. Horizontal Abd: Posterior roll, Anterior slide

  4. Horizontal Add: Anterior roll, Posterior slide

  5. Ext. Rotation: Posterior roll, Anterior slide

  6. Int. Rotation: Anterior roll, Posterior slide

  7. Abduction: Superior roll, Inferior slide

  8. Adduction: Inferior roll, Superior slide
• Subacromial Space


  • Below acromion, above GH joint, Functional joint, Contains: Bursa: subacromial and subdeltoid bursa, Supraspinatus –tendon and muscle portion, Biceps tendon, A lot of impingements happen due to the acromion process

  
• Scapulohumeral Rhythm


  GH motion + scap rotation shoulder flexion/abduction with elevation, 150-180o, 2:1, variable, More ROM with stability, Increased joint congruency Minimizes active insufficiency
• Phases of Scapulohumeral Rhythm

  1. Setting (0-30 degrees abduction)

  2. Mid-range (30-90 degrees abduction): 60 degrees GH, 30 degrees ST

  3. End-range (90-180 degrees): 120 degrees GH, 60 degrees ST
• Deltoid-Rotator Cuff Mechanism


  Deltoid causes upward translation of humerus + short rotator cuff muscles causes downward translation = balanced forces that abduct humerus and control humeral head, Interruption: tissue trauma, shoulder dysfunction, Deltoids (superior roll) + SITS muscles (slide, helps with making the humeral head to be more congruent with the glenoid fossa)
• Elbow Joint


  • Humeroulnar joint, Humeroradial joint, Uniaxial hinge joint -> one degree of freedom: Flexion-extension

  
• Elbow ROM

  • Flexion: 145 degrees (variable range: 120-160 degrees), Range reduced when FA not in full supination, Soft end-feel, Functional range (used in daily activity): 30-130 degrees
  • Extension: 0 degrees, Hard end-feel
• Valgus Stress


  Medial ligaments are stressed, Outward force (lateral to medial)
• Varus Stress


  Lateral ligaments are stressed, Inward force (medial to lateral)
• Radioulnar Joint


  • Proximal + distal, One degree of freedom: Supination (90 degrees) + Firm end feel, Pronation (80-90 degrees) + Hard/firm end feel, Ulna serves as a rigid base -> FA and wrist function, Ulna stationary while radius pivots during movement, Hand and wrist connect to radius while ulna is stationary, Wrist and hand muscles provide stability but no motion to elbow; connected to humeral epicondyles
• Wrist Joint


  • Radiocarpal, Midcarpal, Stability: ligaments, muscles, Biaxial: Flexion (volar) - mostly in RCJ's axis, Extension (dorsi) - mostly in MCJ's axis, Radial deviation (abduction), Ulnar deviation (adduction)

  
• Coupling


  Flexion: with slight UD and supination, Extension: with slight RD
• Wrist Muscles

  Antagonists: Flexion-extension: FCU vs ECU, FCR vs ECRL, Synergists: Ulnar deviation: FCU + ECU, Radial deviation: FCR + ECRL
• Hand Joints

  • Carpometacarpal joints (2nd - 5th digits): Flexion (incr arch) - extension (dec arch), Varying ROM: 5th - most mobile, 3rd-least mobile, Metacarpophalangeal joints: Condyloid, 2 degrees of movement: Flexion-extension, abduction-adduction, Interphalangeal joints (DIP + PIP): Hinge, 1-degree of freedom: Flexion-extension
• Tenodesis


  Wrist extension - finger flexion, Wrist flexion - finger extension, Provides grasping mechanism
• Grip Strength

  Influenced by position of the wrist: 30 - 40 degrees wrist extension, 3x greater grip > wrist flexed 40 degrees; maximal grip strength achieved without compromising grip endurance, Implications on optimal positions for orthosis, Wrist flexion has twice the work capacity than wrist extension, Radial deviation has slightly higher work capacity than ulnar deviation

  
• Functional Hand Position

  Wrist: Extension 20 degrees, UD 10 degrees, Hand: MCP flexion 45 degrees, PIP flexion 30 - 45 degrees, DIP flexion 10 - 20 degrees

  
• Intrinsic Hand Positions


  • Power Grip
  • Hook Grip
  • Cylindrical Grip
  • Spherical Grip
  • Fist Grip
  • Lateral Prehension
  • Precision Grip
  • Lateral Pinch Grip
  • Three-Prong Chuck
  • Tip to Tip Grip
  • Pad to Pad Grip

  
• Power Grip


  Full-hand prehension

  Partially flexes fingers and palm

  Thumb is adducted or in opposition (Counterpressure maintain grip and stabilize object, Except for hook grip)

  Isometric

  
• Hook Grip


  Carry or support an object, Uses palm and 2nd to 5th digits; thumb is not in use, FDS, FDP (for load carried more distally)

  
• Cylindrical Grip


  For cylindrical objects, Fingers and palm flexed to grasp around object; adjacent and parallel to each other, Thumb position varies, usually flexed and adducted, Wrist in neutral flex/ext, UD, FDP, FDS (more force), interossei

  
• Spherical Grip


  For round objects, Greater spread of fingers, not parallel, MCP joints abducted, partially flexed, Thumb position varies, in opposition and flexed at MCP and/or IP, FDS, FDP, thenar muscles, more interossei activity, ED contracts against flexor force for controlled release of object

  
• Fist Grip


  Digital palmar prehension pattern, Closing of fist over a comparatively narrow object, Fingers usually parallel to one another, Thumb adducted against object/opposition to fingers, FDP, FDS

  
• Lateral Prehension

  Extensor muscle predominate, Not powerful, not used in in-hand manipulation, Object held in between extended fingers
• Precision Grip


  Accuracy and fine touch, Finger-thumb precision, Flexor surface of finger/s, Thumb abducted, positioned against pulp of fingers (except lateral pinch)

  
• Lateral Pinch Grip

  Key grip-least precise, Contact between thumb pad and radial index finger, FDP, FDS, 1st dorsal interossei, FPL, FPB, AdP, Used person with hand paralysis-tenodesis