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114 Cards in this Set
- Front
- Back
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What is vector composition?
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calculating the magnitude and direction of the sum of several forces
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What is vector resolution?
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calculating the forces that are produced directly on the joint surface (ie-compression, distraction and shearing, or sliding)
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What is the purpose of intra abdominal pressure in lifting?
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`a structure under pressure is relatively stiff; it resists bending (flexion) more than an unpressurized structure.
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What 3 mm can contract to increase intra abdominal pressure (IAP)?
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internal oblique, transverse abdominis, latissimus dorsi
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How do the Internal oblique, transverse abdominis and latissimus dorsi increase IAP?
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flatten the lower abdominal wall
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What is the main law used in breathing?
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air will flow from an area of high pressure to an area of lower pressure
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What is the ideal gas law?
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PV=nRT
R=gas constant T=temp n=number of moles of gas P=absolute pressure of gas V=volume of gas |
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What are some implications of the ideal gas law?
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*at a given temp, (pressure x volume) is a constant quantity
*pressure and volume vary inversely |
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What is Boyle's law?
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The volume occupied by a gas is inversely proportional to the pressure exerted by the gas. Therefore, increasing the volume lowers the pressure of the contained air
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How do we apply Boyle's law to breathing?
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when we contract our mm (diaphragm, scalenes, intercostals) we are increasing the volume of the chest cavity, thus we lower the pressure of the chest cavity-->causing the inflow of air from area of high pressure to area of low pressure
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What is the difference between quiet and forced expiration?
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quiet: mm of inspiration relax, and intra thoracic volume is decreased by elastic recoil
forced: requires the use of additional mm like the abs |
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What surface landmark is used to find the posterior inferior boundary of the lung?
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Spinous process of T10
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Where, in relation to the spine, is the base of the scapular spine?
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T4
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Where, in relation to the spine, is the inferior angle of the scapula?
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T8
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What surface landmark is used to find the anterior, inferior boundary of the lung?
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xiphoid process
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In which ways does the rib cage move during inspiration? expiration/
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inspiration: elevates and expands
expiration: descends and contracts |
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At what joint is rib cage movement occurring in?
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the costovertebral joint (2 articulation)
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What lig encapsulates the articulation between the vertebral body and the rib neck?
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radiate lig
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What lig encapsulates the articulation between the rib's angle and the transverse process?
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costotransversa lig
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In which direction do the most superior ribs move during inhalation?
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anterior
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In which direction do the most inferior ribs move during inhalation?
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lateral
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How is the movement of the ribs similar to the rotation of a bucket handle?
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during inspiration the shaft of the ribs elevates in a path perpendicular to the axis of rotation, and is attached in both the anterior and posterior ribs are attached to other bones.
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what mm are used during inspiration in quiet breathing?
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diaphragm
scalenes external intercostals |
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What mm are used during expiration in quiet breathing?
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elastic recoil of lung tissue
surface tension gravity on ribs internal intercostals |
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What mm are used during inspiration in forced breathing?
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sternocleidomastoid
pect major pect minor serratus anterior serratus post superior upper iliocostalis |
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What mm are used during expiration in forced breathing?
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abs (rectus, int, ext)
lower iliocostalis lower longissimus serratus posterior inferior |
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What is another name for all of the muscles used in forced breathing?
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secondary (accessory) respiratory mm
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In what position do secondary respiratory mm work best?
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closed chain; therefore, put hands on knees or behind head when try to catch breath
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When are accessory mm of inspiration used?
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in healthy ppl to incr. rate and volume of air
ppl w/ only partial inn. of diaphragm ppl w/ COPD |
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What N innervates the diaphragm?
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Phrenic N (C3, 4, 5)
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Which root of the phrenic n (C3, 4, or 5) is the primary innervation, and is necessary to be intact to allow for independent breathing?
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C4
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What performs 70-80% of inspiration?
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diaphragm
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What causes the lower ribs to expand laterally in inspiration?
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as diaphragm contracts, increases intra abdominal pressure which eventually stops downward descent of diaphragm and therefore lower 2 (floating ribs) expand out
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What is another name for ppl w/ COPD?
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blue bloaters
due to bluish color of lips |
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What is another name for ppl w/ emphysema (a form of COPD)
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pink puffers
bc pts puff to oxygenate their blood and this gives them a reddish complexion |
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What are some symptoms of COPD?
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continual inflammation and narrowing of the bronchioles, chronic cough, mucous filled airways.
Eventually alveolar walls become overdistended and slowly destruct causing loss of elastic recoil Finally, develop right sided heart failure |
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How do ppl w/ COPD make up for lack of air?
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use mm of forced inspiration, stand/sit with arms fixed
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What occurs during rt sided heart failure?
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rt ventricle is unable to pump blood to the lungs and then back to L ventricle leading to insufficient oxygen reaching blood and venous swelling
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What causes emphysema?
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COPD caused by exposure to toxic chemicals, incl cigarettes
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What are symptoms of emphysema?
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loss of elasticity of lung, destruction of alveolar walls, shortness of breath
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How do ppl w/ emphysema compensate for lack of oxygen
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"puffing" or incr breathing rate
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What are more severe symptoms of emphysema?
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arteries in lungs begin to constrict and the heart has to work harder to push blood into the lungs, over time this extra work will cause heart failure
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What is paradoxical breathing?
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When diaphragm still works, but other mm of inspiration and forced expiration leading to the constricting of the rib cage (instead of expanding) during inhalation.
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People w/ which injury are most likely to have paradoxical breathing?
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spinal cord injury just below C4
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What are the 4 joints of the shoulder?
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sternoclavicular
acromioclavicular scapulothoracic "joint" glenohumeral |
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How many axises does each joint of the shoulder have?
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SC: 3
AC: 3 Scapulothoracic: 3 GH: 3 |
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Which joint is not a true anatomical joint?
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scapulothoracic
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Why is the scapulothoracic "joint" not a joint?
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no articulation, but rather a translation between the ant part of scapula and post ribs that allow for 3 degrees of movement
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What are the 3 degrees of freedom at the scapulothoracic joint?
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1: elevation/depression
2: adduction/abduction 3: anterior/posterior (not seen in normal scapular movement) |
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What are the 3 degrees of freedom for rotatory motion?
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scapular winging around vertical adis at AC joint (abnormal)
scapular tipping around lateral axis at AC joint (abnormal) scapular upward and downward rotation around an A-P axis either through the AC or SC joint (normal during flex, abduct, and scaption) |
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What is scapulohumeral movement?
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shoulder elevation involves scapular movement at scapulothoracic joint and humeral movbement at the GH joint.
Describes the timing of movement at these joint during shoulder elevation |
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What is involved during the first 30 degrees of shoulder elevation/
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"setting phase," movement in largely GH
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What is involved after the first 30 degrees of shoulder elevation?
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GH and scapulothoracic joints move in 2:1 ratio
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What are 2 purposes of scapulohumeral rhythm?
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1. preserves the length-tension relationships of GH mm
2. prevents impingement between the humerus and acromion |
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What are scapular upward rotators during 30-90 degrees of movement??
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Upper trap
Serratus anterior (SC joint) |
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What are scapular upward rotators after 90 degrees of movement?
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lower trap
serratus ant (AC joint) |
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What mm are downward rotators?
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rhomboids
levator scapulae |
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What mm are scapular depressors?
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pect minor (ant)
lower trap (post) |
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What mm are scapular elevators?
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upper trap
levator scapulae |
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What kind of joint is the SC joint?
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saddle (sellar) joint w/ intra-articular disk
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What are important ligs of SC joint?
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interclavicular lig (connects clavicles)
sternoclavicular lig (stabilizes sternal end of clavicle) costoclavicular lig (contribute to scapular rhythm and prevents extreme elevation of clavicle) |
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What occurs around the SC joints A-P axis?
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clavicular elevation and depression
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What occurs around the SC joints verticle axis?
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clavicular protraction and retraction
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What occurs around the SC joints longitudinal axis
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clavicular backward and forward rotation
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What are the ligaments of the AC joint?
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acromioclavicular lig (stabilizes acromial end of clavicle)
coracoclavicular lig (prevents AC joint separation |
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What is the main purpose of the AC joint?
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allows the scapula to move in 3 dimensions so that it follows the contours of the ribcage (saddle joint)
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What are the 2 joints that attach the scapula to the axial skeleton that must be free to allow normal scapular movement?
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SC and AC joint
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Where are the coracohumeral ligs located?
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extend from inferior side of the coracoid to the greater tuberosity and lesser tuberosity of humerus
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What do the coracohumeral ligs form?
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part of the roof of the biceps sheath
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What do the coraco humeral ligs do?
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prevent adduction, inferior translation, and external rotation in GH joint, and provides stability to the long head of the biceps tendon
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What ligs are the primary restraints to posterior translation w/ arm flexed, adducted and internally rotated (reflex position during fall)?
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superior glenohumeral lig and coracohumeral lig
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What does the anterior band of the coracohumeral lig limit?
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GH extension
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What does the posterior band of the coracohumeral lig limit?
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GH flexion
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What does the superior GH lig limit?
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inferior and AP translation when taut in full adduction
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What does the middle GH lig limit?
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anterior restraint to GH joint in 45-60 degrees of abduction, limits extremes of external rotation
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What does the inferior GH lig further divide into?
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3 bands: anterior, posterior and axillary pouch
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When does the inferior GH lig become taut?
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in 90 degrees of abduction
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What is the function of the inferior GH lig?
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acts as a sling and supports the suspended humeral head (cradle to resist inferior and AP translation), Anterior and posterior bands become taut in external and internal rotation respectively
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Why is the anterior band of the IGHL very important?
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primary lig restraint to anterior translation of the HOH in abducted and neutral positions
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What does the transverse humeral lig contain?
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crosses the bicipital groove and contains the tendon of the long head of the biceps w/in groove
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What is the glenoid labrum?
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a fibrocartilaginous rim attached around the margin of the glenoid cavity
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What is the glenoid labrum continuous with?
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continuous above with the tendon of the long head of the biceps, which gives off 2 fasciculi to blend w/ the fibrous tissue of the labrum
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What is the purpose of the glenoid labrum?
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deepens the articular cavity, and protects the edges of the bone
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What is contained w/in the subacromial region?
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subacromial bursae, supraspinatus tendon, and long head of biceps tendon
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Which area is at huge risk for impingement if GH joint biomechanics are impaired?
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subacromial region
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During abduction, the humerus' greater tubercle will impinge on the coracoacromial lig or the acromion process unless the humerus does what?
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externally rotates
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What ligament helps prevent impingement of the greater tubercle on the coracoacromial lig? how?
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glenohumeral lig tightens when we abduct and leads to ER of the humerus
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What mm are used to avoid impingement during GH Abduction/
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infraspinatus and teres minor (externally rotate)
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What mm avoid impingement of the subacromial region during GH flexion, abduction, and scaption?
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infraspinatus, teres minor, subscapularis (glide humeral head downward and HOH rolls upward)
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What are the closed pack positions of the GH joint?
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horizontal abduction and external rotation
flexion and internal rotation |
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What is the "T" in The Shoulder Rules?
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Thoracic spine: in order for the shoulder joint to move properly, the thoracic spine must be in full extension
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What is the "S" in The Shoulder Rules (TSR)?
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Scapula: during shoulder elevation (flex, abduct, scaption), the scapula must rotate upwardly around 2 axes.
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How does excessive thoracic spine kyphosis cause improper shoulder movement?
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it causes the scapula to become elevated, downwardly rotated, and abducted on the thorax leading the glenoid fossa to tip downward and causing poor stability
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What does the clavicle do as the scapula rotates upward?
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clavicle elevates
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What causes clavicular elevation to cease?
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the costoclavicular lig become taut,
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What ceases upward rotation at the AC joint?
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the coracoclavicular lig becomes taut and pulls on the clavicle causing backward rotation
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How does clavicular backward rotation give the scapula addition ROM on the thorax?
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it elevates the clavicle's distal end
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What does the "R" of The Shoulder Rules (TSR) stand for?
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Rotator cuff:
Supraspinatus Infraspinatus Teres Minor Subscapulares "Sits" mm |
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Which rotator cuff mm is the "carrying" mm?
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Supraspinatus bc its line of pull approximates the HOH into the glenoid fossa
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FUNCTION supraspinatus mm
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abduct GH joint through the first 10-15 degrees of motion, approximates HOH
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FUNCTION Infraspinatus & Teres Minor
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assist in gliding the HOH inferior during GH flexion, abduction, and scaption
External rotators approximate HOH in glenoid fossa |
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FUNCTION subscapularis
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glide HOH inferior in GH flex, abduct, and scaption
approximates HOH in glenoid fossa |
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Why are The Shoulder Rules important?
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The deltoid (major mover of GH joint) causes upward glide of HOH during flexion and abduction. Therefore need these rules to function to prevent impingement
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GH joint flexors
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long head of biceps brachii
coracobrachialis anterior deltoid |
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GH joint extensors
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triceps brachii
latissimus dorsi teres major |
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GH joint abductors
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supraspinatus (first 10-15 degrees)
Middle Deltoid |
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GH joint internal rotators
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pectoralis major
latissimus dorsi subscapularis |
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GH joint external rotators
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infraspinatus
teres minor |
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GH joint scaption mm
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deltoid
supraspinatus |
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What must you pay attention to when using GH flexion, abduction, and scaption
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scapular upward rotation (or else will cause impingement
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What movement occurs at the scapula during GH adductiona nd extension?
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downward rotation
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What mm are important for downward rotation of the scapula?
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rhomboids
latissimus dorsi teres major |
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What sort of movements require GH extensior or adduction?
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closed chain (pushing up off of chair)
**open chain: rowing/sawing |
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What are all endfeels at the GH joint?
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ligamentous
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