Human Movement Exam 3: The Master Blaster

Front 1

Elbow joint axis

Back 1

lateral

(through the Medial and Humeral Lateral Epicondyles)

Front 2

Elbow joint movments

Back 2

Flexion/Extension

Front 3

close packed position of elbow

Back 3

extension

Front 4

Radio-ulnar joint axis

Back 4

oblique line that connects the superior and inferior radio-ulnar joints

Front 5

radio-ulnar joint motion

Back 5

pronation/supination

Front 6

Humero-Ulnar Joint in an Open Chain

Back 6

The concave ulnar surface rolls and glides in same direction on convex humeral surface.

Front 7

Humero-Ulnar Joint in a Closed Chain

Back 7

The convex humeral surface rolls and glides in opposite directions on the concave ulnar surface

Front 8

arthrokinematics during Open Chain Elbow Extension

Back 8

The ulna rolls and glides posteriorly on humerus while
radius moves distally
ulna and radius spread apart
ulna and radius pronate with respect to each other.

Front 9

arthrokinematics during Open Chain Elbow Flexion

Back 9

The ulna rolls and glides anteriorly on humerus while
radius moves proximally
ulna and radius move closer together
ulna and radius supinate with respect to each other

Front 10

elbow flexors

Back 10

Extensor Carpi Radialis Longus
pronator teres
flexor carpi radialis
palmaris longus
biceps
brachialis
Brachioradialis

Front 11

elbow extensors

Back 11

triceps
anconeus

Front 12

forearm pronators

Back 12

Pronator Quadratus
Pronator Teres
Flexor Carpi Radialis

Front 13

forearm supinators

Back 13

Supinator
Biceps
(Extensor Pollicis Longus)
(Extensor Indicis)

Front 14

Carpal muscles that act at the wrist and, in some cases, the elbow

Back 14

EXTENSOR CARPI RADIALIS LONGUS
EXTENSOR CARPI RADIALIS BREVIS
EXTENSOR CARPI ULNARIS
FLEXOR CARPI RADIALIS
FLEXOR CARPI ULNARIS
PALMARIS LONGUS

Front 15

Extrinsic hand mm that act on the second through fourth digits:

Back 15

EXTENSOR DIGITORUM
EXTENSOR INDICIS (PROPRIUS)
EXTENSOR DIGITI MINIMI (PROPRIUS)
FLEXOR DIGITORUM SUPERFICIALIS
FLEXOR DIGITORUM PROFUNDUS

Front 16

Extrinsic thumb muscles that act on the first digit:

Back 16

FLEXOR POLLICIS LONGUS
EXTENSOR POLLICIS LONGUS
EXTENSOR POLLICIS BREVIS
ABDUCTOR POLLICIS LONGUS

Front 17

Intrinsic hand muscles that act only on the digits

Back 17

THENAR MUSCLES and ADDUCTOR POLLICIS
HYPOTHENAR MUSCLES
LUMBRICALES
DORSAL INTEROSSEI
PALMAR INTEROSSEI

Front 18

close packed position of wrist

Back 18

extension

Front 19

Radial and Ulnar Deviation occur around an axis through

Back 19

through the head of the capitate

Front 20

Wrist flexion and extension occurs around an axis that

Back 20

migrates distally during extension. Although your text states (obviously correctly) that the axis passes through the capitate, we will use the scaphoid as our landmark during labs as it is palpable and marks the more distal component of the capitate

Front 21

during open chain wrist flexion

Back 21

The scaphoid/lunate roll anteriorly (toward palm) and glide posteriorly (toward dorsum)

Front 22

during open chain wrist extension

Back 22

The scaphoid/lunate roll posteriorly(toward dorsum) and glide anteriorly (toward palm).

Front 23

during ulnar deviation arthrokinematics

Back 23

The scaphoid/lunate roll toward ulna and glide toward radius

Front 24

during radial deviation arthrokinematics

Back 24

The scaphoid/lunate roll toward radius and glide toward ulna.

Front 25

5 pillars of the wrist

Back 25

1. Extensor Carpi Radialis Longus (ECRL)
2. Extensor Carpi Radialis Brevis (ECRB)
3. Extensor Carpi Ulnaris (ECU)
4. Flexorr Carpi Radialis (FCR)
5. Flexor Carpi Ulnaris (FCU)
(Palmaris Longus is the sixth man)

Front 26

shared fxn of wrist pillars

Back 26

These wrist muscles are responsible for stabilizing the wrist during all hand and finger movements, and allowing fine motor activity in the fingers

Front 27

wrist pillars that extend wrist

Back 27

extensor carpi radialis longus
extensor carpi radialis brevis
extensor carpi ulnaris

Front 28

wrist pillars that flex wrist

Back 28

Flexor Carpi radialis
Flexor Carpi Ulnaris
palmaris longus

Front 29

wrist pillars ulnar deviators

Back 29

flexor carpi ulnaris
extensor carpi ulnaris

Front 30

wrist pillars radial deviators

Back 30

flexor carpi radialis
extensor carpi radialis longus
extesnor carpi radialis brevis

Front 31

What is the role of the wrist extensors (ECRB, ECRL, ECU) when you make a tight fist or firmly grab an object?

Back 31

Maintain appropriate length and tension (force) in finger flexors so they can produce strong grip

Front 32

Open your fingers forcefully and observe that the wrist flexes automatically…WHY??

Back 32

The role of the wrist flexors (FCU, FCR) is to maintain appropriate length and tension in finger extensors they can forcefully open the hand.

Front 33

Palpate the Extensor Carpi Ulnaris as you quickly move the thumb away from the second digit. Why is the ECU active during this maneuver?

Back 33

-Abductor Pollicis Longus and Extensor Pollicis Brevis move thumb but also radially deviate wrist;

-The Extensor Carip Ulnaris thus acts as a true synergist in that it ulnarly deviates the wrist.

Front 34

Carpal tunnel contains

Back 34

-Flexor Carpi Radialis tendon
-Flexor Pollicis Longus tendon
-Median Nerve
-tendons of Flexor Digitorum Superficialis and Flexor Digitorum Profundus
-Vascular structures

Front 35

What causes carpal tunnel syndrome?

Back 35

-Repetitive motion can produce a tenosynovitis in the tendon sheaths of the long flexor muscles.

-This, in turn, can increase hydrostatic pressure in the tunnel, causing compression damage to median nerve

Front 36

carpal tunnel syndrome's impairments

Back 36

-pain and paresthesia in the distribution of the median nerve.
-weakness of muscles innervated by the median nerve, the thenar muscles, and the first and second lumbricales

Front 37

CMC joint close packed position

Back 37

You cannot passively rotate the CMC when you place it in full opposition or full reposition; these are the CMC joint's close packed positions. In these positions, the capsular fibers are maximally elongated and taut, and so prevent CMC rotation

Front 38

extensor mechanism of the thumb receives fibers from

Back 38

-abductor pollicis brevis (median nerve)
-adductor pollicis (ulnar nerve)
-ulnar head of flexor pollicis brevis / first palmar -interosseous (ulnar nerve)
-extensor pollicis longus (radial nerve)

Front 39

tendons which make up anatomical snuff box

Back 39

The Abductor Pollicis Longus and the Extensor Pollicis Brevis (radial border).
The Extensor Pollicis Longus (ulnar border)

Front 40

3 thenar muscles and basic fxn

Back 40

Abductor Pollicis Brevis
Flexor Pollicis Brevis
Opponens Pollicis

Position thumb for grasping

Front 41

abductor pollicis brevis action and insertion

Back 41

Abducts the CMC and MCP joint

extends the IP joint of the thumb via extensor expansion

Attaches to the trapezium and to base of the first proximal phalanx; crosses MCP and CMC joints

Front 42

flexor pollicis brevis action and insertion

Back 42

Proximal phalanx of thumb

Flex metacarpaphalangeal and carpometacarpal joints of the thumb

Assists in opposition.

Front 43

opponens pollicis action and insertion

Back 43

shaft of first metacarpal

Crosses only CMC joint; its oblique fibers abduct, flex, and rotate the CMC to oppose thumb to other digits.

Front 44

adductor pollicis action

Back 44

Adducts first MP joint by approximating 1st and 3rd metacarpals

Depending on the CMC's initial position, the Adductor Pollicis can flex the MP joint

Can assist with IP extension through its attachment to the thumb's extensor mechanism

Front 45

flexor pollicis longus action and insertion

Back 45

Base of distal phalanx of thumb

flexion to the IP, MCP, CMC, and wrist

radial abduction

Front 46

extensor pollicis longus attachments and actions

Back 46

-attaches proximally to ulna, and crosses wrist, CMC, MP, and IP joints.
-The extensor pollicis longus extends the IP, MCP, and CMC joints of the thumb. Because the muscle passes dorsal to the medial lateral axis of the CMC joint, it also causes adduction at that joint.
-radial deviation/wrist extension

Front 47

Extensor pollicis brevis attachment and action

Back 47

Attaches proximally to radius, its tendon passing through common sheath with that of APL, then attaches to base of proximal phalanx

extends the MCP and the CMC joints of the thumb

radially deviate wrist/wrist flexion

Front 48

abductor pollicis longus insertion and actions

Back 48

Base of 1st metacarpal – radial side

a prime abductor of the CMC joint

can also extend CMC joint

radial abduction and wrist flexion

Front 49

Rapid flexion of the thumb's IP joint involves the flexor pollicis longus (FPL), and is often accompanied by palpable activity in the abductor pollicis longus. The first CMC joint may even abduct. Why is the APL active?

Back 49

The APL activity counters FPL's tendency to flex the CMC joint in the plane of the palm

Front 50

Rapid extension of the thumb's IP joint involves the extensor pollicis longus (EPL), and is often accompanied by palpable activity in the thenar muscles. The first CMC joint may even flex in the plane of the palm. Why does this cause the opponens pollicis to activate?

Back 50

Activity in the opponens pollicis counters the EPL's tendency to extend the first CMC joint or adduct it in a plane perpendicular to the palm.

Front 51

The extensor carpi ulnaris is often active when the abductor pollicis longus is in use. Why?

Back 51

Since the APL also produces radial deviation of the wrist, the extensor carpi ulnaris (ECU) may also act to prevent wrist motion.

Front 52

power grasp definition and examples

Back 52

In a power grasp the adductor pollicis stabilizes an object against the palm; the hand's position is static.

Ex: grabbing a ball in palm, carrying a suitcase, pinching a floppy disc

Front 53

precision grasp definition and examples

Back 53

Muscles are active that abduct or oppose the thumb; the hand's position is dynamic.

Ex: holding a pencil, key-grip

Front 54

3 arches of the hand

Back 54

1. Proximal Transverse Arch (rigid)
2. Distal Transverse Arch (flexible, maintained by activity in the hand's intrinsic muscles)
3. Longitudinal Arch (same as #2)

Front 55

hand arches purpose

Back 55

The arches provide a balance between stability and mobility for grasping. For instance, we produce the so-called "chuck grasp" by using the more stable second and third metacarpals, instead of the more mobile fourth and fifth metacarpals.

Front 56

close packed position MP joint

Back 56

1st: extension

2 – 5: Flexion

Front 57

PIP and DIP close packed position

Back 57

extension

Front 58

MP joints arthrokinematics

Back 58

Because the proximal joint surface is convex and distal surface is concave…
Roll and glide occur in same direction
anterior glide occurs with MP flexion
posterior glide occurs with MP extension.

Front 59

IP joints arthrokinematics

Back 59

Because the IP proximal joint surface is also convex and the distal surface is concave…
roll and glide occur in same direction
anterior glide occurs with IP flexion
posterior glide occurs with IP extension

Front 60

2 muscles responsible for finger flexion

Back 60

Flexor digitorum profundus and flexor digitorum superficialis

Front 61

5 structures that compose extensor mechanism

Back 61

1. Muscle – The Extensor Digitorum Communis tendon (EDC)
2. central band (or "slip“, or “tendon”) of EDC (not contractile tissue)
3. two lateral bands
4. oblique retinacular ligaments (ORL)
5. The dorsal hood (aka dorsal aponeurosis or aponeurotic sleeve)

Front 62

Extensor Digitorum Communis tendon (EDC) fxn

Back 62

extends the metacarpophalangeal joints.

Front 63

central band fxn

Back 63

tension is placed into this central tendon or slip, that tension can extend the PIP joint

Front 64

lateral bands fxn

Back 64

tension in the lateral bands extend the DIP joints.

Front 65

oblique retinacular ligaments fxn

Back 65

purpose is to coordinate movement between the PIP and DIP joints

Front 66

dorsal hood fxn

Back 66

The lumbricales and interossei attach into the
extensor mechanism via the oblique and
transverse fibers of the dorsal hood and assist
the EDC with extension of the PIP and DIP joints

Front 67

Dorsal interossei actions

Back 67

The dorsal interossei produce MP abduction and, in certain instances, MP flexion. Because they attach to the extensor mechanism, they can also produce PIP and DIP extension

Front 68

palmar interossei actions

Back 68

They produce MP adduction and, in certain instances, MP flexion. They also produce PIP and DIP extension when they introduce tension into the extensor mechanism.

Front 69

indirect effect of hand opening of interossei

Back 69

: The production of a flexion torque at the MCP joint. This prevents the extensor digitorum from hyperextending the MCP joint – which is an action that would prematurely dissipate most of its contractile force.

Front 70

lumbricales action

Back 70

Acting alone, the lumbricales produce MP flexion, PIP and DIP extension, by introducing tension into the extensor mechanism.

Front 71

2 ways extensor mechanism works

Back 71

-activity in the intrinsic muscles that attach to the extensor mechanism always produces DIP and PIP extension.
-Passive flexion of the MP joint (try it yourself!) elongates the extensor mechanism and extends the PIP and DIP joints

Front 72

why are wrist flexors active during active finger extension?

Back 72

-maintain the optimal length of the EDC during active finger extension

-offset the large extension moment of the EDC at the wrist – thus allowing its action at the MCP joints instead.

Front 73

lordosis typically found in what spinal regions?

Back 73

cervical and lumbar

Front 74

kyphosis typically found in what spinal regions?

Back 74

thoracic and sacrococcygeal

Front 75

fryette's law #1

Back 75

lateral flexion and rotation occur in opposite directions (neutral mechanics- facets are not engaged or locked)

Only applies to lumbar and thoracic

Front 76

fryette's law #2

Back 76

if segments are fully engaged in flexion/extension then lateral flexion and rotatio occur in the same direction.

This always applies to cervical spine

Front 77

fryette's law #3

Back 77

if motion is reduced in one plane, motion in the other planes is reduced

Front 78

3 erector spinae muscles

Back 78

spinalis
longissimus
iliocostalis

Front 79

3 transversospinalis muscles

Back 79

multifidi
rotatores
semispinalis

Front 80

side bending right muscles contributions

Back 80

Initiated concentrically with right rectus abdominis, right internal oblique, right external oblique, right erector spinae group (superficial muscles) and right deep group (transversospinalis group)

Front 81

side bending left muscles contributions

Back 81

Initiated concentrically with left rectus abdominis, left internal oblique, left external oblique, left erector spinae group (superficial muscles) and left deep group (transversospinalis group)

Front 82

right rotation muscle contributions

Back 82

Initiated concentrically with right internal oblique, left external oblique, right erector spinae group (superficial muscles) and left deep group (transversospinalis group)

Front 83

left rotation muscle contributions

Back 83

Initiated concentrically with left internal oblique, right external oblique, left erector spinae group (superficial muscles) and right deep group (transversospinalis group

Front 84

trunk flexion muscle contributions

Back 84

Initiated concentrically with right and left rectus abdominis, right and left internal oblique, right and left external oblique

Front 85

trunk extension muscle contributions

Back 85

Initiated concentrically with right and left erector spinae group (superficial muscles) and right and left deep group (transversospinalis group)

Front 86

anterior pelvic tilt done using

Back 86

uses hip flexors and spinal extensors – therefore it increases lumbar lordosis.

Front 87

posterior pelvic tilt done using

Back 87

uses the hip extensors and abdominals - therefore it decreases the pelvic tilt – causing lumbar FLEXION

Front 88

When rolling to the right in an open chain (leading with your shoulders, moving the left shoulder forward and off the floor to rotate towards the right) gravity is resisting this motion by producing leftward rotation. Which muscles are used?

Back 88

concentrically use your use the: Right internal oblique, left external oblique, right erector spinae group (superficial muscles) and left deep group (transversospinalis group), and eccentrically use left internal oblique, right external oblique, left erector spinae group (superficial muscles) and right deep group (transversospinalis group

Front 89

Roll moving the pelvis first: When performing leftward rotation in a closed chain (the left side of the pelvis moves forward while the shoulders remain fixed on the bed), gravity produces backward rotation on the pelvis. Which muscles are used?

Back 89

Muscles that produce leftward rotation act concentrically. We know this activity occurs largely from the abdominals….however the trunk extensors also assist with rotation….so we use the: left internal oblique, right external oblique, left erector spinae group (superficial muscles) and right deep group (transversospinalis group), and the opposite groups of muscles eccentrically.

Front 90

While in a supine position, elevate your left lower extremity by flexing the left hip. If you palpate your anterior trunk muscles (abdominals), you'll note that they become active. Explain this muscle activity

Back 90

When you are supine and flex your left hip your pelvis is also brought into an interior pelvic tilt by your hip flexors. You need something that posteriorly tilts the pelvis for stability as a stabilizing synergy. You can use the abdominals to do so, or you can use the OTHER (left) hip extensor – which also produces a poster pelvic tilt

Front 91

While lying on the right side, abduct the left hip. You can palpate in the lower trunk muscle activity that is similar to what you observed in the previous problem. Explain this muscle activity

Back 91

When performing open chain hip abduction while side lying the hip abductor muscles are also pulling the pelvis caudally. Lateral abdominal muscles (probably mostly internal and external obliques on the abducting hip side) must act as stabilizers isometrically in order to counter the effects of the hip abductors on the pelvis

Front 92

How is scoliosis named? (left vs. right scoliosis)

Back 92

1) Scoliosis is named for the side of the convexity as well as for the location. For example, left thoracic socoliosis is a right lateral flexion in the thoracic spine.

Front 93

side of rib hump for scoliosis

Back 93

2) The posterior rib hump that develops from a thoracic scoliosis is always on the side of the rotation. So a left lateral flexion (right scoliosis) prodices a right rotation with a posterior rib hump on the right side of the back.

Front 94

"S" shaped curve cause

Back 94

3) Many times a curve in one side of the back is compensated for by a curve in another part of the back. This results in an “S” shaped curve

Front 95

Triceps activity during forceful pronation/supination

Back 95

In addition to pronation and supination, the pronator teres (a radio-ulnar pronator) as well as the biceps (a radio-ulnar supinator) also have lines of pull of application for elbow flexion. The triceps activate in order to prevent elbow movement from occurring

Front 96

2 purposes of wrist extensors during a firm grip

Back 96

1. Maintain the wrist in extension so that the finger flexors do not flex it
2. Maintain an appropriate length-tension relationship of the long finger flexors by elongating them over the wrist joint so that they can develop more tension in the fingers.

Front 97

The metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints are all slightly flexed when the hand is relaxed.
Why?

Back 97

Because the resting lengths of the long finger flexors (the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) are shorter than the resting lengths of the long extensors (extensor digitorum communis, extensor indicis, and extensor digiti minimi).

Front 98

Passive wrist extension increases flexion in the MCP, PIP, and DIP. Why?

Back 98

Because wrist extension elongates the FDP and FDS. This change in length increases passive force in the FDP and FDS, so they produce finger flexion.

Front 99

c. Passive wrist flexion extends (decreases flexion) in the MCP,PIP,and DIP. Why?

Back 99

Because wrist flexion shortens the FDP and FDS. This change in length decreases passive force in the FDP and FDS, decreasing their contribution to finger flexion. Wrist flexion also elongates the extensor digitorum. This change in length increases passive force in that muscle, producing finger extension

Front 100

Activity in the triceps brachii during forceful gripping

Back 100

the extensor carpi radialis works to extend the wrist to maintain a forceful grip. While doing so it causes elbow flexion. The triceps counters this elbow flexion

Front 101

Why does the wrist flex during forcefull finger extension?

Back 101

The flexor carpi radialis and the flexor carpi ulnaris are active with forceful finger extension to prevent over shortening of the extensor digitorum by elongating this muscle over the wrist joint

Front 102

3 ways lumbricales contribute to hand opening

Back 102

1. Producing tension into the central tendon (extends the PIP joint) and the lateral bands (extends the DIP joint).
2. produce MP flexion which counters the extensor digitorum’s tendancy to hyperexted the MP joints.
3. create slack into the distal part of the flexor digitorum profundus – making finger extension easier.

Front 103

interossei contribution to forceful hand opening

Back 103

by producing tension into the extensor mechanism and adding to MP joint flexion. In addition, the dorsal interossei abduct the fingers – useful in forceful hand opening and dropping dangerous objects from the hand.

Front 104

interossei contribution to forceful fist making

Back 104

We use the Interosseous muscles in hand closure, even though they can contribute to PIP and DIP extension because once the MP joints are flexed, these muscles have lines of application to assist in MP flexion. In addition, when making a tight fist the palmar interossei aid in holding the fingers together (adduction) for a tighter grip. Without them the grip is weak

Front 105

Consider a person whose grasp is so weak that he or she cannot grip a spoon to eat or a pen to write. How might you modify implements like eating utensils or tools to facilitate this person's function

Back 105

Building up handles elongate the muscles of the hand, particularly the Flexor Digitorum Profundus and Superficialis. When a muscle is weak, it can develop more force when it is elongated

Front 106

To move the thumb without also moving the wrist, the "snuffbox" muscles must act in a synergy with what carpal muscles?

Back 106

Extensor carpi ulnaris, flexor carpi ulnaris – however – if wrist flexion or extension is also desired, of course only one of the “pillars of the wrist” can be used.

Front 107

In which extrinsic thumb muscle does passive force develop as a result of the wrist extension?

Back 107

Flexor Pollicis Longus

Front 108

IN which extrinsic finger muscles does passive force develop as a result of the wrist extension?

Back 108

Flexor Digitorum Profundus and Superficialis

Front 109

What kinds of patients might need to use a passive or tenodesis grip?

Back 109

Specifically patients with C6 quadriplegia whose wrist extensors are innervated, but their fingers and thumb are not! In fact, the extensor carpi radialis longus is the ONLY muscle innervated distal to the elbow. However, this strategy can enhance any patient who has a weak grip.

Front 110

which wrist muscles are required for tenodesis grip?

Back 110

Extensor Carpi Radialis longus - if the patient has innervation to them the extensor carpi radialis brevis and extensor carpi ulnaris can also help!

Front 111

thumb extension- primary muscles

Back 111

the extensor pollicis longus extends the IP joint of the thumb directly assisted by the abductor pollicis brevis via the extensor mechanism