Lecture 7
( Gait analysis system )

#biomechanics1
Bu

أنا MUC😔
ابعتي عالبوت يبعتولك.

دي أسئلة د/الشريف لـ CNS والفايلات اللي قبلها شرح وأسئلة برضوه.

1- Sensory
2- Motor

#Neuro_physiology

ادعولنا❤️.

آمين.🤍

🖇️ Resistance direction 🖇️
هنجمع الresistance بتاعة كل الحركات علشان مهمين 🫶🏻
Resistance is givin in:
▫️grade 4 (Good ) >>>moderate resistance
▫️ grade 5 ( Normal )>>>
maximum resistance+ hold
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
1️⃣ Shoulder joint:
▫️ Flexion>>>down
▫️ Hyperextension>>> down
▫️Abduction>>> down
▫️Horizontal abduction>>> down
▫️Horizontal adduction ( pectoralis major)
- Clavicular head / upper fibers :
out and dowm
- sternal head / lower fibers :
out and up
▫️ lateral rotation>>> down
▫️ medial rotation>>>down
▫️ كلهم down ماعدا pectoralis نركز عليهاا مهممة 🫵🏻
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
2️⃣ Scapular movements:
▫️ Protraction (Ab) and upward rotation = serratus anterior>>> down
▫️ Elevation = upper trapizius or levator scapulae>>> down
▫️ Retraction (Ad) = middle trapizius>>> on the lateral border of scapula
▫️ Retraction (Ad) + depression =  lower trapizius>>> up and out, on the lateral border of scapula
▫️Retraction (Ad) + downward rotation = Rhomboideus muscles>>>  out and slightly down,on the medial border of the scapula
▫️الوحيدة اللى من ال medial border
Rhommmboids يبقى mmmedial border
حد يتلغبط بقى 😂🫶🏻
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
3️⃣ Elbow joint:
▫️elbow flexion>>> down
▫️ elbow extension>>> down
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
4️⃣ Wrist joint>>>
▫️ Wrist flexion:
- ( flexor Carpi ulnaris) :
In the direction of extension and toward radial side
- ( flexor Carpi radialis) :
In the direction of extension and
toward ulnar side

▫️ Wrist extension:
- ( extensor Carpi ulnaris) :
In the direction of flexion and toward radial side
- ( extensor radialis longus and brevis) :
In the direction of flexion and  toward ulnar side
مهميييين
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
5️⃣ Forearm:
▫️ Supination>>>
on the dorsal surface of distal end of radius with counterpressure against the ventral surface of the ulna
▫️ Pronation>>>
on the volar surface of distal end of  radius with counterpressure against the dorsal surface of the ulna
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
6️⃣ Thumb ab, ad:
▫️Thumb ab >>>
- (Abductor Pollicis Brevis) :
on the lateral border of the first/ proximal phalanx of the thumb
- (Abductor pollicis Longus) :
on the lateral border of the first Metacarpal bone

▫️ Thumb ad ( Adductor pollicis) >>>
on the medial border of the distal Phalanx of the thumb

🖇️ROM🖇️
👉🏻 Shoulder joint
▫️ flexion >>>0:90°
▫️ Hyperextension >>>0:50°
( Beyond mid line )
▫️ Ab/ Ad >>>0:90°
▫️ Horizontal ab/ ad>>>0:135°
▫️ Lateral/ medial rotation>>>0: 90°
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
👉🏻 Scapular movements
▫️ Protraction (Ab) and upward rotation>>> 3:4 fingers
▫️ Elevation >>> 3 fingers
▫️ Retraction (Ad) >>> 3:4 fingers
▫️ Retraction (Ad) + depression >>> 3:4 fingers
▫️Retraction (Ad) + downward rotation>>> 3:4 fingers
  _ _ _ _ _ _ _ _ _ _ _ _ _ _
👉🏻 Elbow joint:
▫️elbow flexion/extension>>>        0:145°-160°
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
👉🏻 Wrist joint :
▫️ Wrist flexion>>>0:80°-90°
▫️ Wrist extension>>> 0:70°
▫️ Ulnar deviation>>> 0:30°-35°
▫️ Radial deviation>>> 0:20°-25°
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
👉🏻 Forearm:
▫️ Supination/ pronation>>>
0:90° ( from the mid position)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
👉🏻 Thumb:
▫️Ab/Ad >>> 0:40°-50°
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _
👉🏻 Fingers:
▫️ MCPJ Flexion>>>0:90°
▫️ MCPJ extension>>>
0:20°-30° ( Beyond mid line )
▫️ Proximal IPJ>>>0:120°
▫️ Distal IPJ>>> 0:80°
▫️ Fingers ab/ ad >>>0:20°-25°

Limitation in movements...🤔

SHOULDER FLEXION
👉 limited by ankylosis of the shoulder joint.

SHOULDER EXTENSION
👉 limited by the tension of shoulder flexor muscles.

SHOULDER ABDUCTION
👉 limited by ankylose of the shoulder joint.

SHOULDER HORIZONTAL ABDUCTION
👉 limited by the following factors:
-Tension of anterior fibers of capsule of glenohumeral joint.
- Tension of pectoralis major and deltoid anterior fibers.

SHOULDER HORIZONTAL ADDUCTION
👉 limited by the following factors: 
-Tension of shoulder extensor muscles.
- Contact of arm with the chest.

SHOULDER EXTERNAL ROTATION
👉 limited by the following factors:
-Tension of superior portion of capsular ligament and coracohumeral ligament.
-Tension of medial rotator muscles of the shoulder.

SHOULDER INTERNAL ROTATION
👉 limited by the following factors:
-Tension of superior portion of capsular ligament
-Tension of lateral rotator muscles of the shoulder.

Scapular Abduction and Upward Rotation
👉 limited by the following factors:
1- Tension of trapezoid ligament (limits upward rotation of scapula upon clavicle).
2. Tension of Trapezius and Rhomboids major and minor.

Scapular Elevation
👉 limited by the following factors:
1-Tension of Costoclavicular ligament
2-  Tension of pectoralis minor, Subclavius and Trapezius (lower fibers).

Scapular Adduction
👉 limited by the following factors:
1- Tension of the conoid ligament (limits backward rotation of scapula upon clavicle).
2- Tension of Pectoralis major and minor and serratus anterior muscles.
3- Contact of vertebral border of scapula with spinal musculature.

SCAPULAR DEPRESSION AND ADDUCTION
👉 limited by the following factors: 
- Tension of interclavicular ligament and articular disc of sternoclavicular joint.
- Tension of trapezius (upper fibers)- levator scapulae and sternocleidomastoid (clavicular head) muscles.

SCAPULAR ADDUCTION AND DOWNWARD ROTATION
👉 limited by the following factors:
1- Tension of the conoid ligament .
2- Tension of Pectoralis major and minor and serratus anterior muscles.
3- Contact of vertebral border of scapula with spinal musculature.

THUMB ABDUCTION
👉 limited by the following factors:
- Tension of skin between thumb index finger.
- Tension of first Interosseus Dorsales Muscle.

THUMB ADDUCTION
👉 limited by contact of thumb with second metacarpal bone.

ELBOW FLEXION
👉 limited by the following factors:
- Contact of muscle masses on volar aspect of arm and forearm.
- Contact of coronoid process with coronoid fossa of humerus.

ELBOW EXTENSION
👉 limited by the following factors:
- Tension of radial and ulnar collateral ligaments of elbow joint.
- Tension of flexor muscles of forearm.
- Contact of olecranon process with olecranon fossa on posterior aspect of humerus.

FOREARM SUPINATION
👉 limited by the following factors:
- Tension of volar radioulnar ligament and ulnar collateral ligament of wrist joint.
●Tension of pronator muscles of forearm.
●Tension of lowest fibers of interosseous membrane.

FOREARM PRONATION
👉 limited by the following factors:
- Tension of dorsal radioulnar and dorsal radiocarpal ligaments.
- Tension of lowest fiber of interosseous membrane.
- Tension in supinator muscles.

WRIST FLEXION
👉 limited by tension of dorsal radiocarpal ligament.

WRIST EXTENSION
👉 limited by tension of the palmar radiocarpal ligament.

FLEXION OF MCP JOINTS
👉 limited by tension of expansions of extensor tendons of fingers.

EXTENSION OF MCP JOINTS
👉 limited by the following factors:
- Tension of palmar and collateral ligaments.
- Tension of flexor muscles of fingers

FLEXION OF PROXIMAL AND DISTAL IP JOINTS
👉 limited by tension of expansion of extensor digitorum communis tendons (dorsal ligament).

FINGER ABDUCTION
👉 limited by tension of fascia and skin between fingers.

FINGER ADDUCTION
👉 limited by the contact of each fingers.

تجميعة ال palpation ❤️👀
👊 Palpation of Shoulder Muscles
1. Shoulder Flexion
👉 Anterior Deltoid: Anterior aspect of the shoulder joint.
2. Shoulder Extension
👉 Teres Major: Lower border of the axilla.
👉 Latissimus Dorsi: Inferior angle of the scapula.
3. Shoulder Abduction
👉 Middle Fiber of Deltoid: Lateral surface of the upper third of the arm.
4. Shoulder Horizontal Abduction
👉 Posterior Fiber of Deltoid: Posterior aspect of the shoulder joint.
5. Shoulder Horizontal Adduction
👉 Pectoralis Major: Anterior aspect of the upper arm.
6. Shoulder External Rotation
👉 Teres Minor: Axillary border of the scapula.
👉 Infraspinatus: Below the spine of the scapula.
7. Shoulder Internal Rotation
👉 Subscapularis: Deep in the axilla near its insertion.
👉 Latissimus Dorsi: Inferior angle of the scapula.
👉 Pectoralis Major: Anterior aspect of the upper arm.

👊 Palpation of Scapular Muscles
1. Abduction and Upward Rotation
👉 Serratus Anterior: Outer surface of the ribs.
2. Elevation
👉 Upper Trapezius: Parallel to the cervical vertebrae near the insertion above the clavicle.
3. Adduction
👉 Middle Trapezius: Between the root of the spine of the scapula and the vertebral column.
4. Adduction and Depression
👉 Lower Trapezius: Between the last thoracic vertebra and the scapula.
5. Adduction and Downward Rotation (Rhomboids)
👉 Between the vertebral border of the scapula and the lateral fiber of the lower trapezius.

👊 Palpation of Elbow Muscles
1. Elbow Flexion
👉 Biceps Brachii: Antecubital space.
👉 Brachioradialis: Bulk on the anterolateral aspect of the elbow.
2. Elbow Extension
👉 Triceps Brachii: Posterior surface of the arm.
👉 Anconeus: Posterior surface of the elbow.

👊 Palpation of Forearm Muscles
1. Forearm Supination
👉 Biceps Brachii: Antecubital space.
👉 Supinator: Radial side of the forearm (lateral).
2. Forearm Pronation
👉 Pronator Teres: Upper third of the volar surface of the forearm, forming a diagonal line from the humeral condyle to the lateral border of the radius.

👊 Palpation of Thumb Muscles
1. Thumb Abduction
👉 Abductor Pollicis Brevis: On the thenar eminence, lateral to the flexor pollicis brevis.
👉 Abductor Pollicis Longus: Near the insertion point.
2. Thumb Adduction
👉Adductor Pollicis:Between the first dorsal interosseous and the first metacarpal bone.

👊 Palpation of Wrist Muscles
1. Wrist Flexion
👉 Flexor Carpi Ulnaris: Distal medial palmar surface.
👉 Flexor Carpi Radialis: Distal lateral palmar surface.
2. Wrist Extension
👉 Extensor Carpi Radialis: Distal lateral dorsal surface of the wrist in line with the second and third metacarpal bones.
👉 Extensor Carpi Ulnaris: Medial dorsal surface of the wrist in line with the fifth metacarpal.

👊 Flex Proximal and Distal IPJ
1. Flexor digitorum superficialis
👉 At wrist, under palmaris longus.
2. Flexor digitorum profundus
👉 Palmar surface of middle phalanges.

👊 Fingers Abduction
👉 Interosseous dorsales: Deep between metacarpal bones on the dorsum of the hand.

👊 Flexion MCPJ
👉 Lumbricales
👉 Dorsal and palmar interosseous
✓ Light pressure on the palmar surface of proximal phalanges.

👊 Extension MCPJ
👉 Palpate tendon of finger extensors on the dorsum of the hand, passing over metacarpal bones.

« أجهزة المحاضرة الثامنة »

👊 عشان أعمل muscle test عندى طريقتين
👊 subjective
دى الثيرابيست اللى بيعملها يعنى مش بتكون accurate بنسبة كبيرة وبنستخدم فيها goniometer العادى
👊 objective
دى بتكون طريقه أكثر accurate وبنستخدم فيها Electro goniometer

Electro goniometer
👊measure dynamic ROM
( During activity)
👊used at biomechanical and physical therapy research

Potentiometer
👊attached with 2arms
واحد منهم متصل بال proximal part بتاع patient , والتانى متصل بال distal part بتاع patient , وحركة ال 2arms بتعمل تغيير في قيمة resistance

✓ال electrogeniometer ممكن يتكون من 3 potentiometer وده بيخليه يقدر يقيس الحركة فى 3 cardinal planes
👊advantage
»accurate
»measure joint excursion ( total arc of motion)
»measure absolute limb position
👊وناخد بالنا أنه accurate لل joint excursion أكتر من absolute limb ، بس هما الاتنين accurate 🥴
👊disadvantage
»large time
» high cost