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

Plurimeter
👊is an instrument used for measuring Rom of Joints.

👊Consist of Container with freely moving needle that's counterweighted to Keep It in vertical Position

👊The housing is filled with special oil (at Container).
وده فايدته إيه بقى ؟؟
1-For lubricate bearing of axis

2-For dampens ossilication of needle indicator when instrument is rotated.

👊Face of dial with degree
1- Large
2-allow easy and Clear reading

👊Housing (containers) Can be rotated 360 degrees

👊Advantage

»accurate, Speed, ease

»easier reading (Dial large-Clear)

»Allow measurement that weren't Possible with Convential geniometer,Such as:
Spine, height of rib hump,
Lumbar bulge in scillosis rotalion,
eversion and inversion of hindfront
👈بيقيس أماكن مش بقدر اقيسها بالجنيوميتر العادى

👊rotating dial ( zero position ) can be easily Set it in Vertical or horizontal Position allowing easy measurement.

👊only 2 Fingers are required to hold (Index-middle )
👊3 fingers others use  to stabilize instrument on moving part of body, other hand Free for Stabilization of body or guidance of motion.

👊APPly in vertical Position

👊Base of device
>>held Steadily of moving Part. >>Substitute for convential Stationary and movable arms

انا عارف ان المادة صعبة بس مش لدرجة تحطلي أسبانى فى المحاضرة 😂😂

وأفضل 3 أيام تصمهم في الشهر هما الأيام البِيض..
ودول اللي هما أيام 13 و14 و15 من الشهر الهجري

ودول برضو اللي هيبدءوا بكرة بإذن الله، وغير كده كمان بكرة الاتنين، وصيام يوم الاثنين سنة عن النبي صلى الله عليه وسلم

فأنت انوي الصيام ومتضيعش أجر الصيام في الأيام المباركة دي، وحتى اليوم قصير والجو حلو للصيام ومش حر فهيبقى صيام سهل بإذن الله، فمتضيعوش ويلا نصوم❤️