Slide 1 - Home Page by dffhrtcv3

VIEWS: 3 PAGES: 61

									Spine, Hip, Knee, & Foot:
Skeletal and muscular considerations
in movement
OVERVIEW

        Role of the region

        Contributions of the boney
           structure to stability and mobility

        Contributions of the muscular
         structures to stability and mobility

        Impact of each region on other
           regions in upright function
Spine & Trunk
Skeletal and muscular considerations
in movement
Spine & Trunk

Skeletal role in posture & movement?
1. Connect the   Upper body

                 Lower body
2. Position the head for interaction
3. Support and position the UEs for
   purposeful function
Role of Boney
Structures in
Movement
 A: Frontal Plane

 B: Sagittal Plane

 C:Transverse Plane



 In sitting and standing,
 what structure serves as the base for the spine?
vertebrae

vertebral body
pedicles                                                 4

transverse processes                                                 3

spinous process                                          7    2
                                                               5


articular surface for facet
                                                         1
laminae
vertebral foramen


                              From: McMinn’s Color Atlas of Human Anatomy,
                              Abrahams, Gutchings, Marks, 4th edition
                            Primary Movements?
In the spine there are 33
vertebral segments:                   Cervical

• 7 cervical vertebrae
(C1-7)

• 12 thoracic vertebrae
                                      Thoracic
(T1-12)

• 5 lumbar vertebrae
(L1-5)

• 5 sacral vertebrae
 (sacrum)                              Lumbar


• 4 coccygeal bones
 ( coccyx )
Boney structure of the Spine
 Atlanto-occipital:
   Primary action: flexion/extension
   Slight lateral bending
   Almost no rotation

 Atlanto-axial:
   Primary action: rotation (50% of cervical
    rotation)
   Seconday: flex/ext
   Almost no lateral flexion

 C2-7:
   Very mobile: flex/ext, lat flex, rotate
Boney structure of the Spine
 T1-12

   Primary actions: flexion/extension,
    lateral bending, rotation

   Rotation decreases as you progress
    caudally down the thoracic spine toward
    the lumbar spine

   T 7-T8 – the point where counter
    rotation occurs
Points of transition in the
spine




   C7

   T1
T7, T8
Point of
counter-rotation in the
Thoracic spine


   WHY?
                               Does this impact
                                our handling?


                             “True Ribs”
                               Ribs 1-7

                              “False Ribs”
                              Ribs 8-10
                               attached to cartilage
Diaphragm:                    Ribs 11, 12
Lowest 4 ribs                  free floating
Lowest 6 costal cartilages
Role of the Deep
Muscles of the Back
   Deepest muscles
    (cross 1 segment)
        Interspinalis
        Intertransversarus

   Intermediate muscles
        Rotators (cross 1 or 2 segments)
        Multifidi (cross 2-4 segments)
        Semispinalis (cross 6-8 segments

So what is the primary role
of these muscles?
Role of the Deep
Muscles of the Back


      The plan for stability
       plus mobility:
          Diagonal
          Horizontal
          Vertical
Role of the Muscles of the Back
   Erector Spinae
    (medial to lateral)
        Spinalis
        Longissimus
        Iliocostalis


What is the primary action
of each of these muscles?

                                                          Drawings adapted from
 ***Note the lateral position of the   Kinesiology of the Musculoskeletal System,
 iliocostalis & longissimus muscles                               Neumann 2002
Role of Trunk Muscles
 Rectus
  abdominus

 External
  Obliques

 Internal
  Obliques

 Transverse
  abdominus                       External Oblique
               Rectus Abdominus                      Internal Oblique
What Movement do we get
from:
 Rectus
 External oblique bilaterally, unilaterally?
 Internal oblique bilaterally, unilaterally?
     What Movement do we get
     from:
1. What muscles give us lateral flexion in the frontal plane?
2. What muscles give us rotation with flexion?
3.   What muscles give us rotation with extension?
Stability

               The plan for
                 stability
                   plus
                mobility:

                Diagonal
                Horizontal
                Vertical
What about stability??
Summary:


      What does this mean
             to our
           handling
            and our
         facilitations?
Hip & Pelvis
Skeletal and muscular considerations
in movement
Hip & Pelvis

Skeletal role in posture &
  movement?
1. Weightbearing
2. Movement of the hip joint allows
  translation of the trunk unit through
  space
3. Pelvis is the base for the spine
Role of Boney
Structures in
Movement
 A: Frontal Plane

 B: Sagittal Plane

 C:Transverse Plane

 Are there any boney
 limitations to hip
 movement in any plane?
Built for
strength

 Ball and socket joint
 Acetabulum covers ½
  the head of the femur
 Femur is:
   longest bone in the body
   ¼ total height
   strongest bone in the
    body
Hip Structure:
Angle of Inclination

             Angle between the:
               •long axis
                  &
               •Neck

             Typically 126° in
             adults
Hip Structure:
Angle of Inclination




Typical : 126°   Coxa Valga:       Coxa Vara:
                 Increased angle   Decreased angle
                 of inclination    of inclination
 Hip Structure:
 Angle of Inclination
The angle of inclination establishes the line of weightbearing
into the acetabulum.




        Coxa Valga:                         Coxa Vara:
 Increased angle of inclination     Decreased angle of inclination
 • favors hip dislocation           • hip very stable
 • poor angle of pull for the       • weak pull of hip abductors
   gluteus medius                   • abnormal wear on head
Hip Dislocation

     Red Flags:
     Uneven gluteal folds
     One leg looks shorter or “uneven”
     Child appears uncomfortable or
         fusses when a hip is moved


Bilateral dislocated hips are much more difficult
 to detect clinically than unilateral dislocations
Hip Integrity
 Classification:
    1. Normal
   2. Subluxable – femoral head can
     be displaced to the acetabular
     rim but is still in the socket
   3. Dislocatable -- femoral head is
     in the socket but can be dislocated
   4. Dislocated but reducible
   5. Dislocated and not reducible
Hip Integrity
       Hip Integrity: Piston test




   Normal
   Subluxable
   Dislocatable
   Dislocated but reducible
   Dislocated and not reducible
     Hip Integrity: Hart’s Sign
     Unequal hip abduction




    Normal
    Subluxable
    Dislocatable
    Dislocated but reducible
    Dislocated and not reducible



    Parents often notice it during diapering or dressing.
Hip Integrity: Galeazzi
Sign

Uneven Knees

               Can also be done with
               the femurs perpendicular
               to the surface and the
               feet off the surface
Hip Integrity: Galeazzi
Sign

Uneven Knees
                  Normal WHY?
                  Subluxable
                  Dislocatable
                  Dislocated but reducible
                  Dislocated and not
                   reducible
Hip Integrity: Ortolani’s Sign


             Hip “Click”

             Parents may notice
             it when dressing or moving
             the child.
Hip Integrity: Ortolani’s Sign
                Normal WHY?
                Subluxable
                Dislocatable
                Dislocated but reducible
                Dislocated and not reducible



                  Deceptive: A soft click
                  may be the iliofemoral
                  ligament moving over
                  the anterior surface of
                  the head of the femur
 Femoral Torsion: a twisting
 of the femoral bone
Angle between:
      the transcondylar axis of the knee
      the axis of the femoral neck




                             newborn 50° (disputed)
                             adult 15°
Femoral Antetorsion
Femoral   Retroversion
Measuring Torsion:
Ryder test




               What alternative if
     hip flexion contractures are present?
2 issues:

   1. twisting of the femur
              Torsion

   2. functional position of the
      femoral neck and head
      in relation to the acetabulum
                Version
Antetorsion   Anteversion
Retrotorsion   Retroversion
Version




        Internal
     femoral rotation


                           External
                        femoral rotation
Hip/Pelvic
Musculature

 Hip Flexors
     Iliopsoas
     Tensor facia latae
     Rectus femoris
     Sartorius


                               Anterior view
                           Right lower extremity
Hip Flexion Contracture
Thomas Test




      What might make the test difficult
            or mask the results?
Concept:
Free segment moves on the fixed
segment
                Movement of hip
                 flexors:

                 Pelvis on Femur
                         or
                 Femur on pelvis
Hip/Pelvic
Musculature
 Hip Extensors
   Gluteus maximus

   Hamstrings
    • biceps femoris
    • semitendinosus
    • semimembranosus

   Adductor magnus
    (posterior head)
                           Posterior view
                        Left lower extremity
Clinically, what problem
would we see with hip
extensor tightness?
Hip/Pelvic
Musculature
 Hip Abductors

   Gluteus medius

   Gluteus minimus

   Tensor fascia latae
                          Posterior view   Anterior view
                           right lower      right lower
                            extremity        extremity
Free segment moves on the fixed
segment

                    Movement of hip
                    abductors:

                    Pelvis on Femur
                            or
                    Femur on pelvis

  Posterior view
  Of left hip
What happens when abductors are:

     Tight?




     Weak?
Concept:
Muscle action may change
depending on joint position


 Gluteus medius



 Gluteus minimus
Hip/Pelvic
Musculature
 Hip Adductors

   Adductor brevis

   Adductor longus

   Adductor magnus
   (both heads)
                          Anterior view
                      right lower extremity
Muscle action may
change depending
on joint position


 Adductor Longus




                    Anterior right   Posterior right
                    Pelvis & femur   femur
Hip/Pelvic
Musculature
 Hip External Rotators

     Gluteus maximus
     Piriformis
     Gemeilus superior
     Obturator internus
     Gemeilus inferior
     Quadratus femoris
     Sartorius
                              Posterior view
                           Left lower extremity
Hip/Pelvic
Musculature
 Hip Internal Rotators
Hip/Pelvic
Musculature
 Secondary Hip Internal Rotators
     Gluteus minimus (anterior fibers)
     Gluteus medius (anterior fibers)
     Tensor fascia latae
     Adductor longus
     Adductor brevis
     Medial hamstrings (semimembranosus,
      semitendinosus)
      (Arnold 2000, 2001), (Lynn 2009) (Delp 1999)
Important Points:
1. Facilitate muscles…not bones Stay off the
   pelvis!

2. Mobile segments move on the fixed
   segments…2 sides to every coin.

3. Muscle function can change with joint
   position…ALIGNMENT IS ESSENTIAL TO
   FUNCTION!!!

4. Challenge your assumptions!!!!
Surface Anatomy
Find:
   • Spinous Processes: Kyphosis, Lordosis, Scoliosis
   • C7 Spinous Process
   • T7 –T8
   • Sacrum
   • ASIS
   • PSIS
   • Head of the Trochanter

								
To top