INTRODUCTION OF KINESIOLOGY:

KINESIOLOGY is the study of movement brings anatomy, physiology, physics and geometry and relates them to

human movement.

It is based on the principles of mechanics, neuromuscular anatomy and neuromuscular physiology.

Bio mechanics used mechanical principle that related to the static and dynamic activities of human body.

Dynamics activity has kinetics and kinematics. Kinetics is those forces causing movement. Kinematics is time, space and

mass aspect of a moving system.

Anatomical position (Palm facing forward) and fundamental position (palm facing the sides of the body).

Medial refers to the location/position toward the midline and lateral refers to the position away from the midline.

Anterior (ventral) refers to the front of the body and posterior (dorsal) refers to the back of the body. Proximal means

towards the trunk and distal means away from the trunk.

Humans are Biped two legged animals.

Linear movements (Translatory motion) occur more or less in straight line from one location to another location.

Movement of object in a fixed point is called angular or rotator motion and of object in a curved path is called curvilinear

motion.

Common to see both type of movement in same time. Example movement within body is angular and outside body is

linear. Movement of scapula is linear, but clavicle attach to the scapula is angular get its motion from sternoclavicular

joint.

Joint moves in different direction around axes and planes.

Osteokinematics- movement of bones around joint axes. Arthrokinematics deals with joint surface movement.

Flexion causing decrease in the joint angle. Occur with anterior surface of the articulation bone. In case of neck it is

bowing down motion, however with knee the posterior surface approximate with each other causing flexion. Flexion

begins at 180 degree extension to 0 degree thus it is a decrease in joint angle.

Extension –straightening movement of one bone from another causing an increase of the joint angle thus return the

body part to the anatomical position. Hyper extension – extension behind the anatomical position.

Skeletal system- rigid frame work of the human body made of numerous bones, protect vital organs and manufacture of

the blood cells (Main sites are ilium, vertebra, sternum and ribs).

Axial skeletal – forms upright part of the body. Consists of 80 bones (head thorax and vertebrae)

Appendicular skeletal- attaches to the axial skeletal. Consists of 126 bones

Composition of bones:

Considered as an organ as made of different type of tissue (Fibrous, cartilaginous, osseous, nervous and

vascular). 1/3 made of organic material which gives elasticity 2/3 made of inorganic material provide hardness and

strength which makes bone opaque to x-rays.

Compact bone- makes hard, dense outer shell completely covers the bone, thick along the shaft and thin at the edges of

the long bones also thick in the plates of the flat bones.

Cancellous bone- makes porous spongy portion called trabeculae, ARRANGED in a pattern to resists local stress and

strain.

Structure of the bone:

Epiphysis- each end of the diaphysis tends to be wider than the shaft, osseous in adult cartilaginous (Epiphyseal plate) in

growing bone, longitudinal growth occur.

Diaphysis- shaft of the bone mostly compact, center is medullary cannal contains marrow provide passage to the

nutrients arteries also decrease weights of the bone.

Endosteum- membrane that lines medullary canal, contain osteoclast responsible for bone resorbtion

Periosteum- thin fibrous membrane covering all of the bone except articulating surface (Covered with hyline cartilage).

Serves as attachment point for tendons and ligaments

Young bones:

Pressure epiphysis located at the ends of the bone where growth of long bones occur (Common problem at pressure

epiphysis- Legg-calve-perthes disease, slipped femoral capital epiphysis)

Traction Epiphysis located where tendon attached to the bone subjected to pulling, traction forces (Common problem at

traction epiphysis is Osgood schlatter diseases).

Problem occur only during bone growing years.

Types of bones:

Long bone, short bones, flat bones, irregular bone, sesmoid bones.

JOINT- connection between two bones that allows great (as in shoulder joint but provide little stability) or little (as in

sternoclavicular joint but quite stable) motion, bear or transfers weight of the body and provide stability contains

SYNOVIAL FLUID which LUBRICATE joint and nourishes the cartilages.

FIBROUS JOINTS: (has thin layer of fibrous periosteum b/w bones) ex: Sutures of the skull.

3 types of fibrous joint

Synarthrosis – Suture Joint (No motion between the bones) —ends of the bone SHAPED to allow them interlock.

Syndesmosis – ligamentious joint that fibrous tissue holding the joint such as ligaments or INTEROSSEOUS.

Minimal stretching and twisting occur in that joint example distal radio Ulnar joint and tibiofibular joint

Gomphosis (Bolting together) – ex: joint between the tooth and wall of Dental socket in the mandible and

maxilla.

CARTILAGINOUS JOINT or amphiarthrodial joint (allow only small motion and great deal of stability) - has hyaline or fibro

cartilage between the bones, example vertebral bodies- fibrous cartilage connecting the vertebral bodies, first sterno

costal joint

SYNOVIAL JOINT or Diarthroidial joint (Allow great deal of motion) - no direct union between the bones- has a CAVITY

filled with SYNOVIAL FLUID covered with capsule. Outer layer is strong fibrous tissue that holds the joint and inner layer

lined with Synovial membrane that secrete synovial fluid.

NON AXIAL (AXES) JOINT tends to be linear instead of angular- joint surface is flat and glide over one another instead of

movement around the other. Motion occur secondarily to the other motion. Example movement around the carpal

bones during wrist flexion, extension, abduction or adduction.

UNIAXIAL JOINT- angular motion occur in one plane and one axis like a hinge. Example humero-ulnar joint, IP joint of

fingers , knee joint except in last few degrees of extension. Elbow radio ulnar joint – radius moves over radial notch of

ulnar in transverse plane during pronation and supination of forearm, motion of atlanto axial joint of C1 around C2

provide head rotation.

BIAXIAL JOINT MOTION: Ex: wrist movement occur in two different direction FLEXION and EXTENSIN in sagittal plane and

frontal axis &RADIAL and ULNAR deviation in Sagittal axis.

CONDYLOID or ELLIPSOID Joint in which bi directional movement occur at MP Joint.

SADDLE JOINT: (where articular surface of Joints are concave in one and convex in other direction) CMC Joint of Thumb

– Bidirectional movement occur

MULTI AXIAL JOINT (Ball and socket Joint) - motion occur in three axis ex : HIP and SHOULDER motion

JOINT STRUCTURE:

Amount and direction of motion in the joint surface are dictated by the Shape and articular surface of each

bone.

Supported by the Ligaments (Fibrous connective tissue which is flexible (Provide Joint motion) but not elastic to

Keep bone in Close Approximation and Protection to Joint Preventing excessive Joint movement).

Joint capsule that surround and encase the joint. EX: Shoulder completely encase the Joint provide a vacuum to

holds head of humerus against Glenoid Fossa, in other capsule may not be completely enclose.

Two layer of Joint capsule- Outer Fibrous tissue covers the articular surface reinforced by ligaments and give

protection to the joint.

Inner Synovial tissue- Thick vascular connective tissue secretes synovial Fluid to

lubricates articular cartilage, reduce joint friction and act as a shock absorber

Cartilage – Dense Fibrous connective tissue with stand greater amount of pressure and tension. Three types of

cartilage (Hyaline cartilage { no blood or nerve supply get nutrients from synovial fluid}, Fibro cartilage { as a shock

absorber in weight bearing joints Ex: knee (as menisci) and vertebrae, between Clavicle and sternum, Shoulder as

labrum deepens the glenoid fossa}, Elastic cartilage – helps to maintain shape of the structure located in Eustachian tube

, also in larynx as its motion important to speech.

Tendon connect muscle to the joint to provide motion to the joint may be flat or rounded

Bursae {FLUID filled with in synovial membrane} where excessive friction occur

JOINT MOTION:

Movement of one bone over the other bone by the help of muscle under voluntary control is called

physiological or osteokinematic motion (Joint motion). These motions are done in isokinetic – isotonic-

isometric exercise.

END FEEL:

PASSIVE ROM done for assist ROM or to determine the nature of the resistance at end ROM.

End feel is the subjective assessment of the quality of the feel when slight pressure applied at end of

the joint passive ROM by CYRIAX 1983.

BONY END FEEL- hard and abrupt limit to the joint motion. Also called hard end feel. Ex: elbow

extension.

CAPSULAR END FEEL- hard leathery like limitations. Ex: ROM of shoulder joint related to capsular

restriction.

EMPTY END FEEL- lack of mechanical limitation of joint ROM. Common in SOFT tissue disruption.

CHARACTERISTIIC OF LIMITATION of MOTION:

Rebounded phenomenon- Springy block.

Soft tissue approximation

Muscle guarding- common in muscle spasm as a protective response

ARTHROKINEMATIC (Joint surface motion):

Movement within the joint at the joint surface. Also defined as adjoining joint surfaces move on each

other during osteo kinematics.

Accessory motions are that accompany classical motion of the joint to attain full ROM and pain less function

of the joint. Necessary for joint mobilization (Passive oscillatory motion apply through external force)

Joint play movements- involuntarily happed due to external force. Gliding, spinning and rolling

movements. Occur at the end of the joint active ROM.

Component movement- takes place within a joint to facilitate active motion.

Type of motion occurs at the joint in relation to the articulating surface of the bone:

Joint surface are either ovoid or sellar

Synovial joints are ovoid have one joint surface concave and other surface convex. Example

metacarpophalangeal joints. One bone end is larger than its adjacent bone end. Provide greater ROM.

Sellar joints – each joint surface is convex in one direction and concave in other direction. It is

also called saddle joint. Example carpometa carpal joint of thumb.

TYPES of arthrokinematic movements:

Roll, glide and spin.

ROLL: new point of surface come on contact while roll.

GLIDE: Linear movement of the joint parallel to the adjacent joint surface.

SPIN: Rotation or spin of the joint surface on the fixed adjacent joint surface.

Combination of all three motions occur in a joint movement. Example: knee joint perform all three type of

arthrokinematic motion to obtain knee flexion and extension.

CONVEX CONCAVE LAW:

Determines the movement of the joint surface in the specific direction during motion.

The concave joint surface moves on the convex joint surface in the same direction during

motion, but convex joint surface moves in the opposite direction on the concave joint surface.

JOINT CONGRUENCY:

Joint surfaces of the ovoid or sellar congruent in one position and incongruent in all other

position. When the joint is congruent (i) Surfaces have maximum contact with each other, (ii) difficult to

distract , (iii) and tightly compressed. The ligament and capsule holding the holding the joint are taut. This is

known as closed packed position. Usually happen at one extreme of the ROM.

To test integrity or stability of the ligaments or capsular structure the joints placed in the closed

packed position. also suspect to injure in the closed packed position. when the joint is swollen it cannot be

moved into the closed packed position.

In all other position the joint is incongruent. The position of maximum incongruency is called loosed

packed position. Capsular structure are lax, passive separation of joint occur.

In open packed position certain amount of joint play or accessory motion occur. So joint play is not a

voluntary movement. Also muscle is fully relaxed in this state. So able to apply external force by the trained

Practitioner. Joint mobilization technique is applied best in open packed position.

While applying joint mobilization three type of forces are applied: Traction or distraction, compression

or Approximation, shearing.

Distraction or traction: Force applied pulled the joint apart

Approximation or compression: external force applied to causing the joint close together.

Shearing: Occurs parallel to the surface, causing the gliding motion.

MUSCULAR SYSTEM:

Muscle attached at both end to the bone crosses one or two joint making motion. The more movable

part is called insertion and less movable portion is origin. Another point considered about muscle attachment is origin is

always close to the axial skeletal and insertion always away from the axial skeletal. In closed kinematic chain the origin

moves towards the insertion when the insertion point of muscle is fixed.

Naming the muscles:

Depends on

Location: example tibialis anterior

Shape: example trapezius as it is trapezoidal in shape.

Size: Pectoralis major and Pectoralis minor

Action: extensor Carpi ulnaris.

Number of muscle heads: Triceps as it is three headed.

Attachment: Sternocledomastoid muscle

Direction of muscle fiber: external and internal oblique.

Muscle fiber arrangement in a muscle:

Arranged either parallel or oblique. Parallel muscle fibers have more ROM potential but oblique muscle fibers

are more numerous in the given area means have Greater strength potential but smaller ROM potential.

Properties of muscle fibers:

No other tissues in the body that muscle has following character which might be understood when muscle is in

normal resting length (when a muscle is in unstimulated state where no external force acting on the muscle).

IRRITABILITY: is the ability of the muscle response (contract) to either motor nerve or external electrical

stimulus.

CONTRACTALITY: shortening of the muscle when receiving adequate stimulus.

EXTENSIBILITY: ability of the muscle to stretch to the external force applied.

ELSATICITY: ability of the muscle to RECOIL to its normal resting length when stimulation is removed.

LENGTH TENSION RELATIONSHIP OF A MUSCLE FIBER:

Tension is force build up within a muscle. Passive tension due to external force involves non contractile

unit of the muscle. Active tension is due to external stimulus involve contractile unit of the muscle.

Amount of tension= length of the muscle fiber.

Tone is the state of readiness in all the state of the muscle that allows the muscle to act immediately

and easily when needed. Muscle can be shortening ½ of its resting length also stretched twice as far as it can be

stretched though variation occurs between the muscles.

Excursion of muscle is the maximum elongation to the maximum shortening form the resting length.

There is OPTIMUM range of the muscle with in which the muscle contract efficiently.

ACTIVE AND PASSIVE INSUFFICIENCY:

ONE JOINT MUSCLE: Muscle excursion is greater than the ROM allowed by that joint.

TWO JOINT MUSCLES: Muscle excursion is lesser compare to the combined motion of the joint.

Tension in the muscle is insufficient in both extremes. Brunnstrom use active and passive insufficiency to

describe these terms

Active insufficiency: occur in agonist when a muscle reaches a point cannot shorten further more.

Example: Hamstring two joint muscle has sufficient tension either flex the knee or extend the hip but

not both at a time. The muscle became actively insufficient. If push further to do both at same time there is chance for

cramp because of muscle run out of contractility before the ROM.

Passive insufficiency: occur in antagonist where muscle cannot elongate further without any damage to the

fibers.

Example: Hamstring enough to stretch over each joint (Hip and knee) individually but not both at same

time.

Agonist became actively insufficient before passive insufficiency of the antagonist.

Purpose of stretching:

Maintain or regain the normal resting length.

Flexibility to lengthen the resting length of the muscle

Tendon action of a muscle:

Some degree of finger flexion and extension done (accomplished) by the passive insufficiency of the tendon.

Example: placing wrist on the table pronate forearm and flex the wrist the finger go for extension vice

versa. If these tendon is tight these motion are pronounced called tendon action of muscle.

Types of muscle contraction:

Isometric contraction: tension in the muscle without changing the length of the muscle.

Isotonic contraction: occur when muscle contract both muscle length and joint angle changes without change in

the tone of the muscle

Are of two types: Concentric contraction (Common in acceleration activities) example straightening the

knee while sitting against the gravity using the quadriceps muscle and eccentric contraction (common in the

deceleration) example: straightening the knee on prone towards the gravity sing the quadriceps muscle. Shortening of

the muscle is microscopically but lengthening view grossly.

Isokinetic contraction: done one by specific instrument in which resistance varies but velocity or speed remains

same. Speed is preset in the machine which Isokinetic contraction

Role of muscles (are specific to a joint):

It plays different role during the joint motion depend on the direction of motion and amount of

resistance it over come. If these VARIABLE changes the role also change

As an agonist it initiates the motion also called Prime movers and as a assisting mover determined by size, angle

of pull, leverage and contractile potential.

When the antagonist contract at the same time of agonist contraction a co-contraction occur.

It occurs when there is a need for accuracy. Common when a person tends to learn a difficult activity.

As a stabilizer (fixator) a muscle or a muscle group supports a joint or a part to work efficiently.

As a neutralizer to prevent unwanted motion in case if muscle do two more action but needed only one action.

Example: biceps

Factors that determine the muscle play in a joint motion:

Major, minor or no role depend upon size, angle of pull, location and possible joint motion in relation to

JOINT AXIS.

Example: compare to triceps anconeus will have little effect on the elbow joint thus triceps is the prime mover in

elbow extension.

Most of the muscles have diagonal line of pull.

KINETIC CHAINS: it is defined as the series of rigid links connected in such a way to allow the motions. As these links are

connected movement in one link causes motion in other

Close kinetic chains: distal segments fixed and the proximal segments moves. Example: standing up from the

sitting in the chair.

Open kinetic chain: distal segment is freed and the proximal segments are fixed. Example: extending the knee

while sitting the hip and ankle not move and the motion occur in the knee. Lying on the bed freely able to move

upper and the lower limb

NERVOUS SYSTEM:

Complex mechanism that stimulates, controls and co ordinate other system of the bodies. It is divided in

to ANS (Sympathetic and parasympathetic), CNS and PNS.

CNS: consists of brain and spinal cord. ANS: Sympathetic (deals with stress and stimulation) and para

sympathetic (deals with conserving energy).

Neurons are the fundamental unit of nervous system. Contains Cell body, dendrites which receive the impulses from

other part of nervous system t the cell body, axon covered by fatty tissue called Mylein sheath ends which in turn

urrounded by the Neurilemma. Mylein interrupted at the every half millimeter called Node of ranvier.

TRACT is the group of mylineated nerve fibers through which it conduct the information from one ared to another.

Depending on the location within CNS it is named as fasciculus, pudincle, brachium or Lemnicus. A group of fibers in the

PNS called spinal nerves, plexus, and nerve root.

Cell body of the efferent neuron located in the anterior horn cells of the spinal cord, emerges out as a spinal

nerves (PNS) end s in the motor end plate of the muscle fiber.

Motor efferent nerve conducts the impulses from the spinal cord to the periphery. Sensory afferent neuron

conducts impulses to the dorsal root ganglion in the posterior horn of the spinal cord.

Another kind of neuron called Interneuron found within the CNS transmits and integrates sensory and motor

impulses.

CENTRAL NERVOUS SYSTEM:

Components of CNS are brain and spinal cord.

BRIAN weights around 3 pounds: divided in to cerebrum, cerebllum and brain stem

Cerebrum- maintain higher mental function occupy superior and anterior portion above crerbellum and brain

stem divided in to R and L cerebral hemispherejoinded by the corpus collusum. Each hemisphere diviided in to four

lobes frontal parietal, temporal and occipital covered by cortex which has many cell layers. Each lobes has many known

function that yet to be discovered.

Frontal lobe- personality development motor movement and expressive speech

Occipital lobe- vision and recognization of shape size and color.

Parietal lobe- controls gross sensation such as touch and pressure, fine sensation such as texture,

weight, size and shape, reading skills

Temporal lobe- associated with behaviour, hearing, language reception and understanding.

Deep with cerebral cortex is Thalamus as a relay station for body sensation where the pain is perceived and

deep inside is the hypothalamus responsible function and behaviour of hormone and the basal ganglion for co

ordination of motor movement

BRAIN STEM: divided in to mid brain (upper pportion of brain stem located below the cerebrum), pons and

medula oblagata.

Midbrain- center for visual reflexes

Pons- in latin BRIDGE between mid brain brain and medula ooblagata

Medulla oblagata- caudal portion of the brain stem countinous as a spinal cord. Center for

automatic control of respiration and heart rate.

Most of the spinal nerves are comes from the brain stem and all fiber tract from spinal cord & peripherial nerves

to and from the higher centers passes through this areas.

SPINAL CORD: begins at the base of the skull passes through the FORAMAN MAGNUM of the skull and

continuous as the spinal cord.

CEREBELLUM: synonyms called little brain located in the posterior portion of the cranium behind Pons and

medulla. Covered superiorly by posterior portion of the cerebrum. Controls muscle coordination, tone and posture.

COVERINGS of the BRAIN: has bony (Skull), membranous (Meninges Dura mater, arachanoid membrane, Pia

mater {which carry blood supply to the brain}, meninges of brain continuous with the spinal meninges) and fluid

(Between sub arachanoid and pia mater called sub arachanoid space through which CSF circulates) covering.

Choroid plexus (capillary network) of four ventricles produces CSF act as shock absorption

CIRCLE OF WILLIS:

Blood supply to the brain called circle of Willis comes from branch of internal carotid and vertebral arteries are

the branch of aortic arch.

From Aortic arch arises right and left common carotid arteries. At the level of Jaw divided in to external and

internal carotid arteries

Internal carotid arteries enters the skull through the carotid canal branches in to anterior cerebral artery

(supplies medial surface of the brain) and middle cerebral artery (supplies lateral cerebral hemisphere)

Vertebral artery also branch of aortic arch enters the skull through the transverse foramina of the cervical

vertebra supplies posterior portion of the brain gives branch to the medulla and cerebellum join together form basillary

arteries also supplies part of medulla as well as mid brain and pons.

Basillary artery branches to form posterior cerebral arteries which supplies occipital and temporal lobe.

The anterior and posterior cerebral arteries joined at the base of the brain through the posterior communicating

arteries leads to formation of circle of willis

The right and left anterior cerebral arteries joined together by anterior communicating arteries

SIGNIFICANT OF CIRCLE OF WILLIS: failure of one of the major arteries does not decreases the blood supply of the brain

because of the anastamosis.

BASICS BIO MECHANICS- while learning the movement of the body (Kinesiology) also important to learn the

force applied on body to move it.

Mechanics is the branch of physics deals with the study of forces and the motion produced by their action.

Bio mechanics- takiing the principles and methode of mechanics & applied to the structure and function of the

human body.

Force is a push or pull action. A vector is a quantity having both magnitute and direction. Force is a vection ex

when throw a ball it moves in certain direction and certain speed.

A scalar quantity describes only the magnitude in terms of length, mass and feet. Mass is the amount of matter

that a body contains.

Inertia is the property of matter that cause matter to resist any change of its motion in either speed or direction.

Mass is measured of inertia that is its resistance to a change in motion.

Torque is the tendency of the force to produce rotation about an axis.

Friction is the force between the two surface to prevent motion of one surface across the another.

Velocity is the vector that decribes the speed measures in units feets/seconds or miles/hour.

LAWS OF MOTIONS:

NEWTON’S FIRST LAW: an object at rest tends to be at rest and object at motion tends to be in motion with same speed

and in same direction unless acted upon by unbalanced force. An force is needed to overcome the inertia of aobject to

move stop or change the direction. Ex; kicking a soccer ball it rolls till any force act on it. However because of friction

with surface causes the ball to stop.

NEWTON’S LAW OF ACCLERATION: Accleration is the cange in velocity of the object. Acccleration of the object depends

upon the strength of the force applied on it also change the direction of the object F= ma

Newton’s second law also deals with Mass of an object. A=1/m. if applied same force for two different object of

different weight object with less mass acclerate more than object with great mass.

NEWTON’S 3RD

LAW OF MOTION: for every action there is an equal and opposite reaction. Example trampoline.

FORCE: force is either a push (compression) or the pull (tension). Movement occur in the direction of greater

force if two forces act on a object. Force is the vector quantity has both magnitude direction

Types of forces—linear force, parallel force, concurrent forces,

Resultant forces- ex ant and pos deltoid have common point of insertion but acts in different function,,when act

parallel result in abduction of shoulder

Torque (moment of force): Force couple or couple force occur when two equal force act in opposite direction about an

axis resulting in turning effect.

Torque = magnitude of force x perpendicular distance between line of action and axis of rotation (moment arm)

Torque > when angle of pull is at 90 degree (angular force or movement force). Example quadriceps act as a

angular force as its moment arm increased by patella, without patella moment arm is smaller so much of the force of

quadriceps directed back to the joint provide only stability. Past 90 degree stabilizing force became a dislocating force as

force directed away from the joint.

Torque < when angle of pull is either decrease or increase

No torque is produced if the force is acted directly at the axis of rotation. Although it’s not quite possible the line of pull

is some have close to the joint of axis in this condition it act as stabilizing force (torque with short moment arm act as a

stabilizing force. Ex: corocobrachialis has very short moment arm with shoulder joint so it act as a good stabilizing force

than flexing the shoulder.

As muscle increasing its angular force it’s decreasing its stabilizing force. But thoughts its range of motion

stabilizing and angular force may vary.

LEVER: it is a rigid bar which rotate about a fixed axis when a force is applied to overcome the resistance. Force

may be muscular but not always and the resistance will be gravity or external weight.

Force arm is the perpendicular distance between the force and the axis.

Resistance arm is the perpendicular distance between the resistance and the axis.

The arrangement of axis in relation to the force and resistance determines three types of lever.

1st

class lever: the axis is between the force and resistance. Example atlanto occipital joint. Mechanical advantage is

balance.

2nd

class lever: resistance located between the force and axis. Example plantar flexion of the foot. MCP joint as axis,

plantar flexor as force and weight on the tibia as resistance and biceps brachi in elbow extension in which axis is the

elbow joint , biceps brachi is the resistance and the force arm and the hand is the force. Mechannical advange is used for

power.

3rd

class lever: force is between the axis and the resistance. Example biceps brachia in elbow flexion. Axis is elbow joint,

force is biceps brachia and the resistance is the hand or the external weight in the hand. Mechanical advantage is ROM.

Mechanical advantage is the ratio between the force arm and the resistance arm.

FA=RA, MA=1.

FA> RA MA >1. Therefore to move an object with less force FA move a greater distance

FA<RA MA <1. More force is needed too move an object with shorter FA distance.

Ex: extension of the knee with knee as axis and quadriceps as resistance. By applying a force at distal tibia take

less effort then applying force at proximal tibia

SHOULDER COMPLEX

Shoulder complex consist of shoulder gridle (had scapula, clavicle, sternum and rib cage) and GH joint (Scapula

and humerus).

The purpose of the shoulder joint is to allow the upper extremity to place in various position to accomplish

various activities. Its most mobile joint in the body with less ligamentious tissue.

Shoulder complex includes sternoclavicular joint, acromioclavicular joint, glenohumerol joint and

scapulothoracic joint.

Scapulothoracic articulation is not a pure joint as scapula not have any point of fixation over the thorax, but

attaches to the thorax through clavicle and several muscles.

SHOULDER GRIDLE:

consist of scapula, clavicla and sternum.

Sternoclavicular and acromioclavicular joint allow shoulder gridle motion.

The shoulder gridle motions are elevation and depression, protraction and retraction, uppward and

downward rotation.

BONES and LAND MARKS:

Scapula traingular shaped bone located on the posterior thoracic wall laterally. Its anterior surface is

concave attaches over the convex thorax wall.

Resting position: located between the second and seventh rib 2-3 cm laterally to the spinous process of

the vertebra. Spine of the scapula located at the level of 3rd

or 4th

thoracic vertebra end as acromian process.

It has superior angle, inferior angle and concave glenoid fossa.

CLAVICLE: S shaped bone has two ends, sternal and acromian end. It connect upper extremity to the axial

skeleton at sternoclavicular joint.

JOINTS and LIGAMENTS:

Sternoclavicular joint: Upper limb attaches to the axial skeletal through sternoclavicular joint (synovial joint of

double gliding motion). Motion at sternoclavicular joint accompany shoulder gridle movement. Joint capsule is

reinforced by anterior and posterior sternoclavicular ligament, superiorly by the interclavicular ligament and

costoclavicular ligament between the inferior surface of the clavicle and superior surface of the first rib. Has articular

disk act as a shock absorber especially fall on out stretched hand.

During shoulder elevation and depression motion occur between the clavicle and articular disk, and during protraction

and retraction motion occur between the disk and sternum.

Acromioclavicular joint: between acromian process of scapula and lateral end of the clavicle. Plane shaped synovial joint

with three plane motion. Motions are minimal but important to shoulder motion. Reinforced b superior and inferior

acromioclavicular ligament prevent the dislocation of the lateral end of the clavicle. Coracoclavicular ligament and

coracoacromion ligament is two accessory ligament.

JOINTS MOTIONS: linear moment (protraction, retraction, elevation and depression) because these motion seen best by

viewing scapula w/o moving humerus and angular motion (upper and downward rotation of the scapula) because having

the axis (inferior angle of scapula) for rotation. However shoulder joint motion accompany angular motion. During

upward rotation of scapula humerus either abduct or flexed and while return to anatomical position Sh Jt has to extend

or adduct

Because of interrelated activities of joint, impairment at one joint affect the function of other joint.

Scapulohumeral rhythm: describes relationship between the shoulder gridle and shoulder joint. First 30 degree of

motion is purely shoulder joint motion. Further for every 2 degree of shoulder motion accompanied by 1 degree of

shoulder gridle motion. This 2:1 ratio is called scapulohumeral rhythm.

Angle of pull: several factor determine the role of muscle that play in particular joint motion. Location, size, joint motion

possible and angle of pull.

MUSCLES OF SHOULDER GRIDLE:

Five muscle responsible for motion of the scapula. Four on posterior and one in the anterior.

Trapezius: large superficial back muscle of diamond shape. Anatomically single muscle divided functionally in to :

Upper trapezius: FRO M: occipital protruburance, nuchal ligament of spinous process of C1 to C4. TO: lateral end

of the clavicle and acromian process. AOP: is diagonally vertical its FUNCTION is elevation and upward rotation of the

scapula. Assisting in scapula retraction.

Middle trapezius: FROM: nuchal ligament and spinous process of lower cervical vertebra and upper thoracic

vertebra. TO: inner border of spinous process. AOP: is diagonally horizontal its FUNCTION is retraction and upward

rotation of the scapula since its point of attachment is above the axis of rotation.

Lower trapezius: FROM: spinous process of middle and lower cervical vertebra. TO: base of spine of scapula.

AOP: diagonally vertical its FUNCTION depression and upward rotation of the scapula and assistive in retraction.

UPPER and lower trapezius are antagonist in elevation and depression. All three part work together in retraction but

middle trapezius being the prime mover. Nerve supply: spinal accessory CN XI and C3-C4 sensory

LEVATOR SCAPULAE: FROM: transverse process of C1-C4 . TO: vertebral border of scapula, between the superior angle

and base of scapula spine. AOP: diagonally vertical FUNCTION is elevation and downward rotation. Assistive in

retraction. NERVE SUPPLY: dorsal scapular nerve and C3-C4 cervical nerves.

RHOMBOID MUSCLE: anatomically difficult to differentiate minor and major and functionally have same function. FROM:

spinous process of C7 to T5. TO: vertebral border of scapula between the spine of the scapula and inferior angle. AOP:

has both vertical and horizontal line of pull its FUNCTION both as elevation and retraction of the scapula and downward

rotation of the scapula. NERVE SUPPLY: dorsal scapular nerve.

SERRATUS ANTERIOR: named from its Saw tooth appearance. Attached antero-laterally on the thoracic wall FROM:

lateral surface of upper eight ribs. TO: passes between the scapula and ribs laterally attached to the vertebral border of

the scapula. AOP: outward horizontal line of pull its FUNCTION is protraction and lower fibers of SA responsible for

upward rotation of the scapula. Keep vertebral border of the scapula with the thoracic wall. NERVE SUPPLY: long

thoracic nerve C5-C7, injury cause weakness of serratus anterior leads to winging of scapula.

PECTORALIS MINOR MUSCLE: lies deep to the pectorals major muscle on anterior surface. FROM: anterior surface of the

3rd

to the 5th

rib costal cartilage. TO: coracoid process of the scapula. AOP: vertical line of pull its FUNCTION is prime

mover in depression, protraction, downward rotation and scapular tilt. NERVE SUPPLY: medial pectoral nerve C8-T1.

FORCE COUPLE: various muscle acting together to accomplish same motion. In shoulder gridle

Upward rotation: upper trapezius pulls muscle upward and lower trapezius pulls the muscles downward and lower fibers

of trapezius pulls the muscle outward.

Downward rotation: pects minor pull scapula downward and rhomboids pull the muscle in and elevate the scapula.

Downward rotation motion accompanied shoulder extension.

REVERSAL OF MUSCLE ACTION:

Shoulder gridle motions are moving insertion towards the origin. However is insertion is stabilized origin will move is

called reversal of muscle action.

Upper trapezius: extending the head and neck, lateral bending of the neck to ipsilateral, and rotating the head to contra

lateral side.

Lower trapezius: with scapula stabilize, lower trapezius helps in elevating the trunk. Common in walking with crutch,

with planting crutches on the floor the persons swings the body through.

Levator scapula with splenius cervicis assistant help in lateral bending and rotating of the neck ipsilaterally.

Nerve supply of shoulder gridle muscle:

Get its most of the innervations from the proximal to the BRACHIAL PLEXUS.

trapezius - Motor -11TH

cranial nerve –. Sensory: C3-C4.

Levator scapulae- C3-C4 with partial innervations from dorsal scapular nerve of C5.

Serratus anterior- long thoracic nerve C5-C7

Rhomboids- dorsal scapular nerve.

Pectorals minor- medial pectoral nerve.

SHOULDER JOINT:

Ball and socket joint with motion in all three planes and axis. ARTICULATION: head of the humerus articulate with the

glenoid fossa of the scapula. Highly movable and less stable of all human joint.

Four group of motion possible at shoulder joint:

Flexion and extension (sagital plane/coronal axis), abduction and adduction (coronal plane/ AP axis), medial and

lateral rotation (transverse plane/vertical axis), horizontal abduction (30 degree ) and adduction (120 degree ) with

shoulder in 90 degree of abduction (transverse plane/vertical axis).

Hyper extension in sagital or transverse plane occur at approximately 45 from normal anatomical position.

Circumduction is defined as arc of motion which is the combination of all shoulder motion. Scaption occur in scapular

plane is approximately 30 deg

BONES AND LANDMARKS:

SCAPULA:

Glenoid fossa- concave oval shaped socket on the lateral end of the scapula.

Glenoid labrum- fibro cartilaginous ring makes the glenoid fossa shallow, attached to the rim of the fossa

Sub scapular fossa- concave portion of the costal surface of the scapula.

Supra and infra spinous fossa- space above and below the spine of the scapula on the posterior side of scapula.

Axillary border- inferior end of glenoid fossa to inferior angle of scapula.

Acromian process- spine of the scapula ends as flattened bone on the lateral aspect of the scapula above the glenoid

fossa.

HUMERUS: longest and largest bone of upper extremity. Divided into head of humerus, shaft and condylar area.

Head of the humerus divided in to anatomical and surgical neck.

Shaft is the area between the surgical neck proximally and epicondyle distally.

Greater tubercles – large projection lateral to humeral head provide attachment for Supraspinatus ,

Infraspinatus , Teres minor.

Lesser tubercle – small projection on the anterior surface medial to greater tubercles, provide attachment for

Subscapularis.

Deltoid tuberosity- lateral side of the shaft of humerus

Bicipital groove- longitudinal groove between the tubercles, hold the bicipital tendon.

Bicipital ridges- crest of greater and lesser tubercles also called lateral and medial lips of bicipital groove

respectively hold the pectorals major and Lattisimus dorsi & teres major (lady between the two major) muscle

respectively.

LIGAMENTS AND STRUCTURES OF JOINT:

Joint capsule – thin walled spacious container that attach to the rim of the glenoid fossa of the scapula and anatomical

neck of the humerus. Has outer fibrous and inner synovial membrane.

When arms are at side the superior portion of capsule is taut and inferior is slack vice versa in abducted.

Superior middle and inferior gleno humeral ligament (not well defined) reinforces the capsule anteriorly.

Coraco humeral ligament – from lateral side of coracoid process of the scapula to the medial side of the greater tubercle

of the humerus strengthen the upper part of the joint capsule.

Glenoid labrum- attaches to the rim of the glenoid fossa- function is to deepens the glenoid fossa for articulation of the

head of the humerus.

BURSAE AROUND THE SHOULDER JOINT: several bursae found around the shoulder joint.

Sub deltoid bursae between the deltoid muscle and joint capsule.

Sub acromial bursae below the acromian process and Coraco acromial ligament between them and the joint capsule

continuous with sub deltoid bursae.

Rotator cuff – tendinous band formed by blending together of insertion of Supraspinatus, Infraspinatus and teres minor

and subscapularis. Function to keep the humeral head with glenoid fossa while motion and at rest of shoulder joint.

Thoracolumbar fascia- aponeurosis a superficial fibrous tissue arise from spinous process of lower thoracic and lumbar

vertebra, posterior iliac crest, supra spinal ligament provide broad attachment for Lattisimus dorsi muscle.

Stability of gleno humeral joint:

Shallow glenoid fossa deepened by glenoid labrum. Fossa positioned laterally, upward and anteriorly.

Capsule completely surround the joint creates partial vacuum held humeral head against glenoid fossa.

Rotator cuff muscles blends and attaches as flattened tendon on humeral head maintain the joint stability during

motion.

Common shoulder pathologies:

Acromio clavicular separation- 1st

degree sprain stretch of AC ligament, 2nd

degree sprain rupture of AC ligament and

stretch of Coracoclavicular ligament, 3rd

degree rupture of both AC and CC ligament.

Clavicular # common in mid clavicular region and humeral head # commonly seen in fall on outstretched hand.

Anterior shoulder dislocation- common in assault with extended and externally rotated shoulder ,

Shaft of humerus # commonly affect the radial nerve as it is superficial to bone, pathological # by benign tumor.

Gleno humeral subluxation- common in stroke or neuro vascular injury of brain, where there is weakness of rotator cuff

muscle.

Impingment syndrome- compression of structures b/w coracoacomial arch and head of humerus, common in over use

injury.

Swimmer’s shoulder – common in free style, back stroke and butter fly stroke.

Adhesive capsulitis/ frozen shoulder- fibrosis and inflammation of shoulder joint capsule.

Rotator cuff tear- result of acute trauma and slow degeneration.

Bicipital tendinitis- inflammation of long head of bicep tendon in the bicipital groove due to overuse injury, pop out of

groove when muscle is abducted and laterally rotated.

MUSCLE OF SHOULDER JOINT:

Muscle of shoulder joint are;

Deltoid, supraspinatus, pectorals major, Lattisimus dorsi, infraspinatus, subscapularis, teres major, biceps and triceps.

DELTOID: triangular shaped muscle giving rounded shape to the shoulder, divided in to anterior, middle and posterior.

Supply by axillary nerve (C5-C6)

Anterior deltoid- FROM anterior border of the lateral end of the clavicle to the deltoid tuberosity of the

humerus. Has oblique line of pull in anatomical position of shoulder so its FUNCTION is abduction, flexion, medial

rotation and in 90 ® abduction it has horizontal line of pull so its FUNCTION is horizontal adduction.

Middle deltoid- FROM lateral border of the acromian process to the deltoid tuberosity. Has vertical line of pull

lateral to the joint axis so its FUNCTION is abduction.

Posterior deltoid- FROM posterior border of the spine of the scapula to the deltoid tuberosity. Has oblique line

of pull posterior to the joint axis so its FUNCTION is extension, abduction and lateral rotation. In 90 ® of shoulder

abduction the line of pull is horizontal, so help in horizontal abduction.

SUPRASPINATUS: FROM supra spinous fossa of the scapula passes underneath the acromian process TO the greater

tubercle of the humerus. EMG studies shows that this muscles active throughout the abduction of the shoulder. Also

stabilizing the shoulder joint I position. NERVE SUPPLY: supra scapular nerve ( C5 C6).

PECTORALIS MAJOR: anterior muscles of the shoulder joint also largest muscles of the shoulder, is superficial muscle

except for its distal attachment. Divided in to two part. Clavicular and sternal portion.

Clavicular portion: FROM medial third of the clavicle has more vertical line of the pull so its FUNCTION is flexion

of the shoulder joint up to 0 to 30 ® of flexion and decrease in the effectiveness up to 90 ® . after 90® of shoulder flexion

the line of pull became horizontal . so it is safe to say that this portion of the pects major effective only in the initial 60®

of flexion.

Sternal portion: FROM sternal and costal cartilage of the first 6 ribs has vertical line of pull in shoulder full

flexion and loss its effectiveness at 90® of extension, but effective in 180-150® of shoulder extension motion, and

ineffective when shoulder approach the 90® of extension. So safe to say this portion of the muscle effective in initial 60®

of shoulder extension.

Both portion of the pects effective in initial degree of the motion occur in the sagital plane.

TO: lateral lip of the spiral groove deeply.

FUNCTION: antagonist in shoulder flexion and extension. Agonist in shoulder abduction, medial rotation,

horizontal adduction. NERVE SUPPLY: medial and lateral pectoral nerve (C5-T1).

LATTISSIMUS DORSI: superficial and posterior muscles of the shoulder joint except for small portion covered by

trapezius. FROM lower thoracic and lumbar vertebra from T7 to L5 passes distally through the axilla TO the medial lip of

the bicipital groove.

FUNCTION: as is cross inferior and medial to the joint axis it is a strongest agonist in the shoulder

extension, medial rotation , adduction and hyper extension of the shoulder joint.

REVERSAL OF MUSCLE ACTION (closed chain activity of the Lattisimus dorsi): when the distal attachment is stabilized

due to attachment on the Ilium and sacrum it elevate the pelvis helpful in crutch walking.

NERVE SUPPLY: thoraco dorsal nerve (C6-C8).

TERES MAJOR: FROM axillary border of the scapula just below teres minor TO the medial lip of the bicipital groove.

Travel along with Lattisimus dorsi. This muscle is called “little helper” as it do all the action of the LATS except hyper

extension but less effective as it is smaller in size. NERVE SUPPLY: sub scapular nerve (C5-C6).

INFRASPINATUS: FROM infraspinous process of the scapula TO middle groove of the greater tubercle of humerus.

FUNCTION: shoulder lateral rotation and horizontal abduction. NERVE SUPPLY: supra scapular nerve (C5-C6).

TERES MINOR MUSCLE:FROM axillary border of the scapula along with teres major TO the inferior groove of the greater

tubercle. Whereas teres major muscle passes through the axilla to attach below the lesser tubercle anteriorly.

FUNCTION: lateral rotation and horizontal abduction. NERVE SUPPLY: axillary nerve (C5,C6).

Long head of triceps passes between the teres minor and major in the axilla.

SUBSCAPULARIS: FROM sub scapular fossa of the scapula runs laterally crosses shoulder joint anteriorly and attach to

the Lesser tubercle of the humerus. FUNCTION: medial rotation. NERVE SUPPLY: Sub scapular nerve (C5,C6)

CORACOBRACHILIS: FROM coracoid process of the scapula to the mid shaft of the humerus medially. Has vertical line of

pull close to the joint axis, so its act as a STABILIZIING FORCE than the ANGULAR FORCE. NERVE SUPPLY:

musculocutaneous nerve (C6-C7)

Humeral head has more articular surface than the glenoid fossa. If humeral head simply rotates in the glenoid fossa, it

comes out of articular surface in abduction, also vertical pull of the deltoid make the head against the acromian process.

It’s the ARTHROKINEMATIC MOVEMENT (roll, glide, spin) keeps the humeral head in articular surface during

OSTEOKINEMATIC MOTION of the shoulder joint.

ELBOW COMPLEX

Complex joint made up of 3 bones, consist of 2 joints, 3 ligaments and capsule.

Elbow joint is the articulation between the distal humerus and proximal part of ulna and radius.

Distal humerus has trochlea and capitulum. Trochlea is lower than capitulum of humerus form carrying angle.

Proximal ulna have Trochlear notch and olecrenon process articulate with capitulum of humerus.

Proximal radius have superior concave surface articulate with convex capitulum of humerus.

MOTION: uniaxial hinge joint provide flexion and extension. Approximately 145® of flexion from 0® of extension.

Superior radioulnar joint: circular head of radius articulate with radial notch of ulna to form this joint. at distal end the

ulnar notch of radius rotating around the head of ulna form distal radio ulnar joint. Radio ulnar joint is a uniaxial pivot

joint provide pronation and Supination of forearm. The radius moves over ulna during motion with ulna stable, locked

by its bony shape in proximal end.

Hyper extension of elbow is restricted by olecranon process of ulna. Rarely occur due to annular ligament laxity.

CARRYING ANGLE: in anatomical position longitudinal axes of humerus and forearm form this angle. 5® in male 15® in

female approximately. Trochlea is lower than capitulum of humerus form carrying angle. .’. Rotation of ulna and radius

around Trochlea and capitulum of humerus is not in a straight line like a typical hinge. This angle is quite functional in

getting our hand to our mouth during eating.

BONES AND LANDMARK:

SCAPULA:

SUPRAGLENOID TUBERCLE: raised superior portion of glenoid fossa, provide attachment for long head of biceps.

INFRAGLENOID TUBERCLE: Raised inferior portion of glenoid fossa, provide attachment for long head of triceps.

CORACOID PROCESS: Anterior projection on superior border of scapula, provide attachment for short head of biceps and

pects minor.

HUMERUS DISTAL END:

TROCHLEA: Has medial and lateral lip and medial and lateral surface, wholly present on medial part of distal

humerus articulate with Trochlear notch of ulna.

CAPITULUM: rounded convex area lateral to the trochlea.

MEDIAL EPICONDYLE: Provide attachment for Pronator teres.

LATERAL EPICONDYLE: Provide attachment for Supinator and anconeus.

LATERAL SUPRACONDYLOR RIDGE: Provide attachment for brachio radialis

OLECRANON FOSSA: On the posterior surface of the distal humerus between the two epicondyle articulate with

the olecranon process of ulna.

ULNA: medial bone of forearm parallel to radius. Has OLECRANON PROCESS form posterior surface of proximal

ulna, which give insertion to the triceps. TROCHLEAR NOTCH/ semilunar notch form anterior surface of proximal ulna.

CORONOID PROCESS: below Trochlear notch provide attachment for brachialis muscles. ULNAR TUBEROSITY: Below the

coronoid process. RADIAL NOTCH: lateral to the coronoid process for articulation of head of radius.

RADIUS: Lateral bone of forearm contains HEAD: flat rounded shapes with depressed superior surface. RADIAL

TUBEROSITY: located medial side below the head, provide attachment for biceps muscles.

LIGAMENTS OF ELBOW JOINT:

MEDIAL COLLATERAL LIGAMENT: Triangular in shape, spans medial side of the elbow. Attaches on MEDIAL

epicondyle of the humerus divided and run obliquely to attach to the coronoid and olecranon process of Ulna.

LATERAL COLLATERAL LIGAMENT: triangular in shape. Attaches proximally on LATERAL epicondyle of humerus

and distally on the Annular ligament and lateral side of ulna.

ANNULAR LIGAMENT: encompassing the head of radius attaches to the radial notch of ULNA anteriorly and

posteriorly.

JOINT CAPSULE: encompass trochlea, capitulum and fossa between them attaches proximally on the distal end

of humerus, distally attaches under radial notch of Ulna encompass coronoid process and Trochlear notch of ulna,

around the head of radius.

Reinforces antero posteriorly by annular ligament, medio-laterally by collateral ligaments.

RADIO-ULNAR ARTIICULATION held by INTEROSSEOUS MEMBRANE located between the bone along the shaft.

COMMON ELBOW PATHOLOGIES:

LATERAL EPICONDYLITIS: (TENNIS ELBOW) over use/ increase pressure on the extensors of wrist due to increase

moment arm. ECRB particularly affected. Common among racquet sports.

ECRB NURSE MAID ELBOW

MEDIAL EPICONDYLITIS: (GLOFER’S ELBOW) inflammation of flexor’s of wrist due too over use or repetitive stress.

NURSE MAID ELBOW OR PULLED ELBOW: Sudden strong traction on the children elbow subluxing radial head from

annular ligaments.

ELBOW DISLOCATION: Rare common in strong downward force in slightly flexed elbow, cause elbow to slide posteriorly,

rarely kink the brachial artery cause Volkmann’s ischemic contracture (devasting complication) also common in supra

condylar fracture cause the ischemic necrosis of forearm muscles.

SUPRACONDYLOR FRACTURE: common in children while fall on outstretched hand.

MUSCLES OF ELBOW and FOREARM:

BRACHIALIS, BICEPS BRACHIA, BRACHIORADIALIS, TRICEPS, ANCONEUS, PRONATOR TERES, PRONATOR QUDRATUS and

SUPINATOR

BRACHIALIS: mid shaft of humerus FROM medial and lateral surface SPANS the elbow joint anteriorly and

ATTACHES to the CORONOID process of ulna and no attachments on radius. Lies deep to biceps muscles. It is named as

work horse for Elbow joint as it is a very strong elbow flexor regardless of position. NERVE SUPPLIED: Musculocutaneous

nerve (C5 C6).

Brachio radialis Biceps brachia

BICEPS BRACHIA: Name implies it has two heads short head from coracoid process and long head from

supraglenoid tubercle of scapula runs over humerus and out of joint capsule to descend through the bicipital groove.

The two heads join to from common muscle belly SPANS anterior surface of arm. Attaches to the radial tuberosity of the

humerus. FUNCTION elbow flexor in the mid range, because of its oblique attachment on radius it also function as a

Supinator of forearm at 90® of elbow flexion. As elbow extended the moment arm decrease so stabilizing force is more

than angular force. NERVE SUPPLIED: Musculocutaneous nerve.

BRACHIO-RADIALIS: name implies it has two attachments one in humerus and another in radius. FROM slightly

above lateral epicondyle of humerus over supracondylor ridge cross the elbow anteriorly and lateriorly distally attach

proximal to the styloid process of radius. FUNCTION: Has vertical line of pull so effective in elbow flexion. NERVE

SUPPLIED: Radial nerve

ANCONEUS: FROM posterior surface of lateral epicondyle SPANS elbow joint posteriorly TO olecranon process

laterally and inferiorly. BEST ROLE: It lies top of annular ligament and attach to a part of it. Assist in elbow extension.

NERVE SUPPLIED: Radial nerve.

TRICEPS BRACHIA ANCONEUS

TRICEPS BRACHIA: Name implies 3 head. Long head, lateral head and medial head. Long head from infraglenoid

tubercle descends between teres major and minor to join with other two heads.

Lateral head from lateral part of posterior surface of shaft below greater tubercle. Medial head just below the

lateral head attachment. FUNCTION: quiet vertical line of pull very effective in elbow extension. NERVE SUPPLIED: Radial

nerve (C7C8)

PRONATOR TERES: Name implies pronation function and its cord like shape. FROM Medial epicondyle of

humerus and medial part of coronoid process of ulna runs obliquely TO attach to the midpoint of the radius lateral

surface. FUNCTION: pronation of the forearm also assist in elbow flexion as it cross anterior to elbow joint. NERVE

SUPPLIED: Median nerve

PRONATOR QUDRATUS: Name implies pronation function and qudratus shape. Located deep on the distal

surface of forearm. FROM distal one fourth of ulna TO the distal one fourth of radius. Has horizontal line of pull.

FUNCTION: pronation. NERVE SUPPLIED: median nerve

SUPINATOR: Spans the elbow joint laterally from posterior to anterior surface. FROM lateral epicondyle and

adjacent ulna surface posteriorly, crosses laterally wraps around the proximal radius and attaché on it. FUNCTION:

Supination in combine with biceps. NERVE SUPPLIED: Radial nerve (C8, T1)

WRIST JOINT

Complex joint of the body like ankle joint.

Made up of two joint: Radiocarpal joint and mid carpal joint. Ulna not take part in wrist joint as an articular disk separate

the ulna and scaphoid, lunate, triquetral.

RADIOCARPAL JOINT: formed proximally by concave part of distal radius, articular disk and distally by convex part of

scaphoid, lunate and triquetrum.

Pisiform located more anteriorly on the triquetrum. SYNOVIAL joint of condyloid variety. Provide biaxial joint motion

flexion/ extension and radial and ulnar deviation.

MIDCARPAL JOINT: between two rows of carpal bone. It’s a palne joint of irregular shape, allow glidiing motion

contribute to radiocarpal joint motion.

Joint motion: flexion (App 90®) and extension (App 70®) occur in frontal axis and sagittal plane. Ulnar (App 35®)and

radial (App 25®) deviation occur in sagittal axis and frontal plane.

BONES AND LANDMARKS:

Starting from thumb carpal bones are arranged in two rows. Scaphoid, lunate, triquetrium and pisiform are in proximal

row. Trapezium, trapezoid, capitate and hamate are in distal row. These short bones are arranged in an arc with

convexity on posterior side and concavity on anterior side. This arched arrangement gives thumb to oppose with greater

ability.

DISTAL STYLOID PROCESS: projection on lateral side of radius and posteriomedial side of ulna. Provide attachment for

collateral ligament.

HOOK OF HAMATE: projection on anterior surface. Provide attachment for transverse carpal ligament.

Medial and lateral Epicondyle provide attachment for common flexor and extensor tendon.

SUPRACONDYLOR RIDGE proximal to the lateral epicondyle, provide attachment for ECRL.

LIGAMENTS OF WRIST JOINT:

FOUR major ligaments and numerous intercarpal ligaments support the radiocarpal joint.

RADIAL COLLATERAL LIGAMENT: from styloid process of radius TO scaphoid and trapezium. Provide lateral support.

ULNAR COLLATERAL LIGAMENT: from styloid process of ulna TO pisiform and triquetrum. Provide medial support.

PALMAR RADIOCARPAL LIGAMENT: from anterior surface of radius and ulna TO anterior surface of proximal carpal

bones and capitate bone in distal row. Control wrist extension.

DORSAL RADIOCARPAL LIGAMENT: FROM posterior surface of distal radius to proximal carpal bones except pisiform as

it is located anterior. Control wrist flexion.

JOINT CAPSULE: encloses radiocarpal joint. Reinforced by these major four ligaments.

ARTICULAR DISK at distal ulna end articulates with lunate and triquetrum.

MUSCLES OF WRIST JOINT:

Muscles that spanned and have primary function in the wrist are discussed here. These have some general statements:

1st

flexor attach on medial epicondyle extensor attach on lateral epicondyle.

2nd

distal attachment of all wrist muscles is at metacarpals.

3rd

name of the muscles tell generally action (flexor/extensor) on the wrist (carpi), side of the distal attachment.

ANTERIOR POSTERIOR

FLEXOR CARPI ULNARIS

FLEXOR CARPI RADIALIS

PALMARIS LONGUS

EXTENSOR CARPI RADIALIS LONGUS

EXTENSOR CARPI RADIALIS BREVIS

EXTENSOR CARPI ULNARIS

ANTERIOR:

FLEXOR CARPI ULNARIS: superficial muscle FROM medial epicondyle runs anteriorly and ulnar side TO base of the fifth

metacarpal and pisiform bone. Only wrist muscle attach to the carpal bone. FUNCTION wrist flexion and ulnar deviation.

Supplied by Ulnar nerve (C8-T1)

FCU FCR PL

FLEXOR CARPI RADIALIS: also a superficial muscle FROM medial epicondyle runs diagonally across anterior forearm TO

base of the 2nd

and 3rd

metacarpal. FUNCTION: wrist flexion and radial deviation. Supplied by median nerve (C6-C7).

PALMARIS LONGUS: FROM common flexor origin runs anterior to the forearm TO the midline of the palmar aponeurosis.

So it has one bony attachment at proximal end. Easily identified at base of wrist during wrist flexion against resistance.

FUNCTION: assist in wrist flexion. NERVE: median nerve.

POSTERIOR:

EXTENSOR CARPI RADIALIS LONGUS: FROM extensor origin runs lateral side of posterior forearm passes under two

tendons that goes to the thumb and extensor retinaculum TO base of the 2nd

metacarpal. FUNCTION: extension and

radial deviation. NERVE: Radial nerve.

ECRL ECRB ECU

EXTENSOR CARPI RADIALIS BREVIS: FROM common extensor origin lies next to the ECRL. Like ECRL it passes under two

tendons that go to the thumb and extensor retinaculum TO base of the 3rd

metacarpal close to the axis of ulnar and

radial deviation. FUNCTION assists in radial deviation, prime mover in wrist extension. NERVE: Radial nerve

EXTENSOR CARPI ULNARIS: FROM common extensor origin runs medially TO the base of the fifth metacarpal. FUNCTION

wrist extension and ulnar deviation. NERVE: Radial nerve.

KINESIOLOGY OF HAND

Distal part of the upper extremity. Accomplish various functional activities ranging from simple to complex task

by placing hand in various positions.

Hand consists of thumb and finger metacarpals and phalanges.

JOINT AND MOTION OF THUMB:

THUMB 1st

digit of the hand made of CMC, MCP, and IP joint.

CMC JOINT OF THUMB: - Saddle joint with each joint surface convex in one direction and concave in other

direction b/w trapezium and base of the 1st

metacarpal. Provide triaxial motion Flexion/ Extension parallel to the palm of

the hand, abduction/adduction Perpendicular to the palm of the hand, opposition/ Reposition referred as an accessory

motion that accompanies active movement essential for normal motion. CMC jt Allow more mobility as well as stability.

MCP JOINT OF THUMB: - Hinge joint b/w head of the metacarpal and base of 1st

phalanges. Provide uniaxial

motion of flexion and extension.

IP JOINT OF THUMB: - One phalangeal joint provide flexion and extension.

JOINT AND MOTION OF FINGER:

2ND

. 3RD

, 4TH

, AND 5TH

DIGITS. Each digits having 4 joints: - CMC, MCP, PIP, DIP.

CMC joint: Non axial irregular joint provide stability than mobility. base of second metacarpal articulate with

trapezoid, 3rd

metacarpal articulate with capitate, 4th

and 5th

metacarpal articulate with hamate. 5th

CMC joint is mobile

that provide some opposition function.

MCP joint: biaxial condyloid joint. Articulation b/w head of the metacarpal and base of the proximal phalanges.

Provide flexion/ extension, abduction/adduction.

IP joints: 2 IP joints of fingers b/w proximal and middle phalanges, middle and distal phalanges. Uniaxial joint

provide flexion/extension.

BONES AND LANDMARKS:

Hand made upp of 5 metacarpal, 14 phalanges. Proximal end of phalanges and metacarpal are called base, distal

ends are called head.

LIGAMENTS OF HAND:

FLEXOR RETINACULUM: Covers the anterior surface of the wrist carpal bones and distal part of ulan and radius

in mediolaterally (horizontal) direction. FUNC: hold the tendons of the flexor, prevent the pull away while flex the wrist.

FR divided in to two (i) Palmar carpal ligament, (ii) Transverse carpal ligament.

Palmar carpal ligament: It’s Proximal and superficial. Distal fibers blends with transverse carpal ligament.

Attache to the styloid process of ulna and radius.

Transverse carpal ligament: It’s distal and deep. Attaches medialy on Pisiform and hook of hamate,

laterally on scaphoid and trapezium. Arches over carpal bones forming tunnel through which MEDIAN

nerve and 9 Flexor tendon crosses.

EXTENSOR RETINACULUM: Fibrous band covering the wrist on the posterior side in horizontal direction from

styloid process of ulna medially to the triquetrum, pisiform and lateral side of radius. FUNC: holds the extensor tendon

of wrist.

EXTENSOR EXPANSION LIG/ HOOD: Triangular ligament covers the dorsum and sides of proximal phalanx of the

fingers. ED tendon blends in to it. Broader at the base at MCP jt, at the PIP jt it is joined by tendon of lumbricals and

interossei

ARCHES OF HAND: Bony skeleton reinforced by the ligaments forms the arches of the hand.

Proximal carpal arch: formed by proximal part of metacarpal and carpal bones, maintained by flexor

retinaculum.

Distal carpal arch: formed by heads of metacarpal.

Longitudinal arch: Perpendicular to proximal and distal carpal arch. It begins at wrist runs along the metacarpal

and phalanges of each digit.

MUSCLES OF WRIST:

The muscles of forearm that have primary function on joints of hand and wrist divided in to

EXTRINSIC MUSCLES INTRINSIC MUSCLES

ANTERIOR:

Flexor digitorum superficialis

Flexor digitorum profundus

Flexor pollicis longus

POSTERIOR:

Extensor digitorum

Extensor indicis

Extensor digiti minimi

Abductor pollicis longus

Extensor pollicis longus

Extensor pollicis brevis

FLEXOR DIGITORUM SUPERFICIALIS: FROM medial epicondyle of humerus, also coronoid process of Ulna and oblique

line of radius. TO shaft of the middle phalanx by split in to two. FUNCTION flexion of MCP and PIP. NERVE SUPPLIED

Median nerve.

FLEXORDIGITORUM SUPERFICIALIS FLEXOR DIGITORUM PROFUNDUS

FLEXOR DIGITORUM PROFUNDUS: Lies deep to FDS. FROM anterior surface of ulna and medial surface of coronoid

process, passes deep till end of spliting FDS tendon. TO base of distal phalanx. FUNCTION MCP, PIP, DIP flexion. NERVE

SUPPLIED median and ulnar nerve.

EXTENSOR DIGITORUM MUSCLES: FROM lateral epicondyle of humerus TO the distal phalanx of the thumb by passes

under the extersor retinaculum via extensor hood. Only common extensor muscles of finger. Interconnecting bands

joining the tendons of Extensor muscles in the area of metacarpal that limits the individual finger extension. FUNCTION:

extension of MCP, PIP, and DIP joints from second to fifth fingers. Nerve : radial nerve.

ED EDM EIM

EXTENSOR INDICIS MUSCLES: FROM posterior aspect of distal ulna TO the base of the distal phalanx. Cross the extensor

retinaculum medial to EDM and attach to the extensor hood. FUNCTION: extension of index finger at MCP, PIP, and DIP.

EXTENSOR DIGITI MINIMI: long, narrow and deep muscles FROM common extensor orgin to the base of distal phalanx

of the fifth finger via extensor hood. Passes under the extensor retinaculum.

MUSCLES OF POLLICES:

Pollices = thumb. Four muscles of thumb.

FLEXOR POLLICES LONGUS: FROM anterior surface of the radius and interosseous membrane TO the distal phalanx of

the thumb. FUNCTION: flexion of CMC, MCP and IP joints of thumb.

ABDUCTOR POLLICES LONGUS: FROM middle portion of ulna, radius distal to the supinator and interosseous membrane

TO base of Metacarpal by passing unter extersor retinaculum. Function: Abduction of thumb at CMC joint.

EXTENSOR POLLICIS BREVIS: deep muscles of posterior forearm FROM distal end of posterior radius TO the base of the

thumbs proximal phalanges just medial to the APL. FUNCTION: extension of MCP joint of thumb.

EXTENSOR POLLICIS LONGUS: FROM mid third of ulna and interosseous membrane to the base of distal phalanx of

thumb. FUNCTION: Extension of CMC, MCP and IP joint.

Anatomical snuff box: a depression formed on extending of the thumb appears to be b/w two tendon. Actually the

borders of the anatomical snuff box formed by 3 tendon.

Abductor pollicis longus and extensor pollicis brevis formed lateral border. Extensor pollicis longus formed

medial border.

INTRINSIC MUSCLES OF HAND:

Have proximal attachment at or distal to the carpal bones. Function in fine motor and prehension

control of the hand.

Divided in to Thenar, hypothenar and palm muscles.

THENAR MUSCLES:

FLEXOR POLLICIS BREVIS: FROM flexor retinaculum and trapezium bone TO the base of the proximal phalanx of

thumb. Flexion of CMC, MCP jt of thumb.

ABDUCTOR POLLICIS BREVIS: lies lateral to the FPB FROM flexor retinaculum and scaphoid and trapezium bone

TO the base of the proximal phalanx of the thumb. Abduction at CMC joint of thumb.

FPB AbPB OP

OPPONENS POLLICIS MUSCLES: FROM trapezium and flexor retinaculum TO lateral surface of shaft of first

metacarpal.

All the Thenar muscles are supplied by median nerve except adductor pollicis brevis.

HYPOTHENAR MUSCLES:

FLEXOR DIGITI MINIMI: FROM hook of the hamate & flexor retinaculum TO the base of the proximal phalanx of

the little finger. Flexion of MCP joint of little finger.

ABDUCTOR DIGITI MINIMI: lies medial to the FDM FROM pisiform bone and FCU tendon TO base of the proximal

phalanx of the fifth finger. Abduction of little finger.

OPPONENS DIGITI MINIMI: FROM hook of the hamate & flexor retinaculum TO ULNAR border of fifth metacarpal

FDM OpDM

Abductor digiti minimi adductor pollicis brevis

DEEP PALM GROUP:

Adductor pollicis muscles: LOCATED deep and not take part in thenar eminence formation. FROM capitate, base of

second metacarpal, palmar surface of 3rd

metacarpal. TO base of the promimal phalanx of thumb. FUNCTION

adduction of thumb. SUPPLIED ulnar nerve.

LUMBRICALS: Have no bony attachement. Only tendon attachment. FROM tendon of FDP proximally and spanning MCP

jt anteriorly then passes posteriorly at proximal phalanges to attach distally at extensor expansion hood. FUNCTION:

MCP flexion and PIP, DIP extension.

1st

lumbrical : unipennate. FROM radial side of radial tendon of FDP (corresponding to index finger). Passes

posteriorly on the radial side to insert at extensor expansion hood at MCP jt.

2nd

lumbrical: unipennate. FROM radial side of radial tendon of FDP (corresponding to middle finger). Passes

posteriorly on the radial side to insert at extensor expansion hood at MCP jt of middle finger.

3rd

lumbrical: Bipennate. ONE HEAD FROM ulnar side of the FDP tendon of middle finger, SECOND HEAD FROM

radial side of FDP tendon of ring finger(fourth digit). Passes posteriorly on the radial side to insert at extensor expansion

hood at MCP jt of ring finger.

4th

lumbrical: bipennate.ONE HEAD FROM ulnar side of the FDP tendon of ring finger, SECOND HEAD FROM

radial side of FDP tendon of little finger. Passes posteriorly on the radial side to insert at extensor hood of MCP joint of

little finger.

1st

and 2nd

lumbricals supplied by median nerve. 3rd

and 4th

lumbricals supplied by ulnar nerve.

PALMAR INTEROSSEI MUSCLES: 4 palmar interossei muscles are there which are unipennate.

Medial part of FPB considered as 1st

palmar interossei, supplied by ulnar nerve. Where lateral part of FPB

supplied by median nerve.

2nd

PI: FROM ulnar side of shaft of 2nd

metacarpal to the base of the proximal phalanx of index finger ulnarly.

3rd

PI: FROM radial side of shaft of the ring finger to the base of the proximal phalanx of ring finger radialy.

4th

PI: FROM radial side of shaft of the little finger to the base of the proximal phalanx of little finger radialy.

FUNCTION: adduction of fingers. SUPPLIED ulnar nerve.

DORSAL INTEROSSEI:

FROM Adjacent metacarpal TO base of the proximal phalanx. 1st

and 2nd

DI inserted on radial side of the index

and middle finger. 3rd

and 4th

DI inserted on the ulnar side of the ring and middle finger. FUNCTION abduction of finger.

SUPPLIED by ulnar nerve. Little finger has abductor digiti minimi for abduction.

Consise from clinical kinesiology and anotomy

Wait for other parts of musculoskeletal system.