Orthopedics
“The branch of medical science that
deals with the prevention or correction of
disorders involving locomotor structures of
the body, especially the skeleton, joints,
muscles, fascia, and other supporting
structures such as ligaments and
cartilage.”
Taber’s pg. 1647
Anatomic Position
Body in the erect standing position with
the feet just slightly separated and the
arms hanging by the side, elbows straight,
and the palms of the hands facing
forwards.
Dutton 2012. pg. 107
Directional Terms
Superior / Cranial
Inferior / Caudal
Anterior / Ventral
Posterior / Dorsal
Midline
Dutton, 2012. pg. 107
Planes of the body
Sagittal: divides the body into right and
left halves
Frontal: divides the body into front and
back halves
Transverse: divides the body into top and
bottom halves
Dutton, 2012. pg. 108
Length-Tension Relationship
When looking at the actin and myosin
filaments, watching the overlap of the
actin and myosin filaments will determine
the optimal length for that muscle to
produce the strongest contractile force
Dutton, 2012. pg. 115
Length-Tension Relationship
Active insufficiency: the muscle is
incapable of shortening to necessary
extent to allow full range of motion at all
joints crossed.
Passive insufficiency: the muscle cannot
stretch to the necessary extent for full
range of motion in the opposite direction
of all joints crossed
Dutton, 2012. pg. 115
Types of muscle contractions
Isometric: a static contraction without
change in muscle length
Isotonic: a dynamic contraction where
change in muscle length is produced
Concentric: dynamic contraction where
tension is produced shortening the muscle
Eccentric: dynamic contraction where
tension is produced lengthening the muscle
Dutton, 2012. pg. 229
Balance
Static- the ability to maintain stable anti-gravity position while at rest
Dynamic- the ability to stabilize the body when the support surface is moving or when the body is moving on a stable surface
Automatic Postural Reactions- the ability to maintain balance during unexpected external perturbations
Dutton, 2012. pg. 249
Joint Position
Open-Packed – position of least joint
congruity
Closed-Packed- position of maximum joint
congruity
Dutton, 2012. pg. 119
Closed-Packed
Maximal tautness of ligaments
Maximal surface congruity
Minimal joint volume
Maximal stability of the joint
Dutton, 2012. pg. 119
Open-Packed
“Loose packed” or “resting” position
Slack of major ligaments
Minimal surface congruity
Minimal joint surface contact
Maximal joint volume
Minimal joint stability
Dutton, 2012. pg. 119
Joint Mobilizations
Manual treatment modality that uses
manual passive techniques to enhance
arthrokinematic movement.
Dutton, 2012. pg. 160
Arthrokinematic Movements
Occur at bone ends, without regard to
body movement.
“ACCESSORY MOVEMENTS”
Motions specific to articulating joint surfaces
Not volitional
Glide (Slide), spin, and roll
Also referred to as “joint play”
Shankman, 2011. pg. 202
Glide (Slide)
One portion of the articular surface
comes into contact with a series of
locations on the corresponding surface
Shankman, 2011. pg. 202
Spin
Portion of one joint spins (clockwise or
counterclockwise) around the stationary
longitudinal axis
Shankman, 2011. pg. 202
Roll
Multiple points of contact on one joint
surface come into contact with multiple
points on the corresponding joint surface.
Shankman, 2011. pg. 202
Joint Mobilizations
Improve joint mobility
Decrease joint pain
Restoring accessory movement
Decrease muscle guarding
Lengthening tissue surrounding joints
Increased proprioceptive awareness
Dutton, 2012. pg. 160
Grades of Joint Mobilizations
Grade I: small oscillation or joint motion occurring in the beginning of the available ROM
Grade II: larger amplitude motion occurring in the beginning to midrange of available ROM
Grade III: larger amplitude motion occurring from midrange to end of available ROM
Grade IV: small oscillation or joint motion occurring at the very end range of available ROM
Grade V: high velocity thrust of small amplitude at the end of available ROM
Shankman, 2011. pg. 204
Joint Mobilizations
Grades I and II: typically used to treat
pain or when ROM produces pain
Grades III and IV: typically used to treat
joint restrictions
Shankman, 2011. pg. 204
Upper and Lower Quarter
Screens
Used when there is no history available
Used when signs and symptoms are
unexplainable
Dutton, 2012. pg. 98
Upper Quarter Screens
Appropriate for upper thoracic, upper
extremity, and cervical problems
Dutton, 2012. pg. 98
Upper Quarter Screens
Postural assessment: observed from front, back and
side looking for asymmetry
Range of motion: Active cervical and UE ROM with
overpressure if no pain is felt
Resistive Testing: testing at various innervation levels
from C1-T1
Reflex Testing: Biceps (C5), brachioradialis (C6), and
triceps (C7)
Dermatomes: dermatomes at various innervation levels
from C2-T1
Dutton, 2012. pg. 98-99
Lower Quarter Screens
Used to determine thoracic, lower
extremity, and lumbosacral problems.
Dutton. 2012. pg. 98
Lower Quarter Screens
Posture: observed from front, back, and sides looking for
asymmetry
Range of motion: AROM of lumbosacral spine and LE’s
with overpressure if no pain is noted
Resistive testing: testing at various innervation levels
from L1-S1
Reflex testing: Patellar (L4) and Achilles (S1)
Dermatomes: testing at various levels from L1-S5
Dutton, 2012. pg. 100-101