Kinesiology: The Mechanics and Pathomechanics of Human Movement

 

Equip your students with the knowledge they need to be effective physical therapists with the updated Third Edition of Kinesiology: The Mechanics and Pathomechanics of Human Movement. Now in vibrant full color, the Third Edition provides a clinical, applied look at anatomy and mechanics that reflects the latest research findings and the most current developments in the field. As your students move through the text, they don’t just learn the principles of motion; they learn how these principles apply to patient care. New Thought Problems with critical thinking exercises ask students to think through the types of decisions they will be making as physical therapy professionals.

 

 

Table of Contents:

 

PART I: Biomechanical Principles

CHAPTER 1: Introduction to Biomechanical Analysis

CHAPTER CONTENTS

Mathematical Overview

Units of Measurement

TABLE 1.1: Units Used in Biomechanics

Trigonometry

Figure 1.1

Vector Analysis

Figure 1.2

VECTOR ADDITION

VECTOR MULTIPLICATION

Figure 1.3

EXAMINING THE FORCES BOX 1.1: Addition of Two Vectors

Coordinate Systems

Figure 1.4

Forces and Moments

Forces

Figure 1.5

Moments

Figure 1.6

Figure 1.7

Figure 1.8

Muscle Forces

CLINICAL RELEVANCE

MUSCLE FORCES

EXAMINING THE FORCES BOX 1.2: Moment Arms of the Deltoid (MAd) and the Supraspinatus (MAs)

Statics

Newton’s Laws

Solving Problems

EXAMINING THE FORCES BOX 1.3: A Free-Body Diagram

Simple Musculoskeletal Problems

LINEAR FORCES

PARALLEL FORCES

LEVERS

Figure 1.9

Center of Gravity and Stability

Figure 1.10

Advanced Musculoskeletal Problems

TABLE 1.2: Body Segment Parameters

FORCE ANALYSIS WITH A SINGLE MUSCLE

Figure 1.11

EXAMINING THE FORCES BOX 1.4: Static Equilibrium Equations Considering Only the Supraspinatus

EXAMINING THE FORCES BOX 1.5: Static Equilibrium Equations Considering Only the Deltoid Muscle

CLINICAL RELEVANCE

SUPRASPINATUS AND DELTOID MUSCLE FORCES

FORCE ANALYSIS WITH MULTIPLE MUSCLES

Kinematics

Rotational and Translational Motion

Figure 1.12

Figure 1.13

Displacement, Velocity, and Acceleration

TABLE 1.3: Kinematic Relationships

Figure 1.14

Kinetics

Inertial Forces

EXAMINING THE FORCES BOX 1.6: Static and Dynamic Equilibrium

EXAMINING THE FORCES BOX 1.7: Calculating the Radius of Gyration and Moment of Inertia of the Lower Extremity About the Hip Joint

Work, Energy, and Power

Friction

Figure 1.15

Summary

Thought Problems

REFERENCES

MUSCULOSKELETAL BIOMECHANICS TEXTBOOKS

CHAPTER 2: Mechanical Properties of Materials

CHAPTER CONTENTS

Basic Material Properties

EXAMINING THE FORCES BOX 2.1: The Paper Clip Experiment

EXAMINING THE FORCES BOX 2.2: Experiment to Test the Breaking Point of Wires of Different Thickness

Stress and Strain

Figure 2.1

Figure 2.2

EXAMINING THE FORCES BOX 2.3: Calculation of Stress in a Wire

EXAMINING THE FORCES BOX 2.4: Experiment to Assess the Strain in Rubber Bands of Different Lengths

Figure 2.3

The Tension Test

The Basics (Young’s Modulus, Poisson’s Ratio)

Figure 2.4

Figure 2.5

Figure 2.6

Figure 2.7

Load to Failure

Figure 2.8

Figure 2.9

Figure 2.10

Figure 2.11

Figure 2.12

EXAMINING THE FORCES BOX 2.5: Hooke’s Law

EXAMINING THE FORCES BOX 2.6: Properties of Different Materials

Figure 2.13

Material Fracture

Fracture Toughness

Figure 2.14

Figure 2.15

Fatigue

Figure 2.16

Figure 2.17

CLINICAL RELEVANCE

STRESS FRACTURES

Loading Rate

CLINICAL RELEVANCE

LOADING RATES

Figure 2.18

CLINICAL RELEVANCE

SPLINTING TO STRETCH A JOINT CONTRACTURE

Bending and Torsion

Bending

EXAMINING THE FORCES BOX 2.7: The Beam Bending Equation

EXAMINING THE FORCES BOX 2.8: Will the Ulna Break When “Bent” by Lifting a Load?

EXAMINING THE FORCES BOX 2.9: Shear Stresses in a Beam Subjected to Torsion

Torsion

Figure 2.19

CLINICAL RELEVANCE

BENDING VERSUS TORSION FRACTURES

EXAMINING THE FORCES BOX 2.10: A Torsion Experiment

Buckling

Figure 2.20

Figure 2.21

EXAMINING THE FORCES BOX 2.11: A Different Mode of Buckling

EXAMINING THE FORCES BOX 2.12: Do End Conditions Really Affect Buckling?

Summary

Thought Problems

ADDITIONAL READING

CHAPTER 3: Biomechanics of Bone

CHAPTER CONTENTS

Brief Review of Bone Biology, Structure, and Chemical Composition

Figure 3.1

Figure 3.2

Mechanical Properties of Bone

CLINICAL RELEVANCE

FRACTURES RESULTING FROM DIFFERENT KINDS OF LOADING

Material Properties Versus Geometry

Anisotropy

Figure 3.3

EXAMINING THE FORCES BOX 3.1: An Experiment to Demonstrate Anisotropic Behavior

Figure 3.4

Elastic Constants of Bone

CLINICAL RELEVANCE

ARTIFICIAL JOINTS

Figure 3.5

Strength

Fracture Toughness

Strain Rate

CLINICAL RELEVANCE

EFFECTS OF LOADING RATE IN BONE

Figure 3.6

Changes in Mechanical Properties with Age and Activity

CLINICAL RELEVANCE

PREVENTING AND TREATING OSTEOPOROSIS

Fracture Healing

CLINICAL RELEVANCE

A LIMB-LENGTHENING PROCEDURE

Figure 3.7

Summary

Thought Problems

REFERENCES

CHAPTER 4: Biomechanics of Skeletal Muscle

CHAPTER CONTENTS

Structure of Skeletal Muscle

Structure of an Individual Muscle Fiber

Figure 4.1

THE SLIDING FILAMENT THEORY OF MUSCLE CONTRACTION

Figure 4.2

Figure 4.3

Noncontractile Components of Muscle

INTRACELLULAR PROTEIN

CLINICAL RELEVANCE

MUSCLE DISEASES

EXTRACELLULAR MATRIX (ECM)

Figure 4.4

CLINICAL RELEVANCE

MUSCLE CONTRACTURE

TENDONS

Factors That Influence a Muscle’s Ability to Produce a Motion

Effect of Fiber Length on Joint Excursion

Figure 4.5

ARCHITECTURE OF SKELETAL MUSCLE

Figure 4.6

Figure 4.7

Effect of Muscle Moment Arms on Joint Excursion

Figure 4.8

Figure 4.9

Joint Excursion as a Function of Both Fiber Length and the Anatomical Moment Arm of a Muscle

CLINICAL RELEVANCE

CONSIDERATIONS REGARDING TENDON TRANSFERS

Factors That Influence a Muscle’s Strength

Muscle Size and Its Effect on Force Production

Figure 4.10

Figure 4.11

Relationship Between Force Production and Instantaneous Muscle Length (Stretch)

Figure 4.12

Figure 4.13

Figure 4.14

CLINICAL RELEVANCE

THE LENGTH-TENSION RELATIONSHIP OF MUSCLES IN VIVO

Figure 4.15

CLINICAL RELEVANCE

STRETCH-SHORTENING CYCLE OF MUSCLE CONTRACTION IN SPORTS

Relationship Between a Muscle’s Moment Arm and Its Force Production

Figure 4.16

Figure 4.17

Figure 4.18

INTERACTION BETWEEN A MUSCLE’S LENGTH AND ITS MOMENT ARM WITH CHANGING JOINT POSITIONS

CLINICAL RELEVANCE

JOINT POSITION’S INFLUENCE ON MUSCLE STRENGTH

Figure 4.19

Relationship Between Force Production and Contraction Velocity

EFFECTS OF THE MAGNITUDE OF THE CONTRACTION VELOCITY ON FORCE PRODUCTION IN MUSCLE

Figure 4.20

CLINICAL RELEVANCE

EXAMINING MUSCLE STRENGTH IN THE CLINIC

EFFECTS OF THE DIRECTION OF CONTRACTION ON FORCE PRODUCTION IN MUSCLE

Figure 4.21

CLINICAL RELEVANCE

POST-EXERCISE MUSCLE SORENESS

Figure 4.22

Figure 4.23

Relationship Between Force Production and Level of Recruitment of Motor Units Within the Muscle

CLINICAL RELEVANCE

ASSESSMENT OF PEAK STRENGTH

CLINICAL RELEVANCE

ACTIVATION FAILURE IN INDIVIDUALS WITH OSTEOARTHRITIS

Relationship Between Force Production and Motor Unit Type

TABLE 4.1: Characteristics of Motor Unit Types

Adaptation of Muscle to Altered Function

Adaptation of Muscle to Prolonged Length Changes

CHANGES IN MUSCLE WITH PROLONGED LENGTHENING

CHANGES IN MUSCLE HELD IN A SHORTENED POSITION FOR A PROLONGED PERIOD

CLINICAL RELEVANCE

PROLONGED LENGTH CHANGES IN MUSCLE AS THE RESULT OF POSTURAL ABNORMALITIES

Adaptations of Muscle to Sustained Changes in Activity Level

CLINICAL RELEVANCE

DISUSE ATROPHY IN PATIENTS

CLINICAL RELEVANCE

EXERCISING IN SPACE

AGING AS ANOTHER MODEL OF ALTERED ACTIVITY

CLINICAL RELEVANCE

DECREASED STRENGTH WITH AGING

Summary

Thought Problems

REFERENCES

CHAPTER 5: Biomechanics of Cartilage

CHAPTER CONTENTS

Figure 5.1

Composition and Structure of Articular Cartilage

Figure 5.2

Figure 5.3

CLINICAL RELEVANCE

STRUCTURE AND COMPOSITION

TABLE 5.1: Stages in the Development and Progression of Degeneration of Articular Cartilage in Osteoarthritis

Mechanical Behavior and Modeling

CLINICAL RELEVANCE

BIPHASIC MODEL OF CARTILAGE

Material Properties

Figure 5.4

Figure 5.5

Figure 5.6

CLINICAL RELEVANCE

VARIABLE PERMEABILITY

EXAMINING THE FORCES BOX 5.1: Quantitative Definition of Permeability

Figure 5.7

CLINICAL RELEVANCE

PERMEABILITY OF OSTEOARTHRITIC CARTILAGE

Relationship Between Mechanical Properties and Composition

Figure 5.8

Figure 5.9

CLINICAL RELEVANCE

MATERIAL PROPERTIES OF CARTILAGE

Mechanical Failure of Cartilage

Figure 5.10

CLINICAL RELEVANCE

INCIDENCE OF OSTEOARTHRITIS AT THE ANKLE

Figure 5.11

Figure 5.12

Figure 5.13

Figure 5.14

Joint Lubrication

CLINICAL RELEVANCE

Models of Osteoarthritis

CLINICAL RELEVANCE

OSTEOARTHRITIS

Exercise and Cartilage Health

CLINICAL RELEVANCE

EXERCISE THERAPY

Summary

Thought Problems

REFERENCES

CHAPTER 6: Biomechanics of Tendons and Ligaments

CHAPTER CONTENTS

Structure of Connective Tissue

Composition of Tendons and Ligaments

Figure 6.1

TABLE 6.1: Differences Between the Structure and Composition of Tendons and Ligaments

EXTRACELLULAR MATRIX: FIBERS

Figure 6.2

CLINICAL RELEVANCE

GENETIC DISORDERS AFFECTING COLLAGEN

EXTRACELLULAR MATRIX: GROUND SUBSTANCE

Figure 6.3

ENTHESES: INSERTION OF TENDON OR LIGAMENT INTO BONE

Mechanical Properties

Figure 6.4

Determination of Stress and Strain

Stress–Strain Curve for Tendons and Ligaments

Figure 6.5

Figure 6.6

TABLE 6.2: Peak Strain in Human Anterior Cruciate Ligaments During Selected Rehabilitation Activities (n = 8-18)

Modes of Failure

Effects of Physical Conditions on Mechanical Properties

EFFECTS OF RATE AND DURATION OF FORCE APPLICATION

CLINICAL RELEVANCE

USING LOW-LOAD PROLONGED STRESS TO SAFELY INCREASE JOINT RANGE OF MOTION

EFFECTS OF TEMPERATURE

Figure 6.7

Figure 6.8

CLINICAL RELEVANCE

CLINICAL RELEVANCE: USING HEAT TO INCREASE RANGE OF MOTION

Biological Effects on Mechanical Properties

EFFECTS OF MATURATION AND AGING

Figure 6.9

Figure 6.10

CLINICAL RELEVANCE

IMPLICATIONS OF RESISTANCE EXERCISE FOR MAINTENANCE OF TENDON STRENGTH AND STIFFNESS IN OLDER ADULTS

CLINICAL RELEVANCE

EFFECTS OF AGE ON FUNCTIONAL CAPACITY OF LIGAMENTS AND TENDONS

EFFECT OF HORMONES

Response of Tendons and Ligaments to Stress Deprivation

Immobilization and Remobilization of Normal Connective Tissue

Figure 6.11

Figure 6.12

Figure 6.13

CLINICAL RELEVANCE

TREATMENT DURING AND FOLLOWING IMMOBILIZATION

Immobilization and Mobilization in Healing Connective Tissue

CLINICAL RELEVANCE

EARLY MOBILIZATION OF TENDON REPAIRS

CLINICAL RELEVANCE

TREATMENT OF TENDON AND LIGAMENT TEARS

Response of Tendons and Ligaments to Stress Enhancement

Figure 6.14

CLINICAL RELEVANCE

PATELLAR TENDON GRAFTS

CLINICAL RELEVANCE

TENDINOPATHY

Summary

Thought Problems

REFERENCES

CHAPTER 7: Biomechanics of Joints

CHAPTER CONTENTS

Classification and Structure of Human Joints

Diarthroses

JOINT CAPSULE AND SYNOvIAL MEMBRANE

CLINICAL RELEVANCE

JOINT SPRAIN

CLINICAL RELEVANCE

RHEUMATOID ARTHRITIS

CLINICAL RELEVANCE

EARLY REMOBILIZATION FOLLOWING JOINT INJURY

Joint Motion

Classification of Motion

PLANES AND AXES OF MOTION

Figure 7.1

DEGREES OF FREEDOM

Figure 7.2

COMBINING TRANSLATION AND ROTATION IN A SYNOVIAL JOINT

Figure 7.3

Figure 7.4

CLINICAL RELEVANCE

JOINT MOBILIZATION

INSTANT CENTER OF ROTATION

Figure 7.5

Figure 7.6

CLINICAL RELEVANCE

GONIOMETRY

Figure 7.7

Classification of Synovial Joints

TABLE 7.1: Classification of Synovial Joints

Factors Influencing Motion at a Joint

Figure 7.8

The Effect of Joint Structure on Joint Motion

JOINT SURFACES

Figure 7.9

Figure 7.10

CLINICAL RELEVANCE

THE KNEE JOINT

LIGAMENTOUS SUPPORT

CLINICAL RELEVANCE

GLENOHUMERAL JOINT STABILITY

Figure 7.11

External Forces on a Joint

Figure 7.12

CLINICAL RELEVANCE

MUSCLES USED TO DESCEND AND ASCEND STAIRS

Figure 7.13

Figure 7.14

CLINICAL RELEVANCE

JOINT PROTECTION TECHNIQUES

Interactions Between Joints and the External Environment

CLINICAL RELEVANCE

LOCOMOTION

Summary

Thought Problems

REFERENCES

PART II: Kinesiology of the Upper Extremity

UNIT 1: SHOULDER UNIT: THE SHOULDER COMPLEX

CHAPTER 8: Structure and Function of the Bones and Joints of the Shoulder Complex

CHAPTER CONTENTS

Structure of the Bones of the Shoulder Complex

Clavicle

Figure 8.1

Scapula

Figure 8.2

Figure 8.3

Figure 8.4

Figure 8.5

Figure 8.6

Figure 8.7

CLINICAL RELEVANCE

SCAPULAR POSITION IN SHOULDER DDYSFUNCTION

PROXIMAL HUMERUS

Figure 8.8

Figure 8.9

CLINICAL RELEVANCE

THE DEPTH OF THE BICIPITAL GROOVE

Sternum and Thorax

Figure 8.10

Figure 8.11

Structure of the Joints and Supporting Structures of the Shoulder Complex

Sternoclavicular Joint

Figure 8.12

Figure 8.13

CLINICAL RELEVANCE

FRACTURE OF THE CLAVICLE

Figure 8.14

Figure 8.15

Figure 8.16

Acromioclavicular Joint

Figure 8.17

Figure 8.18

Figure 8.19

CLINICAL RELEVANCE

DISLOCATION OF THE ACROMIOCLAVICULAR (AC) JOINT

Figure 8.20

Figure 8.21

CLINICAL RELEVANCE

OSTEOARTHRITIS OF THE ACROMIOCLAVICULAR JOINT

Scapulothoracic Joint

Figure 8.22

Figure 8.23

Glenohumeral Joint

Figure 8.24

SUPPORTING STRUCTURES OF THE GLENOHUMERAL JOINT

Figure 8.25

Figure 8.26

CLINICAL RELEVANCE

ADHESIVE CAPSULITIS

Figure 8.27

CLINICAL RELEVANCE

EXAMINING OR STRETCHING THE GLENOHUMERAL JOINT LIGAMENTS

MOTIONS OF THE GLENOHUMERAL JOINT

Figure 8.28

CLINICAL RELEVANCE

SHOULDER IMPINGEMENT SYNDROME IN COMPETITIVE SWIMMERS

Total Shoulder Movement

Figure 8.29

Movement of the Scapula and Humerus During Arm–Trunk Elevation

Figure 8.30

TABLE 8.1: Reported Average Ratios of Glenohumeral to Scapulothoracic Motion During Active Arm-Trunk Elevation in the Plane of the Scapula

CLINICAL RELEVANCE

ANOTHER POSSIBLE MECHANISM PRODUCING SHOULDER IMPINGEMENT SYNDROME

Sternoclavicular and Acromioclavicular Motion During Arm–Trunk Elevation

Figure 8.31

Figure 8.32

Impairments in Individual Joints and their Effects on Shoulder Motion

LOSS OF GLENOHUMERAL OR SCAPULOTHORACIC JOINT MOTION

CLINICAL RELEVANCE

MEASUREMENT OF MEDIAL ROTATION ROM OF THE SHOULDER

Figure 8.33

Figure 8.34

CLINICAL RELEVANCE

NO WONDER SHOULDER IMPINGEMENT IS SO COMMON!

LOSS OF STERNOCLAVICULAR OR ACROMIOCLAVICULAR JOINT MOTION

CLINICAL RELEVANCE

IDENTIFYING LINKS BETWEEN A PATIENT’S COMPLAINTS AND ABNORMAL JOINT MOBILITY

Shoulder Range of Motion

TABLE 8.2: Normal ROM Values from the Literature (in Degrees)

CLINICAL RELEVANCE

SHOULDER MOTION IN ACTIVITIES OF DAILY LIVING

Summary

Thought Problems

REFERENCES

CHAPTER 9: Mechanics and Pathomechanics of Muscle Activity at the Shoulder Complex

CHAPTER CONTENTS

Figure 9.1

Axioscapular and Axioclavicular Muscles

Figure 9.2

Trapezius

Figure 9.3

ACTIONS OF THE UPPER TRAPEZIUS

MUSCLE ATTACHMENT BOX 9.1: Attachments and Innervation of the Trapezius

Figure 9.4

EFFECTS OF WEAKNESS OF THE UPPER TRAPEZIUS

EFFECTS OF TIGHTNESS OF THE UPPER TRAPEZIUS

ACTIONS OF THE MIDDLE TRAPEZIUS

WEAKNESS OF THE MIDDLE TRAPEZIUS

TIGHTNESS OF THE MIDDLE TRAPEZIUS

ACTIONS OF THE LOWER TRAPEZIUS

CLINICAL RELEVANCE

MANUAL MUSCLE TESTING OF THE LOWER TRAPEZIUS

Figure 9.5

Figure 9.6

WEAKNESS OF THE LOWER TRAPEZIUS

TIGHTNESS OF THE LOWER TRAPEZIUS

Figure 9.7

ACTIONS OF THE ENTIRE TRAPEZIUS

Figure 9.8

Figure 9.9

CLINICAL RELEVANCE

SPINAL ACCESSORY NERVE INJURY

Serratus Anterior

Figure 9.10

MUSCLE ATTACHMENT BOX 9.2: Attachments and Innervation of the Serratus Anterior

ACTIONS OF THE SERRATUS ANTERIOR

WEAKNESS OF THE SERRATUS ANTERIOR

Figure 9.11

Figure 9.12

Figure 9.13

Figure 9.14

CLINICAL RELEVANCE

SCAPULAR WINGING DUE TO SERRATUS ANTERIOR WEAKNESS

Figure 9.15

CONSEQUENCES OF WEAKNESS OF THE SERRATUS ANTERIOR AND TRAPEZIUS MUSCLES

CLINICAL RELEVANCE

WEAKNESS OF THE SERRATUS ANTERIOR OR TRAPEZIUS MUSCLE

TIGHTNESS OF THE SERRATUS ANTERIOR

MUSCLE ATTACHMENT BOX 9.3: Attachments and Innervation of the Levator Scapulae

Levator Scapulae, Rhomboid Major, and Rhomboid Minor

Figure 9.16

ACTIONS OF THE LEVATOR SCAPULAE, RHOMBOID MAJOR, AND RHOMBOID MINOR

MUSCLE ATTACHMENT BOX 9.4: Attachments and Innervation of the Rhomboid Major and Minor

Figure 9.17

WEAKNESS OF THE LEVATOR SCAPULAE, RHOMBOID MAJOR, AND RHOMBOID MINOR

TIGHTNESS OF THE LEVATOR SCAPULAE, RHOMBOID MAJOR, AND RHOMBOID MINOR

CLINICAL RELEVANCE

PAIN IN THE LEVATOR SCAPULAE, RHOMBOID MAJOR, AND RHOMBOID MINOR

Pectoralis Minor

Figure 9.18

ACTION

MUSCLE ATTACHMENT BOX 9.5: Attachments and Innervation of the Pectoralis Minor

Figure 9.19

Figure 9.20

Figure 9.21

WEAKNESS OF THE PECTORALIS MINOR

TIGHTNESS OF THE PECTORALIS MINOR

Figure 9.22

CLINICAL RELEVANCE

TIGHTNESS OF THE PECTORALIS MINOR

Subclavius

MUSCLE ATTACHMENT BOX 9.6: Attachments and Innervation of the Subclavius

ACTIONS OF THE SUBCLAVIUS

EFFECTS OF WEAKNESS AND TIGHTNESS OF THE SUBCLAVIUS

Sternocleidomastoid

MUSCLE ATTACHMENT BOX 9.7: Attachments and Innervation of the Sternocleidomastoid

Summary of Axioscapular and Axioclavicular Muscles

Scapulohumeral Muscles

Figure 9.23

MUSCLE ATTACHMENT BOX 9.8: Attachments and Innervation of the Deltoid

Deltoid

Figure 9.24

ACTIONS OF THE ANTERIOR DELTOID

Figure 9.25

EFFECTS OF WEAKNESS OF THE ANTERIOR DELTOID

EFFECTS OF TIGHTNESS OF THE ANTERIOR DELTOID

ACTIONS OF THE POSTERIOR DELTOID

EFFECTS OF WEAKNESS OF THE POSTERIOR DELTOID

EFFECTS OF TIGHTNESS OF THE POSTERIOR DELTOID

ACTIONS OF THE MIDDLE DELTOID

EFFECTS OF WEAKNESS OF THE MIDDLE DELTOID

EFFECTS OF TIGHTNESS OF THE MIDDLE DELTOID

Supraspinatus

Figure 9.26

MUSCLE ATTACHMENT BOX 9.9: Attachments and Innervation of the Supraspinatus

ACTIONS OF THE SUPRASPINATUS

Figure 9.27

CLINICAL RELEVANCE

INFERIOR SUBLUXATION OF THE GLENOHUMERAL JOINT

Figure 9.28

EFFECTS OF WEAKNESS OF THE SUPRASPINATUS

EFFECTS OF TIGHTNESS OF THE SUPRASPINATUS

Infraspinatus

Figure 9.29

ACTIONS OF THE INFRASPINATUS

MUSCLE ATTACHMENT BOX 9.10: Attachments and Innervation of the Infraspinatus

EFFECTS OF WEAKNESS OF THE INFRASPINATUS

EFFECTS OF TIGHTNESS OF THE INFRASPINATUS

Teres Minor

MUSCLE ATTACHMENT BOX 9.11: Attachments and Innervation of the Teres Minor

ACTIONS OF THE TERES MINOR

EFFECTS OF WEAKNESS OF THE TERES MINOR

EFFECTS OF TIGHTNESS OF THE TERES MINOR

Subscapularis

Figure 9.30

ACTIONS OF THE SUBSCAPULARIS

MUSCLE ATTACHMENT BOX 9.12: Attachments and Innervation of the Subscapularis

EFFECTS OF WEAKNESS OF THE SUBSCAPULARIS

CLINICAL RELEVANCE

SUBSCAPULARIS WEAKNESS

EFFECTS OF TIGHTNESS OF THE SUBSCAPULARIS

DYNAMIC STABILIZATION BY THE ROTATOR CUFF

CLINICAL RELEVANCE

ROTATOR CUFF MUSCLES AND REHABILITATION OF THE UNSTABLE GLENOHUMERAL JOINT

COORDINATED ACTIVITY OF DELTOID AND ROTATOR CUFF MUSCLES DURING SHOULDER ELEVATION

Figure 9.31

Figure 9.32

CLINICAL RELEVANCE

ROTATOR CUFF WEAKNESS, ANOTHER POSSIBLE CAUSE OF IMPINGEMENT SYNDROME

Teres Major

Figure 9.33

Figure 9.34

MUSCLE ATTACHMENT BOX 9.13: Attachments and Innervation of the Teres Major

EFFECTS OF WEAKNESS OF THE TERES MAJOR

EFFECTS OF TIGHTNESS OF THE TERES MAJOR

Figure 9.35

Coracobrachialis

Figure 9.36

EFFECTS OF WEAKNESS OR TIGHTNESS OF THE CORACOBRACHIALIS

MUSCLE ATTACHMENT BOX 9.14: Attachments and Innervation of the Coracobrachialis

Summary of the Scapulohumeral Muscles

Axiohumeral Muscles

Pectoralis Major

ACTIONS OF THE PECTORALIS MAJOR

MUSCLE ATTACHMENT BOX 9.15: Attachments and Innervation of the Pectoralis Major

EFFECTS OF WEAKNESS OF THE PECTORALIS MAJOR

CLINICAL RELEVANCE

RADICAL MASTECTOMY, A CASE REPORT

EFFECTS OF TIGHTNESS OF THE PECTORALIS MAJOR

ACTIONS OF THE PECTORALIS MAJOR—CLAVICULAR PORTION

Figure 9.37

EFFECTS OF WEAKNESS OF THE CLAVICULAR PORTION OF THE PECTORALIS MAJOR

EFFECTS OF TIGHTNESS OF THE CLAVICULAR PORTION OF THE PECTORALIS MAJOR

ACTIONS OF THE PECTORALIS MAJOR—STERNAL PORTION

Figure 9.38

CLINICAL RELEVANCE

MANUAL MUSCLE TEST OF THE STERNAL PORTION OF THE PECTORALIS MAJOR

Figure 9.39

EFFECTS OF WEAKNESS OF THE STERNAL PORTION OF THE PECTORALIS MAJOR

EFFECTS OF TIGHTNESS OF THE STERNAL PORTION OF THE PECTORALIS MAJOR

Latissimus Dorsi

MUSCLE ATTACHMENT BOX 9.16: Attachments and Innervation of the Latissimus Dorsi

ACTIONS OF THE LATISSIMUS DORSI MUSCLE

EFFECTS OF WEAKNESS OF THE LATISSIMUS DORSI

CLINICAL RELEVANCE

LATISSIMUS DORSI PEDICLE FOR RECONSTRUCTIVE SURGERY

EFFECTS OF TIGHTNESS OF THE LATISSIMUS DORSI

Figure 9.40

Shoulder Depression

Figure 9.41

CLINICAL RELEVANCE

UPPER EXTREMITY WEIGHT BEARING

Figure 9.42

Figure 9.43

Summary of the Axiohumeral Muscles

Muscle Strength Comparisons

Summary

Thought Problems

REFERENCES

CHAPTER 10: Analysis of the Forces on the Shoulder Complex During Activity

CHAPTER CONTENTS

Two-Dimensional Analysis of the Forces on the Glenohumeral Joint

Figure 10.1

EXAMINING THE FORCES BOX 10.1: Two-Dimensional Analysis of the Joint Reaction Force (J) on the Head of the Humerus with the Shoulder Abducted to 90° and the Elbow Extended

Figure 10.2

Figure 10.3

Figure 10.4

Figure 10.5

EXAMINING THE FORCES BOX 10.2: Two-Dimensional Analysis of the Joint Reaction Force on the Head of the Humerus with the Shoulder Abducted to 90° and the Elbow Flexed to 90°

CLINICAL RELEVANCE

ARTHRITIC CHANGES IN THE GLENOHUMERAL JOINT

Mechanical Demands Placed on Structures Throughout the Shoulder Complex

CLINICAL RELEVANCE

CASE REPORT

Forces on the Shoulder Complex When the Upper Extremity Is Used for Propulsion

Connections Between Analyses of Joint and Muscle Forces and Clinical Practice

Summary

Thought Problems

REFERENCES

UNIT 2: ELBOW UNIT

CHAPTER 11: Structure and Function of the Bones and Noncontractile Elements of the Elbow

CHAPTER CONTENTS

Structure of the Bones of the Elbow

Figure 11.1

Distal Humerus

Figure 11.2

Figure 11.3

Figure 11.4

CLINICAL RELEVANCE

THE “CRAZY BONE” OF THE ELBOW

Figure 11.5

Figure 11.6

Figure 11.7

Proximal Ulna

Figure 11.8

Figure 11.9

Figure 11.10

Proximal Radius

Figure 11.11

Figure 11.12

Articulations and Supporting Structures of the Elbow

Humeroulnar and Humeroradial Articulations

HUMEROULNAR ARTICULATION

Figure 11.13

Figure 11.14

Figure 11.15

CLINICAL RELEVANCE

CHANGES IN BONY ALIGNMENT FOLLOWING FRACTURE

Figure 11.16

Figure 11.17

HUMERORADIAL ARTICULATION

Figure 11.18

Structures Stabilizing the Humeroulnar and Humeroradial Articulations

CLINICAL RELEVANCE

HUMEROULNAR DISLOCATIONS

Figure 11.19

Figure 11.20

CLINICAL RELEVANCE

JOINT SWELLING AND ELBOW FLEXION CONTRACTURES

Figure 11.21

Figure 11.22

CLINICAL RELEVANCE

PITCHERS’ ELBOW

Figure 11.23

Figure 11.24

CLINICAL RELEVANCE

RADIAL HEAD EXCISION

Superior Radioulnar Joint

Figure 11.25

ANNULAR LIGAMENT

Figure 11.26

CLINICAL RELEVANCE

“PULLED ELBOW” INJURIES

OBLIQUE CORD AND INTEROSSEOUS MEMBRANE

CLINICAL RELEVANCE

LOAD DISTRIBUTION AT THE ELBOW

Figure 11.27

Motion of the Elbow Joint

FLEXION AND EXTENSION

CLINICAL RELEVANCE

ELBOW JOINT TOTAL ARTHROPLASTY

PRONATION AND SUPINATION

Figure 11.28

RANGES OF ELBOW MOTION REPORTED IN THE LITERATURE

TABLE 11.1: Normal Passive ROM Values from the Literature (in Degrees)

CLINICAL RELEVANCE

CLINICAL JUDGMENTS FROM ROM MEASUREMENTS

CLINICAL RELEVANCE

COMPENSATIONS FOR RESTRICTED ELBOW ROM

STRUCTURES LIMITING NORMAL ROM AT THE ELBOW

CLINICAL RELEVANCE

ELBOW MOTION AND END-FEELS

Comparison of the Shoulder and the Elbow

Summary

Thought Problems

REFERENCES

CHAPTER 12: Mechanics and Pathomechanics of Muscle Activity at the Elbow

CHAPTER CONTENTS

Elbow Flexor Muscles

Figure 12.1

Biceps Brachii

MUSCLE ATTACHMENT BOX 12.1: Attachments and Innervation of the Biceps Brachii

ACTIONS

Figure 12.2

Figure 12.3

CLINICAL RELEVANCE

CHANGING SHOULDER POSITION TO AFFECT BICEPS BRACHII CONTRACTILE FORCE AT THE ELBOW

Figure 12.4

CLINICAL RELEVANCE

TENDINOPATHY OF THE LONG HEAD OF THE BICEPS

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

CLINICAL RELEVANCE

IDENTIFYING TIGHTNESS OF THE BICEPS BRACHII

Figure 12.5

Figure 12.6

Brachialis

MUSCLE ATTACHMENT BOX 12.2: Attachments and Innervation of the Brachialis

ACTIONS

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

CLINICAL RELEVANCE

IDENTIFYING TIGHTNESS OF THE BRACHIALIS MUSCLE

Figure 12.7

MUSCLE ATTACHMENT BOX 12.3: Attachments and Innervation of the Brachioradialis

Brachioradialis

ACTIONS

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Pronator Teres

ACTIONS

MUSCLE ATTACHMENT BOX 12.4: Attachments and Innervation of the Pronator Teres

CLINICAL RELEVANCE

MANUAL MUSCLE TESTING THE MUSCLES THAT PRONATE THE FOREARM

Figure 12.8

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Figure 12.9

Comparisons Among the Elbow Flexors

STRUCTURAL COMPARISONS OF THE ELBOW FLEXORS

Figure 12.10

Figure 12.11

Figure 12.12

Figure 12.13

Figure 12.14

COMPARISONS OF FLEXOR MUSCLE ACTIVITY DURING ELBOW MOTION USING EMG DATA

Figure 12.15

Figure 12.16

TABLE 12.1: Summary of EMG Data for the Elbow Flexor Muscles

CLINICAL RELEVANCE

IDENTIFYING INDIVIDUAL WEAKNESS IN THE ELBOW FLEXORS

Figure 12.17

Elbow Extensor Muscles

Figure 12.18

Triceps Brachii

ACTIONS

MUSCLE ATTACHMENT BOX 12.5: Attachments and Innervation of the Triceps Brachii

EFFECTS OF WEAKNESS

Figure 12.19

CLINICAL RELEVANCE

TRICEPS WEAKNESS IN INDIVIDUALS WITH TETRAPLEGIA

Figure 12.20

EFFECTS OF TIGHTNESS

CLINICAL RELEVANCE

ASYMMETRICAL TONIC NECK REFLEX (ATNR) IN A CHILD WITH A DEVELOPMENTAL DISORDER

Figure 12.21

Anconeus

ACTIONS

MUSCLE ATTACHMENT BOX 12.6: Attachments and Innervation of the Anconeus

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Supinator Muscles

Supinator

Figure 12.22

ACTIONS

MUSCLE ATTACHMENT BOX 12.7: Attachments and Innervation of the Supinator

CLINICAL RELEVANCE

MANUAL MUSCLE TESTING OF THE SUPINATOR MUSCLE

Figure 12.23

EFFECTS OF WEAKNESS

CLINICAL RELEVANCE

A CASE REPORT

EFFECTS OF TIGHTNESS

Comparisons of the Strength of Elbow Flexion and Extension

TABLE 12.2: Strength of Elbow Flexor and Extensor Muscle Groups Reported in the Literature

Summary

Thought Problems

REFERENCES

CHAPTER 13: Analysis of the Forces at the Elbow During Activity

CHAPTER CONTENTS

Analysis of the Forces Exerted at the Elbow

Forces on the Elbow During Simple Upper Extremity Lifting Techniques

Figure 13.1

EXAMINING THE FORCES BOX 13.1: Two-Dimensional Analysis of the Forces in the Elbow While Holding a Five-Pound Load with the Elbow Flexed to 30°

Figure 13.2

EXAMINING THE FORCES BOX 13.2: Calculation of the Internal Moment (Mi) Required to Hold a Five-Pound Weight with the Elbow Flexed to 30°

CLINICAL RELEVANCE

ELBOW LOADS IN BASEBALL PITCHERS

Forces on the Elbow During Upper Extremity Weight Bearing

Figure 13.3

EXAMINING THE FORCES BOX 13.3: Calculation of the Extension Force of the Triceps Brachii (T) and the Internal Extension Moment (Mi) Generated at the Elbow During Crutch Walking

CLINICAL RELEVANCE

THE IMPACT OF CRUTCH HEIGHT ON ELBOW JOINT MOMENTS

Figure 13.4

Stresses Applied to the Articular Surfaces of the Elbow

Figure 13.5

Figure 13.6

CLINICAL RELEVANCE

OLECRANON FRACTURES

Figure 13.7

Summary

Thought Problems

REFERENCES

UNIT 3: WRIST AND HAND UNIT

CHAPTER 14: Structure and Function of the Bones and Joints of the Wrist and Hand

CHAPTER CONTENTS

Structure of the Bones of the Wrist and Hand

Distal Radius and Shaft

Figure 14.1

Figure 14.2

Figure 14.3

Figure 14.4

CLINICAL RELEVANCE

DISTAL RADIUS FRACTURE

Distal Ulna and Shaft

Figure 14.5

Figure 14.6

CLINICAL RELEVANCE

ULNAR VARIANCE

Figure 14.7

Carpal Bones

Figure 14.8

Figure 14.9

Figure 14.10

Figure 14.11

SCAPHOID (ALSO KNOWN AS THE NAVICULAR)

CLINICAL RELEVANCE

SCAPHOID FRACTURE AND AVASCULAR NECROSIS

Figure 14.12

Figure 14.13

LUNATE

CLINICAL RELEVANCE

LUNATE DISLOCATION

Figure 14.14

TRIQUETRUM

PISIFORM

TRAPEZIUM (FORMERLY KNOWN AS THE GREATER MULTANGULAR)

Figure 14.15

TRAPEZOID (FORMERLY KNOWN AS THE LESSER MULTANGULAR)

CAPITATE

HAMATE

Figure 14.16

Figure 14.17

Metacarpals

Figure 14.18

Figure 14.19

Figure 14.20

Figure 14.21

Phalanges

Figure 14.22

Sesamoid Bones

Bony Landmarks

Articulations and Supporting Structures of the Joints of the Wrist and Hand

Distal Radioulnar Joint

Figure 14.23

CLINICAL RELEVANCE

ARTHRITIS OF THE DISTAL RADIOULNAR JOINT (DRUJ)

SUPPORTING STRUCTURES OF THE DISTAL RADIOULNAR JOINT

Figure 14.24

CLINICAL RELEVANCE

TIGHTNESS OF THE DISTAL RADIOULNAR JOINT CAPSULE AND LIMITED PRONATION AND SUPINATION ROM

Figure 14.25

Figure 14.26

MOTIONS OF THE DISTAL RADIOULNAR JOINT

Joints of the Wrist

RADIOCARPAL JOINT

Figure 14.27

MIDCARPAL JOINT

Figure 14.28

Figure 14.29

INTERCARPAL JOINTS

CLINICAL RELEVANCE

CARPAL TUNNEL RELEASE

EXTRACAPSULAR SUPPORTING STRUCTURES OF THE WRIST

Figure 14.30

Figure 14.31

TABLE 14.1: Extrinsic Ligaments of the Wrist

TABLE 14.2: Intrinsic Ligaments of the Wrist

CLINICAL RELEVANCE

LUNATE INSTABILITY—A CASE REPORT

Figure 14.32

Figure 14.33

Movements of the Wrist

Figure 14.34

MOVEMENT IN THE PROXIMAL ROW OF CARPAL BONES

Figure 14.35

CLINICAL RELEVANCE

MOBILIZATION TECHNIQUES FOR THE WRIST

Global Wrist Motions

Figure 14.36

CLINICAL RELEVANCE

WRIST ROM

CLINICAL RELEVANCE

WRIST INSTABILITY DURING PRONATION AND SUPINATION

WRIST ROM REPORTED IN THE LITERATURE

TABLE 14.3: Normal ROM Values for Wrist Movement from the Literature

CLINICAL RELEVANCE

WRIST POSITIONS DURING FUNCTION

Figure 14.37

Figure 14.38

Figure 14.39

Carpometacarpal Joints

CMC JOINT OF THE THUMB

Figure 14.40

CLINICAL RELEVANCE

OSTEOARTHRITIS OF THE CMC JOINT OF THE THUMB

Figure 14.41

TABLE 14.4: Normal ROM Values from the Literature for Motion of the CMC of the Thumb

CLINICAL RELEVANCE

OSTEOARTHRITIS OF THE THUMB’S CMC JOINT

Figure 14.42

CMC AND INTERMETACARPAL JOINTS OF THE FINGERS

Figure 14.43

CLINICAL RELEVANCE

THE EFFECT OF CMC JOINT MOTION ON WRIST FLEXION AND EXTENSION ROM MEASURES

Figure 14.44

Figure 14.45

CLINICAL RELEVANCE

LOSS OF THE VOLAR ARCH

MCP Joints of the Digits

MCP JOINT OF THE THUMB

Figure 14.46

CLINICAL RELEVANCE

SKIER’S THUMB (ALSO KNOWN AS GAMEKEEPER’S THUMB)

Figure 14.47

MCP JOINTS OF THE FINGERS

Figure 14.48

Figure 14.49

CLINICAL RELEVANCE

FUNCTIONAL IMPAIRMENT RESULTING FROM TIGHTNESS IN THE COLLATERAL LIGAMENTS

CLINICAL RELEVANCE

JOINT MOBILIZATIONS TO RESTORE MCP FLEXION AND EXTENSION

Figure 14.50

TABLE 14.5: Normal ROM Values (°) from the Literature for Motion of the MCP of the Fingers

CLINICAL RELEVANCE

KEYBOARD USE

Figure 14.51

Interphalangeal Joints of the Fingers and Thumb

Figure 14.52

Figure 14.53

TABLE 14.6: Normal ROM Values (°) from the Literature for Motion of the Interphalangeal Joint of the Thumb and the PIP Joints of Fingers

TABLE 14.7: Normal ROM Values(°) from the Literature for Motion of the DIP Joints of the Fingers

CLINICAL RELEVANCE

MEASURES OF FINGER MOBILITY IN THE CLINIC

Figure 14.54

Summary

Thought Problems

REFERENCES

CHAPTER 15: Mechanics and Pathomechanics of the Muscles of the Forearm

CHAPTER CONTENTS

Figure 15.1

Superficial Muscles on the Volar Surface of the Forearm

Figure 15.2

Pronator Teres

Flexor Carpi Radialis

ACTIONS

Figure 15.3

MUSCLE ATTACHMENT BOX 15.1: Attachments and Innervation of the Flexor Carpi Radialis

Figure 15.4

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Palmaris Longus

Figure 15.5

ACTIONS

MUSCLE ATTACHMENT BOX 15.2: Attachments and Innervation of the Palmaris Longus

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Flexor Digitorum Superficialis (Also Known as Flexor Digitorum Sublimis)

ACTIONS

MUSCLE ATTACHMENT BOX 15.3: Attachments and Innervation of the Flexor Digitorum Superficialis

Figure 15.6

CLINICAL RELEVANCE

CLINICAL ASSESSMENT OF THE INTEGRITY OF THE FLEXOR DIGITORUM SUPERFICIALIS

Figure 15.7

CLINICAL RELEVANCE

SUBSTITUTION PATTERNS OBSERVED DURING MANUAL MUSCLE TESTING OF WRIST MUSCLES

Figure 15.8

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Flexor Carpi Ulnaris

Figure 15.9

ACTIONS

MUSCLE ATTACHMENT BOX 15.4: Attachments and Innervation of the Flexor Carpi Ulnaris

Figure 15.10

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Superficial Muscles on the Dorsal Surface of the Forearm

Figure 15.11

Extensor Carpi Radialis Longus and Extensor Carpi Radialis Brevis

ACTIONS

MUSCLE ATTACHMENT BOX 15.5: Attachments and Innervation of the Extensor Carpi Radialis Longus

Figure 15.12

Figure 15.13

MUSCLE ATTACHMENT BOX 15.6: Attachments and Innervation of the Extensor Carpi Radialis Brevis

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Extensor Digitorum (Also Known as Extensor Digitorum Communis)

Figure 15.14

MUSCLE ATTACHMENT BOX 15.7: Attachments and Innervation of the Extensor Digitorum

Figure 15.15

CLINICAL RELEVANCE

INDEPENDENT FINGER MOVEMENT

Figure 15.16

ACTIONS

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Figure 15.17

Figure 15.18

Figure 15.19

CLINICAL RELEVANCE

FLEXION ROM AT THE PIP AND DIP JOINTS

Figure 15.20

Figure 15.21

Extensor Digiti Minimi (Also Known as Extensor Digiti Quinti)

ACTIONS

MUSCLE ATTACHMENT BOX 15.8: Attachments and Innervation of the Extensor Digiti Minimi

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Extensor Carpi Ulnaris

ACTIONS

MUSCLE ATTACHMENT BOX 15.9: Attachments and Innervation of the Extensor Carpi Ulnaris

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Combined Actions of the Five Dedicated Wrist Muscles

Figure 15.22

CLINICAL RELEVANCE

IMPAIRMENT OF A SINGLE DEDICATED WRIST MUSCLE

Deep Muscles on the Volar Surface of the Forearm

Figure 15.23

Flexor Digitorum Profundus

ACTIONS

MUSCLE ATTACHMENT BOX 15.10: Attachments and Innervation of the Flexor Digitorum Profundus

CLINICAL RELEVANCE

MMT OF THE FLEXOR DIGITORUM PROFUNDUS

Figure 15.24

Figure 15.25

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Figure 15.26

Flexor Pollicis Longus

ACTIONS

MUSCLE ATTACHMENT BOX 15.11: Attachments and Innervation of the Flexor Pollicis Longus

EFFECTS OF WEAKNESS

CLINICAL RELEVANCE

A CASE REPORT

EFFECTS OF TIGHTNESS

Figure 15.27

Pronator Quadratus

ACTIONS

MUSCLE ATTACHMENT BOX 15.12: Attachments and Innervation of the Pronator Quadratus

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Deep Muscles on the Dorsal Surface of the Forearm

Figure 15.28

Supinator

Abductor Pollicis Longus

MUSCLE ATTACHMENT BOX 15.13: Attachments and Innervation of the Abductor Pollicis Longus

ACTIONS

Figure 15.29

Figure 15.30

Figure 15.31

Figure 15.32

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Extensor Pollicis Brevis

MUSCLE ATTACHMENT BOX 15.14: Attachments and Innervation of the Extensor Pollicis Brevis

ACTIONS

Figure 15.33

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

CLINICAL RELEVANCE

DE QUERVAIN’S DISEASE

Extensor Pollicis Longus

MUSCLE ATTACHMENT BOX 15.15: Attachments and Innervation of the Extensor Pollicis Longus

ACTIONS

Figure 15.34

Figure 15.35

CLINICAL RELEVANCE

USE OF THE “SNUFF BOX MUSCLES” IN WRIST MOTIONS

Figure 15.36

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Extensor Indicis (Also Known as the Extensor Indicis Proprius)

MUSCLE ATTACHMENT BOX 15.16: Attachments and Innervation of the Extensor Indicis

ACTIONS

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Synergistic Function of the Forearm Muscles to the Wrist and Hand

Active Coordination Between the Dedicated Wrist Muscles and the Finger Muscles

Figure 15.37

Figure 15.38

CLINICAL RELEVANCE

“TENNIS ELBOW”

Passive Interactions Between the Dedicated Wrist Muscles and the Finger Muscles

CLINICAL RELEVANCE

TENODESIS

Figure 15.39

Comparisons of Strengths in Muscles of the Forearm

Pronation Versus Supination

CLINICAL RELEVANCE

ASSESSING STRENGTH OF PRONATION AND SUPINATION

Wrist Flexion Versus Extension

Figure 15.40

TABLE 15.1: Approximate Physiological Cross-Sectional Areas (PCSA) and Moment Arms for the Five Primary Dedicated Wrist Muscles

CLINICAL RELEVANCE

MMT OF THE WRIST

Radial Versus Ulnar Deviation of the Wrist

Finger Flexion Versus Extension

Summary

Thought Problems

REFERENCES

CHAPTER 16: Analysis of the Forces at the Wrist During Activity

CHAPTER CONTENTS

Analysis of Forces at the Wrist

EXAMINING THE FORCES BOX 16.1: Determining the Joint Reaction Force on the Wrist During Weight Bearing with Crutches

Figure 16.1

Review of the Forces on the Wrist

Figure 16.2

CLINICAL RELEVANCE

USE OF ASSISTIVE DEVICES FOR AMBULATION IN INDIVIDUALS WITH RHEUMATOID ARTHRITIS

Figure 16.3

CLINICAL RELEVANCE

WORK-RELATED WRIST AND HAND INJURIES

Figure 16.4

Figure 16.5

Figure 16.6

CLINICAL RELEVANCE

LOADS IN TENDONS AROUND THE WRIST DURING ACTIVITY

Analysis of Stresses Applied to the Wrist Joint During Activity

CLINICAL RELEVANCE

PRESSURE CHANGES WITH CARPAL INSTABILITIES

Clinical Implications of Studies Analyzing the Forces and Stresses on the Wrist

Summary

Thought Problems

REFERENCES

CHAPTER 17: Mechanics and Pathomechanics of the Special Connective Tissues in the Hand

CHAPTER CONTENTS

Landmarks Within the Hand

Figure 17.1

Figure 17.2

CLINICAL RELEVANCE

EDEMA IN THE HAND

Connective Tissue in the Hand

Palmar Aponeuroses

Figure 17.3

CLINICAL RELEVANCE

DUPUYTREN’S CONTRACTURE

Figure 17.4

Figure 17.5

CLINICAL RELEVANCE

SWELLING WITHIN THE COMPARTMENTS OF THE HAND OR FINGERS

Retinacular, or Pulley, Systems

Figure 17.6

RETINACULAR SYSTEMS AT THE WRIST

CLINICAL RELEVANCE

TRANSVERSE CARPAL LIGAMENT RECONSTRUCTION

Figure 17.7

RETINACULAR SYSTEMS AT THE DIGITS

Figure 17.8

CLINICAL RELEVANCE

PULLEY INJURIES IN ROCK CLIMBERS

Figure 17.9

Tendon Sheaths

Figure 17.10

Figure 17.11

CLINICAL RELEVANCE

“NO MAN’S LAND”

Figure 17.12

CLINICAL RELEVANCE

TRIGGER FINGER

Figure 17.13

Structures that Anchor the Flexor and Extensor Apparatus of the Fingers

Figure 17.14

Figure 17.15

Figure 17.16

CLINICAL RELEVANCE

BOUTONNIERE AND SWAN NECK DEFORMITIES

Figure 17.17

Figure 17.18

Figure 17.19

Figure 17.20

Summary

Thought Problems

REFERENCES

CHAPTER 18: Mechanics and Pathomechanics of the Intrinsic Muscles of the Hand

CHAPTER CONTENTS

Primary Intrinsic Movers of the Thumb

Figure 18.1

Abductor Pollicis Brevis

MUSCLE ATTACHMENT BOX 18.1: Attachments and Innervation of the Abductor Pollicis Brevis

ACTIONS

EFFECTS OF WEAKNESS OF THE ABDUCTOR POLLICIS BREVIS

Figure 18.2

Flexor Pollicis Brevis

MUSCLE ATTACHMENT BOX 18.2: Attachments and Innervation of the Flexor Pollicis Brevis

ACTIONS

EFFECTS OF WEAKNESS

Opponens Pollicis

ACTIONS

MUSCLE ATTACHMENT BOX 18.3: Attachments and Innervation of the Opponens Pollicis

EFFECTS OF WEAKNESS

Adductor Pollicis

MUSCLE ATTACHMENT BOX 18.4: Attachments and Innervation of the Adductor Pollicis

ACTIONS

Figure 18.3

Figure 18.4

Figure 18.5

EFFECTS OF TIGHTNESS AND WEAKNESS

CLINICAL RELEVANCE

FROMENT’S SIGN

Figure 18.6

Primary Intrinsic Movers of the Little Finger

Figure 18.7

Figure 18.8

Abductor Digiti Minimi (Also Known as the Abductor Digiti Quinti)

ACTIONS

MUSCLE ATTACHMENT BOX 18.5: Attachments and Innervation of the Abductor Digiti Minimi

Flexor Digiti Minimi (Also Known as Flexor Digiti Quinti)

ACTIONS

MUSCLE ATTACHMENT BOX 18.6: Attachments and Innervation of the Flexor Digiti Minimi

Opponens Digiti Minimi (Also Known as Opponens Digiti Quinti)

ACTIONS

Figure 18.9

EFFECTS OF WEAKNESS OF THE HYPOTHENAR MUSCLES

MUSCLE ATTACHMENT BOX 18.7: Attachments and Innervation of the Opponens Digiti Minimi

CLINICAL RELEVANCE

WEAKNESS OF THE HYPOTHENAR MUSCLES

Figure 18.10

Interossei and Lumbricals

Dorsal Interossei

Figure 18.11

MUSCLE ATTACHMENT BOX 18.8: Attachments and Innervation of the Dorsal Interossei

ACTIONS

EFFECTS OF WEAKNESS

Palmar Interossei

MUSCLE ATTACHMENT BOX 18.9: Attachments and Innervation of the Palmar Interossei

ACTIONS

EFFECTS OF WEAKNESS

Figure 18.12

Lumbrical Muscles

MUSCLE ATTACHMENT BOX 18.10: Attachments and Innervation of the Lumbrical Muscles

ACTIONS

Figure 18.13

TABLE 18.1: Muscles Active During Combined Movements and Postures of the MCP and IP Joints of the Fingers

Figure 18.14

EFFECTS OF WEAKNESS

Figure 18.15

EFFECTS OF TIGHTNESS OF THE LUMBRICAL, INTEROSSEOUS, AND HYPOTHENAR MUSCLES

Figure 18.16

Classic Deformities Resulting from Muscle Imbalances in the Hand

Figure 18.17

Ulnar Nerve Injury

ULNAR NERVE INJURIES AT THE WRIST

Figure 18.18

Figure 18.19

ULNAR NERVE INJURY AT THE ELBOW

Median Nerve Injury

MEDIAN NERVE INJURY AT THE WRIST

Figure 18.20

CLINICAL RELEVANCE

MEDIAN NERVE INJURY AT THE WRIST

Figure 18.21

MEDIAN NERVE INJURY AT THE ELBOW

Radial Nerve Injury

Figure 18.22

CLINICAL RELEVANCE

DROP WRIST DEFORMITY

Figure 18.23

Figure 18.24

Sensory Deficits Associated with Nerve Injuries to the Hand

Summary

Thought Problems

REFERENCES

CHAPTER 19: Mechanics and Pathomechanics of Pinch and Grasp

CHAPTER CONTENTS

Prehension

Figure 19.1

Figure 19.2

Necessary Elements of Pinch

REQUIREMENTS OF NORMAL PINCH

Figure 19.3

Figure 19.4

TABLE 19.1: Positions of the Joints of the Thumb and Finger in Tip-to-Tip Pinch

Figure 19.5

Figure 19.6

EFFECTS OF ABNORMAL JOINT POSITIONS AND MUSCLE WEAKNESS ON PINCH MECHANICS

CLINICAL RELEVANCE

INSUFFICIENT WEB SPACE BETWEEN THE THUMB AND INDEX FINGER: A CASE REPORT

Figure 19.7

Figure 19.8

Figure 19.9

Necessary Elements of Powerful Grasp

REQUIREMENTS OF NORMAL POWERFUL GRASP

Figure 19.10

Figure 19.11

Figure 19.12

COMPARISONS BETWEEN PINCH AND GRASP

TABLE 19.2: Reported Peak Grip and Pinch Strengths in Men and Women in Kilogram

Forces on the Fingers and Thumb During Activities

Analysis of the Forces in the Fingers

Figure 19.13

CLINICAL RELEVANCE

PINCH PATTERNS IN INDIVIDUALS WITH WEAKNESS OF THE INTRINSIC MUSCLES

Figure 19.14

EXAMINING THE FORCES BOX 19.1

Review of the Forces Generated During Pinch and Grasp

Figure 19.15

TABLE 19.3: Reported Joint Reaction Forces Generated at the PIP and MCP Joints when Twisting a Jar Lid

CLINICAL RELEVANCE

OCCUPATIONAL HAZARDS

EXAMINING THE FORCES BOX 19.2: Calculation of the Forces at the DIP Joint During Pinch

EXAMINING THE FORCES BOX 19.3: Calculations of the Muscle Forces at the PIP and MCP Joints During Pinch

CLINICAL RELEVANCE

OSTEOARTHRITIS IN THE HAND

Figure 19.16

Figure 19.17

CLINICAL RELEVANCE

SPLINTS TO OPTIMIZE FINGER AND THUMB JOINT ALIGNMENT

Figure 19.18

Using Force Analysis to Make Clinical Decisions

How Forces Contribute to the Finger Deformity of Ulnar Drift with Volar Subluxation

Figure 19.19

Figure 19.20

Figure 19.21

Figure 19.22

CLINICAL RELEVANCE

JOINT PROTECTION PRINCIPLES

Figure 19.23

Protecting a Surgically Repaired Tendon in the Finger

CLINICAL RELEVANCE

RECOMMENDATIONS FOR EARLY ACTIVE MOTION OF TENDON REPAIRS

Relationship Between the Forces in the Finger Flexor Muscles and Carpal Tunnel Syndrome

CLINICAL RELEVANCE

CONSERVATIVE MANAGEMENT OF CTS

Forces Are Key in Ergonomic Assessments of Work-Related Musculoskeletal Disorders

CLINICAL RELEVANCE

FUNCTIONAL CAPACITY EVALUATIONS

Summary

Thought Problems

REFERENCES

PART III: Kinesiology of the Head and Spine

UNIT 4: MUSCULOSKELETAL FUNCTIONS WITHIN THE HEAD

CHAPTER 20: Mechanics and Pathomechanics of the Muscles of the Face and Eyes

CHAPTER CONTENTS

Distribution of the Facial Nerve

Figure 20.1

Muscles Innervated by the Facial Nerve

CLINICAL RELEVANCE

FACIAL CREASES

Muscles of the Scalp and Ears

Figure 20.2

FRONTALIS AND OCCIPITALIS

MUSCLE ATTACHMENT BOX 20.1: Attachments and Innervation of the Occipitofrontalis

Actions

Weakness

Figure 20.3

Figure 20.4

AURICULARES ANTERIOR, SUPERIOR, AND POSTERIOR

MUSCLE ATTACHMENT BOX 20.2: Attachments and Innervation of the Auriculares

Action

Facial Muscles Surrounding the Eyes

Figure 20.5

ORBICULARIS OCULI

MUSCLE ATTACHMENT BOX 20.3: Attachments and Innervation of the Orbicularis Oculi

Weakness

Figure 20.6

CLINICAL RELEVANCE

WEAKNESS OF THE ORBICULARIS OCULI

LEVATOR PALPEBRAE SUPERIORIS

MUSCLE ATTACHMENT BOX 20.4: Attachments and Innervation of the Levator Palpebrae Superioris

Action

Weakness

CORRUGATOR

MUSCLE ATTACHMENT BOX 20.5: Attachments and Innervation of the Corrugator Supercilii

Action

Figure 20.7

Weakness

Muscles of the Nose

Figure 20.8

PROCERUS

MUSCLE ATTACHMENT BOX 20.6: Attachments and Innervation of the Procerus

Action

Figure 20.9

NASALIS

MUSCLE ATTACHMENT BOX 20.7: Attachments and Innervation of the Nasalis

Actions

DILATOR NARIS

MUSCLE ATTACHMENT BOX 20.8: Attachments and Innervation of the Dilator Naris

Actions

DEPRESSOR SEPTI

MUSCLE ATTACHMENT BOX 20.9: Attachments and Innervation of the Depressor Septi

Action

Muscles of the Mouth

Figure 20.10

Figure 20.11

CLINICAL RELEVANCE

BELL’S PALSY

Figure 20.12

ORBICULARIS ORIS

MUSCLE ATTACHMENT BOX 20.10: Attachments and Innervation of the Orbicularis Oris

Actions

Weakness

Figure 20.13

MENTALIS

MUSCLE ATTACHMENT BOX 20.11: Attachments and Innervation of the Mentalis

Actions

Figure 20.14

Weakness

ZYGOMATICUS

MUSCLE ATTACHMENT BOX 20.12: Attachments and Innervation of the Zygomaticus

Actions

Figure 20.15

Weakness

Figure 20.16

CLINICAL RELEVANCE

PSYCHOLOGICAL CHALLENGES FOR A PATIENT WITH FACIAL PALSY

RISORIUS

MUSCLE ATTACHMENT BOX 20.13: Attachments and Innervation of the Risorius

Actions

Figure 20.17

Weakness

LEVATOR LABII SUPERIORIS AND LEVATOR LABII SUPERIORIS ALAEQUE NASI

MUSCLE ATTACHMENT BOX 20.14: Attachments and Innervation of the Levator Labii Superioris and Levator Labii Superioris Alaeque Nasi

Actions

Weakness

LEVATOR ANGULI ORIS (ALSO KNOWN AS CANINUS)

MUSCLE ATTACHMENT BOX 20.15: Attachments and Innervation of the Levator Anguli Oris (Caninus)

Actions

Figure 20.18

Weakness

DEPRESSOR LABII INFERIORIS

MUSCLE ATTACHMENT BOX 20.16: Attachments and Innervation of the Depressor Labii Inferioris

Actions

Weakness

DEPRESSOR ANGULI ORIS

MUSCLE ATTACHMENT BOX 20.17: Attachments and Innervation of the Depressor Anguli Oris

Actions

Figure 20.19

Weakness

Figure 20.20

PLATYSMA

MUSCLE ATTACHMENT BOX 20.18: Attachments and Innervation of the Platysma

Actions

Figure 20.21

Weakness

BUCCINATOR

MUSCLE ATTACHMENT BOX 20.19: Attachments and Innervation of the Buccinator

Actions

Weakness

Muscles That Move the Eyes

Figure 20.22

Figure 20.23

Figure 20.24

MEDIALAND LATERAL RECTUS MUSCLES

MUSCLE ATTACHMENT BOX 20.20: Attachments and Innervation of the Medial and Lateral Rectus Muscles

Actions

Figure 20.25

SUPERIOR AND INFERIOR RECTUS MUSCLES

MUSCLE ATTACHMENT BOX 20.21: Attachments and Innervation of the Superior and Inferior Rectus Muscles

Actions

Figure 20.26

Actions

SUPERIOR OBLIQUE

MUSCLE ATTACHMENT BOX 20.22: Attachments and Innervation of the Superior Oblique Muscle

Actions

INFERIOR OBLIQUE

MUSCLE ATTACHMENT BOX 20.23: Attachments and Innervation of the Inferior Oblique Muscle

Actions

WEAKNESS OF THE MUSCLES THAT MOVE THE EYE

CLINICAL RELEVANCE

RESTORING MUSCLE BALANCE SURGICALLY

CLINICAL RELEVANCE

TROCHLEAR NERVE INJURY

Summary

Thought Problems

REFERENCES

CHAPTER 21: Mechanics and Pathomechanics of Vocalization

CHAPTER CONTENTS

Larynx

Figure 21.1

Figure 21.2

Laryngeal Cartilages

CRICOID CARTILAGE

Figure 21.3

THYROID CARTILAGE

Figure 21.4

Figure 21.5

Figure 21.6

EPIGLOTTIS

Figure 21.7

ARYTENOID CARTILAGES

Figure 21.8

Figure 21.9

CORNICULATE AND CUNEIFORM CARTILAGES

Vocal Folds

Figure 21.10

CLINICAL RELEVANCE

RHEUMATOID ARTHRITIS CAN AFFECT THE CRICOARYTENOID JOINTS

Intrinsic Muscles of the Larynx

MUSCLE ATTACHMENT BOX 21.1: Attachments and Innervation of the Oblique Interarytenoid Muscle

Muscles that Close the Vocal Cords

Figure 21.11

ACTIONS OF THE TRANSVERSE AND OBLIQUE INTERARYTENOID MUSCLES

ACTION OF THE LATERAL CRICOARYTENOID MUSCLES

MUSCLE ATTACHMENT BOX 21.2: Attachments and Innervation of the Transverse Interarytenoid Muscle

MUSCLE ATTACHMENT BOX 21.3: Attachments and Innervation of the Lateral Cricoarytenoid Muscle

MUSCLE ATTACHMENT BOX 21.4: Attachments and Innervation of the Posterior Cricoarytenoid Muscle

Muscles That Open the Vocal Cords

ACTION OF THE POSTERIOR CRICOARYTENOID MUSCLES

Figure 21.12

MUSCLE ATTACHMENT BOX 21.5: Attachments and Innervation of the Cricothyroid Muscle

Muscles That Alter the Tension in the Vocal Cords

ACTION OF THE CRICOTHYROID MUSCLE

MUSCLE ATTACHMENT BOX 21.6: Attachments and Innervation of the Thyroarytenoid Muscle

Figure 21.13

ACTION OF THE THYROARYTENOID MUSCLE

Figure 21.14

Mechanism of Voice Production

Phonation

Resonance and Pronunciation

CLINICAL RELEVANCE

THE ROLE OF BREATH CONTROL IN SPEECH—CASE REPORTS

Common Abnormalities in Voice Production

Summary

Thought Problems

REFERENCES

CHAPTER 22: Mechanics and Pathomechanics of Swallowing

CHAPTER CONTENTS

CLINICAL RELEVANCE

A CASE REPORT

Food Pathway from Mouth to Stomach

Figure 22.1

Muscles of the Mouth

Muscles of the Tongue

Figure 22.2

INTRINSIC MUSCLES OF THE TONGUE

MUSCLE ATTACHMENT BOX 22.1: Attachments and Innervation of the Intrinsic Muscles of the Tongue

Actions

EXTRINSIC MUSCLES OF THE TONGUE

Figure 22.3

MUSCLE ATTACHMENT BOX 22.2: Attachments and Innervation of the Extrinsic Muscles of the Tongue

Actions

Muscles of the Soft Palate

Figure 22.4

MUSCLE ATTACHMENT BOX 22.3: Attachments and Innervation of the Muscles of the Soft Palate

LEVATOR YELI PALATINI

Figure 22.5

Figure 22.6

TENSOR YELI PALATINI

MUSCULUS UYULAE

PALATOPHARYNGEUS

Muscles of the Pharynx

MUSCLE ATTACHMENT BOX 22.4: Attachments and Innervation of the Muscles of the Pharynx

Figure 22.7

SUPERIOR, MIDDLE, AND INFERIOR CONSTRICTOR MUSCLES

Suprahyoid Muscles

MUSCLE ATTACHMENT BOX 22.5: Attachments and Innervation of the Suprahyoid Muscles

Figure 22.8

Figure 22.9

DIGASTRIC

Actions

STYLOHYOID

Actions

MYLOHYOID

Actions

GENIOHYOID

Actions

Infrahyoid Muscles

Figure 22.10

MUSCLE ATTACHMENT BOX 22.6: Attachments and Innervation of the Infrahyoid Muscles

ACTIONS

Figure 22.11

Figure 22.12

Intrinsic Muscles of the Larynx

Normal Sequence of Swallowing

Oral Phase

Pharyngeal Phase

CLINICAL RELEVANCE

THE ROLE OF CORRECT POSTURE IN SWALLOWING

Esophageal Phase

Common Abnormalities in Swallowing

Impairments of the Oral Preparatory Phase

Impairments of the Oral Phase

Impairments of the Pharyngeal Phase

Impairments of the Esophageal Phase

Signs of Swallowing Impairment

CLINICAL RELEVANCE

EXERCISES TO IMPROVING SWALLOWING

Summary

Thought Problems

REFERENCES

CHAPTER 23: Structure and Function of the Articular Structures of the TMJ

CHAPTER CONTENTS

Bony Structures That Constitute and Influence the TMJ

Figure 23.1

Cranium

Figure 23.2

TEMPORAL BONE

Figure 23.3

CLINICAL RELEVANCE

EAR SYMPTOMATOLOGY wITH TMJ DYSFUNCTION

SPHENOID BONE

Figure 23.4

CLINICAL RELEVANCE

PALPATION OF THE HAMULUS AND LATERAL PTERYGOID MUSCLE

Figure 23.5

ZYGOMATIC, MAXILLA, AND PALATINE BONES

Figure 23.6

MANDIBLE

Figure 23.7

Figure 23.8

Figure 23.9

Articular Structures of the TMJ

Figure 23.10

CLINICAL RELEVANCE

WITHSTANDING LARGE FORCES AT THE TMJ

Figure 23.11

Articular Disc

Figure 23.12

CLINICAL RELEVANCE

DISC PATHOLOGY

Joint Capsule and Ligaments

Figure 23.13

JOINT CAPSULE

TEMPOROMANDIBULAR LIGAMENT

THE STYLOMANDIBULAR AND SPHENOMANDIBULAR LIGAMENTS

THE DISCOMALLEOLAR LIGAMENT AND THE MALLEOMANDIBULAR LIGAMENTS

Articular Functions of the TMJ

CLINICAL RELEVANCE

IMPACT OF SYNCHRONOUS MOVEMENT ON EXAMINATION OF THE TMJ

Static Positions of the TMJ

CLINICAL RELEVANCE

THE RELATIONSHIP BETWEEN OCCLUSION AND TMJ DISORDERS

Functional Motions of the TMJ

OPENING AND CLOSING THE MOUTH

PROTRUSION, RETRUSION, AND LATERAL MOTION

CLINICAL RELEVANCE

IMPACT OF CLENCHING ON TMJ FUNCTION

Figure 23.14

Disc Movement

CLINICAL RELEVANCE

SOUNDS ELICITED DURING OPENING AND CLOSING

Normal Ranges of Motion at the TMJ

TABLE 23.1: Normal Range of Motion of the Mandible

CLINICAL RELEVANCE

MEASURING OPENING

Figure 23.15

Relationship Between the Head and Neck and the TMJ

CLINICAL RELEVANCE

HEAD AND NECK POSTURE IN INDIVIDUALS WITH TMJ PAIN

Figure 23.16

Summary

Thought Problems

REFERENCES

CHAPTER 24: Mechanics and Pathomechanics of the Muscles of the TMJ

CHAPTER CONTENTS

Muscles of Mastication

Figure 24.1

Figure 24.2

Figure 24.3

CLINICAL RELEVANCE

TRIGEMINAL NEURALGIA

Masseter

Figure 24.4

ACTIONS

MUSCLE ATTACHMENT BOX 24.1: Attachments and Innervation of the Masseter Muscle

Figure 24.5

CLINICAL RELEVANCE

MASSETER FATIGUE AND GUM CHEWING

MUSCLE ATTACHMENT BOX 24.2: Attachments and Innervation of the Temporalis Muscle

Temporalis

Figure 24.6

ACTIONS

Figure 24.7

Medial Pterygoid

Figure 24.8

ACTIONS

MUSCLE ATTACHMENT BOX 24.3: Attachments and Innervation of the Medial Pterygoid Muscle

Figure 24.9

CLINICAL RELEVANCE

BRUXISM

Lateral Pterygoid

MUSCLE ATTACHMENT BOX 24.4: Attachments and Innervation of the Lateral Pterygoid Muscle

ACTIONS

CLINICAL RELEVANCE

CLINICAL IMPLICATIONS OF THE LATERAL PTERYGOID MUSCLE

Figure 24.10

Accessory Muscles

Figure 24.11

Figure 24.12

CLINICAL RELEVANCE

TONGUE POSITION DURING ACTIVE EXERCISE OF THE TMJS

Figure 24.13

Mastication

Mandibular Motion During Chewing

Figure 24.14

Figure 24.15

Muscle Activity During Mastication

MUSCLES THAT MOVE THE MANDIBLE DURING MASTICATION

STABILIZATION OF THE BALANCING SIDE OF THE MANDIBLE

Figure 24.16

MAINTAIN APPROPRIATE ALIGNMENT BETWEEN THE DISC AND MANDIBULAR CONDYLE

Figure 24.17

CONTROL FOOD LOCATION

CLINICAL RELEVANCE

MUSCLE DYSFUNCTION IN TMJ DISORDERS

Summary

Thought Problems

REFERENCES

CHAPTER 25: Analysis of the Forces on the TMJ During Activity

CHAPTER CONTENTS

Two-Dimensional Analysis of the Forces in the TMJ Complex

EXAMINING THE FORCES BOX 25.1: Two-Dimensional Analysis of the Forces in the Temporomandibular Joint During Maximal Bite Between the Molars

EXAMINING THE FORCES BOX 25.2: Two-Dimensional Analysis of the Forces in the TMJ During Maximal Bite Between the Incisors

Results from Sophisticated Modeling of the TMJ

Bite Force

CLINICAL RELEVANCE

CHANGES IN DIET IN PATIENTS WITH TMJ DYSFUNCTION

CLINICAL RELEVANCE

PARAFUNCTIONAL HABITS CAN CONTRIBUTE TO OVERLOAD ON TMJ AND CLINICAL FINDINGS

Joint Reaction Forces

CLINICAL RELEVANCE

“MY TMJ HURTS EVEN IF I CHEW ON THE OPPOSITE SIDE!”

Figure 25.1

CLINICAL RELEVANCE

TRACTION OF THE CERVICAL SPINE

Figure 25.2

Summary

Thought Problems

REFERENCES

UNIT 5: SPINE UNIT

CHAPTER 26: Structure and Function of the Bones and Joints of the Cervical Spine

CHAPTER CONTENTS

Structure of the Bones of the Cervical Spine

Craniovertebral Vertebrae

ATLAS

Figure 26.1

Figure 26.2

CLINICAL RELEVANCE

ATLANTO-OCCIPITAL RANGE OF MOTION

AXIS

Figure 26.3

CLINICAL RELEVANCE

VERTEBRAL ARTERY TEST

Lower Column C3–C7 Vertebrae

Figure 26.4

Figure 26.5

Figure 26.6

Figure 26.7

Joints of the Cervical Spine

Craniovertebral Joints

Figure 26.8

Figure 26.9

CLINICAL RELEVANCE

THE MENISCOIDS AS A SOURCE OF PAIN

LIGAMENTS OF THE CRANIOVERTEBRAL JOINTS

Transverse Ligament

Figure 26.10

CLINICAL RELEVANCE

FRACTURE OF THE DENS

Alar Ligaments

CLINICAL RELEVANCE

REAR-END MOTOR VEHICLE ACCIDENTS

Membrana Tectoria

Figure 26.11

Figure 26.12

Atlanto-Occipital and Atlantoaxial Membranes

Apical Ligament

Joints of the Lower Cervical Spine

INTERBODY JOINTS

Figure 26.13

CLINICAL RELEVANCE

DISCOGENIC PAIN

CLINICAL RELEVANCE

CERVICAL DISC STRUCTURE

ZYGAPOPHYSIAL JOINTS

CLINICAL RELEVANCE

WHIPLASH INJURIES

LIGAMENTS OF THE LOWER CERVICAL SPINE

Longitudinal Ligaments

Ligamentum Flavum

Figure 26.14

Ligamentum Nuchae

CLINICAL RELEVANCE

LIGAMENTUM NUCHAE

Normal Range of Motion

Total Motion of the Cervical Spine

TABLE 26.1: Reported Extremes of Active Range of Motion

TABLE 26.2: Reported Extremes of Passive Range of Motion

CLINICAL RELEVANCE

CERVICAL RANGE OF MOTION

Segmental Motion of the Craniovertebral Joints

ATLANTO-OCCIPITAL JOINTS

TABLE 26.3: Range of Flexion–Extension at the Atlanto-Occipital Joint

CLINICAL RELEVANCE

DISTINGUISHING NORMAL AND ABNORMAL RANGE OF MOTION

TABLE 26.4: Range of Motion for Lateral Flexion and Axial Rotation at the Atlantooccipital Joint

CLINICAL RELEVANCE

ATLANTO-OCCIPITAL ROTATION

ATLANTOAXIAL JOINTS

Figure 26.15

TABLE 26.5: Average Motion at the Atlantoaxial Joint Complex

Figure 26.16

SEGMENTAL CRANIOVERTEBRAL MOTION

CLINICAL RELEVANCE

HEAD POSTURE AFFECTS CERVICAL RANGE OF MOTION

Segmental Motion of the Lower Cervical Region

Figure 26.17

TABLE 26.6: Normal Ranges of Segmental Motion During Cervical Spine Flexion and Extension

TABLE 26.7: Mean Values and Ranges of Segmental Axial Rotation

TABLE 26.8: Normal Range of Axial Rotation with Coupled Flexion–Extension and Side Bending

Figure 26.18

Figure 26.19

Figure 26.20

Figure 26.21

Summary

Thought Problems

REFERENCES

CHAPTER 27: Mechanics and Pathomechanics of the Cervical Musculature

CHAPTER CONTENTS

Extensors of the Head and Neck

Deep Plane

SUBOCCIPITAL MUSCLES

Figure 27.1

Actions

MUSCLE ATTACHMENT BOX 27.1: Attachments and Innervation of the Rectus Capitis Posterior Minor

MUSCLE ATTACHMENT BOX 27.2: Attachments and Innervation of the Superior Oblique

MUSCLE ATTACHMENT BOX 27.3: Attachments and Innervation of the Rectus Capitis Posterior Major

MUSCLE ATTACHMENT BOX 27.4: Attachments and Innervation of the Inferior Oblique

CLINICAL RELEVANCE

CERVICAL HEADACHES

Figure 27.2

TRANSVERSOSPINAL MUSCLES

MUSCLE ATTACHMENT BOX 27.5: Attachments and Innervation of the Multifidus

Actions

Figure 27.3

CLINICAL RELEVANCE

FATTY INFILTRATION OF THE EXTENSOR MUSCLES FOLLOWING WHIPLASH

Semispinalis Plane

SEMISPINALIS CAPITIS AND CERVICIS

Figure 27.4

MUSCLE ATTACHMENT BOX 27.6: Attachments and Innervation of the Semispinalis Capitis

Actions

MUSCLE ATTACHMENT BOX 27.7: Attachments and Innervation of the Semispinalis Cervicis

CLINICAL RELEVANCE

IMPAIRMENTS OF THE SEMISPINALIS CAPITIS MUSCLE

Splenius and Levator Scapulae Plane

SPLENIUS CAPITIS AND CERVICIS

Figure 27.5

Actions

LEVATOR SCAPULAE

Actions

MUSCLE ATTACHMENT BOX 27.8: Attachments and Innervation of the Splenius Capitis and Cervicis

MUSCLE ATTACHMENT BOX 27.9: Attachments and Innervation of the Levator Scapulae

Figure 27.6

Figure 27.7

CLINICAL RELEVANCE

NECK AND SHOULDER PAIN ASSOCIATED WITH THE LEVATOR SCAPULAE

LONGISSIMUS CAPITIS

Figure 27.8

Actions

MUSCLE ATTACHMENT BOX 27.10: Attachments and Innervation of the Longissimus Capitis

Superficial Plane

TRAPEZIUS

Figure 27.9

Actions

CLINICAL RELEVANCE

WEAKNESS AND STRAINS OF THE TRAPEZIUS MUSCLE

Figure 27.10

MUSCLE ATTACHMENT BOX 27.11: Attachments and Innervation of the Trapezius

Flexors of the Head and Neck

STERNOCLEIDOMASTOID

MUSCLE ATTACHMENT BOX 27.12: Attachments and Innervation of the Sternocleidomastoid

Actions

CLINICAL RELEVANCE

TORTICOLLIS

Figure 27.11

SCALENE MUSCLES

Figure 27.12

Actions

MUSCLE ATTACHMENT BOX 27.13: Attachments and Innervation of the Anterior Scalene

MUSCLE ATTACHMENT BOX 27.14: Attachments and Innervation of the Middle Scalene

MUSCLE ATTACHMENT BOX 27.15: Attachments and Innervation of the Posterior Scalene

CLINICAL RELEVANCE

SCALENUS ANTICUS SYNDROME

Figure 27.13

DEEP CERVICAL FLEXOR MUSCLES

MUSCLE ATTACHMENT BOX 27.16: Attachments and Innervation of the Longus Capitis

MUSCLE ATTACHMENT BOX 27.17: Attachments and Innervation of the Longus Colli

MUSCLE ATTACHMENT BOX 27.18: Attachments and Innervation of the Rectus Capitis Anterior

MUSCLE ATTACHMENT BOX 27.19: Attachments and Innervation of the Rectus Capitis Lateralis

Muscle Function in the Cervical Spine

TABLE 27.1: Cervical Muscles Grouped According to Their Actions

Muscle Interactions and Activation Patterns

Figure 27.14

Figure 27.15

TABLE 27.2: Types of Contractions of Cervical Muscles: How Position Alters the Muscle Group and Type of Contraction Used During Specific Motions

Effects of Mechanical Neck Pain on Cervical Muscles

CLINICAL RELEVANCE

PAIN AND MUSCLE REHABILITATION

Effects of Posture on Cervical Muscles

Figure 27.16

Summary

Thought Problems

REFERENCES

CHAPTER 28: Analysis of the Forces on the Cervical Spine During Activity

CHAPTER CONTENTS

Two-Dimensional Analysis of the Loads on the Cervical Spine

Figure 28.1

EXAMINING THE FORCES BOX 28.1: Calculation of the Muscle and Joint Reaction Forces at the Atlanto-Occipital (AO) Joint

EXAMINING THE FORCES BOX 28.2: Calculation of the Muscle and Joint Reaction Forces at the C7–T1 Joint

CLINICAL RELEVANCE

CERVICAL DISC DEGENERATION

Figure 28.2

Loads on the Cervical Spine

Static Loading of the Cervical Spine

Figure 28.3

STRENGTH OF THE CERVICAL SPINE TO RESIST STATIC LOADS

Dynamic Loading of the Cervical Spine

IMPACT LOADING OF THE CERVICAL SPINE

CLINICAL RELEVANCE

AMERICAN FOOTBALL

Figure 28.4

Figure 28.5

ACCELERATION INJURIES TO THE CERVICAL SPINE

Figure 28.6

CLINICAL RELEVANCE

MOTOR VEHICLE ACCIDENTS

Summary

Thought Problems

REFERENCES

CHAPTER 29: Structure and Function of the Bones and Joints of the Thoracic Spine

CHAPTER CONTENTS

Figure 29.1

Structure of the Thoracic Vertebrae

Bodies of Thoracic Vertebrae

Figure 29.2

Figure 29.3

CLINICAL RELEVANCE

COMPRESSION FRACTURES OF THE THORACIC VERTEBRAE

Figure 29.4

Vertebral Arch of a Thoracic Vertebra

Figure 29.5

CLINICAL RELEVANCE

SPINAL CORD IMPINGEMENT

ARTICULAR PROCESSES OF A THORACIC VERTEBRA

Figure 29.6

MUSCULAR PROCESSES OF A THORACIC VERTEBRA

Figure 29.7

CLINICAL RELEVANCE

PALPATION OF THE THORACIC SPINE

Bones of the Thoracic Cage

Ribs

Figure 29.8

Sternum

Figure 29.9

Joints of the Thoracic Region

Figure 29.10

Joints Between Adjacent Vertebrae

INTERBODY JOINTS

Figure 29.11

CLINICAL RELEVANCE

HERNIATION OF THORACIC DISCS

FACET JOINTS

SUPPORTING STRUCTURES

Figure 29.12

Articulations Joining the Ribs to the Vertebrae and Sternum

ARTICULATIONS BETVVEEN THE RIBS AND THE VERTEBRAE

Figure 29.13

Figure 29.14

Figure 29.15

CLINICAL RELEVANCE

RIB FRACTURES

ARTICULATIONS BETWEEN THE RIBS AND STERNUM

Figure 29.16

Figure 29.17

CLINICAL RELEVANCE

PAIN AT THE COSTOSTERNAL JUNCTIONS

Movements of the Thoracic Spine and Thorax

Thoracic Spine Motion

SEGMENTAL MOTION

Figure 29.18

Figure 29.19

Figure 29.20

TOTAL MOBILITY OF THE THORACIC SPINE

TABLE 29.1: ROM of the Thoracic Spine in Individuals Without Spinal Impairment

CLINICAL RELEVANCE

THORACIC MOBILITY

Motion of the Rib Cage

ELEVATION AND DEPRESSION OF THE RIBS

Figure 29.21

TABLE 29.2: Circumferential Chest Excursions in Subjects with Normal Pulmonary Function

CLINICAL RELEVANCE

CHEST EXPANSION IN PATIENTS WITH ANKYLOSING SPONDYLITIS

MOTIONS OF THE RIBS WITH THORACIC MOTION

Figure 29.22

CLINICAL RELEVANCE

COUPLED MOTIONS AND IDIOPATHIC SCOLIOSIS IN THE THORACIC SPINE

Figure 29.23

MOVEMENTS OF THE COSTAL CARTILAGES AND STERNUM

Figure 29.24

CLINICAL RELEVANCE

INCREASED STIFFNESS OF THE COSTAL CARTILAGES WITH AGING

Mechanics of Respiration

Figure 29.25

Summary

REFERENCES

CHAPTER 30: Mechanics and Pathomechanics of the Muscles of the Thoracic Spine

CHAPTER CONTENTS

Figure 30.1

Muscles of the Posterior Thorax

Superficial Layer

Figure 30.2

Figure 30.3

Figure 30.4

Deep Layer of the Posterior Thoracic Region

ERECTOR SPINAE

Figure 30.5

Action

MUSCLE ATTACHMENT BOX 30.1: Attachments and Innervation of the Iliocostalis Muscles Affecting the Thoracic and Lumbar Spines

MUSCLE ATTACHMENT BOX 30.2: Attachments and Innervation of the Longissimus Muscles Affecting the Thoracic and Lumbar Spines

MUSCLE ATTACHMENT BOX 30.3: Attachments and Innervation of the Longissimus Muscles Affecting the Thoracic and Lumbar Spines

Figure 30.6

Figure 30.7

TRANSVERSOSPINALES

Figure 30.8

MUSCLE ATTACHMENT BOX 30.4: Attachment and Innervation of the Semispinalis Muscles

Action

MUSCLE ATTACHMENT BOX 30.5: Attachment and Innervation of the Multifidus

MUSCLE ATTACHMENT BOX 30.6: Attachment and Innervation of the Rotatores

Figure 30.9

MUSCLE ATTACHMENT BOX 30.7: Attachment and Innervation of the Interspinales

INTERSPINALES AND INTERTRANSVERSARII

IMPAIRMENT OF THE MUSCLES OF THE POSTERIOR THORAX

MUSCLE ATTACHMENT BOX 30.8: Attachment and Innervation of the Intertransversarii

CLINICAL RELEVANCE

TREATING IDIOPATHIC SCOLIOSIS WITH EXERCISE

Intrinsic Muscles of the Thorax

Serratus Posterior Superior and Inferior

Figure 30.10

Intercostal Muscles

Figure 30.11

ACTION

MUSCLE ATTACHMENT BOX 30.9: Attachments and Innervation of the Serratus Posterior Superior

MUSCLE ATTACHMENT BOX 30.10: Attachments and Innervation of the Serratus Posterior Inferior

MUSCLE ATTACHMENT BOX 30.11: Attachment and Innervation of the External Intercostals

MUSCLE ATTACHMENT BOX 30.12: Attachment and Innervation of the Internal Intercostals

MUSCLE ATTACHMENT BOX 30.13: Attachment and Innervation of the Innermost Intercostal Muscles (Intercostales Intimi)

Figure 30.12

IMPAIRMENT OF THE INTERCOSTAL MUSCLES

CLINICAL RELEVANCE

PARADOXICAL BREATHING

Figure 30.13

Transversus Thoracis, Subcostales, and Levatores Costarum

Figure 30.14

Diaphragm

Figure 30.15

MUSCLE ATTACHMENT BOX 30.14: Attachment and Innervation of the Subcostales

ACTION

MUSCLE ATTACHMENT BOX 30.15: Attachment and Innervation of Transversus Thoracis

MUSCLE ATTACHMENT BOX 30.16: Attachment and Innervation of the Levatores Costarum

MUSCLE ATTACHMENT BOX 30.17: Attachment and Innervation of the Diaphragm

Figure 30.16

CLINICAL RELEVANCE

VALSALVA MANEUVER

IMPAIRMENT OF THE DIAPHRAGM

Muscle Activity During Respiration

Muscles of Inspiration

CLINICAL RELEVANCE

RESPIRATORY MUSCLE TRAINING IN HEALTH AND DISEASE

Muscles of Expiration

Figure 30.17

Summary

Thought Problems

REFERENCES

CHAPTER 31: Loads Sustained by the Thoracic Spine

CHAPTER CONTENTS

Two-Dimensional Analysis of the Forces on the Thoracic Spine

Figure 31.1

EXAMINING THE FORCES BOX 31.1: Flexion Moments on the Thoracic Spine

Figure 31.2

Figure 31.3

Figure 31.4

CLINICAL RELEVANCE

COMPRESSION FRACTURES IN THE THORACIC SPINE, WEDGE, AND BURST FRACTURES

Loads on the Thoracic Spine

EXAMINING THE FORCES BOX 31.2: Compressive Loads on a Thoracic Vertebra

CLINICAL RELEVANCE

SPONTANEOUS VERTEBRAL FRACTURES

Summary

Thought Problems

REFERENCES

CHAPTER 32: Structure and Function of the Bones and Joints of the Lumbar Spine

CHAPTER CONTENTS

Structure of the Bones and Ligaments of the Lumbar Spine

General Overview of the Osteocartilaginous Lumbar Spine

Figure 32.1

Figure 32.2

Figure 32.3

VERTEBRAL BODIES

CLINICAL RELEVANCE

AREAS OF THE VERTEBRAE THAT ARE PREDISPOSED TO INJURY OR DISEASE

NEURALARCH

CLINICAL RELEVANCE

SPONDYLOLYSIS

Figure 32.4

VERTEBRAL FORAMINA

Figure 32.5

CLINICAL RELEVANCE

SPINAL STENOSIS

Ligamentous Support of the Lumbar Spine

Figure 32.6

TABLE 32.1: Displacements Opposed by Lumbar Ligaments

CLINICAL RELEVANCE

MOTOR CONTROL

Thoracolumbar Fascia

Figure 32.7

Palpable Bony and Ligamentous Structures of the Lumbar Spine

Structure of the Joints of the Lumbar Spine

Facet Joints

Figure 32.8

Figure 32.9

CLINICAL RELEVANCE

THE CONTRIBUTION OF THE FACET JOINTS TO LOW BACK PAIN

Intervertebral Joint

Figure 32.10

VERTEBRAL ENDPLATE

INTERVERTEBRAL DISC

Annulus Fibrosus

Figure 32.11

Nucleus Pulposus

Figure 32.12

CLINICAL RELEVANCE

THE FLUID CONTENT OF THE IVD AND ITS RELATIONSHIP TO LOW BACK PAIN

Mechanical Properties of the IVD

Compression

Figure 32.13

Bending

Figure 32.14

CLINICAL RELEVANCE

DEFORMATION OF THE NUCLEUS PULPOSUS AS A BASIS FOR BACK EXERCISES

Figure 32.15

Rotation

Figure 32.16

IVD Pressures During Activities of Daily Living

CLINICAL RELEVANCE

THE INTERVERTEBRAL DISC AS A SOURCE OF SYMPTOMS OF LOW BACK PAIN

Motion of the Lumbar Spine

Gross Motion of the Lumbar Spine

TABLE 32.2: Gross Motions of the Lumbar Spine Based upon Cardinal Planes

LUMBAR FLEXION

TABLE 32.3: General Trends for Angular Displacement at the Segmental Levels of the Lumbar Spine (in Degrees)

CLINICAL RELEVANCE

THE RELATIONSHIP OF INEXTENSIBLE HAMSTRING MUSCLES TO LOW BACK PAIN

LUMBAR EXTENSION

LUMBAR ROTATION AND SIDE BENDING

Joint Coupling in the Lumbar Spine

Segmental Motion of the Lumbar Spine

TABLE 32.4: The Twelve Motions of a Lumbar Motion Segment

SEGMENTAL MOTION IN THE SAGITTAL PLANE

CLINICAL RELEVANCE

FLEXION VERSUS EXTENSION EXERCISES

SEGMENTAL MOTION IN THE TRANSVERSE AND FRONTAL PLANE

Clinical Methods of Lumbar Range of Motion Assessment

LINEAR DISPLACEMENT OF THE SPINOUS PROCESSES OF THE LUMBAR SPINE

Figure 32.17

ANGULAR DISPLACEMENT OF THE LUMBAR SPINE

Figure 32.18

TABLE 32.5: Normal Values (95% Confidence Intervals) for Adults Without LBP and with Chronic LBP (in Degrees)

Normative Values for Lumbar Range of Motion

TABLE 32.6: Approximate Mean Values for Lumbar Range of Motion (in Degrees) as Measured with a Spondylometer

MANUAL ASSESSMENT OF PASSIVE INTERVERTEBRAL MOTION

Relating the Osteocartilaginous Lumbar Spine to Functional Demands

EXAMINING THE FORCES BOX 32.1: Summary of Structures that Resist Loading in the Lumbar Spine and Common Injuries that Occur from Excessive Loading

Summary

Thought Problems

REFERENCES

CHAPTER 33: Mechanics and Pathomechanics of Muscles Acting on the Lumbar Spine

CHAPTER CONTENTS

Muscle Size

Figure 33.1

TABLE 33.1: Raw Cross-Sectional Areas (mm2) (Standard Deviation) Measured Directly from MRI Scans

TABLE 33.2: Raw Lateral Distances (mm) between Muscle Centroids and Intervertebral Disc Centroid (Standard Deviation)

TABLE 33.3: Raw Anterior–Posterior Distances (mm) Between Muscle Centroids and Intervertebral Disc Centroid (Standard Deviation)

Muscle Groups

Rotatores and Intertransversarii

Figure 33.2

CLINICAL RELEVANCE

MANUAL THERAPY AND THE FUNCTION OF THE ROTATORES AND INTERTRANSVERSARII

Extensors: Longissimus, Iliocostalis, and Multifidus Groups

TABLE 33.4: Examples of Corrected Cross-Sectional Areas and A–P and Lateral Moment Arms Perpendicular to the Muscle Fiber Line of Action Using the Appropriate Cosines: These Values Should Be Used in Biomechanical Models Rather Than the Uncorrected Values Obtained Directly from Scan Slices

MUSCLE ATTACHMENT BOX 33.1: Attachments and Innervation of the Rotatores

MUSCLE ATTACHMENT BOX 33.2: Attachments and Innervation of Intertransversarii

MUSCLE ATTACHMENT BOX 33.3: Attachments and Innervation of the Longissimus Thoracis Pars Lumborum

MUSCLE ATTACHMENT BOX 33.4: Attachments and Innervation of the Iliocostalis Lumborum

MUSCLE ATTACHMENT BOX 33.5: Attachments and Innervation of the Multifidus

Figure 33.3

Figure 33.4

Figure 33.5

Figure 33.6

CLINICAL RELEVANCE

EXERCISE FOR THE EXTENSOR MUSCLES OF THE LOW BACK

Abdominal Muscles

RECTUS ABDOMINIS

TABLE 33.5: Subject Averages of EMG Activation Normalized to 100% MVC—Mean and (Standard Deviation)

MUSCLE ATTACHMENT BOX 33.6: Attachments and Innervation of the Rectus Abdominis

ABDOMINAL WALL

Figure 33.7

MUSCLE ATTACHMENT BOX 33.7: Attachments and Innervation of the External Oblique

MUSCLE ATTACHMENT BOX 33.8: Attachments and Innervation of the Internal Oblique

MUSCLE ATTACHMENT BOX 33.9: Attachments and Innervation of the Transversus Abdominis

CLINICAL RELEVANCE

ABDOMINAL MUSCLE EXERCISES

Special Case of the Quadratus Lumborum and Psoas Major

Figure 33.8

MUSCLE ATTACHMENT BOX 33.10: Attachments and Innervation of the Quadratus Lumborum

CLINICAL RELEVANCE

QUADRATUS LUMBORUM

Summary

Thought Problems

Acknowledgments

REFERENCES

CHAPTER 34: Analysis of the Forces on the Lumbar Spine During Activity

CHAPTER CONTENTS

Normal Biomechanics and Pathomechanics of the Lumbar Spine

Loads on the Low Back During Lifting, Walking, Sitting, and Carrying

TABLE 34.1: Musculature Forces and Shear and Compressive Contributions to Spine Load During a Squat Lift of 27 kg that Required a Lumbar Extensor Moment of 450 Nm

Figure 34.1

CLINICAL RELEVANCE

WALKING AND LOW BACK PAIN

CLINICAL RELEVANCE

WALKING EXERCISE IN A POOL: AQUATHERAPY

Loads on the Low Back During Sitting

Loads on the Low Back During Carrying

TABLE 34.2: Spine Compression for Load Carrying with the Load in One Hand or in Both Hands at the Instant in Time Where the Left Foot Was in Contact with the Force Plate and the Right Foot Was Completely Off of the Ground

Biomechanics of the Passive Tissues of the Lumbar Spine

Functional Consideration for the Interspinous and Supraspinous Ligaments

Figure 34.2

MECHANISMS OF INJURY

Figure 34.3

TABLE 34.3: Individual Muscle and Passive Tissue Forces and the Lumbar Moments, Compression, and Shear Forces During Full Flexion Together with Just the Forces in a More Neutral Lumbar Posture, Demonstrating the Shift from Muscle to Passive Tissue and the Resultant Effects on Joint Compression and Shear

CLINICAL RELEVANCE

LIFTING POSTURE

Figure 34.4

CLINICAL RELEVANCE

LOW BACK INJURIES FROM FALLS

Functional Consideration of the Vertebrae

THE VERTEBRAL BODY

Figure 34.5

Figure 34.6

POSTERIOR ELEMENTS OF THE VERTEBRA

CLINICAL RELEVANCE

ENDPLATE FRACTURES

Modic Changes and What They Mean

Functional Consideration of the Intervertebral Disc

Figure 34.7

CLINICAL RELEVANCE

MECHANISMS OF TISSUE FAILURE

Functional Consideration for the Lumbodorsal Fascia

Spine Stability: Muscle Stiffness and Co-contraction, Motor Control, and the Link to the Clinic

Figure 34.8

CLINICAL RELEVANCE

JOINT STABILITY AND CLINICAL PRACTICE

Clinical Application: Using Biomechanics to Build Better Rehabilitation Programs for Low Back Injury

Preventing Injury: What Does the Patient Need to Know?

Toward Developing Scientifically Justified Low Back Rehabilitation Exercises

CLINICAL RELEVANCE

BENT-KNEE SIT-UPS

ISSUES OF FLEXIBILITY

Figure 34.9

Confusion Regarding Spine Flexion

Issues of Strength and Endurance

AEROBIC EXERCISE

Exercises for the Abdominal Muscles (Anterior and Lateral) and Quadratus Lumborum

Clinical Bottom Line

CLINICAL RELEVANCE

EXERCISES FOR MUSCLES OF THE ABDOMINAL WALL

Figure 34.10

Figure 34.11

Exercises for the Back Extensors

Figure 34.12

Should Abdominal Belts Be Worn?

Beginner’s Program for Stabilization

Notes for Exercise Prescription

Summary

Thought Problems

Acknowledgments

REFERENCES

CHAPTER 35: Structure and Function of the Bones and Joints of the Pelvis

CHAPTER CONTENTS

Figure 35.1

TABLE 35.1: Comparison of Osteological Features of the Limb Girdles

Osteology of Pelvic and Associated Structures

Lumbar Spine and L5 Vertebra

Figure 35.2

Figure 35.3

Figure 35.4

TABLE 35.2: Atypical Osteological Features of the Fifth Lumbar Vertebra and Attached Structures

CLINICAL RELEVANCE

OBLIQUE RADIOGRAPH OF LUMBAR VERTEBRAE

Figure 35.5

Sacrum

Figure 35.6

TABLE 35.3: Osteological Features of the Sacrum and Coccyx and Attached Structures

BASE

Figure 35.7

LATERAL PART

CLINICAL RELEVANCE

POSITION OF THE SACRAL CORNUA

APEX

CLINICAL RELEVANCE

LUMBOSACRAL ANOMALIES

Figure 35.8

Figure 35.9

OSSIFICATION

Coccyx

Figure 35.10

Innominate Bone

Figure 35.11

Figure 35.12

TABLE 35.4: Osteological Features of the Innominate Bone and Attached Structures

ILIUM

CLINICAL RELEVANCE

TRANSVERSE PLANE OF ILIAC CRESTS

Figure 35.13

Medial Surface

Lateral Surface

Anterior Border

CLINICAL RELEVANCE

POSITION OF THE ASIS

Posterior Border

ISCHIUM

Figure 35.14

Ischial Spine

Ischial Tuberosity

Figure 35.15

Figure 35.16

PUBIS

Superior Pubic Ramus

Inferior Pubic Ramus and Ischial Ramus

CLINICAL RELEVANCE

SACROTUBEROUS LIGAMENT AND PUDENDAL CANAL

Figure 35.17

OBTURATOR FORAMEN AND OBTURATOR MEMBRANE

PALPATION OF BONY PROMINENCES AND JOINTS OF THE PELVIS

OSSIFICATION

CLINICAL RELEVANCE

OSSIFICATION AND FUSION OF THE INNOMINATE BONE

Sexual Differences

Figure 35.18

TABLE 35.5: Differences Between Female and Male Pelvis that Represent Adaptations for Childbearing

CLINICAL RELEVANCE

PELVIC DIAMETERS AND TYPES OF PELVES

Figure 35.19

Figure 35.20

Figure 35.21

Figure 35.22

Pelvic Joints and Periarticular Structures

Figure 35.23

Figure 35.24

Figure 35.25

Lumbosacral Junction

Figure 35.26

CLINICAL RELEVANCE

LUMBOSACRAL ANGLE

Figure 35.27

Figure 35.28

CLINICAL RELEVANCE

PARS INTERARTICULARIS DEFECTS

Figure 35.29

Sacrococcygeal Junction

CLINICAL RELEVANCE

COCCYX AND SACROCOCCYGEAL JUNCTION

Sacroiliac Joint

STRUCTURE

Figure 35.30

Figure 35.31

CLINICAL RELEVANCE

CAN YOU PALPATE THE SIJ?

SUPPORTING STRUCTURES OF THE SIJ

Figure 35.32

Figure 35.33

MOTION

TABLE 35.6: Movement of Sacroiliac Joint

Symmetrical Motion

Figure 35.34

Figure 35.35

Figure 35.36

Asymmetrical Motion

RELATIONSHIP BETWEEN FORM AND FUNCTION OF THE SIJ

Figure 35.37

CLINICAL RELEVANCE

PIRIFORMIS SYNDROME IN THE SETTING OF SIJ DYSFUNCTION

Lumbopelvic Rhythm

Figure 35.38

CLINICAL RELEVANCE

INFLUENCE OF HORMONES ON MOTION

INNERVATION

CLINICAL RELEVANCE

INNERVATION OF THE SIJ

Symphysis Pubis

Figure 35.39

Figure 35.40

CLINICAL RELEVANCE

SYMPHYSIS PUBIS DYSFUNCTION

Pathology or Functional Adaptation?

Summary

Thought Problems

REFERENCES

CHAPTER 36: Mechanics and Pathomechanics of Muscle Activity in the Pelvis

CHAPTER CONTENTS

Developmental Anatomy of the Pelvic Floor

CLINICAL RELEVANCE

EXTRA PELVIC FUNCTION OF THE PELVIC FLOOR MUSCLES

Muscles of the Pelvis and Perineum

Pelvic Muscles Associated with Somatic Function

Figure 36.1

Pelvic Muscles Associated with Visceral Function

TABLE 36.1: Muscles of the Pelvis

CLINICAL RELEVANCE

HIP AND PELVIC FLOOR IMPAIRMENT

Figure 36.2

Figure 36.3

CLINICAL RELEVANCE

PELVIC GIRDLE INSTABILITY AND PELVIC FLOOR SYMPTOMS

Perineal Muscles

Figure 36.4

Figure 36.5

TABLE 36.2: Muscles of the Perineum

Figure 36.6

Figure 36.7

Figure 36.8

Figure 36.9

Figure 36.10

Figure 36.11

Somatic (External) Sphincters

CLINICAL RELEVANCE

POSTPARTUM WEAKNESS OF THE PELVIC MUSCULATURE

Functional and Metabolic Properties of Pelvic and Perineal Muscle Fibers

CLINICAL RELEVANCE

PELVIC AND PERINEAL MUSCLE FIBER TYPES

Central Tendon of the Perineum

Figure 36.12

CLINICAL RELEVANCE

CENTRAL TENDON OF THE PERINEUM

Nervous Control of Muscles of the Pelvis and Perineum

Spinal Centers

Figure 36.13

Figure 36.14

Supraspinal Centers

CLINICAL RELEVANCE

NEURAL CONTROL OF URINATION

Degenerative Diseases

CLINICAL RELEVANCE

STRIATED MUSCLE FIBERS OF THE PELVIC DIAPHRAGM AND PERINEUM

Specific Functions of Pelvic and Perineal Musculature

Urinary Continence and Micturition

Figure 36.15

TABLE 36.3: Functional Coordination of Visceral and Somatic Musculature of the Pelvis and Perineum

Anorectal Continence and Defecation

CLINICAL RELEVANCE

DEFECATION REFLEXES AND DIGITAL STIMULATION

Sexual Function

Parturition

Pelvic Muscle Dysfunction

Pelvic Organ Prolapse

Urinary Incontinence

CLINICAL RELEVANCE

AGE-RELATED PELVIC MUSCLE CHANGES

Anorectal Incontinence

Role of the Therapist in Management of Pelvic Floor Dysfunction

Summary

Thought Problems

REFERENCES

CHAPTER 37: Analysis of the Forces on the Pelvis During Activity

CHAPTER CONTENTS

Forces Sustained at the Lumbosacral Junction

Figure 37.1

Two-Dimensional Example of the Analysis of Forces on the Pelvis

EXAMINING THE FORCES BOX 37.1: Simplified Two-Dimensional Analysis of the Loads on the Lumbosacral Junction

Figure 37.2

Figure 37.3

Figure 37.4

Figure 37.5

CLINICAL RELEVANCE

SPONDYLOLISTHESIS

Loads at the Lumbosacral Junction

LOADS IN THE LUMBOSACRAL REGION DURING BENDING AND LIFTING

LOADS ON THE LUMBOSACRAL JOINT DURING WALKING

Figure 37.6

Forces Sustained at the Sacroiliac Joints

Overview of the Analytical Model of the Sacroiliac Joint

Figure 37.7

EXAMINING THE FORCES BOX 37.2: Examination of the Forces on the Sacroiliac Joint During Stance on One Leg

CLINICAL RELEVANCE

THE ACTIVE STRAIGHT LEG RAISING TEST (ASLR) IN PREGNANT WOMEN

Sacroiliac Joint Forces from the Literature

Mechanics of Pelvic Fractures

CLINICAL RELEVANCE

STRESS FRACTURES OF THE PELVIS

Summary

Thought Problems

REFERENCES

PART IV: Kinesiology of the Lower Extremity

UNIT 6: HIP UNIT

CHAPTER 38: Structure and Function of the Bones and Noncontractile Elements of the Hip

CHAPTER CONTENTS

Structure of the Bones of the Hip

Innominate Bone

Figure 38.1

Figure 38.2

CLINICAL RELEVANCE

DIAGNOSTIC ASSESSMENT FOR ACETABULAR LABRAL TEARS

Figure 38.3

Femur

Figure 38.4

Figure 38.5

CLINICAL RELEVANCE

FEMORAL ACETABULAR IMPINGEMENT

Figure 38.6

Figure 38.7

Figure 38.8

Structure of the Hip Joint

Joint Capsule

Figure 38.9

CLINICAL RELEVANCE

FRACTURES OF THE FEMORAL NECK

Iliofemoral, Pubofemoral, and Ischiofemoral Ligaments

Figure 38.10

Additional Ligaments

Figure 38.11

Hip Joint Stability

Figure 38.12

CLINICAL RELEVANCE

HIP JOINT CONTRACTURES

Hip Joint Mobility

Alignment of the Articulating Surfaces

Figure 38.13

CLINICAL RELEVANCE

TREATMENT OF DEVELOPMENTAL DISPLACEMENT OF THE HIP (DDH)

Figure 38.14

Figure 38.15

Figure 38.16

Figure 38.17

CLINICAL RELEVANCE

SLIPPED CAPITAL FEMORAL EPIPHYSIS

Figure 38.18

Figure 38.19

Figure 38.20

Figure 38.21

Figure 38.22

CLINICAL RELEVANCE

TREATMENT FOR EXCESSIVE FEMORAL ANTEVERSION

Figure 38.23

CLINICAL RELEVANCE

TOTAL HIP ARTHROPLASTY

Normal Motion of the Hip

Normal Range of Motion

TABLE 38.1: Hip ROM (°) in Healthy Individuals Reported in the Literature

CLINICAL RELEVANCE

CLINICAL DIAGNOSIS OF HIP OSTEOARTHRITIS (HOA)

Normal Limiting Structures of Hip ROM

Contribution of the Pelvis to Hip Motion

Figure 38.24

Figure 38.25

Figure 38.26

Interaction of the Hip Joint and Lumbar Spine in Hip Motion

Figure 38.27

Figure 38.28

CLINICAL RELEVANCE

COMPENSATIONS FOR DECREASED HIP MOTION

Hip Motion in Activities of Daily Living

CLINICAL RELEVANCE

PRECAUTIONS AFTER TOTAL HIP REPLACEMENT

Figure 38.29

Comparison of the Hip Joint to the Glenohumeral Joint

Summary

Thought Problems

REFERENCES

CHAPTER 39: Mechanics and Pathomechanics of Muscle Activity at the Hip

CHAPTER CONTENTS

Figure 39.1

Flexors of the Hip

Figure 39.2

Psoas Major

ACTIONS

MUSCLE ATTACHMENT BOX 39.1: Attachments and Innervation of the Psoas Major

Figure 39.3

CLINICAL RELEVANCE

PSOAS MAJOR CONTRACTION INCREASES LOW BACK PAIN

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

MUSCLE ATTACHMENT BOX 39.2: Attachments and Innervation of the Iliacus

Iliacus

ACTIONS

EFFECTS OF WEAKNESS

Figure 39.4

EFFECTS OF TIGHTNESS

CLINICAL RELEVANCE

HIP FLEXION CONTRACTURES

Figure 39.5

Figure 39.6

Psoas Minor

MUSCLE ATTACHMENT BOX 39.3: Attachments and Innervation of the Psoas Minor

ACTIONS

Extensors of the Hip

Figure 39.7

Gluteus Maximus

ACTIONS

MUSCLE ATTACHMENT BOX 39.4: Attachments and Innervation of the Gluteus Maximus

Figure 39.8

WEAKNESS

Figure 39.9

CLINICAL RELEVANCE

GLUTEUS MAXIMUS WEAKNESS AND GAIT

TIGHTNESS

CLINICAL RELEVANCE

GLUTEUS MAXIMUS TIGHTNESS AND LOW BACK PAIN

Abductors of the Hip

Figure 39.10

MUSCLE ATTACHMENT BOX 39.5: Attachments and Innervation of the Gluteus Medius

MUSCLE ATTACHMENT BOX 39.6: Attachments and Innervation of the Gluteus Minimus

Gluteus Medius

ACTIONS

Gluteus Minimus

ACTIONS

Figure 39.11

Functional Role of the Hip Abductors

Figure 39.12

CLINICAL RELEVANCE

THE ROLE OF GLUTEAL MUSCLES IN KNEE STABILIZATION AND REHABILITATION

Figure 39.13

Figure 39.14

Figure 39.15

Effects of Weakness of the Abductor Muscles

Figure 39.16

CLINICAL RELEVANCE

TRENDELENBURG TEST

Effects of Tightness of the Abductor Muscles

Figure 39.17

MUSCLE ATTACHMENT BOX 39.7: Attachments and Innervation of the Pectineus

Adductors of the Hip

Figure 39.18

MUSCLE ATTACHMENT BOX 39.8: Attachments and Innervation of the Adductor Brevis

Pectineus

ACTIONS

MUSCLE ATTACHMENT BOX 39.9: Attachments and Innervation of the Adductor Longus

Adductor Brevis

ACTIONS

Adductor Longus

ACTIONS

CLINICAL RELEVANCE

GROIN INJURIES

Adductor Magnus

MUSCLE ATTACHMENT BOX 39.10: Attachments and Innervation of the Adductor Magnus

ACTIONS

Functional Role of the Adductors of the Hip

Figure 39.19

Effects of Weakness

Effects of Tightness

CLINICAL RELEVANCE

ADDUCTOR SPASTICITY IN CHILDREN

Short Lateral Rotators of the Hip

Figure 39.20

MUSCLE ATTACHMENT BOX 39.11: Attachments and Innervation of the Piriformis

MUSCLE ATTACHMENT BOX 39.12: Attachments and Innervation of the Obturator Internus

MUSCLE ATTACHMENT BOX 39.13: Attachments and Innervation of the Superior and Inferior Gemelli

MUSCLE ATTACHMENT BOX 39.14: Attachments and Innervation of the Quadratus Femoris

MUSCLE ATTACHMENT BOX 39.15: Attachments and Innervation of the Obturator Externus

Group Actions

CLINICAL RELEVANCE

ROLE OF THE SHORT LATERAL ROTATORS IN HIP STABILITY

Effects of Weakness and Tightness

CLINICAL RELEVANCE

PIRIFORMIS SYNDROME

Figure 39.21

Medial Rotators of the Hip

Comparisons of Muscle Group Strengths

Summary

Thought Problems

REFERENCES

CHAPTER 40: Analysis of the Forces on the Hip During Activity

CHAPTER CONTENTS

Kinetics of Single-Limb Stance

Figure 40.1

Figure 40.2

EXAMINING THE FORCES BOX 40.1: 2-D Analysis of Single-Limb Stance

Figure 40.3

EXAMINING THE FORCES BOX 40.2: 2-D Analysis of Single-Limb Stance Using a Cane in the Contralateral Hand

Figure 40.4

Figure 40.5

CLINICAL RELEVANCE

GAIT TRAINING TO USE A CANE OR SINGLE CRUTCH

Figure 40.6

CLINICAL RELEVANCE

CHANGING MUSCLES’ MECHANICAL ADVANTAGE THROUGH SURGERY

Analysis of Forces Under Dynamic Conditions

CLINICAL RELEVANCE

HIP JOINT STRESSES AND CLINICAL OUTCOMES IN AVASCULAR NECROSIS

Practical Applications of Force Analysis

Figure 40.7

Summary

Thought Problems

REFERENCES

UNIT 7: KNEE UNIT

CHAPTER 41: Structure and Function of the Bones and Noncontractile Elements of the Knee

CHAPTER CONTENTS

Bones of the Knee Joint

Shaft and Distal Femur

Figure 41.1

MEDIAL CONDYLE

Figure 41.2

Figure 41.3

Figure 41.4

LATERAL CONDYLE

Proximal Tibia

Figure 41.5

Figure 41.6

ARTICULAR SURFACES OF THE PROXIMAL TIBIA

Effects of the Shapes of the Articular Surfaces on Tibiofemoral Joint Motion

DISPARITY BETWEEN THE TIBIAL AND FEMORAL SURFACES

Figure 41.7

DISPARITY BETWEEN THE SIZE OF THE MEDIAL AND LATERAL FEMORAL CONDYLES

VARIABILITY OF CURVATURE IN ALL OF THE ARTICULAR SURFACES OF THE TIBIOFEMORAL JOINT

Tibiofemoral Motion

Figure 41.8

Figure 41.9

CLINICAL RELEVANCE

TIBIOFEMORAL JOINT MOTION

Patella

Figure 41.10

CLINICAL RELEVANCE

PATELLECTOMY

Figure 41.11

Proximal Fibula

Palpable Landmarks of the Knee

Articular Structures of the Knee

Organization of the Trabecular Bone and Articular Cartilage Found in the Knee

Figure 41.12

Menisci

STRUCTURE

Figure 41.13

Figure 41.14

CLINICAL RELEVANCE

TREATMENT OF MENISCAL TEARS

FUNCTION OF THE MENISCI

Figure 41.15

CLINICAL RELEVANCE

MENISCECTOMY

Motion of the Menisci on the Tibia

Figure 41.16

MENISCAL LESIONS

Figure 41.17

CLINICAL RELEVANCE

TESTING FOR MENISCAL TEARS

Noncontractile Supporting Structures

ARTICULAR CAPSULE OF THE KNEE JOINT

Figure 41.18

Figure 41.19

CLINICAL RELEVANCE

EFFECTS OF LIMITED PATELLOFEMORAL JOINT MOTION

Figure 41.20

CLINICAL RELEVANCE

KNEE JOINT SWELLING AND FLEXION CONTRACTURES

COLLATERAL LIGAMENTS

Figure 41.21

Figure 41.22

Figure 41.23

CLINICAL RELEVANCE

TEARS OF THE DEEP OR SUPERFICIAL PORTION OF THE MEDIAL COLLATERAL LIGAMENT

CLINICAL RELEVANCE

TESTING THE INTEGRITY OF THE COLLATERAL LIGAMENTS OF THE KNEE

Figure 41.24

CRUCIATE LIGAMENTS

Figure 41.25

CLINICAL RELEVANCE

PIVOT SHIFT TEST OF THE ANTERIOR CRUCIATE LIGAMENT

Figure 41.26

Figure 41.27

CLINICAL RELEVANCE

SURGICAL RECONSTRUCTION OF ACL TEARS

Figure 41.28

ACCESSORY LIGAMENTS OF THE KNEE

CONCLUSIONS REGARDING THE CONNECTIVE TISSUE SUPPORT OF THE KNEE

CLINICAL RELEVANCE

INJURIES TO THE PRIMARY LIGAMENTS OF THE KNEE

Normal Alignment of the Knee Joint

Frontal Plane Alignment

Figure 41.29

Figure 41.30

Figure 41.31

Sagittal Plane Alignment

Figure 41.32

Transverse Plane Alignment

Figure 41.33

Alignment of the Patellofemoral Joint

Medial-Lateral Alignment

Proximal–Distal Alignment

Figure 41.34

Angular Positioning of the Patella

PATELLAR TILT

Figure 41.35

SULCUS ANGLE

CONGRUENCE ANGLE

CLINICAL RELEVANCE

ASSOCIATIONS BETWEEN PATELLAR MALALIGNMENTS AND JOINT PATHOLOGY AND PAIN

Motion of the Knee

Normal Range of Motion of the Knee in the Sagittal Plane

TABLE 41.1: Normal ROM of the Knee Reported in the Literature

CLINICAL RELEVANCE

KNEE ROM IMPAIRMENTS

Transverse and Frontal Plane Rotations of the Knee

Patellofemoral Motion

TRANSLATION OF THE PATELLA DURING KNEE FLEXION

ROTATION OF THE PATELLA DURING KNEE FLEXION

Figure 41.36

Figure 41.37

Figure 41.38

CLINICAL RELEVANCE

PATELLOFEMORAL CONTACT AREA WITH PATELLAR SUBLUXATION

Summary

REFERENCES

CHAPTER 42: Mechanics and Pathomechanics of Muscle Activity at the Knee

CHAPTER CONTENTS

Extensors of the Knee

Figure 42.1

Rectus Femoris

ACTIONS

MUSCLE ATTACHMENT BOX 42.1: Attachments and Innervation of the Rectus Femoris

CLINICAL RELEVANCE

EXERCISING THE QUADRICEPS FEMORIS MUSCLE

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Figure 42.2

CLINICAL RELEVANCE

ASSESSING TIGHTNESS OF THE RECTUS FEMORIS

Figure 42.3

Vastus Intermedius

ACTIONS

EFFECTS OF WEAKNESS

MUSCLE ATTACHMENT BOX 42.2: Attachments and Innervation of the Vastus Intermedius

EFFECTS OF TIGHTNESS

Vastus Lateralis

ACTIONS

MUSCLE ATTACHMENT BOX 42.3: Attachments and Innervation of the Vastus Lateralis

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Vastus Medialis

Figure 42.4

ACTIONS

MUSCLE ATTACHMENT BOX 42.4: Attachments and Innervation of the Vastus Medialis

Figure 42.5

Figure 42.6

Figure 42.7

Figure 42.8

EFFECTS OF WEAKNESS

CLINICAL RELEVANCE

STRENGTHENING THE VASTUS MEDIALIS

EFFECTS OF TIGHTNESS

Functional Considerations for the Quadriceps Femoris Muscle

CLINICAL RELEVANCE

EFFECT OF CHAIR HEIGHT ON FUNCTIONALLY IMPAIRED ELDERLY INDIVIDUALS

Figure 42.9

Flexors of the Knee

Figure 42.10

Hamstrings

MUSCLE ATTACHMENT BOX 42.5: Attachments and Innervation of the Biceps Femoris

MUSCLE ATTACHMENT BOX 42.6: Attachments and Innervation of the Semimembranosus

ACTIONS

MUSCLE ATTACHMENT BOX 42.7: Attachments and Innervation of the Semitendinosus

Figure 42.11

CLINICAL RELEVANCE

ROLE OF HAMSTRING MUSCLE ACTIVITY IN THE DYSFUNCTIONAL KNEE

Figure 42.12

Figure 42.13

EFFECTS OF WEAKNESS

CLINICAL RELEVANCE

CAN HAMSTRING STRENGTHENING PREVENT LOW BACK INJURIES DURING LIFTING TASKS?

EFFECTS OF TIGHTNESS

Figure 42.14

Figure 42.15

Mechanics of Two-Joint Muscles at the Knee

Popliteus

MUSCLE ATTACHMENT BOX 42.8: Attachments and Innervation of the Popliteus

ACTIONS

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Functional Implications of Flexion Contractures of the Knee

Medial Rotators of the Knee

Figure 42.16

Sartorius

ACTIONS

MUSCLE ATTACHMENT BOX 42.9: Attachments and Innervation of the Sartorius

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Gracilis

ACTIONS

MUSCLE ATTACHMENT BOX 42.10: Attachments and Innervation of the Gracilis

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Pes Anserinus

Figure 42.17

Figure 42.18

CLINICAL RELEVANCE

CASE REPORT

Lateral Rotators of the Knee

Figure 42.19

Tensor Fasciae Latae

MUSCLE ATTACHMENT BOX 42.11: Attachments and Innervation of the Tensor Fasciae Latae

ACTIONS

Figure 42.20

Figure 42.21

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

CLINICAL RELEVANCE

OBER’S TEST

Figure 42.22

CLINICAL RELEVANCE

THE TENSOR FASCIAE LATAE CHALLENGE

Figure 42.23

Strength of the Flexor and Extensor Muscles of the Knee

Comparisons Between Extension and Flexion Strength at the Knee

Factors Influencing Muscle Strength at the Knee

CLINICAL RELEVANCE

DECREASED KNEE STRENGTH IN OLD AGE

Effects of Joint Position on Muscle Strength at the Knee

QUADRICEPS FEMORIS

Figure 42.24

HAMSTRING MUSCLES

Summary

Thought Problems

REFERENCES

CHAPTER 43: Analysis of the Forces on the Knee During Activity

CHAPTER CONTENTS

Two-Dimensional Analysis of the Force in the Quadriceps Femoris Muscle During Knee Extension

EXAMINING THE FORCES BOX 43.1: Calculation of the Quadriceps Femoris Force

Figure 43.1

Figure 43.2

Effect of Mode of Exercise on Quadriceps Femoris Force

KNEE EXTENSION RESISTANCE DELIVERED BY A PULLEY SYSTEM

Figure 43.3

KNEE EXTENSION AGAINST AN ISOKINETIC DYNAMOMETER

Figure 43.4

KNEE EXTENSION EXERCISES USING A CLOSED-CHAIN FORMAT

Figure 43.5

Figure 43.6

EXAMINING THE FORCES BOX 43.2: Calculation of the Internal Moment at the Knee

CLINICAL RELEVANCE

AvULSION FRACTURE OF THE TIBIAL TUBEROSITY: A CASE STUDY

Forces and Moments on the Structures of the Knee Joint During Activity

Forces and Moments on the Tibiofemoral Joint

TABLE 43.1: Loads on the Tibiofemoral Joint During Functional Activities

Association Between Loads on the Knee and Osteoarthritis of the Knee

EXAMINING THE FORCES BOX 43.3: Calculation of the Reaction Forces on the Tibiofemoral Joint

CLINICAL RELEVANCE

ALTERING THE STRESSES APPLIED TO THE KNEE

Figure 43.7

Figure 43.8

CLINICAL RELEVANCE

REDUCING THE ADDUCTION MOMENT

Association Between Loads on the Knee and ACL Injuries

Figure 43.9

CLINICAL RELEVANCE

REDUCING ABDUCTION MOMENTS ON THE KNEE TO PROTECT THE ACL

Figure 43.10

CLINICAL RELEVANCE

FORCES IN THE ACL DURING CONTRACTION OF THE QUADRICEPS FEMORIS MUSCLE

Figure 43.11

Co-Contraction of Muscles Across the Knee

Figure 43.12

CLINICAL RELEVANCE

THE TRADE-OFF OF CO-CONTRACTIONS

Associations Between Loads on the Knee and Patellofemoral Joint Pain

Figure 43.13

CLINICAL RELEVANCE

REDUCING THE PATELLOFEMORAL JOINT REACTION FORCE

Figure 43.14

EXAMINING THE FORCES BOX 43.4: Calculate the Forces on the Patella

Figure 43.15

CLINICAL RELEVANCE

PATELLOFEMORAL JOINT FORCES IN THREE DIFFERENT EXERCISES

Figure 43.16

CLINICAL RELEVANCE

PATELLAR BRACING OR TAPING TO REDUCE LATERAL TRACKING

Choosing the Right Exercise

TABLE 43.2: Comparison of the Mechanics of Quadriceps-Strengthening Exercises Between 0° and 90° of Knee Flexion

Interactions Between Hip and Knee Loads

Figure 43.17

Summary

Thought Problems

REFERENCES

UNIT 8: ANKLE AND FOOT UNIT

CHAPTER 44: Structure and Function of the Bones and Noncontractile Elements of the Ankle and Foot Complex

CHAPTER CONTENTS

Bones of the Ankle and Foot

Figure 44.1

Shaft and Distal Tibia

TIBIAL SHAFT

Figure 44.2

DISTAL TIBIA

CLINICAL RELEVANCE

TRIMALLEOLAR FRACTURE

Figure 44.3

Alignment of the Tibia

Figure 44.4

CLINICAL RELEVANCE

TORSIONAL DEFORMITIES OF THE TIBIA

Fibula

HEAD OF THE FIBULA

SHAFT OF THE FIBULA

LATERAL MALLEOLUS

CLINICAL RELEVANCE

FRACTURES OF THE DISTAL TIBIA AND FIBULA

Tarsal Bones

TALUS

Figure 44.5

CALCANEUS

CLINICAL RELEVANCE

SINUS TARSI

Figure 44.6

CLINICAL RELEVANCE

CALCANEAL FRACTURES

Figure 44.7

NAVICULAR

Figure 44.8

CUBOID

THREE CUNEIFORM BONES

Bones of the Digits

Figure 44.9

METATARSAL BONES

CLINICAL RELEVANCE

METATARSAL LENGTH

PHALANGES

Structural Organization of the Foot

Figure 44.10

Joints and Supporting Structures of the Leg and Foot

Figure 44.11

TABLE 44.1: Terminology Convention for Triplanar Motion of the Ankle and Foot

TABLE 44.2: Variation in Terminology Describing Ankle and Foot Pronation

Joints and Supporting Structures Between the Tibia and Fibula

Figure 44.12

PROXIMAL TIBIOFIBULAR JOINT

DISTAL TIBIOFIBULAR JOINT

CLINICAL RELEVANCE

HIGH ANKLE SPRAINS

MOTION OF THE TIBIOFIBULAR JOINTS

Figure 44.13

CLINICAL RELEVANCE

MOBILIZATION OF THE DISTAL TIBIOFIBULAR JOINT

Joints of the Foot

STRUCTURE AND SUPPORTING ELEMENTS OF THE ANKLE JOINT

CLINICAL RELEVANCE

OSTEOARTHRITIS OF THE ANKLE

TABLE 44.3: Components of the Collateral Ligaments of the Ankle

Figure 44.14

Figure 44.15

ANKLE JOINT MOTION

CLINICAL RELEVANCE

MANUAL THERAPY OF THE ANKLE JOINT

Figure 44.16

Range of Motion of the Ankle

TABLE 44.4: Reported Passive and Active Ankle ROM

STRUCTURE AND SUPPORTING ELEMENTS OF THE SUBTALAR JOINT

Figure 44.17

Figure 44.18

Figure 44.19

Figure 44.20

CLINICAL RELEVANCE

INVERSION ANKLE SPRAINS

Figure 44.21

MOTION OF THE SUBTALAR JOINT COMPLEX

CLINICAL RELEVANCE

SUBTALAR JOINT—A HINGE OR MULTIAXIAL JOINT?

Figure 44.22

Figure 44.23

Figure 44.24

Range of Motion of the Subtalar Joint

Figure 44.25

TABLE 44.5: Reported Ranges of Motion of the Subtalar Joint (in Degrees)

TRANSVERSE TARSAL JOINT

Talonavicular Joint

Figure 44.26

Calcaneocuboid Joint

Figure 44.27

Motion of the Transverse Tarsal Joint

Figure 44.28

CLINICAL RELEVANCE

TRANSVERSE TARSAL JOINT MOTION

Figure 44.29

DISTAL INTERTARSAL JOINTS

CLINICAL RELEVANCE

TARSAL COALITION

TARSOMETATARSAL AND iNTERMETATARSAL JOINTS OF THE TOES

METATARSOPHALANGEAL JOINTS OF THE TOES

Figure 44.30

Figure 44.31

CLINICAL RELEVANCE

CLAW AND HAMMER TOE DEFORMITIES OF THE TOES

Figure 44.32

Motion of the Metatarsophalangeal Joints

Figure 44.33

CLINICAL RELEVANCE

HALLUX VALGUS

CLINICAL RELEVANCE

HALLUX RIGIDUS

INTERPHALANGEAL JOINTS OF THE TOES

Motion of the Whole Foot

CLINICAL RELEVANCE

DANCING EN POINTE

Figure 44.34

PLANTAR FASCIA

Figure 44.35

CLINICAL RELEVANCE

PLANTAR FASCiiTIS—A CASE REPORT

Closed-Chain Motion of the Foot

Foot Alignment

Arches of the Foot

Figure 44.36

CLINICAL RELEVANCE

RUNNING INJURIES

Figure 44.37

Subtalar Neutral Position

CLINICAL RELEVANCE

FOOT ORTHOSES FOR TREATMENT OF A VARUS HINDFOOT DEFORMITY

Figure 44.38

Figure 44.39

Summary

Thought Problems

REFERENCES

CHAPTER 45: Mechanics and Pathomechanics of Muscle Activity at the Ankle and Foot

CHAPTER CONTENTS

Muscles of the Anterior Compartment

Figure 45.1

Figure 45.2

Anterior Tibialis

ACTIONS

Figure 45.3

MUSCLE ATTACHMENT BOX 45.1: Attachments and Innervation of the Anterior Tibialis

EFFECTS OF WEAKNESS

Figure 45.4

EFFECTS OF TIGHTNESS

Extensor Hallucis Longus

ACTIONS

MUSCLE ATTACHMENT BOX 45.2: Attachments and Innervation of the Extensor Hallucis Longus

EFFECTS OF WEAKNESS

CLINICAL RELEVANCE

SCREENING FOR L5 NERVE ROOT INVOLVEMENT

EFFECTS OF TIGHTNESS

CLINICAL RELEVANCE

CLAW DEFORMITIES OF THE TOES

Extensor Digitorum Longus

ACTIONS

MUSCLE ATTACHMENT BOX 45.3: Attachments and Innervation of the Extensor Digitorum Longus

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Peroneus Tertius

MUSCLE ATTACHMENT BOX 45.4: Attachments and Innervation of the Peroneus Tertius

ACTIONS

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Superficial Muscles of the Posterior Compartment

Figure 45.5

Achilles Tendon

Figure 45.6

CLINICAL RELEVANCE

A CURIOUS FINDING IN ELITE SPRINTERS

clinical relevance

ACHILLES TENDON RUPTURES

Gastrocnemius

ACTIONS

MUSCLE ATTACHMENT BOX 45.5: Attachments and Innervation of the Gastrocnemius

Figure 45.7

clinical relevance

TESTING KNEE FLEXION STRENGTH

Figure 45.8

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Figure 45.9

clinical relevance

ASSOCIATIONS BETWEEN GASTROCNEMIUS TIGHTNESS AND PLANTAR FASCIITIS

Soleus

ACTIONS

MUSCLE ATTACHMENT BOX 45.6: Attachments and Innervation of the Soleus

Figure 45.10

Figure 45.11

Figure 45.12

CLINICAL RELEVANCE

CASE REPORT ON AN INDIVIDUAL WITH QUADRICEPS WEAKNESS

EFFECTS OF WEAKNESS

Figure 45.13

EFFECTS OF TIGHTNESS

Figure 45.14

Figure 45.15

Plantaris

MUSCLE ATTACHMENT BOX 45.7: Attachments and Innervation of the Plantaris

ACTIONS

EFFECTS OF WEAKNESS AND TIGHTNESS

CLINICAL RELEVANCE

“TENNIS LEG”

Deep Muscles of the Posterior Compartment

Figure 45.16

Posterior Tibialis

MUSCLE ATTACHMENT BOX 45.8: Attachments and Innervation of the Posterior Tibialis

ACTIONS

EFFECTS OF WEAKNESS

CLINICAL RELEVANCE

POSTERIOR TIBIALIS TENDON DYSFUNCTION

EFFECTS OF TIGHTNESS

Flexor Digitorum Longus

ACTIONS

CLINICAL RELEVANCE

MANUAL MUSCLE TESTING OF THE FLEXOR DIGITORUM LONGUS

MUSCLE ATTACHMENT BOX 45.9: Attachments and Innervation of the Flexor Digitorum Longus

Figure 45.17

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Flexor Hallucis Longus

ACTIONS

MUSCLE ATTACHMENT BOX 45.10: Attachments and Innervation of the Flexor Hallucis Longus

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

CLINICAL RELEVANCE

TIGHTNESS OF THE FLEXOR HALLUCIS LONGUS IN RUNNERS

Figure 45.18

Muscles of the Lateral Compartment of the Leg

Figure 45.19

Peroneus Longus (Also Known as Fibularis Longus)

ACTIONS

MUSCLE ATTACHMENT BOX 45.11: Attachments and Innervation of the Peroneus Longus

Figure 45.20

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Figure 45.21

Figure 45.22

Peroneus Brevis (Also Known as Fibularis Brevis)

ACTIONS

MUSCLE ATTACHMENT BOX 45.12: Attachments and Innervation of the Peroneus Brevis

CLINICAL RELEVANCE

INVERSION SPRAINS OF THE ANKLE

EFFECTS OF WEAKNESS

EFFECTS OF TIGHTNESS

Intrinsic Muscles of the Foot

First Muscular Layer in the Foot

Figure 45.23

ABDUCTOR HALLUCIS

MUSCLE ATTACHMENT BOX 45.13: Attachments and Innervation of the Abductor Hallucis

FLEXOR DIGITORUM BREVIS

ABDUCTOR DIGITI MINIMI

MUSCLE ATTACHMENT BOX 45.14: Attachments and Innervation of the Flexor Digitorum Brevis

MUSCLE ATTACHMENT BOX 45.15: Attachments and Innervation of the Abductor Digiti Minimi

Second Muscular Layer in the Foot

FLEXOR DIGITORUM ACCESSORIUS

Figure 45.24

MUSCLE ATTACHMENT BOX 45.16: Attachments and Innervation of the Flexor Digitorum Accessorius

LUMBRICALS

Third Muscular Layer in the Foot

Figure 45.25

FLEXOR HALLUCIS BREVIS

MUSCLE ATTACHMENT BOX 45.17: Attachments and Innervation of the Lumbricals

MUSCLE ATTACHMENT BOX 45.18: Attachments and Innervation of the Flexor Hallucis Brevis

CLINICAL RELEVANCE

SESAMOID BONES OF THE GREAT TOE

ADDUCTOR HALLUCIS

MUSCLE ATTACHMENT BOX 45.19: Attachments and Innervation of the Adductor Hallucis

Fourth Muscular Layer in the Foot

Figure 45.26

MUSCLE ATTACHMENT BOX 45.20: Attachments and Innervation of the Flexor Digiti Minimi Brevis

MUSCLE ATTACHMENT BOX 45.21: Attachments and Innervation of the Plantar Interossei (3 Muscles)

MUSCLE ATTACHMENT BOX 45.22: Attachments and Innervation of the Dorsal Interossei (4 Muscles)

Extensor Digitorum Brevis

MUSCLE ATTACHMENT BOX 45.23: Attachments and Innervation of the Extensor Digitorum Brevis

Group Effects of the Intrinsic Muscles of the Foot

Comparisons of Group Muscle Strength

TABLE 45.1: Comparisons of Peak Plantar and Dorsiflexion Torques

TABLE 45.2: Physiological Cross-Sectional Areas (PCSAs) of Muscles That Invert and Evert the Foot

CLINICAL RELEVANCE

STRENGTH TESTING OF INVERSION AND EVERSION

CLINICAL RELEVANCE

THE PAPER GRIP TEST

Figure 45.27

Summary

Thought Problems

REFERENCES

CHAPTER 46: Analysis of the Forces on the Ankle and Foot During Activity

CHAPTER CONTENTS

Two-Dimensional Analysis of the Forces in the Foot

Two-Dimensional Analysis at the Ankle

Figure 46.1

EXAMINING THE FORCES BOX 46.1: Calculation of Forces at the Ankle While Standing on Tiptoes

CLINICAL RELEVANCE

MANUAL MUSCLE TEST OF THE PLANTARFLEXOR MUSCLES

Forces Applied to the Ankle and Tarsal Regions During Activity

CLINICAL RELEVANCE

ANKLE OSTEOARTHRITIS

Two-Dimensional Analysis of Forces on the Great Toe

Forces on the Great Toe During Gait

CLINICAL RELEVANCE

LARGE LOADS ON THE METATARSAL BONES

Figure 46.2

Loads on the Plantar Surface of the Foot During Weight Bearing

EXAMINING THE FORCES BOX 46.2: Calculation of the Joint Reaction Force at the First Metatarsophalangeal Joint During Gait

Figure 46.3

CLINICAL RELEVANCE

SKIN ULCERS IN THE INSENSITIVE FOOT

Summary

Thought Problems

REFERENCES

PART V: Posture and Gait

CHAPTER 47: Characteristics of Normal Posture and Common Postural Abnormalities

CHAPTER CONTENTS

Normal Posture

Postural Sway

Figure 47.1

CLINICAL RELEVANCE

ASSESSING STABILITY IN QUIET STANDING

Segmental Alignment in Normal Posture

SAGITTAL PLANE ALIGNMENT OF THE BODY IN NORMAL POSTURE

TABLE 47.1: Alignment in the Sagittal Plane of Body Landmarks with Respect to the Ankle During Erect Standing

Figure 47.2

Axioskeleton Sagittal Plane Alignment

Figure 47.3

Figure 47.4

Figure 47.5

Figure 47.6

TABLE 47.2: Measurements of Pelvic Orientation Reported in the Literature

Figure 47.7

Figure 47.8

CLINICAL RELEVANCE

IS POSTURE REEDUCATION A USEFUL INTERVENTION STRATEGY FOR A PATIENT WITH LOW BACK PAIN?

Figure 47.9

CLINICAL RELEVANCE

MONITORING CHANGES IN FORWARD HEAD POSTURE

Figure 47.10

FRONTAL AND TRANSVERSE PLANE ALIGNMENT IN NORMAL ERECT POSTURE

Figure 47.11

Figure 47.12

Figure 47.13

Figure 47.14

CLINICAL RELEVANCE

RELATING POSTURAL FINDINGS TO IMPAIRMENTS OF THE NEUROMUSCULOSKELETAL SYSTEM: A CASE REPORT

Figure 47.15

Muscular Control of Normal Posture

Figure 47.16

TABLE 47.3: External Moments Applied to the Joints Based on the Center of Mass Line

CLINICAL RELEVANCE

MAINTAINING ERECT POSTURE IN THE PRESENCE OF MUSCLE WEAKNESS: A PATIENT WITH PARAPLEGIA

Figure 47.17

Figure 47.18

Postural Malalignments

TABLE 47.4: Common Postural Abnormalities in the Sagittal Plane

TABLE 47.5: Common Postural Abnormalities in the Frontal and Transverse Planes

Figure 47.19

Muscle Imbalances Reported in Postural Malalignments

Summary

Thought Problems

REFERENCES

CHAPTER 48: Characteristics of Normal Gait and Factors Influencing It

CHAPTER CONTENTS

The Gait Cycle, the Basic Unit of Gait

Figure 48.1

Figure 48.2

Figure 48.3

Kinematics of Locomotion

Temporal and Distance Parameters of a Stride

Figure 48.4

DISTANCE CHARACTERISTICS OF THE STRIDE

TABLE 48.1: Distance Parameters of Stride in Young Healthy Adults

TEMPORAL CHARACTERISTICS OF THE STRIDE

TABLE 48.2: Temporal Parameters of Stride in Young Healthy Adults

CLINICAL RELEVANCE

EFFECTS OF STANDING HEIGHT ON DISTANCE AND TEMPORAL CHARACTERISTICS OF GAIT

Angular Displacements of Joints

SAGITTAL PLANE MOTIONS OF THE LOWER EXTREMITIES

Figure 48.5

CLINICAL RELEVANCE

ASSOCIATED MOVEMENTS IN AN INDIVIDUAL FOLLOWING STROKE

FRONTAL PLANE MOTIONS OF THE LOWER EXTREMITIES

Figure 48.6

Figure 48.7

Figure 48.8

TRANSVERSE PLANE MOTIONS OF THE LOWER EXTREMITIES

Figure 48.9

Figure 48.10

Figure 48.11

CLINICAL RELEVANCE

PROLONGED PRONATION DURING LOADING RESPONSE

MOTIONS OF THE TRUNK

CLINICAL RELEVANCE

THE TRUNK’S CONTRIBUTION TO SMOOTH GAIT

Muscle Activity During Locomotion

Figure 48.12

CLINICAL RELEVANCE

WHAT MUSCLES ARE CRITICAL TO GAIT?

Kinetics of Locomotion

Joint Moments and Reaction Forces

DYNAMIC EQUILIBRIUM

Figure 48.13

TABLE 48.3: Reported Peak Joint Reaction Forces During Normal Gait in Units of Body Weight

EXAMINING THE FORCES BOX 48.1: Equations of Motion in Two Dimensions for the Leg–Foot Segment During Early Swing

Figure 48.14

Figure 48.15

CLINICAL RELEVANCE

KNEE ADDUCTION MOMENT

Figure 48.16

Figure 48.17

CLINICAL RELEVANCE

STRATEGIC GAIT COMPENSATIONS

GROUND REACTION FORCES

Figure 48.18

EXAMINING THE FORCES BOX 48.2: The Contribution of Acceleration to the Vertical Ground Reaction Force

CLINICAL RELEVANCE

GROUND REACTION FORCES AND JOINT PAIN

Figure 48.19

Figure 48.20

Energetics of Gait: Power, Work, and Mechanical Energy

JOINT POWER

Figure 48.21

Figure 48.22

CLINICAL RELEVANCE

JOINT POWERS IN INDIVIDUALS WITH GAIT DYSFUNCTIONS

MECHANICAL ENERGY

Figure 48.23

CLINICAL RELEVANCE

ENERGY COST OF WALKING WITH KNEE OSTEOARTHRITIS

CLINICAL RELEVANCE

ENERGY TRANSFER AMONG LIMB SEGMENTS IN ABNORMAL GAIT

Factors that Influence Parameters of Gait

Gender

Walking Speed

CLINICAL RELEVANCE

WALKING SPEED IN INDIVIDUALS WITH GAIT IMPAIRMENTS

Age

TABLE 48.4: Commonly Reported Changes in Gait in Older Adults

CLINICAL RELEVANCE

DON’T IGNORE THE PLANTAR FLEXORS!

CLINICAL RELEVANCE

EVALUATION AND TREATMENT OF GAIT DYSFUNCTION IN ELDERS

Running Biomechanics

Figure 48.24

Kinematics of Running Gait

TABLE 48.5: Normative Sagittal Plane Range of Motion Values for Running [174]a

TABLE 48.6: Peak Joint Excursions in Overground Running [185]

SAGITTAL PLANE

FRONTAL PLANE

TRANSVERSE PLANE

Muscle Control of Running

Kinetics of Running Gait

CLINICAL RELEVANCE

GENDER DIFFERENCES IN RUNNERS

Summary

Thought Problems

REFERENCES

Back Matter

INDEX

 

An aparitie	1 Jan. 2016
Autor	Carol A. Oatis
Dimensiuni	21.34 x 3.81 x 27.94 cm
Editura	LWW
Format	Hardcover
ISBN	9781451191561
Limba	Engleza
Nr pag	1032