1. Chapter 4 The Shoulder
1.1. Parts
1.1.1. Full range requires:
1.1.1.1. Humeral motion
1.1.1.2. Scapular motion
1.1.1.3. Clavicular motion
1.1.2. Glenohumeral joint
1.1.2.1. Anatomy
1.1.2.1.1. Synovial ball-and-socket
1.1.2.1.2. Convex head of humerus
1.1.2.1.3. Concave glenoid fossa
1.1.2.1.4. Reinforced by
1.1.2.2. Osteo- and Arthro- kinematics
1.1.2.2.1. 3 degrees of freedom
1.1.2.2.2. Open chain is always convex on concave
1.1.2.3. Capsular pattern (restriction):
1.1.2.3.1. Greatest: Lateral rotation
1.1.2.3.2. Some: abduction
1.1.2.3.3. Less: medial rotation
1.1.3. Sternoclavicular joint
1.1.3.1. Anatomy
1.1.3.1.1. Synovial saddle
1.1.3.1.2. Clavicular surface
1.1.3.1.3. Opposing joint surface
1.1.3.1.4. Reinforced by
1.1.3.2. Osteo- and Arthro- kinematics
1.1.3.2.1. 3 degrees of freedom
1.1.4. Acromioclavicular joint
1.1.4.1. Anatomy
1.1.4.1.1. Synovial joint with variable shape
1.1.4.1.2. Scapular joint surface
1.1.4.1.3. Clavicular joint surface
1.1.4.1.4. Reinforced by
1.1.4.2. Osteo- and Arthro- kinematics
1.1.4.2.1. 3 degrees of freedom
1.1.5. Scapulothoracic joint
1.1.5.1. Anatomy
1.1.5.1.1. Functional rather than anatomical joint
1.1.5.1.2. Anterior surface of scapular
1.1.5.1.3. Posterior surface of thorax
1.1.5.2. Osteo- and Arthro- kinematics
1.1.5.2.1. Motions are caused by independent or combined motions of SC and AC joints
1.1.5.2.2. Motion consists of a sliding of the scapula on the thorax
1.2. Procedure
1.2.1. Differences between specific and complex
1.2.1.1. Joint specific PROM
1.2.1.1.1. Useful for identifying specific issues
1.2.1.1.2. Flexion
1.2.1.1.3. Extension
1.2.1.1.4. Abduction
1.2.1.1.5. Medial rotation
1.2.1.1.6. Lateral rotation
1.2.1.2. Joint complex PROM
1.2.1.2.1. Useful for evaluating functional ROM
1.2.1.2.2. Flexion
1.2.1.2.3. Extension
1.2.1.2.4. Abduction
1.2.1.2.5. Medial rotation
1.2.1.2.6. Lateral rotation
1.2.2. Same for both
1.2.2.1. Flexion
1.2.2.1.1. Testing Position
1.2.2.1.2. Testing motion
1.2.2.1.3. Goniometer alignment
1.2.2.2. Extension
1.2.2.2.1. Testing position
1.2.2.2.2. Testing motion
1.2.2.2.3. Goniometer alignment
1.2.2.3. Abduction
1.2.2.3.1. Testing position
1.2.2.3.2. Testing motion
1.2.2.3.3. Goniometer alignment
1.2.2.4. Adduction
1.2.2.4.1. Not usually measured and recorded because it is the return to zero staring position from full abduction
1.2.2.5. Medial rotation
1.2.2.5.1. Testing position
1.2.2.5.2. Testing motion
1.2.2.5.3. Goniometer alignment
1.2.2.6. Lateral rotation
1.2.2.6.1. Testing position
1.2.2.6.2. Testing motion
1.2.2.6.3. Goniometer alignment
1.3. Normal Values
1.3.1. Glenohumeral motion
1.3.1.1. Ellenbecker et al
1.3.1.1.1. 11-17 yrs
1.3.1.2. Boon and Smith
1.3.1.2.1. 12-18 yrs
1.3.1.3. Lannan et al
1.3.1.3.1. 21-40 yrs
1.3.2. Shoulder complex motion
1.3.2.1. AAOS
1.3.2.1.1. Flexion: 180
1.3.2.1.2. Extension: 60
1.3.2.1.3. Abduction: 180
1.3.2.1.4. Medial rotation: 70
1.3.2.1.5. Lateral rotation 90
1.3.2.2. AMA
1.3.2.2.1. Flexion: 180
1.3.2.2.2. Extension: 50
1.3.2.2.3. Abduction: 180
1.3.2.2.4. Medial rotation: 90
1.3.2.2.5. Lateral rotation: 90
1.3.2.3. Wanatabe et al
1.3.2.3.1. 0-2 yrs
1.3.2.3.2. 1-5 yrs
1.3.2.4. Boone
1.3.2.4.1. 6-12 yrs
1.3.2.4.2. 13-19 yrs
1.3.2.4.3. 20-29 yrs
1.3.2.4.4. 30-39 yrs
1.3.2.4.5. 40-54 yrs
1.3.2.5. Greene and Wolf
1.3.2.5.1. 18-55 yrs
1.3.2.6. Boone and Azen
1.3.2.6.1. 20-54 yrs
1.3.2.7. Walker et al
1.3.2.7.1. 60-85 yrs
1.3.2.8. Downey et al
1.3.2.8.1. 61-93 yrs
1.4. Functional Values
1.4.1. Eating
1.4.1.1. Matsen
1.4.1.1.1. Flexion
1.4.1.1.2. Horizontal adduction
1.4.1.2. Safaee-Rad et al
1.4.1.2.1. Flexion
1.4.1.2.2. Abduction
1.4.1.2.3. Medial rotation
1.4.2. Drinking with a cup
1.4.2.1. Safaee-Rad et al
1.4.2.1.1. Flexion
1.4.2.1.2. Abduction
1.4.2.1.3. Medial rotation
1.4.3. Washing axilla
1.4.3.1. Matsen
1.4.3.1.1. Flexion
1.4.4. Combing hair
1.4.4.1. Matsen
1.4.4.1.1. Horizontal adduction
1.4.4.1.2. Abduction
1.4.4.1.3. Horizontal adduction??
1.4.5. Maximal elevation
1.4.5.1. Matsen
1.4.5.1.1. Flexion/abduction
1.4.6. Maximal reaching up back
1.4.6.1. Matsen
1.4.6.1.1. Horizontal adduction
1.4.6.1.2. Extension
1.4.6.1.3. Horizontal abduction
1.4.7. Reaching perineum
1.4.7.1. Matsen
1.4.7.1.1. Extension
1.4.7.1.2. Horizontal abduction
2. Chapter 5 The Elbow
2.1. Parts
2.1.1. Humeroulnar + Humeroradial joints
2.1.1.1. Anatomy
2.1.1.1.1. Compound synovial hinge
2.1.1.2. Osteo- and Arthro- kinematics
2.1.1.2.1. 1 degree of freedom
2.1.1.3. Capsular pattern
2.1.1.3.1. Flexion more limited than extension
2.1.1.3.2. Supination and pronation only limited in extreme cases
2.1.2. Superior and Inferior Radioulnar joints
2.1.2.1. Anatomy
2.1.2.1.1. Synovial pivot joint
2.1.2.2. Osteo- and Arthro- kinematics
2.1.2.2.1. Mechanically linked
2.1.2.2.2. 1 degree of freedom
2.1.2.3. Capsular pattern
2.1.2.3.1. Equal limitation of supination and pronation
2.2. Procedure
2.2.1. Flexion
2.2.1.1. Testing position
2.2.1.1.1. Supine
2.2.1.1.2. Shoulder in neutral
2.2.1.1.3. Place a pad under the distal end of the humerus
2.2.1.1.4. Forearm in full supination
2.2.1.2. Stabilization
2.2.1.2.1. Stabilize the humerus to prevent flexion of the shoulder
2.2.1.3. Testing motion
2.2.1.3.1. Maintain the forearm in supination during the motion
2.2.1.4. End-feel
2.2.1.4.1. Soft
2.2.1.4.2. If muscle bulk is small, may be:
2.2.1.4.3. Marked by flexion of the shoulder
2.2.1.5. Goniometer alignment
2.2.1.5.1. Fulcrum
2.2.1.5.2. Proximal arm
2.2.1.5.3. Distal arm
2.2.1.5.4. "What do I do with my hands?"
2.2.2. Extension
2.2.2.1. End-feel
2.2.2.1.1. Hard
2.2.2.1.2. Sometimes firm
2.2.2.1.3. Marked by extension of the shoulder
2.2.3. Forearm pronation
2.2.3.1. Testing Position
2.2.3.1.1. Sitting
2.2.3.1.2. Shoulder neutral
2.2.3.1.3. Elbow flexed to 90 degrees
2.2.3.1.4. Forearm supported and neutral
2.2.3.2. Stabilization
2.2.3.2.1. Stabilize the distal end of the humerus
2.2.3.3. End-feel
2.2.3.3.1. May be Hard
2.2.3.3.2. May be firm
2.2.3.4. Goniometer alignment
2.2.3.4.1. Fulcrum
2.2.3.4.2. Proximal arm
2.2.3.4.3. Distal arm
2.2.3.4.4. "What do I do with my hands?"
2.2.4. Forearm supination
2.2.4.1. Stabilization
2.2.4.1.1. Stabilize the distal end of the humeus
2.2.4.2. End-feel
2.2.4.2.1. Firm
2.2.4.2.2. Marked by lateral rotation and adduction of the shoulder
2.2.4.3. Goniometer alignment
2.2.4.3.1. Fulcrum
2.2.4.3.2. Proximal arm
2.2.4.3.3. Distal arm
2.2.5. Muscle length testing
2.2.5.1. Biceps brachii
2.2.5.1.1. Starting Position
2.2.5.1.2. Stabilization
2.2.5.1.3. End-feel
2.2.5.1.4. Goniometer alignment
2.2.5.2. Triceps brachii
2.2.5.2.1. Starting Position
2.2.5.2.2. Stabilization
2.2.5.2.3. End-feel
2.2.5.2.4. Goniometer alignment
2.3. Normal Values
2.3.1. AAOS
2.3.1.1. Flexion
2.3.1.1.1. 150
2.3.1.2. Extension
2.3.1.2.1. 0
2.3.1.3. Pronation
2.3.1.3.1. 80
2.3.1.4. Supination
2.3.1.4.1. 80
2.3.2. AMA
2.3.2.1. Flexion
2.3.2.1.1. 140
2.3.2.2. Extension
2.3.2.2.1. 0
2.3.2.3. Pronation
2.3.2.3.1. 80
2.3.2.4. Supination
2.3.2.4.1. 80
2.3.3. Wanatabe etal
2.3.3.1. 2 wks - 2yrs
2.3.3.1.1. Males and Females (n = 45)
2.3.4. Hacker et al
2.3.4.1. 18 mos-5 yrs
2.3.4.1.1. Males (n= 19)
2.3.4.2. 1-7 yrs
2.3.4.2.1. Males (n = 72)
2.3.5. Gunal et al
2.3.5.1. 18-22 yrs
2.3.5.1.1. Males (n = 1000)
2.3.6. Greene & Wolfe
2.3.6.1. 18-55 yrs
2.3.6.1.1. Males and Females (n = 20)
2.3.7. Boone and Azen
2.3.7.1. 6-12 yrs
2.3.7.1.1. Males (n = 17)
2.3.7.2. 13-19 yrs
2.3.7.2.1. Males (n = 17)
2.3.7.3. 20-29 yrs
2.3.7.3.1. Males (n = 19)
2.3.7.4. 20-54 yrs
2.3.7.4.1. Males (n = 56)
2.3.7.5. 30-39 yrs
2.3.7.5.1. Males (n = 18)
2.3.8. Walker et al
2.3.8.1. 40-54 yrs
2.3.8.1.1. Males (n = 19)
2.3.8.2. 60-85 yrs
2.3.8.2.1. Males (n = 30)
2.4. Functional Values
2.4.1. Click for table
3. Chapter 6 The Wrist
3.1. Parts
3.1.1. Radiocarpal and Midcarpal joints
3.1.1.1. Anatomy
3.1.1.1.1. Condyloid
3.1.1.2. Osteo- and Arthro- kinematics
3.1.1.2.1. 2 degrees of freedom
3.1.1.3. Capsular pattern
3.1.1.3.1. Equal limitation of flexion an extension
3.1.1.3.2. Slight limitation of radial and ulnar deviation
3.2. Procedure
3.2.1. Flexion
3.2.1.1. Testing position
3.2.1.1.1. Sitting
3.2.1.1.2. Next to a supporting surface
3.2.1.1.3. Shoulder abducted to 90 degrees
3.2.1.1.4. Elbow flexed to 90 degrees
3.2.1.1.5. Palm of hand facing down
3.2.1.1.6. Forearm resting on supporting surface
3.2.1.1.7. Hand free to move
3.2.1.1.8. Avoid radial or ulnar deviation, as well as flexion of the fingers
3.2.1.2. Stabilization
3.2.1.2.1. Stabilize the radius and ulna
3.2.1.3. Testing motion
3.2.1.3.1. Maintain the wrist in neutral
3.2.1.4. End-feel
3.2.1.4.1. Firm
3.2.1.4.2. Marked by lifting of forearm
3.2.1.5. Goniometer alignment
3.2.1.5.1. Fulcrum
3.2.1.5.2. Proximal arm
3.2.1.5.3. Distal arm
3.2.1.5.4. "What do I do with my hands?"
3.2.2. Extension
3.2.2.1. Testing position
3.2.2.1.1. Sitting
3.2.2.1.2. Next to supporting surface
3.2.2.1.3. Shoulder abducted to 90 degrees
3.2.2.1.4. Elbow flexed to 90 degrees
3.2.2.1.5. Palm of hand facing ground
3.2.2.1.6. Forearm resting on supportive device, with hand free to move
3.2.2.1.7. Avoid radial and ulnar deviation as well as extension of the fingers
3.2.2.2. Stabilization
3.2.2.2.1. Stabilize the radius and ulna
3.2.2.3. Testing Motion
3.2.2.3.1. Maintain the wrist in neutral
3.2.2.4. End-feel
3.2.2.4.1. Firm
3.2.2.4.2. May be hard
3.2.2.4.3. Marked by lifting of forearm
3.2.2.5. Goniometer alignment
3.2.2.5.1. Fulcrum
3.2.2.5.2. Proximal arm
3.2.2.5.3. Distal arm
3.2.3. Radial deviation
3.2.3.1. Testing position
3.2.3.1.1. Sitting
3.2.3.1.2. Next to a supporting surface
3.2.3.1.3. Shoulder abducted to 90 degrees
3.2.3.1.4. Elbow flexed to 90 degrees
3.2.3.1.5. Palm of hand facing ground
3.2.3.1.6. Forearm and hand resting on supportive device
3.2.3.2. Stabilization
3.2.3.2.1. Stabilize the radius and ulna
3.2.3.3. Testing motion
3.2.3.3.1. Maintain the wrist in neutral
3.2.3.3.2. Avoid rotating the hand
3.2.3.4. End-feel
3.2.3.4.1. Hard
3.2.3.4.2. May be firm
3.2.3.4.3. Marked by elbow flexion
3.2.3.5. Goniometer alignment
3.2.3.5.1. Fulcrum
3.2.3.5.2. Proximal arm
3.2.3.5.3. Distal arm
3.2.4. Ulnar deviation
3.2.4.1. Testing position
3.2.4.1.1. Sitting
3.2.4.1.2. Next to a supporting surface
3.2.4.1.3. Shoulder abducted to 90 degrees
3.2.4.1.4. Elbow flexed to 90 degrees
3.2.4.1.5. Palm of hand facing ground
3.2.4.1.6. Rest the forearm and hand on a supporting surface
3.2.4.2. Stabilization
3.2.4.2.1. Stabilize the radius and ulna
3.2.4.3. Testing motion
3.2.4.3.1. Maintain the wrist in neutral
3.2.4.3.2. Avoid rotating the hand
3.2.4.4. End-feel
3.2.4.4.1. Firm
3.2.4.4.2. Marked by elbow exension
3.2.4.5. Goniometer alignment
3.2.4.5.1. Fulcrum
3.2.4.5.2. Proximal arm
3.2.4.5.3. Distal arm
3.2.5. Muscle length testing
3.2.5.1. Flexor digitorum profundis and Flexor digitorum superficialis
3.2.5.1.1. Starting position
3.2.5.1.2. Stabilization
3.2.5.1.3. End-feel
3.2.5.1.4. Goniometer alignment
3.2.5.2. Extensor digitorum, Extensor indicis, and Extensor digiti minimi
3.2.5.2.1. Starting position
3.2.5.2.2. Stabilization
3.2.5.2.3. End-feel
3.2.5.2.4. Goniometer alignment
3.3. Normal Values
3.3.1. AAOS
3.3.1.1. Flexion
3.3.1.1.1. 80
3.3.1.2. Extension
3.3.1.2.1. 70
3.3.1.3. Radial deviation
3.3.1.3.1. 20
3.3.1.4. Ulnar deviation
3.3.1.4.1. 30
3.3.2. AMA
3.3.2.1. Flexion
3.3.2.1.1. 60
3.3.2.2. Extension
3.3.2.2.1. 60
3.3.2.3. Radial deviation
3.3.2.3.1. 20
3.3.2.4. Ulnar deviation
3.3.2.4.1. 30
3.3.3. Boone and Azen
3.3.3.1. 20-29 yrs
3.3.3.1.1. Males (n = 19)
3.3.3.2. 20-54 yrs
3.3.3.2.1. Males (n = 56)
3.3.3.3. 25-34 yrs
3.3.3.3.1. Males (n = 15)
3.3.3.4. 30-39 yrs
3.3.3.4.1. Males (n = 18)
3.3.3.5. 40-54 yrs
3.3.3.5.1. Males (n = 19)
3.3.4. Stubs et al
3.3.4.1. 35-44 yrs
3.3.4.1.1. Male (n = 20)
3.3.4.2. 45-54 yrs
3.3.4.2.1. Males (n = 20)
3.3.5. Greene and Wolf
3.3.5.1. 18-55 yrs
3.3.5.1.1. Males and Females (n = 20)
3.3.6. Ryu et al
3.3.6.1. Age?
3.3.6.1.1. Males and Females (n = 40)
3.3.7. Walker et al
3.3.7.1. 60-85 yrs
3.3.7.1.1. Males (n = 30)
3.3.8. Chaparro et al
3.3.8.1. 60-90+ yrs
3.3.8.1.1. Males (n = 62)
3.3.9. Kalscheur et al
3.3.9.1. 66-86 yrs
3.3.9.1.1. Males (n = 25)
3.4. Functional Values
3.4.1. Click for table