Orthopedics in

Physical

TherapyPTA 216

Orthopedics

“The branch of medical science that

deals with the prevention or correction of

disorders involving locomotor structures of

the body, especially the skeleton, joints,

muscles, fascia, and other supporting

structures such as ligaments and

cartilage.”

Taber’s pg. 1647

Quick ReviewTerms Used in Orthopedics

Anatomic Position

Body in the erect standing position with

the feet just slightly separated and the

arms hanging by the side, elbows straight,

and the palms of the hands facing

forwards.

Dutton 2012. pg. 107

Directional Terms

Superior / Cranial

Inferior / Caudal

Anterior / Ventral

Posterior / Dorsal

Midline

Dutton, 2012. pg. 107

Planes of the body

Sagittal: divides the body into right and

left halves

Frontal: divides the body into front and

back halves

Transverse: divides the body into top and

bottom halves

Dutton, 2012. pg. 108

Length-Tension Relationship

When looking at the actin and myosin

filaments, watching the overlap of the

actin and myosin filaments will determine

the optimal length for that muscle to

produce the strongest contractile force

Dutton, 2012. pg. 115

Length-Tension Relationship

Active insufficiency: the muscle is

incapable of shortening to necessary

extent to allow full range of motion at all

joints crossed.

Passive insufficiency: the muscle cannot

stretch to the necessary extent for full

range of motion in the opposite direction

of all joints crossed

Dutton, 2012. pg. 115

Types of muscle contractions

Isometric: a static contraction without

change in muscle length

Isotonic: a dynamic contraction where

change in muscle length is produced

Concentric: dynamic contraction where

tension is produced shortening the muscle

Eccentric: dynamic contraction where

tension is produced lengthening the muscle

Dutton, 2012. pg. 229

Balance

Static- the ability to maintain stable anti-gravity position while at rest

Dynamic- the ability to stabilize the body when the support surface is moving or when the body is moving on a stable surface

Automatic Postural Reactions- the ability to maintain balance during unexpected external perturbations

Dutton, 2012. pg. 249

Fractures

Open vs Closed

Displaced vs Non-displaced

Type of fracture

Dutton, 2012. pg. 142

Fractures

Complete

Incomplete

Spiral

Comminuted

Avulsion

Dutton,2012. pg. 143

OrthopedicsKinesiology and Manual Techniques

Joint Position

Open-Packed – position of least joint

congruity

Closed-Packed- position of maximum joint

congruity

Dutton, 2012. pg. 119

Closed-Packed

Maximal tautness of ligaments

Maximal surface congruity

Minimal joint volume

Maximal stability of the joint

Dutton, 2012. pg. 119

Open-Packed

“Loose packed” or “resting” position

Slack of major ligaments

Minimal surface congruity

Minimal joint surface contact

Maximal joint volume

Minimal joint stability

Dutton, 2012. pg. 119

Joint Mobilizations

Manual treatment modality that uses

manual passive techniques to enhance

arthrokinematic movement.

Dutton, 2012. pg. 160

Arthrokinematic Movements

Occur at bone ends, without regard to

body movement.

“ACCESSORY MOVEMENTS”

Motions specific to articulating joint surfaces

Not volitional

Glide (Slide), spin, and roll

Also referred to as “joint play”

Shankman, 2011. pg. 202

Glide (Slide)

One portion of the articular surface

comes into contact with a series of

locations on the corresponding surface

Shankman, 2011. pg. 202

Spin

Portion of one joint spins (clockwise or

counterclockwise) around the stationary

longitudinal axis

Shankman, 2011. pg. 202

Roll

Multiple points of contact on one joint

surface come into contact with multiple

points on the corresponding joint surface.

Shankman, 2011. pg. 202

Joint Mobilizations

Improve joint mobility

Decrease joint pain

Restoring accessory movement

Decrease muscle guarding

Lengthening tissue surrounding joints

Increased proprioceptive awareness

Dutton, 2012. pg. 160

Grades of Joint Mobilizations

Grade I: small oscillation or joint motion occurring in the beginning of the available ROM

Grade II: larger amplitude motion occurring in the beginning to midrange of available ROM

Grade III: larger amplitude motion occurring from midrange to end of available ROM

Grade IV: small oscillation or joint motion occurring at the very end range of available ROM

Grade V: high velocity thrust of small amplitude at the end of available ROM

Shankman, 2011. pg. 204

Joint Mobilizations

Grades I and II: typically used to treat

pain or when ROM produces pain

Grades III and IV: typically used to treat

joint restrictions

Shankman, 2011. pg. 204

Upper and Lower Quarter

Screens

Used when there is no history available

Used when signs and symptoms are

unexplainable

Dutton, 2012. pg. 98

Upper Quarter Screens

Appropriate for upper thoracic, upper

extremity, and cervical problems

Dutton, 2012. pg. 98

Upper Quarter Screens

Postural assessment: observed from front, back and

side looking for asymmetry

Range of motion: Active cervical and UE ROM with

overpressure if no pain is felt

Resistive Testing: testing at various innervation levels

from C1-T1

Reflex Testing: Biceps (C5), brachioradialis (C6), and

triceps (C7)

Dermatomes: dermatomes at various innervation levels

from C2-T1

Dutton, 2012. pg. 98-99

Lower Quarter Screens

Used to determine thoracic, lower

extremity, and lumbosacral problems.

Dutton. 2012. pg. 98

Lower Quarter Screens

Posture: observed from front, back, and sides looking for

asymmetry

Range of motion: AROM of lumbosacral spine and LE’s

with overpressure if no pain is noted

Resistive testing: testing at various innervation levels

from L1-S1

Reflex testing: Patellar (L4) and Achilles (S1)

Dermatomes: testing at various levels from L1-S5

Dutton, 2012. pg. 100-101

Bibliography

Dutton, Orthopaedics for the Physical

Therapist Assistant. Jones&Bartlett. 2012

Shankman, Fundamental Orthopedic

Management for the Physical Therapist

Assistant, 3rd edition. Mosby.2011