Winning Hands Massage

Joint Dynamics

On this page: Shoulder Joint | Knee Joint | Hip Joint | Hand | Ankle Joint | Spine

SHOULDER JOINT

The shoulder joint consists of the glenohumerol joint, acromioclavicular joint, sternoclavicular joint and the scapulothoracic joint, which is not technically a true joint.. The bony structures consist of the humerus, scapula, and clavicle. Soft tissue consists of 18 major muscles, including the rotator cuff muscles (Supraspinatus, Infraspinatus, Subscapularis, and Teres Minor), several ligaments including the coracoclavicular (trapezoid and conoid), coracohumeral, and coracoacromial, labrum, bursas and brachial plexus nerve. The shoulder joint is the most active and complex joint of the body. The capsule and ligament act as stabilizers, while the muscles and tendons play a dynamic role. Rhythmic cooperation of the shoulder joints ensures smooth movement in all directions.

Normal range of motion

Flexion 0° to 180° / Extension 0° to 60°
Abduction 0° to 180° / Adduction 0° to 45°
Horizontal abduction 0° to 45° / Horizontal adduction 0° to 135°
Internal rotation 0° to 70° / External rotation 0° to 90°

Common problems

Common problems are rotator cuff muscle strain or tear, labrum rupture, impingement syndrome, adhesive capsulitis, subluxation, dislocation and fracture. Abnormal repetitive over-head motions and over-loading lifts can affect the surrounding soft tissues. Immobilization after upper extremity surgery may cause tissue atrophy and stiffness, restricting motion, especially external rotation and flexion. Rotator cuff muscle soreness is a common among computer users, caused by long-term computer use without adequate support. Other common problems include the Pectoralis Minor Syndrome and Costoclavicular forms of Thoracic Outlet Syndrome which mimic the pain symptoms of Carpal Tunnel Syndrome.

KNEE JOINT

The knee joint includes the tibiofemoral, patellofemoral, and superior tibiofibular joints. There are two menisci which are semilunar-shaped discs of fibrocartilage between the femoral condyles and tibial plateaus. Their main functions are shock absorption and stability enhancement. There are many ligaments to provide stability and prevent excessive motion. The anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL) are the key ligaments for stabilization of the knee joint.

Normal range of motion

Flexion 0° to 135° / Extension 0° to 15°
Internal rotation 0° to 30° / External rotation 0° to 40°

Common problems

With age, cartilage thins, ability of tissue to stretch declines, and production of synovial fluid in the joint capsule decreases. Poor posture, over-use, force impact, and acute sports injury all apply abnormal forces to the knee joint. These all progress over time and can result in chondromalacia and osteoarthritis. The ACL and PCL are ligaments inside the knee capsule. Sudden, unexpected anterior-posterior or rotating forces may tear these ligaments. MCL and LCL tears occur when the knee suffers excessive valgus -varus stress or torsion. The medial meniscus is more easily injured than lateral meniscus. Medial meniscus injuries are also usually combined with MCL and ACL tears.

HIP JOINT

The hip joint is located in the pelvic girdle and consists of the acetabulum and proximal part of femur. This is a multiaxial ball-and-socket joint like the glenohumerol (shoulder) joint. The hip joint has a stronger labral rim combined with the ligament and capsule. Reinforcement by associated soft tissues provides good stability.

Normal range of motion

Flexion 0° to 135° / Extension 0° to 15°
Abduction 0° to 45° / Adduction 0° to 30°
Internal rotation 0° to 40~70° / External rotation 0° to 60~90°

Common problems

Apparent leg length discrepancy (LLD) is a common problem. True actual differences in leg length, however, are relatively rare. The problem more often than not is actually soft tissue dysfunction caused by a chronically contracted Iliopsoas muscle group consisting of the Psoas Major and Iliacus. Other common soft tissue dysfunctions affecting the hip complex are Piriformis Syndrome or Runner’s Hip, often leading to impingement of the Sciatic nerve, and myofascial restrictions in the lower thoracic and lumbar back which can result in severe lateral rotation of the legs and feet. Additional problems include hip dislocation and fracture. Two types of situation will give rise to total hip replacement, the avascular necrosis (AVN) and osteoarthritis (OA).

HAND

There are carpometacarpal (CM), metacarpophalangeal (MCP), and proximal and distal interphalangeal joints in the hand. The bony structure includes carpals, metacarpals, and proximal /middle / and distal phalanges bones. Each bone, except the carpals, is joined by tendons that flex or extend the joints on the dorsal and palmar surfaces. At the proximal levels, intrinsic muscles of the hand also produce motions to either side.

Normal range of motion

Thumb

Carpometacarpal (CM) joint

Flexion 0° to 50° / Extension 0°

Abduction 0° to 70° / Adduction 0° to 30°

Metacarpophalangeal (MCP) joint

Flexion 0° to 50° / Extension 0°

Interphalangeal (IP) joint

Flexion 0° to 80° / Extension 0° to 5°

Finger

Carpometacarpal (CM) joint

Flexion 0° to 90° / Extension 0° to 45°

Proximal interphalangeal (PIP) joint

Flexion 0° to 115° / Extension 0°

Distal interphalangeal (DIP) joint

Flexion 0° to 90° / Extension 0°to 20°

Common problems

Finger injuries commonly occur as a result of recreational and occupational accidents. Most of the problems are mallet finger, boutonniere deformity, swan-neck deformity, trigger finger, dislocation of the PIP / DIP joints, and fracture. Common injuries among basketball, baseball or football players are contusion and sprain of the PIP / DIP capsules. Degenerative joint disease or osteoarthritis (OA) and immune system problem (RA) can attack those joints and cause deformity of the hand.

ANKLE JOINT

The ankle joint consists of the tibiofibular, talocrural and subtalar joints. The tibiofibular joint is connected by the anterior tibiofibular, posterior tibiofibular, inferior transverse ligament and interosseous membrane. The talocrural joint located between the talus, the medial malleolus of the distal tibia, and lateral malleolus of the distal fibula. The subtalar joint is an articulation between the talus and calcaneus. The medial ligament complex consisting of the tibionavicular, tibiocalcanean, posterior tibiotalar and anterior tibiotalar ligaments is very strong; The lateral side has several separated ligaments; including the anterior talofibular, calcaneofibular, posterior talofibular ligament. The key muscles surrounding the ankle are peroneal muscles (longus and brevis), triceps surae, and anterior / posterior tibialis.

Normal range of motion

Plantarflexion 0° to 50° / Dorsiflexion 0° to 20°
Pronation 0° to 30° / Supination 0° to 45°

Common problems

Over 80% of the population suffers from ankle and foot problems, ankle sprain being the most common. The lateral ligaments are easily injured during recreational and sports activities because they are weaker than the medial ligaments and the bony structures act as a barrier for against eversion. Peroneal muscle sprain, Achilles tendonitis, and fracture are very commonly seen with severe ankle sprain and over-use syndrome. High ankle sprain is a sprain over the malleolus level reaching the interosseous membrane. The bony spur is a degenerative sign resulting from repetitive or over-loading activity. Another common problem associated with the foot is Plantar Fascitis. While this is not technically an ankle injury, it can be caused by ankle injuries which adversely affect posture and balance.

SPINE

The spine has three main sections, cervical, thoracic, and lumbar. There are seven cervical vertebrae (C1-C7), twelve thoracic (T1-T12), and five lumbar (L1-L5). In addition, there are two fused vertebrae, the sacrum and the coccyx. The twelve thoracic and five lumbar vertebrae make up the thoracolumbar spine. The cervical spine supports the head and allows anterior, posterior, and lateral flexion and extension, plus rotation of the head and neck. C2, called the axis, forms a pivot with C1, called the atlas, around which the head rotates on the cervical spine. Normal curvature is lordotic (eyes pointing up). The thoracolumbar spine (T1-L5) has two normal curvatures, lordotic in the lumbar region and kyphotic in the thoracic region. The primary spinal functions are to maintain an erect posture, provide stability and mobility, transmit loads, absorb shocks, and protect the spinal cord.

There are seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae, one fused sacrum and one fused coccyx. The whole thoracolumbar spine responds for trunk motions. The cervical spine mainly supports the head, the second cervical vertebra, the axis, forms a pivot around which the atlas - first cervical vertebra - and skull can rotate. The spine has four functions. First, to maintain erect posture and stability, second, to provide mobility of the head, neck and trunk, third, to transmit the loads and absorb shock, fourth, to protect the spinal cord.

Normal range of motion

Cervical spine

Flexion 0° to 80° / Extension 0° to 70°

Lateral flexion 0° to 45°

Rotation 0° to 90°

Thoracolumbar spine

Flexion 0° to 80° / Extension 0° to 30° (mainly T6 to L5)

Lateral flexion 0° to 35°

Common problems

Cervical spine

Common problems include facet joint dysfunction, subluxations, disc herniations, fractures, and related soft tissue issues such as whiplash, neck muscle strain, ligament sprain, and spinal cord injury.

Common problems are facet joint problem (stiff neck), herniated disc between the C7-T1 vertebrae, fracture, whiplash, neck muscle strain, intervertebral ligament sprain, and spinal cord injury.

Thoracic spine

Common problems associated with the thoracic spine include scoliosis, hyperlordosis, hyperkyphosis, vertebral and rib subluxations, disc herniations and ruptures, fractures, and muscle and ligament strains and sprains. Scoliosis is a side-bending, S curvature of the thoracolumbar spine and may be either structural or functional. Structural scoliosis is a skeletal deformation of the spine and ribcage and generally worsens over time unless properly treated at onset. Functional scoliosis presents the same outward symptom of pronounced S curvature but the cause is muscle imbalance pulling the spine out of alignment and not an actual deformation of the spine itself. Hyperlordosis and hyperkyphosis are exaggerated C curvatures of the lumbar and thoracic regions.

Lumbar spine

Over 80% of the population suffers from lower back pain. Common problems include back muscle strain, intervertebral ligament sprain, herniated discs between L1-L5, bone spurs, fracture and spinal cord injury. Signs of spinal degenerative disc disease include spondylosis; a degeneration of the intervertebral disc; spondylolysis; an interarticularis or the arch defect; spondylolisthesis; and retrolisthesis, a displacement of the relative vertebral body.

Elbow Joint

Elbow joints include ulnohumeral, radiohumeral and superior radioulnar joints. Numerous ligaments surround the joint capsule. The elbow joint itself is a simple hinge joint, consisting of the humerus, ulna and radius. The humerus and ulna bone shaft form an angle, called the "carrying angle". Normal carrying range angle is about 10° to 15°, with a higher degree among females than males on average.

Normal range of motion

Flexion 0° to 150° / Extension 0°~10°
Pronation 0° to 90° / Supination 0° to 90°

Common problems

Most problems occur on the medial and lateral epicondyles of the humerus, which are the proximal muscle attachment points for the wrist extensors and flexors. Golfer’s Elbow (Lateral Epicondylitis) involves the forearm flexors while Tennis Elbow (Medial Epicondylitis) involves the forearm extensors. The conditions are so-named because of the impact force and soft-tissue injury generated or caused by the respective differences between golf and tennis swings. Even though both are referred to as “itis,” the disease is not technically an inflammation, but a micro-defect on the tendon and its sheath. Other problems include olecranon process fracture, dislocation, olecranon bursitis, and ulnar nerve impingement. The medial ligaments suffer excessive valgus force during throwing exercise, and the lateral side receives the compressive force at the same time. Some adolescents have a problem on the secondary bone growth center, caused by over-use and repetitive stretch of the apophysis.

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