UPSC MainsMEDICAL-SCIENCE-PAPER-I2016 Marks
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Q13.

Movements

How to Approach

This question requires a detailed understanding of movements within the human body, specifically focusing on anatomical and orthopedic perspectives. The answer should categorize different types of movements, describe the anatomical structures involved, and explain how these movements are assessed and affected by orthopedic conditions. A structured approach, classifying movements by joint type and plane, is crucial. Include examples of muscles responsible for specific movements and common orthopedic pathologies affecting them.

Model Answer

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Introduction

Movement is a fundamental characteristic of life, and in the human body, it’s orchestrated by a complex interplay of the musculoskeletal system. Anatomically, movement refers to any change in position of a body part or the whole body. Orthopedically, understanding movement is crucial for diagnosing and treating conditions affecting joints, muscles, and bones. These movements occur in specific planes around axes, and are classified based on the type of joint and the direction of motion. A thorough understanding of these principles is essential for clinicians to accurately assess and manage musculoskeletal disorders.

Types of Movements

Movements can be broadly classified based on the joint they occur at and the plane in which they take place. The three primary planes of motion are:

  • Sagittal Plane: Divides the body into left and right halves. Movements include flexion and extension.
  • Frontal (Coronal) Plane: Divides the body into anterior and posterior halves. Movements include abduction and adduction.
  • Transverse Plane: Divides the body into superior and inferior halves. Movements include rotation.

Movements at Specific Joints

1. Shoulder Joint

The shoulder joint is a ball-and-socket joint allowing a wide range of motion. Key movements include:

  • Flexion: Raising the arm forward. (Muscles: Anterior Deltoid, Pectoralis Major)
  • Extension: Moving the arm backward. (Muscles: Posterior Deltoid, Latissimus Dorsi)
  • Abduction: Raising the arm away from the body. (Muscle: Middle Deltoid)
  • Adduction: Bringing the arm towards the body. (Muscles: Pectoralis Major, Latissimus Dorsi)
  • Internal Rotation: Rotating the arm inward. (Muscles: Subscapularis)
  • External Rotation: Rotating the arm outward. (Muscles: Infraspinatus, Teres Minor)

Common Orthopedic Condition: Rotator cuff tear affecting external rotation and abduction.

2. Elbow Joint

The elbow is a hinge joint primarily allowing flexion and extension.

  • Flexion: Bending the elbow. (Muscle: Biceps Brachii, Brachialis)
  • Extension: Straightening the elbow. (Muscle: Triceps Brachii)
  • Pronation & Supination: Rotation of the forearm (Muscles: Pronator Teres/Quadratus, Supinator)

Common Orthopedic Condition: Tennis elbow (lateral epicondylitis) affecting extension.

3. Hip Joint

Similar to the shoulder, the hip is a ball-and-socket joint.

  • Flexion: Bringing the knee towards the chest. (Muscle: Iliopsoas, Rectus Femoris)
  • Extension: Moving the leg backward. (Muscles: Gluteus Maximus, Hamstrings)
  • Abduction: Moving the leg away from the midline. (Muscle: Gluteus Medius)
  • Adduction: Bringing the leg towards the midline. (Muscles: Adductor Longus, Adductor Magnus)
  • Internal Rotation: Rotating the leg inward.
  • External Rotation: Rotating the leg outward.

Common Orthopedic Condition: Osteoarthritis affecting range of motion in all planes.

4. Knee Joint

Primarily a hinge joint, allowing flexion and extension.

  • Flexion: Bending the knee. (Muscles: Hamstrings)
  • Extension: Straightening the knee. (Muscle: Quadriceps Femoris)

Common Orthopedic Condition: Ligament injuries (ACL, MCL) restricting movement and causing instability.

5. Ankle Joint

Allows dorsiflexion, plantarflexion, inversion, and eversion.

  • Dorsiflexion: Lifting the foot upwards. (Muscle: Tibialis Anterior)
  • Plantarflexion: Pointing the foot downwards. (Muscle: Gastrocnemius, Soleus)
  • Inversion: Turning the sole of the foot inward.
  • Eversion: Turning the sole of the foot outward.

Common Orthopedic Condition: Ankle sprain affecting inversion/eversion.

Assessing Movements

Range of Motion (ROM) is assessed using a goniometer. Active ROM (patient performs the movement) and passive ROM (examiner performs the movement) are evaluated. Muscle strength is assessed using manual muscle testing (MMT) graded on a scale of 0-5.

Movement Plane Muscles Involved (Example) Common Orthopedic Pathology
Flexion (Elbow) Sagittal Biceps Brachii Tennis Elbow
Abduction (Shoulder) Frontal Middle Deltoid Rotator Cuff Tear
Extension (Hip) Sagittal Gluteus Maximus Osteoarthritis

Conclusion

Understanding movements is central to both anatomical study and orthopedic practice. Accurate assessment of range of motion, muscle strength, and identification of limitations are crucial for diagnosis and treatment planning. The interplay between muscles, joints, and planes of motion dictates functional movement, and disruptions to this system can lead to a wide range of orthopedic conditions. Continued research into biomechanics and rehabilitation strategies will further enhance our ability to restore and optimize movement in patients.

Answer Length

This is a comprehensive model answer for learning purposes and may exceed the word limit. In the exam, always adhere to the prescribed word count.

Additional Resources

Key Definitions

Kinematics
The study of motion without regard to the forces that cause it. It describes the displacement, velocity, and acceleration of body segments.
Proprioception
The body's ability to sense its position, location, and movement in space. It is crucial for maintaining balance and coordinating movements.

Key Statistics

Approximately 25% of adults experience musculoskeletal pain annually, impacting their ability to perform daily activities.

Source: National Institutes of Health (NIH), 2019 (Knowledge Cutoff)

Lower back pain is the leading cause of disability worldwide, affecting an estimated 80% of adults at some point in their lives.

Source: World Health Organization (WHO), 2023 (Knowledge Cutoff)

Examples

Scoliosis

Scoliosis, a lateral curvature of the spine, restricts movements in the sagittal and frontal planes, impacting breathing and overall posture.

Frequently Asked Questions

What is the difference between active and passive range of motion?

Active ROM is the range of motion a patient can achieve independently using their own muscle strength. Passive ROM is the range of motion an examiner can achieve for the patient, indicating the joint's potential range without muscle contraction.

Topics Covered

AnatomyOrthopedicsJoint AnatomyLower LimbMusculoskeletal System