(1) Anatomy & clinical exam L-spine Flashcards
What is the function of the spine?
- protect sc
- structural support
- upright posture
- sensory and proprioception
- haematopoiesis
What is the role of the intervertebral disc?
- motion b/t vertebral bodies
- absorbs/transmits load
- largely avascular
What are the three main parts of the IV disc?
- NP
- AF
- VE
What is the NP?
- gel-like structure that moves
- if AF tears, can leak (sciatica)
- nuclear migration
- compressively loads
What is the AF?
- peripheral & fibrosis
- strong but capable of bulging
- concentric layers
- limited vascular supply
What is the VE?
- interface b/t vertebral body and disc
- bilayer fibrocartilage & bone
- distributes intradiscal pressures onto adjacent vertebrae
- permeable
What is the Cauda Equina?
- network of nerve roots and tracts
- after sc terminates @ L1/2
- bundle of paired spinal nerves
- innervates pelvic organs and LL
What is the Lumbar-sacral plexus?
network supplying the skin and musculature of the lower limb
Where is the lumbar plexus?
T12 to L4
Where is the sacral plexus?
L5 to S4
What are the anatomical planes of motion of the L-Spine?
- Coronal (frontal)
- Sagittal (L + R)
- Axial (upper & lower)
What are the normative ranges for lumbar flexion & extension?
- flexion 50 degrees
- extension 15 degrees
What are the normative values for lumbar lateral flexion & rotation?
- lateral flexion 20 degrees
- rotation 5 degrees
What are the 4 steps of the clinical exam of the lumbar spine?
- observation
- AROM
- Neuro exam
- Segmental palpation
What is looked for during observation?
- Antalgic
- Asymmetry
- Deformities
- Muscle bulk
- Standing posture
What is gowers sign?
- difficulty rising from a squatting/sitting position
What is involved in the neuro exam?
- dermatomes
- myotomes
- reflexes
What are myotomes?
group of muscles innervated by a single nerve
What does L1-L2 innervate?
hip flexion
What does L3 innervate?
knee extension
What does L4 innervate?
ankle dorsiflexion
What does L5 innervate?
big toe extension
What does S1 innervate?
ankle plantarflexion
What does S2 innervate?
knee flexion
What nerve does the knee jerk test?
L3
What nerve does the ankle jerk test?
S1
What does the babinski test look for?
UMNL
What spinous processes are level with the iliac crest and PSIS?
L4 and S2
What do PAIVMs stand for?
Passive accessory intervertebral movements
