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OS > 1. Thoracic and Lumbar Spinal Mechanics > Flashcards

1. Thoracic and Lumbar Spinal Mechanics Flashcards

1
Q

Landmarks of the gravitational line (lateral)

A
  • external auditory canal
  • head of the humerus L3
  • anterior 1/3 sacrum
  • lateral malleolus
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2
Q

Spinal curves (lateral view)

A
  • cervical lordosis
  • thoracic kyphosis
  • lumbar lordosis
  • sacral kyphosis
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3
Q

characteristics of thoracic vertebra (T1-T12)

A
  • body: medium sized, heart-shaped, w/ costal facets
  • spinous process: long, slope postero-inferiorly
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4
Q

characteristics of lumbar vertebra (L1-L5)

A
  • body: large, kidney-shaped
  • spinous process: short, broad
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5
Q

rule of 3’s

A

refer to the location of spinous process in relation to the transverse process in the thoracic spine

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6
Q

rule of 3’s: T1-T3 (T12)

A

SP @ level of corresponding TP

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7
Q

rule of 3’s: T4-T6 (T11)

A

SP @ 1/2 segment below corresponding TP

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8
Q

rule of 3’s: T7-T9 (and T10)

A

SP @ level of TP 1 vertebrae below

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9
Q

orientation of superior facets: cervical region

A

BUM (backward, upward, medial)

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10
Q

orientation of superior facets: thoracic region

A

BUL (backward, upward, lateral)

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11
Q

orientation of superior facets: lumbar region

A

BM (backward, medial)

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12
Q

strong, broad fibrous band that covers and connects anterolateral aspects of the vertebral bodies and IV discs; limits extension

A

anterior longitudinal ligament

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13
Q

narrow, weaker band that runs with the vertebral canal along the posterior aspect of the vertebral bodies; resists hyperflexion; prevents posterior herniation of nucleus pulposus

A

posterior longitudinal ligament

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14
Q

connects the laminae of adjacent vertebra

A

ligamentum flava

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15
Q

connects adjoining spinous processes

A

interspinous ligaments

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16
Q

connects adjoining transverse processes

A

intertransverse ligaments

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17
Q

ligaments from L5 TP to iliac crest

A

iliolumbar ligament

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18
Q

[important] transversospinalis muscles of the spine

A
  • semispinalis
  • rotatores longi
  • rotatores breves
  • multifudus
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19
Q

extends the thoracic spine (bilaterally) and rotates thoracic spine to opposite side (unilaterally)

A

rotatores muscles (breves and longi)

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20
Q

extends spine (bilaterally) and flexes spine to the same side/rotates to opposite side (unilaterally)

A

multifudus m.

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21
Q

extends thoracic and cervical spines and head (bilaterally) and bends head, cervical and thoracic spines to the same side, rotates to the opposite side (unilaterally)

A

semispinalis muscles (capitis, cervicis, thoracis)

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22
Q

vertebral motion: flexion

A

S1 > vertical, C7 (40-90 degrees)

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23
Q

vertebral motion: extension

A

S1 > vertical, C7 (20-45 degrees)

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24
Q

vertebral motion: sidebending

A

S1 > vertical, C7 (15-30 degrees)

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25
Q

vertebral motion: rotation

A

center of head > acromion, ASIS (3-18 degrees)

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26
Q

consistent association of a motion along or about one axis w/ another motion about or along a second axis (prinicipal motion cannot occur without associated motion)

A

coupled motion

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27
Q

relationship of joint mechanics with surrounding structures to increase ROM

A

linkage

28
Q

vertebral motion

A

movement of the anterior/superior surface of the vertebra

29
Q

excessive motion (or restriction)

A

in reference to the vertebra above in a functional vertebral unit

30
Q

vertebral unit

A

2 adjacent vertebra + associated IV disc

31
Q

physiologic barrier

A

limit of active motion

32
Q

anatomic barrier

A

limit of motion imposed by anatomic structure; limit of passive motion

33
Q

elastic barrier

A

range between the physiologic and anatomic barrier of motion in which passive ligamentous stretching occurs before tissue disruption

34
Q

restrictive barrier

A

functional limit within the anatomic range of motion; abnomrally diminishes the normal physiologic range

35
Q

Why does spinal SD matter?

A
  • restrictions of motion in the spine
  • reduce efficiency
  • impair flow of fluids
  • alter nerve function
  • creaste structural imbalance
36
Q

Fryette: Type I Spinal Mechanics

A

In neutral range, sidebending and rotation are coupled in opposite directions. Rotation is towards the convexity of the spine. Tends to be a group of vertebra.

(Arrows point in opposite directions - sidebending and rotation are opposite)

37
Q

Fryette: Type II Spinal Mechanics

A

In sufficient flexion or extension (non-neutral), sidebending and rotation are coupled in the same direction. Rotation is towards the concavity. Tends to be a single vertebra.

38
Q

Mnemonic for Fryette Type One

A

TONGO

39
Q

Mnemonic for Fryette Type Two

A

TTOSS

40
Q

Name steps of SD nomenclature (Type 1)

A
  1. Locate vertebra or group.
  2. Indicate position (neutral).
  3. Indicate sidebending.
  4. Indicate rotation.
41
Q

Name steps of SD nomenclature (Type 2)

A
  1. Locate the vertebra or group.
  2. Indicate position (flexion or extension).
  3. Indicate sidebending.
  4. Indicate rotation.
42
Q

Fryette: Type III (“Third Principle”)

A
  • Initiating movement of a vertebral segment in any plane of motion will modify the movement of that segment in other planes of motion.
  • If motion is restricted in one direction, motion will also be restricted in other directions.
  • If motion is improved in one direction, motion will improve in other directions.
43
Q

What happens if you push anterior on the left transverse process?

A

vertebra rotates right

44
Q

Name other ways to say “spine is rotated right.”

A
  • posterior transverse process (PTP) on the right
  • right PTP
  • rotated right
  • hard end-feel w/ rotation to the left
  • hard end-feel on the right (when applying anterior force to right TP)
  • restricted in rotation to the left
  • will not rotate to the left
  • lives in right rotation
  • held to the right
45
Q

Describe resistance and ease of motion with sidebending motion.

A

If sidebent to the right, resistance is encountered when translating to the right & ease of motion felt with translation to the left.

46
Q

vertebral level: spine of scapula

A

T3 SP/T3 TP

47
Q

vertebral level: inferior angle of scapula

A

SP T7/TP T8

48
Q

vertebral level: iliac crest

A

level of L4

49
Q

Scoliosis with convexity to the right

A

Dextro-scoliosis (frames the heart)

50
Q

Scoliosis with convexity to the left

A

Levo-scoliosis (obscures the heart)

51
Q

Scoliosis physical exam

A
  • asymmetry of sacral base/perisapular area
  • rib cage prominence
  • leg length discrepancies
  • Cobb angle
  • Forward Bending test
  • scoliomenter
52
Q

Scoliosis management based on Cobb angle

A
  • <25 degrees: conservative - monitor w/ frequent radiographs
  • 25-45 degrees: non-operative - bracing
  • > 50 degrees: surgical fusion - prevents progression
53
Q

Possible complications with scoliosis

A
  • respiratory compromise > 50 degrees
  • cardiac compromise > 75 degrees
54
Q

Radiculopathy

A
  • pain with dermatomal distribution
  • neurologic func may be impaired
    • LE weakness
    • diminished reflexes
  • acute, may become chronic
  • work-up: MRI
  • test: SLR
55
Q

SLR test

A
  • Raise leg w/ knee extended
  • Result: pain = (+) test
    • pain from 15-30 degrees = lumbar disc etiology
56
Q

Spinal stenosis

A
  • bilateral lower limb pain
  • neurogenic claudication
  • neurological function may be impaired
    • LE weakness
    • diminished reflexes
  • typically chronic
  • work-up: MRI
  • test: SLR
57
Q

Cauda equina syndrome

A
  • emergent
  • impaired neurological function
    • saddle anesthesia
    • lower extremity weakness
    • diminished reflexes
    • urinary retention
  • usually traumatic
  • work-up: MRI
58
Q

spina bifida oculta

A

failure of the neural tube to close w/o herniation

59
Q

meningocele

A

failure of neural tube to close w/ protrusions of the meninges through defect

60
Q

myelomeningocele

A

failure of neural tube to close w/ protrusion of meninges and SC through defect

61
Q

Things to look for on lumbar x-rays (lateral & A/P)

A
  • vertebral bodies
  • lines
  • intervertebral discs
62
Q

Sacralization

A

one or both TPs of L5 are long and articulate w/ the sacrum (DJD)

63
Q

Lumbarization

A

failure of S1 to fuse w/ rest of sacrum (uncommon)

64
Q

Spina bifida

A

defect in closure of the lamina

65
Q

What does this image show?

A

spondylosis

66
Q

What does this image show?

A

spondylolysis

67
Q

What does this image show?

A

spondylolesthesis (slipping of 1 vertebra on another)

OS (9 decks)

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