2.1 DSA: Thoracic And Lumbar Spine Mechanics Flashcards by Deleted Deleted

Curvatures associated with the 4 regions of the spine

Cervical lordosis

Thoracic kyphosis

Lumbar lordosis

Sacral kyphosis

How well did you know this?

Not at all

Perfectly

Describe bodies of thoracic vertebrae T1-T12 in terms of size, shape, and any unique characteristics

Medium size

Heart shape

Costal facets

How well did you know this?

Not at all

Perfectly

Describe spinous processes of thoracic vertebrae T1-T12

Long

Slope postero-inferiorly

How well did you know this?

Not at all

Perfectly

Describe bodies of lumbar vertebrae L1-L5 in terms of size and shape

Large size

Kidney shape

How well did you know this?

Not at all

Perfectly

Describe spinous processes of lumbar vertebrae L1-5

Short, broad

How well did you know this?

Not at all

Perfectly

What are the 3 total components of a single vertebral unit?

2 adjacent vertebrae

Associated intervertebral disc

How well did you know this?

Not at all

Perfectly

Describe the superior facet orientation of cervical vertebrae

Backwards
Upwards
Medial

How well did you know this?

Not at all

Perfectly

Describe the superior facet orientation of thoracic vertebrae

Backwards
Upwards
Lateral

How well did you know this?

Not at all

Perfectly

Describe the superior facet orientation of lumbar vertebrae

Backwards

Medial

How well did you know this?

Not at all

Perfectly

What are the 5 ligaments associated with the spine?

Anterior longitudinal ligament

Posterior longitudinal ligament

Ligamentum flava

Interspinous ligaments

Intertransverse ligaments

How well did you know this?

Not at all

Perfectly

Which ligament associated with the spine connects the laminae of adjacent vertebrae?

Ligamentum flava

How well did you know this?

Not at all

Perfectly

Which ligament associated with the spine connects adjoining spinous processes?

Interspinous ligaments

How well did you know this?

Not at all

Perfectly

Which ligament associated with the spine consists of a strong, broad, fibrous band that covers and connects the anterolateral aspects of the vertebral bodies and intervertebral discs?

Anterior longitudinal ligament

How well did you know this?

Not at all

Perfectly

The anterior longitudinal ligament limits what type of motion?

Extension

How well did you know this?

Not at all

Perfectly

Which ligament associated with the spine consists of a narrower, somewhat weaker band that runs within the vertebral canal along the posterior aspect of the vertebral bodies?

Posterior longitudinal ligament

How well did you know this?

Not at all

Perfectly

What type of motion is resisted by the posterior longitudinal ligament? What does this prevent?

Resists hyperflexion

Prevents posterior herniation of nucleus pulposus

How well did you know this?

Not at all

Perfectly

Which ligament associated with the spine connects adjoining transverse processes?

Intertransverse ligaments

How well did you know this?

Not at all

Perfectly

What additional ligament associated with the spine is also associated with the pelvis?

Iliolumbar ligament

How well did you know this?

Not at all

Perfectly

What are the 4 transversospinalis muscles of the spine?

Semispinalis thoracis m.

Rotatores longus m.

Rotatores brevis m.

Multifidus m.

How well did you know this?

Not at all

Perfectly

T/F: Rotatores longus m. and Rotatores brevis m. have the same origin, insertion, and action

True

Origin/insertion is T1-12 between transverse and spinous processes of adjacent vertebrae

Action: bilaterally extends thoracic spine, unilaterally rotates thoracic spine to opposite side

How well did you know this?

Not at all

Perfectly

What is the bilateral vs. unilateral action of rotatores longus m. and rotatores brevis m.?

Bilateral = extension of thoracic spine

Unilateral = rotation of thoracic spine to opposite side

How well did you know this?

Not at all

Perfectly

Origin/insertion/innervation of multifidus m.

Origin: sacrum, ilium, mamillary processes of L1-5, transverse and articular processes of T1-4, C4-7

Insertion: superomedially to spinous processes, skipping to 2-4 vertebrae

Innervation: posterior rami of spinal nn.

How well did you know this?

Not at all

Perfectly

Bilateral vs. unilateral actions of multifidus m.

Bilateral: extends spine

Unilateral: flexes spine to same side, rotates it to opposite side

How well did you know this?

Not at all

Perfectly

3 divisions of semispinalis m.

Semispinalis capitis m.

Semispinalis cervicis m.

Semispinalis thoracis m.

How well did you know this?

Not at all

Perfectly

Origins of 3 divisions of semispinalis mm.

Semispinalis capitis m: transverse and articular processes of C4-T7 Semispinalis cervicis m: transverse processes of T1-6 Semispinalis thoracis m: transverse processes of T6-12

Insertion of 3 divisions of semispinalis m.

Capitis: occipital bone between superior/inferior nuchal lines Cervicis: spinous processes of C2-5 Thoracis: spinous processes of C6-T4

Bilateral vs. unilateral actions of semispinalis m.

Bilateral: extends thoracic and cervical spines and head (stabilizes craniovertebral joints) Unilateral: bends head, cervical and thoracic spines to same side, rotates to opposite side

ROM for general vertebral flexion

40-90

ROM for general vertebral extension

20-45

ROM for general vertebral sidebending

15-30

ROM for general vertebral rotation

3-8

_________ ________ refers to consistent association of a motion along or about one axis, with another motion about or along a 2nd axis

Coupled motion [the principle motion cannot be produced without the associated motion occurring as well]

________ refers to the relationship of joint mechanics with surrounding structures; this concept contributes to an increased ROM that may occur between the shoulder and spine or the spine and hip

Linkage

What effect does linkage have on joint assessment?

Specific joint assessment requires joint isolation for accurate measurement and evaluation Functional assessment of a joint may assess linkage Must note normal ROM vs. result of compensation d/t linkage

What type of barrier is the limit of active motion?

Physiologic barrier

What type of barrier is the limit of motion imposed by a structure as well as the limit of passive motion?

Anatomic barrier

What type of barrier is the range between the physiologic and anatomic barriers in which passive ligamentous stretching occurs before tissue disruption?

Elastic barrier

What type of barrier is the functional limit within the anatomic ROM which abnormally diminishes the normal physiologic range?

Restrictive barrier

What are some physiological effects of spinal somatic dysfunction?

Reduction in efficiency Impairment of fluid flow Alterations in nerve function Creation of stuctural imbalance

Vertebral motion is always referenced to what surface of the vertebrae?

Anterior/superior

Excessive motion (or restriction) is referred of the vertebra _________ in a functional vertebral unit

Above [ex: excess motion of L2 is the motion of L2 on L3]

Who described physiologic motion of the spine and published a set of 2 principles in 1918 referring to spinal motion?

Harrison Fryette, DO -applicable to thoracic and lumbar spine [CR Nelson, DO developed the 3rd principle in 1948]

Fryette: Type One Mechanics: In the ________ range, sidebending and rotation are coupled in _________ directions. Rotation is towards the convexity of the spine. Tends to be in a ________ of vertebra.

Neutral Opposite -rotation is toward spine convexity Group [Remember TONGO - Type One Neutral Group Opposite]

Fryette Type Two Mechanics: In sufficient __________ or ____________, sidebending and rotation are coupled in the __________ direction. Rotation is towards the concavity. Tends to be a ________ vertebra.

Flexion; extension Same Single

In a person with cervical spine flexion somatic dysfunction, they prefer the motion of _________ and are restricted to __________

Flexion; extension

In a left hip abduction somatic dysfunction, the patient prefers _________ and is restricted to _________

Abduction; adduction

Describe a T1-3, N, S^R, R^L somatic dysfunction

T1-T3 Neutral position Sidebent right (restricted to left sidebending) Rotated left (restricted to right rotation)

Name the somatic dysfunction in a patient at T9, non-neutral position, restriction to right sidebending, and rotated left

T9 F (or E) S^L R^L

What is the 3rd Fryette principle?

Initiating movement of a vertebral segment in any plane of motion will modify the movement of that segment in other planes of motion [states that if motion is restricted in one direction, motion will also be restricted in other directions, the same goes for improvement of motion]

The first 2 Fryette's principles only apply to what region(s) of the spine?

Thoracic and Lumbar only!

Rotation occurs in what plane and around what axis?

Transverse (horizontal) plane Superior-inferior axis

Sidebending occurs in what plane and around what axis?

Coronal (frontal) plane Anterior-posterior axis

Flexion/extension occurs in what plane and around what axis?

Sagittal plane Horizontal (left-right) axis

If a physician pushes anteriorly on right transverse process, rotational movement will be induced in the ________ plane and the vertebra rotates ______

Transverse; left

What are some equivalent ways of stating that the patient has a posterior transverse process on the right?

``` Right PTP Rotated right Hard end feel with rotation to the left Restricted in left rotation Will not rotate left Lives in right rotation Held to the right ```

What is the rule of 3's as it applies to spinous processes?

T1-3 Spinous process loacted at the level of the corresponding transverse process T4-6 Spinous process located 1/2 a segment below the corresponding transverse process T7-9 Spinous process located at the level of transverse process of vertebrae one below ``` T10 = Same as T7-9 T11 = Same as T4-6 T12 = Same as T1-3 ```

What spinal landmarks are present at the level of the spine of the scapula?

T3 spinous process | T3 transverse process

What spinal landmarks are present at the level of the inferior angle of the scapula?

Spinous process of T7 | Transverse process of T8

What spinal landmarks are present at the level of the iliac crest?

Level of L4 vertebra

what ligament is commonly injured in obese patients?

iliolumbar l

What are 4 effects of restriction in motion in the spine?

1. reduce efficiency 2. impair flow of fluids 3. alter nerve function 4. create structural imbalance

what muscles are primarily responsible for fryette type 2 mechanics?

rotatores muscles

How would you diagnose this? - Affected T3-8 - Neutral, no change in F/E - Sidebent right - Rotated left

T3-8 N SrRl

If the question stem presents wording stating, "hard end feel with rotation to the left" or "hard end feel on the right" - what would be the rotational SD diagnosis? (aka where the vertebrae likes to go)

R-right

Epidemiology of scoliosis

2% population, more common in female

How is scoliosis named?

toward convexity Levo-left (obscure heart) Dextro-right (frame heart)

When is bracing indicated in scoliosis?

25-45 Cobb angle

At what angle in scoliosis is there resp compromise? cardiac compromise?

resp: >50 cardiac: >75

what are common conditions and causes of mechanical low back pain with radiation below the knee? (3)

1. Radiculopathy- herniated nucleus pulpous 2. spinal stenosis 3. cauda equina

If there was a herniation at L4-5, where would the: 1. pain present 2. numbness 3. weakness 4. atrophy 5. reflexes

1. over sacroiliac joint, hip, lateral thigh and leg 2. lateral leg and 1st 3 toes 3. dorsiflexion of great toe and foot; difficulty walking on heel; possible foot drop 4. minor atrophy 5. internal hamstring reflex diminished or absent

If there was a herniation at L5-S1, where would the: 1. pain present 2. numbness 3. weakness 4. atrophy 5. reflexes

1. sacroiliac joint, hip, posterolateral thigh and leg to heel 2. back of calf, lateral heel, foot to toe 3. plantar flexion of foot and big toe, difficulty walking on toes 4. gastrocnemius and soleus 5. ankle jerk diminished or absent

Sacrilization

one or both TP's of L5 are long and articulate/fuse with sacrum

lumbarization

failure of S1 to fuse with rest of sacrum

Head and neck sympathetic range

T1-4

Heart sympathetic range

T1-5

Lungs sympathetic range

T2-7

Esophagus and UE sympathetic range

T2-8

Upper GU sympathetic range

T10-11

Lower GU sympathetic range

T12-L2

Adrenal medulla sympathetic range

T10

Appendix sympathetic range

T12

Bladder sympathetic range

T11-L2

Upper GI sympathetic range

T5-9

Middle GI sympathetic range

T10-11

Lower GI sympathetic range

T12-L2

Uterus and cervix sympathetic range

T10-L2

LE, urethra, Erectile tissue sympathetic range

T11-L2

Prostate sympathetic range

T12-L2

What viscerosomatic reflexes are influences by the pelvic splanchnic N? (6)

- Lower GU - bladder - lower GI - uterus and cervix - LE, urethra, erectile tissue - prostate *rest by Vagus N.

what spinal landmarks are at the scapular spine?

T3 spinous process and transverse process

what muscles are involved in type 2 dysfunction?

short segmental ms of spine

What TART changes would you see with a type 1 dysfunction?

chronic - cool, dry skin - decreased edema - ropy - fibrotic

What TART changes would you see with a type 2 dysfunction?

acute - erythematous - boggy - increased moisture - hypertonic ms

if you felt ease of motion with translation to to the left and resistance to the right, what is the diagnosis?

sidebent right

Rotation occurs in what plane and axis?

Plane: transverse (horizontal) Axis: superior-inferior

What level is mid GI viscerosomatic reflex at and what organs comprise this?

T10-11 | Ligament of Treitz-jejunum, ileum - Ileocecal valve

Flexion/Extension occurs in what plane and axis?

Plane: sagittal Axis: horizontal (right to left)

pt presents with a hunched over, how would you name this in terms of spinal curvature and in what plane?

thoracic kyphosis in sagittal plane

what spinal landmarks are at the inferior angle of the scapula?

T7 spinous process | T8 transverse process

what spinal landmarks are at the iliac crest?

L4 vertebrae

Which organs may have reflexes to the low back (T10-L5)? 1. heart 2. lungs 3. kidney 4. pancreas 5. colon

kidney and colon

What level is upper GU viscerosomatic reflex at and what are the defining groups for the area?

T10-11 | Kidney to Upper 1/3 ureter

What level is upper GI viscerosomatic reflex at and what organs comprise this?

T5-9 | Mouth to Ligament of Treitz

What level is mid GI viscerosomatic reflex at and what organs comprise this?

T10-11 | Ligament of Treitz to Ileocecal valve

What level is lower GI viscerosomatic reflex at and what are the defining groups for the area?

T12-L2 | iliocecal valve to anus

What level is lower GU viscerosomatic reflex at and what are the defining groups for the area?

T12-L2 | Lower 2/3 ureter to urethra

What level is bladder viscerosomatic reflex at

T11-12