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Year 1: OS Exam 1 > 2.1 DSA: Thoracic And Lumbar Spine Mechanics > Flashcards

2.1 DSA: Thoracic And Lumbar Spine Mechanics Flashcards

1
Q

Curvatures associated with the 4 regions of the spine

A

Cervical lordosis

Thoracic kyphosis

Lumbar lordosis

Sacral kyphosis

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2
Q

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

A

Medium size

Heart shape

Costal facets

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3
Q

Describe spinous processes of thoracic vertebrae T1-T12

A

Long

Slope postero-inferiorly

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4
Q

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

A

Large size

Kidney shape

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5
Q

Describe spinous processes of lumbar vertebrae L1-5

A

Short, broad

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6
Q

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

A

2 adjacent vertebrae

Associated intervertebral disc

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7
Q

Describe the superior facet orientation of cervical vertebrae

A

Backwards
Upwards
Medial

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8
Q

Describe the superior facet orientation of thoracic vertebrae

A

Backwards
Upwards
Lateral

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9
Q

Describe the superior facet orientation of lumbar vertebrae

A

Backwards

Medial

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10
Q

What are the 5 ligaments associated with the spine?

A

Anterior longitudinal ligament

Posterior longitudinal ligament

Ligamentum flava

Interspinous ligaments

Intertransverse ligaments

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11
Q

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

A

Ligamentum flava

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12
Q

Which ligament associated with the spine connects adjoining spinous processes?

A

Interspinous ligaments

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13
Q

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?

A

Anterior longitudinal ligament

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14
Q

The anterior longitudinal ligament limits what type of motion?

A

Extension

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15
Q

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?

A

Posterior longitudinal ligament

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16
Q

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

A

Resists hyperflexion

Prevents posterior herniation of nucleus pulposus

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17
Q

Which ligament associated with the spine connects adjoining transverse processes?

A

Intertransverse ligaments

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18
Q

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

A

Iliolumbar ligament

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19
Q

What are the 4 transversospinalis muscles of the spine?

A

Semispinalis thoracis m.

Rotatores longus m.

Rotatores brevis m.

Multifidus m.

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20
Q

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

A

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

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21
Q

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

A

Bilateral = extension of thoracic spine

Unilateral = rotation of thoracic spine to opposite side

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22
Q

Origin/insertion/innervation of multifidus m.

A

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.

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23
Q

Bilateral vs. unilateral actions of multifidus m.

A

Bilateral: extends spine

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

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24
Q

3 divisions of semispinalis m.

A

Semispinalis capitis m.

Semispinalis cervicis m.

Semispinalis thoracis m.

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25
Q

Origins of 3 divisions of semispinalis mm.

A

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

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26
Q

Insertion of 3 divisions of semispinalis m.

A

Capitis: occipital bone between superior/inferior nuchal lines

Cervicis: spinous processes of C2-5

Thoracis: spinous processes of C6-T4

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27
Q

Bilateral vs. unilateral actions of semispinalis m.

A

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

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28
Q

ROM for general vertebral flexion

A

40-90

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29
Q

ROM for general vertebral extension

A

20-45

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30
Q

ROM for general vertebral sidebending

A

15-30

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31
Q

ROM for general vertebral rotation

A

3-8

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32
Q

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

A

Coupled motion

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

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33
Q

________ 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

A

Linkage

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34
Q

What effect does linkage have on joint assessment?

A

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

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35
Q

What type of barrier is the limit of active motion?

A

Physiologic barrier

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36
Q

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

A

Anatomic barrier

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37
Q

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

A

Elastic barrier

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38
Q

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

A

Restrictive barrier

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39
Q

What are some physiological effects of spinal somatic dysfunction?

A

Reduction in efficiency

Impairment of fluid flow

Alterations in nerve function

Creation of stuctural imbalance

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40
Q

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

A

Anterior/superior

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41
Q

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

A

Above

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

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42
Q

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

A

Harrison Fryette, DO
-applicable to thoracic and lumbar spine

[CR Nelson, DO developed the 3rd principle in 1948]

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43
Q

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.

A

Neutral
Opposite
-rotation is toward spine convexity
Group

[Remember TONGO - Type One Neutral Group Opposite]

44
Q

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.

A

Flexion; extension

Same

Single

45
Q

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

A

Flexion; extension

46
Q

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

A

Abduction; adduction

47
Q

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

A

T1-T3

Neutral position

Sidebent right (restricted to left sidebending)

Rotated left (restricted to right rotation)

48
Q

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

A

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

49
Q

What is the 3rd Fryette 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

[states that if motion is restricted in one direction, motion will also be restricted in other directions, the same goes for improvement of motion]

50
Q

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

A

Thoracic and Lumbar only!

51
Q

Rotation occurs in what plane and around what axis?

A

Transverse (horizontal) plane

Superior-inferior axis

52
Q

Sidebending occurs in what plane and around what axis?

A

Coronal (frontal) plane

Anterior-posterior axis

53
Q

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

A

Sagittal plane

Horizontal (left-right) axis

54
Q

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

A

Transverse; left

55
Q

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

A 
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
56
Q

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

A

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
57
Q

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

A

T3 spinous process

T3 transverse process

58
Q

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

A

Spinous process of T7

Transverse process of T8

59
Q

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

A

Level of L4 vertebra

60
Q

what ligament is commonly injured in obese patients?

A

iliolumbar l

61
Q

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

A
  1. reduce efficiency
  2. impair flow of fluids
  3. alter nerve function
  4. create structural imbalance
62
Q

what muscles are primarily responsible for fryette type 2 mechanics?

A

rotatores muscles

63
Q

How would you diagnose this?

  • Affected T3-8
  • Neutral, no change in F/E
  • Sidebent right
  • Rotated left
A

T3-8 N SrRl

64
Q

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)

A

R-right

65
Q

Epidemiology of scoliosis

A

2% population, more common in female

66
Q

How is scoliosis named?

A

toward convexity

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

67
Q

When is bracing indicated in scoliosis?

A

25-45 Cobb angle

68
Q

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

A

resp: >50
cardiac: >75

69
Q

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

A
  1. Radiculopathy- herniated nucleus pulpous
  2. spinal stenosis
  3. cauda equina
70
Q

If there was a herniation at L4-5, where would the:

  1. pain present
  2. numbness
  3. weakness
  4. atrophy
  5. reflexes
A
  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
71
Q

If there was a herniation at L5-S1, where would the:

  1. pain present
  2. numbness
  3. weakness
  4. atrophy
  5. reflexes
A
  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
72
Q

Sacrilization

A

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

73
Q

lumbarization

A

failure of S1 to fuse with rest of sacrum

74
Q

Head and neck sympathetic range

A

T1-4

75
Q

Heart sympathetic range

A

T1-5

76
Q

Lungs sympathetic range

A

T2-7

77
Q

Esophagus and UE sympathetic range

A

T2-8

78
Q

Upper GU sympathetic range

A

T10-11

79
Q

Lower GU sympathetic range

A

T12-L2

80
Q

Adrenal medulla sympathetic range

A

T10

81
Q

Appendix sympathetic range

A

T12

82
Q

Bladder sympathetic range

A

T11-L2

83
Q

Upper GI sympathetic range

A

T5-9

84
Q

Middle GI sympathetic range

A

T10-11

85
Q

Lower GI sympathetic range

A

T12-L2

86
Q

Uterus and cervix sympathetic range

A

T10-L2

87
Q

LE, urethra, Erectile tissue sympathetic range

A

T11-L2

88
Q

Prostate sympathetic range

A

T12-L2

89
Q

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

A
  • Lower GU
  • bladder
  • lower GI
  • uterus and cervix
  • LE, urethra, erectile tissue
  • prostate

*rest by Vagus N.

90
Q

what spinal landmarks are at the scapular spine?

A

T3 spinous process and transverse process

91
Q

what muscles are involved in type 2 dysfunction?

A

short segmental ms of spine

92
Q

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

A

chronic

  • cool, dry skin
  • decreased edema
  • ropy
  • fibrotic
93
Q

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

A

acute

  • erythematous
  • boggy
  • increased moisture
  • hypertonic ms
94
Q

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

A

sidebent right

95
Q

Rotation occurs in what plane and axis?

A

Plane: transverse (horizontal)
Axis: superior-inferior

96
Q

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

A

T10-11

Ligament of Treitz-jejunum, ileum - Ileocecal valve

97
Q

Flexion/Extension occurs in what plane and axis?

A

Plane: sagittal
Axis: horizontal (right to left)

98
Q

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

A

thoracic kyphosis in sagittal plane

99
Q

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

A

T7 spinous process

T8 transverse process

100
Q

what spinal landmarks are at the iliac crest?

A

L4 vertebrae

101
Q

Which organs may have reflexes to the low back (T10-L5)?

  1. heart
  2. lungs
  3. kidney
  4. pancreas
  5. colon
A

kidney and colon

102
Q

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

A

T10-11

Kidney to Upper 1/3 ureter

103
Q

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

A

T5-9

Mouth to Ligament of Treitz

104
Q

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

A

T10-11

Ligament of Treitz to Ileocecal valve

105
Q

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

A

T12-L2

iliocecal valve to anus

106
Q

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

A

T12-L2

Lower 2/3 ureter to urethra

107
Q

What level is bladder viscerosomatic reflex at

A

T11-12

Year 1: OS Exam 1 (39 decks)

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