AFAB II- Exam 1 Flashcards by Siva Pye

3 divisions of a vertebrae:

The ______ ________ is anterior primary, weight-bearing component

vertebral body

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3 divisions of a vertebrae:

The ________ _______ include the transverse/spinous processes, laminae, and articular processes

posterior elements

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3 divisions of a vertebrae:

With the _________, the bridge connects to the body-posterior elements; they are also thick and strong

pedicles

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3 divisions of a vertebrae:

The _________ transfer muscle forces applied to the posterior elements for dispersion across the body/disc

pedicles

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The spinal curves provide ______ and ________ (spring like)

strength; resilience

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Spinal curves are vulnerable to what???

shear forces at transitions

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Spinal curves are involved with :

______ position

____ deposition

_______ strength & endurance

connective tissue __________

_______ supported by the body

_______ of facets, ________ bodies, and ________

limb

fat

muscle

extensibility

loads

shape; vertebral; discs

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_________ ________ : ant lamina to posterior lamina, end ROM flexion, 80% elastin, posterior to spinal cord

A. Interspinous ligament
B. Ligamentum Flavum
C. ALL

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_________ ________: between adjacent spinous processes; blends with LF – more elastin; more superficial more collagen and blend with SS lig, fiber direction varies – L/S

A. Supraspinous ligament
B. PLL
C. Interspinous ligament

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_________ _________: between tips of spinous processes; resist separation – flexion; less developed in L/S

A. Supraspinous ligaments
B. ALL
C. Intertransverse ligaments

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__________ _____________: are thin, taut in contralateral flexion

A. PLL
B. Supraspinous ligaments
C. Intertransverse ligaments

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The ________ is long, strong strap, occiput to sacrum, fibers into and reinforce anterior disc

A. PLL
B. ALL

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Which ligament is on the posterior surfaces of vertebral bodies C2-sacrum (in canal) and blends with and reinforces posterior discs?

PLL

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Which ligaments cover the entire rim of facets, connect and stabilize, and are reinforced by adjacent muscles (multifidus)?

Capsular ligaments

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Which ligaments go with each Axis of Motion?

ALL
PLL
Ligamentum Flavum
Interspinous Lig.
Supraspinous Lig.
Intertransverse Lig.
Facet (zygoapohysial) joint capsules

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Label These

Interspinous Lig.
Capsular Lig.
Ligamentum Flavum
ALL
PLL
IAR

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______ _______ is a loss of intervertebral stiffness that can lead to abnormal and increased intervertebral motion

spinal instability

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The ________ ________ is The amount of intervertebral movement that occurs with the least passive resistance from the surrounding tissues (minimal stiffness zone)

neutral zone

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With the neutral zone, chronic ________ can cause further injury

instability

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Core stability can also be viewed from a _________ level as well as the whole spine

segmental

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What happens when the neutral zone is larger than normal?

the spinal segments become unstable

*there will be more slide, glide, and rotation between the vertebrae

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The neutral zone has been found to increase with ______ and _________ and decrease with ______ ______

injury; degeneration

muscle force

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With injury (DDD) the _____ ______ pattern changes and influences the motion of the whole spine, potentially causing pain and _________

vertebral motion; hypermobility

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Which of the 3 subsystems…. consists of the bony structures, ligaments, joint capsules, discs, and passive portion of the musculotendinous units. This system is thought to send feedback to the neural subsystem about joint positions and challenges to stability at the passive level

passive system

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Which of the 3 subsystems.... is composed of the muscles and tendons and is the subject of the core exercises later

active system

Which of the 3 subsystems.... receives and transmits information from and to the other two systems to manage spinal stability. Neuromuscular control can be compromised in patients with LBP and must be considered in a core stabilization program

neural subsystem

Lumbopelvic Structure and Design is an example of what type of stability?

Passive

Neural Mediation is an example of what type of stability?

Neural

Muscular Force Transfer is an example of what type of stability?

Active

Marked or chronic instability causes further injury to where?

local ligaments facets discs

Marked or chronic instability can result in loss of P! free _____

ROM

Thoracic vertebrae: 2-9 Have a ________ pointing SP

downward

With the thoracic vertebrae 2-9, the sup/inf articular processes are oriented _________ and are aligned close to the ______ plane

vertically; frontal

With the thoracic vertebrae 2-9, the superior articular facets face ________

posterior

With the thoracic vertebrae 2-9, the inferior articular facets face ________

Thoracic vertebrae: 2-9 have a pair of ______ facets

costal

What are the atypical thoracic vertebrae?

T1, T10-12

T1 has full ______ attachment and ______

costal; demifacets

T10-12 has a full _______ attachment

costal

With the thoracic vertebrae: It is larger; ____ shaped; and contains the _____ facets

heart; costal

What shape is the thoracic vertebrae?

circular

The TP's of the thoracic vertebrae are short or long? contain articular facets for ____

long; ribs

The SP's of the thoracic vertebrae, are long and point ______

inferiorly

The lumbar region has massive wide _____ for support

bodies

With the lumbar region, the TP's project ________ A. medially B. laterally C. anterior-lateral

B. laterally

With the lumbar region, 1-4 disc are ____ and 5 is _____ and _______

thin; strong; thick

With the lumbar region, the _______ processes are off the sup. articular surfaces (posterior side)

mamillary

In the lumbar region, the articular facets are oriented ______

vertically

The lumbar facets are... superior or inferior? convex or concave? faces medial to medial posterior or lateral to anterior-lateral?

superior concave medial to medial posterior

The lumbar facets are oriented closest to what plane in the upper L/S?

sagittal

The lumbar facets are oriented midway between the ______and ______ plane in the lower L/S

sagittal; frontal

In the lumbar region, the inferior articular processes are convex or concave? lateral to anterior-lateral or medial to medial-posterior?

convex lateral to anterior-lateral

Diurnal Fluctuations in the discs: When supine, there is ____ pressure that attracts water and ________ slightly when sleeping

low; swells

With durnal fluctuations, ____ forces push water out of the ____

WB; disc

With diurnal fluctuations, there is ___% in height change

With diurnal fluctuations, relating to age: as _________ reduces, water retaining reduces

proteoglycans (GAGs)

With diurnal fluctuations: There is less __________ pressure and the patient can have a dx of _________ disc

hydrostatic degenerative

With diurnal fluctuations, ______ ________ shows : loss of distinction AF/NP, nuclear bulging, and loss of disc space

MR Imaging

What is this called?

T1- weight MR image anterior spondylolisthesis of L5 on S1

With vertebral endplates, they are relatively _____ cartilaginous ______ that cover most of sup/inf surface of vertebral bodies

thin; caps

With vertebral endplates, the surface facing disc is _________ that binds directly and strongly to collagen in the ______ A. articular cartilage; NP B. fibrocartilage; AF C. tissue; AF

B. fibrocartilage; AF

With vertebral endplates, the surface facing bone is _______ __________ and becomes what...?

calcified; cartilage weakly affixated to bone

The outer rings of the AF have ________ supply; there is limited healing at the ______

vascular; disc

With vertebral endplates, there is diffusion of _____ and _____

O2; glucose

Name These

1. iliolumbar ligament 2. anterior sacroiliac ligament 3. sacrospinous ligament 4. sacrotuberous ligament 5. anterior longitudinal ligament 6. iliolumbar ligament (deep part) 7. interosseus ligament 8. anterior sacrococcygeal ligament

Know this chart

With spine forces, the highest force is what?

bending over and picking up a box

With spine forces, the lowest force is what?

supine position

Which force applies the most stress on the disc? A. leaned back B. straight sitting C. slumped

Which force applies the least stress on the disc? A. straight sitting B. leaned back C. slumped

With IVD as a hydrostatic pressure distributor: 80% of load carried on the ________ joint in standing at L/Spine, 20 % _______ elements

intervertebral; posterior

With IVD as a hydrostatic pressure distributor: The disc are designed as _______ _______- can handle the forces of what?

shock absorbers; BW & muscle activation

With IVD as a hydrostatic pressure distributor: _____ _____ _______: biomechanical interaction water-based NP & annular rings

Load sharing system

With IVD as a hydrostatic pressure distributor: ________ loads push endplates inward to the _______

Compressive, NP

With IVD as a hydrostatic pressure distributor: The _____ slowly deforms radially vs _____

NP; AF

With IVD as a hydrostatic pressure distributor: Stretched rings of _______ and ________ create tension to resist/balance force, this is uniformly transferred to the _______ ________, then return when the load is _____

colagen; elastin vertebral bodies off

With IVD as a hydrostatic pressure distributor: _________ resists a fast/strongly applied load; less resistance to slow or light compression (flexible low loads/rigid at higher loads)

viscoelastic

With ____° of thoracolumbar flexion, there is _____° of thoracic flexion and ______° degrees of lumbar flexion

85; 35; 50

Flexion or Extension?

EXT

Flexion or Extension

FLX

With ____° of thoracolumbar EXT, there is _____° of thoracic EXT and ______° degrees of lumbar EXT

35; 25; 10

Rotation is ____-_____° in the horizontal plane

25;35

Lateral Flexion to each side is ___-___°

25;30

Flexion or Extension?

FLX

FLX or EXT?

EXT

What motion is occuring?

Rotation to the left

What motion is occuring?

Lateral flexion to the right

What motion is occuring?

Rotation to the left

What motion is occuring?

Lateral flexion to the right

With increased lumbar spine lordosis, there will be excessive tilt in what direction?

anteriorly

With increased lumbar spine lordosis, an anterior tilt will cause excess stress on which muscles?

hip flexors (contractures) and back extensors

The AF has ___-____ concentric rings of ______ fibers and it is ____° from vertical

15; 25 collagen 65

The AF prevents _______, _______, and ________

distraction, shear, and torsion

With the AF, due to angulation @ ______% of ______ force to stretch ______ ; in the direction of the force

90 torsion fibers

With the AF, it entraps/encases _____-______ nucleus

liquid; based

With the AF: it is ___-_____% collagen and (____-____%) in nucleus)

50;60 15;20

With the AF, the elastin is interspersed parallel to the rings of collagen, this is called _______ ________?

circumferential elasticity

With the AF, the outer layers disc is only ________ nerves, it binds to the _____/______

spinal; ALL; PLL

With the AF, the outer layer is more ______ and the inner layer is more ______

collagen; water

Flexion is a reversal of _______

lordosis

With flexion, the discs move _______

anteriorly

With extension, the disc move _______

posteriorly

With flexion, the inferior articular facets slide _____/______

superior/anterior

With flexion, there is compression on the _______ aspects of disc and bodies

With flexion, the ______ and _____ change size

foramina and canal

With flexion, this stretches the ______ ligaments and causes the _____ to migrate in a posterior direction

posterior; NP

With extension, the inferior articular facets slide _____/_______

inferior; posterior

Hyperextension can cause the tips of the inf articular process to contact the ______ _______...this can cause damage and compress the ________ ligaments

adjacent lamina posterior

With extension, the size of the intervertebral foramina is ______ and the nucleus presses _______

reduced; anterior

Full ______ _______ has been shown to reduce pressure within the disc and reduced contact pressure between disc materials and neural tissues... this also known as what?

lumbar extension centralization

Axial rotation is ___-___-° each side

5;7

With rot to the R , the _____ inferior facet _______ and R inf _____/______ from R sup. facet

left approximates gaps; distracts

With axial rotation, there is a bony rotation due to ________ of the facets

alignment

With LF, one side of the facets slide ______ and the other side ________

superiorly; inferiorly

Inspiration of the ribs move how?? This creates slight __________ in the T/S

upward/outward (bucket handle) or post/sup' extension

Expiration of the ribs moves how?? This creates slight _______ in the T/S

down/inward or ant/inf flexion

What is contracting or tight in posterior pelvic tilt?

Contraction of the hip extensors/abs

Lumbar spine kinematics 3 degrees of freedom: Flexion: ___-____° ( ) Extension: ___-_____° Axial Rotation: ___-___° LF: ____°

45; 55 15; 25 5; 7 20

Structures that resist shear at L5/S1 1. 2. 3. 4. 5.

Shear 1. Disc 2. Capsule of facets 3. ALL 4. Wide and sturdy facets (frontal plane) 5. Iliolumbar ligaments

With structures that resist shear at L5/S1: The iliolumbar ligaments- inf aspect of __-__ AND _______ _________---> inf. to the _____/anterior to ______ and upper lat. sacrum- is a firm anchor between ____ and _____/sacrum

L4; 5 quadratus lumborum ilium SIJ L5 ilium

__________ refers to symptoms returning toward the origin of pain or resolving completely

centralization

__________ refers to symptoms of pain or numbness/tingling traveling away from the pain

peripheralization

_______ ________ is the The kinematic relationship between the spine and hips during sagittal plane motions

lumbopelvic rhythm

With lumbopelvic rhythm, pay attention to the pattern and _______ ______ recruitment pattern- this could help address dysfunctions

trunk extensor

Variations for lumbopelvic rhythm: ____° lumbar/ ____° hip (pelvic-on-femoral) Usually 3 phases: ________ flexion; ________ flexion and ______ flexion- mostly hip flexion Limited hip _______ and limited _______ flexion

45; 60 lumbar; lumbar; hip flexion; lumbar

With lumbopelvic rhythm: A normal kinematic strategy used to flex the trunk from a standing position, incorporating a near simultaneous ____ degrees of flexion of the _____ spine and ___ degrees of hip (______-on-______) flexion

45; lumbar; 60 pelvic; femoral

With lumbopelvic rhythm: With limited flexion in the hips (for example, from tight ________), greater flexion is required of the ______and ______ thoracic spines

hamstrings lumbar; thoracic

With lumbopelvic rhythm: With limited lumbar mobility, greater flexion is required of the _____ ______

hip joints

What are the regions SIJ pain can occur?

L5-S3 spinal n. less often L4-S2

Pain with SIJ can occur in the ipsilateral _____ _____ medial ________ ________ long _______ ligaments

lower lumbar buttocks PSIS SIJ

Thoracolumbar fascia plays an important in _______ ________ of the low _____ and _______

mechanical stability back; SIJ

Thoracolumbar fascia is most extensive in the ______ _______

lower back

With the thoracolumbar fascia, the anterior and middle layers are anchored to the _______

TPs

The posterior layers of the thoracolumbar fascia are attched to the _____, ______, lat, and _______

SP; L/S; PSIS

The sacral joint surface is ____-shaped or ____-shaped; vertical, ______, and horizontal long arm

Ear; L short

Sacral articular cartilage is normally ____ and _____

white; smooth

Hyaline cartilage is ___-___ mm

1; 3

With the sacral joint surface, interlocking contours prevent _______ ________ of the scarum

downward gliding

The sacral joint surface has ________ ridges and ______ that are matched by reciprocal shapes on the ______-

irregular; depressions; ilium

The articular surface of the sacrum is twisted _____ _____ _____

from above downwards

The SIJ- ilia side is mainly ____________

fibrocartilage

The SIJ is a ________ joint

synovial

SIJ- the joint capsule has 2 layers, external _____ layer, and inner ______ layer

fibrous; synovial

When the iliac crests move on scarum = ________ motion/ ________

innominate motion; iliosacral

When the sacrum moves on the iliac crests (innominates) = _______ ________

sacroiliac motion

SIJ-sacrum 3 planes of motion: ____/____/____/____

FLX EXT LF ROT

Motion occuring within the pelvis: ______ _____ is full nutation, standing when ______- gravity/ligs/muscles

close packed loaded

Motion occuring within the pelvis: When _____- it is unloaded or ______ ______ the sacrum tends to return to ____________ or less stable

supine; open packed counternutation

Anterior/forward motion or ________ causes _______ of the sacrum

nutation; flexion

Posterior; backward motion or __________ causes _________ of the sacrum

counternutation; extension

Bilateral motion of the sacrum occurs with ______/_______ bending of the trunk

forward; backward

Unilateral motion of the sacrum occurs with _______/_________ of the LE's

flexion; extension

Sacral _________ :is when the sacral base moves posteriorly and superiorly; glides _______ along the long arm and _______ up the short arm

counternutation anteriorly posteriorly

With counternutation of the sacrum, the motion is resited by the _____ ______ ______

long dorsal ligament

Sacral ________: is forward motion of the sacral promontory into the pelvis- coronal axis...________ and ________

nutation anteriorly; inferiorly

With nutation of the sacrum, it glides ________ down the ______ arm and __________ along the ______ arm

inferiorly short posteriorly short

With nutation of the sacrum, the motion is resisted by ______ shape of sacrum, ______/depressions in joint surface, ________ and sacrotuberous ligaments

wedge ridges interosseous

The _____ ramus forms nerves that innervate muscles/joints/skin of the posterior trunk and neck

dorsal

The _______ ramus generally forms nerves to innervate muscles/joints/skin of ant/lat neck, and extremities

ventral

Trunk motion bilaterally is pure _____/______

FLX; EXT

Trunk motion unilaterally adds a component of _____ ______/_____

lat FLX; ROT

3 layers of musculature trunk?

Superficial Intermediate Deep

What are the 5 superficial back muscles?

Trapezius Latissimus Dorsi Rhomboids Levator Scapula Serratus Anterior

What are the 2 intermediate muscles?

Serratus posterior superior Serratus posterior inferior

What are the 3 muscle groups within the deep layer of the muscles?

Erector Spinae Group (spinalis, longissimus, iliocostalis) Transversospinal group (semispinalis muscles, multifidi, rotatores) Short segments group (interspinalis muscles, intertransversarius muscles)

Multifidi Muscle Origin?

Posterior sacrum to C2

Multifidi Muscle insertion?

TP to SP 1 or 2-4 vertebrae above

The multifidi is the ________ and most developed in the _______ region, ___/____ of muscular ________ capacity

thickest lumbar 2/3 stabilizing

The multifidi muscle fills the space between ____/_____

TP; SP

The multifidi muscle has a relatively large ____-_________ area

cross; sectional

The _______ muscles atrophy quickly with injury and P! A. extensor B. flexor C. multifidi

With the multifidi, the ______ and ______ ________ surround them

TA; thoracolumbar fascia

The intermediate layer: is deep to the ________ and _________; it is _____ and helps with __________

rhomboids; lats thin respiration

All superficial and intermediate muscles are considered _________

extrinsic

All superficial and intermediate muscles are innervated by the ______ rami/______

ventral; plexi

The superficial muscle group has bilteral help with _____ AND unilateral with ______ ________/________

EXT Lat Flexion; ROT

The deep muscle group is innervated by the ________ rami and are considered _______

dorsal; intrinsic

The deep layer of muscles become progressively ______ and more ________

shorter; angulated

The ______ _______ experiences a number of morphological and neurophysiological changes following a ____ _____ injury

lumbar multifidus low back

The lumbar multifidus experiences a number of morphological and neurophysiological changes following a low back injury One of these changes is?????

segmental atrophy at the level of pathology *more on the symptomatic side (as quickly as 24hrs. after injury)

With a disc injury, it is called ______ and it's either ______ or ______ _______

HNP; posterior; posterior lateral

With a disc injury, it involves the ______ and fragments of dislodged ______

nucleus; endplates

With a disc injury, the _____ can stay inside ______

NP; AF

With a disc injury, it can _______ or ________ beyond the posterior rim of the ______ _______

bulge; protrude vertebral body

With a disc injury, it can _______ through the ____ (and PLL)

herniate AF

With a disc injury, it can _______ into the ______ space

extrude; epidural

With a disc injury, it can become lodged or break off and that is called _________

sequestration

The greatest injury risk during the sit-up arises if hip flexion occurs without....? This may happen because of lack of _______ _______, ______ ______ dominance, or an inability to flex the ______ _______ (stiff spine)

trunk curl abdominal strength; hip flexor; lumbar spine

When doing a sit-up... Hip flexor without a trunk curl (lumbar flexion) causes dangerous ______ ______ forces from __________ of the lumbar spine

anterior shear hyperextension

Fill in the blanks

abdominal rectus abdominis hip flexor pelvic; femoral

Fill in the blanks

discs; spinal flexion hip flexion

Fill in the blanks

trunk flexion; axial rotation IO rectus abdominis axial rotation

_______ _______: is a separation in the abdomen that occurs when the tissue between the rectus abdominis muscles—the two sides of your “six pack”—stretches or tears at the central vertical line. It's most common in....?

Diastasis Rectus pregnant women

______ _________ is when the portion of the whole movement segment is stabilized

Relative stabilization

Which group of muscles: - Control precise alignment and stiffness - High density muscle spindles - Varying angles act as guidewires

short deep local muscles

Which group of muscles: - Longer muscles - Important torque generators - Provide strong links between regions (cranium/spine/pelvis/legs)

global or extrinsic muscles

When the UE is lifted, it is preceded by ___ ____________

TA contraction

A _______ is when the nucleus migrates but remains contained in annulus

bulge

________ is when the nucleus migrates through the outer annulus

extrusion

_____ ______ is when the nucleus migrates and breaks away from the annulus

free sequestration

The ________ and ________ muscles: -Extremely short length - Crosses only 1 intervertebral junction - Most developed in the cervical region - Bilateral and blends with interspinous ligament - Extension (IS) and lateral flexion (IT) - Rich in muscles spindles – sensory feedback

interspinalis; intertransversarius