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Winter 2023 - Essential Biomechanics and Kinesiology > Axial Skeleton- "Cervical, Thoracic, and Lumbar"- WK13 (Ch9+10) > Flashcards

Axial Skeleton- "Cervical, Thoracic, and Lumbar"- WK13 (Ch9+10) Flashcards

1
Q

Explain the spinal coupling that occurrs in the mid-lower cervical spine.

A

spinal-coupling: movement in one plane associated with movement in another

-Lateral flexion of mid-cervical region is coupled with ipsilateral rotation.

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2
Q

What happens if the transverse ligament of the atlas is ruptured ?

A

The atlas can slip anteriorly relative to the axis and possibly damage the spinal cord.

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3
Q

What happens if the alar ligament is ruptured ?

A

axial rotational instability; loss of A-O and A-A contralateral coupling pattern

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4
Q

Describe the arthrokinematics of the: A-O joint in flexion, extension, rotation, and lateral flexion.

A

flexion: anterior roll and posterior slide
extension: posterior roll and anterior slide
rotation: not much movement
lateral flexion: RT= RT roll, LT slide; LT= LT roll and RT slide

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5
Q

Describe the arthrokinematics of the: A-A joint during flexion, extension and horizontal plane motion

A

flexion and extension: tilting
rotation: atlas slides in rotary movement

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6
Q

Describe the arthrokinematics of the: C2-7 joints during flexion, extension, horizontal plane motion

A

flexion: slide superior and anterior
extension: slide inferior and posterior
rotation: the inferior facets slide posterior and slightly inferiorly on the same side of rotation and anterior and slightly superiorly on the side opposite the rotation.

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7
Q

Protraction causes _________ of the mid-lower cervical spine and __________ of the upper cervical spine. Retraction causes____________ of the mid-lower cervical spine and ____________ of the upper cervical spine.

A

flexion, extension

extension, flexion

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8
Q

Your patient has limited cervical rotation ROM. Write a goal for this patient to achieve the functional ROM needed to look at their blind spots while driving.

A

the patient will achieve 30 degrees of cranial rotation within 4 weeks to adequately check their blindspots.

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9
Q

Upper cervical rotation and extension stretches which vertebral artery ?

A

contralateral

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10
Q

Why doesn’t the upper cervical spine follow the natural coupling pattern of the rest of the cervical spine ?

A

because A-O and A-A joints act independently, as in they’re not obligated by their facets. This helps to keep eyes forward during neck movement.

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11
Q

What happens at the A-A joint during lateral flexion of C2-7?

A

A-A contralateral rotation

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12
Q

What happens at the A-O joint during C2-7 cervical rotation ?

A

A-O contralateral flexion

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13
Q

How could you position a patient’s neck to alleviate pressure on an inflamed nerve in the right C5 IVF ?

A

position neck in flexion, contralateral lateral flexion, and axial rotation to the left.

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14
Q

OIIA: SCM

A

O:Lateral surface of mastoid process of temporal bone and lateral half of superior nuchal line
I:Sternal head: anterior surface of manubrium of sternum
Clavicular head: superior surface of medial third of clavicle
I:Spinal accessory nerve (CN XI, motor); C3 and C4 nerves (pain and proprioception)
A:Unilateral contraction: tilts head to same side (i.e., laterally flexes neck) and rotates it so face is turned superiorly toward opposite side
Bilateral contraction: (1) extends neck at atlanto-occipital joints , (2) flexes cervical vertebrae so that chin approaches manubrium, or (3) extends superior cervical vertebrae while flexing inferior vertebrae, so chin is thrust forward with head kept level
With cervical vertebrae fixed, may elevate manubrium and medial ends of clavicles, assisting pump-handle action of deep respiration

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15
Q

OIIA: Anterior Scalene

A

O:Transverse processes of C3–C6 vertebrae
I:1st rib
I:Cervical spinal nerves C4–C6
A:Flexes neck laterally; elevates 1st rib during forced inspirationa

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16
Q

OIIA: Middle Scalene

A

O:Posterior tubercles of transverse processes of C5–C7 vertebrae
I:Superior surface of 1st rib; posterior to groove for subclavian artery
I:Anterior rami of cervical spinal nerves
A:Flexes neck laterally; elevates 1st rib during forced inspirationa

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17
Q

OIIA: Posterior Scalene

A

O:Posterior tubercles of transverse processes of C5–C7 vertebrae
I:External border of 2nd rib
I:Anterior rami of cervical spinal nerves C7 and C8
A:Flexes neck laterally; elevates 2nd rib during forced inspirationa

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18
Q

OIIA: Longus Colli

A

O:Anterior tubercle of C1 vertebra (atlas); bodies of C1–C3 and transverse processes of C3–C6 vertebrae
I:Bodies of C5–T3 vertebrae; transverse processes of C3–C5 vertebrae
I:Anterior rami of C2–C6 spinal nerves
A:Flexes neck with rotation (torsion) to opposite side if acting unilaterally

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19
Q

OIIA: Longus Capitis

A

O:Basilar part of occipital bone
I:Anterior tubercles of C3–C6 transverse processes
I:Anterior rami of C1–C3 spinal nerves
A:Flex head

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20
Q

OIIA: Rectus Capitis Anterior

A

O:Base of cranium, just anterior to occipital condyle
I:Anterior surface of lateral mass of atlas (C1 vertebra)
I:Branches from loop between C1 and C2 spinal nerves
A:Flex head

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21
Q

OIIA: Rectus Capitis Lateralis

A

O:Jugular process of occipital bone
I:Transverse process of atlas (C1 vertebra)
I:Branches from loop between C1 and C2 spinal nerves
A:Flexes head and helps stabilize it

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22
Q

OIIA: Splenius Capitis

A

O:Lateral aspect of mastoid process and lateral third of superior nuchal line
I:Inferior half of nuchal ligament and spinous processes of superior six thoracic vertebrae
I:Posterior rami of middle cervical spinal nerves
A:Laterally flexes and rotates head and neck to same side; acting bilaterally, extends head and neck

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23
Q

OIIA: Obliquus Capitis Superior

A

O:Transverse process of vertebra C1
I:Occipital bone between superior and inferior nuchal lines
I: Suboccipital nerve
A: head extension and rotation

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24
Q

OIIA:Obliquus Capitis Inferior

A

O:Posterior tubercle of posterior arch of vertebra C2 (axis)
I:Transverse process of vertebra C1 (atlas)
I: Suboccipital nerve
A: head extension and rotation

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25
Q

OIIA: Rectus Capitis Posterior Major

A

O:Spinous process of vertebra C2
I:Lateral part of inferior nuchal line of occipital bone
I: Suboccipital nerve
A: head extension and rotation

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26
Q

OIIA: Rectus Capitis Posterior Minor

A

O:Posterior tubercle of posterior arch of vertebra C1 (atlas)
I:Medial part of inferior nuchal line of occipital bone
I: Suboccipital nerve
A: head extension and rotation

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27
Q

OIIA: Splenius Cervicis

A

O:Nuchal ligament and spinous processes of C7–T6 vertebrae
I:tubercles of transverse processes of C1–C3 or C4 vertebrae
I:Posterior rami of spinal nerves
A: Acting unilaterally: laterally flexes the neck and rotates the head to side of active muscles
Acting bilaterally: extend the head and neck

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28
Q

Which muscles would you want to train for neck stability ? What exercises would activate these muscles ?

A

Levator Scapulae, Scalenes, SCM, Trapezius

Neck extensions,flexions, lateral flexions

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29
Q

Why do osteophytes develop in the cervical spine and how do they affect other structures ?

A

dehydrated discs lead to uncinate joint contact, force leads to osteophyte development. Could compress nerve root.

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30
Q

Explain the effects of whiplash on structures of the neck.

A

-ALL Injury; strain to alar ligaments, longus colli and capitis, ant. viscera
- compressed discs, facets.

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31
Q

What is regional interdependence ?

A

One muscle’s action depends on the stabilization force of another.
Like when Upper trap is dependent on longus colli.

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32
Q

Describe the arthrokinematics of the thoracic facets during: flexion, extension, rotation, and lateral flexion

A

flexion: superior and anterior sliding of inferior facets
extension: inferior and posterior sliding of inferior facets
rotation: facets slide contralaterally
lateral flexion: ipsilateral facet slide inferior; contralateral facet slides superior

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33
Q

OIIA: Iliocostalis

A

O:Arises by a broad tendon from the posterior part of the iliac crest, posterior surface of the sacrum, sacro-iliac ligaments, sacral and inferior lumbar spinous processes, and supraspinous ligament
I:Iliocostalis: lumborum, thoracis, cervicis; fibers run superiorly to angles of lower ribs and cervical transverse processes.
I:Posterior rami of spinal nerves
A: Acting bilaterally: extend vertebral column and head; as back is flexed, control movement via eccentric contraction
Acting unilaterally: laterally flex vertebral column

34
Q

OIIA: Longissimus

A

O:Arises by a broad tendon from the posterior part of the iliac crest, posterior surface of the sacrum, sacro-iliac ligaments, sacral and inferior lumbar spinous processes, and supraspinous ligament
I:Longissimus: thoracis, cervicis, capitis; fibers run superiorly to ribs between tubercles and angles to transverse processes in thoracic and cervical regions and to mastoid process of temporal bone.
I:Posterior rami of spinal nerves
A: Acting bilaterally: extend vertebral column and head; as back is flexed, control movement via eccentric contraction
Acting unilaterally: laterally flex vertebral column

35
Q

OIIA: Spinalis

A

O:Arises by a broad tendon from the posterior part of the iliac crest, posterior surface of the sacrum, sacro-iliac ligaments, sacral and inferior lumbar spinous processes, and supraspinous ligament
I:Spinalis: thoracis, cervicis, capitis; fibers run superiorly to spinous processes in the upper thoracic region and to cranium.
I:Posterior rami of spinal nerves
A:Acting bilaterally: extend vertebral column and head; as back is flexed, control movement via eccentric contraction
Acting unilaterally: laterally flex vertebral column

36
Q

OIIA: Semispinalis

A

O:Semispinalis: arises from transverse processes of C4–T12 vertebrae
I:Semispinalis: thoracis, cervicis, capitis; fibers run superomedially to occipital bone and spinous processes in thoracic and cervical regions, spanning 4–6 segments.
I:Posterior rami of spinal nerves
A:Semispinalis: extends head and thoracic and cervical regions of vertebral column and rotates them contralaterally

37
Q

OIIA: Multifidi

A

O:Multifidus: arises from posterior sacrum, posterior superior iliac spine of the ilium, aponeurosis of erector spinae, sacro-iliac ligaments, mammillary processes of lumbar vertebrae, transverse processes of T1–T3, articular processes of C4–C7
I:Multifidus: thickest in lumbar region; fibers pass obliquely superomedially to entire length of spinous processes, located 2–4 segments superior to proximal attachment.
I:Posterior rami of spinal nervesa
A:Multifidus: stabilizes vertebrae during local movements of vertebral column

38
Q

OIIA: Rotatores

A

O:Rotatores: arises from transverse processes of vertebrae; best developed in thoracic region
I:Rotatores: fibers pass superomedially to attach to junction of lamina and transverse process or spinous process of vertebra immediately (brevis) or 2 segments (longus) superior to vertebra of attachment.
I:Posterior rami of spinal nerves
A:Rotatores: stabilizes vertebrae and assist with local extension and rotatory movements of vertebral column; may function as organs of proprioception

39
Q

OIIA: Interspinalis

A

O:Superior surfaces of spinous processes of cervical and lumbar vertebrae
I:Inferior surfaces of spinous processes of vertebra superior to vertebra of proximal attachment
I:Posterior rami of spinal nerves
A:Aid in extension and rotation of vertebral column

40
Q

OIIA: Intertransversarii

A

O:Transverse processes of cervical and lumbar vertebrae
I:Transverse processes of adjacent vertebrae
I:Posterior and anterior rami of spinal nerves
A:Aid in lateral flexion of vertebral column; acting bilaterally, stabilize vertebral column

41
Q

OIIA: Rectus Abdominis

A

O:Pubic symphysis and pubic crest
I:Xiphoid process and 5th–7th costal cartilages
I:Thoraco-abdominal nerves (anterior rami of T6–T12 spinal nerves)
A:Flexes trunk (lumbar vertebrae) and compresses abdominal viscera; stabilizes and controls tilt of pelvis (anti-lordosis)

42
Q

OIIA: External Oblique

A

O:External surfaces of 5th–12th ribs
I:Linea alba, pubic tubercle, and anterior half of iliac crest
I:Thoraco-abdominal nerves (T7–T11 spinal nerves) and subcostal nerve
A:Compresses and supports abdominal viscerab and flexes and rotates trunk

43
Q

OIIA: Internal Oblique

A

O:Thoracolumbar fascia, anterior two thirds of iliac crest, and connective tissue deep to lateral third of inguinal ligament
I:Inferior borders of 10th–12th ribs, linea alba, and pecten pubis via conjoint tendon
I:Thoraco-abdominal nerves (anterior rami of T6–T12 spinal nerves) and first lumbar nerve
A:Compresses and supports abdominal viscerab and flexes and rotates trunk

44
Q

OIIA: Transversus Abdominis

A

O:Internal surfaces of 7th–12th costal cartilages, thoracolumbar fascia, iliac crest, and connective tissue deep to lateral third of inguinal ligament
I:Linea alba with aponeurosis of internal oblique, pubic crest, and pecten pubis via conjoint tendon
I:Thoraco-abdominal nerves (anterior rami of T6–T12 spinal nerves) and first lumbar nerve
A:Compresses and supports abdominal viscerab

45
Q

OIIA: Psoas Major

A

O:Transverse processes of lumbar vertebrae; sides of bodies of T12–L5 vertebrae and intervening intervertebral discs
I:By a strong tendon to lesser trochanter of femur
I:Anterior rami of lumbar nerves L1, L2, and L3
A:Acting inferiorly with iliacus, it flexes the thigh; acting superiorly, it flexes the vertebral column laterally; it is used to balance the trunk; when sitting, it acts inferiorly with the iliacus to flex the trunk

46
Q

OIIA: Iliacus

A

O:Superior two thirds of iliac fossa, ala of sacrum, and anterior sacro-iliac ligaments
I:Lesser trochanter of femur and shaft inferior to it and to psoas major tendon
I:Femoral nerve (L2–L4)
A:Flexes thigh and stabilizes hip joint; acts with psoas major

47
Q

OIIA: QL

A

O:Medial half of inferior border of 12th ribs and tips of lumbar transverse processes
I:Iliolumbar ligament and internal lip of iliac crest
I:Anterior branches of T12 and L1–L4 nerves
A:Extends and laterally flexes vertebral column; fixes 12th rib during inspiration

48
Q

What is the flexion-relaxation phenomenon and how does it adversely affect the lumbar spine ?

A

When the erector spinae cease electric eccentric control during trunk flexion; passive tissues are then thought to provide enough resistance to further flexion.

A flexed and relaxed spine cannot resist anterior shear causing damage.

49
Q

How is psoas major unique in its line of force throughout the lumbar spine in the sagittal plane?

A

distally psoas can increase lumbar lordosis, can extend upper lumbar spine. However, as a whole it is a vertical stabilizer as its superior line of force passes posterior to frontal axis.

50
Q

What pathology can occur at the T-L junction ?

A

hypermobility of the T-L junction due to changing facet direction ( frontal to sagittal)

traumatic paraplegia; if large flexion torque delivered at transition

51
Q

How is scoliosis named ?

A

side of convexity

52
Q

What is the difference between structural and functional scoliosis ?

A

strucutral: fixed; young F>M; cannot be corrected
Functional: corrected w/ postural shift.

53
Q

What kind of coupling occurs with structural scoliosis ?

A

contralateral spinal coupling; right lateral flexion=left rotation; rib hump on side of convexity.

54
Q

How does thoracic kyphosis affect the moment arm created by the line of gravity ?

A

increased EMA

55
Q

What affect does thoracic kyphosis and an increased EMA have on structures of the spine and thorax ?

A

adaptive shortening of lax ligaments, disc stress, impacts inspiration, vital capacity, and balance

56
Q

Describe lumbar facet arthrokinematics for the following motions: flexion, extension, rotation, lateral flexion

A

flexion: superior and anterior sliding of inferior facets
extension: inferior and posterior sliding of inferior facets
rotation: ipsilateral facets seperate contralateral facets get closer
lateral flexion: ipislateral facet slides down; contralateral slides up

57
Q

What happens to the contact area and contact pressure of the lumbar facets at extremes of flexion and extension ?

A

at extremes of flexion and extension the sharp lumbar facets poke into the adjacent lamina region. At extremes of flexion paradoxically increases contact pressure while minimizing contact area of facets.

58
Q

How does lumbar flexion affect the IVF and nerve roots ? discs ?

A

expands IVF

could cause posterior migration of discs which could impinge nerve roots, this is an HNP

59
Q

What position will reduce pressure on the lumbar discs ?

A

“full sustained” lumbar extension

60
Q

Describe proper lumbopelvic rhythm during forward bending.

A

45 degrees of lumbar flexion + 60 degrees of hip flexion

61
Q

What are the consequences of limited hip flexion ?

A

Compensation by the lumbar spine and consequent stress on joints and tissues

62
Q

What are the consequences of limited lumbar flexion ?

A

Compensation by the hip which requires more juice from hip extensors, causing hip compression.

63
Q

Describe proper lumbopelvic rhythm during return from forward bending.

A

early phase dominated by hip extensors and middle late phase is when the lumbar extensors kick in.

64
Q

How does the T-L fascia help to stabilize the lumbar spine ?

A

via muscular attachments

65
Q

How do transversus abd. and internal obliques help to stabilize the lumbar spine ?

A

By anticipating contractions; feedforward mechanism to decrease counter-movement; connect to T-L fascia

66
Q

What happens to the multifidi in patients with low back pain ?

A

increased fat content, atrophy, and neuromuscular inhibition

67
Q

What muscles would you want to strengthen to increase lumbar stability? and what exercises would be best ?

A

Trans. abd. internal obliques, multifidi

ab exercises; crunches, rotational crunches, back extensions

68
Q

How does anterior pelvic tilting affect the lumbar spine ?

A

accentuation of lumbar lordosis

69
Q

What happens at the L5-S1 junction ?

A

anterior inclination that leads to shear force which is worsened by an anterior pelvic tilt.

70
Q

Which structures resist anterior shear in the lumbosacral region?

A

ALL, discs, facet capsules, iliolumbar ligament

71
Q

What is a spondylolisthesis ?

A

anterior displacement of vertebrae relative to another.

72
Q

What lumbar motion would want to avoid with a spondylolsithesis ?

A

extension/lordosis

73
Q

How does posterior pelvic tilting affect the lumbar spine ?

A

decrease lordosis

74
Q

Which muscles form force couples for pelvic tilting when the lumbar spine is stabilized ?: anterior tilt

A

hip flexor and back extensors

75
Q

what happens to the lumbar spine if the hip flexors are too tight ?

A

increased lordosis

76
Q

Which muscles form force couples for pelvic tilting when the lumbar spine is stabilized ?: posterior tilt

A

hip extensors and abdominals

77
Q

What is the difference between a disc protrusion, extrusion, and sequestration ?

A

protrusion: nucleus still within annulus
extrusion: nucleus herniates through annulus
sequestration: nuclear material stuck in epidural space

78
Q

What are some causes for disc bulging ?

A

sustained lumbar flexion, low magnitude forces over years, sudden strenous event

79
Q

How can a disc bulge resolve without specific intervention ?

A

macrophage release resorbs disc

80
Q

Where does disc related pain come from ?

A

The disc itself or consequences of an HNP, damage to innvervations periphery, PLL, or end plates or neural tissue

81
Q

What is peripheral sensitization ?

A

when pain is amplified by inflammatory markers like cytokines, mast cells etc. nociceptors also invade region causing pain

Winter 2023 - Essential Biomechanics and Kinesiology (16 decks)

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