Basic Science Concepts and Applied Chiropractic Principles Flashcards
Cervical vertebra characteristics: C1 C2 axis epistropheus C7 vertebra prominens Facets
Transverse foramina, bifid spinous, rectangular body
no body, large lateral mass, A+P arches and tubercles
Dens
Long, non-bifid spinous, absent anterior tubercle
45o BUM, transverse, rotation
Thoracic vertebra characteristics:
Facets
Costal facets on body, heart-shaped body, sloping spinous process
60o BUL coronal for lateral bend
Lumbar vertebra characteristics:
Facets
Kidney-shaped body, mammillary and accessory processes
90o BM sagittal for flex/ext
Sacral characteristics:
Facet
5 fused vertebra in shape of triangle
90o B, coronal for lat bend
Alar/check ligament:
Posterior dens to medial occipital condyles; limits contralateral axis rotation around dens
Apical ligament:
Apex of dens to anterior edge of foramen magnum
ALL:
Sacrum to base of occiput, thick, strong, prevents hyperextension
Cruciate ligament:
Superior and inferior parts; C2 to occiput; btw coliculi atlantis to limit lateral translation and flexion of the neck
Interspinous ligament:
Btw adjacent spinouses prevent posterior translation
Intertransverse ligament:
Btw adjacent TVP to limit lateral bend
Ligamentum flavum:
Btw adjacent laminae, elastin to prevent buckling in extension
Ligamentum nuchae:
Continuation of supraspinous ligament from C7 to EOP
Posterior atlanto-occipital membrane:
Btw posterior arch of C1 and occiput may be calcified resulting in posterior ponticle
PLL:
C2 to sacrum thin and weak to prevent hyperflexion
Supraspinous:
Connects tips of spinous process from C7 to S5 limits flexion
Tectorial membrane:
Continue PLL beyond body of C2 to anterior foramen magnum
IVD features:
Fibrocartilage tissue btw endplates and attached to them with Sharpey fibers with an annulus fibrosis made of 15-20 concentric laminae made of Type 1 collagen fibers which are 65o to horizontal and alternating ad a nucleus pulposus with T2 collagen fibers and proteoglycans
Innervated by sinuvertebral N and gray sympathetic rami
Interverteral foramen boundaries:
Contents?
Superior: pedicle and inferior vertebral notch of vertebra above
Inferior: Pedicle and superior vertebral notch of vertebra below
Anterior: Postlat adjacent vertebral body, IVD, disc protrustion or large posterior osteophytes encroach
Posterior: Ant facet joint and capsule, hypertrophic ligament flavum and osteophytes from facet can encroach
Content: Spinal N, NR, DRG, spinal A/V, 2-4 sinuvertebral nerves, transforaminal ligaments and CT
Sinuvertebral N aka Recurrent meningeal N
Supplies PLL, posterior dura, posterior outer 1/3 of disc, perisoteum of nearby bone
Spinal canal:
Foramen magnum to bottom of sacrum
Posterior to vertebral bodies and anterior to neural arches
SC, N, meninges, CSF, BV and CT inside
Smallest in T spine, larges in C spine
Triangular in cervical and lumbar, oval in thoracic
Vertebral A Parts, termination, most vulnerable where?
Subclavian A to transverse foramen C6, then transverse foramina C6-C1, Behind lateral mass and up to foramen magnum
Then foramen magnum to basilar A
Most vulnerable in Part 3 with exreme rotation and hperextension
Circle of Willis:
Two vertebral A form Basilar to posterior cerebral A
Internal carotids to anterior cerebral connected by anterior communicating A
Posterior communicating A connect internal carotid to posterior cerebral arteries (occipital lobe and inferior temporal lob)
Middle cerebral MC affected in stroke (frontal, parietal, superior temporal lobes - Broca and internal capsule)
PICA is a branch of vertebral and supplies lower posterior cerebellum and lateral medulla
Hyperextension and rotation of upper cervicals can damage vertebral A –> Wallenberg’s syndrome (dysphage, dysarthria, ipsilateral Horner’s, ipsilateral loss of pain and temperature in face and contralateral loss of pain and temperature in rest of body)
Suboccipital triangle boundaries, roof, floor, contents:
All muscles spllied by?
Boundaries: rectus capitis posterior major (SP C2-occiput), obliquus capitis superior (TVP C1-Co), obliquus capitis inferior (SP C2 to TVP C1)
Roof: deep fascia covered by semispinalis capitis
Floor: posterior arch of C1
Contents: 3rd part of vertebral A, suboccipital N C and suboccipital V
Dorsal ramus C1 of suboccipital N
Nerve fiber, innervation, function A-alpha A beta A gamma A delta B C
Aa-motor (to skeletal muscle)
Ab-sensory (touch, vibration, 2pt touch discrimination)
Ag-motor (to muscle spindle)
Ad - sensory (Fast pain, temperature, crude touch)
B - autonomic preganglionic autonomic fibers
C - ANS and sensory - postganglionic slow pain
Sensory fiber, N fiber, ex, rate of adaptation Ia Ib II III IV
Aa muscle spindle afferent slow adapt
Aa GTO slow adapt
Ab Pacinian corpuscle; respond to vibration, rapid
Ag Receptor for touch, pressure, fast pain, rapid
C free nerve ending; pain, temperature slow
Mechanoreceptor location type sensitive to fast/slow Ruffini Pacinian GTO FNE Meissner Merkel Muscle spindle
Ruffini joint, I, stretch, slow
Pacinian joint and skin, II, vibration, rapid
GTO joint III, stretch, slow
FNE joint and skin IV, stretch and pain, rapid
Meissner skin – texture rapid
Merkel skin – pressure slow
Muscle spindle muscle – stretch slow
Dorsal column
Ascending Mechanoreceptors (vibration/fine touch) --> nuclei gracilis/cuneatus X in medulla --> VPL nucleus of thalamus
Spinothalamic anterolateral system
Nociceptors (thermoreceptors, crude touch, pressure) –> Lamina I and II in dorsal horn of grey matter X in SC –> VPL nuclus of thalamus
Dorsal spinocerebellar
Unconscious proprioception from lower limb –> Clarke’s nucleus (dorsal) found in Lamina VII in thoracic) –> stays ipsilateral to cerebellum via inferior peduncle
Ventral spinocerebellar
Unconscious proprioception from lower and upper limb –> Lamin VII X @SC + @pons so ipsilaterl cerebellum via superior cerebellar peduncle
Lateral corticospinal
Voluntary control of muscles in limbs
Ventral corticospinal
Voluntary control of muscles in head, neck, trunk
Rubrospinal
Excites proximal flexors (biceps) inhibits extensors in upper limb
Reticulospinal
Restricts voluntary movements through gamma motor neurons
Tectospinal
Influences head and eye turning reflexes in response to light
Vestibulospinal
Involved in postural reflexes, neck muscles, extensors of back and limbs
Raphespinal
Inhibits nociception by releasing serotonin and acts on C fibers
Rexed Laminae I II III and IV V VII VIII and IX X
Caps dorsal horn, below dorsolateral tract of Lissauer; carries pain
Substantia gelatinosa;releases substance P
Nucleus proprius; carries mechanoreception and crude touch
Contains neurons that responds to noxious and visceral afferent stimuli
Contains Clarke’s nucleus and intermediolateral horn
Contains motor neuron groups in ventral horn
Gray matter surrounding central canal of spinal cord
Compare sympathetic to parasymathetic
Sympathetic: T1-L2, paravertebral gnanglia, posterior hypothalamic nuclei origin, short preganglionic fibers, long postganglionic,secrete epinephrine, cause vasodilation of coronary blood vessels, dilate pupils, increae heart rate and force, decrease secretions, and gut motility, contract gut sphincter bladder sphincter and skinblood vessels, relax bladder wall and bronchial mooth muscle increase sweat production and increase secretions
Parasympathetic: CN 3, 7, 9, 10 and S2-4, enteric ganglia, originate in anterior hypothalamic nuclei, long preganglionic and short postganglionic fibers, secreteacetylcholine, casoconstrict coronary blood vessels, constrict pupils, slow heart rate and force, increase secretions, gut mobility, relax gut sphincter and bladder sphincter, contract bladder wall and bronchialsmooth muscle
Pain-withdrawal reflex relation to cross extensor
Afferent arm carries sensory impulses from naked nerve endings in skin to dorsal horn of spinal cord where it synapses w/interneuron which synapses w/alpha motor neuron in anterior horn of spinal cord connected to flexor to pull away
Efferent arm causes extensor of affected limb to relax X extensor causes extensor muscles in opposite limb to contract to balance body
Somatovisceral
Alteration in spine results in visceral activity
Subluxation of T7 result is dyspepsia or pinching skin of neck cause dilation of pupil in affected side
Viscervisceral
Alteration in gut results in visceral activity
Compression of carotid sinus in neck drops BP and slows heart
Viscerosomatic
Alteration in gut results in somatic activity
Gallbladder inflammation may result in spasm of paraspinal muscles or shoulder pain
Anterior motion segment is made of?
Two vertebral bodies separated by an intervertebral discs
Posterior motion segment is made of?
Articular facts and synovial membranes full of nociceptors and mechnoreceptors
Luschka/uncovertebral joint:
Uncinates fromsuperior aspect of vertebral bodies and corresponding areas on inferolateral surfaces on adjacent vertebral bodies; degenerative changes in spine in older people to limit lateral translation
Coupling
Cervical: lateral flexion coupled with rotation of body in transverse plane to same side; so spinous process deviates to opposite (convex) side when neck is bent
Lumbar: Lateral flexion with axial rotation of body along transverse plane to opposite side so spinous deviates to same (concave) side
Hysteresis
Loss of energy in form of het during repetitive loading and unloading of viscoelastic substances in same way bending a wire back and forth generates heat
Bell-Magendie law
Anterior horn of spinal cord is motor, while posterior is sensory
Davis law
Soft tissue remodels itself in response to demands; for example when foot is held in pronation long enough soft tissue on one side will stretch and mucles on side shorten
Heuter-Volkman law
Pressure on epiphysis retard rate of growth and decreased pressure increases rate of growth
Hilton’s law
Nerve that innervate a muscle that acts on a joint also innervate joint and area of skin near the joint
Empty vs soft vs firm vs hard end feel
Empty: stop due to request of pt due to pain
Soft: stopped due to compression of soft tissue like edema or effusion
Firm: stop when capsule reached limit of stretch
Hard: stop when bone reaches bone
Spina bifida vs occulta vs with meningocele vs with rachischisis
Bifida: ossification centers that form vertebral arch fail to develop leading to absence of arch
Occulta: tuft of hair and dimple over defective arch hidden beneath normal skin
Meningocele: meninges protrude through defect in vertebral arch
Rachischisis: Caudal end of neural tube doesn’t close
Subluxation descriptions Functional pathological traumatic Defect Fixation Hypermobile
Functional: slight malpositin w or w/o fixation w/normal articular integrity
pathological: malposition and fixation due to degenerative articular changes
traumatic: Due to external mechanical forces accompanied by muscle spasm
Defect Resulting from a congenital defect
Fixation hypomobile spinal segment
Hypermobile damage to spinal unit resulting in increased obility
Types of fixation
I: muscular due to hypertonicity of muscle
II: ligamentous due to shortening of ligaments around a joint
III: capsular/articular: due to shortening of capsule or development of intra-articular adhesions
IV: bone due to development of osteophytes
Five Component model of vertebral subluxation by Faye
Neuropathophysiological: Irritation of nerve leads to sensory or motor changes, compression leads to degeneration and muscle atrophy, lack of oxygen causes change in nerve function, little pressure is needed to change interneural blood flow and axonal transport, axoplasmic aberration alters growth and homeostasis of nerve
Kinesiopathological: hypo/hypermobility, aberrant motion, loss of joint play
Myopathological (myology): muscle spasm or atrophy
Histopathological: hypoxia, anoxia, ischemia causes inflammation
Biochemical: release of histamine, PG, kinins
The adjustment causes discharge among which fibers to inhibit pain?
A beta
Chromium use? deficiency?
Glucose transport
Impaired glucose tolerance
Copper use? deficiency?
ETC
Muscle weakness and microcytic anemia
Folic acid use? deficiency?
DNA and RNA synthesis
Neural tube defects, microcytic normochromic anemia
Iodine use? deficiency?
Thyroid hormone synthesis
Cretinism, goiter, myxedema
Iron use? deficiency?
Formation of hemoglobin ETC
Pale mucosa, koilonychia, microcytic hypochromic anemia
Magnesium use? deficiency?
ATP complexes
Paresthesia and muscle cramps
Niacin B3 use? deficiency?
Precursor for NAD(P)
Dermatitis, diarrhea, dementia
Riboflavin B2 use? deficiency?
Cofactor for FADH
Fatigue, cheilosis, magenta-coloured tongue
Selenium use? deficiency?
Protection from free radicals
Heart failure due to cardiomyopathy
Thiamine B1 use? deficiency?
Cofactor in pyruvate kinase
Dermatitis, paresthesia, heart failure or Korsakoffs psychosis
Vitamin B12 use? deficiency?
Synthesis of DNA, methionine and succinyl CoA
Beef-red tongue, paresthesia, sensory ataxia (damage of dorsal columns) w/accumulation of homocysteine
Vitamin C use? deficiency?
Hydroxylation of proline in synthesis of collagen
Bleeding swollen gums, poor wound healing, loose teeth due to defective collagen synthesis
Zinc use? deficiency?
Carbonic anhydrase cofactor
Alopecia, poor wound healing, hypogonadism
Vegans
Weigh less, lower cholesterol, lower risk of CVD and cancer
Deficiencies in calcium, iron B12, D, Zn need supplement to avoid decrease bone mass and anemia
Gastric bypass
Lose weight to reverse diabetes but may risk B12 deficiency
Excessive homocysteine linked to
CVD, osteoporosis, diabetes and some forms of dementia
