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My BOC > Chapter 25 - The Spine > Flashcards

Chapter 25 - The Spine Flashcards

1
Q

facet joint dysfunction

A

localized pain over the joint, can be acute or insidious onset. pain in all movements other than flexion.

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2
Q

suspect facet joint dysfunction, what tests should be performed. what other injuries need to be ruled out?

A

disc lesions, spondy, stenosing etc

perform tests for disc lesions such as quadrant, valsalva, tension signs, SLR test, etc.

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3
Q

Pain patterns and symptoms of facet joint dysfunction

A

pain in all movements except flexion
spasming muscles
may be degenerative in nature causing nerve entrapment and associated problems

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4
Q

Lumbar Disc Pathology

A

rupture - acute onset

can also be degenerative

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5
Q

lumbar disc pathology pain patterns

A

pain at disc area - also pain along spinal nerve root.
paint down low back and through butt and thigh, possibly into the food
may be limited in all motions

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6
Q

when suspecting lumbar disc problem, what tests?

A

valsalva, SLR test, well cross SLR, milligram’s, tension signs, femoral nerve tension sign,
-tests that cause stretching nerve, or look for ‘space occupying lesion’

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7
Q

disc lesion - what imaging

A

MRI

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8
Q

DDx for disc lesion

A

spondy, stenosis, prirformis syndrome, facet joint dysfunction

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9
Q

Lordosis

A

increase curvature of lumbar

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10
Q

Kyphosis

A

increase curvature of thoracic

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11
Q

briefly describe the anatomy of the spine

A 
cervical, thoracic, lumbar, sacrum, cocyx
7 C
12 T
5 L
33 vertebrae

lordotic curve
kyphotic curve
lordotic curve

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12
Q

articulation between the vertebral bodies is what type of joint? what movements occur here

A

cartilaginous

forward gliding, lateral gliding, compression and distraction

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13
Q

facet joints in the vertebrae are what type of joint?

A

synovial joint.

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14
Q

name the major ligaments of the spine. what movements do they restrict?

A

anterior longitudinal - restrict extension
posterior longitudinal - restrict flexion
supraspinous - attaches at every spinous process - limits flexion and rotation of the spine

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15
Q

muscles that extend the spine

A

erector spinae

  • iliocostalis
  • longissimus
  • spinalis
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16
Q

spinal cord anatomy

A

extends from foramen magnum to L1-L2 where it forms the caudal equina

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17
Q

how many pairs of spinal nerves

A

31

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18
Q

roots of nerves

A

anterior (motor)

posterior (sensory)

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19
Q

injuries occurring above L3 - what must one worry about?

A

spinal cord damage

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20
Q

name the plexuses and the nerves they involve

A 
Cervical ( C1-C4 )
Brachial (C5-T1)
Lumbar (L1-L4)
Sacral (L4-S4)
Coccygeal (S4-S5)
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21
Q

name the nerves of brachial plexus

A 
axillary 
radial 
msuculocutaneous 
ulnar 
median
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22
Q

axillary - perform nerve test

A

abudcts arm , laterally rotates arm

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23
Q

radial - perform nerve test

A

extends/flexes elbow
extends writs and fingers
thumb muscles

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24
Q

musculotaneous perform nerve test

A

flexes arm, and forearm

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25
Q

ulnar - perform nerve test

A

flexes wrist and fingers, abducts/adducts fingers

thumb muscle - palmar muscles

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26
Q

median perform nerve test

A

pronates,
flexes wrist and fingers
-thumb musclse and thenar/palmar muscles

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27
Q

movements of the vertebral column

A

flexion, extension, lateral flexion, rotation

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28
Q

trunk rotation

A

external/internal obliques

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29
Q

lateral flexion

A

quadratus lumborum, obliques, lats, iliopsoas, rectus abdominus on involved side

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30
Q

flexion

A

75% occurs at lumbosacral joint
lengthening of deep and superficial back muscles
contraction of abs, obliques and hip flexors

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31
Q

football helmets do not protect against what?

A

neck injuries

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32
Q

what is spearing?

A

athlete uses the helmet as a weapon by striking the opponent with its top

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33
Q

most serious football cervical injuries result from what MOI?

A

axial loading while spearing

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34
Q

neck flexion at the time of contact can cause what type of injuries

A

fracture or dislocation

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35
Q

most catastrophic diving accidents happen in how deep of water

A

less than 5 feet with arms not extended in front of face

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36
Q

read NATA positions statement on head down tackiling and spearing

A

now

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37
Q

managing low back pain

A

avoiding stress, correcting biomechanics, correct lifting techniques, core stabilization

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38
Q

when taking the history of the spine, what is most critical to know? give examples of questions

A

if the spinal cord was damaged

  • what happened?
  • did you hit someone with or land directly on top of your head?
  • were you knocked out or unconscious?
  • pain in your neck? tingling or numbness anywhere?
  • equal muscle strength in hands?
  • unable to move ankle or toes?
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39
Q

what are you looking for in the observation portion of a spinal evaluation

A 
posture abnormalities
look from all angles
kyphosis
forward head
swayback - anterior shifting of the pelvis
lordosis
scoliosis
flatback
level shoulders, symmetry
-ask the patient to perform all movements - note painful ones
-level pelvis
-unusual curve in lumbar area
-sitting, standing, and lying
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40
Q

common cause of thoracic pain

A

dysfunction of joints - usually facet joint

-associated with increased pain when placing chin on chest

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41
Q

Trendelenburg Test

A

tests for glute med weakness
-lift uninvolved leg
positive test: pelvis lowers on non-weight bearing side

nerve root impingement, damage to nerve, muscle weakeness

42
Q

Thomas Test

A

Hip flexor tightness - supine
if leg cannot be brought all the way back - tightness of that hip flexor
if opposite knee bends - tightness of that iliopsoas group (leg examiner is holding)
if opposite leg lifts up off the table - tightness of opposite hip flexors

43
Q

Ely’s Test

A

hip flexor tightness - prone (specifically rectus femoris)
passive flexion of the knee results in hip flexion,
causes hip to rise up off the table

44
Q

Beevor’s Sign

A

hook lying position
pt performs abdominal curl
look for movement of the umbilicus

  • segmental involvement of the nerves innervating the rectus abdominis (T5-T12)
  • umbilicus will move toward stronger muscle group
45
Q

Valsalva test

A

pt is sitting,
bear down, or blow air through fist
-increases intrathecal pressure - paint secondary to space-occupying lesion (herniated disk, tumor, osteophyte)

46
Q

Milgram Test

A

supine
patient holds bilateral leg raise for 30 sec
-increases pressure on lumbar nerve roots.
-if there is a disk lesion - both legs will drop

pt cannot hold legs, cannot lift leg, or experiences pain is a positive test sign

47
Q

Kernig’s Test

A

supine - pt performs SLR until pain occurs, when pain occurs, pt flexes the knee. pn should be relieved when knee flexes

nerve root imingement secondary to a bulging disk or bony entrapment
or
irritation of the dural sheath
or
irritation of the meninges
48
Q

Brudzinski’s test

A

if not pn is is present during Kerngi’s Test, elongate the spine by flexing the cervical spine

49
Q

hyporflexia

A

flaccidity of ht muscles, denervation atrophy

due to lower motor neuron trauma

50
Q

SLR Test

A

test of lasegue
passive raise leg, until pn is felt or full ROM achieved,

postive test: pn at end of ROM

  • radiating pn
  • highly significant is pn is at 30 degrees or less of hip flexion

implies: Sciatica
pn felt before end of ROM (70) may involve disk

lower leg to point of no pain and dorsiflex the ankle, if no pain is felt - the prior pain was do to tight hamstrings

51
Q

Well (Cross) SLR Test

A

elevate unaffected leg

positive test: pain experienced on the side opposite being raised

-large space occupying lesion

52
Q

Slump Test

A 
pt is sitting over edge of table
slump shoulders - apply overpressure
flex neck 
extend knee
dorsiflex the ankle
repeat steps on opposite side

-if pn is felt anywhere - relax the current position to relieve pain and then redo the position to see if symptoms reappear

sciatic pain or reproduction of other neurologic symptoms
impingement of dural lining, spinal cord, or nerve roots

53
Q

Quadrant Test

A

pt is standing - moves into extension followed by side bending and rotation to the affected side
-examiner provides overpressure through the shoulders

positive test: reproduces pain

radiating pn: compression of the intervertebral foramina impinging the lumbar nerve roots

local pain - facet joint pathology

54
Q

Run through a neurologic screen of the Lower Extremity

A 
L1/L2 - hip flexion
L3 - knee extension
L4 - dorsiflexion
L5 - great toe extension
S1 - eversion
S2 - knee flexion

L2-L4 - patellar reflex
L5-S1 - achilles tendon reflex
S2 - hamstring tendon reflex

55
Q

Femoral Nerve Stretch Test

A

prone - pillow under abdomen
leg is bent - passively extend hip

postive test: pn at anterior and lateral thigh

nerve root impingement at L2-L4

associated with false positives

56
Q

Tension Sign

A

Supine - hip flexed, knee flexed 90/90
palpate tibial portion of the sciatic nerve
extend knee

tenderness and pain

sciatic nerve irritation

57
Q

Bowstring

A

variation of tension sign

extend knee until pain, flex knee to relieve pain, press the nerve to reestablish symptoms

58
Q

Single Leg Stance Test

A

pt is standing, lifts on leg, extends back, repeat on opposite leg

pain is noted in the lumbar spin or SI area
shear forces on pars inarticularis by the iliopsoas pulling the vertebrae anteriorly, causing pain

59
Q

FABERE (Patrick’s), Gaenslen, Compression/Distraction

A

SI dysfunction

60
Q

review upper motor neuron screens

A

C4 - shoulder - shoulder raise
C5 - deltoid - abduction - biceps reflex
C6 - lateral aspect of forearm, elbow flexion - brachial reflex
C7 - middle finger/palm - elbow ext - triceps reflex
C8 - median lower forearm - opposition
T1 - median upper arm - armpit - finger abduction

61
Q

Upper Motor Neuron Lesions Tests

A

Babinski - bottom of foot
-great toe extends and other toes splay

Oppenheim - down the lower medial leg
-great toe extends and other toes splay or patient reports hypersensitivity

62
Q

Cervical Compression Test

A

reproduces pain symptoms
axial load

-compression of the facet joints and narrowing of the intervertebral foramen resulting in pain

63
Q

spurling test

A

axial load with lateral bending

nerve root impingement by narrowing of neural foramina

64
Q

Cervical Distraction test

A

pt is supine

should relieve symptoms
-implies that compression of facet joints and or stenosis is causing pain

65
Q

Vertebral Artery Test

A

+ dizziness, confusion, nystagmus, unilateral pupil changes, nausea

implies: occlusion of the cervical vertebral arteries

66
Q

Shoulder Abduction Test

A

hand on top of head for 30 sec

+decrease in symptoms due to decreased tension on the nerve root

implies: herniated disk or nerve root compression

67
Q

Brachial Plexus Traction Test

A

push head away from shoulder

+ reproduces pain or paresthesia throughout involved extremity

imples: brachial plexus neuroplaxia
- tension for pn on side being stretched
- nerve root compression for pn on side being bent towards

68
Q

Adson’s Test

A

tests for Thoracic Outlet Syndrome

pull arm away - take pulse, turn head towards examiner

+ radial pulse disappears or diminishes

implies: subclavian artery is occluded between the anterior and middle scalene muscles and the pec minor

69
Q

Allen Test

A

tests for Thoracic Outlet Syndrome

abduct and ext rotate arm, head looks away
take pulse

+ pulse diminishes or disappears

pec minor is compression the neurovascular bundle

70
Q

Military Brace Position TEst

A

tests for Thoracic Outlet Syndrome

pull arm back, pt looks up
take pulse

pulse disappears or diminishes

subclavian artery is blocked by the costoclavicular structures of the shoulder

71
Q

Roos test

A

for Thoracic Outlet Syndrome

72
Q

ecto/meso/endo - morph

A

ecto - tall skinny
meso - body builder
endo - short fat

73
Q

Spondyalgia

A

pain arising from the vertebrae

74
Q

Spondylitis

A

inflammation of the vertebrae

75
Q

Spondylizema

A

downard displacement of a vertebra caused by degeneration of the one below it

76
Q

spondylolithesis

A

forward slippage of a vertebra on the one below it

77
Q

spondylolysis

A

degeneration of a vertebral structure secondary to repetitive stress
-usually affects the pars inarticularis

-collared scotty dog

78
Q

spondylopathy

A

any disorder of the vertebrae

79
Q

spondylosis

A

arthritis or osteoarthritis of the vertebrae; results in pressure being placed on the vertebral nerve roots

80
Q

step deformities often occur at

A

L4/L5 and S1

81
Q

Spinal Stenosis

A

narrowing of the spinal canal or intervertebral foramen
-degeneration associated with aging

-pn with walking, numbness, tingling, muscle weakness, radiating pn, leg pn with standing resolved with sitting,

82
Q

intervertebral disk lesions

A

degeneration of disk causes loss of water from the nucleus pulpous

protusion - prolapse - extrusion - sequestration

many remain asymptomatic

s/s - radicular pain
insidious onset, repetitive stress, 
changes in body position are painful
-slow, deliberate gait due to pain and pressure
-flattened lumbar spine
-standing with lateral shift

tests: femoral nerve stretch test, tension sign

83
Q

Scheurermann’s disease

A

juvenile kyphosis

vertebral bodies wedge anteriorly , creating an abnormally rounded spine

84
Q

dysarthria

A

speech impairment caused by dysfunction of the muscles and joints associated with speech

85
Q

dysphasia

A

speech impairment caused by a brain lesion

86
Q

myelopathy

A

diseases that affect the spinal cord

87
Q

primary movement at atlanto-occipital joint

A

C0-C1 articulation

flexion and extension

88
Q

atlanto-axial joint primary movement

A

cervical rotation C1-C2

89
Q

why is the superior cervical region of the spine prone to acute injuries

A

lack of bony restraint of substantial facet joints of lower vertebra increasing case of subluxations

90
Q

coupled motion

A

the association of one motion about an axis with other motion around a different axis.

91
Q

cervical spine extension causes a decrease in..

A

space within the foramen where the nerve root pass

92
Q

orientation of major spinal ligaments from posterior to anterior

A 
supraspinous ligament
interspinous ligament
ligamentum flavum
posterior longitudinal ligament
(vertebral bodies)
anterior longitudinal ligament
93
Q

vertebral disks are not found where?

A

at C0-C1 and C1-C2

94
Q

cervical plexus

A

composed of C1-C4

95
Q

where is the pars inarticularis, why is it notable?

A

area between the superior and inferior facets of a vertebra

common site of stress fractures in the lumbar spine

96
Q

Waddell signs

A

physical findings such as pain with axial loading, widespread tenderness, and an excessive show of emotion that may be present in patients with greater behavioral influences on their pain

97
Q

incontinence

A

loss of bowel or bladder control

98
Q

Café-Au-Lait spots

A

normally occurring skin discolorations or may represent collagen disease or neurofibromatosis

99
Q

neurofibromatosis

A

increased cell growth of neural tissues; normally a benign condition; pain possible secondary to pressure on the local nerves

100
Q

faun’s beard

A

spina bifida occulta

101
Q

step off deformities indicate

A

spondylolisthesis

102
Q

what to palpate on the neck

A

spinous process, transverse process, traps, hyoid, sternocleidomastoid, scalene, thyroid cartilage, carotid artery, lymph nodes under the mandible

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