Chpt. 9- Orthopedics: Spine Flashcards
How many curves for each:
Lordodic Cruve?
Kyphotic Curve?
L=2
K=1
How many spine roots?
31
What is the pedicle?
pillar of bone, leads up to spinal canal
What are the 3 ligaments that stabilize the spine?
- Ligamentum Flavium
- Posterior Longitudinal Ligament
- Anterior Longitudinal Ligament
What are 4 general conditions involving the spine?
- Degenerative Disc Disease
- Disc herniations
- Pinched nerves
- Laminectomy (lamina removed)
What 3 things happen to the spine in DDD (Degenerative disc disease) ?
-loses water
-loses height/shrinking=
PINCHED disc because the space between the vertebrae becomes smaller
In DDD, the degenerative changes happens in the ___, ___, and ___, which cause the spinal segment to become loose and ____.
- disc
- facet joints
- ligaments
- unstable
What is a herniated or ruptured disc?
When the nucleus pushes through the torn annulus and into the spinal canal
So what actually causes pain in DDD?
pressure on the nerves and inflammation
Where do bone spurs develop in DDD? What do bones spurs do?
- around the facet joints and the discs
- bone spurs press on the nerves of the spine that pass through the neural foramina
how do disc herniations usually occur?
due to flexing forward and quickly moving side ways
What are 2 good exercises for Herniated discs (DDD)?
- mackenzie exercises
- back extension exercises
*lying prone + reduces pressure on disc
What are 5 causes of the pinched nerve?
- Disc herniations
- DDD (DEGENERATIVE DISK DISEASE)
- Bone spurs
- Tumors
- Ligament buckling in the foramen
What is a last surgical resort if pain is severe for pinched nerve?
Laminectomy: surgical procedure to relieve pressure on the spinal cord due to spinal stenosis
What is Spinal stenosis?
bone spurs that press against the spinal cord, leading to a myelopathy
What does the rehab consists of for Laminectomy?
Walking
- stationary cycling
- arm cycling (for cardiovascular exercises)
Why is there such a high prevalence of Whiplashes in BC? (3 reasons)
- High altitude ( ex. cacahaula)
- Multi cutural nation (ppl dont know how to drive in an environment like this)
- Aging population (driving over 90)
What are 5 symptoms of whiplash?
- Neck pain or neck pain that travels down the arm (radiculopathy)
- Headaches
- Low back pain (LBP)
- Jaw pain (TMJ)
- Dizziness
What is TMJ? What can it also cause?
Tempomandibular joint
–> Painful headaches
Is it uncommon to have a delay in symptoms after a whiplash?
No!
What are the 2 extremes of the Task Force on Whiplash and WAD (Whiplash Associated Disorder) Classification Scale?
Grade 0= No complaint or physical sign
Grade IV: Neck pain and fracture or dislocation
What are some factor affecting the severity of WAD?
- getting hit from behind
- previous neck pain/headaches
- previous similar injury
- poor POSTURE at the time of impact
- sitting in front rather than back
*Wearing a seatbelt makes it worse actually for WAD
What is the Acute phase for Whiplash?
- Collars
- NSAIDs (anti inflammatory drugs)
- heat/ cold
- light ROM, isometric exercises (resist in 4 directions)
What other modalities could be used for the Acute phase of Whiplash?
What muscle do we have to strengthen in the neck?
-Modalities such as TNS and IFC may help with pain relief
– Longus colli
What is a Scheuermann’s disease?
when the THORACIC KYPHOSIS angle is too far (more than 45 degrees)
*normal curve is: 25-40 degrees
What happens in Scheuermann’s disease?
(like Osteoperosis for kids)
- front of vertebral crushes itself
-the front of the vertebral body becomes wedge-shaped, possibly from abnormal growth
Patients with Scheuermann’s disease it is more likely to form “______” which is a condition that form _____ of disc material inside the vertebral body (vertebrae)
- Schmori’s nodes
- pockets
What are 3 etiologys (reasons) for Thoracic Kyphosis?
- genetics
- childhood osteoporosis
- mechanical reasons
What do doctors commonly use for Scheuermann’s Kyphosis?
And what does it do?
When is it NOT effective?
Milwaukee brace:
- holds shoulders back and gradually straightens the thoracic curve
- NOT EFFECTIVE: when angle is more than 75 degrees
What are two common surgical procedures to treat Thoracic Kyphosis?
When is it NOT effective?
- Posterior fusion
- Combined fusion (very SERIOUS surgery)
-NOT EFFECTIVE: when angle is more than 65 degrees
Instability in the Lumbar spine can happen because: (3)
- DDD
- Trauma, such as falling or rotation injury at work/sports
- Disc herniation
Pain is frequently worse in _____ or _____ with Lumbar Spine instability. Pain also often radiates down the ___.
- Extension
- Rotation
-leg
What is one reason why the Lumbar spine might be unstable?
Spondylolisthesis
What is Spondylolisthesis ?
One vertebrae slipping forward on the other vertebrae due to a FRACTURE, degeneration of the FACET JOINTS or CONGENITAL
What is an exercise for Spondylolisthesis?
-posterior pelvic tilt
What are the 3 grades for Sacroiliac joint dysfunction ?
Sacroiliac (joint between sacrum and ilium)
Grade 1: 25% slippage
Grade 2: 50% slippage
Grade 3: over 50% slippage
During adulhood, the SI joint barely moves, but when is the SI joint more relaxed?
at the end of pregnancy: hormones cause it being ore relaxed
The older one gets, the more likely that the joint is completely ____.
ankylosed
When do you use a Belt for Sacroiliac joint injuries?
How long is it supposed to be worn for?
- during EXERCISES; specifically compression of pelvic
- all day, for 6 week period
What muscle is very IMPORTANT to train in the Core?
The Transverse Abdominis
What is Neutral Spine?
the midpoint between full lordosis (anterior tilt) and full posterior tilt
What are 2 appropriate exercises for Transverse Abdominis?
- CONTRACTION ex. lying on back; palpate finger inferomedially (lower middle)
1-2 inches from ASIS - SIDELYING; clamshell ex. (moving knees together and apart)
When is the Pelvic Floor muscle stabilized?
Exercise?
When it is weak, and when you are incontinent (or have troubles controlling flow of urine)
- KEGEL exercises; Contraction
