Class 1: Intro Flashcards
Why know spinal orthopaedics?
- to understand complaint
- to assess and treat appropriately
- to recommend appropriate rehabilitation and homecare
- to communicate with other health care professionals
HOPMNRS
History Observation Palpation Movement Neurological Special Tests (or Selective Tissue Tension Tests)
Axial skeleton
skull, vertebrae, ribs, sacrum
Appendicular skeleton
bones of upper and lower limbs, including clavicles, scapulae, and innominiates
Innominates
The three sub-bones that make up half of the pelvis: ilium, ischium and pubis. AKA the Coxa. Does not include sacrum
How many presacral vertebrae?
24: 7 cervical, 12 thoracic, 5 lumbar
How many spinal segments?
33: 24 presacral, 5 sacral, 4 coccygeal
Primary curves
= Kyphotic curves
Thoracic and sacral
Secondary curves
= lordotic curves
Cervical and lumbar
What causes lordotic curves?
Wedge shaped discs (especially cervical).
*Lower lumbar vertebral bodies are also wedge shaped
What causes kyphotic curves?
Wedge shaped vertebral bodies. (shorter on anterior side)
Normal spinal curves offer:
Flexibility
Shock absorption
Stiffness and stability
Level of sacral promontory
S1 (articulates with L5)
Level of iliac crest
L4
Level of PSIS
S2
Vertebrae have how many joints?
Three
2 x facet
1 x intervertebral
Position of superior articular facet?
C-spine: BUM (backwards, upwards, medial)
T-spine: BUL (backwards, upwards, lateral)
L-spine: BM (backwards, medial)
Inguinal ligament runs from
ASIS to pubic tubercle
Biomechanical functions of the spine
- housing and protection
- support
- mobility
- control
Basic functional unit of the spine
Spinal Motion Segment
Spinal Motion Segment
Adjacent halves of two vertebrae, the IVD, facet joints, and supporting structures.
Basic functional unit of the spine
The pelvis is made up of:
Three bony bits (two iliac bones and sacrum)
Three joints: (two SI joints and pubic symphysis)
Sacroiliac Joint
Small amplitude movement; rarely fused.
Shock absorbers
Iliac articular surface of the SI joint is covered in:
fibrocartilage
Sacral articular surface of the SI joint is covered in:
hyaline cartilage
Fryette’s First Law
When the spine is neutral, lateral flexion is accompanied by rotation to the opposite side
Fryette’s Second Law
When the spine is flexed or extended, lateral flexion is accompanied by rotation to the same side
Nutation
Sacral flexion
Sacral promontory moves anteriorly and inferiorly
Apex of sacrum moves posteriorly
Iliac bones move apart
Ischial tuberosities approximate
Counternutation
Sacral extension
Sacral promontory moves posteriorly and superiorly
Sacral apex moves anteriorly
Iliac bones approximate
Ischial tuberosities move further apart
Position of sacrum is determined by
Forces from on high
Position of ilium is controlled by
Movement of femur
Disc-vertebrae height ratio determines
Degree of movement at spinal segments
Orientation of articular facets determines
The types of movement available at a spinal segment
Loose pack
Resting position. Minimal congruence between articular surfaces
CLose Pack
Maximum congruence (and hence tension) between articular surfaces.
Tonic Muscles
Janda
Postural muscles
Tend to become tight/hypertonic, develop contractures
Calves, hip flexors, QL, hammies, pec maj, upper traps
Phasic Muscles
Janda
Non-postural muscles
Tend to become weak and inhibited
Lower traps, v lat and VMO, rhomboids, tib ant
Lumbosacral Angle
Sacrum to middle L5 body
140º
Lumbar Lordotic Curve
Top L1-Base L3
50º
Sacral Angle
Top of sacral base with horizon
30º
Pelvic Angle
S2 to top of pubic symphysis, with the horizon
30º
Spondylosis
Degeneration of IVD
Spondylolysis
Defect in the Pars articularis of vertebral arch
Spondylolisthesis
Forward displacement of one vertebrae
Lumbarization
Mobile (unfused) S1
Sacralization
Fused L5
Greatest movement of L-spine
L5/S1
Normal pelvic tilt
7-15º. ish