conditions of the back Flashcards
what does the spine do (5)
upright posture, allows mvt, protects sc (vertebral foramen and transverse foramen for spinal n.), m. and lig attachment
how many vertebrae and nerve roots are in the c-spine what vertebrae allow rotation
7 vertebrae and 8 n. roots
atlas (c1) and axis (c2) allow rotation
what part of the spine attaches to the ribs, incases the lungs and heart and diaphragm
the thoracic vertebrae
what part of the spine has larger bodies for weight bearing and allows for minimal rotation
lumbar spine (thicker and take on the majority of the load)
what is the purpose of the intervertebral discs (3)
allow mvt, absorbs shock and increases space for transverse foramen (looses height w age)
what is the purpose of facet joints
allow rotation bc of how they sit
is it more common to injure m. of the spine or lig of the spine
m.
what ligaments are stretched by flexion of the spine
interspinous lig, supraspinous lig, post longitudinal lig
what lig is stretched by extension of the spine and which is stretched by side bending to opposite side
extension: anterior longitudinal ligament,
side bend: intertransverse lig
if there pressure to the lumbar plexus what can it affect
can affect m. of lower extremity
what m. are affected by whiplash moi
m. of the cervical spine (tighten up normally; upper traps, levator scapula, …)
axial loading puts stress on the dics and the vertebrae and will cause what
decreased height, space in transverse foramen will decrease, impingement of the n. roots
what can repetitive forward bending cause
disc move post, can put pressure on n. roots,= so comes out posterior
what is stenosis (where can it occur what is it acquired secondary to and what are the s/s)
can occur anywhere in the spine (will decrease space where the n. root runs), acquired secondary to osteophyte formation (protective moi)
s/s: quadriplegia (depending on the level of severity), burning/tingling/numbness, motor changes (n. isn’t sending the signal properly), pain in area, happens w age when too much loading
what is a disc herniation (moi, where is it most common and what age, s/s)
moi: whiplash (disc pushed back and stays there bc of hyperextension of the spine), repetitive flexion or extension, compression
posterior lateral is most common (bc we do more flexion and ant region of sc is stronger)
s/s: radiating pain, pain with valsava maneuver (pinky=c7, middle finger=c5)
L4/5, L5/S1 most common l-spine (30 -50 yo)
cervical spine is more common in older individuals (C4/5 and C5/6 most common)
what are the diff types of disc herniations
degeneration: tears in annulus fibrosis
prolapse: nucleus finds way thru annulus
extrusion: material moves into sc (may impinge)
sequestration: further into sc, may migrate
how do disc herniation develop and what can you palpate
years and years of mod pain (no pain bc no pressure on n. roots, might fell stiffness in the back) until 1 day the back will spasm with ridiculous motion
pain on palpation of the transverse, spinous process but won’t be able to feel the herniation
what is degenerative disc disease (moi and s/s)
chronic disease that occurs w age or in pliametric people, olympic lifters and gymnast jumping)
moi: compression, repetitive flexion, age (plays huge role in dx), high impact
s/s:radicular pain, loss of motor function, pain w valsava maneuver
lumbar dermatomes and sensory loss (L1/2, L3/4, L4/5, L5/S1)
L1-2: front of thigh and groin to knee
L3-4: ant mid thigh over patella and medial lower leg to great toe
L4-5: lateral thigh, ant leg, top of foot, and middle three toes
L5-S1: post lateral thigh and lower leg to lateral foot and 5th toe
lumbar myotomes weakness
L1-2: psoas/adductors
L3-4: ankle dorsiflexion
L4-5: toe extension
L5-S1: ankle plantar flexion
cervical dermatomes and sensory loss
C1-C2: top of head, forehead C3: entire neck C4: shoulder area, clavicle C5: deltoid area C6: radial side of hand to thumb C7: index, middle and ring fingers C8: little finger T1: medial side of forearm
cervical myotome weakness (resist them in that mvt to see if weak; mmt)
C1-C2: neck flexion C3: lateral flexion C4: shoulder elevation C5: shoulder abduction C6: elbow flex, and/or wrist extension C7: elbow extension and/or wrist flexion C8: thumb extension T1: finger abduction/adduction
torticolis what is it (s/s)
starts w spasm (SCM is the most affected)
head tilt towards one shoulder and chin rotates towards opposite shoulder
congenital and acquired
s/s: loss of rom, palpable lump or swelling involved muscles
cervical sprains (moi, location and s/s)
moi: occur at extreme motions, violent m. contractions
occur at any ligament
s/s: pain, stiffness, and restricted rom
cervical strains (moi, location, m. involved and s/s)
moi: forceful contrations/eccentric, extreme rom
usually involved SCM and UFT (usually involves scalenes, levator scapulae and splenius m. )
s/s: pain, decrease rom, m. spasm, pain w contraction or stretching of a m. (mmt or flex test will be positive)
brachial plexus conditions
neural structure that innervates upper extremity stretch injury compression injury (direct blow)
acute burners (moi, s/s, how long will it last)
moi: forceful separation of neck from shoulder
s/s: immediate, severe, burning pain and prickly paresthesia that radiates down the arm
subsides in 5-10 minutes (if true spinal inj; won’t subside)
weakness may persist for hours or even days (abduction and external rotation)
what is the RTP for an acute burner
if strength and function returns completely after 5 min than can rtp
must have:
- no neck pain, arm pain, or impaired sensation
- full pain free rom in the neck and upper extremity
- normal strength on mmt as compared to pre-season testing
- normal deep tendon reflexes
- negative brachial plexus traction test
what are the signs and prognosis of neuropraxia (grade 1 burner)
signs: temporary loss of sensation and/or loss of motor function, may demyelinise but axon is intact ( no injury to the n. itself)
prognosis: recovery within a few days to a few weeks
what are the signs and prognosis of axonotmesis (grade 2 burner)
signs: significant motor and mild sensory deficits, axonal damage
prognosis: deficits last at least 2 weeks. Regrowth is slow, but full or normal function is usually restored
what are the signs and prognosis of neurotmesis (grade 3 burner
signs: motor and sensory deficits persist for up to 1 year. Nerve lacerated/avulsed (lost most of motor function)
prognosis: poor prognosis, surgical intervention
suprascapular n. injury (innervates what m., moi, s/s)
innervates the supraspinatus, infraspinatus and GH joint capsule (lack of rotator cuff strength can lead to many other injuries)
moi: OH motions that generate rapid torque and velocity forces during cocking, acceleration and release phases
s/s: m. weakness and atrophy, secondary injuries (ie: impingement, tendinitis, bursitis, etc)
thoracic spine contusions, sprains and strains (moi, s/s)
moi: direct blows, violent m. contractions
s/s: pain, ecchymosis, m. spasm, limited swelling, decreased rom and function
thoracic fx (protected by what, moi)
well protected w rib cage (rib fx are more common: sob, deep breathing will hurt, will use other m. to breath so thigh neck)
moi: compression loads (tackle, fall on butt), women w osteopenia, repetitive stress from activities such as running (repetitive rotations)
what is scheurmann’s disease (what does it do, what age groups)
increased kyphosis (thicker on post aspect and thinner on ant aspect)
related to mechanical stress
older people and woman past menopause
degeneration of the epiphyseal end plates of the vertebral body (involves 3 adjacent vertebral segments)
scoliosis (may affect what, what types exist)
may affect heart and lung function
sideways cruve
structural (development of b.) or functional (posture, m. imbalance, pain affects the ability to remain upright)
lumbar and thoracic (most common)
pars interarticularis fx (lumbar spine injuries) (moi, what types exist)
weakest bony portion of the vertebral neural arch (common in gymnasts; lots of hyperextension)
moi: mechanical stress from axial loading (repetitive loading in flexion, hyperextension and rotation), congenital
spondylolysis or spondylolisthesis
spondylolysis vs spondylolisthesis
spondylolysis: fx only to one side (complete fx or small stress fx), fx of pars interarticularis, stress -> complete
spondylolisthesis: bilateral separation of pars resulting in ant displacement of vertebrae w respect to vertebrae below (vertebrae will slip forward)
often diagnosed in children 10-15
s/s of spondy’s
can be asymptomatic, low back pain, neurological symptoms, unilateral dull ache aggravated by activity (hyperextension and rotation will increase pain and flexion can help bc it will push it post), mm spasm of erector spinae or hamstrings, flattened lumbosacral curve
facet joint pathology what types of inj can occur, what is the moi
subluxation or dislocation, facet joint syndrome (inflammation, stands in hyperlordotic position and gets pushed back during sports), degeneration of facet itself (arthritis), mechanical injury to joint capsule-sprain
moi: hyperextension
s/s of facet joint pathology
- point tenderness, flattening of the back
- pain w rotation, extension, lateral bending
- limited flexibility of pelvic musculature
- relieved in flexion
what can sciatica be caused by
inflammatory condition of the sciatic n. (S1 and S2 myotones affected)
can be caused by herniated disk, annular tear, m. related disease, spinal stenosis, facet joint pathology, compression of n. btw piriformis m.
what is an SI joint sprain (or dysfunction) moi and s/s
moi:
- postural imbalance or m. loss that allows that normal SI mvt normally
- traumatic; bending and twisting
- repetitive stress from lifting
- fall on buttocks
- excessive side to side mvt (running and uneven terrain, extreme flexion and rotation will cause sprain to those lig)
s/s:
- pain in SI area, extends to butt/post thigh
- pelvic imbalance
- standing one leg, climbing stairs pain will increase
- lateral bending to that side, flexion
