DSA: Thoracic and Lumbar Spinal Mechanics

Question 1

What are the important landmarks that the line of gravity passes through?

Answer 1

1. External auditory canal
2. Head of humerus
3. L3
4. Anterior 1/3 of the sacrum
5. Lateral malleolus

Question 2

What type of spinal curve does each spinal segment have?

Answer 2

cervical and lumbar: lordosis

thoracic and sacral: kyphosis

Question 3

What are the characteristics of thoracic vertebrae?

Answer 3

Body: medium sized, heart shaped, costal facets present

Spinous processes: long, sloped postero-inferiorly

Question 4

What are the characteristics of lumbar vertebrae?

Answer 4

Body: Large, kidney shaped

SP: Short, broad

Question 5

What makes up a vertebral unit?

Answer 5

Two adjacent vertebrae and the associated intervertebral disc

Question 6

What does the rule of 3’s refer to?

Answer 6

Location of the spinous process in relation to the transverse process (for thoracic spine only!)

Question 7

Apply the rule of 3’s to T1-3

Answer 7

Spinous process at the level of the corresponding transverse process

Question 8

Apply the rule of 3’s to T4-6

Answer 8

Spinous process located 1/2 segment below the corresponding transverse process

Question 9

Apply the rule of 3’s to T7-9

Answer 9

Spinous process located 1 full segment below the corresponding transverse process (located at the level of the transverse process of the vertebrae below)

Question 10

Apply the rule of 3’s to T10-12

Answer 10

T10: same as T7-9 (SP one full segment below TP)
T11: same as T4-6 (SP 1/2 segment below TP)
T12: same as T1-3 (SP at same level as TP)

Question 11

What is the orientation of the superior facets of cervical vertebrae?

Answer 11

BUM: Backwards, upwards, medial

Question 12

What is the orientation of the superior facets of thoracic vertebrae?

Answer 12

BUL: Backwards, upwards, lateral

Question 13

What is the orientation of the superior facets of lumbar vertebrae?

Answer 13

BM: Backwards, medial

Question 14

Describe the location and function of the anterior longitudinal ligament

Answer 14

• covers and connects anterolateral aspects of vertebral bodies and IV disks
• limits extension

Question 15

Describe the location and function of the posterior longitudinal ligament

Answer 15

• runs within the vertebral canal along the posterior aspect of the vertebral bodies
• resists hyperflexion, prevents posterior herniation of the nucleus pulposus

Question 16

Describe the location of the ligamentum flava

Answer 16

-connect the lamina of adjacent vertebrae

Question 17

Describe the location of interspinous ligaments

Answer 17

connects adjacent spinous processes

Question 18

Describe the location of the intertransverse ligaments

Answer 18

connects adjoining transverse processes

Question 19

What is the action of semispinalis m.?

Answer 19

Bilateral: Extends
Unilateral: bends, rotates

Question 20

What is the action of rotatores m.?

Answer 20

Bilateral: Extends
Unilateral: rotates

Question 21

What is the action of multifidus m.?

Answer 21

Bilateral: Extends
Unilateral: flexes, rotates

Question 22

What are the gross ranges of motion of the lumbar spine?

Answer 22

Flexion: 40-90
Extension: 20-45
Sidebending: 15-30
Rotation: 3-18

Question 23

What is coupled motion?

Answer 23

Consistent association of a motion along or about one axis, with another motion about or along a 2nd axis

Question 24

What is linkage?

Answer 24

• relationship of joint with surrounding structures
• by linking multiple structures, increase ROM
• aka block surrounding structures to evaluate movement of one joint/region

Question 25

How do you name motion of a vertebra?

Answer 25

Always references the movement of the anterior/superior surface of vertebra Excessive motion (or restriction) is in reference to vertebra above in a functional unit (ex. excess motion of L2 is the motion of L2 on L3)

Question 26

Restrictions of motion in the spine can:

Answer 26

- reduce efficiency - impair flow of fluids - alter nerve function - create structural imbalance

Question 27

What is Fryette Type 1 mechanics?

Answer 27

TONGO - In the neutral range, sidebending and rotation are coupled in opposite directions - Rotation is toward the convexity of the spine - tends to be a group of vertebra *Only applies to thoracic and lumbar spine*

Question 28

What is Fryette Type 2 mechanics?

Answer 28

- In sufficient flexion or extension, sidebending and rotation are coupled in the same direction - Rotation is toward the concavity of the spine - Tends to be a single vertebra *Only applies to thoracic and lumbar spine*

Question 29

How do you name SD of the spine?

Answer 29

For where it likes to go ex. T1-3 N Sr Rl T1-3 have restrictions sidebending left and rotating right, no improvement in flexion or extension

Question 30

What is fryette's 3rd principle?

Answer 30

- movement of a vertebral segment in any plane of motion will modify the movement of that segment in other planes of motion - if motion is restricted in one direction, motion will be restricted in other directions

Question 31

What are some ways to say "R rotation somatic dysfunction"

Answer 31

- PTP on right - rotated right - hard end feel with rotation to the left - hard end feel on the right - restricted rotation to the left - will not rotate left - lives in right rotation - held to the right

Question 32

How do you name scoliosis?

Answer 32

Toward the convexity - levoscoliosis: toward left (obscures heart) - dextroscoliosis: toward right (frames the heart)

Question 33

Describe the clinical features of a herniated disk at L4-5

Answer 33

Pain: sacroiliac joint, hip, lateral thigh, leg Numbness: Lateral leg, first 3 toes Weakness: of dorsiflexion of great toe and foot, difficulty walking on heel Reflexes: diminished/absent internal hamstring reflex

Question 34

Describe the clinical features of a herniated disk at L5-S1

Answer 34

Pain: SI joint, hip, posterolateral thigh, leg to heel Numbness: back of calf, lateral heel, foot to toe Weakness: plantar flexion of foot and great toe, difficulty walking on toes Atrophy: gastrocnemius and soleus Reflexes: ankle jerk diminished or absent

Question 35

What is sacralization?

Answer 35

one or both TP's of L5 are long and articulate with the sacrum

Question 36

What is lumbarization?

Answer 36

failure of S1 to fuse with the rest of the sacrum

Question 37

What levels do you see exit of nerves contributing to sympathetic viscerosomatic reflexes?

Answer 37

T1-L2