Exam 2 Flashcards
1
Q
Which thoracic spine vertebrae are transitional?
A
T1 and T12
2
Q
do thoracic or cervical vertebrae have larger bodies?
A
thoracic
3
Q
Vertebral bodies have?
A
transverse and anterior-posterior diameters
4
Q
Why dont thoracic vertebrae have transverse foramen?
A
There is no vertebral a. to protect
5
Q
Transverse processes are more ____ than cervical?
A
posterior
6
Q
Inferior facets of superior verebrae face?
A
inferior and anterior
7
Q
Superior facets of the inferior vertebrae face?
A
superior and posterior
8
Q
Decreased Weight bearing occurs on the facet joints compared to C-spine due to?
A
Facet articulations are 60* from horizontal place
9
Q
what is responsible for resisting compression in verterbral body?
A
vertical, oblique and horizontal trabeculae in spongy bone
10
Q
What is the zone of weakness?
A
Decreased trabeculae bone. Can lead to ant comp fractures,
11
Q
with age kyphosis?
A
increases, more anterior pressure in thoracic spine
12
Q
vertical trabeculae fibers resist?
A
compression
13
Q
Horizontal trabeculae fibers resist?
A
tension/shear
14
Q
Does the vertebral arch have a lot or less trabeculae?
A
multiple, making it more supported for weight bearing
15
Q
Difference between spondylysis v.s spondylolythesis?
A
spondylolysis is just fracture
spondylolythesis
16
Q
Ribs
A
restrict ROM
17
Q
Upper thoracic ROM?
A
rotation and sidebending
18
Q
Lower thoracic ROM?
A
flexion and extension
19
Q
Middle thoracic ROM?
A
little bit of everything
20
Q
Freyette’s law upper thoracic spine?
A
SB and rotation occur in the same direction in neutral and non-neutral biomechanics
21
Q
Freyette’s law lower thoracic spine?
A
SB and rotation occur in opposite directions
22
Q
Degrees of freedom in the thoracic spine?
A
3* (flexion/extension, Sb, rotation)
23
Q
Why does upper thoracic have decreased flexion/extension?
A
facets lie in frontal plane
60* from horizontal plane
24
Q
Why does lower thoracic have increased flexion/extension?
A
2* from sagittal plane
25
What does rule of 3s help to determine?
SP and TP orientation
26
Orientation of T1-T3 SPs?
Level with respective Tps
27
Orientation of T4-T6 SPs?
1/2 level below respective TPs
28
Orientation of T7-T9 SPs?
SP 1 full level below respective TPs
29
Orientation of T10 SPs?
SP 1 full level below
30
Orientation of T11 and T12?
Sp 1/2 level below, SP in line with TP
31
What structures provide check rein to flexion?
PLL, ligamentum flavum, erector spinae, Spinal cord
Anterior vertebral body + IV disc
32
What structures check rein to extension?
ALL, rectus abdominus,
Post vertebral body + disc, spinous process
33
What structures check rein to side bending?
Contralateral musculature Intratransverse compression
Ribs
34
What happens to facets and IV foramen with sidebending?
closing of facets and IV foramen
Posterior inferior motion
35
Distortion of rib pair?
this happens during rotation
One rib goes posterior the other goes anterior
magnitude dependent on CV and CT joint motion
36
Check rein for rotation?
winding of the disc
ribs
37
Scoliosis is named according to?
direction of convexity and region
38
what is a type I scoliotic dysfunction?
rib hump evident
39
Primary curve v.s secondary curve?
primary: congenital
secondary: compensatory
40
Describe normal Thoracic LOG?
LOG anterior to thoracic (flexion moment)
PLL counteracts
41
Describe LOG action due to a moderate kyphosis?
Increased anterior (increased flexion moment)
PLL and erector spinae
42
Describe Severe kyphosis affect on LOG?
Even greater anterior (larger flexion moment)
erector spina and PLL
Upper cervical spine will go into extension to counteract
43
Where do ribs 1-7 attach?
true ribs
attach directly to cartilage to sternum
44
Where do ribs 8-10 attach
false ribs
attach to costal cartilage above attaching to sternum
45
Where do ribs 11-12 attach?
floating ribs (no attachment to sternum)
46
what type of joint are the costovertebral joints?
planar synovial
47
head of rib is?
convex
48
T2-T8 facets are?
formed by 2 concave demifacets on inferior and superior body of vertebrae
49
T1, T11, T12 articulate with?
only 1 vertebrae
50
The vertebral facets of T9-T12 are?
posterior to the pedicles
51
Ribs 2-10 also articulate with?
intervertebral discs
52
Which costovertebral joints have more mobility?
those that articulate with only one vertebrae
53
How does rotation and gliding occur in CV joint?
Rib springing
54
Where does Functional internal rotation lie to spinous process?
T5
55
Where does Functional external rotation lie to spinous process?
T3
56
What is the total degrees of ROM for Horizontal Abduction
Horizontal Adduction
120-140' AB
40-60' ADD
57
What is the total degree of ROM for extension or hyperextension?
60-80'
58
What are the four joints that make up the shoulder complex?
Glenohumeral
scapulothoracic
acromioclavicular
sternoclavicular
59
What are the four joints that make up the shoulder complex?
Glenohumeral
scapulothoracic
acromioclavicular
sternoclavicular
60
Where does the superior angle of the scapular in respects to spinous process?
T2
61
Where does the inferior angle of the scapular in respects to spinous process?
T7
62
What angle of upward rotation does the scapula lie in?
3-5 degrees
63
Why does the scapular have upward rotation at rest?
Because it creates a shelf for humeral head to stop dislocation
64
When the scapula elevates it causes more anterior tilting which can lead to
AC impingement
upper cross syndrome
65
Upward rotation promotes ______stability. With what contribution?
inferior
Glenoid contribution
CH & SGH ligament contribution
66
What is scapular dumping?
When there is relaxation (adaptive stretch) of coracohumeral ligament and superior glenohumeral ligament
downward rotation means no shelf
inferior translation/ dislocation
67
What is the typical posture for scapular dumping?
Rounded Shoulder
inferior translation
increase kyphosis
68
What is the normal range for anterior tilting of the scapula?
9'-20'
69
What are you to likely see with anterior tilting greater than 20 degrees?
Subacromial impingement
w/ inc. kyphosis
osteoporosis
menopausal women
70
What is the scapulo-clavicular angle?
50 degrees
POS 30' anterior to frontal plane
Clavicular retraction angle is 20'
71
What is the purpose of scapulothoracic motion?
appropriately position the glenoid to allow optimal motion
72
Scapulothroacic motion has _____translation and _____rotary motion? What are they?
Translation
-elevation/depression
-protraction/retraction
Rotary
-upward/downward rotation
-anterior/posterior tilting or tipping
-medial/lateral rotation
73
What motion is coupled with protraction of the scapula?
Medial rotation = protraction
74
What motion is coupled with retraction of the scapula?
Lateral rotation = retraction
75
What is the pathology that reveals the entire medial border of the scapula?
scapular winging
76
What causes scapular winging?
neuropathy of the long thoracic n.
adaptive shortening of serratus anterior
77
What is the pathology that reveals the inferior angle?
Excessive anterior tipping
78
What causes excessive anterior tipping?
adaptive shortening of pec minor
79
At neutral where is the instanenous center of rotation
at the spine of the scapula
80
What is the concavity of the AC joint?
Convex lateral clavical
concave acromion
81
What type of joint is the AC joint?
Synovial joint with an fibrocartilaginous disc
82
What ligaments stabilize the AC joint
Conoid, trapezoid and AC ligamentts
83
What ligament is responsible for posterior tilting of the scap
Conoid ligament
84
What type of joint is the costotransverse joint?
planar, synovial between ribs and TP
85
Which thoracic vertebrae have costotransverse jiont?
T-T10
86
Convexity of the costal facet? costal tubercle?
costal facet: concave
costal tubercle: convex
87
Some rotation is allowed at which costotransverse joint?
T1-T6
88
Which costotransverse joint is flat?
T7-T8
89
What type of joint is the costosternal joint?
Planar, synovial
except rib 1: cartilagenous
90
Where do costosternal joint ribs 1-7 articulate with?
sternum
91
what do costosternal joint ribs 8-10 articulate with?
costocartilage
92
what do costosternal joint ribs 11 and 12 articulate with?
nothing babe
93
Rib 1 kinematics?
Costosternal joint is stiff
Elevates with inspiration
costovertebral joint: superior and posterior
94
axis for Costovertebral and costosternal joint?
2* to CKC,
CS moves vertically but no rotation
95
around what axis does rib 1-6 motion occur?
M-L axis
Nearly in the fronal plane
96
around what axis does rib 7-10 motion occur?
A-P axis
Nearly sagittal plane
97
Ribs 1-6 motion can be described as ?
pump handle
increased A-P dimension
98
Rib 7- 10 motion can be described as?
Bucket handle
increased lateral dimention
99
Rib 7- 10 motion can be described as?
Bucket handle
increased lateral dimension
up and out
100
Rib 11-12 motion can be described as?
caliper
lateral dimension
101
Welcome to the shoulder :)
102
From base position how many degrees of UE ER do we have? what plane of motion is this happening in?
40-60*, transverse plane
103
At 90* abduction how many degrees of UE ER do we have? what plane of motion
90-100, sagittal plane
104
At 90* abduction how many degree of UE IR do we have?
45-60*
105
What is the ideal level of functional internal rotation and functional er?
FIR: spinous process of T5
FER: Spinous process of T3
106
Ideal degrees of horizontal abduction?
120-140
107
ideal degrees of horizontal adduction?
40-60*
108
Ideal degrees of extension?
60-80*
109
What are the 4 joints of the UE?
glenohumeral
scapulothoracic
acromioclavicular
sternoclavicular
110
What are the main movements in the scapulothoracic joint?
rotary: upward/downward rotation, tilt, medial-lateral rotation
translatory:protraction/retraction + elevation, depression
111
how much scapular upward rotation do we have at rest?
3-5*
112
Upward rotation of scapula promotes?
inferior stability
113
What contributes to upward rotation of scapula?
Glenoid
Coracohumeral ligament
SGH ligament (superior glenohumeral ligament)
114
What capsuloligamentous scapular dumping?
relaxation of Coracohumeral and SGH ligament
Will produce false sulcus test
115
Scapulathoracic joint is slightly anterior tilted in neutral. to what degree?
9-20*
116
A pathologically elevated scap will lead to more?
anterior tilting
potential for impingement
117
Anterior tilt of scap does what to muscles?
adaptively shortening elevators
Adaptively lengthens depressor
increases impingement of subacromial structures
118
What is the plane of the scapula?
30* anterior to frontal plane
119
What is the scapulo-clavicular angle?
50*
120
what is the clavicular retraction angle?
20*
121
Main function of the scapulothoracic joint?
appropriate position glenoid
122
Do scapulothoracic motions occur independently?
no
123
Elevation of scapula does what to the clavicule?
elevation
124
Elevation and depression is coupled with which two motions?
anterior and posterior tilt
125
What is protraction and retraction coupled with?
medial and lateral rotation
126
Anterior tilting involves what movement of the superior/inferior angles?
anterior displacement of superior angle
posterior displacement of inferior angle
127
Posterior tilting involves what movement of the superior/ inferior angles?
posterior displacement of superior angle
anterior displacement of inferior angle
128
Tilting is coupled with?
retraction/protraction
Upward/downward rotation
129
Rotary motions of the scapulothoracic joint occur around?
vertical axis of AC joint
130
medial rotation of the scapula does what to the glenoid fossa?
lateral rotation?
faces more anteriorly
Faces more posteriorly
131
What motion is affected with scapular winging?
medial/lateral rotation
medial rotation is excessive
132
upward rotation of scapula, does what to the glenoid? clavicle? inferior angle?
upward of glenoid
elevation of clavicle
superolateral displacement
133
What are the 3 rotary motions of the acromioclavicular joint?
anterior/posterior tipping
medial/lateral rotation
upward/downward rotation
134
What type of mechanism would injure AC joint?
Lateral FOOSH
Lateral force
135
Convexity of the acromial end of the clavicle?
convex
136
Convexity of the acromion?
Concave
137
What type of joint is the AC joint?
Fibrocartilagenouw
138
The AC joint is stabilized by?
Conoid, trapezoid, AC ligaments
139
What is the benefit of a fibrocartilagenous joint?
Healing properties
140
What type of joint is the sternoelavicular joint?
Synovial w/ articular disc
141
SC motions are linked with which snap motion?
Elevation depression, protraction, retraction, post/ant rotation
142
Convexity of sternal end of clavicle?
Convex
143
Convexity of sternum
Concave
144
Transverse plane convexities of clavicle and sternum?
Opposite of frontal plane. Concave clavicle, convex sternum
145
Post rotation of Sc joint is coupled with what scap motion
Upward rotation after 30° clavicle elevation
146
Max rotation at Sc joint?
30-55°
147
Anterior rotation at sc joint?
No ant. Rotation (from neutral)
148
The glenoid cavity has-more concavity in which direction?
Superior → inferior
149
What is angle of humeral head?
130°150°
150
Which directions does the humeral head face?
Medial, superior, posterior
151
Issue with glenoid + humerus orientation?
Humerus is superior, glenoid is inferior
152
ER at gh joint? At base? @ 90°?
40-60° 90-100°
153
IR at GH joint at 90°?
45-60°
154
Elevation @GH joint?
0-120°, informal!
155
Full elevation of the UE requires___ to prevent impingement and provide greater humeral articulation.
External rotation
156
Mechanical purpose of scapulohumeral rhythm?
Increase ROM of elevation
Increases inferior stability of GH
Maintains optimal length tension relationship
157
Describe phase 1A of UE elevation.
0-30* scaption/ 0-60* flexion
predominantly glenohumeral
scapula seeks a position of stability
158
Describe Phase 1B of UE elevation?
30-90* scaption/60-90* elevation
Consistent upward scapula motion
Acromion elevation, elevates clavicle
IC @ root of spine and SC joint
159
Describe phase 2A of UE elevation?
90-120 of elevation
claviclar elevation tension loads costoclavicular ligaments
Costoclavicular ligaments limit elevation
IC shifts to AC joint
160
Describe phase 2B of UE elevation?
120-end ROM elevation
ICR @ AC joint
Scapular upward rotation combined with corocoid depression
Depression of corocoid tension loads coraclavicular ligaments
161
What causes posterior clavicular rotation?
Coracoclavicular tension from phase 2B impacts downward force on posterior clavicle through conoid ligament
162
The "Crank" shape of the clavicle allows for what?
30* further clavicular elevation of outer clavicle during 2B
posterior clavicle able to aid scapular tilting
163
Describe phase 1B scapular rotation?
Upper trap creates upward rotation via superomedial force on acromion
Lower serratus creates upward force via inferolateral force
Rhomboid and mid trap provide stabilization
lower trap tries to do downward rotation but it cant do to MA
164
Describe phase 2B scapular rotation?
lower trap does upward rotation
Upper trap moment arm decreases
Lower serratus (large MA) upward rotation (inferolateral force)
Rhomboid and mid trap stabilizat
165
During abduction describe the roles of the serratus and trapezius?
trap is more important
trap paralysis ROM would only be 75*
serratus paralysis: full ROM possible
166
During flexion describe the roles of the serratus and trapezius?
serratus most important
Serratus paralysis: limited flexion
Trap paralysis: full flexion
167
If the trapezius was working alone how much flexion could it create?
20* upward rotation during flexion
168
Describe the synergist action between deltoid and supraspinatus?
deltoid only will produce superior humeral translation
Supraspinatusreduces this by compressing head into gloid
169
Factors involved in glenohumeral stability?
negative intra articular pressure
labral concavity compression
capsular constraint mechanism
Scapulohumeral muscles
Capsuloligamentous restraint
170
What is negative intra-articular pressure?
venting produces inferior subluxation
less force needed to translate humeral head in other directions
171
Stability ratio equation related to labrum concavity?
stability ratio= translation force/compressive load x100
172
With intact labrum the glenohumeral joint resists dislocation force up to____% of the compressive loads?
64%
173
Which muscles compress the humeral head into the glenoid allowing for stability?
deltoid, supraspinatus, infraspinatus, teres minor
174
Most increase in which translation (direction) with decreased muscle contractility?
anterior translation (46%increase)
175
Least increase in translation (direction) with decreased RC muscle contractility?
inferior translation (0% increase)
176
RC muscles act as a buttress by_____?
centering the humeral head in the glenoid
177
How do capsuloligamentous structures add to GH stability?
GH ligaments restrain motion
motion will take the "slack: out of the ligaments
178
What is the capsular constraint mechanism?
End ROM motion takes slack out of ligament
Contribute to obligate humeral head translation
179
Anterior humeral capsule check rein for?
ER
180
The pec minor muscle attaches to the coracoid at what clock position?
4 oclock
181
What muscles attach to the coracoid at 7 oclock?
coracobrachialis
biceps brachii
182
what attaches to the coracoid at 10 oclock?
coracoacromial ligament
183
What position on the clock do the coracoclavicular ligaments attach to the coracoid?
11 oclock + midnight
