Final Material Flashcards
What is a vertebral unit?
2 adjacent vertebrae and the associated intervertebral disc
Describe the rule of 3 for T1-T3
spinous process is located at the level of the corresponding transverse process
Describe the rule of 3 for T4-T6
spinous process is located 1/2 segment below the corresponding transverse process
Describe the rule of 3 for T7-T9
spinous process is located at the level of the transverse process of the vertebrae below
Where do T10-T12 fit into the rule of 3
T10 is the same as T7-9
T11 is the same as T4-6
T12 is the same as T1-3
Describe cervical superior facet orientation
BUM -> backwards, upwards, and medial
Describe thoracic superior facet orientation
BUL -> backwards, upwards, and lateral
Describe lumbar superior facet orientation
BM -> backward and medial
Describe Fryette Principle: Type One Mechanics
SD is in neutral (not flexion or extension); sidebending and rotation are coupled in opposite directions; tends to be a group of vertebrae
TONGO
Type One Neutral Group Opposite
Describe Fryette Principle: Type Two Mechanics
SD is non-neutral (it’s either in flexion or extension); side bending and rotation are coupled in the same direction; tends to be a single vertebrae
TT(NN)SS
Type Two (Non-Neutral) Single Same
Describe Fryette: Third Principle
initiating movement of a vertebral segment in any plan of motion will modify the movement of that segment in other planes of motion; if movement is restricted in one direction, it will be restricted in other directions
For what parts of the spine does Fryette’s first 2 principles work for?
thoracic and lumbar spine only
Which part of the spine is located at the spine of the scapula?
T3 spinous process and transverse process
Which part of the spine is located at the inferior angle of the scapula?
T7 spinous process
T8 transverse process
Which part of the spine is located at the iliac crest?
L4 vertebrae
How is scoliosis named?
towards the convexity; levo = left; dextro = right
What will you see of PE of someone w/ scoliosis?
asymmetry at the waist and shoulder; possible rib cage prominence; leg length discrepancies; Cobb Angle
How do you manage scoliosis?
based on Cobb angle
<25 degrees: conservative: monitor w/ radiographs
25-45 degrees: non-operative: bracing
> 45 degrees: surgical fusion
What is seen w/ radiculopathy? How would you work it up?
pain w/ dermatomal distribution, LE weakness/diminished reflexes
Positive straight leg test and perform an MRI
What is considered a positive straight leg test? What does it indicate?
raise leg w/ knee extended; pain from 15-30 degrees -> lumbar disc etiology
What is seen w/ spinal stenosis? How would you work it up?
bilateral LE pain, LE weakness, diminished reflexes
Positive straight leg raise and perform an MRI
What is seen w/ caudal equine syndrome? How would you work it up?
emergency (usually traumatic) -> LE weakness, saddle anesthesia, urinary retention
Perform an MRI
Sympathetic influence of head and neck
T1-T4
Sympathetic influence of heart
T1-T5
Sympathetic influence of lungs
T2-T7
Sympathetic influence of esophagus and UEs
T2-T8
Sympathetic influence of bladder
T11-L2
Sympathetic influence of upper GU (kidney)
Sympathetic influence of lower GU
upper GU (kidney to upper 1/3 of ureter) -> T10-T11 lower GU (lower 2/3 of ureter to urethra -> T12-L2
Sympathetic influence of upper GI
Sympathetic influence of middle GI
Sympathetic influence of lower GI
upper GI (mouth to ligament of treitz) ->T5-T9 middle GI (L. of Treitz to ileocecal valve) -> T10-T11 lower GI (ileocecal valve to anus)-> T12-L2
Sympathetic influence of uterus/cervix
T10-L2
Sympathetic influence of LE, urethra, and erectile tissue
T11-L2
Sympathetic influence of Prostate
T12-L2
Which parts of the spine have kyphosis?
Which parts have lordosis?
kyphosis = thoracic and sacral lordosis = cervical and lumbar
Flexion/Extension is in which plane? Axis?
Sagittal plane;
horizontal (left to right) axis
Sidebending is in which plane? Axis?
Coronal (frontal) plane; anterior-posterior axis
Rotation is in which plane? Axis?
Transverse (horizontal) plane; superior-inferior axis
On PE you determine a pt’s 7-9th thoracic vertebra are rotated right and sideband left; no change in flexion or extension. How would you document SD?
T7-9 N RrSl
What actions do the rotatores perform? What type of mechanics are they connected to?
Bilateral: extends T spine
Unilateral: rotates T spine to opposite side
Type 2 mechanics -> single segment
What actions do the multifidus M. perform? What type of mechanics are they connected to?
Bilateral: extends spine
Unilateral: flexes spine to same side; rotates to opposite side
Type 1 mechanics -> multiple segments
What actions do the semispinalis perform? What type of mechanics are they connected to?
Bilateral: extends T and C spine and head
Unilateral: bends head and rotates to opposite side
Type 1 mechanics -> multiple segments
Which organs receive parasympathetic innervation from the pelvic splanchnic nerves?
bladder, lower GI, lower GU, uterus and cervix, LE, urethra, erectile tissue and prostate
What are all other levels not innervated by pelvic splanchnic N. innervated by for parasympathetics?
Vagus N.
Where do nerves exit cervical vertebrae?
ABOVE the vertebral body
What is the OA joint?
What is the AA joint?
OA - atlanto-occipital joint
AA - atlanto-axial joint
What is the primary motion of the AA joint? What does the joint not do?
primary motion is rotation; almost no sidebending or flexion/extension
How are rotation and sidebending related in C2-C7? Which is most common in C2-C7 -> flexion/extension/neutral?
usually occur in same direction; type II like; flexion/extension most common
Contraindications for soft tissue in cervical region
fractures, open wounds, surgical site, infection, DVT, coagulopathy, neoplasm
Indications for soft tissue in cervical region
cervical SD w/ significant soft tissue component
Indications for HVLA and ART in cervical region
SD with ROM restriction most likely attributed to SD in cervical facet joint, AA joint, or OA joint (hard, firm end-feel)
Contraindications for HVLA and ART in cervical region
advanced RA, down’s syndrome, carotid artery disease, malignancy, radiculopathy, dwarfism
Indications for MET or Still’s technique in cervical region
cervical SD
Contraindications for MET or Still’s technique in cervical region
undiagnosed joint swelling, severe osteoporosis, neoplasm, infection, hematoma, RA, fracture, dislocation
From what embryological structure does lymphatic vessels, lymph nodes, and spleen develop?
mesoderm
From what embryological structure does the thymus and part of the tonsils develop?
endoderm
Which parts of the lymphatic system are pressure sensitive? What does this mean?
Spleen and liver; movement of the diaphragm drives splenic and hepatic fluid movement
Which organ creates half the body’s lymph?
liver
Which lymphatic organs have little/no function in adults?
Thymus, Tonsils, and Appendix
35-60% of the drainage through the thoracic duct is associated w/ what?
respiration
Describe the histology of lymph channels
blind endothelial tubes composed of a single layer of leaky squamous epithelium
Describe lymphangions
chain of muscular units that posses bicuspid valves; contract regularly throughout lymphatic system moving lymph in a peristaltic wave
What are 7 factors to consider when evaluating lymph nodes?
size, shape, consistency, tenderness, mobility, color, warmth
Describe Virchow’s node
left supra-clavicular node -> usually relates to intra-thoracic/ABD cancer
What are epitrochlear nodes related to?
secondary syphilis
What is the name of the origin of the thoracic duct? Where is it located?
cisterna chyli which is a dilation at L1-2
Describe the termination of the thoracic duct
Pierces Sibson’s fascia at superior inlet, U turns to empty into L subclavian/internal jugular veins
From where in the body does the thoracic duct drain?
left head/neck, left UE, left thorax/ABD, and everything inferior to the umbilicus
From where in the body does the right lymphatic duct drain?
right head/neck, right UE, right thorax, heart, lungs (except LUL)
Name the 4 functions of lymphatics
maintain fluid balance, tissue cleaning/purification, defense, nutrition
Describe normal pressure of interstitial fluid. What happens if it goes wrong?
normal pressure is -6.3 mmHg (negative pressure system); if pressure is greater than/equal to 0, lymph capillaries collapse and flow ceases
What role does the diaphragm play in mechanisms of lymphatic flow?
with each breath, contraction increases negative intrathoracic pressure and pulls fluid centrally; also exerts direct pressure on cisterna chyli which pushes fluid up
What role does the pelvic diaphragm play in mechanisms of lymphatic flow? What may cause it to be dysfunctional?
helps move fluid from LE and pelvis to thoracic duct; may be dysfunctional in dysmenorrhea, endometriosis, post labor/delivery, BPH, etc.
How does the sympathetic nervous system affect lymph valves?
increased sympathetics -> tighter valves -> decreased lymph flow into venous system
How does the sympathetic nervous system affect lymphatic smooth muscle?
increased sympathetics -> decreased peristalsis -> lymphatic congestion
What is the main consequence of a poorly functioning lymphatic system?
Edema
What are some effects of edema?
compression of structures (vascular, neuronal, SOB), decreased tissue waste removal, decreased pathogen clearance and immunity, chronic states of fibrosis/contractures
What are the indications of lymphatic OMT?
edema, tissue congestion, infection, inflammation
Absolute contraindications for lymphatic OMT?
anuria -> need kidneys functioning to process fluid return
necrotizing fasciitis
pt unable to tolerate treatment
pt refuses treatment
What are some relative contraindications for lymphatic OMT?
COPD, asthma exacerbation, unstable cardiac conditions, untreated coagulopathies, cancer, chronic infections, diseased organ, pregnancy, circulatory disorders
What are the common and uncommon compensatory (zink) patterns?
common -> L/R/L/R (80%)
uncommon -> R/L/R/L (20%)
What are the transition zones of the spine?
OA, C1, C2 -> craniocervical junction
C7, T1 -> cervical thoracic junction
T12, L1 - thoracolumbar junction
L5, Sacrum -> lumbosacral junction
What is the sequence of treatment in lymphatics?
open pathways to remove restriction to flow -> maximize diaphragmatic functions -> increase pressure differentials -> mobilize targeted tissue fluids
What does BLT stand for? What is another name for it?
Balanced Ligamentous Tension (BLT); LAS (ligamentous articular strain)
What type of technique is BLT and what is the position of all treatments?
describes as indirect passive treatment where position of all treatments are done at shifted neutral
What are the indications of BLT?
SD involving ligamentous articular strains and areas of lymphatic congestion or local edema
What are the relative contraindications of BLT?
fractures, open wounds, ST or bony infections, abscesses, DVT, anticoagulation, post-operative, or aortic aneurysm
Describe changes in ligament tensions?
ligaments don’t stretch and contract like muscles so their is very little change in tension; relationship between join’t ligaments will change as the joint changes position but tension will stay balanced throughout the ligament
What happens to collagen during immobilization?
collagen is overall lost b/c the rate of degradation exceeds the rate of synthesis
What are the 3 steps in BLT?
- positioning -> place the segment in an indirect position (shifted neutral)
- activating force -> have the pt hold their breath to facilitate release
- reevaluate for motion improvement
What does FPR stand for?
Facilitated Positional Release
What type of treatment is FPR?
indirect passive treatment
What are the advantages of FPR?
easily applied, effective, time efficient, pt satisfaction, thorough (b/c of time efficiency)
FPR indications
myofascial or articular SD
FPR Absolute Contraindications
unstable fracture, neurological sxs brought on by treatment position, exacerbation of life-threatening sx by treatment position in a monitored pt
FPR relative contraindications
tx not tolerated well or significant sx during process, comorbidities that put pt at risk for fx, moderate to severe joint instability, spinal stenosis/root impingement
What is the proposed mechanism of FPR?
SD maintained by increased gamma motor neurons of muscle in segment; by putting muscle in neutral position, it eliminates afferent excitatory input which unloads the joint and leads to soft tissue
What are the 4 steps in FPR?
- setup -> continuous assessment of SD and place pt in neutral position
- activating force -> compression, torsion, or distraction
- positioning -> hold 3-5 seconds
- return to starting position and re-evaluate
What type of treatment is Still’s technique?
Indirect and direct -> start at shifted neutral and end at anatomic barrier (push through restrictive barrier)
Advantages of Still’s technique?
same as FPR -> easy, effective, time efficient, pt satisfaction, thorough
Indications of Still’s
SD in virtually all tissues of the body
Contraindications of Still’s
not advisable across recent wounds or fractures less than 6 weeks old
What are the 5 steps to Still’s technique?
- initial treatment position -> indirect
- add localizing force (less than or equal to 5lbs compression)
- move through RB while maintaining force in a smooth path
- end at the final treatment position -> direct at anatomic barrier
- return pt to neutral and reassess
What usually accompanies a compression fracture? What is the work-up?
history of trauma or osteoporosis
Work-up: A-P and lateral fims
