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Intro Flashcards

1
Q

Why should RMTs know spinal orthopaedics?

A
  • To acquire knowledge to understand the guest complaint
  • To be able to assess and treat the complaint
  • To recommend the appropriate rehabilitation and home/self care
  • To communication with other health care practitioners
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2
Q

Axial skeleton =

A

skull, vertebrae, sacrum, ribs, sternum

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3
Q

Appendicular skeleton =

A

bones of upper and lower limbs; includes clavicles, scapulae,
and innominates

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4
Q

there are _____ presacral vertebrae:

A

24 (7 cervical, 12 thoracic, 5 lumbar)

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5
Q
  • in total the spine has _____ segments:
A

33 (24 presacral, and 5 sacral, 4 coccygeal)

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6
Q

thoracic spine is in _____ , while the cervical and lumbar

regions are in ______

A

kyphosis (kyphotic curve)

lordosis (lordotic curve)

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7
Q

normal spinal curves offer _______ , as well as _______ to the intervertebral joints

A

flexibility,shock-absorption

stiffness and
stability

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8
Q
  • the thoracic curve is secondary to _______ of the _______; the same applies of the ________.
A

-the decreased vertical height

-anterior
thoracic vertebral border

-sacral curve

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9
Q

thoracic kyphosis is due to the

A

shape of the vertebral bodies

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10
Q

biomechanical functions of the spine

A
  1. housing and protection – of spinal cord
  2. support – transfers weight and flexion movements to pelvis; framework
    for attachments of internal organs
  3. mobility
  4. control
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11
Q

basic functional unit of the spine is spinal motion segment

A 
- adjacent halves of two vertebrae, interposed disk and articular facet joints, 
supporting structures (ligaments, blood vessels, nerves, muscles)
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12
Q

posterior articulations (facet joints) control

A

amplitude and direction of movement

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13
Q

Facet Orientations;

Cervical

A

superior:
inferior:

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14
Q

Facet Orientations;

Thoracic

A
  • T1 (transitional):
  • T2 - T11:
  • T11 - T12 (transitional):
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15
Q

Facet Orientations;

Lumbar

A

superior:
inferior:

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16
Q

the pelvis is made up of two innominates

- an innominate is the combination of three bones:

A

the ilium, ischium and

pubis

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17
Q

the pelvis is an enclosed osteoarticular ring made up of three bony parts ______, and three joints ______

A

(two iliac
bones and the sacrum)

(two sacroiliac joints and the pubic
symphysis)

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18
Q

FISH

A

the iliac articular surface is covered in fibrocartilage; the sacral articular surface is
covered in hyaline cartilage

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19
Q

early degenerative changes are found to occur on the

A

iliac surface rather than both

surfaces simultaneously

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20
Q

nutation

A

(flexion) sacral promontory moves anteriorly and inferiorly
- apex of the sacrum moves posteriorly
- iliac bones approximate
- ischial tuberosities move apart

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21
Q

counternutation

A

(extension)

  • sacral promontory moves superiorly and posteriorly
  • apex of the sacrum moves anteriorly
  • iliac bones move apart
  • ischial tuberosities approximate
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22
Q

movements of the sacrum correspond to movements of the spine

- in forward bending,

A

there is initially a counternutation of the sacrum, then

with complete spinal flexion a nutation of the sacrum

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23
Q

position of the sacrum is determined by

A

a force that reaches it from above

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24
Q

position of ilium is controlled by

A

movement of the femur

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25
Q

Spinal Kinematics

A
  • disk-vertebral height ratio largely determines the degree of movement at spinal
    segments
  • types of movement that may occur at spinal segments depend on the orientation of
    the articular facets of each level
  • added factors: rib cage limits thoracic motion, pelvis (and its tilt) increases trunk
    motion
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26
Q

Freyette’s Laws

A
  • describes coupling of the various spinal motions with one another
  • not strict laws, but evolving concepts
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27
Q

Freyette’s First Law

A

When any part of the thoracic or lumbar vertebral segments is in neutral position
without locking of the articular facets, rotation and sidebending are in the opposite
directions. This does not include the cervical spine. Neutral sidebending produces
rotation to the other side: the vertebral body will turn toward the convexity that is being
formed, with maximum rotation occurring near the apex of the curve.

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28
Q

Freyette’s Second Law

A

If the vertebral segments are in full flexion or extension with the articular facets
locked or engaged, rotation and sidebending are to the same side.

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29
Q

joint play =

A

small ROM, beyond regular AROM, that is obtained passively

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30
Q

joint play movements are

A

accessory movements of the joint and required for full

painless function and AROM

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31
Q

loss of joint play =

A

joint dysfunction

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32
Q

normal joint play is usually

A

less than 4mm in any direction

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33
Q

Tonic Muscles

A
  • muscles responsible for maintaining upright posture
  • tendency to become tight and hypertonic with pathology or develop contractures
  • less likely to atrophy
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34
Q

Phasic Muscles

A 
all other (non postural) muscles
• tendency to become weak and inhibited with pathology
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35
Q

Greatest mvmnt L spine

A

L5 S1

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36
Q

Pelvic tilt measurements

A

7-10 deg men

10-15 degree women

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37
Q 
Muscles "balancing" 
the pelvis (A) The posterior oblique muscle system includes
A

the

latissimus dorsi, gluteus maximus, and thoracolumbar fascia

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38
Q 
Muscles "balancing" 
the pelvis(B) The anterior oblique muscle system includes
A

the external
and internal obliques, contralateral adductors of the thigh,
and intervening anterior abdominal fascia

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39
Q

Muscles “balancing” The inner muscle unit including

A

multifidus, transverse

abdominus, and the pelvic floor muscles

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40
Q

Sacroiliac joints:

A
  • Resting position – neutral
  • Capsular pattern – pain when joints stressed
  • Close pack position – nutation
  • Loose pack position – counternutation
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41
Q

Sacroiliac Joints are both a

A

synovial (“C “shaped – convex
iliac surface/fibrocartilage) & syndesmosis jt.
(Sacral surface – slightly concave / hyaline cartilage) with
an interosseous membrane

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42
Q

in adulthood the articulating surfaces become

A

• irregular and fit into one another /restricts movement & adds joint
strength for weight-bearing

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43
Q

Fibrocartilage

contains

A 
bundles of 
collagen fibers in its 
matrix. It does not 
have a perichondrium. 
Combining strength 
and rigidity, it is the 
strongest of the three 
types of cartilage.
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44
Q

Fibrocartilage Found at

A 
the pubic symphsis, 
intertebral disc, 
menisci at the knees 
and portions of 
tendons that insert 
into the cartilage
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45
Q

Hyaline cartilage is the most .

A

abundant but weakest type of cartilage and has fine collagen fibers embedded in a gel-type matrix. affords flexibility and support, and at joints, reduces friction and absorbs shock

46
Q

Hyaline cartilage is Found at

A 
the 
end of long bones, 
anterior ends of ribs, 
nose, parts of the 
larynx, trachea, 
bronchi, bronchial 
tubes, embryonic and 
fetal skeleton
47
Q

Elastic cartilage

contains

A 
a 
threadlike network 
of elastic fibers 
within the matrix. A 
perichondrium is 
present. It provides 
strength and 
elasticity and 
maintains the 
shape of certain 
organs
48
Q

Elastic cartilage found at

A

top of
larynx, part of the
external ear and
auditory tubes.

49
Q

Long Posterior Ligaments

Action / movement it limits

A

Anterior pelvic rotation/ sacral counter nutation

50
Q

Short Posterior
Ligaments
Action / movement it limits

A

All pelvic and sacral movement,

esp. prevention of inflare

51
Q

Posterior
Interosseous
Ligaments
Action / movement it limits

A

Shearing forces on the joint

52
Q

Anterior SI
Ligaments
Action / movement it limits

A

Prevents outflaring of the ilium

53
Q

Sacrotuberous
Ligaments
Action / movement it limits

A

Nutation and posterior rotation of the
innominate
* Biceps femoris attaches to
Sacrotuberous ligament *

54
Q

Iliolumbar
Ligaments
Action / movement it limits

A

Stabilizes L5 on the ilium

55
Q

Sacrospinous
Ligaments
Action / movement it limits

A

Nutation and posterior rotation of the

innominate

56
Q

PELVIS characteristics:

A
  • Gynecoid, shorter + wider (predominantly female)

* Android (primarily male)

57
Q

Structural Pathologies of the Pelvis

UPSLIP;

A 
- ASIS+PSIS will both be higher 
on effected side
- Ilium moves up on sacrum
Other causes:
short leg on other side
Muscle spasm
58
Q

Structural Pathologies of the Pelvis

DOWNSLIP;

A
  • ASIS+PSIS will both be lower on
    effected side
  • Ilium moves down on sacrum
59
Q

Structural Pathologies of the Pelvis

INFLARE;

A
  • PSIS is more lateral, ASIS moves
    medially
  • Can also indicate anterior
    rotated ilium
60
Q

Structural Pathologies of the Pelvis

OUTFLARE:

A

-PSIS is more medial, ASIS moves
laterally
- Can also indicate posterior
rotated ilium

61
Q 
Structural Pathologies of the Pelvis
ANTERIOR ROTATION (ilium):
A

-Ilium rotates anterior & slightly
superior on the sacrum
-Commonly accompanies inflare

62
Q 
Structural Pathologies of the Pelvis
POSTERIOR ROTATION (ilium):
A
  • Ilium rotates posterior &
    slightly inferior on the sacrum
  • Commonly accompanies
    outflare
63
Q

LUMBARIZATON:

A

-S1 segment of
sacrum is mobile
-Behaves like a
lumbar vertebrae

64
Q

SACRALIZATION:

A
  • L5 immobile on S1
    (sacral fusion)
  • L5 behaves like S1
65
Q

Pelvic Pathologies

A
  • Degenerative / inflammatory arthritis
  • Pelvis fractures
  • Pubic Symphysis disruption
  • SI joint disruption /altered mechanics
  • Coccydynia
66
Q

Level of iliac crests

*normal =

A

level with L4

67
Q

Level of PSIS,

*normal =

A

dimples at S2

68
Q

PELVIS PALPATION

• Anterior observational view.

A

(A) Level of anterior superior iliac
spines. Are they equidistance to center line? (B) Level of iliac
crests.

69
Q

PELVIS PALPATION

Posterior observational view

A 
(A) Level of iliac crests
*normal = level with L4
(B) Level of PSIS, 
*normal = dimples at S2 
(C) Level of ischial
tuberosities
(D) Level of gluteal folds
70
Q

PELVIS – Motion Palpation

A 
• (A) Starting position for sacral 
spine and posterior superior iliac 
spine. 
• (B) Hip flexion; the ilium (PSIS) 
should drop inferiorly
• (C) Starting position for sacral 
spine and ischial tuberosity. 
• (D) Hip flexion; Ischial tuberosity
should move inferior + lateral
71
Q

Treatment techniques for ant / posterior rotation of the ilium& SI joint fixation include:

A

Positioning of the client – Prone
Specific pillowing for Ant / Post rotations of the iliums – using wedges

On Anteriorly rotation ilium– place wedge under ASIS – this will encourage posterior rotation of that ilium.
Mobilize sacrum into nutation and ilium posterior
Contract hamstrings
On Posterior rotated ilium – place wedge under Greater trochanter
mobilize PSIS anterior and sacrum into conter-nutation.
Contract quadriceps

72
Q

On Anteriorly rotation ilium– place wedge under

A

ASIS – this will encourage posterior rotation of that ilium.
Mobilize sacrum into nutation and ilium posterior
Contract hamstrings

73
Q

On Posterior rotated ilium – place wedge under

A

Greater trochanter
mobilize PSIS anterior and sacrum into conter-nutation.
Contract quadriceps

74
Q

Treatment techniques for ant / posterior rotation of the ilium& SI joint fixation include:

A

Positioning of the client – sidlying
To increasing anterior rotation – bring top leg into extension, as you mobilize the PSIS anterior. Also contract quadriceps

To increase posterior rotation – bring top leg into flexion; engage the ASIS and ischialtuberosity and mobilize in posterior direction. Contract hamstrings.

75
Q

To increasing anterior rotation –

A

bring top leg into extension, as you mobilize the PSIS anterior. Also contract quadriceps

76
Q

To increase posterior rotation –

A

bring top leg into flexion; engage the ASIS and ischialtuberosity and mobilize in posterior direction. Contract hamstrings.

77
Q

Musculature of the Lumbar spine:

A

Transverse Abdominalis
– commonly weak in people with low back pain
Multifidus
QL,Iliopsoas, erectorspinae, latisimusdorsi

78
Q

Ligaments and fascia of the Lumbar spine:

A 
Interspinous
Intraspinous
Iliolumbar
Anterior longitudinal
Thoracolumbar fascia
79
Q

Abdominal Regions

A
  • R Hypochondrium (1/2 Liver, Gall Bladder)
  • Epigastric region (1/2 liver, esophagus, upper stomach, pancreas)
  • L Hypochondrium (Spleen, L cholic flexure)
  • R Flank (Lower portion liver and gall badder,ascending colon, R colic flexure)
  • Umbilical (bottom stomach,Transverse colon, duodenum)
  • L Flank (jejunum, descending colon)
  • R Groin (Ceacum, R ilium, inguinal lig)
  • Pubic Region (sigmoid colon, rectum, anal canal, anus)
  • L Groin (descending colon, ilium, inguinal lig)
80
Q

Lumbar Spinal Vertibrea

A
  • Body
  • Pedicle
  • Transverse Process
  • Lamina
  • Spinous Process
  • Vertebral Foramen
  • Superior Articular Facet (Med/Post)
  • Inferior Articular Facet (Lat/Ant)
81
Q

Transitional vertebrae

A

(L1 & L5)

82
Q

Normal Lordodic Curve =

A

50° (5 discs)

Any change to the lordosis can cause a nerve root irritation

83
Q

A contributing factor to low back pain is the

A

loss of the lumbar curve

84
Q

Superior facet =

Inferior facet =

A

faces medial and slightly posterior

faces lateral and slightly anterior

85
Q

Lumbar facet orientation

A

Allows for movements of flexion/extension /lateral flexion/rotation

86
Q

Concave / convex rule in the lumbar vertebrae

With flexion

A

(anterior roll / posterior glide) = SP’s move further apart and posteriorly

87
Q

Concave / convex rule in the lumbar vertebrae

With extension

A

(posterior roll / anterior glide) = SP’s move closer together and anteriorly

88
Q

Epidemiology Lumbar

A

5% related to disk … 95% related to disk (books differ)

Bone:Osteoperosis, compression fracture, degenerative changes
Joint:DDD, DJD, facet lock, osteophytes (leads to bony fusion that then places pressure on nerves)

Referral:Ovaries, prostate, kidney, aortic aneryism

Muscles, fascia, ligaments-strains and sprains
Nerves:L4-L5 most commonBlood vessels:Aneurism

Other: space occupying lesion, genetics…

89
Q

Congential Pathologies:

Spina bifida

A

Latin for “split spine” is a developmental birth defect caused by the incomplete closure of the embryonic neural tube. Some vertebrae overlying the spinal cord are not fully formed and remain unfused and open. If the opening is large enough, this allows a portion of the spinal cord to stick out through the opening in the bones.
The most common location of the malformations is the lumbar and sacral areas.
The incidence of spina bifida can be decreased by up to 75% when daily folic acid supplements are taken prior to conception.

90
Q

Spondylolysis
CAUSES:
DIAGNOSIS:

A

Spondylolysis
Is a defect in the pars interarticularis of a vertebra.
The great majority of cases occur in the lowest of the lumbar vertebrae (L5), but spondylolysis may also occur in the other lumbar vertebrae, as well as in the thoracic vertebrae.

CAUSES:
Congenital
Typically caused by stress fracture of the bone, and is especially common in adolescents who overtrain in activities such as tennis, diving, martial arts & gymnastics

DIAGNOSIS:
- The defect is seen in the oblique lumbar radiograph. An oblique x-ray of the lumbar spine shows a “Scotty Dog” appearance

91
Q

Spondylolysis

A

A defect in the pars interarticularis or the arch of the vertebra

92
Q

Spondylolisthesis

A

A forward displacement of one vertebra over another

93
Q

Retrolisthesis

A

A backward displacement of one vertebra over another

94
Q

Meyerding Grading System

A

is used to classify the degree of vertebral slippage. Slips are graded on the basis of the percentage that one vertebral body has slipped forward over the vertebral body below.

95
Q

Meyerding Grading System used for?

A

is used to classify the degree of vertebral slippage. Slips are graded on the basis of the percentage that one vertebral body has slipped forward over the vertebral body below.

96
Q

Meyerding Grading System

A 
Grade I: 1-24% 
Grade II: 25-49% 
Grade III: 50-74% 
Grade IV: 75%-99% slip. 
Grade V: Complete slip (100%), 
known as spondyloptosis
97
Q

Other Lumbar Pathologies

A 
DDD/ arthritis
Disc protrusion-herniation
Spinal stenosis
Nerve root compression & facet lock
Fracture & Soft tissue injury
Hypo / Hyper lordosis
Medical lower back pain – muscles, ligaments and fascia involvement
98
Q

DEGENERATIVE DISK DISEASE (DDD):

A

Phase I:Dysfunctional
In the first phase of the degeneration process we see a tearing around the outer surfaces of the disc cartilage material. The normal height of the disc has now been compromised as it begins to shrink. The disc has lost some of its effectiveness in providing flexibility and cushioning to the spine.

Phase II: Unstable
In the second phase of degeneration, the joint experiences a progressive loss of strength. Further tearing and loss of disc height and cartilage degeneration occurs.

Phase III: Stabilization
Even further loss of disc height occurs, the surfaces of the vertebrae above and below the disc now start to show moderate to severe damage, the disc has become thin and fibrotic, and we now see the formation of arthritic osteophytes (spurs).

Over time pain and symptoms worsen in the absence of proper treatment.

99
Q

% H2O discs?

A

(70% water)

100
Q

Four stages of disc

protrusion-herniation:

A
  1. Protrusion – the disc bulges posteriorly without any rupture in the annulus firbosis
  2. Prolapse – only the outermost fibers of the annulus fibrosus contains the nucleus
  3. Extrusion – the annulus firbosus is perforated and discal material moves into the epidural space
  4. Sequestration – a formation of discal fragments outside of the disc
101
Q

Protrusion –

A

the disc bulges posteriorly without any rupture in the annulus firbosis

102
Q

Prolapse –

A

only the outermost fibers of the annulus fibrosus contains the nucleus

103
Q

Extrusion –

A

the annulus firbosus is perforated and discal material moves into the epidural space

104
Q

Sequestration –

A

a formation of discal fragments outside of the disc

105
Q

peripheralization and centralrization

A

Periph pain moves away from center

Central pain moves toward core (retreats to source = healing)

106
Q

Herniation

A

Immediate pain – posterior thigh leg and foot

Pain gluteals, hamstrings and down to heel

  • If pain complaint is anterior thigh or groin, then consider hip joint involvement
107
Q

Facet Lock

A

Pain doesn’t go distal to knee

Back gets locked in position (ie. Reach forward into flexion and can’t return to neutral)

108
Q

PSOAS INVOLVEMENT
Hypo-lordosis –
Hyper-lordosis –

A

is accompanied with hip flexion (femur moves around the ilium)

is accompanied with anterior rotation of the ilium (ilium moves around the femur) and lumbar extension

109
Q

Lumbar lordosis

A 
Abdom- long/weak
Erect sp- tight
ASIS-low
PSIS- high
Glutes-Long/weak
Iliopsoas- tight
Hamstring tension- tight
110
Q

Effect of different leg lengths and posture.

A

Note presence of scoliosis on the side with the “short” limb. (A) Normal. (B) Short left femur. (C) Short left tibia. (D) Pronation of left foot.

111
Q

MYOTOMES

A 
C3-5 -Diaphragm
C5- Shld and flex elbow
C6 – Bending Wrist back
C7 -Extend Elbow
C8-Bends fingers
T1-Spreads fingers
T1-12-Chest wall Abdominal Cavity

L1 – L2-Bends hip - Iliopsoas
L3-Extends knee - quadriceps
L4-Dorsiflex – tibalias anterior
L5-Wiggles Toes – extends bid toe

S1-Plantar flex - soleus
S3-5-Pelvic Region

All Sp Tx (3 decks)

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