lecture 14: conditions of the back Flashcards
what are the functions of the spine
- Upright posture
- Allows movement
- Protects spinal cord
- Muscle/ligament attachment
how many vert in the cervical spine
7 vert
how many nerve roots in the cervical spine
8 nerve roots
what are the vertbetrea responnsible for rotation in the cervical
c1 (atlas) and c2 (axis)
which vert has an attached to the ribs
thoracic
the thoracic cage incloses what
tthe heart and lungs
is there alot of rotatation at the lumbar
no
why is there minimal rotation in the lumbar spine
because the facet joints are vertical which also limit extension
why are the bodies of lumbar vert large
for weight bearing
what are the functions of the intervetebral discs
• Allows movement
• Shock absorption
• Increases space for transverse
foramen
what happens to the transverse foramen if there is disk degeretation
it can cause impingments of nerves by decreasing the space
in flexion, what position foes the disc move
backwards
in extension, what postion does the disk move
moves anterioly
what vertebrae are sprains more common in cervical or lumbar
cervical
how is anterior long lig stretched
with extension
how are the interspinous. posterior long lig and supraspinous ligs strtecthed
with flexion
how is the intertranse ligs stretched
by side beining
what is the position of brachial plexus
c5-t1
what are some important muscles of the cervical spine
longus colli SCM uppe rtraps suboccipital lev scap
what muscles of the cervical spine tightten witth instability/whiplash
SCM
upper traps
suboccipital
lev scap
what is the problem with the disk slipping posteriorly
because it can compromise the SC
true or false: stenosis can occur anywhere in the spine
true
what position is more comfortable for those wtih stenosis
flexion
what is stenosis
decreased space in the interverbtebral formane
stenosis is only aquired
false, also congenital
aquired stenosis is secondary to what
osteophyte formation
what are the SS of stenosis
Quadriplegia,
burning/tingling/numbness,
motor changes, pain in area
what position is more comfortable for people with disc herniation
extension
what is the MOI for whiolash
whiplash, repetitive flexion or
extension, compression
what is the most common disc degrenation
posterior lateral
what are the SS of disc hernation
radiating pain, pain with
Valsalva maneuver
what location is mosre common in the L spine for disc herniation and what age
L4/L5 and L5/S1 (30-50)
cervical spine disc herniation is more common in what population
older individuals
what happens to the nucleus polposus in disc herniation
goes through annulus fibrosis
disc herniation is assocaited with tears of what
annulus fibrosus
what is prolapse in disc herniation
nucleus finds a way thorugh the annulus fibfrosus
what is extrusion in disc herniation
material moves into spinal cord (may impinge)
what is sequesteration in disc hernation
matter gets further into spinal cord, can migrate
is generative disk disease chronic or acute
chronic
what is the MOI for degenrative disc diease
compression, high impact,
age
what are the SS for degenrative disc disease
radicular pain, loss of motor
function, pain with Valsalva
maneuver
where is the dermatonme for L1-L2
Front of thigh and
groin to knee
what area of the spine is assocaited with dermatone and sensory loss of Front of thigh and groin to knee
L1/L2
what is the myotome weakness for L1/L2
psoas/adductors
what area of the lumbar spine is assocaited with myotome weakness of psoas and adductors
L1-L2
what is the dermatome for L3-L4
Ant mid thigh over
patella and medial
lower leg to great
toe
what area of the lumbar spine is assocaitied with the dermatone Ant mid thigh over
patella and medial lower leg to great toe
L3-L4
what is the mytome weakness for L3L4
Ankle dorsiflexion
what part of the lumbar spine is assocaited with the mytoine weakness of Ankle dorsiflexion
L3-L4
what is the dematone for L4/L5
Lateral thigh, anterior leg, top of foot, and middle three toes
what part of the lumbar spine is associated with sensory loss of Lateral thigh,
anterior leg, top of foot, and middle three toes
l4/l5
what is the myotone for L4L5
toe extension
what part of the lumbar spine is asosciated with myotome weakness of toe extension
l4/l5
what is the dermatone for l5-s1
Posterior lateral thigh and lower leg to lateral foot and 5th toe
what part of the spine is assocaited with the sensory loss of Posterior lateral thigh and lower leg to lateral foot and 5th toe
l5/s1
what is the mytome weakness for l5/s1
Ankle plantar flexio/n
what part of the spine is assocaited with myotone weakness of Ankle plantar
flexion
l5/s1
what is the dermatome for c1/c2
Top of head, forehead
what part of the spine is assocaited with dermatone of Top of
head,
forehead
c1/c2
what is the myotone weakness of c1/c2
neck flexion
what part of the spine is associated with mytone weakness of neck flexiion
c1/c2
what is the dermatone for c3
entire neck
what part of the spine has the dermatone of the entire neck
c3
what is the myotone weakness of c3
lateral flexion
what part of the spine is assocaited with mytome weakness of lateral flexionn
c3
what is the dermatonne of c4
shoulder area/clavicle
what is the myotome for c4
shoulder elevation
what part of the spine is associated with dermatone of shoulder area/clavicle
c4
what part of the spine is assocaited with myotone weakness of shoulder elevation
c4
what is the dermatone for c5
deltoid area
what part of the spine is associated with dermatone of deltoid area
c5
what is the myptome weakness of c5
should abduction
what part of the spine is associated with myotinne weakness of should abduction
c5
what is the dermatone of c6
Radial side of hand to thumb
what part of the spine is assocaited with dermatone Radial side
of hand to thumb
c6
what is the myotome for c6
Elbow flex
and/or
wrist
extension
what myotine is assocaited with Elbow flex and/or wrist extension
c6
what is the dermatone for c7
Index, middle and ring fingers
what part of the spine is assocaited with the dermatonne Index,
middle and ring fingers
c7
what is the myotome for c7
Elbow extension and/or wrist flexion
what part of the spine is associated with myotone Elbow extension and/or wrist flexion
c7
what is the dermatone for c8
little finger
what part of the spine is associated with dermatone of little finger
c8
what is the mytome for c8
thumb extension
what part of the spine is assocaited to mytoone weakness of thumb extension
c8
what is the dermatone of t1
Medial side of forearm
what part of the spine is assocaited with the dermatoen of Medial side of forearm
t1
what is the myotine for t1
Finger abduction/ adduction
what part of the spine is assocaited with myotine weakness of Finger abduction/ adduction
t1
what is toricolis>
Held tilts toward one shoulder
and chin rotates toward
opposite shoulder
what muscle is at fault in toricolis
SCM is shortnered/spastic
is toricolis onnly congenital
false, also aquired
what are the SS of torticolis
loss of ROM, palpable
lump or swelling in involved
muscles
what is the MOI for cervical sprains
Occur at extreme motions
• Violent muscle contractions
what are the SS of cervical sprains
pain, stiffness, and restricted ROM
what is the MOI of cervical strains
Forceful contractions- eccentric
• Extreme ROM
what muscles are usually innvolved in cervical strains
SCM and UFT
(also maybe scalenes, levator
scapulae and splenius muscle
too
what are the SS of cervical strains
• S/S- pain, decrease ROM, muscle
spasm, pain during contraction
or stretching of muscle
the brachial plexus is a neural structure that innervates what
upper extensionn
what are the 2 ways to injury the brachial [lexus
compression or stretch injur y
what is thje MOi for an acute burner
forceful separation of neck from shoulder
what are the SS for acute burners
• S/S- immediate, severe, burning pain and prickly paresthesia that
radiates down arm
acute burners usually subsides within how long
5-10 mintutes
true or false: Weakness may persist for hours or even days after a burner
(Abduction and external rotation)
true
how to decide if someone can RTP after a burner
If strength and function return completely within 5 minutes
what are the 5 conditions for RTP for acute burney
- 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 3 classifications of burners
neuropraxia
axonotmesis
neurotmesis
what are the signs of neuropraxia
Temporary loss of sensation and/or loss of motor function
May demyelinise but axon in tact
what is the prognosis for neuropraxia
Recovery within a few
days to a few weeks
what is the signs for axonotmesis
Significant motor and mild sensory deficits
Axonal damage
what is the prognosis for axonotmesis
Deficits last at least 2
weeks. Regrowth is slow,
but full or normal
function usually I restored
what is the signs of neurotmesis
Motor and sensory deficits persist for up to 1 year
Nerve lacerated/avulsed
what is the prognosis for neurotmesis
Poor prognosis. Surgical
intervention
suprascapular nevre innnervates what
supraspinatus, infraspinatus and GH joint capsule
what is the MOI for suprascap nerve injury
• MOI: OH motions that generate rapid torque and velocity forces
during cocking, acceleration and release phases
what is the SS for suprascaular nerve injur y
S/S: muscle weakness and atrophy, secondary injuries (ie
impingement, tendinitis, bursitis etc)
what is the MOI for contusions,sprains and strains of thoracic
MOI: direct blows, violent muscle contractions
what are the signs and symptoms of contusions, strains and sprains of thoracic spinen
• S/S- pain, ecchymosis, muscle spasm, limited swelling, decreased
ROM and function
what are commonly strianed muscles in throacic
obliques
lats
rectus abdom
intercostals
are thoracic fracures common>
no beacuse well protected with rib cage so ribs fracures are morew common
what is the MOI for thoracic fracture
compressive loads (tackle, fall on buttocks), women with osteopenia, repetitive stress from activities such as running
wjat os scheurmanns disease
Degeneration of the epiphyseal end plates of the vertebral body
• Involves 3 adjacent vertebral segments
scheurmanns diease is related to what
mechanical stress
in scheurmanns disease, what happens to the vertebral body
anteriior portionn loses part of bone mass
scoliosis is waht
lateral curvature of the spine
can scoliosis only be structural
false, also functionnal
explain structural scoliolis
bone growing/malalligned during adolesscne
ex[lain function scoliosis
muscles are imbalancedand pulling spine in wrong directionn
where are the most common portions of the spine that have scoliosis
lumbar and thoracic
what is the weakest bony portion of the vert neural arch
pars interarticularis
what is the MOI for pars interarticualris
Mechanical stress from axial loading (Repetitive loading in flexion, hyperextension and rotation)
• Congenital
pars interarticualris can lead to what
Spondylolysis vs. spondylolisthesis
what is Spondylolysis
Fracture of pars interarticularis (only 1 side)
• Stress or complete
what is Spondylolisthesis
• Bilateral separation of pars resulting
in anterior displacements of
vertebrae with respect to vertebrae
below (2 sides of vert)
what is the most common site for spondylothesis
l5-s1 (90%)
Spondylolysis vs. Spondylolisthesis is often diangosed at what age and waht sport is common
10-15
gymnasts
what are the SS of Spondylolysis vs. Spondylolisthesis
Can be asymptomatic • Low back pain • Neurological symptoms • Unilateral dull ache aggravated by activity • Hyperextension and rotation • Mm spasm of erector spinae or hamstrings • Flattened lumbosacral curve
what position might help spondys
flexion
what are some examples of facet joint pathology
• Subluxation or dislocation
• Facet joint syndrome (i.e inflammation)
• Degeneration of facet itself (arthritis)
Mechanical injury to joint capsule- sprain
what postion can helo relieve pain in facet joint pathologies
Flexion
what are the SS of facet joint patholgy
- Point tenderness, flattening of back
- Pain with rotation, extension, lateral bending
- Limited flexibility of pelvic musculature
what is sciatica
Inflammatory condition of sciatic
nerve
what can sciatica be caused by
• Herniated disk • Annular tear • Muscle related disease • Spinal stenosis • Facet joint pathology • Compression of nerve between piriformis muscle
what is the MOI for SI joint sprain
- Traumatic- bending, twisting
- repetitive stress from lifting
- Fall on buttocks
- Excessive side to side movement (• Running, Uneven terrain)
what are the SS for SI joint sprain
• Pain in SI area, extends to buttocks/posterior thigh • Pelvic imbalance • Standing one leg, climbing stairs P! • Lateral bending to that side, flexion