Lecture 3- Thoracic Spine and Ribs, Lumbar Spine and Pelvis Flashcards
1
Q
THORACIC SPINE AND RIBS
A
THORACIC SPINE AND RIBS
2
Q
The ___ and ____ thoracic vertebrae are considered transitional vertebrae.
A
1st and 12th
3
Q
What makes ribs articulation with T1 and T10-T12 atypical?
A
They have a full costal facet as opposed to demifacets.
4
Q
The typical thoracic body is wedge shaped for what reason?
A
kyphotic curve
5
Q
Do the typical thoracic vertebrae bodies have full facets or demifacets?
A
demifacets
6
Q
Do the typical thoracic veretebrae have small or large intervertebral discs? How are they shaped?
A
- small, meaning less motion
- wedge shaped just like the bodies
7
Q
The pedicles of typical thoracic vertebrae face _________, resulting in what?
A
- posteriorly
- narrowing of the vertebral canal
8
Q
Less motion at the thoracic vertebrae decreases risk for what?
A
impingement on spinal cord due to narrowing of the canal
9
Q
The typical thoracic vertebrae articular pillars facet joints lie ___ off the frontal plane allowing greater motion into ___________ and __________ and less __________/_________.
A
- 20 degrees
- lateral flexion and rotation
- flexion/extension
10
Q
The typical thoracic vertebrae spinous processes slope inferiorly from T_ to T_. The tip of spinous process lies at the level of the _______ vertebrae for the majority of the thoracic spine.
A
- T5-T8
- caudal
11
Q
The typical thoracic vertebrae joint capsule is more _____ resulting in what?
A
- taut
- less mobility/more stability
12
Q
The ligamentum flavum and anterior longitudinal ligament are ______ in the thoracic spine.
A
thicker, limiting mobility
13
Q
Where is the costovertebral joints?
A
Typical Vertebrae (T2-T9) -head of rib on demifacet of vertebrae above and below and intervertebral disc Atypical Vertebrae (T1, T10-T12) -head of rib on facet of one vertebral body
14
Q
Is the atypical or typical costovertebral joint more mobile?
A
atypical
15
Q
The costovertebral joint is a ________ type joint that permits ________ and ________.
A
- synovial
- gliding and rotation
16
Q
The costotransverse joint is a _____ type joint.
A
synovial
17
Q
T1-T6 costotransverse joints are ______ costal facets of transverse processes with _______ costal tubercle.
T1-T6 promotes __________ movement.
A
- concave
- convex
- rotational
18
Q
T7-T10 costotransverse joints are a _____ articular surface that allows for ________ movement.
A
- flat
- gliding
19
Q
Do T11 and T12 articulate at a costotransverse joint?
A
No
20
Q
The costochondral joints are ________ joints which is what?
These joints have no __________ support.
A
- synchondrosis joints, immovable joint bound by cartilage
- ligamentous
21
Q
- The 1st chondrosternal joint is a _______ joint.
- The 2nd through the 5th chondrosternal joints are _________ joints.
- The 6th through the 7th chondrosternal joints are ________ or ________ joints.
A
- synchondrosis
- synovial
- synchondrosis or synovial
22
Q
Do chondrosternal joints have ligamentous support?
A
Yes
23
Q
As we age, the ___________ joints can ossify leading to restrictive lung disease.
A
chondrosternal
24
Q
What are the osteokinematic movements that can occur at the thoracic spine?
A
- flexion/extension
- lateral flexion
- rotation
25
What limits flexion at the thoracic spine?
- PLL
- ligamentum flavum
- interspinous ligaments
- capsule of facet joints
26
What limits extension at the thoracic spine
- contact of spinous processes
- laminae
- ALL
- capsule of facet joint
- abdominal muscles
27
What limits lateral flexion at the thoracic spine?
facets and ribs
28
What limits rotation at the thoracic spine?
ribs
29
In regards to the arthrokinematics occuring at the thoracic spine, the facet joint slides _____ and ________ for flexion, ________ and ________ for extension.
- superior and anterior
| - inferior and posterior
30
What thoracic vertebrae are very limited in flexion/extension and why?
T1-T6 due to rib cage and frontal orientation of facets
31
The lower thoracic have a higher ability to flex and extend, why?
The facet joints have a more sagittal orientation
32
In regards to the arthrokinematics occuring at the thoracic spine, the facet joint on the contralateral side is sliding _______ while side bending, while the facet joint on the ipsilateral side is sliding __________.
- superior
| - inferior
33
When side bending, what is also occuring at the thoracic spine?
rotation
34
What restricts the motion of lateral flexion (side bending)?
facet joint approximation
35
In regards to the arthrokinematics occuring at the thoracic spine, the facet joints on the contralateral side will slide ________ during rotation while the facet joints on the ipsilateral side will slide ________.
- anteror
| - posterior
36
When rotation occurs, what is also occuring at the thoracic spine?
side bending
37
What restricts the motion of rotation?
motion at costovertebral and costotransverse joints and ability of ribs to deform
38
The amount of rotation _________ in the lower part of the thoracic spine due to facet orientation.
-decreases
39
The upper thoracic spine (T1-T6), lateral flexion and rotation are in the ______ direction. In the lower thoracic spine, lateral flexion and rotation are in the ________ direction.
- same
| - opposite
40
The upper ribs (2-7) is our ____ handle ribs and the diameter change occurs _______/________.
- pump
| - anterior/posterior
41
The lower ribs (8-10) is our ______ handle ribs and the diameter change occurs _____/_______.
- bucket
| - medial/lateral
42
Describe the muscle activation that occurs when doing a diagonal situp.
- external oblique on one side acts synergistically with the internal oblique on the other side
- transverse abominis acts as stabilizer for the obliques
43
What are the primary axial rotators?
-external and internal obliques
44
What are the secondary axial rotators?
- ipsilateral latissimus dorsi
- ipsilateral iliocostalis lumborum
- contralateral transversospinal muscles
45
The multifidi is crucial for _______ stability in lumbar region during axial rotation.
extension
46
What are the overall functions of the thoracic spine and ribs?
- less flexible more stable
- motion is limited secondary to rib cage, spinous processes, taut facet joint capsules, ligamentum flavum and the dimensions of the discs and vertebral bodies
- stable base for muscles that influence craniocervical region
- protection for the thoracic organs
47
What is scoliosis and where is it most common?
- deformity of the vertebal column
| - thoracic spine
48
What is the difference between functional and structural scoliosis?
- Functional- can be corrected actively
| - Structural- can't be corrected actively
49
What is hyperkyphosis?
excessive thoracic kyphosis (humpback)
50
Hyperkyphosis significantly ___________ interbody joint compression
increases, may result in compression fracture
51
LUMBAR SPINE AND PELVIS
LUMBAR SPINE AND PELVIS
52
The body of the lumbar vertebrae have a ________ transverse diameter, why?
- large
| - allows for accepting greater compressive loads from the upper body and the ground reactive forces
53
The vertebral foramen of the lumbar spine is shaped like a _________. It is larger than the ________ but smaller than the _________.
- triangle
- thoracic
- cervical
54
L5 is a __________ vertebrae.
transitional
55
L5 has a _____ shaped body and has a smaller _______ process but a larger ________ process.
- wedge
- spinous
- transverse
56
- The facet joints at the lumbar vertebrae are _______ and _______.
- Anteriorly, the facet joint is aligned nearly with the _______ plane, resisting anterior ______ force.
- Posteriorly, the face joint is aligned nearly with the ________ plane, allowing for greater _______/________ but limiting _________.
- curved and biplanar
- frontal, shear
- sagittal, flexion/extension, rotation
57
The joint capsules in the lumbar region are ____ taut than the thoracic region, resulting in what?
- less
| - more mobility
58
What is the lumbosacral angle?
formed from the 5th lumbar vertebrae and 1st sacral segment
59
Why is the lumbosacral junction an area susceptible to injury and shearing?
An increase in the lumbosacral angle= increased lordosis which increases the amount of shearing forces
60
What are the structures that resist natural shearing force at the lumbar vertebrae?
- intervertebral disc
- facet joint capsules
- ALL and iliolumbar ligaments
61
What is spondylolisthesis and where is it most common?
- slipping of one vertebrae down another
| - most common at L5-S1 junction
62
The lumbar discs are the ______ discs in the spine.
largest
63
The anulus fibrosis has ________ layers oriented in opposite directions at ____ degrees to resist tensile forces in nearly all directions.
- alternating
| - 120
64
The sacroiliac joint is a compound joint with an anterior _______ joint at the articular surfaces and a posterior __________ joint at the tuberosities.
- synovial
| - syndesmosis
65
What type of joint is the pubic symphysis and what muscles provide support to this area?
- cartilaginous joint
| - transverse abdominis, rectus abdominis, internal oblique, adductor longus
66
What are the osteokinematics of the lumbar spine?
- flexion/extension
- lateral flexion
- rotation
- coupled lateral flexion and rotation usually occurs, however, the pattern is inconsistent
67
In regards to the arthrokinematics of the lumbar vertebrae, the facet will glide ________ and _________ with flexion.
- superior
| - anterior
68
When flexing, we get _____ tilting between the bodies of the vertebrae.
anterior
69
In regards to the arthrokinematics of the lumbar vertebrae, the facet joint will glide ________ and ____________ with extension.
- inferior
| - posterior
70
The greatest lumbar extension motion occurs in which lumbar segments?
inferior
71
In regards to the arthrokinematics of the lumbar vertebrae, the facet joint will glide ________ on the contralateral side and will glide ___________ on the ipsilateral side when performing lateral flexion.
- superior
| - inferior
72
The greatest lumbar lateral flexion motion occurs in which lumbar segments?
superior
73
The coupling pattern is __________ in the lumbar vertebrae.
inconsistent
74
In regards to the arthrokinematics of the lumbar vertebrae, the facet joint will glide ______ on the ipsilateral side and in a neutral spine it will __________ with rotation.
- posterior
| - distract
75
In regards to the arthrokinematics of the lumbar vertebrae, the facet joint will glide ________ on the contralateral side and in a neutral spine it will __________ with rotation.
- anterior
| - approximate
76
The greatest lumbar rotation motion occurs in which lumbar segments?
superior
77
What is the lumbo-pelvic rhythm and in what motions does this occur?
- relationship of the lumbar spine and hip joints
| - occur in flexion/extension
78
Lumbar flexion with pelvis rotation ________ ROM.
increases
79
When bending over to touch the toes, _______ flexion is followed by _______ tilting of the pelvis.
- lumbar
| - anterior
80
When rising from a toe touch position, ________ tilting is followed by _______ extension.
- posterior
| - lumbar
81
Movement of the pelvis ______ motion and also ________ amount of flexibility required of the lumbar region.
- increases
| - reduces
82
What is the impact on ROM if the lumbo-pelvic rhythm is impaired?
ROM is decreased whether we have hypomoility at pelvis or at the lumbar region
83
Active muscle force is essential for stabilizing the vertebral column and is often referred to as ____________.
core stability
84
What muscles provide muscular stability to the trunk? What are intrinsic? What are extrinsic?
```
Intrinsic Stabilizers
-semispinalis
-multifidi
-rotatores
-interspinales
intertransversarius
Extrinsic Stabilizers
-rectus abdominus
-external and internal obliques
-transverse abdominis
-erector spinae
-quadratus lumborum
-psoas major
```
85
What does having a stable core do?
- provides structural integrity
- optimizes posture
- limiits excess micromotion
- provides firm base for extremity movement
86
What is the muscle activation that occurs with a full sit-up?
- Trunk flexion with the rectus abdominus
| - Hip flexion occurs with continued activation of the abdominals and recruitment of the hip flexors
87
When performing a sit-up, weak abdominals will result in what?
early hip flexion due to hip flexor dominance of the activity
88
What are recommended lifting mechanics? Why are these strategies preferred?
Reduce velocity of lifting
-decreases amount of back extensor muscle force needed
Reduce magnitude of external load
-reduced weight reduces strain
Reduce length of EMA (extensor moment arm)
-keeping the load close to you makes it easier to lift
89
Difference between a stoop and a squat lift.
Stoop
-primarily extending hips and lumbar
-associated with greater flexion of low back
-greater extension force required from low back and trunk due to longer EMA
-can result in large compression and shear forces on discs
Squat
-begins with knee in max flexion
-extension of knees and hips powered by quads and hip extensors
-allows load to be raised between knees
-EMA is reduced between load and trunk
-advocated as safer
90
Does the SI joint move?
Slightly, nothing that is clinically detectable
91
What are the two terms used to describe the movement of the sacrum on the innominate (hipbone)?
- Nutation
| - Counternutation
92
What is nutation?
Describes the sacral promontory moving anteriorly and inferiorly/ sacral apex moving posterior and superiorly
93
What is counternutation?
Describes the sacral promontory moving posteriorly and superiorly/ sacral apex moving anteriorly
94
What is anterior/posterior pelvic tilt?
Anterior- ASIS and pubic symphysis move inferiorly
| Posterior- ASIS and pubic symphysis move superiorly
95
How does nutation provide stability?
increased nutation at the SI joint tightens several ligaments around the SI joint thus increasing stability and decreasing mobility
96
Nutation provides increased _______ thus improving __________.
- compression
| - stability
97
What are forces contributing to the nutation torque?
- gravity (1st line of stability)
- stretched ligaments (Interosseous and sacrotuberous ligaments)
- muscle activation
98
What is the close-packed position of the SI joint?
full nutation
99
What muscles reinforce the SI joint?
- erector spinae and lumbar multifidi
- diaphragm and pelvic floor
- abdominal muscles
- hip extensor (glut max and biceps femoris)
- latissimus dorsi
- iliacus and piriformis
100
Flexion increases pressure on the _______ disc and shifts disc material _________.
- anterior
| - posterior
101
What are the primary functions of the lumbar spine and pelvis?
- primary function is to provide support for weight of the upper body
- also designed to withstand tremendous compressive loads applied with muscle contraction
- transmit force of vertebral column to LE
- releive stress on the pelvic ring created by movement of the trunk and lower extremities
