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Ortho 1 > Lectures cervical and thoracic spine > Flashcards

Lectures cervical and thoracic spine Flashcards

1
Q

occiput-atlas articulation

A
  • occiput is a convex surface
  • atlas is a concave surface
  • primary motion is “nodding” 15-20 deg
  • side flexion about 10 deg
  • no real rotation
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2
Q

Atlas C1

A
  • no body or spinous process
  • it develops into ondontoid process of C2
  • transverse processes are large
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3
Q

atlas -axis articulation ROM

A
  • C1-C2
  • primary motion is rotation 50 deg
  • flex / ext 10 deg
  • side flex 5 deg
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4
Q

transverse cruciate ligament

A

-holds dens of the axis against the ant. arch of C1

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5
Q

alar ligament

A

-arise from either side of odontoid and attach to medial aspect of occiput

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6
Q

C3-c6 typical vertebrae

A
  • standard body
  • posterior arch
  • transver process
  • foramen
  • spinous process
  • width of body incr as it bears more weight
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7
Q

C7 transitional vertebra variation

A
  • largest spinous process in C/S
  • not bifid SP like the other above
  • Prime attachment fro ligamanetum nuchae, traps, rhombus minor etc.
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8
Q

zygoapophyseal joint

A
  • superior facets face upward, backward, and medially
  • inferior facets face downward, forward and laterally
  • angle in cervical 45 deg
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9
Q

Cloward’s areas

A

C3-4 above scap by level of clavicle
C4-5 medial border top of scapular triangle
C5-6 medial border bottom of scap triangle
C6-7 inf border of scap

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10
Q

intervertebral foramen

A
  • transmits nerve roots to and from the spinal canal to extremities
  • nerve roots usually pinched by disc of same level
  • also contains dural root sleeve, lymphatic channels, small arteries and veins and recurrent meningeal nerve
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11
Q

cervical nerve roots

A
  • more nerve roots than vertebral levels
  • C1 nerve roots passes above C1 vertebrae
  • thus each nerve root below this is named for the vertebrae above it
  • C8 exits b/w C7- T1
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12
Q

nerve root vulnerability

A
  1. epineurium is poorly developed with less collagen and more fragile collagen
  2. perineurium, which acts as diffusion barrier is absent at nerve root level
  3. fasciculi do not branch , thus more fragil and less flexible
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13
Q

open pack of cervical spine

A

slight extension

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14
Q

close pack cervical spin

A

-full extension

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15
Q

capsular pattern of C/S

A

side flexion and rotation equally limited, extension

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16
Q

Cervical SPine ROM

A

flexion 440 deg
extension 75
sidebending 35-45
rotation 80-90

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17
Q

uncinated joints

A
  • saddle shape
  • limits side flexion if C/S
  • uncis is on the superior part f cervical vertebrae
  • joint seems to form as the annulus degenerates
  • not really fully developed until about 18 yo
  • effectively converts a planar joint to more of a concave and beveled surface
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18
Q

vertebral artery

A
  • first branch of subclavian artery
  • enters the foramen at C6
  • torturous oath, transversing up to the occiput at C2
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19
Q

3 common sites of distortion

A
  • skeletal muscles and fascial bands at or near C6 where artery first enters
  • osteophytes around C4-5 and C5-6
  • sliding motion of AA articulation
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20
Q

vertebral artery compromise

A
  • rotation of head >50 deg may lead to contra kinking of vertebral artery
  • VBI test to be done before quadrant
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21
Q

intervertebral disc

A
  • no disc b/w O-C1 or C-2
  • annulus fibrosus has proprioceptors and free nerve endings that are pain sensitive
  • there is virtually no nucleus left after 45 years of age
  • as disc decr in size, uncinated process grows
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22
Q

what biomechanics rule does
O-C1 follow
C2-T1

A

O-C1 - convex on concave rule

C2- T1 follows concave on convex rule

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23
Q

Canadian C Spine dangerous mechanisms

A
  • fall from elevation >/= 3 feet/ 5 stairs
  • axial load to head
  • MVC high speed >100 km/hr, rollover, ejection
  • motorized recreational vehicles
  • bicycle struck or collision
  • ** simple reared MVC excludes
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24
Q

cSpine rule not applicable if

A
  • non-trauma case
  • GCS <15
  • unstable vital signs
  • age <16
  • acute paralysis
  • known vertebral disease
  • previous c-spine surgery
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25
Q

acute radiculopathies are associated with…

A

disc herniation

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26
Q

chronic radiculopathies are associated with …

A

spondylosis

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27
Q

contraindications to manual therapy

A
  • cervical instability esp cranioverterbral region
  • presence of cancer in C/S
  • fracture
  • sublaxation
  • advanced neurologic signs
  • surgical fusion
28
Q

Thoracic vertebrae facet facing…

A

inferior facet face down , forward and slightly medially

-oriented about 60 deg from horizontal

29
Q

Rule of 3’s

A

T1-3 same level as TP
T4-6 SP at a level 1/2 way in b/w its own TP and the TP of the vertebrae below
T7-9 is at the level of the TP of the vertebrae below it
T10 same as T9
T11 same as T6
T12 same as T3

30
Q

intercostalbrachial nerve

A
  • lateral cutaneous branch of the secondintercostal nerve
  • supplies floor of axilla
  • joins with medial branch brachial cutaneous n (medial side of arms to dital elbow)
31
Q

critical zone

A
  • T4-T9
  • spinal canal is narrower here
  • blood supply is reduced
  • large herniated disc can cause central cord compression
  • segmental stiffness may affect neurodynamics in spine and periphery
32
Q

thoracic capsular pattern

A

-side flexion and rotation equally limited, then extension

33
Q

in thoracic flexion which way does facet moves

A
  • Facets glide up and forward
  • this pushes the superior demifacet of the rib head
  • concave tubercle of the rib glides superiorly on convex TP at costotransverse joint
34
Q

in thoracic extension which way does facet move

A
  • Facet glide down and back
  • post rotation of the rib head at costovertebral joint
  • inf glide of the rib at costotransverse joint
35
Q

in thoracic right side bending which way does facet move

A

-right sidebending, right inferior facet of the superior vertebrae glides inferolaterally and the left glides superomedially

36
Q

ROM of thoracic spine

A 
flexion 20-45 deg
extension 25-45 deg
side flexion 20-40 deg
rotation 35-50 deg 
costovertebral expansion 3-7.5 cm
***ankylosing spondylitis: <2.5cm of expansion at T4
37
Q

T5 nerve root referral

A

pain around nipple

38
Q

t7-t8 nerve root referral

A

pain in epigastric area

39
Q

t10-t11 nerve root referral

A

pain in umbilical region

40
Q

t12 nerve root referral

A

pain in groin

41
Q

Causes of flat thorax

A
  • impaired superior gliding of the facet joints
  • reduced ant translation of the superior vertebral body on infer vertebral body
  • restricted internal torsion of the rib joints
  • segmental or multisegmental soft tissue restrictions
42
Q

causes of side flexion restrictions

A
  • inability of the facet in the ipsi side to glide forward and toward the contra side.
  • soft tissue restriction on the ipsi side
  • restricted ipsi lateral translation of the superior vertebrae in the horizontal plane
  • unilateral rib dysfunction
  • unilateral adverse neural tissue
43
Q

extension restrictions of thoracic spine

A
  • inability if the thoracic motion segment to rotate backward in the saggital plane
  • more common in upper thoracic spine and cervicothoracic junction C7-T2
44
Q

Fixed extension restriction caused by

A

Aging due to risk height degeneration

-alteration in shape of the vertebral body

45
Q

Unilateral extension restriction

A
  • Loss of extension, ipsi rotation and sidebending
  • may be caused by facet joint restriction in inferior or lateral glide
  • posterolateral disk protrusion on ipsi side
  • space occupying lesion like disk or osteophyte
46
Q

Round back

A

-decr pelvic inclination, generalized kyphosis

47
Q

hump back

A

-localized, sharp kyphosis, usually normal pelvic inclination

48
Q

flat back

A

-decr pelvic inclination, but no major kyphosis

49
Q

Dowager’s Hump

A

-often in post-menopausal women, wedge fracturing of upper thoracic vertebrae

50
Q

scoliosis

A
  • one or more lateral curvatures of the lumbar or thoracic spine
  • non-structural is correctable
  • structural is typically fixed
  • designated by the level of the apex of the curve
  • direction of the scoliosis is designated by the side of convexity
  • vertebrae tend to rotate toward the convexity of spine creating rib hump
51
Q

non -structural causes of scoliosis

A
  • poor posture
  • nerve root irritation
  • inflammation in the spine
  • leg length
  • hip contractures
52
Q

TOS thoracic outlet syndrome

A
  • usually changes in sensory before motor
  • poorly localized pain in supraclavicular fossa
  • ant shoulder frequently spreads to head/arm
  • paresthesias in post arm/forearm/hand
  • symptoms aggs by extreme shoulder girdle and head positions
  • sleep is disturbed
  • coldness and whiteness
53
Q

T/S and Cancer

A
  • most malignant spinal tumprs are secondary tumors
  • T/S most common site of metastases
    • key to ask about:
  • history of cancer
  • resting or night pain
  • unexplained wt. loss
  • failure of conservative therapy
  • Note age of patient (over 50)
54
Q

Pain of myocardial Origin

A
  • frequently radiates:
  • Over the left pectoral region
  • left shoulder
  • medial arm
  • Jaw
55
Q

Abdominal Pain Referral

A
  • Transmitted through T6-12 disks
  • watch out for Cholecystitis and peptic ulcer disease
    • cholecystitis pain onset 1-2 hrs after a heavy meal
  • -peptic ulcers may be time related to meals as well
56
Q

T4 Syndrome

A
  • symptom complex especially upper T-spine
  • unknown cause
  • Hand or hands always affected
  • T4 actually means T2-7
  • Glove like distribution of paresthesias
  • Dull aching or pressure in or around head
  • No changes in reflex or myotomes
57
Q

T-Spine landmarks

A
  • 2nd costocartilage articulates at sternal angle level with T4-5
  • 7th costocartilage articulates at xiphoid level T9-10
  • Nipple Line T4

Spine of scap T3
inferior angle T7-9

58
Q

What should I clear with pain in thoracic spine

A
  • Above T4- need to clear upper quarter including C/S
  • Below T8- probably do a L/S eval with “seated thoracic rotation”
  • T4-T8 celar C/S and go through mid-thoracic clearing as well as shoulder girdle
59
Q

Cervical extension movement fault tests

A
  • shoulder flexion : C/S anterior shear with extension
  • supine head lift: translation
  • Weak DNF’s
  • prone head lift: translation lower C/S
  • Quad rock back: C/S extension
60
Q

treatments for a cervical extension movement fault

A 
-unloading UE's 
capital flexion
-DNF strengthening
- QUad rock back with C/S control
-shoulder flexion with C/S control
- improve upper T/S extension flexibility
61
Q

cervical flexion movement fault tests

A
  • C/S flexion
  • quadruped position
  • B/L shoulder flexion
  • Prone head lift: through post sheer
62
Q

treatment for cervical flexion movement fault

A
  • normalize scapular position
  • normalize lordotic curve
  • improve thoracic mobility
  • encourage mild thoracic slumping
  • stretch SCM/scalenes
  • Prone and quad C/S rolling into flex/extensopn PICR
63
Q

cervical rotation movement fault test

A
  • cervical rotation : SB’s or extends
  • U/L shoulder flexion: C/S rotation
  • Supine head lift: translation , asymmetrical
  • Prone head lift: translation with SB
  • quad rock back: C/S extension/ rotation
64
Q

treatment for cervical rotation movement fault

A
  • normalize scapular position/muscle pulls
  • C/S rotation in neutral flex-ext PICR training
  • quadruped rockbacks with neutral C/S control
  • B/L wall shoulder flexion with C/S control
  • improve rotation control in different UE positions
65
Q

thoracic flexion movement fault tests

A
  • shoulder flexion
  • quadruped rock back
  • Prone head lift
  • Pec and Lat length
66
Q

treatment for thoracic flexion movement fault

A
  • Prevention of T/S flexion is key in preventing other painful syndromes
  • improve T/S extension
  • improve pec and lat length

Ortho 1 (8 decks)

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