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ms 1 - 2nd shift > lumbar > Flashcards

lumbar Flashcards

1
Q

number of lumbar vertebra

A

5

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2
Q

anterior portion of lumbar vertebra

A

body, pedicles, transverse processes, superior articular processes

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3
Q

posterior portion of lumbar vertebra

A

neural arch composed of laminae, inferior articular processes and spinous process

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4
Q

it’s the part of the lamina between the superior and inferior articular process; site of stress fracture because it is subjected to large bending forces

A

pars interarticularis

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5
Q

innervated structures (pain generators)

A
  • bone: laminae
  • joints: zygoapophyseal
  • disk: only external annulus and potentially diseased disk
  • ligaments: ant longitudinal ligament, post longitudinal ligament, interspinous
  • muscles and fascia
  • nerve root
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6
Q

posterior muscles

A
  • lattisimus dorsi
  • paraspinals: erector spinae (iliocostalis, longissimus and spinalis)

deep layer
- rotatores
- multifudus

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7
Q

non innervated structures (pain generators

A
  • ligamentum flavum
  • disk internal annulus
  • nucleus pulposus
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8
Q

chief extensors of spine

A

erector spinae (iliocostalis, longissimus and spinalis)

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9
Q

tiny segmental stabilizers that act to control lumbar flexion; cannot produce enough force to extend the spine; provides proprioception to spine

A

multifidus

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10
Q

anterior muscles

A

psoas, quadratus lumborum

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11
Q

tightening of this muscle accentuates the normal lordosis in the lumber; can cause zygapophyseal joint pain due to increase force acting on spine

A

psoas muscle

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12
Q

acts in side bending and assists in lumbar flexion

A

quadratus lumborum

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13
Q

abdominal musculature

A

superficial: rectus abdominis, external oblique

deep layer: internal oblique, transverse abdominis

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14
Q

this muscle is important to train in treating lbp bc of it’s connection to the thoracolumbar fascia

A

transverse abdominis

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15
Q

acts as an abdominal and lumbar “brace” particularly when lifting

A

thoracolumbar fascia

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16
Q

pelvic stabilizers; considered as “core muscle” bc of their indirect effect on lumbar spine even though they don’t have attachment to it

A

gluteus medius, piriformis, pelvic floor muscles

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17
Q

stabilizes pelvis during gait

weakness of this muscle can cause pelvic instability which induces lumbar side bending and rotation creating sheer and torsional forces on lumbar discs

A

gluteus medius

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18
Q

hips and sacral rotator; cause excessive external rotation of the hip and sacrum when it is tight and results in shear forces at lumbosacral region

A

piriformis

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19
Q

main proper positioning of the spine

A

pelvic floor muscles

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20
Q

consists of an internal nucleus pulposus and outer annulus fibrosus

A

intervertebral disc

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21
Q

gelatinous inner section of disc; water, proteoglycan, collagen; 90% water at birth but dessicates as we age and lose of their heigt

A

nucleus pulposus

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22
Q

concentric layers of fibers at oblique angle to eo; help withstand strains in any direction

outer layer has more collagen and less proteoglycans and water than inner fiber thus outer layer can resist flexion, extension, rotation, and distraction forces

A

annulus fibrosus

23
Q

lumbar root syndrome of L2

A

dermatome: back, front of thigh to bone

muscle weakness: psoas, hip adductor

reflex/special test affected: none

paresthesia: occasionally front of thigh

24
Q

lumbar root syndrome of L1

A

dermatome: groin, back of trochanter

muscle weakness: none

reflex/special test affected: none

paresthesia: groin

25
Q

lumbar root syndrome of L3

A

dermatome: back, upper buttock, front of thigh and knee, medial lower leg

muscle weakness: psoas, quadriceps - thigh wasting

relfex/special test affected: knee jerk sluggish, pain on full SLR

paresthesia: inner knee, ant lower leg

26
Q

lumbar root syndrome of L4

A

dermatome: inner buttock, outer thigh, inside of leg, dorsum of foot, big toe

weak muscle: tibialis anterior, EHL

reflex/special test affected: SLR limited, neck flexion pain, weak knee jerk , side flexion limited

paresthesia: medial aspect of calf and ankle

27
Q

lumbar root syndrome of L5

A

dermatome: buttock, back and side of thigh, lat aspect of leg, dorsum of foot, inner half of sole and 1st - 3rd toes

muscle weakness: extensor hallucis, peroneals, g medius, ankle dorsiflexors, hamstrings, calf wasting

reflexes/special test affected: SLR limited to one side, neck flexion pain, hamstring reflex decreased, crossed leg raising pain

28
Q

sacral root syndrome of s1

A

dermatome: buttock, back of thigh and lower leg, sole of foot

muscle weakness: calf & hamstrings, wasting of gluteals, peroneals and plantar flexors

reflexes/special test affected: SLR limited, decrease ankle jerk

paresthesia: lateral two toes, lateral foot, lateral leg to knee, plantar aspect of foot

29
Q

sacral root syndrome of s2

A

dermatome: same as s1

muscle weakness: same as s1 except peroneals

relfex/special test affected: SLR limited

paresthesia: lateral leg, knee, heel

30
Q

sacral root syndrome of s3

A

dermatome: inner thigh to knee, groin

muscle weakness: none

reflex/special test affected: none

paresthesia: none

31
Q

sacral root syndrome of s4

A

dermatome: perineum, genitals, lower sacrum

muscle weakness: bladder, rectum

reflex/special test affected: none

paresthesia: saddle area, genitals, anus, impotence

32
Q

common cause of back pain in the elderly, degeneration at zygapophyseal joints w degeneration of discs

pain referred to buttock and back of legs

most common L4-5 and L5-S1

A

lumbar spinodylosis

33
Q

refers to the forward slippage of one vertebral body w respect to the one beneath it

occurs at the lumbosacral junction with L5 slipping over S1, followed by L4-L5

A

spondylolisthesis

34
Q

spondylolisthesis - dysplastic

A
  • congenital anomalies of the lumbosacral junction causing slip to occur
35
Q

spondylolisthesis - isthmic

A
  • most common
  • lack of normal continuity in each part interarticularies or isthmus
36
Q

spondylolisthesis - degenerative

A

slipping of a single bone but has come unstable bc of degenerative disease of facet or zg joint

37
Q

spondylolisthesis - traumatic

A

fracture through part of the vertebra other than the isthmus caused by violence causing ant displacement

38
Q

spondylolisthesis - pathologic

A

caused by deforming or destructive bone disease affecting the facets

39
Q

grade 1 spondylolithesis

A

0-25%

40
Q

grade 2 spondylolithesis

A

25-50%

41
Q

grade 3 spondylolithesis

A

50-75%

42
Q

grade 4 spondylolithesis

A

75-100%

43
Q

over 100%; when he vertebra falls completely off the supporting vertebra

A

spondyloptosis

44
Q

characteristics if isthmic spondylolisthesis

A

most common type is lytic spondylolisthesis caused by absence of continuity at the isthmus d/t unherited fatigue fracture or can be hereditary

more often bilateral, L5-S1

pain maybe slight-severe, localized in lumbosacal joint but may radiate to one or two legs

stiff back worse w exercise of strain

45
Q

characteristics of degenerative spondylolisthesis

A

neural arch is intact and the forward displacement accompanies sever degenerative arthritic changes in zg joint and subadjacent vertebrae

most common involved vertebrae is L4-L5

50 yrs old women

long standing pain on lower back, buttocks or thigh relieved by sitting or reclining

forward flexion back mobility is limited and hip flexion is increased

no neurologic findings

46
Q

term used to describe anatomic defect in pars interarticularies w adjacent bone sclerosis

A

spondylolysis

47
Q

epidemiology of spondylolysis

A

one most common causes of back pain in children and adolescents

defects are not present at birth and develop over time (seen in 4-6% of population)

48
Q

mechanism of spondylolysis

A

usually activity related and occurs from repetitive hyper extension

prevalance as high as 47% in certain athletes (gymnasts, weightlifters, football linemen)

scottie dog present in xray

49
Q

treatment of spondylolysis

A

non operative

observation w no activity limitations (asymptomatic pts w low grade spondylolisthesis or spondylolysis; may participate in contact sport

PT and activity restriction (symptomatic spondylolysis; symptomatic low grade spondylolisthesis)

bracing for 6-12 weeks

surgery (presence of neurologic deficits, instability of spine, pain unrelieved by conservative management, severe/ progressive slipping
- fusion or laminectomy

50
Q

frequently involved in inflammatory arthritis; pregnancy esp in latter weeks or after delivery d/t sacroiliac strain secondary to hormonal relaxation of symphysis pubis

osteomyelitis, infectious arthritis

tenderness over one or both sacroiliac joints medial to the posterior

associated tenderness over symphysis pubis

A

causes of sacroiliac pain/disorder

51
Q

discuss gaenslen’s sign

A

sidelying; hip and knee on affected side are placed in extreme flexion, opposite hip is hyperextended, + if elicit pain

52
Q

pain about the coccyx and lower part of sacrum

A

coccygodynia

53
Q
A

ms 1 - 2nd shift (13 decks)

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