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COMP ORTHO > Lumbar > Flashcards

Lumbar Flashcards

1
Q

Lumbar movements in general

A

a lot of flex/ext
some LF
minimal rotation

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2
Q

Ferguson’s angle is what

A

line parallel to superior aspect of sacrum and horizontal line
Greater in F than M - angle inc in pregnant women
Larger angle = more likely to have back pain

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3
Q

IVD function

A

separate the vertebrae
absorb stress and shock
enable movement in 3 planes

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4
Q

IVD made of what

A

fibrocartilage

NP and AF

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5
Q

IVD with anterior bending (flex)

A

Tension, NP shifts towards region of compression

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6
Q

IVD with posterior bending (ext)

A

Compression, AF bulges towards region of tension

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7
Q

IVD - torsion

A

shear stress increased from center to periphery

denser on outside than in center

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8
Q

Facet joint - orientation at cervical, thoracic, lumbar

A

cervical = 45
thoracic = 60
lumbar = 90
Hardly any rotation in lumbar

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9
Q

External oblique action

A

if contract B will flex

unilateral contraction will do contralateral rot, ipsilateral SB

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10
Q

Internal oblique action

A

Ipsilateral SB and Rot (unilaterally contracting)

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11
Q

Flex/Relaxation phenomenon

A

Flex forward - gravity will take over, use the extensors to control flex ecc, ligaments will stretch out to suport weight

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12
Q

Greater inclination of pelvis leads to what

A

increase shear, compression, and lordosis
makes abs looser
get ant pelvic tilt

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13
Q

Smaller inclination of pelvis leads to what

A

increase compression, decrease shear and lordosis

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14
Q

Shear forces are common where

A

L4-L5 because of superincumbent weight (HAT)

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15
Q

Shear is largest with what pelvic position

A

anterior pelvic tilt

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16
Q

Compression is largest with what pelvic position

A

posterior pelvic tilt

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17
Q

Load based on posture

A 
supine
standing straight
sitting
bending
slouching
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18
Q

Cauda equina syndrome

A

B/B changes, saddle anesthesia, global or progressive weakness in LE, sensory deficits/weakness in L4-S1 dermatomes/myotomes

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19
Q

Red flags

A 
Constant/severe night pain
paralysis
unexplained weight loss
loss of appetite
unusual fatigue 
persistent root pain
pain worse after 1 month 
radicular pain with cough 
paresthesias 
visual disturbance
B nerve root s/s
SOB
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20
Q

Spondylolysis is what

A

separation of vertebrae - sliding between structures
Defect in pars interarticularis “scotty dog fracture”
Most common at L5-S1, common in young women

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21
Q

Spondylolysis s/s - pain with what movement

A

pain with ext

22
Q

Spondylolisthesis is what

A

forward movement of vertebral body, fracture on vertebrae

common at lumbosacral angle

23
Q

Spondylolisthesis s/s - pain with what movement

A

pain with ext/rot

24
Q

Disc herniation

A

Protrusion of NP from the AF

25
Q

Disc herniation - pain with what movemment

A

usually posterolateral herniation
Pain with flexion
repeated flex will peripheralize, ext will centralize

26
Q

Degenerative spinal stenosis - pain with what

A

extension

27
Q

Capsular pattern

A

lat flexion and rotation, then ext

28
Q

Facet joint dysfunction - aggravated with what movement

A

end range movements

29
Q

Lower crossed syndrome

A

Short ES, iliopsoas, gastroc, soleus, hip add

Long abductors, glut max

30
Q

SLR

A

pt supine, passively flex hip with knee ext until pt complains, slowly lower limb and then DF
+ if reproduction of sx with DF foot

31
Q

Quadrant test

A

Pt standing
Intervertebral foramen - pt SB L, rot L, ext to max close L foramen
Facet - pt SB L, rot R, ext to max compress L facet joint?
+ with pain or pares

32
Q

Stork standing test

A

identifies spondylolisthesis
pt stand on one leg - cue pt into trunk ext
+ if pain in low back with ipsi leg on ground

33
Q

McKenzie slide glide test

A

differentiate btw scoliotic curvature vs/ neurologic dysfunction causing lateral shift
Pt stand - stand on side that upper trunk is shifted towards, place shoulders into pt upper trunk, wrap arms around their pelvis, and pull pelvis to normal alignment while stabilizing trunk
+ if reproduction of neuro symptoms as alignment of trunk is corrected

34
Q

Femoral nerve traction test

A

pt lay on nonpainful side with trunk in neutral, head flexed slightly, lower limb and hip/knees flexed
passively extend hip while knee of painful limb is in ext (flex knee if no s/s)

35
Q

Vasalva identifies what

A

space occupying lesion

+ if inc LBP or neuro sx in LE

36
Q

Repeated lumbar flexion should dec pain of what

A

facet or stenosis

37
Q

Repeated lumbar extension should dec pain of what

A

disc problem

38
Q

Babinski - what is pos

A

extension of big toe and splaying (abd) of other toes

39
Q

Freyettes laws of biomechanics - in the neutral spine

A

LF and rot occur in opp directions at lumbar level

40
Q

Freyettes laws of biomechanics - in hyperextended/hyperflexed lumbar spine

A

LF and rot occur in same direction

41
Q

Coupled movement - type I

A

LF and rot in opp directions
Neutral
tends to occur in groups of segments (3+)

42
Q

Coupled movement - type II

A

LF and rot in same directions
Non-neutral
seen in one segment only

43
Q

Group dysfunction

A

3+ segments
type 1
neutral
Restrict in LF in one direction and Rot in other

44
Q

Single segment dysfunction

A

1 vertebral motion unit involved
type II
restriction of Flex/Ext, LF and Rot limited on same side

45
Q

Direction of motion is named by what

A

ant and sup vertebrae

46
Q

If S is first (before R) means what (or if N is first letter)

A

coupled opp

47
Q

If R is first (before S) means what (or if E/F is first letter)

A

coupled same

48
Q

Ex: NSR(L)
Motion available
Position
Motion restriction

A

flex/ext
R SB
L rot

Neutral, R SB, L rot

L SB, R rot

49
Q

Ex: ERS(L)
Motion available
Position
Motion restriction

A

ext
L rot
L SB

extended, L rot, L SB

flexion
R rot, R SB

50
Q

Ex: FRS(R)
Motion available
Position
Motion restriction

A

flexion
R rot
R SB

flex, R rot, R SB

extension
L rot, L SB

51
Q

Example of ERS(R), what motion are restricted?

what happens with flex and ext

A 
ERS(R) - they are extended, R rot, and R SB
R facet does not open
Flexion - R TP prominent
Extension - TPS more equal 
Restriction - flex, L rot, L SB
52
Q

Example of FRS(R), what motion are restricted?

what happens with flex and ext

A 
FRS(R) - they are flex, R rot, R SB
L facet will not close
Ext - R TP more prominent
Flex - TPs equal
Restriction - ext, L rot, L SB

COMP ORTHO (11 decks)

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