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lumbar Flashcards

1
Q

Mercer, Bogduk: lumbar lordosis

A
  • Angle of Sacrum (45deg)
  • L5/S1 disc = wedge
  • L5 vert = wedge
  • Inclination of l/s
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2
Q

Lordosis results in

A
  • Inc compression posterior on discs and z-joints
  • Stretch annulus and ALL anterior
  • Verts tend to move forward in WBing (stopped by z-joints and discs, then ligs)
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3
Q

Pars Interarticularis

A
  • Resist bending forces

- Prone to stress fracture.

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4
Q

Motion segment

A

Lower half of the top vert, disc, and upper half of bottom vert.

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5
Q

Most stabilizing structure in motion segment

A

z-joint:

  • 40% = 2 z-joints
  • 29% = disc
  • 31% = lymphatic, vascular, ligs
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6
Q

Mercer/Dogduk: stabilization

A

Mulrifidi (posterior capsule) and ligamentum flavum (anterior capsule) support z-joints.

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7
Q

Z-Joint orientation

A

Oriented posterior/medial.

  • Resist flexion and rotation
  • concave/convex - NOT planar
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8
Q

Z-joint capsule

A

Fibrous capsule around joint: 2 intra-articular structures (fat pad and meniscoid).
-transmit loads, protect joint during flexion

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9
Q

Disc make up

A
  • Nucleous pulposus (70-90% water)
  • annulus fibrosis: concentric rings, thicker ant and lat
  • vertebral end plant: cartilage layer 1mm thick
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10
Q

Disc function

A

Allow movement and transmit force

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11
Q

Panjabi/Wilkes: stability

A

Stability of spine related to muscular rather than ligamentous factors.
-Breakdown of intrinsic muscles leads to LBP

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12
Q

Panjabi/Wilkes: 3 subsystems of stability

A
  1. Passive (ligs, bones, discs)
  2. Active (muscles and tendons)
  3. Nervous system
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13
Q

Ligamentum flavum

A

medial and lateral portions connect to lamina. elastic and allows return from flexion to extension.
connected to ant capsule of z-joints.
Associated with causing stenosis.

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14
Q

ALL

A
  • runs from c/s to sacrum
  • covers disc ant and part of annulus
  • crura of diaphragm attached to ALL (tendon)
  • Resists extension
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15
Q

PLL

A

-Resists separation of vert in flexion

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16
Q

Supraspinous lig

A

often absent at L5-S1

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17
Q

Iliolumbar ligament

A

from TP L5 to inner edge of ilium in 5 bands.

  • Age 30 = more fibrous vs muscular
  • Prevents ant trans of L5
  • Attached to QL
  • Resists all motions at L5-S1
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18
Q

Meninges and nerve roots

A

Anterior root = motor

Posterior root = sensory

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19
Q

Psoas Major

A

Fascial attachments up to T5 (longus colli fascial attachments down to T5)
-T12-L5: attaches to TP, discs, bodies

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20
Q

Bogduk: Psoas

A
  • Upper fibers tend to extend spine

- Lower fibers flex spine

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21
Q

Basmajian/Janda: Psoas

A

deep fibers of psoas stabilize the spine

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22
Q

QL

A
  • covers lateral 2/3 of ant surface of L1-4 TPs.

- Extends latterally - may have iliolumbar lig connection

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23
Q

Multifidi

A
  • controls flexion
  • compressor of spine
  • increases lordosis
24
Q

Jull, Hodges, Hides: Multifidi

A

multifidi are stabilizers

25
Bogduk: Multifidi
Innervation = medial branch of dorsal ramus
26
Hides: multifidi
Trauma/back pain will inhibit multifidi from stabilizing
27
Vleeming/Lee: Thoracolumbar fascia
supports breathing and force closure
28
Force closure
Done by erector spinae, glute max, lats, biceps femoris
29
Arthrokinematics with flexion: l/s
Facets slide anterior/superior | -opening
30
Arthrokinematics with extension: l/s
facets slide posterior/inferior | -closing
31
Arthrokinematics with SB right: l/s
R post/inf, L ant/sup
32
Anomaly of L5-S1
35% rate of anomaly of articular processes
33
Fryette's Law 1
In neutral, SB and rotation are contralateral in lumbar spine
34
Fryette's Law 2
In flexion/extension, SB and rotation are ipsilateral in lumbar spine
35
Fryette's Law 3
Movement in lumber spine in any direction will decrease amount of movement available in other directions
36
Type 2 non-neutral dysfunctions
- Closing: loss of post/inf glide (worse in ext) - Opening: loss of ant/sup glide (worse in flex) - Single segment = primary dysfunction (worse in 1 direction, corrects in other direction)
37
Hypermobility
Angular/osteokinematic - Consistent loss of motion - can be "normal"
38
Instability
Linear/arthrokinematics - Inconsistent loss of motion - Not stopped by ligs/capsule
39
Panjabi/Dogudk: Neutral Zone
Movement in neutral posture | Minimal resistance to movement is offered by passive vertebral column
40
Panjabi: clinical instability
significant decreased in capacity of stabilizing systems of the spine to maintain intervetebral neutral zones within physiological limits -results in pain and disability
41
Bergmark: local stabilization
Local muscular stabilizing system: TA, multifidus, diaphragm, pelvic floor - controls neutral zone - controls intersegmental motion - "stiffness" of spine
42
Bermark: global stabilization
- superficial muscles - primary movers of spine - transfers load between t/s, ribs, l/s, pelvis - transmits load to local stabilizers
43
Form Closure: Vlemming/Snijders
Congruencey of joints - osseous. | "Puzzle"
44
Force Closure: Vleeming/Snijders
Muscular synergistic stability | "lock and key"
45
Compression-Vibration test
screen for: -potential fx (compression/vib sensitive) -discogenic (comp sens) T12 most common fx at TP Perform: pt supine, hit IT with heel of hand
46
Kidney/Flank pain test
dull or sharp pain, could be several areas. -11/10 pain -Blood in urine, weight loss, hard to move Perform: percussion over kidney
47
Aorta Test
Feel for pulse width and length: -lack of normal "lub-dub" -larger than 3 finger width Hx: 50+ y.o male, heart disease, HBP, family hx, LBP with movement sometimes into leg, pain in solar plexus, boring pain in back.
48
Slump test
lumbrosacral neutral - screen for nerve
49
Position/motion testing
sitting flexion/extension feel for segment positions | -Can be done in prone, sitting back on knees, prone extension.
50
PIVMT
Looking at hyper or hypo mobility: ROM | NOT instability
51
PAIVMT
Combined motion looking at motion segment, not cardinal plane gliding motion tested at end range, opening/closing, 3D lockup
52
PEMT
PAIVMT blocking at same vert
53
CBT
PAIVMT opposite side level below
54
Spring testing
use heel of hand or thumbs, go slowly some instabilities are velocity dependent. Done in prone.
55
Anterior stress test
P->A test sidelying - hips at 70deg, 90deg block segment you want to test, push knees back
56
Posterior stress test
A->P test | sitting, block inf vert - gives and A>P of sup vert
57
Rotational stress test
prone (general) or sidelying (specific)

foundations (7 decks)

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