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foundations > lumbar > Flashcards

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
Q

Bogduk: Multifidi

A

Innervation = medial branch of dorsal ramus

26
Q

Hides: multifidi

A

Trauma/back pain will inhibit multifidi from stabilizing

27
Q

Vleeming/Lee: Thoracolumbar fascia

A

supports breathing and force closure

28
Q

Force closure

A

Done by erector spinae, glute max, lats, biceps femoris

29
Q

Arthrokinematics with flexion: l/s

A

Facets slide anterior/superior

-opening

30
Q

Arthrokinematics with extension: l/s

A

facets slide posterior/inferior

-closing

31
Q

Arthrokinematics with SB right: l/s

A

R post/inf, L ant/sup

32
Q

Anomaly of L5-S1

A

35% rate of anomaly of articular processes

33
Q

Fryette’s Law 1

A

In neutral, SB and rotation are contralateral in lumbar spine

34
Q

Fryette’s Law 2

A

In flexion/extension, SB and rotation are ipsilateral in lumbar spine

35
Q

Fryette’s Law 3

A

Movement in lumber spine in any direction will decrease amount of movement available in other directions

36
Q

Type 2 non-neutral dysfunctions

A
  • 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
Q

Hypermobility

A

Angular/osteokinematic

  • Consistent loss of motion
  • can be “normal”
38
Q

Instability

A

Linear/arthrokinematics

  • Inconsistent loss of motion
  • Not stopped by ligs/capsule
39
Q

Panjabi/Dogudk: Neutral Zone

A

Movement in neutral posture

Minimal resistance to movement is offered by passive vertebral column

40
Q

Panjabi: clinical instability

A

significant decreased in capacity of stabilizing systems of the spine to maintain intervetebral neutral zones within physiological limits
-results in pain and disability

41
Q

Bergmark: local stabilization

A

Local muscular stabilizing system: TA, multifidus, diaphragm, pelvic floor

  • controls neutral zone
  • controls intersegmental motion
  • “stiffness” of spine
42
Q

Bermark: global stabilization

A
  • superficial muscles
  • primary movers of spine
  • transfers load between t/s, ribs, l/s, pelvis
  • transmits load to local stabilizers
43
Q

Form Closure: Vlemming/Snijders

A

Congruencey of joints - osseous.

“Puzzle”

44
Q

Force Closure: Vleeming/Snijders

A

Muscular synergistic stability

“lock and key”

45
Q

Compression-Vibration test

A

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
Q

Kidney/Flank pain test

A

dull or sharp pain, could be several areas.
-11/10 pain
-Blood in urine, weight loss, hard to move
Perform: percussion over kidney

47
Q

Aorta Test

A

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
Q

Slump test

A

lumbrosacral neutral - screen for nerve

49
Q

Position/motion testing

A

sitting flexion/extension feel for segment positions

-Can be done in prone, sitting back on knees, prone extension.

50
Q

PIVMT

A

Looking at hyper or hypo mobility: ROM

NOT instability

51
Q

PAIVMT

A

Combined motion looking at motion segment, not cardinal plane
gliding motion tested at end range, opening/closing, 3D lockup

52
Q

PEMT

A

PAIVMT blocking at same vert

53
Q

CBT

A

PAIVMT opposite side level below

54
Q

Spring testing

A

use heel of hand or thumbs, go slowly
some instabilities are velocity dependent.
Done in prone.

55
Q

Anterior stress test

A

P->A test
sidelying - hips at 70deg, 90deg
block segment you want to test, push knees back

56
Q

Posterior stress test

A

A->P test

sitting, block inf vert - gives and A>P of sup vert

57
Q

Rotational stress test

A

prone (general) or sidelying (specific)

foundations (7 decks)

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