Lumbar I Flashcards
Red flags in correlation w/ LBP
. Tumor/cancer
. Infectious disease
. Fracture
. Progressive focal neurological deficits
. Bowel incontinence, bladder incontinence, saddle anesthesia
. Medical causes (aortic aneurysm, renal stones, pyelonephritis)
Lumbar vertebral ligaments
. Annulus fibrosis
. Capsular ligaments
. Ant. And post. Longitudinal ligaments
. Ligamentum flavum
. Interspinous and supraspinous ligaments
. Determine limits of motion comprising the anatomical barrier
An L5 disc pushes on what spinal nerve root?
S1
What kind of dis bulge impinges on spinal roots?
Posters-lateral bulge
What substance do degenerating discs lose?
Water
Dominant posterior lumbar muscle
Multifidus
Deep lumbar muscles
. Rotatores and multifidus (sidebend and rotate in opposite directions, travel down laterally from spinous process)
. Tissue texture change most specific muscular indicator of segmental somatic dysfunction because they receive innervation from least number of spinal segments
Action of erector spinae
Extend and secondarily sidebend
Quadratus lumborum
. Sidebends
. Stabilizes lower ribs in respiration
Psoas
. Flexes T-L junctions
. Extends L-S junction
. Lat. stabilizer
. Primarily flexes hip
. Prevertebral muscle
. Balances lumbar sine and pelvis on femur
. Tight one can affect lumbar spine, sacrum, and hip
Inf. Portion of sympathetic location
Upper lumbar
Parasympathetic have ___outflow
Sacral outflow
Nociceptor fibers in lumbar area pathway
. . Ascend in sympathetic trunk and synapse in thoracolumbar area
Femoral nerve
. Lumbar plexus (L2-4)
. Roots pass through substance of psoas muscle
. Psoas dysfunction can result in ant. Thigh symptoms
Sacral plexus
. Sacral outflow plus lumbosacral trunk
. Forms sciatic n.
Facet tropism
. Unequal size and facing among facets
. Usual reference is lumbosacral junction
. Lumbosacral facets are normal coronal, lumbar is sagittal
. Is lumbosacral facets asymmetric, one will be sagittal and one will be coronal
Spondylolysis
. Defect in vertebral arch btw sup. And inf. Facets (pars interarticularis)
. When bilateral the vertebra is in 2 pieces
. Post. Piece: laminae, inf. Articular processes, spinous process
. Ant. Piece: remainder of vertebra
. Congenital, brought on by vigorous physical activity
. SI pain common, but treat SI joint and pain persists is indicator
Spondylolisthesis
. When bilateral spondylosis exists and ant. Portion of vertebra is displaced by ant. Inf. Gravity
. Detected by step sign: depression of spinous process compared w/ one below it
. Lateral x-ray best view
. Commonly L5-S1
. Treatment is active lifestyle
Spondylolsthesis grading
1: 1-25% forward slippage
2: 26-50% forward slippage
3: 51-75%
4: 74-100%
Psoas major
. Attaches to ant. Portion of lumbar spine and diaphragmatic crura
. Passes under inguinal ligament and is joined by iliacus muscle and attaches to lesser trochanter
.
Psoas minor
. Absent in 40% of patients
. Connects lumbar spine to pelvis
Psoas function
. Balances lumbar spine and pelvis on femur
. Hip flexion
. Long restriction muscle (hypertonicity compresses hip, SI joint, and lumbar spine)
. Assists w/ postural balance
Psoas dysfunction
. Tight
. Sit ups make it worse
. Postural imbalance (bilaterally tight moves pelvis forward in sagittal plane, unilateral causes patients to look bent at waist)
Psoas in pelvic sideshift test
. Tight on left, shift on right, lumbar curve convex left, sacrum sidebend left to accommodate
Components of psoas diagnosis
. Restriction of hip extension
. Ipsilateral upper lumbar (L1-2) flexed, rotated, and sidebend to side of shorter psoas
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