Lumbar, SI, Cervical and TMJ Flashcards
1
Q
What do spinal curves do and what are they
A
give spinal column 10x more strength
provide shock absorption and balance of COG
Lumbar and cervical-lordosis
Thoracic and sacrum-kyphotic
2
Q
vertebral weight
A
major weight bearing structure
handles compressive loading
3
Q
vertebral arch
A
**Posterior** pedicles transverse process articular process articular facet lamina spinous process
- attachment site for muscles and ligaments
- forms ossseous ring that is vertebral canal
4
Q
facet joints
A
synovial joints
different orientation in the cervical, thoracic and lumbar spine
FUNCTIONS:
guides movement
limits movement
handles 20-30% of compressive loads
5
Q
pedicle
A
connects vertebral body to lamina
6
Q
laminae
A
connect pedicle to the spinous process
7
Q
transverse process and spinous process
A
serve as ligament and muscle insertion sites
8
Q
anterior longitudinal ligament
A
attaches to anterior vertebral bodies and discs
helps limit extension
9
Q
posterior longitudinal ligament
A
attaches to posterior vertebral bodiesand discs
helps to limit flexion
10
Q
ligamentum flavum
A
helps to limit flexion
forms anterior portion of facet
11
Q
interspinous ligament
A
between the spinous processes
helps to limit flexion
12
Q
intertransverse ligament
A
between transverse processes
helps to limit sidebending
13
Q
supraspinous ligament
A
between tips of the spinous processes
helps to limit flexion
14
Q
annulus fibrosis
A
made up of dense layers of collagen fibers and fibrocartilage
fiber orientation changes obliquely from layer to layer giving it tensile strength to resist compression, twisting and bending
fibers of the innermost layer blend with nucleus pulposus
15
Q
nucleus pulposus
A
gelatinous mass located centrally in disc
16
Q
nerve roots
A
exits below the corresponding vertebral body
spinal cord ends between vertebrae L1 and 2 and extends as Cauda Equina
disc pathology usually affects nerve root below
17
Q
dermatomes
A
sensory nerve root distribution
L1-groin
L2-lateral and upper thigh
L3-lateral mid, anterior lower thigh and medial knee
L4-lateral knee, medial lower leg, 1st toe
L5-lateral lower and posterior leg, dorsal foot, 2-4 toes and plantar of 1st toe
S1- lateral foot, plantar foot 2-5 and mid posterior leg
18
Q
Myotomes
A
motor nerve root distribution
L1-2: hip flexion L3- knee extension L4- ankle dorsiflexion L5- 1st toe extension S1- ankle plantar flexion
19
Q
Flexion disc movement
A
anterior portion of the disc is compressed and nucleus pulposus moves POSTERIORLY
20
Q
Extension disc movement
A
posterior portion of disc is compressed and nucleus pulposus moves ANTERIORLY
21
Q
Lateral Flexion disc movement
A
nucleus proplsus moves away from the compression= opposite the direction of the bend
22
Q
disc lesion causes
A
wear and tear of annular fibers
- repeated flexion or rotational movements
- poor circulation to the disc prevents healing of microtears
- any microtears that do heal are weaker once healed
degenerative changes of nucleus propulsus
- nucleus becomes more fibrotic over time
- less water content as disc ages
traumatic rupture of annular fiber
23
Q
protrusion
A
annulus bulges but nucleus is contained within the annulus and supporting structures
only level that can be fixed
24
Q
extruded
A
nucleus extends through the annulus, beyond confines of posterior longitudinal ligament or above/below disc space, still in contact with the disc
25
sequestered
nucleus extends through annulus, separated from the disc and moved away from the prolapsed area
26
disc hernitation
onset usually between 20-55 y.o
most common at L4-5 and L5-S1
usually psoterior lateral protrusions
27
clinical sx of posterior lateral protrusion
pain arise when protrusion of disc applies pressure again other structures
pain tends to increase with sitting, forward bending, coughing, straining, attempting to stand after being in forward flexion position
symptoms tend to be better with walking
may see decrease in lumbar lordosis and lateral shift
28
Neurological signs of protrusion
radiation of pain down the leg
paresthesia or sensory loss in dermatomal pattern
muscle weakness in myotomal pattern
reduced reflexes
RED LIGHT:
loss of bowel/bladder control-there may be spinal cord compression
29
Slump Test
suggest compression from sciatic nerve from herniated disc
patient short sitting with neck flexed
knee passively extended
+pain or increase in symptoms
30
straight leg raise test
suggests sciatic nerve compression from herniated disc
patient supine
therapist passively raises straight leg
+ pain in back of leg or increased parathesia
**may further increase neural tension stretch by passively DF and actively flexing neck
31
rehabilitative management of disc lesions
supportive modalities for pain, traction
ROM to promote centralization- 1st goal before moving onto full program
correct lateral shift
emphasize extension to mechanically minimize disc protrusion
increase lumbar and LE flexibility
increase strength
increase cardiovascular fitness
improve posture
education on anatomy and prevention
32
facet joint impingement
meniscus of the facet capsule beecoems entrapped, impinged or stresed
Cause:
sudden or unusual movement
33
signs of facet joint impingement
onset begins with unusual movement
loss of spinal mobility-back has locked up
pain with spinal motion
muscle guarding
34
rehab for facet joint syndrome
manual or mechanical traction
mobilization techniques
treatment of muscle spasm
35
Lumbar spinal stenosis/foraminal stenosis
narrowing of spinal canal-constricts and compresses nerve roots/cauda equina
degenerative and bone spurs
Cause:
degenerative arthritic changes
repeated stress to the body
36
clinical signs of stenosis
pain in back ro neck
radiular pain, parathesia, weakness, impaired sensastion, diminished reflexes
symptoms frequently increased with extension
usually progressive
can cause patient to fall due to LE wekaness
37
rehab for stenosis
posture education to decrease pinching
flexibility and stretching
patient may have impaired LE strength-gait training, balance training, safety education and LE strengthening may be necessary
steroid injections
may need surgery
38
Ankylosing spondylitis
inflammatory disease that causes joint sclerosis and ligament ossification
- gradual ankylosing of the spine, SI joints, hips and costovertebral joints
- symptoms begin in early adulthood-PROGRESSIVE
affects men more frequently
39
Signs of ankylosisng SPONDI
flat lumbar spine
severe kyphosis in thoracic and cervical spine
increase hip flexion
**Bamboo spine**
40
rehab management for ankylosing
```
patients must faithfully exercise the rest of their lives
avoid flexion activities
promote extension
posture education
positioning
deep breathing exercise
extremity flexibility
```
41
spondylosis
degenerative joint disease/OA of the spine
42
spondylolysis
bony defect in the pars interarticularis-fracture
BUT STILL INTACT
between superior and inferior facets
no abnormal spinal movements
43
spondylolisthesis
bony defect in pars interarticularis
forward slipping of one vertebral segment on the one below it
superior vertebrae slides anterior on the inferior vertebrae
most common at L5-S1
deined by amount of forward displacement of superior vertebrae over inferior vertebrae
ACTUAL FRACTURE
inferior facet, spinous process do not move
*superior and rest of vertebrae shifts forward
44
possible causes of spondylolisthesis
congenital malformation of spinal arch
fracture due traumatic injury
degenerative changes
45
Signs of spondylolisthesis
pain/neuro signs symptoms
aggravated symptoms with extension activities
symptoms with prolonged standing and walking
relieve pain with lying down
46
spobdylolisthese rehab management
Less severe:
- pt. education-avoid progression of slippage
- neutral alignment
- lumbar stabilization exercises
Severe:
-requires surgical fusion
47
Compression fractures
cause:
- Osteoporosis
- trauma
- prolonged steroid use
Signs:
- diagnosis by xray
- pain at fracture site
- neurological signs
48
rehab for compression fractures
pain control
in severe osteoporosis cases-more fractures can occur while its attempting to heal
```
avoid flexion motions
rotation with caution
gentle stabilization
increase mobility-wolf's law
kyphoplasty
```
49
Spinal fusion surgery
one or more vertebral segments of column are sugically fixated or fused to prevent movement
fusion can be internal fixation or bone graphs
surgical approach may be from anterior or posterior
50
rehab for spinal fusion
follow protocol
pt. will initially be splinted or braced
focus on returning to independent functional mobility level with transfers, gait and stairs
log roll tecnique should be taught for bed mobility
scar mobs
muscle flexibility program
trunk stabilization
endurance program
generalized whole body conditioning
51
Laminectomy surgery
lamina is cut into to gain access to herniated disc
herniated material removed
52
rehab for laminectomy
```
follow protocol
functional mobility training
posture and boddy mechanic training
joint mobilization
scar mobs
spinal ROM
UE/LE flexibility
trunk and UE/LE strengthening
endurance
over all conditioning
```
53
sacrum
wedge shaped
| suspending by strong ligaments
54
innominate
ilium, ischium and pubis is one unit
during functional activities the 2 can move in different directions
look at pelvis in halves
55
Posterior Pelvic Tilt
ilium rotates posteriorly bilaterally
both innominates move as one unit
sacrum moves anteriorly 2-4 degrees
56
posterior pelvic tilt in standing
both ASIS move upwardly and posteriorly
rectus ab-pulls anteriorly
glute max and hamstring-pull down posteriorly
57
posterior pelvic tilt in gait
2 ilium/innominates do not move in same direction
```
stance-
femur in contact with ground
stance innominate rotates posteriorly 2-4 degrees
NUTATION
Sacrum is table
```
58
Anterior pelvic tilt
ilium rotated anteriorly
59
anterior pelvic tilt in standing
both asis move downward/anteriorly
erector spinae-pulls up posteriorly
iliopsoas and sartorius pull downward anteriorly
swing phase-foot is off the ground
ilium do not move in the same direction
Counternutation
60
SI dysfunction:
Anterior Rotated Innominate
ASIS moves downward
Pubic symphasis moves downward
iliac crest downward
PSIS upward
Ischial tubs upward
supine to sit - leg appears shorten
tight iliospoas and quads
legnthened and weak glutes and hamstrings
61
Causes of anterior rotation
baseball or golf swing
knee to dashboard injury
forceful diagnoal PNF pattern
repeated PNF pattern
62
rehab for anterior rotation
muscle stretching-iliospoas and quads
strenghten: glutes and hamstrings
modalities
strengthen general core
SI Belt may be option
63
Posterior rotation SI dsyfunction
```
ASIS upward
pubic symphasis upward
iliac crest upward
ischial tubs downward
supine to sit test-lg appears to lengthen
tight glutes and hamstrings
lengthened and weak hip flexors
```
64
causes of posterior rotation
repeated unilateral stance
fall on ischial tuberosity
vertical thrust on to extended leg
lifting in forward bent position with knees locked
65
rehab for posterior rotation
stretch-glutes and hamstrings
strengthen-iliopsoas and quads
modalities
strengthen general core
SI belt for stabilization
66
Palpation for eval of SI joint
```
ASIS
PSIS
ischial tub
iliac crest
greater trochanter
sacrum
```
67
SI standing forward flexion test
patient stands away from therapist
palpates PSIS
pt. flexes forward
any assymetrical motion may be from SI dysfunction
68
Supine to Sit SI test
patient lies supine with knees extended
therapist palpates medial malleolus-equal
patient flexes forward into long sitting
If malleolus changes position=+ sign
69
In sitting if patient leg appears:
short=innominate may be anteriorly rotated on that side
| Long=innominate may be posteriorly rotated on that side
70
Cervical certebra alignement degrees
45
71
Atlanto-occiptal joint
flexion/ext= 15-20 degrees
| atlas has no vertebral body
72
Atlanto=axial joint C1-2
ondontoid process C2
rotation 45-50 degrees
73
vertebral artery
along each side of cervical spine
canal for vertebral artery is transverse foramen
74
7 cervical vertebrae and 8 cervical nerves
cervical nerve is ABOVE corresponding vertebrae for C1-C7
Occiput and C1= c1 nerve root
between c4-c5=C5 nerve root
C7-T1=C8 nerve root
Naming switches at T1-T2
thoracic nerves are below vertebrae
75
motion of cervical spine
flex/ext
rotation: superior vert. rotates on inf.
lateral flexion
76
Lateral flexion to R closes what?
closes R intervertebrae and opens left side
77
When rotation and lateral flexion occur at the same time:
closing on intervertbrae forament follows lateral flexion
78
Reflexes
C5-bicep
C6-brachioradialis
C7-triceps
79
sternocliedomastoid
mastoid process to clavicle and sternum
lateral flexion to same side
rotation to opp. side
80
scalenes
transverese process of c. vertabrae to 1st and 2nd rib
lateral neck flexion
81
levator scap
stransverese process of c2-c4 to superior angle of scap
downward rotation and elevation of scap
82
upper trap
occiput and spinous process of cerv. vertebrae to clavicle and spine of scap
upward rotation and elevation of scapula
83
force inspiration muscles
levator scap
| upper trap
84
deep breathing and chest breathing muscles
sternocleidomastoid
scalenes
85
neck and head positioning /posture
muscles in neck act as stabilizers
posture of the whole body will affect he positioning/posture of head
as head moves forward the lever arm in neck increases and increases the weight of the head
86
Forward head posture muscles
```
TIght:
cerv/thoracic extensors
upper trap
levator scap
Ant; sterno,scalenes,pec major and minor
```
Weak:
scap retractors
-rhomboids
-middle and lower trap
87
cervical disc bulges
C4-C5
C5-C6
**most common**
Causes:
poor posture
heavy lifting
trauma
```
Clinical Signs:
radiating pain
numbness
tingling
weakness
impaired reflexes
```
88
Rehab for cervical disc herniation
```
avoid aggravating positions
manual or mechanical traction
Cervical ROM/gentle stretching
active protraction/retraction
promote centralization
avoid peripheralization
isometric strength/stabilize
pt. education
flexibility of ant. chest wall
thoracic flexibility
UE strength/stabilization
```
89
Red light= compression of spinal cord
```
tingling
numbness or burning pain
abnormal pattern of sensation affected
muscle weakness of UE
loss of hand function/coordination
```
90
whiplash-cervical sprain
hyperextension followed by hyperflexion=often followed by 2nd hyperextension
impact is severe it may cause coup or countercoup injuries to the brain
often a component of rotation or lateral flexion as well
91
cervical hyperextension injuries
possible injury to sternocleidomastoid muscle, anterior long. ligament or intervertebral disc
pain anterior neck area, shoulders and anterior chest
reduced cervical ROM
92
cervical hyperflexion injuries
possible injury to posterior cervical muscles, posterior longitudinal ligament, intervertebral discs
pain posterior neck area, shoulders and upper back
93
rehab for whiplash
acute phase: treat the symptoms
progress to AROM, gentle isometrics, cervical posture mechanics
gentle stretching to tight musculature
postural strengthening
94
torticollos-wryneck
asymmetrical strength or length of sternocleidomastoid
cause:
congenital
-injury in utero
hemiplegia
clinical presentation:
-cervical sidebending towards affected side and rotation away from affected side
95
rehab management for torticollis
stretching tight STM
strengthening supportive muscles
positioning
96
Thoracic Outlet Syndrome
blood vessels and nerves are compressed by structures in the thoracic outlet
- first rib
- scalenes
- pectoralis
97
TOS causes
poor posture
carrying heavy bag
congenital factors
trauma
98
TOS clinical signs
```
UE radicular pain
numbness
paresthesia
weakness
discoloration and impaired circulation
```
99
Tests for TOS
roos test
adsons
allen's
100
rehab for TOS
soft tissue stretching
posture
surgery to remove 1st rib
101
rheumatoid arthritis
presents special problems because of erosion of bone and ligamentous laxities
can lead to instabilities
risk for atlantoaxial subluxation or C4-C5 and C5-6 dislocations
102
Anatomy of TMJ
concave mandibular fossa of temporal bone
| convex mandibular condyle of mandible
103
articular disc of TMJ
articulates with mandibular condyle and temporal bone
| hinge joint that allows some gliding too
104
temporomandibular motions
```
depression: opening of mouth-40 mm
elevation=closing mouth
protration-bring jaw forward
retraction-bring jaw toward skull
lateral deviation
```
105
tmj disorder
symptoms caused by strain on structures around TMJ
cartilage disc at the joint
muscles of jaw, face and neck
teeth
106
Cause of TMJ: malocclusion of teeth
an imbalance between the head, jaw, neck and shoulder girdle
```
faulty joint mechanics form inlfammation
dislocation of condylar head
contractures
asymmetrical forces
restricted motion from periods of immobilization
prolonged open mouth position
```
107
signs of TMJ
```
biting or chewing dificult or discomfort
clicking sign while chewing or opening mouth
earache
grating sensastion while chewing
headache
jaw pain
loss of ROM
```
108
rehab for TMJ
mouth guards
treat the cause
patient education on posture and proper open/close mouth
NSAIDS
reconstructive surgery
