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OS1 > OS1 F > Flashcards

OS1 F Flashcards

1
Q

spine curvatures

A

LKLK

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2
Q

vertebral unit?

A

2 adjacent vertebrae and associated vertebral disc

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3
Q

rule of 3s?

A

t1-t3: spinous and transverse processes same level
t4-t6: spinous 1/2 level below transverse process
t7-t9: spinous at the level of the inferior transverse processes
T10: same as t7-t9
T11: same as t4-t6
t12: same as t1-t3

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4
Q

superior facet orientation of vertebrae?

A 
Cervical = BUM (backwards, upward, medial)
Thoracic = BUL (backwards, upward, lateral)
Lumbar = BM (backwards, medial)

Bumblebee

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5
Q

anterior longitudinal L?

A

connects anterolateral aspects of vertebral bodies and IV discs

limits extension

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6
Q

posterior longitudinal L?

A

runs within vertebral canal and connects posterior vertebral bodies

resists hyperflexion and prevents herniation of nucleus pulposus

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7
Q

ligamentum flava?

A

connects laminae of adjacent vertebrae

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8
Q

interspinous L?

A

connects spinous processes

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9
Q

intertransverse L?

A

connects transverse processes

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10
Q

iliolumbar L?

A

connects base of lumbar spine to ilium

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11
Q

rotatores muscles?

A

longus - b/w transverse processes skipping 1 vertebrae
brevis - b/w transverse processes of adjacent vertebrae

extends thoracic spine bilaterally, rotates thoracic spine to opposite side unilaterally

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12
Q

multifidus muscles?

A

insert spinous processes skipping 2-4 vertebrae

extends spine bilaterlally, side-bends and rotates to opposite side unilaterally

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13
Q

semispinalis muscles?

A

transverse to spinous processes

extends thoracic/cervical spines and head bilaterally, side bends and rotates opposite side of head/cervical/thoracic

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14
Q

coupled motion?

A

motion about 2 axes, principle motion cannot be produced w/o the associated motion

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15
Q

linkage?

A

relationship of joint mechanics, linking joints increases ROM

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16
Q

results of spinal SD?

A

reduce efficiency
impair flow of fluids
alter nerve function
create structural imbalance

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17
Q

vertebral motion nomenclature?

A

motion is the movement of the anterior/superior surface

excessive motion/restriction is in reference to the top vertebrae in the unit (excess motion of L2 is the motion of L2 on L3)

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18
Q

who described physiological motion of the spine?

A

Fryette 1918

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19
Q

developers of principles of spinal motion

A

principles 1 and 2 = fryette (1918)

principle 3 = Nelson (1948)

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20
Q

type 1 Fryette mechanics?

A

in neutral range, sidebending and rotation are coupled in opposite directions (rotation towards convexity) (tends to be group of vertebrae)

Type One Neutral Group Opposite (TONGO)

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21
Q

type 2 Fryette mechanics?

A

in flexion/extension, sidebending and rotation are in the same direction (rotation towards cocavity) (tends to be single vertebrae)

Type Two Ø (non-neutral) Single Same (TTOSS)

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22
Q

naming SDs w/ Fryette

A

if neutral; left sidebending restriction = right rotation restriction, etc

if f/e; left sidebending restriction - left rotation restriction, etc

abbreviated: T3-8 N Sr Rl (Vs/state/restrictions)

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23
Q

type 3 Fryette mechanics?

A

if motion restricted in one direction, it will also be restricted in other directions

if motion improved in one direction, it will also be improved in other directions

summary: movement in any plane modifies movement in other planes

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24
Q

spinal landmarks?

A

spine of scapula - T3 spinous/transverse

inferior angle of scapula - t7 spinous/t8 transverse

iliac crest - l4

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25
Q

scoliosis?

A

lateral curvature of spine (levo-left, dextro-right)

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26
Q

cobb angle?

A 
angle measurement of degree of scoliosis 
<25 = conservative Tx, minor 
25-45 = non-operative, bracing Tx
>45 = surgical fusion required 
>50 = respiratory compromise 
>75 = cardiac compromise
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27
Q

radiculopathy?

A

pinched nerve causing lower back pain radiating to below the knee w/ dermatomal distribution; may have weakened neuro function (weakness, reflexes)

Dx: straight leg test - raise leg w/ knee extended and pain b/w 15-30 degrees indicates lumbar disc etiology

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28
Q

l4-l5 disc hernia manifestations?

A

lateral thigh/leg pain/numbness, first 3 toes pain; weakness to dorsiflexion, diminished hamstring reflex

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29
Q

l5-s1 disc hernia manifestations?

A

posterior thigh/leg pain/numbness, lateral heel/foot pain; weakness to plantarflexion w/ gastrocnemius and soleus atrophy, ankle jerk reflex diminished

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30
Q

spinal stenosis?

A

narrowing of spinal canal on nerve roots; bilateral lower limb pain w/ possible neuro impairment, typically chronic

Dx: straight leg test

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31
Q

cauda equina syndrome?

A

herniated disc impinging cauda equina; impaired neuro function (saddle anesthesia, LE weakness, diminished reflexes, urinary retention)

EMERGENT - work up = MRI

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32
Q

spina bifida occulta
meningocele
myelomeningocele?

A

SBO - failure of neural tube closure w/o herniation
M - failure of neural tube to close w/ meninges hernia
MM - failure of neural tube to close w/ meninges and spinal cord hernia

defect in closure of lamina

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33
Q

sacrilization/lumbarization?

A

S - one or both TPs of L5 are long and articulate w/ sacrum

L - failure of S1 to fuse w/ sacrum

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34
Q

spondylosis/spondylolesthesis?

A

SL - fracture b/w body processes

SLL - slipping of one vertebrae on another

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35
Q

where do nerves exit in C spine?

T/L?

A

above the vertebral body

below vertebral body

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36
Q

vertebrae w/ no vertebral body?

A

atlas (c1)

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37
Q

C-spine lateral view X-ray uses?

A

use for trauma/MVA; is easy to use and you can observe all cervical vertebrae from this angle very easily

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38
Q

things to look for in C-spine x ray?

A

lamina unstable fractures

increased white (bone), spurring, or abnormal growth leading to negative arthritic changes

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39
Q

Hangman’s fracture?

A

spondylolisthesis of C2 w/ a vertebral arch fracture as well as tearing of C2/C3 ligaments

caused by hyperextension of neck

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40
Q

AP C-spine X-ray uses?

A

can see alignment of spinous processes, not all fractures visible on lateral view

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41
Q

misalignment of C-spine usually due to?

A

unilateral facet joint dislocation

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42
Q

space b/w spinous processes in C-spine?

A

no space should be more than 50% wider than the one immediately above or below, if it is = anterior cervical dislocation

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43
Q

open mouth radiograph uses?

A

assessment of C1/C2

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44
Q

burst fracture?

A

seen in open mouth radiograph; if lateral masses of C1 overhang C2 it is indicative of burst fracture

45
Q

45 degree oblique C-spine radiograph uses?

A

visualize IV foramen and present of osteophyte encroachment in spondylosis (OA)

right posterior oblique visualizes left foramina and right anterior oblique visualizes right foramina (posterior visualizes opposite side)

narrowing = MRI and assess soft tissue

46
Q

altanto-occipital (OA) joint motions?

A 
major = F/E
minor = SB/R

Type 1 like SB and R (opposite directions)

47
Q

atlanto-axial (AA) joint motions?

A

primary = rotation; via obliquus capitis inferior Ms

almost no SB/F/E

48
Q

C2-C7 joint motions?

A

R/SB in same direction (type 2)

49
Q

C2-C7 SDs?

A

sagittal plane dysfunctions (F/E/Neut)

50
Q

OA joint diagnosis?

A

restriction to SB right or RL = SBR/RL SD
restriction to SB left or RR = SBL/RR SD

repeat in flexion/extension

  • if end feel more symmetric in F/E add that to SD
  • ex: symmetric in F-> OA F/SBR/RL SD
51
Q

AA joint diagnosis?

A

rotation only, fully flex C-spine to isolate atlas and rotate

greater rotation right = RR SD

52
Q

C2-C7 joint diagnosis?

A

type 2

ex = C4 E RLSL

53
Q

sidebending assessment?

A

translation (pushing) ease towards left = SR SD

fulcrum side = pushing side = SB side you’re assessing

54
Q

contraindications to HVLA in C-spine?

A

RA, down syndrome (L instability), vertebral artery disease, carotid disease, dislocation of dens

55
Q

C6 dermatome affected in Pt; which spinal segment would be effected?

A

C5-C6 b/c it exits above spinal segment

56
Q

lymph tissue from what embryological layers?

A

lymph vessels/nodes/spleen - mesoderm

thymus/tonsils - endoderm

57
Q

spleen palplation?

A

normally not palpable, but it can be found beneath ribs 9-11 on the left side

58
Q

spleen fluid movement driven how?

A

by diaphragm movement; movement is pressure sensitive

59
Q

liver palpation?

A

RUQ; palpable at R costal margin

60
Q

liver fluid movement driven how?

A

movement of diaphragm like spleen; pressure sensitive

61
Q

liver lymphatic function? spleen? thymus?

A

liver - 1/2 of body’s lymph formed here, clears bacteria, drainage site

spleen - rbc recycling, Ig synth, clears bacteria

thymus - maturation of T cells, limited Fx in adults

62
Q

majority of lymph drainage pumped how?

A

associated w/ respiration and cysterna chyli

63
Q

tissues w/o lymphatic vessels but use direct diffusion?

A

epidermis
endomysium (inner lining of muscles)
cartilage
bone marrow

64
Q

pathway from lymph to veins?

A

lymph capillaries -> collecting lymphatics -> afferent lymphatic vessels -> efferent lymphatic vessels -> thoracic duct or R lymphatic duct -> venous system

65
Q

lymphangions?

A

muscular units in lymphatic collector chains; contract and move lymph in peristaltic waves

66
Q

pathway of lymph through a lymph node?

A

afferent lymphatics -> subcapsular space -> outer cortex -> deep cortex -> medullary sinus -> efferent lymphatics

67
Q

superificial lymph nodes found where? deep?

A

superficial - in subcutaneous tissue

deep - beneath fascia, muscles, and organs

68
Q

evaluation of lymph nodes?

A

swollen, soft, painful -> infectious

swollen, hard, non-painful, fixed -> malignant

69
Q

virchow’s node?

A

L supra-clavicular; intra-thoracic or abdominal cancer

70
Q

epitrochlear nodes?

A

swell in secondary syphilis

71
Q

jugulodigastric node?

A

common swelling in upper respiratory infections, below ear

72
Q

L/R lymph drainage in body?

A

thoracic duct: drains LEFT head, neck, UE, thorax, abdomen, and both side of LE

R lymphatic duct: RIGHT UE, thorax, head, neck, abdomen

73
Q

cisterna chyli?

A

origination point of thoracic duct, found at L1-2

74
Q

termination point of thoracic duct?

A

it pierces Sibson’s fascia at superior inlet and U-turns into LSCV/IJV

75
Q

R lymphatic duct origin/termination?

A

origin - RJ/RSC trunks

termination - RSCV/IJV junction

76
Q

functions of lymphatic system?

A

fluid balance
tissue cleansing/purification
defense
nutrition (fat absorption, protein return to blood)

77
Q

mechanisms of lymph flow?

A 
interstitial fluid pressure
diaphagmatic pressure (thoracic and pelvic)
SNS
78
Q

SNS effects on lymph?

A

on lymph valves -> tightens valves, decreases flow

on smooth muscle -> increases tone, decreases peristalsis

79
Q

consequence of poorly functioning lymphatic system?

A

edema

80
Q

causes of edema?

A

increased A pressure (HTN, drugs)
increased V pressure (CHF, obstruction)
decreases plasma osmotic pressure (cirrhosis, malnutrition)
increases capillary permeability (infection)

81
Q

effects of edema?

A

compression of local structures (vascular, neuro, etc)
decreased tissue waste removal (lactic acid, etc)
decreased pathogen clearance
chronic states -> fibroblast recruitment/activation (fibrosis)

82
Q

purpose of lymphatic OMT?

A

improve functional capacity of lymphatic system including:

  • maintenance/purification/cleansing
  • tissue nutrition
83
Q

indications for lymphatic OMT?

A 
edema, congestion, lymphatic stasis
infection
inflammation
pregnancy 
sprains/strains
84
Q

absolute contraindications for lymphatic OMT?

A
  • anuria - kidneys have to be functioning to process extra fluid return
  • necrotizing fascitis in treatment area
  • fracture/dislocation
  • some infections
  • circulatory disorders (obstructions, embolisms…)

Pt refuses to tolerate or refuses Tx

85
Q

compensatory patterns? uncompensated?

A

common - LRLR

uncommon - RLRL

uncompensated - anything else

86
Q

compensatory patterns and lymphatics?

A

uncompensated can contribute to lymphatic congestion

87
Q

fascial patterns of Zink?

A

describes fascial restriction patterns that could restrict lymphatic flow

4 diaphragms = cranial-cervical, cervicothoracic (thoracic inlet), thoracolumbar/ribs, lumbosacral

compensatory patterns

88
Q

diagnosis in lymphatics approach

A
  • evaulate risk/benefit
  • evaluate fascial patterns of Zink
  • evaluate diaphragm/fascia for restriction
  • evaluate for any SD
  • evaluate for tissue congestion
89
Q

steps in evaluating diaphragms/fascia in lymph Tx?

A

1st - thoracic inlet MFR
2nd - SO release for HEENT, doming diaphragm for problems inferior
3rd - ischiorectal release for LE problems

90
Q

sequence of Tx in lymphatic OMT?

A

1 - open pathways to remove restriction
2 - maximize diaphragmatic functions
3 - increase pressure differentials or transmit motion
4 - mobilize targeted tissue fluids (localized to SD)

91
Q

BLT/Stills/FPR: direct/combination/indirect?

A 
Stills = combo
indirect = BLT/FPR
92
Q

BLT involves?

A

minimizaiton of peri-articular tissue load and placement of affected ligaments in a position of equal tension in all planes

93
Q

BLT indications?

A

SD involving ligamentous articular strains

areas of lymphatic congestion/edema

94
Q

BLT contraindications?

A 
fractures
open wounds
ST/bony infections
abscesses
DVT
anticoagulation
post-op conditions
aortic aneurysm
95
Q

biochemical changes w/ immobilization

A
  • fibrofatty infiltrates found in folds/recesses; correspond directly w/ length of immobilization
  • loss of water/glycoaminoglycans in ground substance
  • immobilization <12 weeks -> new collagen in haphazard manner
  • immobilization >12 weeks -> collagen loss
96
Q

physiological changes w/ immobilization

A
  • force needed to move an immobilized joint = 10x normal
  • after repetitions, force required = 3x
  • over time, joint regains normal mobility
97
Q

steps in BLT

A
  • position in BLT
  • activating force (respirations)
  • reevaluate
98
Q

FPR absolute contraindications?

A

unstable fracture
neuro symptoms
life-threatening symptoms

99
Q

FPR relative contraindications?

A

tx not tolerated well
pt at risk for fracture (osteoporosis)
joint instability
spinal stenosis/nerve root impingement

100
Q

FPR mechanism?

A

SD initiated by increased activity in gamma motor system; overall result is increased tension even in neutral

positioning M in neutral resets tension/hypertonicity of M fiber and unloads the joint; all of which soften tissue

101
Q

FPR steps

A
  • position in neutral while monitoring
  • activating force (compression/torsion/distraction)
  • position in SD, hold 3-5 seconds
  • return and re-evaluate
102
Q

Still’s contraindications?

A

wounds/fractures less than 6 weeks old

103
Q

Still’s steps

A
  • position in SD
  • force (compression/traction)
  • move through RB while maintaining force
  • final tx position (RB/AB)
  • return to neutral and reassess TART
104
Q

neural reflexes w/ spinal root for:
biceps
brachioradialis
triceps

A

biceps - c5
br - c6
triceps - c7

105
Q

compression test?

A

pt seated, phys applies axial compression to head

positive = pain down arm -> nerve root compression (cervical radiculopathy)

106
Q

spurling’s maneuver?

A

test in stages each being more provactive, so one positive test stage the testing can end

1- compress head in neutral
2- compress head in extension
3- SB head away from affeected side then toward affected side and add compression

positive = pain down arm -> nerve root compression (cervical radiculopathy)

107
Q

most common compensatory pattern?

A

LRLR

108
Q

when to use BLT/FPR/Stills

A

BLT - fragile Pts, ligamentous articular strains, edema
FPR - hypertonic Ms
Stills - hypertonicity, motion restriction

OS1 (4 decks)

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