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Upper extremity- face, ears, throat, abdomen, lumbar/thoracic spine > Pathologies of lumbar and thoracic spine and anatomy > Flashcards

Pathologies of lumbar and thoracic spine and anatomy Flashcards

1
Q

The hips, pelvis and lumbar spine are ____

A

an integrated unit

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2
Q

The lumbo-pelvic hip complex

A

-operates as an integrated functional unit
- assess in all types of movement dysfunction

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3
Q

Background and significance of low back pain

A

70-80% of adults experience LBP in their lives

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4
Q

Lordosis

A

increased anterior lumbar curve from neutral

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5
Q

kyphosis

A

increases posterior thoracic curve from neutral

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6
Q

Flat back

A

decreased anterior lumbar curve

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7
Q

sway back

A

decreased anterior lumbar curve and increased posterior thoracic curve from neutral

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8
Q

Scoliosis

A

lateral spinal curvature often accompanied by vertebral rotation

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9
Q

how many vertebrae are there

A

33 vertebrae (24 mobile, 9 fused)

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10
Q

Sacralization

A

occurs when the fifth lumbar vertebra becomes fused to the sacrum

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11
Q

Lumbarization

A

Occurs when the first sacral vertebra fails to unite with the remained of the sacrum

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12
Q

Intervertebral disks components

A

Annulus fibrosus
- multilayered fibers, thinner posteriorly
Nucleus pulposus
- 60-70% water (compression & dehyrdration)
- highly elastic, semi gelatinous substance
23 IV discs
- No disc between C0-C1 & C1-C2

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13
Q

Characteristics of intervertebral disc

A

Annulus fibrosus
- highly structured and innervated
Nucleus
- more like crab meat than jelly donut

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14
Q

Ligamentous anatomy

A

-anterior and posterior longitudinal ligaments
- supraspinous ligaments
-interspinous ligaments
- ligamentum flavum
-Facet capsule (can refer pain)

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15
Q

Anterior longitudinal ligament

A

-its role is to limit trunk extension
- provides shape to the disc

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16
Q

Posterior longitudinal ligament

A

-proximal attachment to the occiput
- limit spinal flexion

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17
Q

Supraspinous ligament

A

-attaches to each spinous process of the spine
- limit amount of flexion that occurs

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18
Q

Interspinous ligament

A

-feel the space between the spinous process
- limit amount of trunk flexion

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19
Q

Ligamentum flavum

A

-responsible for lining the posterior aspect of the vertebral canal
-connecting the lamina
-Travels C2-S1

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20
Q

Extrinsic muscles

A

Provide movement associated with UE and scapula
- latissimus dorsi
- external/internal oblique
-trapezius
-rhomboid minor/major
-rectus abdominis

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21
Q

Intrinsic muscles

A

directly influence motion and stability
- iliocostalis lumborum
-longissimus thoracis
- iliocostalis thoracis
-quadratus lumborum
-rotares

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22
Q

Lumbar plexus

A

-L1-L5: innervates anterior and medial muscles of the thigh, medial leg, and foot
-L2-L4: posterior branches form the femoral nerve, anterior branches form the obturator nerve

23
Q

Sacral plexus

A
  • Primarily L5-S2: innervates buttocks, posterior femur muscles, and the entire lower leg
24
Q

Tibial nerve

A
  • continues to descend in the posterior compartment of leg and foot
  • gastroc, soleus, Tom, dick and harry
25
Q

Common peroneal nerve

A
  • travels down the lateral and anterior compartment of the leg and foot
  • fibularis longus and brevis
26
Q

L4-S3 (sciatic nerve)

A
  • supply to biceps long head, semis, hamstrings
27
Q

Constant LBP differential by pain pattern

A

-chemical pain, inflammation

28
Q

Intermittent (70-80%) postural/mechanical dysfunction

A

Increased with sitting
- Disk, SI joint sprain/inflammation
Reduction with sitting
- spondy, facet syndrome, stenosis
Increased with standing
- ligamentous/muscular instability
Increased while side lyinh
- same side> facet or disk
-opposite side> disk
Bowel/ bladder incontinence
- disk extrusion/ sequestration
- stenosis
-cauda equina syndrome

29
Q

Skin markings

A

Neurofibromatosis (cafe au lait)
-genetic disorder causing tumors on nerve tissue
- typically benign but sometimes malignant
- type 1 in children
Spina bifida (faun’s beard)

30
Q

Mechanical Low back pain

A
  • muscle strain (erector spinae, semispinalis, multifidus)
  • spondylosis, spondylolysis, spondylolisthesis
  • spinal stenosis
  • osteoarthritis
31
Q

Discogenic low back pain

A
  • pain can be evident in MRI
    -annular tears
  • herniated nucleus pulposus (HNP)
  • types: protrusion, prolapse, extrusion, sequestration
32
Q

Spinal stenosis

A
  • common in 50-60 yrs old
    s/s:
  • pain during walking
  • weakness distal to insulting area
  • radiating pain, N/T
33
Q

Intervertebral disk syndrome “degenerative disk disease” (DDD) etiologies

A
  1. Poor posture chronically
    - loss of water content with age, decreased protein, and altering of chemical structure
  2. Faulty mechanics
    - excessive flexion & rotation
  3. Trauma
    - violent twist w/flexion
34
Q

Intervertebral disk syndrome pathoetiology

A
  • degeneration of annulus fibrosis
  • nucleus pulposes herniation- extrusion through the annulus fibrosus
  • nerve impingement (root or cord)
35
Q

Intervertebral disk syndrome s/s

A

Radiculopathy
- any disorder of spinal nerve roots
Sciatica
- any pain, N/T, affecting the distribution of the sciatic nerve

36
Q

Sciatica

A
  • affects 40% of population in their lifetime
  • multiple causes of sciatica: herniated disc, stenosis, piriformis syndrome, diabetes
  • could include dull, achy, sharp, radiating, tingling pain
    (increased with flexion/tension)
37
Q

Stages of disc herniation

A
  1. disc degeneration
  2. prolapse
  3. extrusion
  4. sequestration
38
Q

Disc degeneration

A

chemical changes associated with aging causes discs to weaken, without herniation

39
Q

Prolapse

A

disc position changes with some slight impingement into the spinal canal. (bulge or protrusion)

40
Q

Extrusion

A

the nucleus pulposus breaks through the annulus fibrosus but remains within the disc

41
Q

Sequestration

A

the nucleus pulposus breaks through the annulus fibrosus and lies outside the disc in the spinal canal

42
Q

Special tests for DDD

A

s/s:
- regional pain/spasm
- radiating pain
- decreased patellar & achilles reflexes
- tests: SLR, bowstring, valsalva, milgram’s, brudzinskis, slump sit

43
Q

Facet syndrome etiology

A

acute: forced extension (hyper) w/rotation
Chronic: repetitive extension, hyperlordosis

44
Q

Facet syndrome pathology

A

articular lesion, inflammation, osteophytes

45
Q

Facet syndrome s/s

A

pain w/extension & rotation
special test: + quadrant test

46
Q

Spondylolysis etiology

A

congenital anomaly (pars defect) or repetitive extension causing degeneration & Fx

47
Q

Spondylolysis pathology

A

degenerative fracture @ pars interarticularis

48
Q

Spondylolysis s/s

A

regional, localized LBP that restricts extension
special test: Single leg stance (stork stand)

49
Q

Spondylolisthesis etiology

A

chronic LBP extension strain, postural anomaly, rarely direct blow

50
Q

Spondylolisthesis pathology

A

bilateral fracture, subluxation, luxation, anterior displacement (L5 on S1, L4 on L5)

51
Q

Spondylolisthesis s/s

A
  • lower cross syndrome
  • step off deformity
  • decapitated scotty dog on Xray
52
Q

Vertebral fx/ luxation etiology

A

axial load, hyperflexion/rotation, blunt trauma

53
Q

Vertebral fx/luxation s/s

A
  • cervical, chest, extremity pain
  • anesthesia, paresthesia in trunk/limbs
  • weakness
  • loss of bladder control
54
Q

Scoliosis

A

-can be structural or functional
- structural is rigid and fixed
- usually diagnosed @ 10-15 yr old right after growth spurt
-special test: adams forward bend test
- brace as treatment

Upper extremity- face, ears, throat, abdomen, lumbar/thoracic spine (4 decks)

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