Pathophysiology IV Flashcards
tetest 1 , thoracic and lumbar spine
How many vertebrae and articulations in the T spine?
12 vertebrae, each one in involved in six articulations (72 articulations total)
Is stability or mobility prioritized in the T spine?
protection of the thoracic viscera is primary so stability over mobility
What creates the relative stability of the T spine over the C spine?
The rib cage and its many articulations.
The reduced mobility of the T spine has what 3 primary effects?
- Influences the motion available in the spine and shoulder girdle
- Increase potential postural impairments
- Provide important weight bearing mechanism for the spine
Flexion and extension is limited in the upper T spine by what structures?
Ligaments
T or F?
Good pelvic movement is integral to T spine function.
True! Abnormal pelvic tilting can cause issues
In the T spine, what is a sagittal plane deformity c increased anterior concavity called?
Kyphosis
The difference between a dowagers hump, humpback, and round back is dependent on what?
The location of the anterior concavity
Motion in all cardinal planes is possible in the T spine, however the degree of movement is dependent on what?
The segmental level in which movement is occurring
Flexion and extension is limited in upper thoracic due to what?
The facet orientation being closer to the frontal plane
Flexion in spine is limited by what major ligament?
Posterior longitudinal ligament
Extension coupled with posterior translation is limited by what processes?
articular and spinous processes
During respiration, the ribs function as ____
levers
Little movement at the rib ____ produces a large degree of movement in the ____
rib neck, rib shaft
What are the accessory respiration muscles?
scalenes, SCM, pectoralis minor
What is the chief movement during respiration at the neck of ribs 1-6?
Rotation of the neck of ribs 1-6
In ribs 7-10, what is the principal movement during inspiration?
Upward, backward, and medial
*reverse happens during expiration
The anterior ends of ribs are lower than posterior. So when they elevate, what happens?
They move superiorly while rib neck drops inferiorly.
During respiration, ribs 1-10 experiences what movement?
Anterior elevation, like a pump handle
Middle and lower ribs move like a bucket handle during respiration. What direction is this movement?
Lateral elevation
The false ribs have movement during respiration that is similar to the pincer motion of a ____
caliper
T or F?
Good mobility of the pelvis is integral to the thoracic spine
True! excessive tilting can cause compensatory issues.
Postural Dysfunction: Abnormal Pelvic Tilting
- Posterior pelvic tilting in sitting
- Anterior pelvic tilting in standing
What does the following describe? Increase in lumbar and T spine flexion, forward head posture
Posterior pelvic tilting in the sitting position
What does the following describe? Trunk leans backward and overstretches the rectus abdominis and pulling forward of shoulders
Anterior pelvic tilt in standing
What is kyphosis?
Sagittal plane deformity involving an increased anterior concavity
What is sagittal plane deformity involving an increased anterior concavity?
Kyphosis
A kyphosis in the upper dorsal region, often caused by postmenopausal osteoporosis or long term corticosteroid therapy is known as:
Dowagers Hump
A localized, sharp posterior angulation produced by anterior wedging of 1 or 2 thoracic vertebrae also called a gibbus, is more commonly known as
Hump back
Causes of humpback:
fracture, congenital anomaly of spine, result of infection like TB
Three sternal deformities:
- Barrel chest
- Pigeon chest
- Funnel chest
Barrel chest
forward and upward projecting sternum, increases anteroposterior diameter. Results in respiratory difficulty, stretching of intercostal and anterior chest mms
Pigeon chest
Sternum grows outwards and downwards. Lengthens upper abdominal mms and shortens upper intercostals
Funnel chest
Pectus excavatum
Posterior projection of sternum at the xiphoid process. Respiratory and cardiac abnormalities
Intercostal mm strains are typically caused by
trauma after excessive muscular activity
Scoliosis
Rotoscoliosis is more correct term. Spine curves and side flexes. Rotation is towards the convexity. Rib Hump occurs on convex side of the curve.
Non-structural scoliosis
Not bony anomaly. Postural, LLD, or hip contractures in nature
Dowagers Hump
abnormal curvature in the upper thoracic spine *often caused by osteoporosis
Gibbus deformity
structural kyphosis that is a particularly sharp, angular curve
Lordosis (swayback)
abnoraml, inward curvature of a portion of the lower portion of the spine
In scoliosis, does the rib humb occur on the convex or concave side of the curve?
convex
A lateral curvature of the spine, which affects more females than males and can occur at any age, is known as what?
Scoliosis
Structural scoliosis
Irreversible lateral curvature of the spine with fixed rotation of vertebrae. affects girls more than boys during adolescence, idiopathic
Functional scoliosis
a structurally normal spine that appears to have a lateral curve
Two types of low back pain (LBP):
specific and non-specific
Specific LBP:
sx caused by a specific pathophys mechanism, i.e., inflammatory disease, osteoporosis, infection, rheumatoid arthritis, fx, herniated disc, tumor
Nonspecific LBP:
based on exclusion of specific pathology, this account for about 90% of pts with LBP
Factors indicating likelihood of LBP development:
age older than 40-50 years, physical and psychosocial workload, smoking, obesity, comorbidity
How many vertebrae in the L spine?
5
*and NO rib facets
Primary ligamentous support in the L spine:
- Anterior longitudinal ligament
- Posterior longitudinal ligament
- Annulus fibrosis attachments
- Facet joints
- Interosseous ligaments between spinous processes
The integrity of the shape of an IVD is determined by what?
The integrity of its outer wall and annulus fibrosis
An IVD is made of what?
10-12 concentric sheets (lamellae) of predominantly type 1 collagen tissue. It’s held together by proteoglycan gel.
With age, the annular layers in an IVD will decrease, but they will also:
thicken
The Sacroiliac joint is a true ____ joint
diarthrodial
The SI joint joins what structures?
the sacrum and pelvis
the pelvis is AKA
the innonimate
The SI joint joins the sacrum and pelvis via..
iliac bones
How many muscles attach to the sacrum, ilium, or both?
35 mms
Does the function of the SI joint favor stability or mobility?
stability
What is an annulus fibrosis?
The outer part of an intervertebral disc
The Posterior Muscle system is AKA
posterior chain
The TLF (thoracolumbar fascia) and its muscular attachments play an important role in stabilizing what?
lumbopelvic region
The anterior muscle system is AKA
anterior chane
What structure provide an anterior “sling” and assist in stabilizing the lumbar spine and pelvis?
Intern and Extern obliques (along with the posterior oblique sling made of the TLF and its associated structures)
T or F?
The transverse abdominis has attachments to the TLF
True. And also the sheath of the rectus abdominis, diaphragm, iliac crest, and lower 6 costal surfaces
What is one of the most important muscle groups that contribute to the mobility and stability of the lumbopelvic region?
The anterior muscle system via the abdominal wall mechanism
What are the muscles of the anterior muscle system?
Rectus abdominis, intern/extern obliques, transvere abdominis
What mm activates before movement in persons without lumbopelvic pain, but is lost in those with lumbopelvic pain?
Transverse abdominis
What are the three types of lumbar disk injury?
herniation, protrusion, prolapse
What is a disc herniation?
Change in shape of the annulus that causes it to bulge beyond the normal perimeter.
*pain is increased during sitting and bending during compression
What is disc protrustion?
The nuclear material bulges and strains the annulus fibrosis (but doesn’t tear through it) or the posterior longitudinal ligament
*posterior protrusions are most common
Two types of disk prolapse
extrusion and sequestration
Disk prolapse definition:
migrating nuclear material escapes contact with disk entirely and becomes a free fragment in the vertebral canal and epidural space
What is a disk prolapse extrusion?
extension of nuclear material beyond confines of posterior long. ligament or above and below the disk space
What is disk prolapse sequestration?
Extruded nucleus separates from disk and moves away from prolapsed area
Cauda equina syndrome:
loss of bowel control, saddle anesthesia, numbness in legs
this is a medical emergency
What type of protrusion can press against a longitudinal ligament and cause back pain but no neuro symptoms??
Anterior protrusion
Pts with disk related LBP and sciatica may present with what in their pelvis region?
A pelvic “shift” away from side with pain “sciatic scoliosis”
Disk herniations are more common in what population?
men under 45
Etiology of Disk Herniation
- severe trauma or repeated strains
- intervertebral joint degeneration
- faulty posture or body function because of repetitive, poor body mechanics
How is disk herniation diagnosed?
Physical exam, MRI, CT, or myelogram
Define: degenerative spinal stenosis
Narrowing of the spinal canal (central stenosis), nerve root canal, or foramen (lateral stenosis)
How does Degenerative Spinal Stenosis manifest?
As poorly localized pain, paresthesias, cramping in one/both LE brought on by walking and relieve by sitting
*can result in cauda equina compresion
Zygapophyseal joint dysfunction is also known as
Facet Joint Syndrome (FJS)
causes pain and impaired mobility
What are the interventions for FJS?
joint mobs, postural education, exercise progression
Spondylolysis
often occurs in C spine. is a defect of the pars interarticularis of the spine (between facets of verts)
Spondylolisthesis
common in lumbar spine
Anterior slippage. Most rapid change between 1-15 YOA and no more slipping after age 20.
Congenital spondylolisthesis
dysplasia of 5th lumbar
Isthmic spondyloisthesis
cause ny a defect in the pars articularis
Degenerative spondylolisthesis
Dysfunction of the IVS, horizontalization of lamina and facets or sacrum morphology
Traumatic spondylolisthesis
fx or acute dislocation of zygapophyseal joint (this type is rare)
Pathologic spondylolisthesis
disc slippage as a result of infectious processes
spondylolisthesis
Causes chronic midline pain at lumbrosacral junction. May require surgical intervention.
Lumbo-sacral dysfunction is an alternate term for what?
Low back pain
What is spina bifida and what is an alternate term for it?
A defect in the development of the vertebra. AKA: congenital neural tube defect
What is Congenital Neural Tube Defect?
Spina bifida. A defect in development of the vertebra.
Spina bifida occulta:
Absent portion of lamina or spinous process. Spinal cord, meninges, and spinal fluid are normal. NO sx’s expect possible hairy patch. NO neuro sx’s.
*most common and least sever form of spina bifida without protrusion of the spinal cord or meninges
What type of Spina Bifida is asymptomatic expect for a possible hair patch and includes normal spinal cord, meninges, and spinal fluid?
Spina bifida occulta
Spina bifida meningocele
absence of part of the vertebra and meninges protrude with CSF only. Spinal cord intact. Neuro sx’s are rare. Can be repaired with surgery.
What types of spina bifida does the following list describe?
1. Absence of portion of vertebra thru which meninges protrude with CSF
2. Spinal cord intact
3. Neuro sx’s RARE
4. Reparable via surgery
Spina bifida meningocele
Spina bifida myleomeningocele
Protrusion CSF and SPINAL CORD sensory & motor deficits, LE paralysis, incontinence, musculoskeletal deformities, hydrocephalus, possible mental retardation
What is spondylolisthesis?
Anterior sliding of one vertebrae over another. Very common L5-S1. Can cause: pain, diminished reflexes, mm atrophy, decreased strength, numbness
Spondylolysis
bilateral bony defect w/o slipping. Sx’s include: pain & stiffness.
What is the term for a localized narrowing of spinal canal from bony obstruction of arthritis-type buildup?
Spinal stenosis
What is the term for degenerative disease-type fusing and closing of neural tube space that can also be a part of an SI disorder?
Ankylosing Spondylitis
Pain about the coccyx and lower sacrum, usually from trauma to the tailbone is known as
coccygodynia
An intervertebral disc is what proportion water?
80%
Also made of collagenous rings (annulus fibrosis) and nucleus pulosus
Define disc degeneration:
decreased hydration, narrowing which places more stress on the annulus fibrosis and local facet joints
Define disc herniation:
contents of nucleus pulposis bulges at the periphery of annulus fibrosis or actually ruptures through the rings
Spondylolysis can be thought of as a precursor to what?
Spondylolisthesis
Name 2 causes for cauda equina syndrome
- Degenerative spinal stenosis
- Cauda equina
What are the 5 types of spondylolisthesis?
- Congenital
- Isthmic
- Degenerative
- Traumatic
- Patholofic
