Scenario 20 Flashcards
What are the main functions of the vertebral column?
Main axial support for the body preventing attachments to the skull, thorax and pelvic girdle, protection of the spinal cord and flexibility
What is the function of the vertebral body?
To transmit the load from one body to the next, outer shell of cortical bone and trabeculated internal strucure filled with blood
What part of the vertebrae is damaged in osteoporosis?
Cervical trabeculae become spindly
What is the purpose of the laminae?
Protection of the contents of the vertebral column and transmission of force from articular processes to the body
What are the function of the articular processes
Synovial joints permitting a limited ROM
Cevical pivot then vertical
Throacic are vertical (limit flex and ext but permits rotation)
Lumbar- curved (limits rotation)
What are the functions of the pedicles?
Connection between posterior element and body of vert have obliquely arranged trabeculae to withstand forces
What is typical of the cervical vert?
Ant and post tubercles for scalene muscle attachment, neurocentral articulation, FORAMEN TRANSVERSARUM (vert art and veins), large vert formaen for brachial plexus)
What cervical vert are specialised?
C1- atlas- not prominent spine and no body- transverse log
C2- axis- has a dens
C7- long prominent spinous process with no bifid end
What is specialised about the thoracic vertebrae?
Places for articulations with ribs
What is specialised about the lumbar vertebrae?
L1-L2 oval formane (spinal cord), L3-5 corda equina- triangular foramen
What is the total range of flexion and extension of the spine?
250 degrees
What is the purposed of the IVDs?
rocking rotion required for flex and ext
What are the 3 parts of the IVD?
Nucleus pulposes- toothpaste consistency, deformable but cant change volume
Annulus fibrosus- highly ordered lamellae of collagen type I thicker anteriorly and more tightly packed posteriorly, strong and resist deformation
Vertebral end plate- hyaline cartilage surrounding nucleus- permeable between nucleus and bone, prevent nucleus bulging up
Where does the ant longitudinal lig lie?
Anterior surface of the vertebral bodies attached from the occipital bone to upper sacrum
Deep layers from 1 vert to the next, superficial over several vert
Where does the post long lig lie?
inside vert column on post side of the bodies from the axis to the sacrum attaching to IVDs
Where does the ligamentum flavum lie?
Connects lamina of adj vert from articular capsule to place where lamina joins the spine mostly elastic tissue to prevent separation happening too quickly and protecting IVD
Which lig are tense in flexion?
Ant longitudinal slack post long tensed
What lig are tense in extension?
Ant tensed post slack
What is a compression fracture?
Occurs mostly in thoracic region in loading of the spine and flexion/ lat flexion or just from weakening in osteoporosis. Body of the vert most likely to suffer but repairs quickly
What are the possible causes of IVD failure?
Damage to endplate compressing the height of the IVD (happens with age), bending movement thins the annulus if compression happens simultaneously the nucleus can herniate through the annulus
What are the consequences of IVD failure?
Load sharing affected- neural arch increased loss, fluid can be lost fromthe disk or slack ligaments leading to laxity osteophytes may develop restoring stability but decreasing ROM.
What is cauda equina syndrome?
Severe back pain, saddle anaesthesia, bladder and bowel dysfunction, sciatica, lower limb and muscle weakness
What is spondylolysis and sponylolilethsis ?
Idiopathic defect developing on neural arch 85% on L5 can cause back pain. If it results from fracture of the pars interarticularis may result in forward movement of vertebra and sponylolisthesis- scoliosis in children, adult back pain (scottie dog with collar) failure of lamina
What is the outcome of an atlas fracture?
from a vert force through skull, bony ring forces open by occipital condyles need to support with a collar.
What are the guidelines for correct posture?
Bodies COG 5 cm in front of ankle, just in front of knee, just in front of shoulder and through the mastoid process
Which muscles are active in ideal posture?
Soleus, iliopsoas, glut med, tensor fascia lata, erector spinae
What are the usual curvatures of the spine?
Convex cervical, concave thoracic, convex lumbar
What is flat back?
Loss of lumbar lordosis (convex)
What is hollow back?
Enlarged lumbar lordosis- hips back and abdomen hangs forward
What is sway back?
Increased lordosis- overextensing the hips with knees pressed back hard and chest collapsing in
What is the farthest point forward and back in sway back?
Abdomen and upper back (thoracic spine)
What is the farthest point forward and back in normal?
Chest and buttocks
What is the result of a fracture of the dens?
Displacement posteriorly is fatal if not then need a halo cast
What is extension subluxation?
Ant long lig is ruptured and ant parts of spinal cord are forced apart
What is the stance phase of the gait cycle?
60% of cycle
Heel strike- heel of leading foot strikes the floor, mid stance weight is directly over leading limb, toe off- ipsilateral toe loses contact with the ground
What is the swing phase of the cycle?
40% of cycle
Begins when the toe leaves the ground and ends when it re-contacts (accelerate, mid strike and deceleration)
What is the double support phase of the cycle?
22% when one extremity is finishing and the other is starting
How far does the trunk rise and fall?
50mm highest in mid strike and mid swing
How many times in a cycle does the hip flex and extend?
Once- flexion limit at middle of swing and extension before the end of the stance
How many times does the knee flex and extend in one cycle?
Twice- fully extended before heel contact and flexes in early stance, extends again at mid stance and flexes again early in swing
What happens to the ankle joint and foot?
As it makes contact with the ground plantarflexes and pronates and then does the opposite
What is different in childrens gait?
Wider base, no reciprocal arm swinging, no heel contact (flat foot) whole leg externally rotated in swing and very little knee flexion
What is different in stair gait?
Initial contact on ant foot then posteriorly in weight acceptance then pull up phase and forward continuance (ankle plantar flexion generating the energy)
What are the superficial back muscles?
Trapezius, latt dorsi, levator scapulae, rhomboid major and rhomboid minor
What are the intermediate back muscles?
Serratus posterior sup and inf (respiratory)
What are the deep back muscles?
Extensors and rotators of head and neck- splenius capitis and cervicis
Extensors and rotators of vert column- erector spinae and transversospinales
