Scenario 20

Question 1

What are the main functions of the vertebral column?

Answer 1

Main axial support for the body preventing attachments to the skull, thorax and pelvic girdle, protection of the spinal cord and flexibility

Question 2

What is the function of the vertebral body?

Answer 2

To transmit the load from one body to the next, outer shell of cortical bone and trabeculated internal strucure filled with blood

Question 3

What part of the vertebrae is damaged in osteoporosis?

Answer 3

Cervical trabeculae become spindly

Question 4

What is the purpose of the laminae?

Answer 4

Protection of the contents of the vertebral column and transmission of force from articular processes to the body

Question 5

What are the function of the articular processes

Answer 5

Synovial joints permitting a limited ROM
Cevical pivot then vertical
Throacic are vertical (limit flex and ext but permits rotation)
Lumbar- curved (limits rotation)

Question 6

What are the functions of the pedicles?

Answer 6

Connection between posterior element and body of vert have obliquely arranged trabeculae to withstand forces

Question 7

What is typical of the cervical vert?

Answer 7

Ant and post tubercles for scalene muscle attachment, neurocentral articulation, FORAMEN TRANSVERSARUM (vert art and veins), large vert formaen for brachial plexus)

Question 8

What cervical vert are specialised?

Answer 8

C1- atlas- not prominent spine and no body- transverse log
C2- axis- has a dens
C7- long prominent spinous process with no bifid end

Question 9

What is specialised about the thoracic vertebrae?

Answer 9

Places for articulations with ribs

Question 10

What is specialised about the lumbar vertebrae?

Answer 10

L1-L2 oval formane (spinal cord), L3-5 corda equina- triangular foramen

Question 11

What is the total range of flexion and extension of the spine?

Answer 11

250 degrees

Question 12

What is the purposed of the IVDs?

Answer 12

rocking rotion required for flex and ext

Question 13

What are the 3 parts of the IVD?

Answer 13

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

Question 14

Where does the ant longitudinal lig lie?

Answer 14

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

Question 15

Where does the post long lig lie?

Answer 15

inside vert column on post side of the bodies from the axis to the sacrum attaching to IVDs

Question 16

Where does the ligamentum flavum lie?

Answer 16

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

Question 17

Which lig are tense in flexion?

Answer 17

Ant longitudinal slack post long tensed

Question 18

What lig are tense in extension?

Answer 18

Ant tensed post slack

Question 19

What is a compression fracture?

Answer 19

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

Question 20

What are the possible causes of IVD failure?

Answer 20

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

Question 21

What are the consequences of IVD failure?

Answer 21

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.

Question 22

What is cauda equina syndrome?

Answer 22

Severe back pain, saddle anaesthesia, bladder and bowel dysfunction, sciatica, lower limb and muscle weakness

Question 23

What is spondylolysis and sponylolilethsis ?

Answer 23

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

Question 24

What is the outcome of an atlas fracture?

Answer 24

from a vert force through skull, bony ring forces open by occipital condyles need to support with a collar.

Question 25

What are the guidelines for correct posture?

Answer 25

Bodies COG 5 cm in front of ankle, just in front of knee, just in front of shoulder and through the mastoid process

Question 26

Which muscles are active in ideal posture?

Answer 26

Soleus, iliopsoas, glut med, tensor fascia lata, erector spinae

Question 27

What are the usual curvatures of the spine?

Answer 27

Convex cervical, concave thoracic, convex lumbar

Question 28

What is flat back?

Answer 28

Loss of lumbar lordosis (convex)

Question 29

What is hollow back?

Answer 29

Enlarged lumbar lordosis- hips back and abdomen hangs forward

Question 30

What is sway back?

Answer 30

Increased lordosis- overextensing the hips with knees pressed back hard and chest collapsing in

Question 31

What is the farthest point forward and back in sway back?

Answer 31

Abdomen and upper back (thoracic spine)

Question 32

What is the farthest point forward and back in normal?

Answer 32

Chest and buttocks

Question 33

What is the result of a fracture of the dens?

Answer 33

Displacement posteriorly is fatal if not then need a halo cast

Question 34

What is extension subluxation?

Answer 34

Ant long lig is ruptured and ant parts of spinal cord are forced apart

Question 35

What is the stance phase of the gait cycle?

Answer 35

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

Question 36

What is the swing phase of the cycle?

Answer 36

40% of cycle

Begins when the toe leaves the ground and ends when it re-contacts (accelerate, mid strike and deceleration)

Question 37

What is the double support phase of the cycle?

Answer 37

22% when one extremity is finishing and the other is starting

Question 38

How far does the trunk rise and fall?

Answer 38

50mm highest in mid strike and mid swing

Question 39

How many times in a cycle does the hip flex and extend?

Answer 39

Once- flexion limit at middle of swing and extension before the end of the stance

Question 40

How many times does the knee flex and extend in one cycle?

Answer 40

Twice- fully extended before heel contact and flexes in early stance, extends again at mid stance and flexes again early in swing

Question 41

What happens to the ankle joint and foot?

Answer 41

As it makes contact with the ground plantarflexes and pronates and then does the opposite

Question 42

What is different in childrens gait?

Answer 42

Wider base, no reciprocal arm swinging, no heel contact (flat foot) whole leg externally rotated in swing and very little knee flexion

Question 43

What is different in stair gait?

Answer 43

Initial contact on ant foot then posteriorly in weight acceptance then pull up phase and forward continuance (ankle plantar flexion generating the energy)

Question 44

What are the superficial back muscles?

Answer 44

Trapezius, latt dorsi, levator scapulae, rhomboid major and rhomboid minor

Question 45

What are the intermediate back muscles?

Answer 45

Serratus posterior sup and inf (respiratory)

Question 46

What are the deep back muscles?

Answer 46

Extensors and rotators of head and neck- splenius capitis and cervicis
Extensors and rotators of vert column- erector spinae and transversospinales