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kinesiology > spine > Flashcards

spine Flashcards

Kin 1 and 2

1
Q

Where does the anterior longitudinal ligament attach?

A

attaches to anterior aspect of vertebral bodies and disc

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2
Q

The anterior longitudinal ligament primarily resists which direction of movement?

A

extension/hyperextension

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3
Q

Describe a pedicle

A

short, stout pillars with thick walls that connect the vertebral body to the posterior elements

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4
Q

What is the function of a pedicle?

A

To transmit the bending forces from the posterior elements to the vertebral body

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5
Q

Describe the lamina

A

vertical plate that constitutes the central portion of the arch posterior to the pedicles

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6
Q

What is the function of the lamina?

A

Transmit the forces from the articular, transverse and spinous processes to the pedicle

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7
Q

Describe a transverse process

A

lateral projection of bone that originates from the laminae

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8
Q

What is the function of transverse processes?

A

Serves as muscle attachments and provide mechanical lever

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9
Q

describe a spinous process

A

a posterior projection of bone that originates from the central portion of the laminae

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10
Q

What is the function of a spinous process?

A

serves as much attachment and provides mechanical lever; may also serve as a bony block to motion

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11
Q

describe the vertebral foramen

A

opening bordered by the posterior vertebral body and the neural arch

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12
Q

What is the function of a vertebral foramen?

A

combined with all segments, forms a passage and protection for the spinal cord

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13
Q

What is the anterior longitudinal ligament made of?

A

collagen fibers

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14
Q

What does the posterior longitudinal ligament attach to?

A

posterior aspect of vertebral bodies and disc

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15
Q

What movement does the posterior longitudinal ligament primarily resist?

A

flexion/hyperflexion

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16
Q

The ligamentum flavum connects the __________ of ___________ ___________.

A

laminae of adjacent vertebrae

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17
Q

The ligamentum flavum is made of what kind of fibers?

A

elastic

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18
Q

what is the significance with the ligamentum falvum being made of elastic fiber?

A

it is far from the AOR so the this ligament needs to be able to stretch more/further. Elastic fibers allow that.
- won’t buckle
- constant disc compression
- basically it will stabilize a segment and compress load to disc

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19
Q

The ligamentum flavum primarily resists which direction of movement?

A

flexion (excessive separation of the vertebral laminae)

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20
Q

What does the supraspinous ligament connect?

A

posterior aspect of spinous processes (tip to tip)

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21
Q

Interspinous ligament located between what?

A

spinous processes

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22
Q

intertransverse ligament connects what?

A

transverse processes

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23
Q

What is a laminectomy?

A

surgical procedure removing part or all of lamina. relieves pressure on spinal cord or nerves.

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24
Q

Questions to think about:
what problems to laminectomies pose? What problems do laminectomies help with?

A

what occurs to the tissues when the lamina is removed? muscles, ligaments?

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25
Q

What are the 5 mover muscles of neck/back?

some snakes slither so elegantly

A
  1. splenius
  2. semispinalis
  3. sternocleidomastoid
  4. scalenes
  5. erector spinae
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26
Q

what 3 muscles make up the erector spinae?

I LOVE STRETCHING

A

Iliocostalis, longissimus, spinalis

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27
Q

What is torticollis?

A

twisted neck (muscles contract involuntarily -dystonia)

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28
Q

what are symptoms of torticollis?

A
  • neck pain
  • contract SCM (chin to contralateral shoulder)
  • inability to turn head (ipsilaterally)

- can present in many different ways

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29
Q

What are the 5 causes of torticollis?

A
  1. congenital
  2. sleeping awkwardly
  3. slipped facet
  4. herniated disc
  5. viral/bacterial infectioni
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30
Q

What are 8 muscles that aid in stabilization of the back/neck?

Many Interesting Travelers Roam In Scenic Lovely Locations

A
  1. multifidus
  2. intertarnsversarii
  3. transvers abdominis
  4. rotatores
  5. interspinales
  6. suboccipitals
  7. longus colli
  8. longus capitus
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31
Q

What is a fusion?

A

permanently joins 2 or more vertebrae in the spine to eliminate movement (also decrease pain)

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32
Q

What are 7 reasons one would get a spinal fusion?

A
  1. fractured vertebrae
  2. excessive motion (instability)
  3. spondylosis
  4. spondylolethesis (slip)
  5. osteoarthritis
  6. spinal deformity
  7. bludge/herniated disc
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33
Q

Talk about the bodies of each type of vertebrae

A
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34
Q

When it come to the cervical spine there is an anterior shear due to __________. this moves the head _________.

A

anterior LoG (line of gravity). it will move the head forward

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35
Q

What muscle helps resist the LoG which pulls the head back

A

levator scapulae

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36
Q

semispinalis capitis/cervices has an optimal line of pull for ____________ which can increase _________

A

extension, lordosis

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37
Q

During shoulder elevation the upper trapezius acts as the _______, while the longus colli/capitis act as __________

A

agonists, synergist

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38
Q

during shoulder elevation what are examples of an antagonist to the upper trappezius?

A

latissimus dorsi, pectoralis minor

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39
Q

when looking for normal head/neck posture what would you expect to see in the anterior view?

A

no tilting, no rotation, not seeing too much of the top of head or the neck

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40
Q

when looking for normal head/neck posture what would you expect to see in the lateral view?

A

normal lordosis, tragus and nose aligned horizontally

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41
Q

when looking for normal head/neck posture what would you expect to see in the posterior view?

A

seeing normal lordossi, skin folds, no head translation, no head tilt

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42
Q

label

A
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43
Q

label

A
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44
Q

label

A
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45
Q

where do you palpate for cervical flexion?
When do you have the patient stop?
what is the
AOR
SA
MA
AAOS ROM?

A

palpate C7 and T1 spinous processes
have move into flexion and stop when movement at T1 is felt

AOR: external auditory meatus
SA: perpendicular to the floor
MA: base of the nares
ROM: 45° measure difference between beginning and end positions

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46
Q

what is the normal end feel for cervical flexion?

A

firm

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47
Q

where do you palpate for cervical extension?
When do you have the patient stop?
what is the
AOR
SA
MA
AAOS ROM?

A

palpate spinous processes of C7 and T1
instruct the patient to extend the neck to end ROM - this is when T1 moves superiorly after C7
AOR: external auditory meatus
SA: perpendicular to the floor
MA: base of the nares
ROM: 45° measure beginning and end positions

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48
Q

where do you palpate for cervical lateral flexion?
When do you have the patient stop?
what is the
AOR
SA
MA
AAOS ROM?

A

palpate spinous processes of C7 and T1
end range is when T1 moves
AOR: spinous process of C7
SA: aligned between the scapulae, over spinous processes of thoracic spine, perpendicular to floor or table
MA: bisecting the cranium vertically
ROM: 45° measure difference between beginning and end positions

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49
Q

what is normal end feel for cervical extenion?

A

firm

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50
Q

what is normal end feel for cervical lateral flexion?

A

firm

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51
Q

where do you palpate for cervical rotation?
When do you have the patient stop?
what is the
AOR
SA
MA
AAOS ROM?

A

palpate spinous process of C7 and T1
end rom is when T1 moves
AOR: superior surface and center of the cranium
SA: lateral border of acromion
MA: parallel with nose
ROM: 60° measure difference between beginning and end positions

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52
Q

what is normal end feel for cervical rotation?

A

firm

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53
Q

what is the arthrokinematics of lower cervical flexion?

A

always in a 45° plane at facet
up and forward of bilateral superior segments

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54
Q

what is the arthrokinematics of lower cervical extension?

A

always in 45° planet at facet
down and back of bilateral superior segments

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55
Q

what is the arthrokinematics of lower cervical lateral flexion and rotation? (for right side)

A

right facet moves inferior and posterior (down and back); left facet moves superior and anterior (up and forward)

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56
Q

what is the arthrokinematics of lower cervical flexion and rotation? (for left side)

A

left facet moves inferior and posterior (down and back); right facet moves superior and anterior (up and forward)

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57
Q

lateral cervical flexion and rotation are coupled ____________

A

ipsilaterally

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58
Q

arthrokinematics of AA joint (C1-C2)
Flexion:
Extension:

A

tilts anteriorly
tilts posteriorly
*this is due to the transverse ligament *

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59
Q

arthrokinematics of AA joint (c1-C2)
rotation (right)

A

right C1 facet glides posteriorly; left C1 facet glides anteriorly

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60
Q

arthrokinematics of AA joint (C1-C2) rotation (left)

A

left C1 facet glides posteriorly; right C 1 facet glides anteriorly

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61
Q

in the AA joint is there coupling?

A

NO

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62
Q

arthrokinematics of atlanto-occipital joint (C0-C1). which is convex, convave?

A

C0 = convex
C1 = concave
so it is convex moving on concave (opposites)

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63
Q

arthrokinematics OA joint (C0-C1) flexion?

A

rolls anteriorly and glides posteriorly

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64
Q

arthrokinematics OA joint (C0-C1) extension?

A

rolls posteriorly and glides anteriorly

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65
Q

arthrokinematics OA joint (C0-C1) lateral flexion (LF) (right)?

A

right condyle moves medial, inferior and anterior (MIA); left condyle moves lateral, posterior and superior (LPS)

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66
Q

arthrokinematics OA joint (C0-C1) lateral flexion (LF) (Left)?

A

left condyle moves medial, inferior and anterior (MIA); right condyle moves lateral, posterior and superior (LPS)

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67
Q

the orientation of the joints in the OA are positioned in what direction to the sagittal plane?

A

medial

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68
Q

in the OA joint, LF and rotation are coupled ____________?

A

contralaterally

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69
Q

segmental mobility (accessory motion)

what is hypomobilty?

A

less than physiological range

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70
Q

segmental mobility (accessory motion)

what is hypermobility in regards to the deformation/strain curve?

A

increased tendency to move into elastic/plastic zone during daily activites

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71
Q

segmental mobility (accessory motion)

draw and label the segmental mobility deformation curve table.
what are the different zones? when does it become traumatic?

A
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72
Q

segmental mobility (accessory motion)

with hypomobilty what is different with the osteo and arthrokinematics?

A

osteokinematics:decreased ROM
arthrokinematics: decreased joint glide

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73
Q

segmental mobility (accessory motion)

hypermobility(instability) has what differences with osteo and arthrokinematics?

A

decreased or increased ROM (skin fold observed)
increased joint glide
can lead to hypermobilty later in life

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74
Q

segmental mobility (accessory motion)

what is the sequence of events that leads hypermobility to become hypomobility?

A

hypermobility —> altered forces —> bone formation (spurs, bony promineneces) —> hypomobility

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75
Q

segmental mobility (accessory motion)

how does spondylosis lead to hypomobility?

A

abnormal wear/tear —> bone formation —> hypomobility

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76
Q

segmental mobility (accessory motion)

what is spondylosis?

A

type of degenerative disease that can affect any part of spine. normally soft disks between vertebrae provide cushioning, with spondylosis they become compressed

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77
Q

segmental mobility (accessory motion)

what are symptoms of spondylosis?

A
  • pain in the neck/thoracic region/lumbar region
  • pain traveling down extremeties
  • headaches
  • grinding feeling when moving neck
  • weakness in arm and legs
  • numbness
  • stiffness
  • trouble maintaing balance
  • trouble controlling bladder
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78
Q

segmental mobility (accessory motion)

with foraminal compression (stenosis) there can be bone formation like spurs which results in?

A

nerve compression at intervertebral foramen

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79
Q

segmental mobility (accessory motion)

What is foraminal compression?

A

condition that occurs when the openings in the spine narrow, putting pressure on the spinal neves

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80
Q

segmental mobility (accessory motion)

what are 6 causes of foraminal stenosis?

A
  1. osteoarthritis
  2. paget’s disesase (bone overgrowth)
  3. herniated discs
  4. thickened ligaments (bulge into foramen)
  5. tumors
  6. spinal injuries
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81
Q

maximal open-packed position of cervical spine

A

neutral (upright head) - basically just midway between full flexion and full extension

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82
Q

closed-packed position of cervical spine

A

full extension

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83
Q

what is the capsular pattern of the cervical spine

A

equally limited ipsilateral lateral flexion and rotation ROM > limited extension ROM

side flexion and rotations equally limited compared to extension

extension is still limited just less so

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84
Q

capsular pattern is uesd clinically to?

A

see if joint capsule is causing the issue

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85
Q

what is capsular pattern?

A

a pattern of ROM used in the interpretation of joint motion:
a capsular pattern ofrestriction is a limitatioin of pain and movement in a joint specific ratio, which is usually present with arthritis or following prolonged immobilization

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86
Q

waht is non capsular pattern?

A

restriction is a limitation in a joint in any pattern other than a capsular one, and may indicate the presence of either a derangment, a restriction of one part of the joint capsule, or an extra-articular lesion, that obstructs joint motion

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87
Q

to assess the OA joint for pain, range, end feel what direction would you move the head?

A

side bending (lateral flexion)

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88
Q

if you wanted to assess pain, range, endfeel of AA joint what test would you use?

A

flexion-rotation test

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89
Q

if you wanted to assess mid-cervical spine pain, range, endfeel what would you use?

A

side glide

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90
Q

attachments

what is the proximal and distal attachment of splenius capitis?

A

PA: nuchal ligament
DA: fibers run superolaterally to mastoid process of temporal bone and lateral third of superior muchal line of occiptal bone

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91
Q

what is the proximal and distal attachment of splenius cervicis?

A

PA: nuchal igament and spoinous process of C7-T1 vertebrae

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92
Q

what is the proximal and distal attachment of the iliocostalis (erector spinae)?

A

PA: arises by broad tendon from posterior part of iliac crest, posterior surface of sacrum, sacroiliac ligaments, sacral and inferior lumbar spinous processes and supraspinous ligament
DA: lumborum, thoracis, cervicis; fibers run superiorly to angles of lower ribs and cervical transverse processes

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93
Q

anterior structures and related cervical spinous processes

C3 goes with which anterior structure?

A

hyoid bone

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94
Q

anterior structures and related cervical spinous processes

how to identify hyoid bone?

A

gently place fingers in front of patients neck and have them swallow to feel hyoid move

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95
Q

anterior structures and related cervical spinous processes

C4 is equivelent to what anterior structure?

A

thyroid cartilage (V)

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96
Q

anterior structures and related cervical spinous processes

how to palpate thyroid cartilage?

A

from the hyoid bone - move down, the next prominenece is the thyroid cartilage. there is a small V shpe on the supeiror aspect of the thyroid cartilage

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97
Q

anterior structures and related cervical spinous processes

C5 is in line with each anterior structure?

A

thyroid cartilage body

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98
Q

anterior structures and related cervical spinous processes

how to palpate thyroid cartilage body?

A

the body ofthe thyroid cartilge is a flate surface felt onteh lateral aspect beneath the small V

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99
Q

anterior structures and related cervical spinous processes

C6 is in line with each anterior structure?

A

first cricoid ring

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100
Q

anterior structures and related cervical spinous processes

how to palpate cricoid ring

A

inferior to the body ofthe thyroid cartilage is the first cricoid cartilage ring

101
Q

how to palpate for spinous process of T1

A
  • while the patient is sittingwith arms at side, palce fingers dorsally over the spaces betwen where you believe C7, T1 and T2 spinous processes to be
  • place the finger tips of your other hand on the manubrium and press dorsally
  • the superior most spinous porcess to move dorsal is T1
102
Q

what are the 5 cues to palpate the cervical facet joints

A
  1. locate C2 spinous process
  2. move one finger width off of the spinous process on either side
  3. this is the transverse process, the articular pillar is just medial to this
  4. continue to assess the remaining cervical segments moving inferiorly on one side
  5. repeat on other side
103
Q

palpation

Oblique capitis inferior muscle runs from _________ to __________?

A

from spinous proocess of C2 to transverse process of C1

104
Q

innervation

What is the innervation of oblique capitis inferior m?

A

dorsal rami of lower cervical nerves

105
Q

palpation

Oblique capitis superior muscle runs from _________ to __________?

A

trasverse process of C1 to posterior aspect of occipital bone

106
Q

innervation

what is the innervation of Oblique capitis superior muscle

A

dorsal rami sub-occipital nerve C1

107
Q

palpation

rectus capitits posterior major is located where and runs to where?

A

located deep and runs from the spinous process of C2 to deep in the occiput nearthe foramen magnum

107
Q

innervation

What is the innervation of the rectus capitis posterior major muscle?

A

dorsal rami suboccipital nerve C1

108
Q

palpation

rectus capitis posterior minor (more medial) is located where? attaches where?

A

posterior arch of atlas (c1) to inferior nuchal line of occipital bone and adjacent area

109
Q

palpation

what is the set up of patient to palpate sternocleidomastoid?

A

have pateint perform contralateral rotation with slight neck flexion to see the very prominent muscle belly in the aterolateral aspect.
- follow from its orgion on the manubrium and clavicle to the insertion point on the mastoid process

110
Q

posterior triangle

what are the borders of the posterior triangle of the neck?

A

anterior margin of the upper trapezius, the posterior border of the SCM

111
Q

posterior triangle

what structures are found in the poterior triangle of the neck?

A

splenius capitis, levator scapulae, posterior scalene and medial scalene (when palpating from posterior to anterior)

112
Q

referral pattern

trigger points in the SCM can give rise to pain felt in which regions of the head?

A

occipitial, temporal, auricular, zygomatic, frontal

113
Q

nerves, veins, arteries

the external jugular veins drains into what?

A

subclavian vein

114
Q

nerves, veins, arteries

the carotid artery can be palpated at what spinal level?

A

C4 (thyroid cartilage V)

115
Q

nerves, veins, arteries

what other structure can be located at the C4 spinal level along with carotid artery?

A

internal jugular vein

116
Q

The ligaments flavum is a highly elastic ligament this is advantageous because the ligament will not buckle on itself during movement. If the ligament did buckle on itself, it would __________ the spinal cord in the vertebral canal, especially with any movement into ________.

A

compress, extension

117
Q

vertebrae

uncinate proccesses develop around what age range?

A

6-9

this is why kids have very loose maliable necks

118
Q

vertebrae

uncinate processes ________ motion

A

guides (like bumpers)

vertebrae is a terrible driver and runs into unicate process over and over again - this develops extra bone (osteophytes)

119
Q

vertebrae

what is a common site of osteophyte formation

A

uncinate processes

the development of these formations are some indicators of arthritis or development of stiff neck

120
Q

vertebrae

C0- occiput and rests on C1 to form what joint?

A

atlanto-occipital (OA) joint

120
Q

vertebrae

C1 and C2 form what joint?

A

atlantoaxial (AA)

121
Q

ligaments

nuchal ligament attaches to?

A

external occipital protuberance

122
Q

ligaments

alar ligmanets limts _______ and ____________ on contralateral side

A

rotation and lateral flexion

123
Q

ligaments

the taransverse ligament of the cervical spine limits __________ translation of _____ and _____

A

anterior, C1 & C2

124
Q

vertebrae, ligaments

tectorial memebrane is a continuation of what?

A

posterior longitidutinal ligament (PLL)
(C2-occiput)

125
Q

clinical considerations

cervicogenic headaches involves what nerve roots?

A

C1-3 nerve roots

126
Q

intervertebral disc

what percent of the nucleus pulposus is water?

A

70-90%

127
Q

interveretebral disc

what % of nucleus pulposus is proteoglycans (of dry weight?)

A

65%

128
Q

intervertebral disc

what % of the nucleus pulposus is collagen? (of dry weight)

A

20%

129
Q

intervertebral disc

what is the end plate?

A

cartilage covering disc

130
Q

intervertebral disc

what is the role of the end plate?

A

passive diffusion of nutrients from vertebral body to disc (movement is critical)

131
Q

intervertebral disc

what does the annulus fibrosus control?

A

nucleus movement

132
Q

intervertebral disc

what % of the annulus fibrosus is water?

A

60-70%

133
Q

clinical considerations

what are 7 symptoms/tests to indicate cervical myelopathy is present?

A
  1. paresthesia (tingling/numbness)
  2. weakness
  3. hyperreflexia
  4. (hoffman sign)
  5. clonus
  6. loss of fine motor
  7. gait disturbances
134
Q

clinical considerations

what are 3 symptoms of cervical radiculopathy?

A

paresthesia
weakness
hyporeflexia

135
Q

clincial considerations

what is cervical radiculopathy?

A

pinched nerve in neck

136
Q

clincial considerations

what is cervical myelopathy?

A

condition that occurs when the spinal cord is compressed in the neck

137
Q

thoracic spine

why is the posterior height of thoracic vertebrae body longer than anterior height of body (wedge-shaped)?

A

the natural kyphotic posture creates the wedge shaped appearance

138
Q

thoracic spine

what is the normal kyphotic angle?

think about age

A

20-40
increases with age

139
Q

clinical consideration: spine

how does osteoprosis lead to compression fractures?

A

osteoprosis can weaken spinal vertbrae resulting in brittle bones that can lead to compression fractures. the vertebral body will collapse

*leads to hyperkyphosis or loss of height

140
Q

clinical considerations

causes of kyphosis?

6 of them

A
  1. poor posture
  2. muscle weakness
  3. ligament laxity
  4. scheuermann’s disease
  5. bony defect
  6. age
141
Q

clinical considerations

effects of kyphosis

A
  • bending forces
  • wedge deformities
  • facet loading
  • lengthened extensors
  • pain
142
Q

clinical considerations

scheurermann’s disease

A

hyperkyphosis
- anterior wedging
- involves disc and vertebrae
- 12-17 years old

143
Q

clinical considerations

scoliosis

A

sidebend and rotation generally occur in contralateral directions

144
Q

clinical consideration: scoliosis

rotation occurs in same direction as?

A

apex
- named for the side where the apex of the curve is located

apex = point

145
Q

clinical consideration: scoliosis

rib hump

A

posterior prominence of rib cage on side of thoracic rotation

146
Q

clinical consideration:

what test is used to check for rib hump?

A

adam’s test

also known adam forward bend test

147
Q

clinical consideration

what is the adam’s test used for?

A

to diagnosis scoliosis

the middle school forward bend test

148
Q

clinical consideration: scoliosis

what is the cobb angle used for?

A

The Cobb Angle is used as a standard measurement to determine and track the progression of scoliosis. Dr John Cobb invented this method in 1948

149
Q

clinical considerations

what are the cobb angle for
spinal curve
mild scoliosis
moderate scholiosis
severe scoliosis

A

0°-10°
10°-20°
20°-40°
>40°

150
Q

clinicial consideration: thoracic kyphosis

what are the commonly affected (shortened) muscles with posture

A

upper trap
levator scapulae
pectoralis

151
Q

clinicial consideration: thoracic kyphosis

what are the commonly affected (lengthened) muscles with posture?

these muscles may be weak

A

deep neck flexors
lower trap
serratus anterior

152
Q

clinical considerations: posture -scoliosis

commonly affected muscles that are shortened take on what shape?

A

concavity

153
Q

clinical considerations: posture -scoliosis

commonly affected muscles that are lengthened (may be weak) take on what shape?

A

convexity

154
Q

spinous processes - thoracic spine

T 1-3

the rule of 3’s

A

at level of vertebral body

155
Q

spinous processes - thoracic spine

T 4-6

rules of 3’s

A

halfway between vertebral body and level below

156
Q

spinous processes - thoracic spine

T 7-9

rules of 3’s

A

level below vertebral body

157
Q

spinous processes - thoracic spine

T10

rules of 3’s

A

level below vertebral body

158
Q

spinous processes - thoracic spine

T11

rules of 3s

A

halway between vertebral body and level below

159
Q

spinous processes - thoracic spine

T-12

rules of 3’s

A

at level of vertebral body

160
Q

joints - thoracic spine

what are the joints in the thoracic spine?

3 of them C,C,S

A
  • costotransverse joint
  • superior articular facet
  • costocorporeal joint
161
Q

thoracic spine

what TV level have 2 demifacets?

A

T2-8 (articulate with 2 ribs)

162
Q

what is occuring with osteoporosis?

A

osteoclasts are breaking down the bone and the osteoblasts cannot regenrate fast enough - leading to an imbalance that results in breakdown of bone

163
Q

muscle action

what is the function of the levator scapulae?

A

scapular elevation and rotation

164
Q

muscle action

what is the action of serratus posterior superior and inferior

A

elevate ribs 2-5
depress ribs 9-11

165
Q

muscle action

what is the action of spinalis, longissimus, iliocostalis (erector spinae)?

bilaterally and unilaterally

A

bilateral: extend head, cervical and thoracic spines
unilateral: ipislateral lateral flexion of cervical and thoracic spines

166
Q

muscle actions

function of the multifidus bilateral and unilateral

A

bilateral: extend vertebral column
unilateral: lateral flexion and contralateral rotation of vertebral column
also acts as an extensible ligament to stabilize the vertebral column -BIG STABILIZER

167
Q

lumbar lordosis normal rom?

A

40°-60°

168
Q

arthro kin of flexion in lumbar spine

A

up and forward of bilateral superior segment

169
Q

arthro kin of extension in lumbar spine

A

down and back of bilateral superior segment

170
Q

Lateral flexion (to the right) of lumbar spine

A

right facet joint glides down and back, left facet joint glides up and forward

171
Q

What is scheuermanns diease

juvenile kyphosis, or juvenile discogenic disease

A

hyperkyphosis that involves the vertebral bodies and discs of the spine identified by anterior wedging of greater than or equal to 5 degrees in 3 or more adjacent vertebral bodies.

172
Q

what is a stress fracture of pars interarticularis

A

spondylolysis
- fracture at the pars interarticularis typically between L5-S1 lumabr vertebra

173
Q

typical lumbar vertebrae have a foramen shaped like a triangle. what is the significance of this?

A

able to accept more load

174
Q

in typical lumbar vertebra articular pillars are replaced with?

A

lamina groove

175
Q

What is the pars interarticularis?

A
  • space between superior and inferior articular facet
  • part of the lamina. is a space that does not get much blood supply making it more vulnerable to fracture
176
Q

stress fracture of pars interarticularis occurs in what age range?

A
  • younger population (typically age 5-7) when bone is still developing

the bone developing becomes a weak spot - sometimes called the gymnast fracure

177
Q

where does spondylolysis commonly occur?

A

L5-S1

178
Q

spondylolysis can progression to what?

A

spndylolisthesis (slippage)

179
Q

What is spondylolisthesis

A

anterior slippage of lumbar vertebrae, typically a progression from spondylolysis

180
Q

What are the 4 grades of spondylolisthesis?

A

grade 1: 0-25%
grade 2: 25-50%
grade 3: 50-75%
grade 4: 75-100%

*how far anterior one vertebrae is from the one below it

181
Q

what is spondyloptosis?

A

grade 4 - 100% of spondylolisthesis
(a full anterior slipped vertebra)

182
Q

what is normal lumbar lordosis?

A

40°-60°

  • think of ice cream tiliting off of cone
183
Q

what ligament can be prime preventor of spondylolethsis?

A

iliolumbar ligament

184
Q

iliolumbar ligament can limit movement in what directions?

A

all directions and rotation

185
Q
A
186
Q

muscles - lumbar spine

how does erector spinae muscles help resist against falling forward?

A

think - ice cream come falls forward and ES helkp revent that with posterior shear and compression

*ice cream come metaphor

187
Q

what does the iiacus and psoas (iliopsoas) have the capacity to perform movement wise for lumbar spine

A

on stable leg - has capacity to compress and stabilize (also anterior tilting of pelvis)
- less capacity to pull into lordosis

188
Q

what vertebrae does psoas originate on?

A

T12-L4

189
Q

a short iliopsoas has excessive compressive load on a disc, this then prevents the disc from what?

A

being able to pull water/nutrients the disc needs

*think of a sponge that stays squeezed when running under water

190
Q

lumbar laminectomies are common and result in a loss of what 3 things?

also alters arthrokinematics

A
  • proprioception
  • loss of strength
  • loss of endurance

Loss of muscle, ligaments, segmental stability and strength

191
Q

superior facet of lumbar vertebra faces what direction from superior view?

A
  • posterior
  • medial

almost in sagittal plane

192
Q

inferior facet of lumbar vertebra faces what direction?

A
  • anterior
  • lateral

almost in sagittal plane

193
Q
A
194
Q

what osteokinematic movement involves the lumbar spine the most?

A

flexion and extension (sagittal plane)

195
Q

joint arthrokinematics

lumbar flexion arthrokinematics

A

up and forward of bilateral superior segment

196
Q

joint arthrokin

extension of lumbar spin arthrokin

A

down and back of bilateral superior segment

197
Q

joint arthrokin

LF (Right) lumbar spine arthrokin

A

right facet joint glades down and back, left facet joint gludes up and forward

198
Q

rotation of lumbar spine arthro kin (to right)

A

right facet joint separates, left facet joint approximates (orientation of facets)

199
Q

lumbar spine - LF and rotation coupling varies depending on the position of the sipne, but often considered?

A

contralateral

200
Q

lumbopelvic rhythm

trunk flexion degree:
hip flexion degree:
arc of motin:

A
  • 20°
  • 70°
  • 90

-in typical lumbopelvic rhythm hip flexion happens first

201
Q

during early face of flexion returned to extension, where is the line of gravity?

A

through chest

202
Q

degenerataive disc disease (DDD) can be waht type of condition?

A

mechanical or metabolic

203
Q

what are the 5 grades of DDD?

A

grade 1: disc has a uniform high signal in the nucleus on T2
grade 2: central horizontal line of low signal intesnity
grade 3: high intesnity in the central part of the nucleus with lower intensity in the peripheral regions of the nucleus
grade 4: low signal intesnity centrally and blurring of the distinction between nucleus and annulus
grade 5: homogeneous low signal with no distinction between nucleus and annulus

204
Q

DDD mechanical issue aligns with at law?

A

wolfs lawa - bone will respond to forces imparted on it

205
Q

during a mechanical cause of DDD what will occur?

A

lay down of osteophytes to distribute force (but doesnt work)

the more one loads the bone –> keep laying down osteophytes (bony tissue)

206
Q

DDD - metabolic cause

what are the ranges for healthy, aging, degenerative end plates due to DDD?

6 types

A

type 1 = healthy
Type 2,3 = aging
type 4,5,6 = degenerative

207
Q

what are the 6 type grades of end plate injuries?

A

type 1 = normal end plate, no interruption
type 2= thinking of endplate, no break
type 3= focal endplate defect w established disc marrow contact but with maintained endplate contour
type 4= endplate defects <25%
type 5= endplate defect ≥50%
type 6 = extensive damaged endplates up to full distruction

208
Q

what is schmorl’s nodes?

A

migration of nucleus —> endplate fractures

type of herniated disc

209
Q

differences between mechanical DDD and metabolic?

A

mechanical:
- acute or chronic
- osteophyte lay down (wolffs law)
metabolic:
- endplate injuries/fractures
- schmorals nodes (disc herniation)

210
Q

what muscles are shortened here? what muscles are lengthened here?

A

short: iliopsoas (hip flexors), paraspinal muscles (extensors)
lengthened (weake): gluteus amximus, abdominal muscles

211
Q

muscles that are shortened and lengthened in the picture?

A

short: abdominals, hip extensors
long (weak): lumbar extensors, hip flexors

212
Q

What muscles are shortened? lengthened?

A

short: upper abdominals, lumbar back extensors
long (weak): lower abdominals, hip flexors

213
Q

clinical consideratiosn - lumbar spine

maximal open packed position

A

neutral (midway between full flexion and full extension)

214
Q

clinical consideration - lumbar spine

closed packed position?

A

full extension

215
Q

clinical consideration - LUMBAR SPINE

capsular pattern of LS?

A

equally limited ipsilateral LF and rotation ROM; limited extension ROM

216
Q

segmental mobility

PA mobility - lumbar spine

A
217
Q

what are 3 abnomral lumbosacral spine postures?

A
  • hyperlordosis
  • sway back
  • flat back
218
Q

when measure rotation of thoracic spine what is the best position set up?

A

modified childs pose of end of table

219
Q

segmental mobility

what is PPIVM?

A

passsive physiological intervertebral mobility natural segmental mobility achieved with AROM assesses global passive motion

physiological

occurs at a segment in nature (natural)

220
Q

segmental mobility

what is PAIVM?

A

passive accessory intervertebral mobility component of segmental mobility achieved with AROM focus on arthrokinematics (facet joints)

accessory

example: PA = not natural

221
Q

what 3 things are you assessing with segmental mobility?

A
  • pain
  • range
  • endfeel
222
Q

clinical considerations

what is a true restriction in H and I combined motion?

A

true restriction = restricted in same pattern between motions

223
Q

```

~~~

what is inconsistent restriction in H and I combined motion?

A

restricted in one pattern but not the other- they can’t maintain their neutral zone

224
Q

peroneal (fibular) nerve is assessed in a SLR with what food positioning?

A

plantar flexion and inversion

225
Q

sural nerve is assessed in a SLR with what food positioning?

A

dorsiflexion and inversion

226
Q

tibial nerve is assessed in a SLR with what food positioning?

A

dorsiflexion and eversion

227
Q

in H and I testing consistent limitation may be indicitive of?

A

hypomobility

same on both H and I but different from other quadrant

228
Q

in H and I testing inconsistent limitation mya be indicitive of?

A

hypermobility

  • okay in H but may not be in I or vise versa
229
Q

H and I testing is typically performed?

A

after AROM

230
Q

what degree range is taking up slack during a SLR?

A

0°-35° - no dural movement

231
Q

what degree range is ension on neve roots over IVD during SLR?

A

35°-70°

232
Q

when you get above >70° on SLR neural tension testing, what is most likely occuring?

A

primarily joint strain

233
Q

SLR neural tension testing has a high sensitivity indicating that?

A
  • few false negatives
  • neg test = ruled out
234
Q

what is the leg assessed in well leg raise

A

uninvolved limb is raised

235
Q

well leg raise has a high specificity indicating?

A

few false positives
positive test = ruled in

236
Q

what are symptoms of cervicogenic headaches? what nerve roots are assciated with it?

A
  • unilateral pain
  • ipsilateral shoulder pain
  • arm pain
  • nerve root C1-C3
  • segmental mobility that can help assess for pain

*often pain and aching on one side
* pain is also felt from eye, to ispilateral frontal and temoral bone

237
Q

gasserian ganglion –>

A

convering sensory input

238
Q

greater occipital nerve –>

A

primarily sensory input

239
Q

thoracic discogenic pain

  • what % of all disc ruptures? plus symptoms? what can this progress too?
A

0.5%-4.5% (not a lot)
symptoms:
- dermatomal pattern (pressing on nerves)
- chest wall
- upper extremity pain

progress to: radiculopathy or myelopathy

240
Q

in thoracic region what is the disc:body height ratio for upper, middle, lower thoracic? ADH to PDH ratios

A

upper: 1:4.0 –> 27.12% ADH≥PDH
middle: 1:4.7 –> 29.68% ADH ≤ PDH
lower: 1:3.8 –>14.66 % ADH > PDH

241
Q

the abdominal viscera is supplied by what nerves? what trunk?

A
  • greater splanchinic nerve
  • less splanchinic nerve
  • least
  • splanchnic nerve
  • sympathetic trunk (chain)
242
Q

what thoracic levels are involved in mostly flexin/extension (sagittal plane)?

A

T11-T12
T-12-L1

243
Q

what muscles are commonly shorted in thoracic kyphosis?

A

upper trap
levator scapulae
pectoralis

244
Q

what muscles are lengthened (weak) in thoracic kyphosis?

A
  • deep neck flexors (longus colli, longus capitis)
  • lower trap
  • serratus anterior
245
Q

what are cobbs 4 angles?

A
  • 0-10 –> most people normal
  • 10-20 mild scholiosis
  • 20-40 moderate scholiosis
  • > 40 severe scoliosis
246
Q

what rib levels have demifacets?

A

T2-8 (articulate with 2 ribs)

kinesiology (8 decks)

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