Spine Flashcards
C3 - C7 facet orientation
45 degree angle
From C3 to C7 orientation changes from medial to lateral in frontal plane (happens around C5/C6)
OA and AA motion
OA: FLEX/EXT — (rot/SB OPP)
AA: ROT only
C3 - C7 coupling
SB and ROT SAME
Tectorial membrane
Location
Test
Continuation of PLL (C2 to occiput)
Grab occiput and pull into flexion and distraction
Alar ligament
Location
Test
lateral sides of dens to lateral margins of foramen mag
Stabilize C2 and LF head
Transverse ligament
Location
Test
Occipital tubercles to lateral masses of C1
Stabilize C2 and extend backward (sharp purser)
C3 - C7 Facet closing (LF vs. Rot)
Ipsilateral facet closes with LF
Contralateral facet closes with Rot
Motion changes throughout cervical
Flex/Ext stays same as descend
LF decreases from C3-C7
Rot same C3-C7
Scalenes
Ant - flex, LF toward, rot away (TP C3-6 to 1st rib)
Mid - flex, LF (TP C2-7 to 1st rib)
Post - flex, LF toward, rot toward (TP C5-7 to 2nd rib)
Semispinalis mm
Ipsilateral LF, Contralateral Rot, Extension
Go from TP to SP
Splenius mm
Go from SP to TP
Ipsilateral LF and Ipsilateral Rot, Extension
Rim lesion
Horizontal anterior tear in annulus without tearing ALL
Difficulty lifting head off pillow
Diagnostics for radiculopathy (4 criteria)
Pos neurodynamics
Cervical rot less than 60 deg
Distraction test pos
Spurling test pos
Spurling test
Spurling/Compression test
Can just do compression
Or add LF/Ext = spurling
Positive - IVH, nn root impingement
VBI
5 Ds And 3 Ns
Dysarthria, Dizzy, Dysphagia, Diplopia, Drop attacks
Ataxia
Nausea, Nystagmus, Numbness
Disc herniation - cervical - most common at
C6
Thoracic facet orientation
Lateral to medial as move from T1 to T12 (change at about T6/T7)
60 degrees
Movement change as go down thoracic
Flex/Ext inc slightly as you descend
LF is minimal throughout
Rot is minimal throughout but dec at T9-T12
Ribs and thoracic vertebrae
T2-T9 have demifacets for ribs
T1, T10-T12 have complete rib facets
Ratio of disc height to body height reflect
MOBILITY
Body height increases as descend thoracic and mobility increases
Upper thoracic rotation R causes in what rib movement
L rib moves ant and medially
R rib moves post and lateral
Thoracic SP - rules of 3
T1-T3 = SP is at level of same vertebral body (T12 too)
T4-T6 = At disc below (T11 too)
T6-T9 = At vertebrae body below (T10 too)
With unilateral should flexion, what happens to thoracic
Thoracic extension and ipsilateral rot and LF
Thoracic flex leads to what rib motion
Downward rotation
Thoracic ext leads to what rib motion
Upward rotation
Thoracic rot (R) leads to what rib motion
R rib rotate up
L rib rotate down
Thoracic LF (R) leads to what rib motion
Ipsilateral rib down
Contralateral rib up
Pump, Bucket, Caliper
Pump = 1-6, sagittal, ribs move up and ant with insp Bucket = 7-10, up, back, med with insp Caliper = 8-12, transverse, post/lat with insp
If rib torsion and thoracic issue - tx what first
THORACIC SPINE
Scoliosis
ROTATIONAL DEFORMITY - spine is curved with vetebrae rotated towards side of convexity
Rib hump on side of convexity
Rib hump ONLY WITH STRUCTURAL!
Lumbar facet orientation
90 degrees
Post and med
Freyette laws
1 - in NEUTRAL rot and SB occur in OPP
2 - in flex/ext rot and SB occur in SAME
3 - motion introduced in one plane will dec motion in others
FRS(L)
F so we know SAME
So motion avail - flex, rot L, SB L
Restricted in - ext, rot R, SB R
So to tx - put in L sl, ext them, rot R and use legs to SB R
Motion changes throughout lumbar as descend
Flex/Ext - increase as descend
LF - dec at lower
Rot - minimal
Ferguson’s angle
AKA lumbosacral angle
Formed by line through superior aspect of scarum and horizontal (lateral view)
Hyperlord = more than 45 Hypolord = less than 35
Norm is 35-45
Disc herniation rules
C1-8 nerve roots come out ABOVE respective vert
(C5 nerve root is between C4 and C5 vert)
(C8 nerve root is between C7 and T1 vert)
T1-L5 nn roots come out BELOW respective vert
(L2 comes out between L2 and L3 vert)
Herniated disc at T12/L1 is impinging which nerve
T12!
Conus medullaris at what level
L2
This is where cauda equina begins!
L4/L5 disc herniation impinges which nerve?
L5!!!
Below L2 and cervical follow same rule - disc herniation will impinge the nn root level named same as the bottom vertebrae
L2/L3 will impinge L3 even though L2 comes out at L2/L3 articulation
Pt likely to benefit from lumbar stabilization if what
need 3 of 4
Less than 40 yo
Pos prone instability test
SLR greater than 91
Aberrant movement
Tx for instability - pattern
Control NZ - dynamic control - rehab global stabilizers - length/inhibit overactive mm
Positive neurodynamic testing
NEED ALL 4
Reproduction of comparable sign
Changes in s/s with distal mvmnt of extremity
Differences btw sides
Positive nn palpation
Nerves
Femoral = L2 - L4 Sciatic = L4 - S3 Sup peroneal = L5-S1 Deep peroneal = L4-L5 Tibial = S1-S2
Stork Standing
For spondylolisthesis
Stand on one leg - go into ext
If pain on standing leg (+)
Standing - What type of motion (SIJ)
Ilium moving on sacrum (iliosacral movement)
Standing forward bend, Gillet test - looking at Innominate dysfunction (long sitting too)
Sitting - What type of motion (SJ)
Sacrum moves on fixed ilium (sacroiliac movement)
Seated forward bend and sphinx
Nutation
Close packed of SIJ
Anterior tilting of sacrum (glides inf and post)
Inc lumbar lordosis, occurs with exhalation
Sacrum moves ant on ileum
Counternutation
Open packed position of SIJ
Posterior tilting of sacrum (glides ant and sup)
Will decrease lumbar lordosis, occurs with inhalation
Sacral torsions - types
Type 1 = Anterior - L on L or R on R
Type 2 = Posterior - R on L or L on R
Anterior torsion (L on L example)
Deep \_\_\_ Prominent \_\_\_ Lumbar ext Lumbar lordosis PA on sacrum L5
Deep RIGHT Prominent LEFT Lumbar ext EXCESSIVE/NORMAL Lumbar lordosis EXCESSIVE/NORMAL PA on sacrum POSSIBLE L5 SB R, ROT L (follows neutral spine - OPP)
Posterior torsion (R on L example)
Deep \_\_\_ Prominent \_\_\_ Lumbar ext Lumbar lordosis PA on sacrum L5
Deep LEFT Prominent RIGHT Lumbar ext LIMITED Lumbar lordosis FLAT PA on sacrum LIMITED L5 SB L, ROT L
Thigh thrust
Put thenar on pt sacrum (med to PSIS)
Flex hip to 90 and adduct in
Apply shear pressure through femur
Pos if butt pain (SIJ)
Gaenslen
Fully flex hip.knee on affected while keeping other in full ext
Pos if LBP or butt pain - Hip flex causes post inominate rot
Sacral thrust
PA over sacrum
What would indicate SIJ issue
3/5 of provocation tests
SIJ comp/distraction
Gaenslens
Thigh thrust
Sacral thrust
Standing FBT
SIJ hypomobility if one PSIS elevates higher than other
Seated FBT
SIJ hypomobility if PSIS that was lower is higher with forward bend
Gillet
Standing - palpate S2 and PSIS on one side
When flex that hip - if PSIS does not move inf = hypomobility
Long sitting test
For leg length vs. pelvic rotation
pos for post rotation if shorter leg in supine becomes longer in sitting
OPP would happen for ant rotated innominate
