Spine And Pelvis Flashcards
1
Q
Spinal column vertebrae order
A
- cervical = 7
- thoracic = 12
- lumbar = 5
- sacral = 5 (fused)
- coccygeal = 4 (fused)
2
Q
Spinal column
A
- segments vary in shape and size depending on location and purpose
- spine acts a a spring = curves shrink and expand with exerted forces
- provides stability
- kyphosis
- lordosis
3
Q
Kyphosis
A
Anterior curves
(Back bending forwards)
4
Q
Lordosis
A
Posterior curves
(Back bending towards backwards)
5
Q
Joints
A
- atlanto-occipital joint
- atlantoaxial joint
6
Q
Atlanto-occipital joint
A
- interface between skull and spinal column (C1-atlas)
- provides initial movements for flexion and extension
- “yes” joint
7
Q
Atlantoaxial joint
A
- joint between C1 (atlas) and C2 (axis)
- supplies much of the movement for rotation
- “no” joint
8
Q
Movements of trunk
A
- flexion/extension
- rotation
- lateral flexion
9
Q
Movements of neck
A
- flexion/extension
- rotation
- lateral flexion
10
Q
Typical ROM of neck flexion
A
45 degrees
11
Q
Typical ROM of neck extension
A
45 degrees
12
Q
Typical ROM of neck lateral flexion
A
60 degrees
13
Q
Typical ROM of neck rotation
A
45 degrees
14
Q
Clinical implications of the spine
A
- radiculopathy
- rib fractures
- core stability
- hypertonia
- hypotonia
- safe patient handling
- rest and sleep
- hemiparesis
- spinal injuries
- spinal cord injury
- adaptive equipment
15
Q
Radiculopathy
A
- nerve root compression resulting from narrowing of intervertebral foramen
- can occur with fractures, osteoarthritis (OA), or thinning of intervertebral disks
- leads to sensorimotor deficits in muscles/dermatome of nerve root
- you see partial paralysis with bulging or herniated disks (can lead to numbness, tingling, shooting pain)
16
Q
Rib fractures
A
- can result from motor vehicle accident (MVA) or fall
- mild fractures will heal on their own as they are held in place by intercostals muscles
- severe fractures may impact lungs or other vital organs
- require surgical intervention
- will impact respiration
17
Q
Core stability
A
- important motor component of occupation engagement
- infant = trunk control facilitates crawling
- adult = lifting heavy objects
- older adult = functional mobility
- hypertonia
- hypotonia
18
Q
Hypertonia
A
- increased tone (often patients with cerebral palsy)
- stiff, rigid muscles, joint contractures, and spasms
19
Q
Hypotonia
A
- decreased tone
20
Q
Safe patient handling
A
- lifting from your legs = helps avoid shearing forces
- staggering your stance = produces force from the legs
- engaging your core = allows for increased lumbar spine stability with increased abdominal pressure
21
Q
Rest and sleep
A
- important to keep head, shoulders, and neck aligned
- sleeping on your back with knees supported is recommended
- stomach sleeping = place pillow under pelvis (still involve excessive neck rotation)
- side sleeping = place pillow between knees
22
Q
Hemiparesis
A
- can occur from cerebro vascular accident (CVA) or traumatic brain injury (TBI)
- abnormal muscle tone, weakness, and paralysis
- can lead to vestibular, visual, or somatosensory issues
- may never return based on injury
23
Q
Spinal injuries
A
- can occur from improper lifting, traumatic injury, age related changes
- interventions = fusion, laminectomy (a kind of spinal surgery)
- spinal injuries can lead to spinal cord injuries (SCIs)
24
Q
Interventions of spinal injuries
A
- fusion
- laminectomy (a kind of spinal surgery)
25
Spinal cord injury
- high impact trauma (MVA, diving)
- shearing injury = sudden impact to your spine
- injury blocks transmission of neurological signals from brain to body
26
Interventions of rib fractures
- if very severe, surgery
27
Adaptive equipment (AE)
- spinal precautions = no bending, lifting, or twisting (BLT)
- adaptive equipments can assist in ADL/IADL independence
- those with SCIs may not have feeling or use of muscles in lower extremity
28
Precautions of spine
- no bending
- no lifting
- no twisting
(BLT)
29
Pelvis
- stable base of support for head, arms, and trunk
- requires balance to maintain symmetry of entire body
- starting point for evaluation positioning
- anterior tilt = pelvis tilted forwards
- posterior tilt = pelvis tilted backwards
- anatomical position is tilted anteriorly
- formed by joints between two hip bones and the sacrum = sacroiliac joint
30
Sacroiliac joint (SI)
- formed by two hip bones and the sacrum
- designed to stabilize pelvis
- has limited mobility
31
Bony landmarks and additional structures of pelvis
- ilium
- ischium
- pubis
- the hip bones join together to form the acetabulum
- connected via SI joint and pubic symphysis
- anterior superior iliac spine (ASIS)
- posterior superior iliac spine (PSIS)
- ischial tuberosity
32
Acetabulum
- formed by ilium, ischium, and pubis
- a socket for the femoral head
33
Ischial tuberosity
- primary point of pelvic contact with a seating surface
34
Pelvic floor
- interior wall of pelvic cavity
- openings for structures to pass through = urogenital and anorectal
- controlled by surrounding sphincter muscles that regulate urination and defecation
- damage to those muscles can lead to incontinence (bowel or bladder) and issues relating to sexual intercourse and intimacy
35
Clinical implications of pelvic floor
- incontinence
- stress incontinence
- urge incontinence
- pelvic organ prolapse
- cystocoele
- uterine prolapse
- vaginal vault prolapse
- enterocoele
- rectocele
36
Incontinence
- loss of control of bowel or bladder
37
Types of incontinence
- stress incontinence
- urge incontinence
38
Stress incontinence
- involuntary leaking of bowel/bladder due to increased abdominal pressure like coughing, sneezing, or exercise that engage your core
39
Urge incontinence
- inability to control bowel/bladder until an appropriate time for elimination
- leakage occurs before the patient can make it to the bathroom
40
Pelvic organ prolapse
- pelvic floor weakness leads to herniation of the uterus, rectum, or vagina
- can be caused by:
- family history of prolapse
- heavy lifting
- vaginal delivery
- menopause
- obesity
- chronic coughing
- neurological diseases
- physical symptoms:
- bulging/pressure in vagina
- feeling that something is falling out
- pelvic pressure
- urinary incontinence, UTI, pain, increased frequency of urination
- difficult bowel movements
- lower back ache
- painful sexual intercourse
- intervention:
- surgical
- pelvic floor exercise
41
Physical symptoms of pelvic organ prolapse
- bulging/pressure in vagina
- feeling that something is falling out
- pelvic pressure
- urinary incontinence, UTI, pain, increased frequency of urination
- difficult bowel movements
- lower back ache
- painful sexual intercourse
42
Interventions of pelvic organ prolapse
- surgical
- pelvic floor exercise
43
Types of pelvic organ prolapses
- cystocoele
- uterine prolapse
- vaginal vault prolapse
- enterocoele
- rectocele
44
Cystocoele
- bladder falls into uterus
45
Uterine prolapse
- uterus drops into vagina
46
Vaginal vault prolapse
- top of vaginal falls into vaginal canal
- tends to occur after hysterectomy (removal of uterus) because the uterus and overlies are removed, so there are not structures to hold up the vaginal vault
47
Enterocoele
- small bowel pushes against vagina
48
Rectocele
- rectal prolapse
- a portion of rectum prolapses against vaginal canal which makes elimination of uterine harder because of compression in the urethra
49
Clinical implications of the pelvis
- ankylosis spondylitis
- sciatica
- pelvic alignment
- pelvic fractures
50
Ankylosing spondylitis
- inflammatory condition of the spine that can lead to fusion of skeletal structures
- can begin in sacroiliac joint (SI) and move to vertebrae
- leads to immobility
- interventions:
- compensatory strategies
- medication
- rehabilitation
- managing symptoms
51
Interventions of ankylosing spondylitis
- compensatory strategies
- medication
- rehabilitation
- managing symptoms
52
Sciatica
- compression of sciatic nerve
- caused by tightness in piriformis
- compression of back leg
- pain, paresthesia in legs
- intervention:
- stretching
- activity modifications
53
Interventions of sciatica
- stretching
- activity modifications
54
Pelvic alignment
- tilted anteriorly in anatomical position
- want to look at tilt, rotation, and obliquity
- rotation = one ASIS rotated in front of the other
- obliquity = ASIS and PSIS in parallel line or one higher than the other
- important for positioning
55
Pelvic fractures
- bladder, intestines, and kidneys can be affected due to close proximity
- severe pelvic fractures may require surgical intervention and a period of non-weight bearing
56
Interventions of pelvic fractures
- surgery
- period of non-weight bearing
