Spine Stuff - Midterm 2 - Extras Flashcards
spinal stability consists of what 3 subsystems?
- The passive subsystem: VB, facets, ligaments, caps & ms/tendon (passive tension)
- It provides stabilization of the elastic zone
- It limits the size of the neutral zone
- It provides the neural control subsystem with info about vertebral position & motion - The active subsystem: Spinal ms/tendons
- It generates the forces needed to stabilize the spine
- It controls the motion that occurs within the neutral zone &
- It contributes to maintaining the size of the neutral zone
- It provides the neural control subsystem with info about the forces generated by ms - The neural subsystem: It receives info from the passive & active subsystems
- From the info, it determines the requirements for spinal stability & acts on the spinal muscles to produce the required forces
define the neutral zone
Zone in which movt occurs at beginning of ROM before any effective resistance is offered from
- The muscular system or
- The osteo-ligamentous structures
components of the Lx spine scan/observation
slides 9 - 17
what ms is attached to each z-joint?
multifidus (helps w stabilization)
what are the spinal ligaments?
what links does the thoracolumbar fascia have with the body?
slides 8-11
name the inner unit muscles, their function and where they reside
- slides 13-20
name the outer unit muscles, their function and where they reside
slides 13, 21-26
what level does the spinal cord end?
L1/L2
where is the cauda equina?
descrube the nerve roots and rami
slide 33-36
what are the 5 nerve plexuses?
Brachial plexus: radial, median, ulnar n
Lx plexus = Femoral n (L2-L4)
Sacral plexus = Sciatic n (L4-S2 or 3)
describe the glides of the z-joint, close packed position for lx spine, capsular pattern
slide 41-48
where is the IV disc larger/where does it allow for more movement?
Larger in Cx & Lx spine & thin in Tx spine
more movement in Lx spine
describe the annulus fibrosis
- supports the axial load of the body
- innervations (from pain sensors) are more in the posterior or post-lateral aspect of the disc
- a disc tear is more common in the post/post-lat part of the disc
describe the vertebral end plate and it’s function
slides 11-12
describe the nucleus/nucleus hydration/main function
slides 13-15
describe nucleus axial loading
slide 16-18
describe the nucleus intradisc pressure - ie when it is highest and lowest
describe disk changes throughout the day/diurnal changes
describe disc changes relative to age
slide 23-27
describe degenerative disc disease (DDD)
slides 28-31
describe the pathophysiology of IDD/bulge and disc herniation
slides 32-35
describe the potential sources of pain for a disc lesion
slides 36-40
what is the diff btw neurodynamic tests and neuro exam?
describe extra vs intraneural
slides 7-10
what are precautions/contraindications for a neurodynamic assessment?
Contraindications (send back to DR!!)
- Neuro signs that are new or worsened
- Cauda equina signs
- Spinal cords signs
Precautions
- NS irritation, neuro signs that are stable
- Circulatory problems
- Systemic disease (diabetes, Hypothyroidism) - bc they have poorer quality of connective tissue
what entails a (+)’ve neurodynamic test and what does that mean?
(+) test when:
- Reproduce all or some of pt’s symptoms (but not always)
- ↓ ROM
- ↑ Resistance
- Modified normal reaction when compared to opposite side
- Modified symptoms with a distal manoeuver
(+) signs may indicate:
- Irritation of neural system or structures around neural system
- Adherence of neural system or structures around neural system
what levels of disc herniation correspond to what levels of radiculopathy/S&S and wat typed of Lx disc herniation are there?
slides 4-7
how does stenosis lead to radiculopathy?
what are referred pain sites?
- Pain perceived in regions innervated by nerves other than those that innervate the site of noxious stimulation
- It is produces by noxious stimulation of nerve endings within spinal structures such as discs, facet joints or SIJ
- It involves convergence on second-order neurones in the SC
- Referred pain is perceived in regions that share the same segmental innervation as the sources
- Pain is difficult to localise, pattern are not consistent among subjects but are not dermatomal
what are the dermatomes for neuro exam?
Grading: (From American Spinal Injury Association)
0 = If no sensation 1 = Decreased sensation 2 = Normal sensation
what are the myotomes for neuro exam?
Grading:
0 = No contraction
1 = Ms contraction without movt 2 = Movt without gravity 3 = Movt with gravity 4 = Movt against resistance
5 = Normal ms strength
what are the reflexes for neuro exam?
Grading
0: Absent
1: Diminished
2: Average
3: Exaggerated
4: Clonus, very brisk
* > 5 beats for clonus is positive for UMN lesion
what are diagnostic tools used for radiculopathy (WRT MRI ect)
what are the red flag signs for neoplastic conditions?
review the lumbar spine treatment for irreducable derrangement slides in terms of conservative treatment, lumbar traction, and surgical vs non-surgical intervention
- contraindications/percautions for LX traction
- indications for LX traction in supine
see lecture
describe how to interpret neuro exam findings
describe the McKenzie Approach - main concepts + what indicates a good prognosis
slides 2-4
what are the 3 clasifications of the McKenzie approach?
McKenzie Protocol: Derangement type 1
see chart
McKenzie Protocol: Derangement type 2
see chart
McKenzie Protocol: Derangement type 3
see chart
McKenzie Protocol: Derangement type 4
see chart
McKenzie Protocol: Derangement type 5
see chart
McKenzie Protocol: Derangement type 6
see chart
McKenzie Protocol: Derangement type 7
see chart
What are the 3 factoes for SI stability
describe SI form closure - and factors contributing
describe SI force closure
describe SI motor control
what gives the SI joint its stability?
describe the reliability of the SI joint palpation vs mobility ax
Studies that have Ax the reliability of
- Palpation Ax designed to detect pelvic position (Iliac crest, PSIS ASIS, in standing/sitting)
- Mobility Ax (Standing flex test, Standing Gillet test (kinetic test)
- Have shown poor reliability when used in isolation
- Clusters of motion palpation combined with mobility tests have adequate reliability for use in clinical Ax of the SIJ (versus when tests used in isolation)
- If subluxation/displacement of SIJ do occur, we would need to perceive movt smaller than 5mm
- In clinical setting, pht combines the results of the Ax procedures
what is an abnormal leg length descrepancy?
Abnormal > 0.5cm
describe the forward bending test and standing flexion kinetic test
1) forward bending 1
- both PSIS should move superior equally, if unequal/assymetry/torsion, (+)’ve test
2) forward bending 2
- (+)’ve test if counternutation occurs sooner than 60 deg
3) standing flexion kinetic test
- (+) ve: PSIS does not move caudally with hip flex (on same side) - normally it should move caudally
4) standing flexion contralateral kinetic test (for instability)
- Normal: iliac should post rot or remain still relative to Sx
- (+) ve: PSIS ant rotation/Sx counternutation (Failed load transfer through pelvic girdle)
review anatomy/biomechanics of the Tx spine
slides 1-13
review neurology of the Tx spine
slides 14-20
explain the diaphragm, where it lies and what is does during insp and exp
slides 21-25
describe the rib movements at each segment (ie bucket handle, pump handle, etc)
Ribs 1 to 6
-Pump Handle action
- ↑ A/P diameter
- Breathing IN = post rotation
- Breathing OUT = ant rotation
- Sternum ant/sup movement
Ribs 7 to 10
-Bucket Handle action
-↑ transverse diameter
Ribs 11 to 12
-No attachment at the TP/only at VB
-Small movement in all directions
describe the vertebrae of the Cx spine
slides 1-7
describe the Cx intervertebral disc
slide 8-12
describe cervical Z-joints
slides 13-15
describe cervical u joints
slides 16-18
describe muscles in and around Cx spine
slides 19-24
describe Cx spine nerve roots
describe the Cx pain source
slides 2-8
what are the Cx referred pain sites?
define clinical instability, neutral zone, and elastic zone
slides 17-19
describe the 3 subsystems of spinal stability
slides 20-26
describe Cx spine normal and forward head posture and its consequences
slides 59-65
