Test 2 lumbar Flashcards
What percentage of the population experiences LBP at some point in their lives?
80%
What inspection element can clue the doctor in on possible underlying neurological or boney pathologies?
Lipomatas, hairy patches, cafe-au-lait, or birth marks; basically any congenital skin marking
Lipomata
aka lipoma; benign tumor of fatty tissue
Neurofibromatosis
hereditary disorder that produces pigmented spots and pedunclated soft tissue nodules clustered along nerve sheathes
Gibbus deformity
sharp kyphosis in the thoracic spine affecting the normal lordosis of the lumbar spine
Spondylolytic spondylolisthesis
a unilateral or bilateral defect in the pars with anterior or posterior displacement of the vertebra on the vertebra below it
What scale is used to measure spondylos?
Myerding’s Grading Scale
What level is the umbilicus and why is this significant?
L3/4 - where the abdominal aorta bifurcates into common iliac arteries
Ligamentum flavum
connects two consecutive vertebrae
Interspinous ligament
connects two consecutive spinous processes
supraspinous ligament
connects the tip of two adjacent SP’s
Psoas
originates from anterior portions of T12-L5; main hip flexor
Sciatic nerve divides into
tibial and peroneal divisions
What could cause the sciatic nerve to be tender upon palpation?
disc pathology such as a space-occupying lesion
A disc pathology effects the nerve root _____
below (L4 disc pathology affects L5 nerve root)
Aka for disc herniation
extrusion - nucleus pulposa extrudes into the spinal canal and fibers have been torn
What innervates Z joints in the lumbar spine?
Dorsal rami
In what three planes can lumbar motion occur?
frontal, sagittal, transverse
How many degrees of freedom are available in the lumbar spine?
six
Where does most of the lumbar flexion and extension occur? side-bending? rotation?
Lower segmental levels
Mid lumbar levels
Minimal, occurs with lat flexion at lumbosacral junction
Which lumbar motion requires a change in the degree of lordosis?
Flexion - lordosis reverses
Palpation of the lumbar spine should be accompanied by palpation of what other areas?
Hip and pelvic
A heredity (autosomal dominant trait) disorder that produces pigmented spots, and pedunculated soft-tissue nodules clustered along nerve sheaths
Neurofibromatosis
Nodules develop from Neurofibromatosis
during childhood, growing
to more than ___ cm in
size and can reach up to ____ cm in size
0.5, 1.5+
Cafe-au-lait patches are usually
seen over the (3)
- trunk
- pelvis
- flexor creases of the elbows and knees
Bone changes in Neurofibromatosis
may result in
skeletal deformities
Scoliosis, Vertebral body scalloping, Fibrous dysplasia, Tibial Pseudoarthrosis, Sphenoid bone deformity, Mental impairment, seizures, hearing loss, exopht halmosis, decreased visual acuity, and GI bleeding eventually occur
When a patient is standing an inclination or listing to one side or the other may be a sign of a possible \_\_\_\_ \_\_\_\_, secondary to a\_\_\_\_\_ \_\_\_\_
sciatic scoliosis, herniated disc
sharp kyphosis in the lower thoracics, affecting the normal lordosis of the lumbar spine
gibbus deformity
palpable or visible step-off from onenprocess to another maybe indicative of a
spondyloslisthesis
anterior or posterior displacement
of a vertebrae with pars defect indicates
spondylolysis (oblique views)
A unilateral or bilateral defect in the pars interarticularis with
anterior or posterior displacement of a vertebrae on the adjacent lower vertebra
Spondylolytic Spondyloslisthesis
_____ lies at the L3-L4 disc
space at the point where the _____ divides into the common iliacs.
umbilicus, aorta
the primary function of the _______ _____ is to protect the motion segment from anterior shear forces, excessive rotation, and flexion
zygapophyseal joint
Connects two consecutive laminae
Ligamentum flavum
Connects two consecutive spinal processes
Interspinous ligament
Connects the tips of two adjacent spinous processes
Supraspinous Ligament
Functions to restrain flexion, extension, axial rotation, and side bending of L-5 on S-1
Iliolumbar Ligament
separates paravertebral
compartments, and do not have any
mechanical function
intertransverse, transforaminal, and mamillo-accessory (resemble the membranous part of the fascial system)
lumbar spine stabilizer for breathing
Quadratus Lumborum
provide segmental stiffness and control motion
Lumbar multifidus (LM)
Assists the in transmission of extension forces during lifting activities
Thoracolumbar
fascia
Stabilizes the spine against anterior shear and flexion moments
Thoracolumbar
fascia (TLF)
takes origin from the anterior portion of the T12- L5 vertebral bodies and discs- the main hip flexor
Psoas
Pain from a ____
abscess increases
when the hip is
actively flexed
psoas
gives off branches to the hamstrings and then divides into 2 terminal branches – the tibial and the peroneal divisions
sciatic
A disc pathology or a space- occupying lesion can cause the \_\_\_\_ nerve to be tender to palpate
sciatic
To palpate the sciatic nerve –
locate midpoint
between the ____ ____ and the
_____ ____
ischial tuberosity, greater trochanter
A disc is named
after the vertebrae
_____
above
A disc pathology
affects the nerve
root ____
below
little pieces of the
nucleus pulposus protrude into the annular
fibers (weaken annular fibers)
Protrusion
nucleus pops out of the annular fibers NOT yet torn fibers , just stretched
Prolapse aka Bulge
fibers torn,
nucleus bursts into the PLL –
PLL is torn, patient
often describes a shredding noise
Extrusion aka Herniation
multiple pieces of the
nucleus (particles) are in the spinal canal
Sequestration –
_______ joints are innervated by the medial branches of the dorsal rami
zygapophyseal
lateral aspect of IVDs are innervated by
sympathetic innervation
posterior-lateral aspect, outer half of the IVD
sinuvertebral nerve and the grey rami communicants
____ degrees of freedom are available at
the lumbar spine
Six right and left Sagittal (flexion and extension) • Coronal (side bending) • Transverse (rotation)
_____ and ____ of the lumbar
spine occurs in the lower segmental levels
flexion and extension
most of the side bending of the lumbar
spine occurs in the ____ _____ area
mid-lumbar
occurs most at
the lumbosacral junction
rotation
extension involves a _____ roll and
glide of the vertebra, and a posterior and inferior motion of the_____ ____, but not necessarily a change in the degree of lordosis
posterior, zygapophyseal joints
Axial rotation of the lumbar spine amounts to approximately ___ to both sides most occures at L5/S1 at __ degrees
13°, 5 degrees
•Although ____ alignment provides some
valuable information, a positive correlation
has not been made between _____
alignment and pain
spinal, abnormal
It is the _____ of motion and the
symptoms provoked, rather than the
_____ of motion that is more important
quality, quantity
The key muscle tests examine the integrity of the
_____ and the contractile and
inert components of the various muscles
NMJ
isometric tests, the contraction should be
held for at least ___ seconds to demonstrate any
weakness
5
If the clinician suspects weakness, the test is
repeated ______ to assess for fatiguability, which could indicate spinal nerve root
compression.
2-3 times
______ vary considerably between
individuals
Dermatomes
Acute phase goals
• Decrease pain, inflammation, and muscle
spasm
• Promote healing of tissues
• Increase pain-free range of segmental motion
• Regain soft tissue extensibility
• Regain neuromuscular control
• Allow progression to the functional stage
functional phase goals
• Correction of imbalances of strength and
flexibility
• Incorporate neuromuscular re-education
• Strengthening of entire kinetic chain
• Postural correction and retraining
• To initiate and execute functional activities
without pain and while dynamically stabilizing
the spine in an automatic manner
