The Spine Flashcards
the spine
Cervical (C1-C7) Thoracic (T1-T12) Lumbar (L1-L5) Sacrum Coccyx Total of 24 vertebrae
Central supporting structure of trunk and back
Concave curvature to cervical and lumbar
Convex curvature to thoracic and sacrococcygeal
vertebrae
- Vertebral body supports weight bearing (anterior)
- Spinous processes are what you palpate: posterior
- Vertebral foramen encloses spinal cord and intervertebral foramen channel for spinal nerve roots
- Cervical spine: transverse foramen for vertebral artery
cartilaginous joint
- Bony surfaces separated by cartilaginous discs.
- Center of each disc nucleus pulposus (shock absorber)
- Example: vertebral bodies of spine
excessive curvature
kyphosis, kyphoscoliosis, compression fractures (osteoporosis)
loss of curvature
paraspinous muscle spasm, DDD
spine inspection
- From side: inspect for normal/abnormal lordosis and kyphosis
- From back: inspect alignment of shoulders and waist (asymmetry may indicate scoliosis)
- Inspect skin for dimpling, masses or lesions
- Inspect while patient bends forward, look for rib hump (scoliosis affecting the thoracic spine)
scoliosis
- corkscrew-type curvature of spine
- can cause restriction of lung development in children if not corrected
spina bifida
Folic acid deficiency
Open neural tube defect
inspection of cervical spine
posture, spinal curvatures (side), alignment (posterior), skin markings or masses
palpation of cervical spine
spinous processes, facet joints C2-C7; paravertebral muscles
ROM of the neck
Flexion
Extension
Rotation: look over shoulder
Lateral Bending: ear to shoulder
Be sure to stabilize shoulders to accurately assess the cervical spine motion
inspection of thoracic spine
Inspection from the side and back
Inspection with the patient bending forward, evaluate for kyphoscoliosis
palpation of thoracic spine
Palpation of the spinous processes and paravertebral muscles
inspection of lumbar spine
Inspect from side and back
palpation of lumbar spine
- Palpate spinous processes and paraspinal muscles
- Palpate sacroiliac joints
- Palpate sciatic nerve/notch and piriformis muscle
straight leg raise
- test for sciatic nerve impingement
- With the patient sitting or supine, passively raise the affected leg
- If pain and radiculopathy, positive test
- Indicates sciatic nerve impingement
piriformis syndrome
-common cause of buttock and posterior leg pain. Typically, the piriformis muscle becomes taught, tender, and contracted
-deep aching sensation in the mid-gluteal region that is sometimes associated with pain radiating down the posterior leg. The tight piriformis muscle may cause a nerve and vessel entrapment syndrome because of its close proximity to the sciatic nerve and surrounding vessels.
The piriformis muscle exits the pelvis through the greater sciatic foramen and inserts on the greater trochanter of the femur. The obturator internus exits the pelvis by passing through the lesser sciatic foramen. It also inserts on the greater trochanter of the femur. Both muscles assist in the same movement of the thigh (external rotation and abduction).
The primary symptom of piriformis syndrome is buttock pain, with or without posterior thigh pain, that is aggravated by sitting or activity. Associated low back pain suggests involvement of other structures, such as facet joints or iliopsoas muscles. In an isolated piriformis syndrome, the major findings include buttock tenderness from the sacrum to the greater trochanter and reproduction of buttock pain on prolonged hip flexion, adduction, and internal rotation.
Pain is often referred down the posterior portion of the leg following the distribution of the tibial and peroneal branches of the sciatic nerve. These branches become inflamed as they pass over, under, or through the tight piriformis muscle. Pain is thought to be caused by myotendinous breakdown of the piriformis muscle, as well as by focal demyelination of the affected branches of the sciatic nerve. The piriformis muscle is usually tight and contracted, with focal trigger point tenderness on palpation. Piriformis syndrome is frequently associated with sacroiliac dysfunction and leg length discrepancies.
Piriformis syndrome may constitute up to 6-8% of low back pain conditions associated with sciatica. However, patients typically experience symptoms in all 5 toes (multiple dermatomes) rather than in lateral toes (S-1 radiculopathy) or medial toes (L-5 radiculopathy), as is commonly seen in patients with herniated lumbar discs. The straight-leg raise (SLR) test is generally negative, and pain is the predominant symptom; numbness or weakness is rare.
examining lumbar spine
- ROM of the lumbar spine
- Stabilize patient’s pelvis while assessing:
- -Flexion
- -Extension
- -Rotation
- -Lateral bending
most commonly affected nerves
C6-8, L4-S1
dermatomes (spinal nerves)
- Dermatome map
- C6: thumb; C8: ring/pinky fingers
- L4: knee; L5: great toe web space; S1: lateral malleolus
myotomes (peripheral innervation of muscles)
C6-8: Grip strength, wrist flexion/extension, triceps
L3-4: knee extension
L4-5: ankle dorsiflexion, big toe extension (extensor hallucus longus); walking on heels
L5-S1: plantar flexion; walking on toes
deep tendon reflexes (spinal reflexes)
- Biceps (C5-6), Brachioradialis (C5-6), Triceps (C7)
- Patellar (L4), Achilles (S1)
neck pain/injury
- Inspect & palpate neck/C-spine
- Active/passive ROM C-spine
- Dermatomes C6-8
- DTR: biceps, triceps
- AROM/strength in biceps, wrists, triceps, fingers (myotomes)
low back pain/injury
- Inspect & palpate lumbosacral spine, SI joints, hips
- Active/passive ROM lumbar spine
- Dermatomes L2-S1 DTR: patella, Achilles
- Gait
- AROM/strength in LE/toes (myotomes)
- SLR
- Bladder & bowel function
- (Anal sphincter tone, anal wink/reflex)
