the spine Flashcards
cervical spine
portion of the spinal column consisting of the first seven vertebrae that lie in the neck
movements from c0-1
protraction and retraction
movements that happen at c2
rotation
~50%
atlas and axis
1 and 2 cervical vertebrae
support the head
permit cervical rotation
arches in atlas form bony ridge to accommodate odontoid process and medulla of the spinal cord
mobility of the cervical spine
attributed to flat, oblique faceing of the spines articular facets to the horizontal positioning of the SP
thoracic spine
12 vertebrae
long transverse processes and prominent and thin spinous processes
1 through 10 have articular facets on each transverse process with which the ribs articular
the head of the rib articulates between two vertebrae and thus share half of a facet
SR mechanics
c0-2
side bending and rotation are coupled movements and occur in opposite direction
RS mechanics
c3-7
side bending and rotation occur in the same direction
Ribs rule of thirds
T1-3, 12: SP are lame level as TP of same vertebrae
T4-6, 11: SP are 1/2 level inferior from TP of same vertebrae
T7-9, 10: SP are 1 full level inferior from TP of the same vertebrae
lumbar spine
5 vertebrae
support low back and are large and thick
large spinous and transverse process
superior articular processes face medially while the inferior face laterally
all movement occurs here but less flexion and extension
cauda equina L2-S1
sacrum
keystone bone
makes the pelvis
weight transferral bone with pelvis
ligaments make this joint very stable
termination of dural sac
coccyx
four vertebraefused together to form the tailbone
*end filum terminale of dura mater
nucleus pulposus
soft, fibrocartilaginous central portion of intervertebral disk
annulus fibrosus
composed of fibrocartilage, it is the outer portion of the intervertebral disc
intervertebral discs
fibrocartilage pads that separate the cushion the vertebrae
annulus fibrosis and nucleus pulposus
used for shock absorption
anterior longitudinal ligament
connect anterior surface of adjacent vertebral bodies
wide and strong
restricts extension
posterior longitudinal ligament
in vertebral canal
extends full length of the posterior aspect of the bodies of the vertebrae and acts to limit flexion
supraspinous ligament
attaches to each spinous process and is referred to as the ligamentum nuchae in the cervical region
iliolumbar ligament
STRONG
passing from TP of the 5th lumbar vertebrae to the posterior part of the inner lip of the iliac crest
sacroiliac ligament
The posterior SI ligament runs along the back of the sacroiliac joint and provides considerable stability
The ligament connects the back of the hip bones (posterior-superior iliac spine and iliac crest) to the sacrum.
sacrotuberous ligament
sacrum to ischial tuberosity
why sacrotuberous and sacrospinous so important
The sacrotuberous and sacrospinous ligaments create the greater sciatic foramen and the lesser sciatic foramen. The largest nerve in the body, the sciatic nerve, passes through the greater sciatic foramen formed by these ligaments. Trauma to these ligaments, and the consequent inflammation, can lead to sciatic nerve pain, which runs down through the leg along the course of the nerve.
sacrospinous ligament
sacrum to ischial spine
interspinous ligament
between the SP limits rotation and flexion of the spine
ligamentum flavum
connect laminae of the adjacent vertebrae
limits flexion
*spinal stenosis could be secondary to flavum hypertrophy/thickening- as it is in the spinal canal and if thickened can cause neurological symptoms
iliocostaalis L,T,C
O: crest of the sacrum, SP of lumbar and lower thoracic vertebrae, iliac crest and angles of the ribs
I: angles of the ribs, tp of cervical vertebrae
A: extension and SB to one side
longissimus T,Ce,Ca
O: tp of lumbar, thoracic and cervical vertebrae
I: tp of the vertebrae aove the vertebrae of origin and the mastoid process of the temporal bone (Capitus)
A: extension of back and head, head rotation and sb
spinalis thoracic and cervicis
O: spinous process of upper lumbar, lower thoracic and 7th cervical
I: spinous process of upper thoracic and cervical
A: extend
multifidis
O: posterior sacrum, Ilium, transverse processes of lumbar, thoracic, and C4-C7 I: Spinous Processes of a more superior vertebra A: Together: Extend vertebral column Singly: Laterally flex vertebral column and rotate head to opposite side
rotatores
O: TP of each vertebrae
I: SP of the adjacent superior vertebae
A: trunk extension and rotation
interspinales
O: SP below
I: SP above
A: trunk and neck extension
semi spinalis T, Ce, Ca
O: TP of tspine and 7 cervical
I: SP of the 2-4 cervical through the 4 thoracic and occipital bone
A: extension and head rotation
splenius cap, cerv
O: SP of upper tspne and 7cspine and ligamentum nuchae
I: occipital bone, mastoid process of temporal bone and TP of upper 3 c/s
A: extend head and neck, rotation and SB together
more hypermobile/compensatory region in the spine
cervical spine
will increase ROM from another segment in spine
in order to complete entire motion
spine rotation happens at
C2
T9-12
L5-S1
kyphosis
excessive outward curvature of the spine, causing hunching of the back
lordosis
abnormal anterior curvature of the lumbar spine
sway back condition
scoliosis
abnormal lateral curvature of the spine
can be functional and/or structural
vertebral artery test
Patient supine with head supported on table (follow the progression)
1.- Extend head and neck for 30 sec. if no change in symptoms, progress to next step
2.- Extend head and neck with rotation left, then right for 30 seconds, if no change in symptoms progress to next step
3.- With head being cradled off table, extend head and neck for 30 seconds. If no change in symptoms, progress to next step
4.- With head being cradled off table, extend head and neck with rotation left for 30 seconds, and then right
(+) TEST: dizziness, visual disturbances, disorientation, blurred speech, nausea/vomiting
spurling test
TESTING: dysfuction of cervical nerve root
POSITION: sitting, head side bent to uninvovled side, apply pressure through head straight down, repeat with head bent toward involved
(+) TEST: pain and/or paresthesia in dermatomal pattern
brachial plexus test
Application of pressure to head, neck and shoulders to re-create MOI
Lateral flexion of the neck w/ same side pain indicates a compression injury
Lateral flexion of the neck w/ opposite side pain indicates stretch or traction injury
standing forward bend
IS dysfunction
follow with sacral positionals
ilium moving on the sacrum
seated forward bend
SI dysfunction
follow with sacral positionals
sacrum moving on the stabilized ilium
straight leg raise
may indicate problems at the sciatic nerve, SIJ, lumbar spine
pain at 30: hip or inflammed nerve
pain from 30-60: sciatic nerve
if df increases pain: nerve room or sciatic nerve irritation (laseague sign)
pain between 70-90: SIJ
kernig test
pt supine with knee and hip flexed to 90
passively extending knee to elicit pain in the hamstrings
back pain may be a sign of nerve root irritation
brudzinski sign
supine
flexing the neck causes a flex flexion of one or both knees and increase in pain
may indicate lumbar disc or nerve root irritation
well straight leg raise
supine
unaffected leg passively extended into hip flexion
produce low back pain
can radiate along sciatic nerve
nerve root inflammation or disk herniation
milgrim test
INSTRUCT: pt supine, raises both of pt’s legs 2-3 inches off the table and instructs pt to hold legs off the table for 30 seconds
POSITIVE: inability to perform test and/or low back pain
INDICATES: weak abdominal muscles or SOL
The test increases subarachnoid pressure and is positive when the patient is unable to hold the position for 30 seconds without pain, indicating pathology within or outside the spinal cord sheath, such as a herniated disc
hoover test
supine cup both calcanei active straight leg raise of one side if cheating/lying, there wont be any downward pressure on the side that isnt being raised malingering
bowstring test
sciatic nerve irritation
affected side is lifted until pain is felt
the knee is flexed until pain is relieved at which pressure is applied to popliteal fossa
positive indicates a radioculopathy
if lowered leg and ad dorsi and neck flexion: nerve root
FABERS
flexion, abduction, external rotation
supine and figure 4 position
may produce pain in the inguinal region indicating a hip pathology
overpressure to knee produces pain SIJ
FADIR
flexion, adduction, internal rotation
supine laying
test positive if pt indicates increase in low back pain - lumbar pathology
SI compression and distraction
compression or gapping
anterior sacroiliac ligaments
pt reports posterior gluteal or leg pain test is positive
SIJ or sprain
knees to chest test
pulling knees to chest bilaterally will increase symptoms in the lumbar spine
single knee to check causes pain in the posterolateral thigh= sacrotuberous
pain in PSIS when pulling single leg to opposite shoulder= sacroiliac ligament
baby cobra
press ups extend the spine see if pain radiates into buttocks/thigh which indicates herniated disk if pain localizes or more generalizes be more conservative and perhaps surgical
reverse straight leg raise
prone
lifts affect leg
pain in low back= L4 nerve root
spring test
Prone position, downward pressure is applied to the spinous process to assess anterior/posterior motion
determine hyper/hopemobility of a specific segment
prone knee flexion test
athlete prone with knees extended, also prone with knees flexed to 90°; compare lengths by inspecting the heels
a. (+) test: short side=posteriorly rotated SI
whiplash
symptoms caused by sudden, uncontrolled extension and flexion of the neck, often in a automobile accident or big fall on tailbone
wryneck
spasmodic torticollis
torticollis
Torticollis is a problem involving the muscles of the neck that causes the head to tilt down. The term comes from two Latin words: tortus, which means twisted, and collum, which means neck. Sometimes it’s called “wryneck.” If your baby has the condition at birth, it’s called congenital muscular torticollis
scheuermanns kyphosis
increase growth in the posterior t/spine as compared to the anterior t/s leading to a wedged vertebrae
sciatica
pain that follows the pathway of the sciatic nerve, caused by compression or trauma of the nerve or its root
*paul telling us about the wallet in the back pocket
herniated lumbar disc
Description: Prolapse of the annulus fibrosis of lumbar disc into spinal canal.
S/S: Lower back pain, radicular leg pain such as numbness, pins/needles, and tingling more commonly in one leg than the other. dissipating pain. Most note that sitting is their most uncomfortable position. Standing and lying supine is most comfortable.
Physical exam: No back tenderness, straight-leg raise increases radicular pain.
Other: L4/5 is most common. Rarely causes cauda equina syndrome
Imaging: X-Rays, MRI (w/o contrast)
Tx: NSAID, PT, Medrol Dosepak (PO steriods), Epidural steriod injections, surgical (only for neuro involement or cauda equina syndrome)
spondylolisthesis/lysis
spondylolisthesis/lysis
spondylolisthesis is considered a complication of spondylysis
may be some slipping of one vertebrae onto the one below
results in hypermobility of a vertebral segment
L5-S1 most common (step deformity)
spondylosis
degeneration of the vertebrae and a defect in the pars interarticularis (the region between the superior and inferior articulating facet
congenital weakness and occurs as stress fracture
no symptoms unless disc herniation or sudden traumatic hyperextension
begins unilaterally and can extend bilaterally
traction
treatment choice for small protrusion of the nucleus pulposus
subatmospheric pressure is created which puts nucleus into its original position
as well tightening of the longitudinal ligament which also tend to push protrusion back towards its original position
pivms
passive intervertebral movements done in side lying flexion, extension, SB, Rotation important to go slow will indicate hyper/hypo mobility of a vertebral joint and symmetry
alar ligament
extends from sides of the dens to lateral margins of foramen magnum
resists rotation at c0-2
accessory movements of c/spine
rotate to the L
R: anterior and inferior
L: posterior and inferior
to increase stability
biconvex joint
atlas and axis on occiput
apical ligament
The apical ligament is a small ligament that joins the apex (tip) of the dens of C2 to the anterior margin (basion) of the foramen magnum. It is the weak, fibrous remnant of the notochord and does not contribute significantly to stability.
anterior atlantoacxial
strong membrane, fixed, above, to the lower border of the anterior arch of the atlas; below, to the front of the body of the axis.
limits extension
posterior atlantoaxial
The posterior atlantoaxial ligament is a broad, thin membrane attached, above, to the lower border of the posterior arch of the atlas; below, to the upper edges of the lamina of the axis. It is a continuation of the Ligamentum flavum, and is in relation, behind, with the obliqus capitis inferior muscle
limits flexion
