The Spine - CH.25

Question 1

name the ligamentous structures that support the spine and name the direction it limits

Answer 1

anterior long. lig - hyperextension
posterior long. lig - hyperflexion 
interspinous - hyperflexion
supraspinous - hyper flexion
ligamentum flavum - hyperflexion

Question 2

an athlete sustains an injury to T11/12 which causes him to be paraplegic from the hip down whereas another person got the same injury but at L4/L5 but only has a disability with DF and great toe extension - everything else is okay - how is this happening?

Answer 2

cauda equina - end of spinal cord end at L1/2 level - anything above that severs the spinal cord (cuts the entire tail off)

whereas any injury below L3 will only damage the nn root but not the spinal cord itself

Question 3

a patient comes in with an excessive amount of kyphosis at the thoracic and lumbar spine - what do you think could be happening?

Answer 3

scheurman’s disease

Question 4

a patient comes in with pain and tightness at the neck - feels like a pinch in certain ranges of motion, you suspect a possible facet joint sprain at the cervical spine - what’s the first couple test you would do?

Answer 4

cervical neck instability - alar, sharp purser’s, tranverse ligament, VBI

must rule out all cervical instabilities before testing other neck ranges of motion

Question 5

once cervical instabilities have been ruled out, what test would you use for a suspected facet joint sprain?

Answer 5

distraction - see if it eases up 
cervical compression
spurlings 
quadrant test 
Jackson's? 
bakody's side - having forearm on head to take tension off the dura

Question 6

what typical posture would you see in a patient who has a herniated disk?

Answer 6

they tend to side bend towards the same side as the herniation because it takes off the pressure if they were to side bend the other way

Question 7

test for spondylolysis

Answer 7

stork test

(+) pain at lumbar - feeling of instability

Question 8

what are the findings with 30/30-60/70-90 degrees with a straight leg raise

Answer 8

P @ 30: hip problems, potential lumbar problem

P @ 30-60: sciatic nn irritation - “laseauge’s sign” ***if max DF causes increase in symptoms - more likely L3/4 or S1/2

P @ 70-90: SI joint problem

Question 9

demo the kernig’s test

Answer 9

test for nn irritation

Question 10

demo the brudzink’s test

Answer 10

if patient flexes the neck and the knee reflexively bends, likely a nn irritation or tight fascia or sign of meningitis

Question 11

what does the SI compression test, test for?

Answer 11

posterior SI lig

Question 12

what’s the SI Distraction test, test for?

Answer 12

anterior SI lig

Question 13

explain the prone knee flexion test and how is it confirmed?

Answer 13

one leg short = posterior rotation of SI joint of that same side

if they equal out at 90 of knee flex - then it’s a fa sho

Question 14

test the cranial nerves

Answer 14

1-12 
olfactory - smell 
optic - acuity 
oculomotor - tracking 
trochlear - convergence
trigeminal - clench teeth 
abducens - lateral mvmnt of eye
facial - facial expression
vestibulocochlear - hearing 
glossopharyngeal (sensory of tongue, saying words)  
vagus (cah, gah) 
accessory (shrug) 
hypoglossal (shakira)

Question 15

demo dermatomes, myotomes and deep tendon reflexes on your body

Babinski, Clonus, Hoffman’s sign?

Answer 15

do it on yourself

forceful DF - clonus

babinski - stroke foot and see if they extend toes (+)

hoffman’s - flick the middle finger and see if the index and thumb come together involuntarily (+)

Question 16

you see a player about to spear head another athlete during a football game, what do you think could happen?

they go down what do you do?

Answer 16

axial load with slight flexion can cause a cervical fracture or dislocation (commonly at C4,5,6)

stabilize cpsine - call ambulance or get help, tx for shock but if not hold cspine until you can get a collar and board them for transport

Question 17

what can you see to tell the difference b/w cervical fracture and cervical dislocation?

Answer 17

the head (in a dislocation) will be tilted to the same side as the dislocation

Question 18

cervical dislocation are most common in what sport?

Answer 18

diving (flexion and rotation of head moi)

Question 19

5 mechanisms in which the spinal cord can be damaged?

Answer 19

laceration

hemorrhage

contusion

cervical cord neuropraxia

spinal cord shock

Question 20

injuries above or at this level of the csp is automatic death

Answer 20

c3

Question 21

an athlete goes down on the field and doesn’t move - you get there and they’re still awake but they have N/T down their extremities B – after a couple of mins they feel completely fine other than just a sore neck? what condition do you think this is and how should you go about tx-ing it?

Answer 21

cervical cord neuropraxia

• tx as severe neck injury - go get imaging done to rule out fractures or instabilities

Question 22

an athlete gets a blunt force to the head and neck - they become flaccid and then super spastic with no reflexes to hyperreflexive - what could be happening?

Answer 22

spinal cord shock

Question 23

diff b/w complete and incomplete spinal cord shock?

Answer 23

complete - spinal cord completely gone and cut in 1/2 - anything below is not working

incomplete - certain parts of the spinal cord are injured

Question 24

a patient with non-specific sensory loss, is quadraplegic, and no sexual function may have this condition?

Answer 24

central cord syndrome

Question 25

a patient that presents with no sense of touch, motor f(x), vibration and proprioception on ONE side while the other side isn’t picking up pain and temp signal may be displaying this…

Answer 25

Brown-seguard syndrome

Question 26

a patient displays no motor, P sense and temp sense - what condition are they having?

Answer 26

anterior spinal cord syndrome

Question 27

a a patient displays lack of coordination but everything else is completely fine - what condition could they potentially have considered they had a traumatic event previously?

Answer 27

posteriot spinal cord syndrome

Question 28

a patient is playing a game on the field when all of a sudden they stop and come over to you - they display quadrapelgic like symptoms but after 10-15 min or so they’re completely fine - they don’t have neck p to begin with but as the game goes on, they’re fine. what condition could this be?

Answer 28

cervical spine stenosis

Question 29

are patients allowed to return to play after going through a cervical spine stenosis?

Answer 29

yes if no other reason to keep them out of play - must warn them once they get back out there - may need to discourage them from participating in collision sports moving forward

Question 30

an athlete presents with a burner, what is the criteria they must pass in order to go back into play?

Answer 30

dermatomes, myotomes are equal B and normal
no sense of N/T anymore

if the function of the deltoid is intact, they can return to play

Spurling’s must be (-)

Full ROM/strength

Question 31

what’s a test to rule out spinal disk issues?

Answer 31

valsalva maneuver with patient blowing into thumb

Question 32

true definition of sciatica?

Answer 32

peripheral nn root irritation/compression @ intervertebral foramina in low back

psuedoscaitica - piriformis “tightness”

Question 33

explain out loud the different stages of a herniated disk?

common tests to use?

Answer 33

degeneration: the nucleus pulpopus moves through annular fibrosis but doesn’t break through
prolapse: nucleus protrudes out of the annulus
extruded: nucleus comes into contact with the nn root outside
sequestrated: nucleus separates from disk

valsalva, SLR (usually pain at 30 because of the flexion of the low back

Question 34

a client comes in with a hella excessive lordosis and an apparent step deformity - what condition could this person have? they use to be a ballerina and switched over to gymnastics

Answer 34

spondylolithesis

Question 35

diff between spondylolysis and spondylithesis?

Answer 35

spondylolysis occurs unilaterally

spondylolithesis is a B subluxation and slippage of vertebrae

Question 36

a runner goes out for a run and accidentally lands hard on a step that they didn’t see, they come to you complaining of back pain - what do you think is happening?

what test would you do for it?

Answer 36

SI joint sprain

SLR (70-90) 
Ely
Thigh Thrust
Compression
distraction 
Gaenslen's 
sacral thrust 
ITB stretch 
prone knee flex test 
gillet's 
seated flexion test

Question 37

what are the minimal forces one must put on a patient to actually provide sufficient traction?

Answer 37

80 lbs minimal (small woman)

180 - large man

daily 5x/week - 2 weeks