The Spine - CH.25 Flashcards
name the ligamentous structures that support the spine and name the direction it limits
anterior long. lig - hyperextension posterior long. lig - hyperflexion interspinous - hyperflexion supraspinous - hyper flexion ligamentum flavum - hyperflexion
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?
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
a patient comes in with an excessive amount of kyphosis at the thoracic and lumbar spine - what do you think could be happening?
scheurman’s disease
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?
cervical neck instability - alar, sharp purser’s, tranverse ligament, VBI
must rule out all cervical instabilities before testing other neck ranges of motion
once cervical instabilities have been ruled out, what test would you use for a suspected facet joint sprain?
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
what typical posture would you see in a patient who has a herniated disk?
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
test for spondylolysis
stork test
(+) pain at lumbar - feeling of instability
what are the findings with 30/30-60/70-90 degrees with a straight leg raise
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
demo the kernig’s test
test for nn irritation
demo the brudzink’s test
if patient flexes the neck and the knee reflexively bends, likely a nn irritation or tight fascia or sign of meningitis
what does the SI compression test, test for?
posterior SI lig
what’s the SI Distraction test, test for?
anterior SI lig
explain the prone knee flexion test and how is it confirmed?
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
test the cranial nerves
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)
demo dermatomes, myotomes and deep tendon reflexes on your body
Babinski, Clonus, Hoffman’s sign?
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 (+)
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?
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
what can you see to tell the difference b/w cervical fracture and cervical dislocation?
the head (in a dislocation) will be tilted to the same side as the dislocation
cervical dislocation are most common in what sport?
diving (flexion and rotation of head moi)
5 mechanisms in which the spinal cord can be damaged?
laceration
hemorrhage
contusion
cervical cord neuropraxia
spinal cord shock
injuries above or at this level of the csp is automatic death
c3
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?
cervical cord neuropraxia
- tx as severe neck injury - go get imaging done to rule out fractures or instabilities
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?
spinal cord shock
diff b/w complete and incomplete spinal cord shock?
complete - spinal cord completely gone and cut in 1/2 - anything below is not working
incomplete - certain parts of the spinal cord are injured
a patient with non-specific sensory loss, is quadraplegic, and no sexual function may have this condition?
central cord syndrome
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…
Brown-seguard syndrome
a patient displays no motor, P sense and temp sense - what condition are they having?
anterior spinal cord syndrome
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?
posteriot spinal cord syndrome
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?
cervical spine stenosis
are patients allowed to return to play after going through a cervical spine stenosis?
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
an athlete presents with a burner, what is the criteria they must pass in order to go back into play?
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
what’s a test to rule out spinal disk issues?
valsalva maneuver with patient blowing into thumb
true definition of sciatica?
peripheral nn root irritation/compression @ intervertebral foramina in low back
psuedoscaitica - piriformis “tightness”
explain out loud the different stages of a herniated disk?
common tests to use?
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
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
spondylolithesis
diff between spondylolysis and spondylithesis?
spondylolysis occurs unilaterally
spondylolithesis is a B subluxation and slippage of vertebrae
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?
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
what are the minimal forces one must put on a patient to actually provide sufficient traction?
80 lbs minimal (small woman)
180 - large man
daily 5x/week - 2 weeks
