Thoracic And Lumbar ME Flashcards
Vertebral unit
Defined as 2 adjacent vertebrae with associated Disc, ligaments, musculature, vasculature and neural/lymphatic drainage.
Motion is Referred by the superior segment in relation to the lower one
(i.e T3 vertebral unit = T3 in relation T4)
Position of initial injury in type 1 somatic dysfunctions
Generally, patient was in neutral and side-bent towards one direction while rotated to the other at time of injury.
- often manifests as a response to a type 2 dysfunction
Position of initial injury of type 2 somatic dysfunction
Patient was flexed or extended and being side-bent or rotated to one side (usually the same)
- usually manifests at the end of a group if in a group
- extension specifically often is a product of segmental muscle contraction from a viscerosomatic reflex
Scoliosis
Lateral deviation of vertebral column usually greater than 10 degrees one way
More common in female vs male with peak incidence in 12-14 years
Often associated with type 1 issues
1/20 people have some degree of scoliosis
Only 1/200 have clinical symptoms
Named for direction of convexity
Most common type of Scoliosis is single C shaped in the thoracic region. (If it worsens through chronic use, then will eventually become S shaped)
Dextroscoliosis vs levoscoliosis
Dextroscoliosis:
Right side apex
- rotation is right, concave left, convex right, side bent left
Ribs are rotated posteriorly and the space between the right ribs are increased
- more common in thoracic spine
Levoscoliosis
Left sided apex
- rotation is left, concave right, convex left, sidebent right
More common in in lumbar spine
Classifications of scoliosis
Reversibility: functional or structural
Severity: determined on Cobb angles (larger = worse)
Location: thoracic or lumbar, double or single curve
Etiology
Adams test
Pt takes shirt off and stands with feet together with physician behind pt .
Patient bends forward at the waist and physician evaluates for asymmetry
Is neutral the same position for each vertebrae or when seated/lying prone?
No
Due to natural curves of the spine along the AP axis
Why is sidebending more prominent in the lumbar region than the thoracic?
Ribs are present in the thoracic region
Single segment type 1 somatic dysfunction
Very rare and topically only occur at L5.
Very painful and is pretty much the only exception to the principles of Fryette
Are type 1 and type 2 motions normal or abnormal?
Normal motions of the spine. It’s how the vertebrae compensate, the motion itself is not abnormal
Type 1 somatic dysfunction
Occurs in groups w/ spine in neutral range
Side-bending and rotation are opposite
- exist because vertebrae was sidebent and rotated opposite and remained when spine was neutral
Only works for thoracic and lumber vertebral motion only
Type 2 somatic dysfunction
Usually a single vertebrae
Occurs only when spine is in overflexion/extension
Side-bending and rotation are coupled in the SAME direction
- extension type 2 is typically a product of segmental muscle contraction from viscerosomatic reflex*
Ways to screen for thoracic examination
Postural screening
Scoliosis screening
Neurological exam
TART w/ AROM/PROM
Visual inspection
Segmental exams
Principle 3
Initiating motion of a vertebral segment in any plane of motion will modify the movement in other planes of motion (typically reducing it)
NO SOMATIC DYSFUNCTION ASSOCIATED
