Thoracic And Lumbar Mechanics LECT Flashcards
Cervical Curvature?
Lordosis
Thoracic Curvature?
Kyphosis
Lumbar Curvature?
Lordosis
Sacral Curvature?
Kyphosis
Describe the body of the Thoracic Vertebra
Medium size
Heart Shaped
Costal Facets present
Describe the spinous process of the thoracic vertebra
Long
Slope postero-inferiorly
Describe the body of the lumbar vertebra
Large
Kidney shape
Describe the spinous process of the lumbar vertebra
Short
Broad
What is a vertebral unit composed of?
Two adjacent vertebrae
Associated intervertebral disc
Thoracic spinous process located in same plane as the transverse process
T1-3, 12
Thoracic spinous process located 1/2 segment below corresponding transverse process
T4-6, 11
Thoracic spinous process located at the level of the transverse process of the vertebra below
T7-9, 10
Cervical Superior Facet orientation
Backward, Upward, Medial (BUM)
Thoracic superior facet orientation
Backward, upward, lateral (BUL)
Lumbar Superior Facet Orientation
Backward, Medial (BM)
Anterior longitudinal ligament description and action
Strong, broad, fibrous band that covers and connects the anterolateral aspects of the vertebral bodies and IV discs
Limits extension
Posterior Longitudinal Ligament
Narrower, weaker band, runs w/in the vertebral canal along the posterior aspect of the vertebral bodies
Resists hyperflexion
Prevents posterior herniation of nucleus pulposus
Ligamentum flava
Connect the laminae of adjacent vertebra
Interspinous Ligaments
Connects adjoining spinous processes
Intertransverse Ligaments
Connects adjoining transverse processes
Iliolumbar ligament
Attaches superior aspect of ilium to transverse processes of L4–5
Strengthens sacral joint
Rotatores Ms OIA
O/I: T1-12, bw transverse and spinous processes of adjacent vertebra
A: Bilateral - extends thoracic spine
Unilateral - Rotates thoracic spine to the opposite side
Multifidus M. OIAN
O: Sacrum, ilium, mamillary processes of L1-L55, transverse and articular processes of T1-T4, C4-C7
I: Superiomedially to spinous processes, skipping 2-4 vertebrae
A: Bilateral - extends spine
Unilateral - flexes spine to same side, rotates it to opposite side
N: Spinal Ns
Semispinalis Ms. Action
Bilateral: Extends thoracic and cervical spines and head (stabilizes craniovertebral joints)
Unilateral: Bends head, cervical, and thoracic spines to same side, rotates to opposite side
Vertebral Flexion
S1 to vertical C7
40-90 deg
Vertebral Extension
S1 to vertical C7
20-45 deg
Vertebral Sidebending
S1 to vertical C7
15-30 deg
Vertebral rotation
Center of head to acromion, ASIS
3-8 deg
What is coupled motion?
Consistent association of a motion along or about one axis, with another motion about or along a 2nd axis
The principle motion cannot be produced w/o the associated motion occurring as well
Linkage (i.e. effect on ROM)
Relationship of joint mechanics with surrounding structures
ROM - putting multiple joints together allows excess motion
Physiologic barrier
Limit of active motion
Anatomic Barrier
Limit of motion imposed by anatomic structure
Limit of passive motion
Elastic barrier
Range between physiologic and anatomic barrier of motion in which passive ligamentous stretching occurs before tissue disruption
Restrictive barrier
Functional limit within anatomic range of motion
Abnormally diminishes the normal physiologic range
Restrictions of motion in the spine cause ____
Reduced efficiency
Impaired flow of fluid
Altered nerve fxn
Structural imbalance
Excessive motion (restriction) is in reference to the vertebra ____ in a functional vertebral unit
Above
I.e. excess motion of L2 is the motion of L2 on L3
Describe Type I mechanics
TONGO Type One Neutral Grouped Opposite sides (i.e RrSl or RlSr)
Type II mechanics
TTOSS Type Two nOt neutral Single segment (not grouped) Same direction (RrSr, RlSl)
Fryette’s Principles
Type 1 mechanics
Type 2 Mechanics
Fryette’s Third Principle
Fryette’s 3rd principle
Initiating movement of a vertebral segment in any plane of motion will modify the movement of that segment in other planes of motion
If movement is restricted in one direction, motion will be restricted in other directions
If movement is improved in one direction, motion will improve in other directions
Rotation: Plane and axis
Plane: Transverse/Horizontal
Axis: Superior-inferior
Sidebending Plane and Axis
Plane: Coronal/Frontal
Axis: Anterior-Posterior
Flexion/Extension Plane and axis
Plane: Sagittal
Axis: Horizontal (L to R)
A PTP on the R will indicate what?
R rotation
Same for PTP on the L
Spine of the scapula is a landmark for what segment?
T3 transverse and spinous processes
Inferior angle of the scapula is a landmark for what segment?
Spinous process of T7
Transverse process of T8
Iliac crest is a landmark for what vertebra?
L4 vertebra
Scoliosis
Lateral curvature of the spine
2% of population
F>M
Dextroscoliosis
Curvature to the R
Levoscoliosis
Curvature to the L
Physical exam of scoliosis
Asymmetry at waist, shoulders
Rib cage prominence (+ forward bending test)
Cobb Angle
Leg length discrepencies
Complications of Scoliosis
Respiratory compromise (Cobb Angle >50 deg) Cardiac compromise (Cobb angle >75)
Management of Scoliosis
OMT based on Cobb Angle
<25 deg - conservative, monitor with radiographs
25-45 deg - non operative, bracing
>45 deg - Surgical fusion, prevents progression
Radiculopathy
Pain with dermatomal distribution, impaired neurological fxn (LE weakness, diminished reflexes)
Typically acute, may become chronic
+ SLR
Straight Leg Raise Test
Raise the leg with knee extended
+ test = pain, pain from 15-30 deg indicates lumbar disc etiology
Malingering test
Actively raise leg with knee extended
+ test = no activation of contralateral hip extensors
Indicates malingering and lack of effort
Spinal Stenosis
Bi LE pain Neurogenic claudication Impaired neurologic fxn Typically chronic W/u: MRI \+ SLR
Cauda Equina Syndrome
Impaired neurologic fxn
- Saddle anesthesia
- LE weakness
- Diminished reflexes
- Urinary Retention
Emergent, usually traumatic
W/U: MRI
Spina Bifida Occulta
Failure of the neural tube to close without herniation
Meningocele
Failure of the neural tube to close with protrusions of the meninges through the defect
Myelomeningocele
Failure of the neural tube to close with protrusion of the meninges and the spinal cord through the defect
Sacralization
One or both TPs of L5 are long and articulate with the sacrum (DJD)
Lumbarization
Failure of S1 to fuse with the rest of the sacrum (Not common)
Spina Bifida anatomic variation
Defect in the closure of the lamina
Spondylosis
Vertebral bone spurs
Spondylolysis
Vertebral transverse process fracture
No vertebral malalignment
Scotty dog with collar on lumbar imaging
Spondylolethesis
Slipping of one vertebra on another
What is the sympathetic viscerosomatic reflex for head and neck?
T1-T4
What is the sympathetic viscerosomatic reflex for heart?
T1-T5
What is the sympathetic viscerosomatic reflex for lungs?
T2-T7
What is the sympathetic viscerosomatic reflex for the adrenal medulla?
T10
What is the viscerosomatic reflex for Appendix?
T12
What is the sympathetic viscerosomatic reflex for esophagus/UE
T2-T8
What is the sympathetic viscerosomatic reflex for Upper Genitourinary?
T10-T11
What is the sympathetic viscerosomatic reflex for lower GU?
T12-L2
What is the sympathetic viscerosomatic reflex for bladder?
T11-L2
What is the sympathetic viscerosomatic reflex for Upper GI?
T5-T9
What is the viscerosomatic reflex for middle GI?
T10-T11
What is the viscerosomatic reflex for lower GI?
T12-L2
What is the viscerosomatic reflex for uterus and cervix?
T10-L2
What is the viscerosomatic reflex for LE, urethra, and erectile tissue?
T11-L2
What is the viscerosomatic reflex for the prostate?
T12-L2
