Thoracic and Lumbar Spinal Mechanics Flashcards
Vertebral Unit
two adjacent vertebrae
associated intervertebral disc
How many Junctions are there and what are they?
- craniocervical
- cervicothoracic
- Thoracolumbar
- Lumbosacral
Gravitational Line
External Auditory Canal Head of the Humerus L3 Anterior 1/3 of Sacrum Lateral Malleolus
Spinal Curves
Cervical Lordosis
Thoracic Kyphosis
Lumbar Lordosis
Sacral Kyphosis
Thoracic Vertebrae
- Medium, heart shaped, costal facets present
- Spinous Process long and posterio-inferiorly sloped
Lumbar Vertebrae
- Large body, kidney shaped
- Short, broad spinous process
Rule of 3’s
Refers to location of spinous process in relation to the transverse process in the thoracic spine
Rule of 3’s: T1-T3
Spinous process located at level of corresponding transverse process
Rule of 3’s: T4 -T6
Spinous process located 1/2 a segment below the corresponding transverse process
Rule of 3’s: T7 - T9
Spinous process located at the level of the transverse process of the vertebrae one below
Rule of 3’s: T10
Same as T7-T9, spinous process at level of transverse process of below vertebrae
Rule of 3’s: T11
Same as T4-T6, spinous process is 1/2 segment below corresponding transverse process
Rule of 3’s: T12
Same as T1-T3, spinous process at same level of corresponding transverse process
Superior Facet Orientation: Cervical
backward, upward, medial (BUM)
Superior Facet Orientation: Thoracic
backward, upward, lateral (BUL)
Superior Facet Orientation: Lumbar
Backward, Medial (BM)
Ligaments of the spine
- Anterior longitudinal l.
- Posterior longitudinal l.
- Ligamentum Flavum l.
- Interspinous l.
- Intertransverse l.
- Supraspinous l.
Anterior Longitudinal L.
Covers and connects anterolateral aspects of the vertebral bodies and IV discs
- limits extension
Posterior Longitudinal L.
Narrower, runs within vertebral canal along the posterior aspect of vertebral bodies
- Resists hyperflexion
- Prevents posterior herniation of nucleus pulposus
Ligamentum Flava
- Connect the laminae of adjacent vertebra
Interspinous l.
connects adjoining spinous processes
intertransverse l.
connects adjoining transverse processes
Iliolumbar ligaments
- goes up to L4
- Decrease motion at lumbosacral region and stabilize pelvis
Rotatores Breves
Origin: T1-T12 (between transverse and spinous processes of adjacent vertebra
Action: Bilateral - extends thoracic spine
Unilateral - Rotates thoracic spine to opposite side
Rotatores Longi
-T1-T12 between transverse spinous process, skipping one vertebra
-Action:
Bilateral-extends thoracic spine
Unilateral-Rotates thoracic spine to opposite side
Multifidus
-Origin: Sacrum, illium, mamillary processes of L1-L5, transverse and articular
Insertion: Superomedially to spinous processes, sipping two to four vertebrae
-Innervation: Spinal n.
-Action:
Bilateral-Extends spine
Unilateral-Flexes spine to same side, rotates it to opposite side
Semispinalis
Semispinal: capitis, cervicis, thoracis
Skips more than four vertebrae
-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
ROM: Flexion
40-90
ROM: Extension
20-45
ROM: Sidebending
15-30
ROM: Rotation
3-18
Coupled Motion
Consistent association of a motion along or about one axis with another motion about or along a 2nd axis
Linkage
- Relationship of joint mechanics with surrounding structures
- Requires joint isolation for accurate measurement and evaluation
- Compare normal vs. result of compensation
Vertebral nomenclature: Motion
referenced to movement of anterior/superior surface of vertebrae
Vertebral nomenclature: Retriction
reference to vertebrae above in a functional vertebral unit
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
Why does spinal somatic dysfunction matter?
Restrictions of motion in the spine:
- reduce efficiency
- impair flow of fluids
- alter nerve function
- create structural imbalance
Harrison Fryette, DO
Developed first 2 fryette’s principles in 1918
- applicable to thoracic and lumbar spine
- C.R. Nelson, DO developed the third principle in 1948
Fryette: Type one spinal mechanics
- in neutral range (not flexed/extended), sidebending and rotation are coupled in opposite directions
- Rotation toward convexity
- GROUP of vertebrae
TONGO: Type One Neutral Group Opposite
Fryette: Type two spinal mechanics
- in sufficient flexion or extension (non-neutral), sidebending and rotation coupled in SAME direction
- rotation is towards concavity
- tends to be a SINGLE vertebra
TTOSS: Type two 0(non-neutral) Single seg Same direction
Somatic Dysfunction: nomenclature
Type 1 mechanics
- locate vertebrae or group
- indicate position
- indicate sidebending
- indicate rotation
Somatic dysfunction nomenclature: Type 2 mechanics
- Locate vertebra or group
- indicate position
- indicate sidebending
- indicate rotation
Fryette: third principle
Initiation movement of a vertebral segment in any plane of motion will modify the movement of that segment in other planes of motion
- If motion restricted in one direction, motion will also be restricted in other directions
- if motion imporoved in one direction, then improved in other directions
if push on right transverse process, vertebra rotates…
left
if push on left transverse process, vertebra rotates…
right
spine of scapula
T3 spinous process
T3 transverse process
Inferior angle of scapula
T7 spinous process
T8 Transverse process
Iliac Crest
L4 vertebra
Dextroscoliosis
-convexity right (frames heart)
Levoscoliosis
Convexity left (obscures the heart)
Cobb Angle
look at top and bottom of vertebrae in scoliosis and measure angle
-<25: conservative, monitor with radiographs
-25-45: non-operative, bracing
->50: surgical fusion, prevents progression (respiratory compromise)
<75 (cardiac compromise)
Straight Leg Raise Test
-Raise the leg with knee extended, nonspecific test
(+) Test = Pain (reproducing symptoms)
indicates: pain from 15-30 degrees is lumbar disc etiology
Herniated Lumbar nucleus pulposus
L4-L5: pain in sacroiliac joint, hip, lateral thigh, leg
- numbness in lateral leg, first 3 toes
- Weakness in dorsiflexion and difficulty walking on heel
L5-S1: pain in sacroiliac joint, hip posterolateral thigh, leg to heel
- numbness in back of calf, lateral heel, foot to toe
- weakness in plantar flexion and difficulty walking on toes
Spinal Stenosis
Lower extremity weakness and diminished reflexes
- Neurogenic claudication: pain in back and radiating to their leg and stops when seated
- MRI (+) straight leg test
Cauda Equine Syndrome
EMERGENCY -MRI -can be permanent if not taken care of immediately -saddle anesthesia -lower extremity weakness diminished reflexes -urinary retention
Spina Bifida
-Group of congenital anomalies where neural tube fails to completely close
Spina Bifida Oculta
failure of neural tube to close without herniation
-tuft of hair
Meningocele
failure of neural tube to close with protrusions of meninges through defect
Myelomeningocele
failure of neural tube to close with protrusion of meninges and spinal cord through the defect
Sacralization
One or both TP’s of L5 are long and articulate with the sacrum (fuse)
Lumbarization
Failure of S1 to fuse with rest of sacrum (not common)
Spondylosis
bony spurs
Spondylolysis
fracture of articularis and have scotty dog sign
Spondylolesthesis
slipping of one vertebra on another
