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Test and Measures > Thoracic and Lumbar Spine > Flashcards

Thoracic and Lumbar Spine Flashcards

1
Q

Thoracic Resting Position

A

Midway between flexion and extension

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2
Q

Thoracic Closed Packed Postion

A

Extension- bc facets line up

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3
Q

Thoracic Capsular Pattern

A

Side flexion and rotation equally limited–> extension

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4
Q

Thoracic Spine Facet Joint

A
  • most rigid part of vertebral column
  • ribs, ligs, and muscles
  • aligned in a mild kyphosis
  • mobile platform for a movement [UE via ST and SC]
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5
Q

Breast Bone (Sternum)

A

3 sections [manubrium, body and sternum]

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6
Q

Manubriosternal Joint (Sternal Angle)

A

around the 2nd rib

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7
Q

Xiphosternal Joint

A

T9 vertebrae

T7 ribs

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8
Q

Xiphoid Process

A

T9 vertebrae

T6 dermatome

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9
Q

Infrasternal Angle

A

> 90 deg – tightness in internal obliques
< 90 deg – tightness in external obliques-pull inwards
-Find by palpating inferior attachments on the sternum and look at angle between the 2

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10
Q

Thoracic Spine Bony Palpation- Anterior

A

Costochondral Junctions

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11
Q

Thoracic Spine Bony Palpation-Posterior

A
  • First Rib [sitting and prone]
  • Ribs 2-12
  • –Most rounded inferior rib felt anterolatreally is the 10th rib
  • –Inferior and posterolateral to that is the tip of rib 11, ending just anterior to mid-axillary line
  • –Rib 12, inferior and medial to rib 11, it is about an inch or so below rib 11 about 2 – 4 inches from the spinous process
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12
Q

Rib Angles [Palpation]

A
  • Ribs 2-10
  • 1st rib doesn’t posses an angle and 11th and 12th are slight if present
  • 3-4 cm lateral to the tips of the transverse process
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13
Q

Costovertebral (CV) Joints

A
  • Ribs and vertebral bodies
  • Ribs 1, 10, 11, 12 have one vertebral body articulations
  • Ribs 2-9 articulate with the two adjacent vertebrae
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14
Q

Costotransverse (CT) Joints

A
  • Ribs and transverse processes of the same level
  • Ribs 1-10
  • Ribs 11 and 12 do not have these joints.
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15
Q

Costochondral Joints

A
  • Ribs and costal cartilage
  • Ribs 1-7 = True Ribs
  • Ribs 8-10 = False Ribs
  • Ribs 11 and 12 = Floating
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16
Q

Thoracic Rule of Threes

A
  • T1-3: SP at level with TP
  • T4-6: SP are ½ level [thumb width] down than TP
  • T7-9: SP are one full level down from TP
  • T10-12: Starts to come back up
  • –T10: SP is one full level below TP
  • –T11: SP is one half level below TP
  • –T12: SP is even with TP
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17
Q

External Obliques [OINA]

A

-O: Ribs 5-12
-I: Iliac Crest, pubis, lineal alba
-In: Lower intercostal, iliohyogastric and ilioinguinal nerve
-A: Bilaterally compress abdomen and flexes the spine
Unilaterally: Ipsilateral side bending, contralateral rotation

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18
Q

External Oblique Palpation

A
  • Supine with knees bent, place hand on left side of abdomen and lower ribs. Ask partner to raise left shoulder to right hip.
  • Palpate superiorly to the interdigitations with serratus anterior
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19
Q

Internal Obliques [OINA]

A

-O: Lateral inguinal lig, middle lip of iliac crest, thoracolumbar fascia
-I: Pubis, inferior border of ribs 9-12, linea alba
-In: Lower 5 thoracic n, 1st lumbar nerve, iliohypogastric and ilioinguinal n.
-A: Bilaterally compress abdomen and flexes the spine
Unilaterally ispilateally flexes and rotates to same side

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20
Q

Internal Obliques Palpation

A

Palpate between the iliac crest and the umbilicus while partner side bends and rotates to the side you are palpating.

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21
Q

Rectus Abdominis [OINA]

A
  • O: Crest of pubis and pubic tubercle, pubic symphysis
  • I: Cartilages of the 5-7 ribs and xiphoid process
  • In: Spinal nerves T7-12
  • A: Flexes vertebral column, compresses abdomen
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22
Q

Rectus Abdominis Palpation

A
  • Supine with legs bend, locate xiphoid process and ribs just lateral with one hand and superior to pubic crest with other. Palpate between these landmarks while patient attempts to flex and relax their trunk. Attempt to palpate the lateral edge
  • Washboard effect is the transverse fibrous intersections
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23
Q

Transverse Abdominis [OINA]

A
  • O: Lateral 3rd of inguinal ligament, inner lip of iliac crest, inner cartilage of the lower six ribs, thoracolumbar fascia, and interdigitating with diaphragm
  • I: Ends in aponeruosis, front and back of rectus sheath to linea alba and pubis
  • In: Lower sic thoracic n, first lumbar n, iliohypgastic and ilioinguinal n.
  • A: Compresses abdominal viserca and tenses abdominal wall
24
Q

Transverse Abdominis

Palpation

A

Palpating medial to ASIS, ask patient to gently contract after exhaling by bringing belly button into spine. No tilting nor too forceful of a contraction
**most ab exercises target this muscle

25
Q

Erector Spinae

A
  • Divided between cervicis, thoracis, and lumborum
  • Spinalis – medial
  • Longissimus – intermediate [Between spinalis and longissimus you will find the area to palpate the TP of the thoracic and lumbar spine]
  • Iliocostalis – lateral
26
Q

Erector Spinae Palpation

A

Just lateral to the spinous processes, ask patient to attempt to extend trunk. Palpate medial to lateral noting the different layers.

27
Q

Linea Alba

A

Runs vertically down the middle line of the abdomen from the xiphoid process and pubic symphysis and separates the two rectus abdominis muscles.

28
Q

Diaphragm

A
  • Not possible to palpate directly. Can have a bulging out of the abdomen below the rib’s on the anterior side. During quiet respiration, it moves only about 1-2 cm. By curling your fingers around the underside of the ribs, may be felt to push out against the hands with respiration.
  • We can MMT
  • Helps with posture and breathing
  • Ppl who have a hard time breathing can flex forward
29
Q

Pump Handle breathing pattern

A
  • move by rotating around their long axis
  • rotate up with accompaniment of the manubrium/sternum
  • T1-6
30
Q

Bucket Handle breathing pattern

A
  • move upward, backward, and medially
  • T7-10
  • T2-6 at a much lesser degree
31
Q

Caliper Action breathing pattern

A
  • move laterall

- T11 and 12

32
Q

Measuring Chest Expansion

A
  • Males: 4th intercostal space by palpation (approximately nipple line)
  • Females: Just below breasts
  • Have patient take full inspiration and full expiration
  • The difference between max inspiration and expiration is your number
  • best of 2 tries
  • Normal chest expansion is ≥ 5 cm
  • AS < 2.5 cm, severe emphysema ~1 cm
33
Q

Ankylosing spondylosis (AS)

A

fusion of ribs so it’s hard for them to expand

34
Q

Abdominals: Double Leg Lowering (Kendall)

A

-Pt supine, forearms crossed on chest.
-PT assists pt in raising legs to a vertical position.
-Pt is instructed to perform a posterior pelvic tilt flattening back to table
-Instructed to “Hold it flat” while patient lowers legs.
[Grades are based on ROM held]
-Ending position is when PT notices loss of neutral pelvic position.
-angle b/w the extended legs & the table determines strength grade.
[Look at thigh not feet when grading]

35
Q

Sahrmann Core Stability Test

A
  • Ability of a patient to perform specific levels of stability testing while maintaining a neutral/flat spine.
  • Test is stopped if patient cannot maintain flat spine.
  • Test is graded by the level the patient can perform.
  • Looks at disassociation between leg muscles and ab muscles
36
Q

Sahrmann Core Stability Test: Level 1A - Fair

A
  • Initial position to be used for rest of levels.
  • Hooklying, tighten your core keeping back flat and slowly lift 1 leg to 90 degrees keeping your knee bent.
  • Keeping 1st leg up, slowly bring 2nd leg up to same position.
  • *“Up up position”**
37
Q

Sahrmann Core Stability Test: Level 1B – Poor (Motor Training)

A
  • He has strength he just “doesn’t know how to use it”
  • -True strength change in 8 weeks
  • For the pt that cannot perform level 1A
  • Hooklying, keeping back flat, then slide one heel along floor out to straight leg and return to starting position.
38
Q

Sahrmann Core Stability Test: Level 2 – Fair (+)

A
  • Starting in position 1A (both legs up)
  • Slowly lower 1 leg down until heel touches table
  • Slide heel along table out until leg is straight
  • Slide it back until knee is bent
  • Return to position 1A

“One heel slide”

39
Q

Sahrmann Core Stability Test: Level 3 - Good

A
  • Starting in position 1A (both legs up)
  • Slowly lower 1 leg until it is a few inches above table
  • Glide heel above table out until leg is straight
  • Glide it back until knee is bent
  • Return to position 1A

“One heel glide”

40
Q

Sahrmann Core Stability Test: Level 4 – Sport Level

A
  • Starting in position 1A (both legs up)
  • Slowly lower both legs until heels touch the table
  • Slide both heels out until both legs are straight.
  • Slide them back until knees bent
  • Return to position 1A

“Double heel slide”

41
Q

Sahrmann Core Stability Test: Level 5 – Sport Level

A
  • Starting in position 1A (both legs up)
  • Slowly lower both legs until heels are a few inches above table
  • Glide above table both legs out until legs are straight
  • Glide back until knees are bent
  • Return to position 1A

“Double heel glide”

42
Q

LE: Myotomes

A 
L2:  hip flexion
L3:  knee extension
L4:  ankle dorsiflexion
L5:  great toe extension
SI:  ankle eversion, hip extension, plantar flexion
S2:  knee flexion
43
Q

LE: Reflexes

A
  • L3-4: quadriceps
  • S1-2: Achilles
  • L5-S1 Hamstrings
44
Q

Double Inclinometer: Thoracic Flexion

45
Q

Double Inclinometer: Thoracic Extension

46
Q

Double Inclinometer: Thoracic Lateral Flexion

47
Q

Double Inclinometer: Thoracolumbar Flexion

48
Q

Double Inclinometer: Thoracolumbar Extension

49
Q

Double Inclinometer: Thoracolumbar Lateral Flexion

50
Q

Double Inclinometer: Thoracolumbar Rotation

51
Q

Double Inclinometer: Lumbar Flexion

52
Q

Double Inclinometer: Lumbar Extension

53
Q

Double Inclinometer: Lumbar Lateral Flexion

54
Q

Goni: Thoracolumbar Lateral Flexion

55
Q

Goni: Thoracolumbar Rotation

Test and Measures (8 decks)

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