Thoracic Cage, Lumbar SD, and Vertebral Mechanics Flashcards
What is the orientation of the superior facets in the cervical region?
Thoracic Region?
Lumbar Region?
BUM: Backward, upward, medial
BUL: Backward, upward, later
BM: Backward, medial
What prevents backwards extension?
Anterior Longitudinal Ligament
What connects the laminae to adjacent vertebra?
Ligamentum Flava
What ligament resists hyper flexion?
Posterior Longitudinal Ligament
Between Posterior and Anterior Longitudinal Lig, which one is weaker?
Posterior
What ligament connects spinous processes? Transverse processes?
Interspinous Ligaments
Intertransverse Ligaments
What are the 3 primary muscles we talked about that EXTEND the back when used bilaterally?
Rotatores
Multifidis
Semispinalis
What do the rotatores muscles do unilaterally?
bilaterally?
Rotates thoracic spine to the opposite side
extends the thoracic spine
What do the multifidis muscles do unilaterally? Bilaterally?
Flexes spine to same side, rotates to the opposite side
Extends the spine
What do the semispinalis muscles do unilaterally?
Bilaterally?
Bends the head, cervical, and thoracic spines to the same side, rotates to opposite
extends thoracic and cervical spines and head
What is coupled motion?
association of motion along or about one axis with another motion about or along a second axis.
this motion cannot work without them both!
What is linkage?
relationship of joint mechanics with surrounding structures.
linking stuff increases range of motion.
specific joint assessment requires joint isolation for accurate measurement and evaluation.
still moves though.
What are the different barriers?
Physiologic barrier = what the patient can do
anatomic barrier = limit of motion imposed by anatomic structure = limit of passive motion. (what the physician can do)
restrictive barrier - functional limit within the anatomic range of motion. diminishes normal range
What’s between anatomic and physiologic barrier?
Elastic
What happens if you restrict motion in the spine?
reduce efficiency
impair flow of fluids
alter nerve function
structural imbalance
What are Fryette’s principles?
TONGO
Type 2 = same w/ flexion/extension component. not grouped
What are the spinal landmarks?
T3 spine of the scapula (also
What is Scoliosis? What population is it worse in?
What are the two types?
Lateral curvature of the spine. more common in females.
Dextroscoliosis = curving to the lateral right
Levoscoliosis = curving to the lateral left
How do you assess if someone has scoliosis?
have them bend over (forward bending test) and you’ll see the rib cage come up or its just super prominent.
Cobb angle is often used as well.
Scoliometer
How do you know how bad scoliosis is? what are the parameters?
what are the bad angles to be at?
Based on the Cobb angle
less than 25 degrees = monitor with frequent radiographs and OMT
25-45 degrees = non operative = bracing to help recorrect
greater than 45 = surgical fusion to prevent progression
respiratory compromise = 50
cardiac compromise = >75
What are the 3 different mechanical Low back pains?
Radiculopathy
Spinal Stenosis
Cauda Equina Syndrome
What is radiculopathy?
herniated disc
nucleus pulposus impinge on the nerve roots.
they are associated with dermatomes so you’ll have pain and neurologic dysfunction.
diminished reflexes.
typically acute but may become chronic.
how do you know it’s radiculopathy?
how do you know they are falsifying it (malingering)
MRI
(+) straight leg test (raise leg with knee extended and if they say it’s painful and it occurs from 15 to 30 degrees that’s a lumbar etiology.
hold your hand under the contralateral leg that you don’t think is injured. as they raise the leg they’ll push down with the other leg.. indicates that the patient is trying.
What happens to someone who has a herniated L4-5 disc?
pain on the hip and lateral thigh.
numb on first three toes and lateral leg
CAN’T WALK ON HEEL since they can’t lift the foot
What happens to someone who has a herniated disc of L5-S1?
pretty much the same but THEY CAN’T WALK ON THEIR TOES!!
atrophy of gastric or soleus
What is spinal stenosis?
pain bilaterally in lower limbs
neurogenic claudication (pain or cramping due to obstruction of that spinal cord)
CHRONIC
how do you know you have spinal stenosis
MRI and + straight leg test
Cauda Equina Syndrome? why is it so bad?
what is saddle anesthesia?
what other major symptom are they going to present with?
this is worst of the 3 types
protrusion impingement can cause permanent and acute neurological damage.
the part that contacts the saddle is numb
“doc I can’t pee”
What is Spina Bifida?
Neural tube doesn’t form so you have spinal cord opening
Spina Bifida Occulta?
Meningocele
Myelomeningocele
Tuft of hair. no herniation at all, all in the spinal canal
protrusion of meninges in the defect. not that bad
worst one. spinal cord floats out into the protrusion
what’s the first thing you do in the radiographic imaging of lumbar?
second?
third?
vertebral bodies = look for color or breaks.
Lines - smooth anterior line
smooth curve of posterior and look at the spinous processes
intervertebral discs. should be evenly spaced.
What is sacralization?
Lumbarization?
fusion of L5 to the sacrum. articulates with the sacrum.
S1 doesn’t fuse to the rest of the sacrum so it’s by itself like a lumbar vertebra.
What is spondylosis?
spondylolysis
spondylolesthesis
bony spurs on the edges of the vertebral bodies. they create these hook like things
“Scotty dog”.. you have a fracture that makes it look like the dog’s collar
fracture + slipping of one vertebra on another
What are the Viscerosomatic Reflexes?
punt
