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OS I Fall Semester Final > Thoracic & Lumbar Spinal Mechanics > Flashcards

Thoracic & Lumbar Spinal Mechanics Flashcards

1
Q

What are the four junctions from a lateral view?

A
  • craniocervical
  • cervicothoracic
  • thoracolumbar
  • lumbosacral
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2
Q

What structures are on the gravitational line from a lateral view?

A
  • external auditory canal
  • head of the humerus
  • L3
  • anterior 1/3 of sacrum
  • lateral malleolus
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3
Q

What is the curve of the cervical spine?

A

lordosis

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4
Q

What is the curve of the thoracic spine?

A

kyphosis

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5
Q

What is the curve of the lumbar spine?

A

lordosis

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6
Q

What is the curve of the sacral spine?

A

kyphosis

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7
Q

Name three traits of the body of a thoracic vertebra?

A
  • medium size
  • heart shape
  • costal facets
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8
Q

Name two traits of the spinous processes of a thoracic vertebra?

A
  • long

- slope postero-inferiorly

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9
Q

Name two traits of the body of a lumbar vertebra?

A
  • large size

- kidney shape

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10
Q

Name two traits of the spinous processes of a lumbar vertebra?

A
  • short

- broad

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11
Q

What constitutes a vertebral unit?

A

-two adjacent vertebrae and their associated intervertebral disc

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12
Q

Where are the spinous processes of T1-T3 in relation to the transverse processes?

A

at the same level

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13
Q

Where are the spinous processes of T4-T6 in relation to the transverse processes?

A

half a segment below

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14
Q

Where are the spinous processes of T7-T10 in relation to the transverse processes?

A

at the same level of the transverse process of the vertebra below

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15
Q

Where is the spinous process of T11 in relation to the transverse process?

A

half a segment below

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16
Q

Where is the spinous process of T12 in relation to the transverse process?

A

at the same level

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17
Q

What is the orientation of the superior facets for each spinal region?

A

Cervical - backwards, upwards, medial
Thoracic - backwards, upwards, lateral
Lumbar - Backwards, medial
BUM BUL BM

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18
Q

What is the anterior longitudinal ligament?

A
  • strong, broad fibrous band
  • covers/connects anterolateral aspects of vertebral bodies and IV discs
  • limits extension
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19
Q

What is the posterior longitudinal ligament?

A
  • narrow, somewhat weak band
  • runs within vertebral canal along posterior aspect of vertebral bodies
  • resists hyperflexion
  • prevents posterior herniation of nucleus pulposus
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20
Q

What is the ligamentum flavum?

A

connects the lamina of adjacent vertebrae

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21
Q

What are the interspinous ligaments?

A

connect adjoining spinous processes

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22
Q

What are the intertransverse ligaments?

A

connect adjoining transverse processes

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23
Q

Where are the rotatores (brevis and longus), and what do they connect?

A
  • brevis connects transverse process and spinous process of adjacent vertebrae (T2-T12)
  • longus connects transverse process to spinous process two above (T3-T12)
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24
Q

Where are the multifidus and what do they connect?

A

connect mammillary processes of L1-L5, sacrum and ilium … superomedially to spinous process 3-5 vertebrae above

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25
Q

What is the origin/insertion/action of semispinalis capitis?

A

O: transverse and articular process of C4-T7
I: occipital bone b/w inferior/superior nuchal line

A: extend head and spine, rotate to opposite side; sidebend to same side

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26
Q

What is the origin/insertion/action of semispinalis cervicis?

A

O: transverse processes of T1-T6
I: spinous processes of C2-C5

A: extend spine, rotate to opposite side, sidebend to same side

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27
Q

What is the origin/insertion/action of semispinalis thoracis?

A

O: transverse process of T6-T12
I: spinous processes of C6-T4

A: extend spine, sidebend to same side, rotate opposite

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28
Q

Vertebral ranges of motion

A

Flexion: 40-90 degrees
Extension: 20-45 degrees
Sidebending: 15-30 degrees
Rotation: 3-18 degrees

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29
Q

What is coupled motion?

A
  • consistent association of a motion along one axis w/ another motion along a second axis
  • principle motion cannot be produced w/o the associated motion occurring as well
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30
Q

What is linkage?

A

-relationship of joint mechanics w/ surrounding structures

  • linkage = increased range of motion
  • can be normal or a result of compensation
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31
Q

What part of the vertebrae is used as the point of reference when describing motion?

A

the anterior or superior surface

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32
Q

In a vertebral unit, excessive movement or restriction of movement is in reference to what?

A

the upper vertebra

ex: excess motion of L2 is the motion of L2 on L3

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33
Q

What is the physiologic barrier?

A

limit of active motion

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34
Q

What is the anatomic barrier?

A

limit of passive motion

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35
Q

What is the elastic barrier?

A

range between the physiologic barrier and anatomic barrier

36
Q

What is a restrictive barrier?

A
  • limit within the anatomical range of motion

- abnormally diminishes the normal physiologic range

37
Q

What happens when a restrictive barrier is introduced?

A

-shifted neutral

38
Q

What are some consequences of spinal restricted motion?

A
  • reduce efficiency
  • impair flow of fluids
  • alter nerve function
  • creates structural imbalance
39
Q

What did Harrison Fryette’s “Fryette’s Principles” (published in 1918) describe?

A
  • Type I Spinal Mechanics: in neutral, sidebending and rotation are opposite; tends to be a group of vertebrae
  • Type II: in flexion/extension, sidebending and rotation are in same direction; tends to be a single vertebra
40
Q

What spinal muscles are mainly responsible for Fryette’s Type II Mechanics?

A

rotatores m.

41
Q

Who developed Fryette’s Third Principle in 1948?

A

C.R. Nelson, DO

42
Q

What is Fryette’s Third Principle?

A
  • initiating movement of a vertebral segment in any plane of motion will modify movement of that segment in other planes of motion
    ex: if motion is restricted in one direction, motion will also be restricted in other directions (same for improved motion)
43
Q

What transverse process and spinous process is at the level of the spine of the scapula?

A

T3 transverse process

T3 spinous process

44
Q

What transverse process and spinous process is at the level of the inferior angle of the scapula?

A

T8 transverse process

T7 spinous process

45
Q

What vertebra is at the level of the iliac crest?

A

L4

46
Q

What is scoliosis?

A

lateral curvature of the spine

-named toward the convexity:
dextroscoliosis (frames the heart)
levoscoliosis (obscures the heart)

47
Q

What is the important angle of measurement for scoliosis?

A

-Cobb Angle

48
Q

How do you measure a Cobb Angle?

A

Draw a line along the top of the first vertebral segment affected and along the bottom of the last vertebral segment affected, draw a perpendicular line off each, where the two intersect, the superior/inferior angles are the Cobb Angle

49
Q

How would you manage scoliosis w/ a Cobb Angle less than 25 degrees?

A

OMT

-monitor w/ frequent radiographs

50
Q

How would you manage scoliosis w/ a Cobb Angle between 25-45 degrees?

A

non-operative bracing

51
Q

How would you manage scoliosis w/ a Cobb Angle greater than 50 degrees?

A

-surgical fusion (prevents progression)

52
Q

What is a complication of scoliosis w/ a Cobb Angle greater than 50 degrees?

A

respiratory compromise

53
Q

What is a complication of scoliosis w/ a Cobb Angle greater than 75 degrees?

A

cardiac compromise

54
Q

What is radiculopathy?

A
  • pain with dermatomal distribution
  • possible neurological impairment:
  • -lower extremity weakness
  • -diminished reflexes
  • typically acute, may become chronic
55
Q

What diagnostic imagine would you get to diagnose radiculopathy?

A

-MRI

56
Q

What clinical test would you do to diagnose radiculopathy?

A

-straight leg raise test

57
Q

How do you conduct a straight leg raise test?

A

-pt. supine, raise leg w/ knee extended

58
Q

What indicates a positive straight leg raise test?

A

-pain b/w 15-30 degrees indicates lumbar disc etiology

59
Q

What are symptoms of herniated nucleus pulposus in the L4-L5 disc?

A
  • pain in SI joint, hip, lateral thigh, leg
  • numbness in lateral leg, first three toes
  • weakness in dorsiflexion
  • difficulty walking on heel
60
Q

What are symptoms of herniated nucleus pulposus in the L5-S1 disc?

A
  • pain in SI joint, hip, posterolateral thigh, leg to heel
  • numbness in back of calf, lateral heel, foot to toe
  • weakness in plantarflexion
  • difficulty walking on toes
  • atrophy of gastrocnemius and soleus mm.
61
Q

What is spinal stenosis?

A
  • bilateral lower limb pain
  • neurogenic claudication
  • possible neurological impairment
  • -lower extremity weakness
  • -diminished reflexes
  • typically chronic
62
Q

What diagnostic imagining would you get to diagnose spinal stenosis?

A

-MRI

63
Q

What clinical exam would you perform to diagnose spinal stenosis?

A

-straight leg raise test

64
Q

What is cauda equina syndrome?

A
  • usually traumatic; emergency
  • impaired neurological function
  • -saddle anesthesia
  • -lower extremity weakness
  • -diminished reflexes
  • -urinary retention
65
Q

What diagnostic imaging would you get to diagnose cauda equina syndrome?

A

MRI

66
Q

What causes spina bifida occulta?

A

failure of the neural tube to close

-w/o herniation

67
Q

What causes a meningocele?

A

failure of the neural tube to close

-w/ protrusion of the meninges through the defect

68
Q

What causes a myelomeningocele?

A

failure of the neural tube to close

-w/ protrusion of the meninges and spinal cord

69
Q

What is sacralization?

A

-one or both transverse processes of L5 are long and articulate with the sacrum

70
Q

What is lumbarization?

A

-failure of S1 to fuse with the rest of the sacrum

not common

71
Q

What is spina bifida?

A

defect in the closure of the lamina

72
Q

What are the spinal levels of the viscerosomatic reflexes of the head and neck (includes upper esophagus)?

A

T1-T5

73
Q

What are the spinal levels of the viscerosomatic reflexes of the heart?

A

T1-T6

74
Q

What are the spinal levels of the viscerosomatic reflexes of the lungs?

A

T1-T7

75
Q

What are the spinal levels of the viscerosomatic reflexes of the upper GI system (including lower esophagus)?

A

T5-T10

76
Q

What are the spinal levels of the viscerosomatic reflexes of the small intestine and ascending colon?

A

T9-T11

77
Q

What are the spinal levels of the viscerosomatic reflexes of the ascending and transverse colon?

A

T10-L2

78
Q

What are the spinal levels of the viscerosomatic reflexes of the descending colon, sigmoid colon, and rectum?

A

T12-L2

79
Q

What are the spinal levels of the viscerosomatic reflexes of the adrenal region?

A

T5-T10

80
Q

What are the spinal levels of the viscerosomatic reflexes of the genitourinary (including bladder) tract?

A

T10-L2

81
Q

What are the spinal levels of the viscerosomatic reflexes of the upper ureter?

A

T10-T11

82
Q

What are the spinal levels of the viscerosomatic reflexes of the lower ureter?

A

T12-L2

83
Q

What are the spinal levels of the viscerosomatic reflexes of the upper extremities?

A

T2-T7

84
Q

What are the spinal levels of the viscerosomatic reflexes of the lower extremities?

A

T11-L2

85
Q

What organs’ parasympathetics are controlled by the vagus N.?

A

Heart, lungs, esophagus, upper GI, small intestine, kidneys, ascending colon, transverse colon, upper ureter

86
Q

What organs’ parasympathetics are controlled by S2-S4, pelvic splanchnic nerves?

A

colon, rectum, reproductive organs, bladder, pelvis, lower ureter

OS I Fall Semester Final (2 decks)

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