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Thoracic & Lumbar Spinal Mechanics Flashcards

1
Q

What are the normal spinal curvatures?

A

Cervical lordosis
Thoracic kyphosis
Lumbar lordosis
Sacral kyphosis

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2
Q

Lateral Gravitational Line

A 
External auditory canal
Head of Humerus
L3
Anterior 1/3 of sacrum
Lateral malleolus
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3
Q

Thoracic vertebra features

A

Medium size body
Heart shaped
Costal facets present
Long spinous process

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4
Q

Lumbar vertebra features

A

Kidney shaped body

Short & broad spinous process

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5
Q

What makes up a vertebral unit?

A

Two adjacent vertebrae & their associated intervertebral disc

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6
Q

What is the rules of 3s?

A

Refers to the location of the spinous process in relation to the transverse process in the thoracic spine

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7
Q

Rule of 3 for T1-T3

A

Spinous process located at corresponding level of transverse process

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8
Q

Rule of 3 for T4-T6

A

SP located 1/2 segment below corresponding TP

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9
Q

Rule of 3 for T7-10

A

SP located @ level of TP 1 vertebra below

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10
Q

Rule of 3 for T11

A

SP is 1/2 segment below corresponding TP

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11
Q

Rule of 3 for T12

A

SP located @ same level as corresponding TP

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12
Q

Superior facet orientation for Cervical region

A

BUM

Backwards, upward, medial

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13
Q

Superior facet orientation for thoracic region

A

BUL

Backwards, upward, lateral

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14
Q

Superior facet orientation for lumbar region

A

BM

Backward, medial

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15
Q

Anterior longitudinal ligament

A

Strong, fibrous band that connects anterolateral aspects of vertebral bodies & IV discs

**prevents hyperextension (limits extension)

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16
Q

Posterior longitudinal ligament

A

Weaker band that runs in vertebral canal along posterior aspect of vertebral bodies

Resists hyperflexion & prevents posterior herniation of nucleus pulposus

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17
Q

Ligamentum flavum

A

Connects laminae of adj vertebrae

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18
Q

Interspinous ligaments

A

Connects adj SP

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19
Q

Intertransverse ligaments

A

Connect TP of adj vertebrae

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20
Q

Lumbar region ligaments

A 
Anterior longitudinal ligament
Iliolumbar ligament
Anterior sarco-iliac ligaments
Sacrotuberous ligament
Sacrospinous ligament
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21
Q

Rotatores longus & brevis muscles

A

Longus: TP to SP to 1 vertebra above
Brevis: TP to SP of adj vertebra

*extend thoracic spine (unilateral rotate thoracic spine to opp side)

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22
Q

Multifidus m

A

Mostly in lumbar region-along SP, skips 2-4 vertebrae (TP to SP)

Extend spine (flex spine unilaterally & rotate to opp side)

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23
Q

Semispinalis m

A

TP to SP

Extends thoracic & cervical spines & head (unilateral bending of head & rotate spine to opp side)

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24
Q

What is coupled motion?

A

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 without the assoc motion occurring as well

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25
What is linkage?
Relationship of joint mechanics w/ surrounding structures (linking multiple joints together increases ROM)
26
Vertebral motion
Motion is always referenced to anterior/superior surface of vertebra Excessive motion is in reference to vertebra above in a functional vertebral unit
27
What is a restrictive barrier?
Functional limit within the anatomical range of motion (abnormally diminishes physiologic ROM)))
28
What is the elastic barrier?
Range between physiologic & anatomic barriers (end of passive motion)
29
Outcome of restrictions of motions in the spine
Reduced efficiency Impair flow of fluids Alter nerve function Creates structural imbalance
30
Freyette’s Principles (spinal motion mechanics)
Freyette described spinal motion in 1918 (applied to thoracic & lumbar region) **3rd principle in 1948 by CR Nelson
31
Type 1 Spinal Mechanics
In the neutral range, side bending & rotation are coupled in opposite directions (rotation is toward convexity of the spine)
32
Example of type 1 spinal mechanics
Rotate left, side bend right for a GROUP of vertebrae
33
Type 2 spinal mechanics
In sufficient flexion or extension, side bending & rotation are coupled in the same direction (rotation toward concavity) Tends to be a single vertebra
34
SD for type 1 spinal mechanics
1. Locate vertebrae/group 2. Indicate position (N=neutral) 3. Indicate side bending 4. Indicate rotation T 1-3 N S R
35
SD for type 2 spinal mechanics
1. Locate vertebrae/group 2. Indicate position (flex or extend) 3. Indicate side bending 4. Indicate rotation
36
3rd spinal motion mechanics principle
Initiating movement of vertebral segment in any 1 plane of motion will modify the movement of that segment in other planes of motion
37
SD according to 3rd principle
If motion is restricted in 1 direction, motion will also be restricted to other directions (vice versa for improvements in motion)
38
Testing for spinal SD
1. Push anterior on right & left TP (rotational movement in transverse plane) 2. Side bend L & R (restriction or ease of motion in 1 direction)
39
If you translate a TP to the right...
Induces left sidebending
40
Scapular spine
T3 TP & SP
41
Inferior angle of scapula
SP of T7 & TP of T8
42
Iliac crest
Level of L4 vertebra
43
Scoliosis
Lateral curvature of the spine more common in females (2% of pop)
44
Dextroscoliosis
Convexity to right (frames the heart)
45
Levoscoliosis
Convexity to the left (obscures the heart)
46
PE for Scoliosis
Asymmetry of sacral base Rib cage prominences & leg length discrepancies Cobb angle & Forward bending test Scoliometer
47
Management of scoliosis w/ OMT
Cobb angle <25: conservative, monitor w/ X rays 25-45: non-operative, use braces >50: surgical fusion to prevent progression
48
Complications assoc w/ scoliosis
Cobb angle >50: respiratory compromise >75: cardiac compromise
49
What could be indicated from mechanical lower back pain w/ radiation of pain below knee?
Herniated nucleus pulposus Spinal stenosis Cauda equina
50
How do you assess mechanical lower back pain?
Straight leg raise test + test=pain (reproducing symptoms)...if between 15-30 degrees will indicate lumbar disc etiology
51
Herniated L4-L5 disc
Pain in hip, thigh, anterolateral leg, first 3 toes Weak dorsiflexion & difficult to walk on heel Diminished to absent internal hamstring reflex
52
Herniated L5 to S1 disc
Pain in hip & posterolateral thigh & from leg to heel Weak plantarflexion & difficult to walk on toes Atrophy in gastrocnemius & soleus Ankle jerk diminished or absent
53
Spinal stenosis
Bilateral lower limb pain Neurogenic claudication Typically chronic *use MRI & straight leg test
54
Radiculopathy
Pain w/ Dermatome distribution Typically acute, may become chronic Use MRI & straight leg test
55
Cauda equina syndrome
EMERGENT-usually traumatic Impaired neuro function (saddle anesthesia, lower extremity weakness & diminished reflexes, urinary retention) **MRI
56
Spina bifida
Congenital anomalies where neural tube fails to completely close
57
Spina bifida occulta
Failure of neural tube to close w/o herniation
58
Meningocele
Failure of neural tube to close w/ protrusion of meninges thru the defect
59
Myelomeningocele
Failure of neural tube to close w/ protrusions of meninges & spinal cord thru defect
60
What to look for on lateral lumbar vertebrae
Vertebral bodies Lines (anterior, posterior, SP) IV discs
61
Sacralization
One of both TPs of L5 articulate w/ sacrum
62
Lumbarization
Failure of S1 to fuse w/ rest of sacrum
63
Spina bifida (on X-ray)
Defect in closure of lamina
64
Spondylosis
Bony spurs (at top & bottom of vertebrae bodies)
65
Spondylolysis
Look for “dog” fracture
66
Spondylolithesis
Fracture & dislocation (slipping of 1 vertebra on another)
67
Vagus N
Heart, lungs, esophagus, upper GI, small intestines, kidneys, ascending & transverse colon, upper ureter
68
S2-S4 nerves
Colon, rectum, reproductive organs, bladder, pelvis, lower ureter
69
T1-T5 sympathetic
Head & neck
70
T1-T6 sympathetics
Heart
71
T1-T7 sympathetics
Lungs
72
Pelvic splanchnic nerves
Lower genitourinary, bladder, uterus & cervix, LE, prostate, urethra & erectile tissues
73
T5-T10 sympathetics
Upper GI (includes lower esophagus)
74
T9-T11 sympathetics
Small intestine & ascending colon
75
T10-L2 sympathetics
Ascending & transverse colon
76
T12-L2 sympathetics
Descending colon & rectum
77
T5-T10 sympathetics
Adrenal glands
78
T10-L2 sympathetics
Genitourinary tract (includes bladder)
79
T10-T11 & T12-L2 sympathetics
Upper ureter & lower ureter
80
T2-T7 & T11-L2 sympathetics
Upper & lower extremities

OS (18 decks)

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