Thoracic & Lumbar Spinal Mechanics Flashcards
What are the normal spinal curvatures?
Cervical lordosis
Thoracic kyphosis
Lumbar lordosis
Sacral kyphosis
Lateral Gravitational Line
External auditory canal Head of Humerus L3 Anterior 1/3 of sacrum Lateral malleolus
Thoracic vertebra features
Medium size body
Heart shaped
Costal facets present
Long spinous process
Lumbar vertebra features
Kidney shaped body
Short & broad spinous process
What makes up a vertebral unit?
Two adjacent vertebrae & their associated intervertebral disc
What is the rules of 3s?
Refers to the location of the spinous process in relation to the transverse process in the thoracic spine
Rule of 3 for T1-T3
Spinous process located at corresponding level of transverse process
Rule of 3 for T4-T6
SP located 1/2 segment below corresponding TP
Rule of 3 for T7-10
SP located @ level of TP 1 vertebra below
Rule of 3 for T11
SP is 1/2 segment below corresponding TP
Rule of 3 for T12
SP located @ same level as corresponding TP
Superior facet orientation for Cervical region
BUM
Backwards, upward, medial
Superior facet orientation for thoracic region
BUL
Backwards, upward, lateral
Superior facet orientation for lumbar region
BM
Backward, medial
Anterior longitudinal ligament
Strong, fibrous band that connects anterolateral aspects of vertebral bodies & IV discs
**prevents hyperextension (limits extension)
Posterior longitudinal ligament
Weaker band that runs in vertebral canal along posterior aspect of vertebral bodies
Resists hyperflexion & prevents posterior herniation of nucleus pulposus
Ligamentum flavum
Connects laminae of adj vertebrae
Interspinous ligaments
Connects adj SP
Intertransverse ligaments
Connect TP of adj vertebrae
Lumbar region ligaments
Anterior longitudinal ligament Iliolumbar ligament Anterior sarco-iliac ligaments Sacrotuberous ligament Sacrospinous ligament
Rotatores longus & brevis muscles
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)
Multifidus m
Mostly in lumbar region-along SP, skips 2-4 vertebrae (TP to SP)
Extend spine (flex spine unilaterally & rotate to opp side)
Semispinalis m
TP to SP
Extends thoracic & cervical spines & head (unilateral bending of head & rotate spine to opp side)
What is coupled motion?
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
What is linkage?
Relationship of joint mechanics w/ surrounding structures (linking multiple joints together increases ROM)
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
What is a restrictive barrier?
Functional limit within the anatomical range of motion (abnormally diminishes physiologic ROM)))
What is the elastic barrier?
Range between physiologic & anatomic barriers (end of passive motion)
Outcome of restrictions of motions in the spine
Reduced efficiency
Impair flow of fluids
Alter nerve function
Creates structural imbalance
Freyette’s Principles (spinal motion mechanics)
Freyette described spinal motion in 1918 (applied to thoracic & lumbar region)
**3rd principle in 1948 by CR Nelson
Type 1 Spinal Mechanics
In the neutral range, side bending & rotation are coupled in opposite directions (rotation is toward convexity of the spine)
Example of type 1 spinal mechanics
Rotate left, side bend right for a GROUP of vertebrae
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
SD for type 1 spinal mechanics
- Locate vertebrae/group
- Indicate position (N=neutral)
- Indicate side bending
- Indicate rotation
T 1-3 N S R
SD for type 2 spinal mechanics
- Locate vertebrae/group
- Indicate position (flex or extend)
- Indicate side bending
- Indicate rotation
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
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)
Testing for spinal SD
- Push anterior on right & left TP (rotational movement in transverse plane)
- Side bend L & R (restriction or ease of motion in 1 direction)
If you translate a TP to the right…
Induces left sidebending
Scapular spine
T3 TP & SP
Inferior angle of scapula
SP of T7 & TP of T8
Iliac crest
Level of L4 vertebra
Scoliosis
Lateral curvature of the spine
more common in females (2% of pop)
Dextroscoliosis
Convexity to right (frames the heart)
Levoscoliosis
Convexity to the left (obscures the heart)
PE for Scoliosis
Asymmetry of sacral base
Rib cage prominences & leg length discrepancies
Cobb angle & Forward bending test
Scoliometer
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
Complications assoc w/ scoliosis
Cobb angle
> 50: respiratory compromise
75: cardiac compromise
What could be indicated from mechanical lower back pain w/ radiation of pain below knee?
Herniated nucleus pulposus
Spinal stenosis
Cauda equina
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
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
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
Spinal stenosis
Bilateral lower limb pain
Neurogenic claudication
Typically chronic
*use MRI & straight leg test
Radiculopathy
Pain w/ Dermatome distribution
Typically acute, may become chronic
Use MRI & straight leg test
Cauda equina syndrome
EMERGENT-usually traumatic
Impaired neuro function (saddle anesthesia, lower extremity weakness & diminished reflexes, urinary retention)
**MRI
Spina bifida
Congenital anomalies where neural tube fails to completely close
Spina bifida occulta
Failure of neural tube to close w/o herniation
Meningocele
Failure of neural tube to close w/ protrusion of meninges thru the defect
Myelomeningocele
Failure of neural tube to close w/ protrusions of meninges & spinal cord thru defect
What to look for on lateral lumbar vertebrae
Vertebral bodies
Lines (anterior, posterior, SP)
IV discs
Sacralization
One of both TPs of L5 articulate w/ sacrum
Lumbarization
Failure of S1 to fuse w/ rest of sacrum
Spina bifida (on X-ray)
Defect in closure of lamina
Spondylosis
Bony spurs (at top & bottom of vertebrae bodies)
Spondylolysis
Look for “dog” fracture
Spondylolithesis
Fracture & dislocation (slipping of 1 vertebra on another)
Vagus N
Heart, lungs, esophagus, upper GI, small intestines, kidneys, ascending & transverse colon, upper ureter
S2-S4 nerves
Colon, rectum, reproductive organs, bladder, pelvis, lower ureter
T1-T5 sympathetic
Head & neck
T1-T6 sympathetics
Heart
T1-T7 sympathetics
Lungs
Pelvic splanchnic nerves
Lower genitourinary, bladder, uterus & cervix, LE, prostate, urethra & erectile tissues
T5-T10 sympathetics
Upper GI (includes lower esophagus)
T9-T11 sympathetics
Small intestine & ascending colon
T10-L2 sympathetics
Ascending & transverse colon
T12-L2 sympathetics
Descending colon & rectum
T5-T10 sympathetics
Adrenal glands
T10-L2 sympathetics
Genitourinary tract (includes bladder)
T10-T11 & T12-L2 sympathetics
Upper ureter & lower ureter
T2-T7 & T11-L2 sympathetics
Upper & lower extremities
