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MSK > THORACOLUMBAR > Flashcards

THORACOLUMBAR Flashcards

1
Q

True Ribs

A

Ribs 1-7

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2
Q

False Ribs

A

Ribs 8-10

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3
Q

Floating Ribs

A

Ribs 11-12

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4
Q

Caliper Action

A

11-12 (lateral)

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5
Q

Bucket Handle Rotation

A

7-10 (forward, backward, and lateral)

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6
Q

Pump Handle Action

A

1-6 (anteroposterior)

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7
Q

Spondylosis

A

degenerative changes in the intervertebral disc

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8
Q

Spondylolysis

A

defect in the pars interarticularis or arch of vertebra

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9
Q

Spondylolisthesis

A

anterior displacement

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10
Q

Retrolisthesis

A

backward displacement

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11
Q

Lumbarization

A

S1 becomes the sixth lumbar vertebrae

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12
Q

Sacralization

A

L5 fuses with sacrum and coccyx

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13
Q

Lumbar Facet

A

carries 20-25% of axial loading

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14
Q

T7

A

greatest spinous process angulation; upper limb rotation alternates with lower limb rotation

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15
Q

Annulus Fibrosus

A

outer layer; strength and torsional movements

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16
Q

Nucleus Pulposus

A

85-90% of water; decreases to 65% with age; avascular; slightly posterior

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17
Q

Schmorl’s Nodules

A

herniations of nucleus pulposus

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18
Q

Disc Protrusion

A

disc bulges posteriorly without rupture of annulus fibrosus; affects nerve root below

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19
Q

Disc Prolapse

A

annulus fibrosus contains the nucleus

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20
Q

Disc Extrusion

A

annulus fibrosus is perforated and disc material flows into the epidural space

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21
Q

Sequestrated Disc

A

discal fragments form outside the disc proper

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22
Q

Cauda Equina

A

saddle anesthesia; bladder/ bowel dysfunction

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23
Q

Lifting a 20kg with back bent and knees forward

A

169% of disc pressure at L3

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24
Q

Walking

A

15% of disc pressure at L3

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25
Q

Coughing or Straining

A

5-35% of disc pressure at L3

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26
Q

Bending Forward

A

150% of disc pressure at L3

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27
Q

Scheuermann’s Disease

A

13-16 years old

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28
Q

Idiopathic Scoliosis

A

adolescents

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29
Q

Lumbar Disc Problems

A

15-40 y/o

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30
Q

Ankylosing Spondylitis

A

18-45 y/o
male

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31
Q

Spondylosis and OA

A

> 45 y/o

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32
Q

Malignancy

A

> 50 y/o

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33
Q

Scoliosis and LBP gender predisposition

A

females d/t menstruation
(ask: changes in menstruation, altered pain pattern, irregular menstruation, swelling of abdomen and breast)

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34
Q

Pain in thoracic disc lesion

A

no pain in active movements

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35
Q

Pain in nerve root/ spondylosis of thoracic

A

“through the chest pain”

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36
Q

Pain in breathing

A

pulmonary issues; trauma, structural deformities, thoracic pathologies

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37
Q

Pain referred around the chest

A

costovertebral in origin

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38
Q

Pain on true thoracic ribs

A

Localized

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39
Q

Constant ache

A

mechanical, inflammation

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40
Q

Pain on movement

A

mechanical stimulus

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41
Q

Pain accumulates with activity

A

repetitive mechanical stress, inflammation, and degenerative disc

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42
Q

Pain increases with sustained posture

A

fatigue on supporting muscles, gradual creep of tissues

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43
Q

Latent nerve root pain

A

Movement produces acute and temporary neuropraxia

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44
Q

Facet syndromes

A

local pain but can also be referred; ROM is same (restricted from the beginning)

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45
Q

Mechanical LBP/ Lumbago

A

unilateral with no referral to knee (muscle strain/ sprain);

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46
Q

Muscles and Ligaments Affectation

A

movements will decrease and pain will increase

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47
Q

Bilateral pain

A

disc injury, central protrusion, spondylolisthesis, spinal stenosis, metastasis

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48
Q

Thoracic Nerve Pain

A

severe referred in a sloping band along intercostal space

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49
Q

Lumbar Disc Protrusion

A

pain in back and buttocks

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50
Q

Lumbar and Sacroiliac Pain

A

back and posterior leg (lateral aspect)

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51
Q

Hip Pain

A

groin and anterior thigh (medial side of knee)

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52
Q

Pressure on nerve root sheath d/t disc lesion

A

pain followed by paresthesia

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53
Q

Paresthesia without pain

A

cord compression, diabetes, pernicious anemia, multiple sclerosis

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54
Q

Upper lumbar/ lower thoracic disc lesions

A

septic, metabolic disorders, tumors, rheumatic inflammation

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55
Q

Dural Pain

A

coughing, sneezing, straining on thoracic region
extra segmental and felt at larger areas in the lumbar

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56
Q

Radicular Pain

A

felt on 1 dermatome in lumbar

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57
Q

Aggravating Movements in Thoracic

A

active use of arms
pushing and pulling

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58
Q

Costal Pain

A

overhand arm motions and breathing

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59
Q

Intrathecal Pressure

A

lumbar spine affectation (neurological tissue)

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60
Q

Disc Pathology

A

inc in sitting, light twisting, and bending

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61
Q

Relieving Factors in Thoracic

A

raising or bracing arms facilitates accessory muscles of respiration

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62
Q

Acute Back Pain

A

3-4 weeks

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63
Q

Subacute Back Pain

A

up to 12 weeks

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64
Q

Chronic Back Pain

A

> 3 mos
accompanied by deconditioning syndrome

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65
Q

Predictors of Chronicity within 6-8 weeks of Back Pain (Yellow Flags)

A

nerve root pain/ spinal pathology
severity of pain during acute phase
beliefs about pain being work related
psychosocial aspects of work
psychological distress
compensation
time off work
longer someone is off work= lower probability to return to work

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66
Q

Sitting upright into full extension

A

facet pathology

67
Q

Sitting increases pain

A

sustained flexion causing mechanical deformation of the spine/ discogenic pain

68
Q

Forward flexed posture

A

anterior vertebral compression fx

69
Q

Pain on standing relieved by walking & pain on forward flexion s substantial muscle spasm

A

disc involvement in lumbar spine

70
Q

Pain inc in relaxed standing, walking, and prone

A

extension as cause of pain

71
Q

Stiffness or pain after rest

A

Ankylosing Spondylosis or Scheuermann’s Disease

72
Q

Unilateral pain in upper sacroiliac region or groin in extension

A

Iliolumbar Ligament

73
Q

Difficulty in moving into a seated position

A

lumbar instability or lumbar muscle spasm

74
Q

Progressive pain in supine or no relieving position

A

neurogenic or space occupying lesion

75
Q

Postural/ Static

A

spasm or adaptive shortening (iliopsoas)

76
Q

Phasic/ Dynamic

A

abdominals (atrophy)

77
Q

Referred pain for costovertebral, costotransverse, and ribs

A

along the ribs

78
Q

Referred pain for lumbar/ SI

A

buttocks, posterior leg, or lateral aspect of leg

79
Q

Referred pain for cardiac

A

C4-T2 (posteriorly)

80
Q

Referred pain for stomach

A

T6-T8 posteriorly

81
Q

Referred pain for ulcers

A

T4-T6

82
Q

Visceral pain

A

abdominal structures: stomach, liver, pancreas
vague, dull, discrete
follows dermatome
accompanied by nausea

83
Q

Centralization

A

centered on lumbar spine
no radiculation
mechanical LBP

84
Q

Peripheralization

A

moves to the limb

85
Q

Mechanical Low Back Pain

A

cyclic pain
referred to buttocks and thighs
morning stiffness and pain
start pain
pain in forward flexion and returning to erect position
aggravated by extension, side flexion, rotation, walking, standing, sitting, and exercise
relieved by lying down (fetal position) and change in position
pain worsens throughout the day

86
Q

4 Categories of LBP

A

Mechanical LBP/ Back Pain
>disc involvement
>facet joint involvement (strain)
Non-Mechanical LBP/ Leg Pain
>nerve root involvement
>neurogenic intermittent claudication

87
Q

Waddell’s signs

A

pts that need more intense psychosocial examination

88
Q

Acute Back Pain

A

some degree of antalgic painful posture
loss of lumbar lordosis
lateral shift
involuntary d/t muscle spasm

89
Q

Spinal Dysraphism

A

incomplete fusion of the spinal neural tube; manifests as excessive midline hair

90
Q

Herpes Zoster (Shingles)

A

unilat pain on thoracic spine that manifests with erythema

91
Q

Cafe Au Lait Spots

A

neurofibromatosis or collagen disease appearing like a birthmark

92
Q

Spina Bifida Oculta

A

faun’s beard tuff along the spine that can indicate dystrophies

93
Q

Step Deformity in the Lumbar Spine

A

Spondylitic Spondylolisthesis: vertebra above
Spondylolytic Spondylolisthesis:
affected vertebra

94
Q

Normal Alignment of the Scapula to the Thoracic Spine

A

medial edge: T3
inferior angle: T7-9
medial border: ~5cm lat to spinous process

95
Q

Breathing

A

children: abdominally
women: upper thoracic
men: upper and lower thoracic
aged: lower thoracic and abdominally

96
Q

Pigeon Chest/ Pes Carinatum

A

sternum projects downward and forward
increased anteroposterior diameter
restricting ventilation volume

97
Q

Funnel Chest/ Pes Excavatum

A

sternum projects posteriorly due to overgrowth of ribs
anteroposterior diameter is decreased
when breathing, sternum is depressed and kyphosis

98
Q

Barrel Chest

A

common in pts c emphysema
sternum projects forward and upward
increased anteroposterior diameter

99
Q

Depressed Rib in Breathing

A

in inhalation, ribs stopped moving relative to others
highest restricted rib

100
Q

Elevated Rib in Breathing

A

in exhalation, ribs stopped moving relative to others
lowest restricted rib

101
Q

Rib Spring

A

pain when stressing the joint; sign of hypomobility

102
Q

Anteroposterior Movement Palpation

A

pt supine; PT’s hands on upper chest

103
Q

Lateral Movement Position

A

from axilla to the lateral aspect of rib cage
check for pump handle, bucket handle, and caliper action when breathing

104
Q

Structural Rib Dysfunction

A

subluxation or dislocation

105
Q

Torsional Rib Dysfunction

A

hypomobility or hypermobility

106
Q

Respiratory Rib Dysfunction

A

hypomobility of the intercostal spaces, costovertebral, costotransverse

107
Q

Rib Hypermobility

A

elevates relative to the transverse process

108
Q

Rib Hypomobility

A

stops to move before thoracic spine

109
Q

Anterior Subluxation of Rib

A

less prominent rib angle

110
Q

Posterior Subluxation of Rib

A

more prominent rib angle

111
Q

Superior First Subluxation of Rib

A

superior aspect of first rib is elevated

112
Q

Anterior Posterior Rib Compression

A

less prominent rib angle and prominent axillary line

113
Q

Lateral Compression of Rib

A

more prominent rib angle and less prominent midaxillary line

114
Q

External Rib Torsion

A

superior border is prominent

115
Q

Internal Rib Torsion

A

inferior border is prominent

116
Q

Inhalation Restriction

A

rib angle cease rising

117
Q

Exhalation Restriction

A

rib angle stops falling

118
Q

Kyphosis

A

normal 20-40 deg
inc with age (>40 y/o); specifically in females
check for T4-T12 angle (cobb’s method)

119
Q

Hyperkyphosis

A

> 40 deg
limited forward flexion

120
Q

Round Back Posture

A

dec pelvic inclination of about 20 deg
kyphosis

121
Q

Structural Kyphosis

A

d/t tightened muscles from prolonged posture or structural deformities
compensate and maintain center of gravity

122
Q

Scheuermann’s Disease

A

adolescents; structural kyphosis

123
Q

Gibbus/ Hump Back Deformity

A

sharp posterior angulation of one or two thoracic vertebrae
structural kyphosis
pelvic inclination is normal (30 deg)

124
Q

Flat Back Posture

A

decreased pelvic inclination of 20 deg
mobile thoracic spine
no presence of excessive kyphosis

125
Q

Dowager’s Hump

A

postmenopausal osteoporosis
anterior wedge of upper and middle thoracic spine
decreased height

126
Q

Non Structural or Functional Scoliosis

A

mechanical or muscle spasm
scoliotic curve disappears on forward flexion
straight shift

127
Q

Structural Scoliosis

A

genetic, idiopathic, congenital problems (spine affectation)
scoliotic curve maintains on forward flexion
compensating curves that does not disappear
lateral shift

128
Q

Convex

A

ribs pushed posteriorly (posterior rib hump)
vertebral body
ribs are farther apart
lamina is thicker
intervertebral disc is wider
vertebral canal is wider

129
Q

Concave

A

ribs pushed anteriorly
spinous process
ribs are closer together
lamina is thinner
intervertebral disc in narrower
vertebral canal is narrower

130
Q

Dextroscoliosis

A

convexity on right

131
Q

Levoscoliosis

A

convexity on left

132
Q

Torticollis

A

apex on C1-C6

133
Q

Cervicothoracic Curve

A

apex on C7 or T1

134
Q

Thoracic Curve

A

apex between T2-T11

135
Q

Thoracolumbar Curve

A

apex at T12 or L1

136
Q

Lumbar Curve

A

apex bet L2-L4

137
Q

Lumbosacral Curve

A

apex at L5 or S1

138
Q

Normal Pelvic Tilt

A

10-13 deg

139
Q

Severe Scoliosis/ Razorback Spine

A

ribs rotate even in quiet standing

140
Q

Pelvic Crossed Syndrome

A

excessive lordosis
weak long dynamic muscles (inhibited): abdominals & g max
short strong postural muscles (tight): back extensors (erector spinae) and hip flexors (iliopsoas)

141
Q

Layer Syndrome

A

upper and lower crossed syndrome

142
Q

C7-T12 (Thoracic Level)

A

2.7 cm/ 1.1 inch diff in flexion and extension
2.5 cm/ 1 inch diff in extension

143
Q

C7-S1(Thoracolumbar Level)

A

10 cm/ 4 inch diff

144
Q

T12-S1

A

most movement occurs
~7.5 cm/ 3 inch diff

145
Q

Modified Schober’s Test (Lumbar Flexion)

A

PSIS level
10 cm above
5 cm below

146
Q

Fingertip to Floor (Lateral Flex)

A

no standard value; both sides should be equal

147
Q

Forestier’s Bowstringing Sign

A

tight ipsilateral paraspinal muscles during side flexion
presence of ankylosing spondylitis

148
Q

Limited lateral flexion and rotation

A

internal joint capsular problem

149
Q

Limited lateral flexion

A

inside the joint

150
Q

Limited extension and rotation

A

facet syndrome

151
Q

Instability Jog

A

sudden rippling of the muscle during active movement= instability

152
Q

SLR difference in sitting and lying

A

10-20 deg difference

153
Q

Capsular Pattern in the Spine

A

lateral flexion= rotation > extension

154
Q

End feel

A

tissue stretch on all four movements

155
Q

Active Movements on Thoracic Spine

A

forward flexion: 20-45 deg
extension: 25-45 deg
lateral flexion: 20-40 deg
rotation: 35-50 deg
costovertebral expansion (breathing) : 3-7.5 cm or 1-3 inch

156
Q

Active Movements of the Lumbar Spine

A

forward flexion: 40-60
extension: 20-35
side bending: 15-20
rotation: 3-18

157
Q

Myotomes

A

L2: hip flexion
L3: knee extension
L4: ankle dorsiflexion
L5: great toe extension
S1: ankle plantar flexion, eversion, hip extension
S2: knee flexion

158
Q

Chest Expansion

A

Method 1: 4th intercostal space
Method 2: at 3 levels
>axilla: apical expansion
>nipple area/ xiphisternal joint: mid thoracic
>T10: lower thoracic

159
Q

L5-S1

A

most common site problem
bears more weight
CoG passes through
transition between vertebra

160
Q

Dermatomes of Lower Limb

A

L1: inguinal area and sup aspect of medial thigh
L2: middle or lateral ant thigh
L3: medial condyle of femur running inferomedial across the thigh
L4: medial malleolus and anterolateral aspect of the leg
L5: dorsum of the foot at the 3rd MTP
S1: lateral aspect of calcaneus
S2: midpoint of popliteal fossa
S3: horizontal gluteal piece
S4-5: perianal region

161
Q

Reflex Testing

A

patella: L4-L5
medial hamstring: L5-S1
lateral hamstring: S1-S2
posterior tibial: L4-L5
achilles tendon: S1-2

162
Q

Thoracic Nerve Root Symptoms

A

epigastric area: T7-T8, T10-11
umbilical area: T10-T11
nipple area: T5
groin: T12

163
Q

Differences in pain perception

A

skin: superficial, sharp, precisely localized, burning
chest: intermediate in localization and depth, aching, sharp, dull
thoracic viscera: vague, diffuse, deep, aching, dull

MSK (7 decks)

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