Vertebral Column Flashcards
How many total vertebrae are there? How many are... Cervical Thoracic Lumbar Sacral Coccygeal
7 12 5 5 4
What are the 3 joints that compose the vertebral motion system?
1 joint between the vertebral body and the IVD
2 facet joints
Therefore there are how many PAIRS of facet joints?
24
What type of joint are the facet joints?
planar (flat surfaces)
Describe the joints structure of the facet joints
They are covered in hyaline cartilage and have small fibrous synovial meniscoid-like fringes that project between the joint surfaces
What is the function of these intra-articular synovial folds?
They are space fillers and actively assist in the dispersal of synovial fluid
Describe the orientation of the cervical facet joints
They are horizontal and move to more of a 45 degree angle in the lower c-spine
The horizontal articular surfaces of the cervical spine facet joints favor what motion?
axial rotation
Describe the orientation of the thoracic facet joints
Almost vertical direction
The orientation of the nearly vertical facet joints of the thoracic spine facilitate which motion? What does it resist?
Facilitates rotation and resists anterior displacement
Describe the orientation of the lumber facet joints
They are vertical with a J-shaped surface predominantly in the sagittal plane
The vertical orientation of the lumber facet joints restricts which motions?
rotation and anterior shear
What are uncovertebral joints?
Saddle-shaped articulations between the unicate process found on the lateral aspect of the superior surface of the inferior vertebrae and the beveled inferolateral aspect of the superior vertebrae from C3 to T1
How do unicate processes increase stability?
They limit sidebending and posterior translation
What are the 3 parts of the IVDs?
- nucleus pulposus
- annulus fibrosus
- cartilage end plates
IVDs become stressed under what circumstances?
- axial compression
- shearing
- bending
- twisting
IVDs are _____ in the front for cervical and lumbar vertebrae. What does this contribute to?
Thicker
Lordosis
What 2 structures lock the IVDs to the vertebrae?
- end plates
- annular fibers
Where do the majority of spinal injuries occur?
at spinal junctions
What are the 3 sub-systems that contribute to spinal stability?
- passive system (autonomic)
- active system (muscles)
- central nervous system (anticipation and reflexes)
You should train your patient in what spinal zone?
neutral zone
What is the neutral zone?
A region of laxity around the neural resting position of a spinal segment (open-pack)
What are 3 spinal stability exercises emphases?
- strengthen the trunk musculature
- increase the endurance of trunk muscles
- incorporate motor learning principles to address impaired motor control strategies
The movements of the vertebral column occur in ____ patterns
diagonal
The amount of motion available at each region of the spine is determined by what 6 factors?
- disk-vertebral height
- compliance of the fibrocartilate
- dimension/shape of the adjacent vertebral end plates
- age
- disease
- gender
Upper Cervical Spine:
Flexion-Extension = __ degrees
Axial Rotation = __ - __ degrees
minimal
30-40
Lower Cervical Spine:
Flexion-Extension = __ - __ degrees
Axial Rotation = __ - __ degrees
10-20
5-6
Upper Thoracic Spine:
Flexion-Extension = __ degrees
Axial Rotation = __ - __ degrees
Side-Bending = __ degrees
4
5-6
6
Lumbar Spine:
Flexion-Extension = __ - __ degrees
Axial Rotation = __ degrees
Side-Bending = __ - __ degrees
12-20
Minimal
8-9
Where is side-bending greatest in the lumbar spine?
L3-L4
Most motions of the spine occur in 3-dimensionally because of what phenomenon?
coupling
Curvature of the UCS is thought to be to the _____ side whereas it is to the ____ side in the LCS
opposite
same
All motions of a segment are defined by motion of the ____ vertebra on the ____ vertebra
upper
lower
Rotation occurs in which direction?
to the side the anterior aspect of the vertebra is facing
What does Fryette’s first law state?
When any part of the lumbar or thoracic spine is in neutral position, side bending of a vertebra will be OPPOSITE to the side of the rotation of that vertebra.
What does Fryette’s second law state?
When any part of the spine is in a position of flexion or hyperextension, the side bending of the vertebra will be to the same side as the rotation of that vertebra
What does Fryette’s third law state?
If motion in one plane is introduced to the spine any motion occurring in another direction is thereby restricted
A combination of what 3 motions is termed a closing restriction?
extension, side bending, and rotation to the same side as the pain
A combination of what 3 motions is termed an opening restriction?
flexion, side bending, and rotation to the opposite side of the pain
What does position testing involve?
palpation of the soft tissues over paired transverse processes of the spine
Vertebral dysfunctions occur in a combination of movements in the 3 planes, with the key movement being what?
rotation
The direction of a rotational dysfunction is named after the more _____ of the 2 transverse processes
posterior
What are the 3 positions in which testing is to done in?
flexion, extension, and then neutral
What is indicated if there is marked segmental rotation evident at the limit of extension?
one of the facets is unable to complete its inferior motion (down and back glide)
When testing in extension you palpate a segment that is rotated to the left, which facet joint is not moving correctly?
right
What is indicated if there is marked segmental rotation evident at the limit of flexion?
one of the facets is unable to complete its superior motion (upward and forward glide)
When testing in flexion you palpate a segment that is rotated to the left, which facet joint is not moving correctly?
left
If a rotational impairment of a segment exists only in neutral what is the cause of the impairment?
neuromuscular
Where are neuromuscular impairments usually found?
at the spinal junctions, particularly the CT and TL junctions
If a rotational impairment of a segment is consisten throughout flexion, extension, and neutral what is the cause of the impairment?
anatomic anomaly (scoliosis for example)
What 3 components does the McKenzie system focus on?
- Providing a mechanical diagnosis
- Providing a mechanical treatment based on the mechanical diagnosis
- Prevention of recurrence
According to McKenzie what can symptoms of lumbar and/or cervical pathology demonstrate?
a phenomenon of centralization or peripheralization
What is centralization of symptoms?
The immediate or eventual abolition of the most distal extent of referred or radicular pain toward the midline of the spine in response to therapeutic loading strategies
Does centralization occur more commonly with flexion or extension?
extension
True or False
Although centralization of the symptoms can be associated with an increase in spinal pain, it normally indicates improvement in the patient’s condition
True
Is centralization or peripheralization associated with a poorer prognosis?
peripheralization
Describe dynamic McKenzie system tests
A single motion within the movement plane is studied, followed by repetitive motion in the same movement plan direction while the clinician monitors the mechanics and symptoms
When are static McKenzie system tests used?
After dynamic tests to confirm the findings
The results of McKenzie system tests are classified into what 3 syndromes?
- postural
- dysfunction
- derangement
Describe patients with postural syndrome
They demonstrate no spinal deformity or loss of ROM, repeated measures do not produce symptoms, however symptom onset occurs with sustained end-range positions in which pain can be resolved by moving
Dysfunction syndromes result from what?
an adaptive shortening of soft tissues and an overstretching of others
Describe patients with dysfunction syndrome
Pain is intermittent, local, adjacent to the midline and not referred. This pain is also worsened with end-range activities.
Derangement syndromes result from what?
A displacement in the position of joint structures (most commonly the IVDs)
Describe patients with derangement syndrome
Pain is of a sudden onset and associated with paresthesia or numbness, it can be sharp or dull and may also be referred
Patients with ____ displacements feel better when walking and lying.
Patients with _____ displacements feel better in sitting and other flexed postures
posterior
anterior
Which examination technique is designed for patients in the acute stage?
treatment-based classification system
What are the 4 classification systems describe for patients in the cute stage?
1) Mobilization/Manipulation
2) Stabilization
3) Specific Exercise
4) Traction
REVIEW SLIDE 56-59
MOBILIZATION
STABILIZATION
SPECIFIC EXERCISE
TRACTION
The ______ Biomechanical Model is an eclectic approach founded upon an amalgam of doctrines and techniques that incorporate various biomechanical concepts
Canadian
According to the Canadian approach pathologic mechanisms can be extrapolated using what 5 testing procedures?
1) Cyriax upper and lower quarter screens
2) Movement testing
3) Passive physiological intervertebral mobility (PPIVM) tests
4) Passive accessory intervertebral mobility (PAIVM) tests
5) Segmental stability tests
What are PPIVM (passive physiological intervertebral mobility) tests used for?
To determine the amount of segmental mobility available in the spine and assess the ability of each segment to move through its normal ROM
What are PAIVM (passive accessory intervertebral mobility) tests used for?
To assess the joint glides or accessory motions of each joint and determine the type of end-feel encountered
