Vertebral Column Flashcards by Alli Volkens

How many total vertebrae are there?
How many are...
Cervical
Thoracic
Lumbar
Sacral
Coccygeal

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What are the 3 joints that compose the vertebral motion system?

1 joint between the vertebral body and the IVD

2 facet joints

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Therefore there are how many PAIRS of facet joints?

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What type of joint are the facet joints?

planar (flat surfaces)

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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

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What is the function of these intra-articular synovial folds?

They are space fillers and actively assist in the dispersal of synovial fluid

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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

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The horizontal articular surfaces of the cervical spine facet joints favor what motion?

axial rotation

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Describe the orientation of the thoracic facet joints

Almost vertical direction

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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

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Describe the orientation of the lumber facet joints

They are vertical with a J-shaped surface predominantly in the sagittal plane

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The vertical orientation of the lumber facet joints restricts which motions?

rotation and anterior shear

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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

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How do unicate processes increase stability?

They limit sidebending and posterior translation

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What are the 3 parts of the IVDs?

nucleus pulposus
annulus fibrosus
cartilage end plates

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IVDs become stressed under what circumstances?

axial compression
shearing
bending
twisting

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IVDs are _____ in the front for cervical and lumbar vertebrae. What does this contribute to?

Thicker

Lordosis

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What 2 structures lock the IVDs to the vertebrae?

end plates

- annular fibers

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Where do the majority of spinal injuries occur?

at spinal junctions

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What are the 3 sub-systems that contribute to spinal stability?

passive system (autonomic)
active system (muscles)
central nervous system (anticipation and reflexes)

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You should train your patient in what spinal zone?

neutral zone

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What is the neutral zone?

A region of laxity around the neural resting position of a spinal segment (open-pack)

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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

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The movements of the vertebral column occur in ____ patterns

diagonal

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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