Week 5 [not including lab] Flashcards
List the number of vertebrae in the spine and in each section
33 total: 7 cervical 12 thoracic 5 lumbar 5 sacral (fused) 4 coccyx
What is the importance of the spinal vertebrae?
structure helps to distribute force
What does the lateral (transverse) process articulate with?
ribs
Explain the differences between the cervical, thoracic and lumbar spine?
- cervical spine: facets are oriented more horizontally to allow for larger range of motion; allows for flexion, extension, rotation, and lateral flexion
- thoracic spine: articular facets are oriented more vertically; allows for flexion, extension, and rotation; little lateral flexion because of ribs
- lumbar spine: articular facets are oriented in the sagittal plane; allows for lots of flexion and extension but little rotation
Give the function of the intervertebral discs
- stability
- cushioning
How many facet joints are on each vertebrae?
4
Explain the structure of the nucleus pulposus
- nucleus pulposus has a high water content because it is made up of hydrophilic material
- ^proteoglycan fibre is main component (then collagen and water)
Explain the structure of the annulus fibres
- arranged in 15-25 concentric layers (“annulus” like from yearly growth of tree rings)
- fibres are angled and angle changes with alternate layers to allow for a strong configuration
What is it meant when it is said that the disc nucleus pulposus behaves hydrostatically?
- centre of the disc (nucleus pulposus) is like a liquid
- liquids are incompressible
- an applied load creates outward (radial) pressure in all directions inside the disc
Why is sitting more physically demanding on the annulus fibrosis than standing?
- sitting rotates the pelvis posterior
- we lose the lordotic curve in our back
- ends up resulting in greater compressive forces in the discs
What parts of the spine are responsible for:
- flexion and extension
- lateral flexion
- rotation
- flexion and extension: cervical, thoracic, lumbar
- lateral flexion: cervical, thoracic, lumbar
- rotation: cervical and thoracic only
What is the transversospinalis responsible for?
- mostly stabilization
- lateral flexion
- extension
Fill in the blank: when one side of the transversospinalis contracts, it can cause ____________
contralateral rotation
Where do the spinal nerves come from?
intervertebral foramen
Explain the connection of number of nerve roots and vertebrae
- number of nerve roots match up with number of vertebrae EXCEPT in cervical spine (has 8 nerve roots)
- because first cervical nerve root comes out between skull and above C1
- 8th cervical nerve root comes out between C7 and T1
Where does the spinal cord end?
spinal cord ends at L1 and below that its just nerve roots that come out
Where do the sciatic nerves originate?
L4, L5, S1, S2, S3
Define: sciatica
sciatic nerve discomfort
Define: dermatome
dermatome is an area of skin in which sensory nerves derive from a single spinal nerve root
What are some general causes for spinal injuries?
- congenital predispositions
- previous trauma
- mechanical factors (previous trauma like lifting and bending, obesity)
- acute or repetitive trauma
What are some general effects of spinal injuries?
- pain, tenderness, spasm, restricted ROM
- neurological symptoms: weakness, numbness, sciatica (radiating pain), absent deep tendon reflexes
Spinal strains and sprains
- cause
- symptoms
cause - twisting, lifting (reoccurrence is common) symptoms - pain and tenderness - muscle spasm (delayed onset) - restricted ROM - increased warmth - N.B.: if any neurological SSx is present, assume fracture, dislocation, or disc injury (stabilize and transport to hospital)
Spinal strains and sprains
- treatment
- Rest – supine – no more than 2 days
- NSAID
- cold therapy at first
- Heat therapy later
- Physiotherapy or massage Tx
- Comprehensive, supervised rehabilitation program
- Flexibility
- Strengthening § Task-specific
- Correct predisposing factors
- Gradual return to activity
Explain lumbar disc herniation and the four stages
- Nucleus pulposus breaks through annulus fibrosis
- usually occurs at the L4L5 and L5S1 levels
stages:
- protrusion
- prolapsed
- extrusion
- sequestered
What ages are you vulnerable for lumbar disc herniation
- vulnerable between ages 30 to 50 as elasticity and water content of the nucleus pulposus decreases with age
Explain this stage of lumbar disc herniation: disc protrusion
- disc bulge
- cracks in annulus fibrosis begin to appear
Explain this stage of lumbar disc herniation: prolapsed disc
- nucleus pulposus moves completely through annulus fibrosus
Explain this stage of lumbar disc herniation: extruded disc
- nucleus pulposus moves into spinal canal, comes in contact with a nerve root
Explain this stage of lumbar disc herniation: sequestered disc
- portion of nucleus pulposus separates from disc and begins to migrate in spinal canal
Explain the mechanism behind intervertebral disc disease
- forward bending and twisting that places an abnormal strain on the lumbar region
- Herniation or bulging of nucleus pulposus
- Compression of nerve root(s) or spinal cord
- Results in degeneration, tears, and cracks in the annulus fibrosis
- all from faulty body mechanics or trauma
Explain the symptoms behind intervertebral disc disease
- sciatica: Sharp, centrally located pain that radiates unilaterally in a dermatomal pattern to the buttocks and down the back of the leg, or pain across the back
- weakness in lower limbs
- Symptoms are worse in the morning with axial loading such as when patient gets out of bed
- Forward bending and sitting increase pain
- Backward bending reduces pain
- Valsalva increases pain (coughing, sneezing,)
- diminished tendon reflexes
- instability (muscle testing reveals weakness with bilateral differences)
- osteoarthritis (osteophytes, stenosis)
Define: osteophytes
bony lumps (bone spurs) that grow on the bones of the spine or around the joints
Define: stenosis
narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine
Explain the treatments for intervertebral disc disease
Stay conservative if possible:
- loosen tight muscles in areas of pain, and strengthen weak ones
- in particular strengthen the core
- Pain reducing modalities (ice, electrical stimulation)
- Goal: reduce protrusion and restore normal posture
- Manual traction combined with passive backward bending or extension
- Postural self-correction exercises
- For extruded or sequestraded disks you can only modulate pain with electrical stimulation
- Flexion exercises and lying supine in a flexed position may help with comfort
- Signs of nerve damage indicate surgery may be required to eliminate pain and disfunction
Surgery which is last resort:
- discectomy: replacing a disc with an artificial one
- laminectomy: remove part of lamina to give spinal cord more space
- fusion: fuse 2 spinal segments (but this increases stress on spinal segments above and below the fusion which accelerates the degenerative changes in this area)
Brachial plexus neuropraxia
- Hx
- symptoms
history
- Stretching or compression of brachial plexus
- Neck forced laterally
symptoms
- Pain/numbness into fingers, burning, numbness, tingling from shoulder to hand
- Lasts for several minutes
- Athlete may return only if symptoms resolve
Brachial plexus neuropraxia
- treatments
- rest
- If symptoms not diminishing or resolving within a few minutes (or if worsening) send to hospital
Spinal fractures
- causes
- axial load (Cervical spine (head into boards at hockey, helmet to helmet in football); 4th, 5th, and 6th cervical vert most common)
- hyperextension
Spinal fractures
- symptoms
- point tenderness, decreased ROM
- pain in neck, chest, extremities
- numbness/ weakness in trunk and limbs
Spinal fractures
- treatment
- stabilize, c-spine collar, spine board
- if unconscious, assume c-spine injury
What are some tips on management of back injuries
- key is balance: keep demands within functional capacity and expectations with realistic goals
Mainstays
- time (rest, healing)
- cold, heat, NSAIDs, braces
- physiotherapy, massage therapy, chiropractic
- rehabilitation (indefinite)
- correct predisposing factors
- may need to change job or sport
Fill in the blank: Studies found that intervertebral pressure decreased by ____ when the spine was in supine position and by ____ when compared to side lying (compared to standing)
- 75%
- 25%
Fill in the blank: Pressure increased ___ while patient was sitting, ___ when standing and slightly bent forward, by ___ while patient was sitting slightly bent forward, ___ when patient was standing bent far forward, and ___ when patient was sitting bent well forward
- 33%
- 33%
- 45%
- 52%
- 63%
contralateral vs ipsilateral
- contralateral: relating to or denoting the side of the body opposite to that on which a particular structure or condition occurs.
- ipsilateral: belonging to or occurring on the same side of the body.
