03: Spine 1 Flashcards Preview

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Flashcards in 03: Spine 1 Deck (73):
1

thoracic spine abnormalities: posterior

- dowager's hum
- gibbus deformity

2

dowager's hump

pronounced rounding (kyphosis) of upper thoracic

3

Who gets the dowager's hump?

older, osteoporotic women

4

gibbus deformity

sharp angulation of the upper thoracic spine

5

What can cause gibbus deformity?

- infection
- congenital abnormality

6

Is gibbus deformity common?

no

7

3 deformities of the chest cavity

- barrel chest
- pectus caranatum (pigeon chest)
- pectus excavatum (funnel chest)

8

barrel chest

- increased AP diameter of the chest
- affects pulmonary function

9

Which patients commonly have barrel chest?

emphysema patients

10

pectus caranatum
aka

pigeon chest

11

pectus caranatum
- what is it?

- increased AP diameter
- chest goes out far in front and comes back in

12

What causes pectus caranatum?

congenital deformity that develops as you mature

13

pectus excavatum
aka

funnel chest

14

pectus excavatum
- what is it?

- decreased AP diameter
- entire chest wall is concave

15

What causes pectus excavatum?

congenital deformity that develops as you mature

16

What deformities are you looking for in the frontal plane?

lateral curvature (scoliosis)

17

From _______, you should always look at T7 up due to

- T7 up
- due to referral patterns

18

Most common areas in clinic
- most to least

- lumbar
- c-spine
- thoracic

19

What do you use for T-spine palpations?

rule of 3's

20

palpation: T1-T3

- spinous processes are at same level as vertebral bodies
- stick out similarly to c-spine

21

palpation: T4-T6

- spinous processes start sloping inferiorly
- get further apart from each other

22

Where are the spinous processes between T4 and T6?

at IV disc space of level below

23

palpation: T7-T9

spinous processes slope inferior

24

Where are the spinous processes between T7 and T9?

at vertebral body of the one below

25

palpation: T10-T12

- spinous processes start sloping back up

26

Where is the T11 spinous process?

at the disc space below

27

Where is the T12 spinous process?

spinous process is at the level of its body

28

palpation: facet joints

- difficult because thick musculature covers
- palpate transverse processes instead

29

costotransverse junction

over distal end of transverse processes

30

Which vertebrae will you have to use the slide down and up method on to feel the spinous processes and why?

- T7-T9
- inferior sloping processes

31

Where are the transverse processes in relation to the spinous processes (t-spine)?

1-2 body inches over

32

palpation points on anterior chest

- sternal notch, along clavicle, to AC joint
- manubrium
- body
- xiphoid process
- sternocostal joints

33

costochondritis

irritation of inflammation of the costal cartilages at the joint » tenderness

34

In lumbar spine, what are you feeling just before the "drop off" to the side?

transverse processes

35

landmarks:
belly button

space between L3 and L4

36

landmarks:
iliac crest

space between L4 and L5

37

increased lordosis

swayback

38

decreased lordosis

flat back

39

What can create a posterior pelvic tilt

tight hamstrings

40

lateral curvature

scoliosis

41

soft tissue - important structures

- erector spinae
- quadratus lumborum
- rectus abdominis
- external obliques
- internal obliques
- transversus abdominis

42

If you crunch toward the left, which obliques are targeted?

right

43

Don't forget these when you're looking at t-spine!

- traps
- rhomboids
- serratus
- lats
etc...

44

partitioning for goniometry

try to partition lumbar and thoracic away from hip motion

45

When do you stop the patient in forward fold?

when you see an anterior pelvic tilt
(same true for posterior tilt during extension)

46

normative values:
thoracolumbar flexion

4 inches (3 from lumbar, 1 from thoracic)

47

landmarks for thoracolumbar flexion measurements

mark C7 an S2

48

Why use S2 instead of S1 for measuring?

easier to find because of the PSIS

49

normative values:
thoracolumbar extension

- no norms established
- look at pre and post measurements

50

thoracolumbar extension landmarks

C7 and S2

51

normative values:
thoracolumbar lateral flexion

35˚

52

thoracolumbar lateral flexion
- gonio placement

- fulcrum at S2
- stationary arm vertical
- moveable arm vertical along spine

53

normative values:
thoracolumbar rotation

45˚

54

thoracolumbar rotation
- gonio placement

- fulcrum at top of head
- stationary arm in line with ASIS
- moveable arm follows acromion

55

lumbar flexion/extension test

MMST

56

MMST

modified-modifed Schober test

57

MMST procedure for lumbar flexion extension

- mark 15 cm superior to S2
- either flex or extend
- measurement is in inches!

58

normative values:
MMST flexion

3 inches

59

normative values:
MMST extension

1-2 inches? (double check)

60

MMT: lumbar extension grades
5/5

- can clear belly button off table and hold 4 sec
- solid, unwavering, easy

61

MMT: lumbar extension grades
4/5

- can clear belly button off table and hold 4 sec
- can do but shaking, trembling, hard effort

62

MMT: lumbar extension grades
3/5

come through full ROM but unable to hold 4 sec

63

MMT: lumbar extension grades
2/5

partial ROM

64

MMT: thoracic extension grades

- same set-up and grading as lumbar
- off table, only come up to horizontal

65

MMT: thoracic and lumbar flexion grades
5/5

clear inferior angle of scapula with hands behind head

66

MMT: thoracic and lumbar flexion grades
4/5

clear inferior angle with hands across chest

67

MMT: thoracic and lumbar flexion grades
3/5

clear angle with hands out front

68

MMT: thoracic and lumbar flexion grades
2/5

partial ROM

69

MMT: rotation grades
5/5

clear angle with arms behind head

70

MMT: rotation grades
4/5

clear angle arms across chest

71

MMT: rotation grades
3/5

clear angle arms in front

72

MMT: rotation grades
2/5

partial ROM

73

MMT: rotation
If you come up with the right arm, what muscles are you working?

- right external oblique
- left internal oblique