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Pathophysiology IV Flashcards

tetest 1 , thoracic and lumbar spine

1
Q

How many vertebrae and articulations in the T spine?

A

12 vertebrae, each one in involved in six articulations (72 articulations total)

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2
Q

Is stability or mobility prioritized in the T spine?

A

protection of the thoracic viscera is primary so stability over mobility

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3
Q

What creates the relative stability of the T spine over the C spine?

A

The rib cage and its many articulations.

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4
Q

The reduced mobility of the T spine has what 3 primary effects?

A
  1. Influences the motion available in the spine and shoulder girdle
  2. Increase potential postural impairments
  3. Provide important weight bearing mechanism for the spine
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5
Q

Flexion and extension is limited in the upper T spine by what structures?

A

Ligaments

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6
Q

T or F?
Good pelvic movement is integral to T spine function.

A

True! Abnormal pelvic tilting can cause issues

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7
Q

In the T spine, what is a sagittal plane deformity c increased anterior concavity called?

A

Kyphosis

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8
Q

The difference between a dowagers hump, humpback, and round back is dependent on what?

A

The location of the anterior concavity

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9
Q

Motion in all cardinal planes is possible in the T spine, however the degree of movement is dependent on what?

A

The segmental level in which movement is occurring

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10
Q

Flexion and extension is limited in upper thoracic due to what?

A

The facet orientation being closer to the frontal plane

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11
Q

Flexion in spine is limited by what major ligament?

A

Posterior longitudinal ligament

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12
Q

Extension coupled with posterior translation is limited by what processes?

A

articular and spinous processes

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13
Q

During respiration, the ribs function as ____

A

levers

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14
Q

Little movement at the rib ____ produces a large degree of movement in the ____

A

rib neck, rib shaft

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15
Q

What are the accessory respiration muscles?

A

scalenes, SCM, pectoralis minor

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16
Q

What is the chief movement during respiration at the neck of ribs 1-6?

A

Rotation of the neck of ribs 1-6

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17
Q

In ribs 7-10, what is the principal movement during inspiration?

A

Upward, backward, and medial
*reverse happens during expiration

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18
Q

The anterior ends of ribs are lower than posterior. So when they elevate, what happens?

A

They move superiorly while rib neck drops inferiorly.

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19
Q

During respiration, ribs 1-10 experiences what movement?

A

Anterior elevation, like a pump handle

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20
Q

Middle and lower ribs move like a bucket handle during respiration. What direction is this movement?

A

Lateral elevation

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21
Q

The false ribs have movement during respiration that is similar to the pincer motion of a ____

A

caliper

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22
Q

T or F?
Good mobility of the pelvis is integral to the thoracic spine

A

True! excessive tilting can cause compensatory issues.

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23
Q

Postural Dysfunction: Abnormal Pelvic Tilting

A
  1. Posterior pelvic tilting in sitting
  2. Anterior pelvic tilting in standing
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24
Q

What does the following describe? Increase in lumbar and T spine flexion, forward head posture

A

Posterior pelvic tilting in the sitting position

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25
Q

What does the following describe? Trunk leans backward and overstretches the rectus abdominis and pulling forward of shoulders

A

Anterior pelvic tilt in standing

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26
Q

What is kyphosis?

A

Sagittal plane deformity involving an increased anterior concavity

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27
Q

What is sagittal plane deformity involving an increased anterior concavity?

A

Kyphosis

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28
Q

A kyphosis in the upper dorsal region, often caused by postmenopausal osteoporosis or long term corticosteroid therapy is known as:

A

Dowagers Hump

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29
Q

A localized, sharp posterior angulation produced by anterior wedging of 1 or 2 thoracic vertebrae also called a gibbus, is more commonly known as

A

Hump back

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30
Q

Causes of humpback:

A

fracture, congenital anomaly of spine, result of infection like TB

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31
Q

Three sternal deformities:

A
  1. Barrel chest
  2. Pigeon chest
  3. Funnel chest
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32
Q

Barrel chest

A

forward and upward projecting sternum, increases anteroposterior diameter. Results in respiratory difficulty, stretching of intercostal and anterior chest mms

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33
Q

Pigeon chest

A

Sternum grows outwards and downwards. Lengthens upper abdominal mms and shortens upper intercostals

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34
Q

Funnel chest

A

Pectus excavatum
Posterior projection of sternum at the xiphoid process. Respiratory and cardiac abnormalities

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35
Q

Intercostal mm strains are typically caused by

A

trauma after excessive muscular activity

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36
Q

Scoliosis

A

Rotoscoliosis is more correct term. Spine curves and side flexes. Rotation is towards the convexity. Rib Hump occurs on convex side of the curve.

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37
Q

Non-structural scoliosis

A

Not bony anomaly. Postural, LLD, or hip contractures in nature

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38
Q

Dowagers Hump

A

abnormal curvature in the upper thoracic spine *often caused by osteoporosis

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39
Q

Gibbus deformity

A

structural kyphosis that is a particularly sharp, angular curve

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40
Q

Lordosis (swayback)

A

abnoraml, inward curvature of a portion of the lower portion of the spine

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41
Q

In scoliosis, does the rib humb occur on the convex or concave side of the curve?

A

convex

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42
Q

A lateral curvature of the spine, which affects more females than males and can occur at any age, is known as what?

A

Scoliosis

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43
Q

Structural scoliosis

A

Irreversible lateral curvature of the spine with fixed rotation of vertebrae. affects girls more than boys during adolescence, idiopathic

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44
Q

Functional scoliosis

A

a structurally normal spine that appears to have a lateral curve

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45
Q

Two types of low back pain (LBP):

A

specific and non-specific

46
Q

Specific LBP:

A

sx caused by a specific pathophys mechanism, i.e., inflammatory disease, osteoporosis, infection, rheumatoid arthritis, fx, herniated disc, tumor

47
Q

Nonspecific LBP:

A

based on exclusion of specific pathology, this account for about 90% of pts with LBP

48
Q

Factors indicating likelihood of LBP development:

A

age older than 40-50 years, physical and psychosocial workload, smoking, obesity, comorbidity

49
Q

How many vertebrae in the L spine?

A

5
*and NO rib facets

50
Q

Primary ligamentous support in the L spine:

A
  1. Anterior longitudinal ligament
  2. Posterior longitudinal ligament
  3. Annulus fibrosis attachments
  4. Facet joints
  5. Interosseous ligaments between spinous processes
51
Q

The integrity of the shape of an IVD is determined by what?

A

The integrity of its outer wall and annulus fibrosis

52
Q

An IVD is made of what?

A

10-12 concentric sheets (lamellae) of predominantly type 1 collagen tissue. It’s held together by proteoglycan gel.

53
Q

With age, the annular layers in an IVD will decrease, but they will also:

A

thicken

54
Q

The Sacroiliac joint is a true ____ joint

A

diarthrodial

55
Q

The SI joint joins what structures?

A

the sacrum and pelvis

56
Q

the pelvis is AKA

A

the innonimate

57
Q

The SI joint joins the sacrum and pelvis via..

A

iliac bones

58
Q

How many muscles attach to the sacrum, ilium, or both?

A

35 mms

59
Q

Does the function of the SI joint favor stability or mobility?

A

stability

60
Q

What is an annulus fibrosis?

A

The outer part of an intervertebral disc

61
Q

The Posterior Muscle system is AKA

A

posterior chain

62
Q

The TLF (thoracolumbar fascia) and its muscular attachments play an important role in stabilizing what?

A

lumbopelvic region

63
Q

The anterior muscle system is AKA

A

anterior chane

64
Q

What structure provide an anterior “sling” and assist in stabilizing the lumbar spine and pelvis?

A

Intern and Extern obliques (along with the posterior oblique sling made of the TLF and its associated structures)

65
Q

T or F?
The transverse abdominis has attachments to the TLF

A

True. And also the sheath of the rectus abdominis, diaphragm, iliac crest, and lower 6 costal surfaces

66
Q

What is one of the most important muscle groups that contribute to the mobility and stability of the lumbopelvic region?

A

The anterior muscle system via the abdominal wall mechanism

67
Q

What are the muscles of the anterior muscle system?

A

Rectus abdominis, intern/extern obliques, transvere abdominis

68
Q

What mm activates before movement in persons without lumbopelvic pain, but is lost in those with lumbopelvic pain?

A

Transverse abdominis

69
Q

What are the three types of lumbar disk injury?

A

herniation, protrusion, prolapse

70
Q

What is a disc herniation?

A

Change in shape of the annulus that causes it to bulge beyond the normal perimeter.
*pain is increased during sitting and bending during compression

71
Q

What is disc protrustion?

A

The nuclear material bulges and strains the annulus fibrosis (but doesn’t tear through it) or the posterior longitudinal ligament
*posterior protrusions are most common

72
Q

Two types of disk prolapse

A

extrusion and sequestration

73
Q

Disk prolapse definition:

A

migrating nuclear material escapes contact with disk entirely and becomes a free fragment in the vertebral canal and epidural space

74
Q

What is a disk prolapse extrusion?

A

extension of nuclear material beyond confines of posterior long. ligament or above and below the disk space

75
Q

What is disk prolapse sequestration?

A

Extruded nucleus separates from disk and moves away from prolapsed area

76
Q

Cauda equina syndrome:

A

loss of bowel control, saddle anesthesia, numbness in legs
this is a medical emergency

77
Q

What type of protrusion can press against a longitudinal ligament and cause back pain but no neuro symptoms??

A

Anterior protrusion

78
Q

Pts with disk related LBP and sciatica may present with what in their pelvis region?

A

A pelvic “shift” away from side with pain “sciatic scoliosis”

79
Q

Disk herniations are more common in what population?

A

men under 45

80
Q

Etiology of Disk Herniation

A
  1. severe trauma or repeated strains
  2. intervertebral joint degeneration
  3. faulty posture or body function because of repetitive, poor body mechanics
81
Q

How is disk herniation diagnosed?

A

Physical exam, MRI, CT, or myelogram

82
Q

Define: degenerative spinal stenosis

A

Narrowing of the spinal canal (central stenosis), nerve root canal, or foramen (lateral stenosis)

83
Q

How does Degenerative Spinal Stenosis manifest?

A

As poorly localized pain, paresthesias, cramping in one/both LE brought on by walking and relieve by sitting
*can result in cauda equina compresion

84
Q

Zygapophyseal joint dysfunction is also known as

A

Facet Joint Syndrome (FJS)
causes pain and impaired mobility

85
Q

What are the interventions for FJS?

A

joint mobs, postural education, exercise progression

86
Q

Spondylolysis

A

often occurs in C spine. is a defect of the pars interarticularis of the spine (between facets of verts)

87
Q

Spondylolisthesis

A

common in lumbar spine
Anterior slippage. Most rapid change between 1-15 YOA and no more slipping after age 20.

88
Q

Congenital spondylolisthesis

A

dysplasia of 5th lumbar

89
Q

Isthmic spondyloisthesis

A

cause ny a defect in the pars articularis

90
Q

Degenerative spondylolisthesis

A

Dysfunction of the IVS, horizontalization of lamina and facets or sacrum morphology

91
Q

Traumatic spondylolisthesis

A

fx or acute dislocation of zygapophyseal joint (this type is rare)

92
Q

Pathologic spondylolisthesis

A

disc slippage as a result of infectious processes

93
Q

spondylolisthesis

A

Causes chronic midline pain at lumbrosacral junction. May require surgical intervention.

94
Q

Lumbo-sacral dysfunction is an alternate term for what?

A

Low back pain

95
Q

What is spina bifida and what is an alternate term for it?

A

A defect in the development of the vertebra. AKA: congenital neural tube defect

96
Q

What is Congenital Neural Tube Defect?

A

Spina bifida. A defect in development of the vertebra.

97
Q

Spina bifida occulta:

A

Absent portion of lamina or spinous process. Spinal cord, meninges, and spinal fluid are normal. NO sx’s expect possible hairy patch. NO neuro sx’s.
*most common and least sever form of spina bifida without protrusion of the spinal cord or meninges

98
Q

What type of Spina Bifida is asymptomatic expect for a possible hair patch and includes normal spinal cord, meninges, and spinal fluid?

A

Spina bifida occulta

99
Q

Spina bifida meningocele

A

absence of part of the vertebra and meninges protrude with CSF only. Spinal cord intact. Neuro sx’s are rare. Can be repaired with surgery.

100
Q

What types of spina bifida does the following list describe?
1. Absence of portion of vertebra thru which meninges protrude with CSF
2. Spinal cord intact
3. Neuro sx’s RARE
4. Reparable via surgery

A

Spina bifida meningocele

101
Q

Spina bifida myleomeningocele

A

Protrusion CSF and SPINAL CORD sensory & motor deficits, LE paralysis, incontinence, musculoskeletal deformities, hydrocephalus, possible mental retardation

102
Q

What is spondylolisthesis?

A

Anterior sliding of one vertebrae over another. Very common L5-S1. Can cause: pain, diminished reflexes, mm atrophy, decreased strength, numbness

103
Q

Spondylolysis

A

bilateral bony defect w/o slipping. Sx’s include: pain & stiffness.

104
Q

What is the term for a localized narrowing of spinal canal from bony obstruction of arthritis-type buildup?

A

Spinal stenosis

105
Q

What is the term for degenerative disease-type fusing and closing of neural tube space that can also be a part of an SI disorder?

A

Ankylosing Spondylitis

106
Q

Pain about the coccyx and lower sacrum, usually from trauma to the tailbone is known as

A

coccygodynia

107
Q

An intervertebral disc is what proportion water?

A

80%
Also made of collagenous rings (annulus fibrosis) and nucleus pulosus

108
Q

Define disc degeneration:

A

decreased hydration, narrowing which places more stress on the annulus fibrosis and local facet joints

109
Q

Define disc herniation:

A

contents of nucleus pulposis bulges at the periphery of annulus fibrosis or actually ruptures through the rings

110
Q

Spondylolysis can be thought of as a precursor to what?

A

Spondylolisthesis

111
Q

Name 2 causes for cauda equina syndrome

A
  1. Degenerative spinal stenosis
  2. Cauda equina
112
Q

What are the 5 types of spondylolisthesis?

A
  1. Congenital
  2. Isthmic
  3. Degenerative
  4. Traumatic
  5. Patholofic

pta (21 decks)

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