Back Flashcards
(117 cards)
1
Q
Identity the curves of the spine
A
Primary-Kyphotic, Secondary-Lordotic
2
Q
Identify the primary curves
A
Kyphotic: Thoracic and Sacral (primary curve)
3
Q
Identity the secondary curves
A
Lordotic: Cervical and Lumbar, (secondary curve, develop with weight bearing.
4
Q
Identify the movements of the spine
A
Flexion (bend over), Extension (back walkover), Lateral bending (kartwheel), Rotation of head and neck and rotation of trunk neck and head
5
Q
Identify the typical vertebrae
A
C3-L5
6
Q
What two parts of the body of the typical vertebrae fuse to form the transverse process?
A
Vertebral (neural) arch: Pedicles and Lamina
7
Q
What two parts of the body of the typical vertebrae fuse to form the spinous process?
A
the Right neural arch and the Left neural arch (or the L and R pedicles) fuse to form the spinous process
8
Q
What do adjacent superior and inferior articular processes form?
A
Facet (zygapophyseal) joints
9
Q
Where do the superior and inferior articular processes project from?
A
the junction of the pedicle and lamina (so above and below the transverse process.
10
Q
What structure do the typical vertebrae superior and inferior notches form and what exits here?
A
Intervertebral foramen, the spinal nerves exit through here.
11
Q
What forms the vertebral canal?
A
The vertebral foramen when collectively stacked on top of one another.
12
Q
Identify the Atypical Vertebrae
A
Atlas (C1) and Axis (C2)
13
Q
How do you identify the anterior arch of the atlas?
A
the anterior arch is much smaller than the posterior arch. The anterior arch also contains the anterior tubercle while the posterior holds the posterior tubercle.
14
Q
What are the Typical Cervical Vertebrae?
A
C3-C7
15
Q
What are the characteristics of Typical cervical vertebrae?
A
Body-small rectangular, wider to side vs. AP, vertebral foramen is triangular and large
16
Q
Where does the vertebral artery run through the spine?
A
The transverse foramen of C1-C6
17
Q
Where is the spinous process bifid on the spine?
A
C3-C5, and most prominent on C7
18
Q
What are characteristics of thoracic vertebrae?
A
Body-heart shaped, costal facets, Vertebral foramen is circular, small vs C+L, spinous process is long and extends inferior
19
Q
Where do the ribs articulate with the spine?
A
The transverse costal facets T1-10. The transverse process is much longer on these ribs
20
Q
What are important characteristics of the lumbar vertebrae?
A
Body-kidney shaped, Vertebral foramen is triangular, larger than T smaller than C, Spinous process “sturdy hatchet shape”
21
Q
Lordosis
A
Excessive anterior curve (‘belly pushed out’) - D/T pregnacy
22
Q
Kyphosis
A
Excessive posterior curve (hunchbacked) D/T compression fx, postural habits
23
Q
Scoliosis
A
Lateral deviation with rotary component
24
Q
Facet joint structure
A
Synovial joints between superior and inferior facets of articular processes
25
Facet joint arthritis
Facet joints prone to degenerative changes which limit movement and pain
26
Intervertebral joint structure
Disk-shock absorption made of water and collagen fibers,
27
T/F there is NO disk between occiput and C1, C1-C2
T!
28
Structure of disk
Annulus fibrosis: concentricl layers composed of collagen fibers, "crosswoven effect" Anchors disk to bone of cartilaginous end plate, outer layer blends with PLL and ALL
29
T/F there are no nerve endings in the outer layers of the annulus fibrosis
False! There are nerve ending in the outer layers of the annulus fibrosis this is the potential source of pain
30
What effect does aging have on the intervertebral disk?
Nucleus pulposis is made up primarily of water, collagen,, and a loose network of fibers. Aging decreases the proteoglycan content thus less H20 attraction which decreases the joint height.
31
What can clinical issues can effect the intervertebral disk
Fissures-discogenic pain, herniation-compression of nerve routes, and Degenerative changes-loss of disk ht.
32
What are the joints of Luschka and where are they located?
Formed by uncinate process of C3-C7, they are consider a pseudo joint because it looks similar to a synovial joint. They do not allow for a lot of lateral movement, and stabilize the head and neck
33
Describe atlanto axial joint structure
compressed of C1 and C2, includes the dens and the anterior arch which work to rotate the head and neck
34
Describe atlanto-occipital joint structure
Synovial joint between C2 facet and occipital condyles, Provides flexion/extension (nodding) of the head and neck
35
Please put these in order from front to back. Posterior longitudinal ligament, Ligamentum flavum, anterior longitudinal ligament, intraspinous ligaments, supraspinous ligaments
ALL, PLL, Ligamentum flavum, intraspinous ligaments, supraspinous ligaments
36
What is included in the superficial layer of the muscles of the back?
Trapezius, Latissimus Dorsi, Rhomboin and Levator Scapula
37
What are the 2 main enlargements of the spinal cord?
Conus Medularis, and cauda equina
38
What do the superior facets of C1 articulate with?
Occiput
39
What is the job of the arcticulation of the occiput and C1 at the superior facet?
Flexion and extension movement
40
What do the inferior facets of C1 articulate with and what is their action?
C2, rotation movement
41
Where can you palpate the transverse process of C1
Inferior to mastoid process
42
Where is the Dens (odontoid process) located?
C2-forms a synovial joint with anterior arch of C1
43
Action of the dens
Pivot/axis for rotation between C1 and C2.
44
I comparison to the cervical vertebrae the vertebral foramen of the thoracic vertebrae is
a. More circular and progressively smaller
b. More square and progressively larger
C. More triangular and progressively smaller
d. More circular and progressively larger
a. More circular and progressively smaller
45
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Compared to the thoracic vertebrae the body of the cervical vertebrae is?
a. More round
b. More heart shaped
C. More kidney shaped
D.More rectangular
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D. More rectangular
46
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The spinous process of the lumbar vertebrae is
A. Oriented to the inferior
B. Bifid from L1-L4
C. large and thick
D. Most prominent at L5
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C. Large and Thick
47
What are the sacral cornu formed by?
The pedicles of S5
48
When giving an injection to the sacrum what do we palpate?
the Sacral cornu
49
```
What do we call the ALL once it gets above C2?
A. superior atlanto occipital membrane
B. tectorial membrane
C. anterior atlanto occipital membrane
D. posterior atlanto occipital membrane
```
C. Anterior atlanto occipital membrane
50
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What do we call the PLL once it gets above C2?
A. posterior atlanto occipital membrane
B. anterior atlanto occipital membrane
C. Tectorial membrane
D. Nuchal ligament
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C. Tectorial membrane
51
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What do we call the ligamentum flavum once it gets above C2?
A. Posterior atlanto occipital membrane
B. Superior atlanto occiptal membrane
C. Tectorial membrane
D. Inferior atlanto occipital membrane
```
Posterior atlanto occipital membrane
52
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What do we call the supraspinous ligament once it gets abvove C2?
A. Posterior atlanto occipital membrane
B. Anterior atlanto occipital membrane
C. Nuchal ligmaent
D. Tectorial membrane
```
Nuchal ligament
53
```
What ligament stabilizes the dens against the anterior arch of C1?
A. Alar
B. Axillary Ligament
C. Cruciate ligament
D. Posterior Longitudinal Ligament
```
C. Cruciate ligament
54
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What is the function of the Alar ligament?
A. Allow for rotation of C1 and C2
B. Allows for flexion of C1 and C2
C. Limits flexion of C1 and C2
D. Limits rotation of C1 and C2
```
Limits rotation of C1 and C2
55
Trapezius Innervation
CN XI-spinal accessory nerve
56
Superior trapezius attachments
clavicle and occiput
57
Middle trapezius attachments
Acromion, posterior border of scapular spine, and clavicle/occiput
58
Inferior trap attachments
scapular spine, clavicle/occiput
59
inferior trap action
upward rotation
60
Mid trap action
upper back retraction
61
Upper trap action
elevation of spine, upward rotation of scapula, "arm out living life"
62
Latissimus dorsi attachment
Humerus, spinous process, inferior angle of the scapula
63
Action of latissimus dorsi
Hand cuffs action, Internal rotation and adduction
64
Innervation of latissimus dorsi
Thoracodorsal nerve
65
Rhomboid major/minor attachments
spinous process, medial border of scapula
66
Innervation rhomboid major/minor
dorsal scapular nerve
67
Actions Rhomboid major/minor
Shoulder shrug: retracts and rotates scapula, fixes scap to thoracic wall
68
Levator scapula attachments
transverse process of C1-C4 med scap
69
Levator Scapula Innervations
CN 3 &4 and dorsal scapular nerve C5
70
Levator scap Actions
Scapular Movement: Elevates scapula, and ipselateral Lateral flexion of the neck
71
Splenius capitus/cervicus attachments
Nuchal ligament, spinous process, Mastoid process of temp and occipital bone
72
Actions of splenius capitis/cervicus
extend, rotate, and laterally flex the head
73
What are the "verticle column" of the erector spinae
Iliocostalis, Longismus, Spinalis (from out to in)
74
Action of erector spine as a group
Lean forward, not fall on face, (billet extension also assists with flexion)
75
Attachment - semispinalis
occiput, and spinal process (skips 4-6)
76
Attachment for multifidi
every 3-4 spinous process
77
Rotators
attachment from 1-2 spinous process
78
Actions of the Semispinalis, multifid, and rotators
Unilateral-contraateral rotation of the spine
79
Sub-occipital muscles
Rectus capitis posterior major/minor, and Obliquus captious inferior/superior
80
attachments for rectus captious posterior major/minor
spine and occiput
81
What is contained in the sub occipital triangle?
Rectus capitis posterior major, obliquus capitis inferior, and oblique captitis superior, Vertebral after, sub-occipital nerve (C1)
82
Where does the conus medullaris appear in relation to the spine
Thoracolumbar juntion is where the cord ends (conus medullaris) and the caudal equine begins
83
What portion of the meninges forms the denticulate ligaments?
The pia sends out the fibers called the denticulate ligaments.
84
Where does an epidural injection go?
In the fatty space outside the dura, bathes the dura in the medication which diffuses.
85
Where does the dura end and become anchored to the coccyx?
The filum terminale which extends from the tip of the spinal cord to the coccyx
86
Where is the CSF taken from when doing a lumbar puncture?
The Lumbar cistern located below L2
87
Spina bifida occulta
Failure of vertebral arch to fuse-bony defect (usually a coincidental finding)
88
Meningocele
Meninges protrude thorugh bony defect of vertebral arch
89
Myelomeningocele
spinal cord and meninges protrude defect of vertebral arch (very significant)
90
What vessels supply the blood to the Anterior spinal cord?
Anterior segmental medullary artery, and anterior radicular spinal artery
91
What vessels supply the blood to the Posterior spinal cord?
Posteior segmental medullary artery, and posteior radicular artery
92
Describe the position of the AP spine X-ray
shot head on
93
Describe the position of the Lateral view X-ray
from the side (can see the bodies, IVF, and Spinous proc.)
94
What would you need to evaluate for spondylolisthesis pars defect ?
Oblique view X-ray
95
Vertebral Body osteoporosis
Common metabolic bone dz. Demineralization of the bones caused by a disruption of the normal balance of ca.
96
Laminectomy
Surgical excision of one or more spinous process and adjacent supporting vertebral laminae
97
Why are the cervical vertebrae more likely to dislocate?
Because of their more horizontally oriented articular facets
98
What do vertical forces (such as a diving injury) result in in regards to the Atlas?
compression of the lateral mass between occipital condyles and axis which drives the pieces apart- aka-jefferson/burst fx.
99
What can cause a traumatic spondylolysis of C2?
Hyperextension of the head ON the neck (not of the neck as well) aka, hangman's fx
100
Caudal epidural anesthesia
a local anesthetic agent is injected into the fat of the sacra canal that surrounds the proximal portions of the sacral nerves
101
What happens to the nuclei pulposi as we age?
The nuclei pulps dehydrate and we lose elastin and proteoglycans while gaining collagen
102
Herniations of nucleus pulposis extend in what direction?
posterolaterally
103
Where do approx 95% of disk herniations/protrusions occur?
L4-5 or L5-S1
104
What herniation is related to "sciatica"
L5 S1 component of the sciatic nerve
105
atlanto-axial subluxation definition
incomplete dislocation of the median atlanto-axial joint
106
What is a hyperextension injury of the neck most likely to injure?
posterior parts of the vertebrae
107
Severe hyperextension of the neck (whiplash) may result in
ALL is stretched and may be torn, Hyperfelxion may also occur in the rebound and cause facet jumping
108
Spondylolisthesis
dislocation between adjacent vertebrae
109
Lower back pain is usually due to?
Muscular, joint, or fibroskeletal pain
110
Define Back SPRAIN
an injury when only ligaments tissue, or the attachment of ligament to bone, is involved
111
Define Back STRAIN
a common injury in people who participate in sports. Overly strong muscular contraction result of stretching, or microscopic tearing of muscle fibers
112
C1-C3 fx results
No function below head level (ventilator required)
113
C4-C5 fx
quadriplegia - no function of upper and lower limbs (respiration does occur)
114
C6-C8 fx
loss of lower limb function and hand and variable upper limb function
115
T1-T9 fx
Paraplegia paralysis of both lower limbs
116
T10-L1 fx
some thigh muscle function may allow walking with leg braces
117
L2-L3
retention of leg muscle function short leg braces may be required
