conditions of the back

Question 1

what does the spine do (5)

Answer 1

upright posture, allows mvt, protects sc (vertebral foramen and transverse foramen for spinal n.), m. and lig attachment

Question 2

how many vertebrae and nerve roots are in the c-spine what vertebrae allow rotation

Answer 2

7 vertebrae and 8 n. roots

atlas (c1) and axis (c2) allow rotation

Question 3

what part of the spine attaches to the ribs, incases the lungs and heart and diaphragm

Answer 3

the thoracic vertebrae

Question 4

what part of the spine has larger bodies for weight bearing and allows for minimal rotation

Answer 4

lumbar spine (thicker and take on the majority of the load)

Question 5

what is the purpose of the intervertebral discs (3)

Answer 5

allow mvt, absorbs shock and increases space for transverse foramen (looses height w age)

Question 6

what is the purpose of facet joints

Answer 6

allow rotation bc of how they sit

Question 7

is it more common to injure m. of the spine or lig of the spine

Answer 7

m.

Question 8

what ligaments are stretched by flexion of the spine

Answer 8

interspinous lig, supraspinous lig, post longitudinal lig

Question 9

what lig is stretched by extension of the spine and which is stretched by side bending to opposite side

Answer 9

extension: anterior longitudinal ligament,

side bend: intertransverse lig

Question 10

if there pressure to the lumbar plexus what can it affect

Answer 10

can affect m. of lower extremity

Question 11

what m. are affected by whiplash moi

Answer 11

m. of the cervical spine (tighten up normally; upper traps, levator scapula, …)

Question 12

axial loading puts stress on the dics and the vertebrae and will cause what

Answer 12

decreased height, space in transverse foramen will decrease, impingement of the n. roots

Question 13

what can repetitive forward bending cause

Answer 13

disc move post, can put pressure on n. roots,= so comes out posterior

Question 14

what is stenosis (where can it occur what is it acquired secondary to and what are the s/s)

Answer 14

can occur anywhere in the spine (will decrease space where the n. root runs), acquired secondary to osteophyte formation (protective moi)
s/s: quadriplegia (depending on the level of severity), burning/tingling/numbness, motor changes (n. isn’t sending the signal properly), pain in area, happens w age when too much loading

Question 15

what is a disc herniation (moi, where is it most common and what age, s/s)

Answer 15

moi: whiplash (disc pushed back and stays there bc of hyperextension of the spine), repetitive flexion or extension, compression
posterior lateral is most common (bc we do more flexion and ant region of sc is stronger)

s/s: radiating pain, pain with valsava maneuver (pinky=c7, middle finger=c5)

L4/5, L5/S1 most common l-spine (30 -50 yo)
cervical spine is more common in older individuals (C4/5 and C5/6 most common)

Question 16

what are the diff types of disc herniations

Answer 16

degeneration: tears in annulus fibrosis
prolapse: nucleus finds way thru annulus
extrusion: material moves into sc (may impinge)
sequestration: further into sc, may migrate

Question 17

how do disc herniation develop and what can you palpate

Answer 17

years and years of mod pain (no pain bc no pressure on n. roots, might fell stiffness in the back) until 1 day the back will spasm with ridiculous motion
pain on palpation of the transverse, spinous process but won’t be able to feel the herniation

Question 18

what is degenerative disc disease (moi and s/s)

Answer 18

chronic disease that occurs w age or in pliametric people, olympic lifters and gymnast jumping)

moi: compression, repetitive flexion, age (plays huge role in dx), high impact

s/s:radicular pain, loss of motor function, pain w valsava maneuver

Question 19

lumbar dermatomes and sensory loss (L1/2, L3/4, L4/5, L5/S1)

Answer 19

L1-2: front of thigh and groin to knee
L3-4: ant mid thigh over patella and medial lower leg to great toe
L4-5: lateral thigh, ant leg, top of foot, and middle three toes
L5-S1: post lateral thigh and lower leg to lateral foot and 5th toe

Question 20

lumbar myotomes weakness

Answer 20

L1-2: psoas/adductors
L3-4: ankle dorsiflexion
L4-5: toe extension
L5-S1: ankle plantar flexion

Question 21

cervical dermatomes and sensory loss

Answer 21

C1-C2: top of head, forehead
C3: entire neck
C4: shoulder area, clavicle
C5: deltoid area
C6: radial side of hand to thumb
C7: index, middle and ring fingers
C8: little finger
T1: medial side of forearm

Question 22

cervical myotome weakness (resist them in that mvt to see if weak; mmt)

Answer 22

C1-C2: neck flexion
C3: lateral flexion
C4: shoulder elevation
C5: shoulder abduction
C6: elbow flex, and/or wrist extension
C7: elbow extension and/or wrist flexion
C8: thumb extension
T1: finger abduction/adduction

Question 23

torticolis what is it (s/s)

Answer 23

starts w spasm (SCM is the most affected)
head tilt towards one shoulder and chin rotates towards opposite shoulder

congenital and acquired

s/s: loss of rom, palpable lump or swelling involved muscles

Question 24

cervical sprains (moi, location and s/s)

Answer 24

moi: occur at extreme motions, violent m. contractions
occur at any ligament
s/s: pain, stiffness, and restricted rom

Question 25

cervical strains (moi, location, m. involved and s/s)

Answer 25

moi: forceful contrations/eccentric, extreme rom usually involved SCM and UFT (usually involves scalenes, levator scapulae and splenius m. ) s/s: pain, decrease rom, m. spasm, pain w contraction or stretching of a m. (mmt or flex test will be positive)

Question 26

brachial plexus conditions

Answer 26

``` neural structure that innervates upper extremity stretch injury compression injury (direct blow) ```

Question 27

acute burners (moi, s/s, how long will it last)

Answer 27

moi: forceful separation of neck from shoulder s/s: immediate, severe, burning pain and prickly paresthesia that radiates down the arm subsides in 5-10 minutes (if true spinal inj; won't subside) weakness may persist for hours or even days (abduction and external rotation)

Question 28

what is the RTP for an acute burner

Answer 28

if strength and function returns completely after 5 min than can rtp must have: - no neck pain, arm pain, or impaired sensation - full pain free rom in the neck and upper extremity - normal strength on mmt as compared to pre-season testing - normal deep tendon reflexes - negative brachial plexus traction test

Question 29

what are the signs and prognosis of neuropraxia (grade 1 burner)

Answer 29

signs: temporary loss of sensation and/or loss of motor function, may demyelinise but axon is intact ( no injury to the n. itself) prognosis: recovery within a few days to a few weeks

Question 30

what are the signs and prognosis of axonotmesis (grade 2 burner)

Answer 30

signs: significant motor and mild sensory deficits, axonal damage prognosis: deficits last at least 2 weeks. Regrowth is slow, but full or normal function is usually restored

Question 31

what are the signs and prognosis of neurotmesis (grade 3 burner

Answer 31

signs: motor and sensory deficits persist for up to 1 year. Nerve lacerated/avulsed (lost most of motor function) prognosis: poor prognosis, surgical intervention

Question 32

suprascapular n. injury (innervates what m., moi, s/s)

Answer 32

innervates the supraspinatus, infraspinatus and GH joint capsule (lack of rotator cuff strength can lead to many other injuries) moi: OH motions that generate rapid torque and velocity forces during cocking, acceleration and release phases s/s: m. weakness and atrophy, secondary injuries (ie: impingement, tendinitis, bursitis, etc)

Question 33

thoracic spine contusions, sprains and strains (moi, s/s)

Answer 33

moi: direct blows, violent m. contractions | s/s: pain, ecchymosis, m. spasm, limited swelling, decreased rom and function

Question 34

thoracic fx (protected by what, moi)

Answer 34

well protected w rib cage (rib fx are more common: sob, deep breathing will hurt, will use other m. to breath so thigh neck) moi: compression loads (tackle, fall on butt), women w osteopenia, repetitive stress from activities such as running (repetitive rotations)

Question 35

what is scheurmann's disease (what does it do, what age groups)

Answer 35

increased kyphosis (thicker on post aspect and thinner on ant aspect) related to mechanical stress older people and woman past menopause degeneration of the epiphyseal end plates of the vertebral body (involves 3 adjacent vertebral segments)

Question 36

scoliosis (may affect what, what types exist)

Answer 36

may affect heart and lung function sideways cruve structural (development of b.) or functional (posture, m. imbalance, pain affects the ability to remain upright) lumbar and thoracic (most common)

Question 37

pars interarticularis fx (lumbar spine injuries) (moi, what types exist)

Answer 37

weakest bony portion of the vertebral neural arch (common in gymnasts; lots of hyperextension) moi: mechanical stress from axial loading (repetitive loading in flexion, hyperextension and rotation), congenital spondylolysis or spondylolisthesis

Question 38

spondylolysis vs spondylolisthesis

Answer 38

spondylolysis: fx only to one side (complete fx or small stress fx), fx of pars interarticularis, stress -> complete spondylolisthesis: bilateral separation of pars resulting in ant displacement of vertebrae w respect to vertebrae below (vertebrae will slip forward) often diagnosed in children 10-15

Question 39

s/s of spondy's

Answer 39

can be asymptomatic, low back pain, neurological symptoms, unilateral dull ache aggravated by activity (hyperextension and rotation will increase pain and flexion can help bc it will push it post), mm spasm of erector spinae or hamstrings, flattened lumbosacral curve

Question 40

facet joint pathology what types of inj can occur, what is the moi

Answer 40

subluxation or dislocation, facet joint syndrome (inflammation, stands in hyperlordotic position and gets pushed back during sports), degeneration of facet itself (arthritis), mechanical injury to joint capsule-sprain moi: hyperextension

Question 41

s/s of facet joint pathology

Answer 41

- point tenderness, flattening of the back - pain w rotation, extension, lateral bending - limited flexibility of pelvic musculature - relieved in flexion

Question 42

what can sciatica be caused by

Answer 42

inflammatory condition of the sciatic n. (S1 and S2 myotones affected) can be caused by herniated disk, annular tear, m. related disease, spinal stenosis, facet joint pathology, compression of n. btw piriformis m.

Question 43

what is an SI joint sprain (or dysfunction) moi and s/s

Answer 43

moi: - postural imbalance or m. loss that allows that normal SI mvt normally - traumatic; bending and twisting - repetitive stress from lifting - fall on buttocks - excessive side to side mvt (running and uneven terrain, extreme flexion and rotation will cause sprain to those lig) s/s: - pain in SI area, extends to butt/post thigh - pelvic imbalance - standing one leg, climbing stairs pain will increase - lateral bending to that side, flexion