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Orthopedic Impairments & Therapeutic Exercise > Exam 3 Learning Objectives > Flashcards

Exam 3 Learning Objectives Flashcards

1
Q

Components of an Intervertebral Disc

A
  • Nucleus pulposus
  • Annulus fibrosus
  • Vertebral Endplate
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2
Q

Nucleus pulposus

A

Structure
- Central portion of the disc, except in the L-spine → posterior
- Loose collagen fibril network contained w/in an extensive gelatinous matrix (Primarily type II collagen)
- High proteoglycan content at birth, decreases w/ age and is replaced by collagen
- Degeneration begins after 20 years
- Leads to a loss of disc height causing more load to be placed on the facets
- Imbibing properties of the proteoglycans lead to an increased water content percentage (85% at birth, 65% ~60)
Function
- Imbibition
- Force Transmission
- Stress Equalization
- Movement
- Nutrition

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3
Q

Annulus Fibrosus

A

Structure
- Made up of ~20 concentric rings
- Fiber pattern in each ring is offset (~60-120 degrees, depending on the source)
- Well innervated, contributes to discogenic pain when it bulges
Function
- Handles compression, shear, and torsional forces

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4
Q

Vertebral Endplate

A

A 1 mm thick plate of hyaline cartilage that helps attach the disc to the body of the vertebrae from above and below

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5
Q

Alignment of Cervical Facets

A
  • Oblique
  • 45 degrees to transverse plane and parallel to the frontal plane
  • Allows for all movements (flex, ext, lateral flex, and rotation)
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6
Q

Alignment of Thoracic Facets

A
  • 60 degrees to transverse plane and 20 degrees to frontal plane
  • Mostly lateral flexion and rotation w/ limited flexion/extension
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7
Q

Alignment of Lumbar Facets

A
  • 90 degrees to transverse plane and 45 degrees to frontal plane
  • Maximal flexion/extension and lots of lateral flexion
  • Minimal rotation
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8
Q

Why is ligamentum flavum yellow?

A

High elastin content

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9
Q

What is the purpose of the ligamentum flavum?

A
  • Allows it to stretch during flexion and “contract” in extension
  • Helps to add pre-tension to the disc and stabilize the spine in the posterior segment
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10
Q

Cervical Vertebrae

A
  • 7 vertebrae
  • Transverse foramen
  • Bifid spinous process
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11
Q

Atlas

A

Does not have a body or disc

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12
Q

Axis

A
  • Has dens to articulate w/ atlas

- 50% of neck rotation comes from atlantoaxial joint

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13
Q

Thoracic Vertebrae

A

All 12 have a notch in their transverse processes and a facet on their bodies for rib attachment

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14
Q

Lumbar Vertebrae

A
  • Thicker and bigger to handle compressive loads and strong muscle forces
  • Lordotic curve places shear force on the discs at the lower levels
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15
Q

Law of Motion for Cervical Vertebrae

A

Sidebending and rotation to same side

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16
Q

Law of Motion for Thoracic Vertebrae

A

Sidebending and rotation to opposite side

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17
Q

Law of Motion for Lumbar Vertebrae

A

Sidebending and rotation to opposite side except in extreme flexion (same at this point)

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18
Q

Spine Movement- Rotation

A
  • Greatest in cervical and upper thoracic spine

- Limited in lumbar spine until L5-S1

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19
Q

Spine Movement - Flexion

A
  • Greatest in cervical and lumbar spine
  • Increases in thoracic spine moving caudally
  • Spinal flexion occurs in the lumbar spine for the first 50-60 degrees of movement
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20
Q

Spine Movement- Lateral Flexion

A
  • Greatest in cervical and thoracic spine

- Limited in lumbar spine, especially at L5-S1

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21
Q

Factors that Increase Spinal Pressure Under Load

A
  • Position of the object relative to the COM (further = more pressure)
  • Size, shape, weight, density of the object
  • Degree of flexion and rotation of the spine
  • Rate of loading
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22
Q

Function of Facets

A
  • Facets “open” w/ flexion, “close” w/ extension
  • Facets guide movement of the motion segment
  • Assist in load-bearing
  • Greatest load on facets occurs in hypertextension
  • Increased load when fully flexed coupled w/ rotation
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23
Q

4 Steps of Disc Herniation

A
  • Protrusion
  • Prolapse
  • Extrusion
  • Sequestration
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24
Q

Protrusion

A
  • Posterior bulge in the nucleus pulposus

- Does not rupture the innermost laminae

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25
Q

Prolapse

A

Nuclear bulge ruptures all layers except for outermost laminae

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26
Q

Extrusion

A

Nucleus pulposus escapes into the extradiscal space

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27
Q

Sequestration

A
  • Complete rupture and leaking of nucleus into space

- Formation of discal fragments from the annulus fibrosus and nucleus pulposus in the extradiscal space

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28
Q

Cauda Equina Syndrome

A
  • Rarely, a disc herniation can be so big that it fills the entire spinal canal
  • The subsequent pressure on the spinal cord may cause paralysis of the muscles that control the bowels and bladder, as well as bilateral loss of function in lower extremities
29
Q

Sacral Torsion and Nutation

A
  • When the lumbar spine flexes, the sacrum posteriorly nutates (extends)
  • When the lumbar spine extends, the sacrum anteriorly nutates (flexes)
  • Abnormal mechanics in the lumbar spine can negatively affect sacral movement
  • Abnormal sacral position directly affects the pelvis and proper pelvic motion
30
Q

Factors that increases dynamic loads on the spine

A
  • Faster walking speeds = greater load (Greatest at L3-4 found at initial swing)
  • Forward flexed posture increases intradiscal pressure while walking
  • Limiting arm motion increases load and intradiscal pressure
  • Walking is safe overall for back patients, esp at slower speeds
31
Q

Mechanical Back Pain

A
  • Damage or irritation to ligament, muscle, connective tissue, or bone
  • Not directly nerve related
  • Can radiate down to about the level of the knee
32
Q

Possible Causes of Mechanical Back Pain

A
  • Irritated facet capsule
  • Arthritic
  • Degenerative changes
  • Osteophytes on surrounding bone
33
Q

Referred Pain

A
  • Pain perceived at a location other than the site of the painful stimulus
  • Usually used in terms of internal organ referred pain patients
34
Q

Radiating Pain

A

Pain along a nerve root

35
Q

Spoldylolysis

A
  • AKA “Scotty Dog fracture”
  • A defect or stress fracture in the pars interarticularis of the vertebral arch
  • Younger patients have good potential to return to normal activity w/ proper rest, unloading and proper core cork
  • Progression leads to disc and degenerative problems
36
Q

Spondylolisthesis

A
  • Forward slippage of a lumbar vertebrae on the vertebrae below it
  • A secondary effect of spondylolysis due to fracture of the pars interarticularis
  • Distance of slipping determines severity of disc, joint, and nueral involvement
  • Extension is more painful in this condition
37
Q

Distribution of Causes for Spodylolisthesis

A
  • 50% → pars fracture
  • 20% → congenital (no fracture)
  • 30% → older population (degenerative lumbar facets that allow displacement)
38
Q

What is the “core”?

A
  • Everything between lower chest and pelvis (anterior and posterior)
  • Abs, erector spinae, etc
39
Q

What is scoliosis?

A
  • Lateral curvature of the spine
  • Curve is named for the convex side
  • Hump forms based on thoracic motion rules
40
Q

Cobb’s Measurement

A

X-ray is used to measure the curvature in scoliosis

41
Q

Anterior Pelvic Tilt

A
  • Tight Back extensors
  • Tight Hip flexors
  • Weak Hamstrings
  • Weak Abdominals
42
Q

Posterior Pelvic Tilt

A
  • Tight Hamstrings
  • Tight Abdominals
  • Weak Back extensors
  • Weak Hip flexors
43
Q

SI Joint Problems

A

Sacroiliac Problem

Iliosacral Problem

44
Q

Sacroiliac Problem

A

Sacrum is not positions or moving correctly on the innominate

45
Q

Iliosacral Problem

A

The innominate is not moving properly on the sacrum

46
Q

Standing Flexion Test

A
  • Palpate PSIS on both sides w/ thumbs
  • See if one PSIS moves more superiorly than the other when the patient bends over to touch their toes
  • Tells if there is a problem with innominate movement and which side
47
Q

Seated Flexion Test

A
  • Perform same procedure are Standing Flexion Test

- Tells whether or not there is a problem w/ sacral movement (NOT WHICH SIDE)

48
Q

Long Leg Sitting Test

A
  • Check malleoli length when lying supine
  • Have the patient sit up and check length again
  • Anteriorly rotated innominate will shorted
  • Posteriorly rotated innominate will lengthen
49
Q

Gillet’s Test

A
  • 1 thumb on PSIS and the other on the sacral spine
  • Patient flexes hip 90 degrees and PSIS should drop down
  • If PSIS does not drop down test is positive
50
Q

Landmarks used for palpation of hip/pelvis symmetry for SI Joint

A
  • ASIS
  • PSIS
  • Iliac crest
  • Sacral spine
  • Inguinal ligament (pelvic dysfunction)
51
Q

Possible Innominate Problems

A
  • Up/downslip
  • Rotated innominate
  • In/outflare
  • Pubic Dysfunction
52
Q

Possible Sacral Problems

A
  • Left on Left/Right on Right Sacral Torsion

- Left on Right/Right on Left Sacral Torsion

53
Q

Pelvic Neutral

A
  • The position of the pelvis is neither anterior nor posteriorly tilted
  • This position should be maintained for core strengthening exercises
  • Pelvic neutral should be taught to back pain patients to hold during daily activities and exercise
54
Q

Why do sit-ups increase discal pressure?

A
  • When doing sit-ups, the hip flexor muscles (esp psoas major) are predominately used
  • Since these muscles are being used to support the whole upper body, there is a large moment arm on the lumbar vertebrae
  • This moment arm leads to an increase in discal pressure
55
Q

Types of imaging used for evaluating spinal problems

A
  • X-ray
  • MRI
  • CAT Scan
  • Myelogram
  • Discogram
  • Bone scan
56
Q

What is a laminectomy?

A
  • When the major problem appears to be spinal stenosis the spinal canal needs to be made larger
  • Usually done by performing a complete laminectomy
  • Removing the lamina allows more room for the nerves and enables the surgeon to remove bone spurs around the nerves
  • Scar tissue replaces the bone and protects the spinal nerves
57
Q

Rib Dysfunction

A
  • An acute onset of mechanical pain
  • Rib dysfunction is a common cause of thoracic based pain
  • Pain is usually localized in the back, but some can radiate pain around the rib toward the sternum
  • Can exist w/o “back pain” and be evident in respiratory restrictions
  • Subluxations tend to cause nagging pain and tautness of the iliocostalis muscle around the rib angle
58
Q

Pump Handle

A
  • Major movement in upper 6 ribs
  • Inhalation and exhalation
  • Ribs elevate, expands rib cage in anterior direction (1-6)
59
Q

Bucket Handle

A
  • Major movement below rib 6
  • Inhalation and exhalation
  • Lateral-superior direction (7-10)
60
Q

Caliper Motion

A
  • Major movement for ribs 11 and 12

- Movement in lateral direction (transverse plane), opening up anteriorly (8-12)

61
Q

What material helps discs “rehydrate” or increase the water content?

A

Proteoglycans

62
Q

What is imbibition?

A

Taking up and holding fluid

63
Q

What are the stages involved in the chronic pain cycle?

A

Pain → Muscle Tension → Reduced Circulation → Muscle Inflammation → Reduced Movement → Pain

64
Q

Timetable for acute pain

A

3-4 weeks

65
Q

Timetable for subacute pain

A

Up to 12 weeks

66
Q

Timetable for chronic pain

A

Longer than 3 months (12 weeks)

67
Q

Tropism

A
  • Abnormalities that can occur in the shape of the facets
  • Somewhat common to find at the L5-S1 level
  • Can produce abnormal amounts of facet joint stress and degeneration w/ difficulty in particular movements for that segment
68
Q

Distribution for Tropism

A
  • Flat (normal) → 57%
  • Asymmetric half-moon/half-flat shape → 31%
  • Half-moon shape → 12%

Orthopedic Impairments & Therapeutic Exercise (17 decks)

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