exsc 460 FINAL Flashcards Preview

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Flashcards in exsc 460 FINAL Deck (150):
1

Trunk Posture Posterior View: plumb line dropped from ________ should bisect ________

occipital protuberance
vertebral spinous processes

2

angle formed by the direction the spinous process and the frontal plane- should be 90d

angle of protuberance

3

most prominent spinous process

C7 or T1

4

should be symmetrical

ribs
arm to body distance
muscular development (no evidence of spasm or atrophy)

5

Trunk Posture Anterior View: should be symmetrical

muscular development
ribs
body countour

6

Lateral View: curves

cervical-anterior
thoracic-posterior'
lumbar- anterior
sacral- posterior

7

development

cephalocaudal

8

primary curves are:

thoracic and sacrum

9

secondary curves are:

cervical and lumbar

10

at birth:

whole spine is concave

11

at 3 months:

child begins raising head and cervical curve develops

12

at 6-8 months:

child begins to sit up and lumbar curve begins to develop

13

abdominal tonus

lack of protrusion

14

functions of abdominal wall

protection
support of viscera
elimination
forced expiration
trunk flexion and rotation
pelvic tilit
stabilization of trunk and pelvis (most important stabilization muscles)

15

relationship of abdominal muscles to curves of spine

pelvic tilit
lordosis

16

abdominal ptosis

a pathological weakness or absence of the abdominal wall

17

beevors sign

determines integrity of segmental innervation of rectus abdominus and corresponding paraspinal muscles

18

how beevors sign test is performed

patient does 1/4 sit up with arms folded on chest, umbilicus drawn to the stronger or uninvolved side, away from the weakness

19

Deepest layer of the spine

multifidus- rotation toward opposite side and extension
rotatores- same as above
interspinalis- extend vertebrae
intertransversarii- lateral flexion

20

intermediate layer

erector spinae:
spinalis
longissimus
iliocostalis

21

superficial layer

latissimus dorsi
gluteus maximus

22

vertebrae of lumbar spine

large and massive w/ short thick and strong pedicles
facet joints absorb shear and rotational forces in the spine

23

thicker and narrower in the thoracic than in the cervical and lumbar regions
limits hyperextension of spine and forward displacement of one vertebra on another

anterior longitudinal ligament

24

thicker in thoracic than in cervical and lumbar regions
posterior lateral corners of intervertebral discs are poorly covered

posterior longitudinal ligament

25

connects laminae of adjacent vertebrae from axis to sacrum

ligamentum flavum

26

connects tips of spinous processes of adjacent vertebrae from 7th cervical to sacrum

supraspinous ligaments

27

connects the adjoining spinous processes from their tips to their roots

interspinous ligament

28

connects transverse processes of adjacent vertebrae

intertransverse ligament

29

what covers the superior and inferior surfaces of vertebral bodies?

hyaline cartilage

30

intervertebral fibrocartilages (discs) are made up of how much water?

85-90%

31

how much nerve supply does the disc have?

minmal, peripheral posterior aspect of the annulus fibrosus may be innervated by a few nerve fibers from the sinuvertebral nerve

32

what 3 distinct tissues make up the intervertebral disc?

annulus fibrosus
nucleus pulposos
vertebral endplate

33

what is the annulus fibrosus?

outer circumfrence of disc made of 10-20 concentric rings of type 1 collagen fibers that criss cross at an angle of 30-60degrees to the spinal axis

34

is the annulus fibrosus vascular?

only the periphery of the disc is vascular

35

what is the nucleus pulposus?

central portion of the disc
loose collagen fibril network contained within an extensive gelatinous matrix (type II collagen)

36

at birth the nucleus pulposus:

contains a high portion of mucopolysaccharides which cause the disc to resist deformation.
these mucopolysaccharides decrease with age.

37

what is the function of the nucleus pulposus?

transmit vertical loading (compression) to radially directed tensile forces in the annulus

38

is the nucleus pulposus vascular?

no, avascular

39

How does the nucleus pulposus receive nutrition?

passive diffusion from the periphery of the annulus fibrosus and the vertebral bodies

40

what is the vertebral endplate?

thin layers of hyaline cartilage that cover the superior and inferior surfaces of the vertebral bodies.
endplates are 1 mm thick and allow nutrient transport in and out of discs via passive diffusion

41

condition characterized by an abnormal anterior convexity of the lumbar spine

lumbar lordosis
most common postural deviation seen

42

Etiology of lumbar lordosis

mal posture
muscle imbalance
overweight or pregnant
compensation due to kyphosis
fashion-high heels

43

X-ray evalutaion of lumbar lordosis shows:

pelvic angle and sacral angle increase from 30d to 40d
lumbosacral angle decreases from 140
anterior distance between vertebral bodies is greater than normal

44

clinical evaluation of lumbar lordosis

increased pelvic inclination/anterior tilt
lack of pain, edema, or discoloration

45

pathological changes

posture changes: accompanying kyphosis
internal rotation of hips

46

What muscle and Ligament changes accompany lumbar lordosis

abdominals stretched/weakened
low back extensors shortened
hip flexors tight
hip extensors weakened/stretched

47

sporting activities that aggravate lordosis

football lineman
gymnastics
equestrian events

48

Basic 5 exercises for Lumbar Lordosis

pelvic roll
strengthen abdominals
strengthen hip extensors
stretch low back extensors
stretch hip flexors

49

how to establish good postural practice:

encourage regular physical fitness program
provide knowledge base
provide motivation

50

Low Back Pain: Nociceptors detect pain through what 3 changes?

mechanical changes
chemical changes
temperature changes

51

What are mechanical changes?

over stimulation of mechanoreceptors
severe deformation of a tissue=perception of pain

52

What are Chemical changes?

presence of various chemicals such as hydrogen ions, potassium ions, or polypeptides from break down of proteins and acetylcholine. deficiency of blood or oxygen.
longer lasting

53

What are temperature changes?

thermoreceptors produce the perception of pain when extremes in temperature occur.

54

How much of all people will experience back pain during their life?

80%

55

the annual incidence of back pain ranges from:

15-45%

56

vast majority of low back pain takes how long to resolve?

2-3 weeks

57

_____ of patients experience improvement in _____

90%
6-12 weeks

58

recurrence rate:

58-90%

59

what ages are most commonly affected

35-55

60

difficulty in treatment lies with:

ability to achieve a definitive diagnosis

61

3 predisposing factors to etiology of low back pain

poor sitting posture
loss of extension
frequency of flexion

62

low back pain shows a fluctuation of symptoms depending on:

patients activities and postural positions

63

certain positions _____ the pain while others ____ the pain

aggravate
relieve

64

what must be done to determine the movements that are therapeutic to each patient?

mechanical evaluation
patient performs series of end-range spinal movements

65

What is postural syndrome?

soft tissues surrounding the vertebrae are subjected to prolonged periods of mechanical stress. (bending finger back)

66

characteristics of postural syndrome:

pain always intermittent in nature
pain is strictly positional
time factor, pain not immediate
pain removed immediately by postural correction

67

What is dysfunction syndrome?

occurs when adaptively shortened structures surrounding the vertebrae are subjected to mechanical stress on attempting normal end range movement

68

characteristics of dysfunction syndrome:

pain always intermittent in nature
no time factor
pain immediate
pain abolished immediately when stress is removed
pain occurs only at end range of motion, never while moving throughout range of movement
not rapidly reversible
managed by gradual stretching of tight structures
pain should be relieved immediately after stretch
is complete

69

What is derangement syndrome?

anatomical disruption and displacement of part of the intervertebral disc complex at the affected spinal level

70

characteristics of derangement syndrome?

pain usually constant in acute stage
pain produced or exacerbated immediately or eventually by certain movements and positions
pain appears during movement range

71

prevention of low back pain

learn and participate in daily exercise program
"Back school"
reduce stress
quit smoking
watch weight
always warm up and cool down

72

majority of acute low back pain will spontaneously resolve within:

2-6 weeks

73

an aggressive rehabilitation program is focused around an individualized, structured exercise program geared to create improved:

stamina, balanced strength, flexibility, and endurance

74

goal of acute treatment

relieve pain and muscle spasm

75

name several acute treatments:

bed rest 1-2 days
cryotherapy
thermotherapy
massage
manipulation
electrical stimulation

76

goals for post-acute treatment

restore ROM, strength, endurance, and flexibility to enable patient to return to work, sport, etc.

77

McKenzie has popularized the use of _____.

extension exercises to strengthen erector spinae and maintain the neutral curvature of the spine

78

goals of spinal stabilization:

increase capacity of muscular stabilizing system to maintain neutral zone of spine within physiological limits
increase the low back's tolerance to insult through the conditioning of the key musculature
restore muscle, strength, and endurance
reestablish a coordinated muscle activity as required for prevention of recurrence and restoration of function
reduce pain associated with spinal instability

79

stage 1 of spinal stabilization

focuses on activating the local stabilizing muscles

80

stage 2 of spinal stabilization

involves exercises that require a co-contraction of the TrA and MULT during assumption of additional positions

81

stage 3 of spinal stabiliztion

designed to maintain the abdominal draw and nature lordosis contraction during performance of exercises designed to recruit global stabilizers.

82

Etiology of Herniated Intervertebral Discs

Natural degeneration
Sudden or sustained increases in intradiscal pressure
lifting, fall on buttocks, direct trauma to back
anything that increases intradiscal pressure causes posterior fibers of annulus to give way

83

disc becomes softer and more susceptible to injury during:

pregnancy and labor and prolonged periods of bed rest

84

____ of herniated disc patients had a positive family history

32%

85

patients who have a positive family history are _____ greater risk

4-5 times

86

herniated disc pain is accentuated by:

forward bending, coughing, sneezing, lifting, etc.
relieved by recumbency

87

sciatic pain first appears:

as an ache in the buttocks followed by pain in posterior thigh, popliteal area, calf, ankle, and foot

88

lumbar spine deviates away from:

affected side

89

herniation is usually posterolateral, listing toward affected side increases:

pressure on the nerve and therefore increases symptoms

90

______ is usually restricted as it exacerbates the pain.

flexion

91

if tenderness is felt it is found where?

over the vertebral interspace just lateral to the midline in a large protruded disc

92

motor signs are present in ______ of cases

96%

93

sensory signs are found in ______ of pateints

80%

94

straight leg test

patient is supine, hip slightly internally rotated, knee extended, examiner slowly flexes hip until patient complains of pain or tightness.
pain after 70d is probably joint pain
then examiner dorsi flexes the patients foot, if radiating sciatic pain returns, the test is positive

95

well-leg raising test

patient supine, examiner raises unaffected leg, test is positive if sciatic pain produced on affected leg. these ruptures medial to nerve root.

96

Bowstring Test

straight leg test with knee slightly flexed. thumb or finger pressure applied in popliteal space. if radiating sciatic pain, test is positive.

97

most common site of problems in vertebral column

L5,S1 because it bears the most weight
transition between fixed sacrum and flexible lumbar vertebrae
greatest angle

98

studies by Armstrong and Shah found that the nucleus migrates:

forward in lumbar extension and backward in lumbar flexion

99

Protruded Disc

blugling of an intact annulus fibrosus

100

prolapsed disc

only the outer fibers of the annulus contain the bulging nucleus

101

extruded disc

disc material that extend beyond the annulus but still in continuity with disc material within disc space

102

sequestrated disc

disc material lies outside the annulus and is no longer in continuity with the disc material

103

schmorl's nodes

herniation of nucleus pulposus into the vertebral body

104

before surgery is undertaken, ____ and ____ of herniation must be established

existence and exact location

105

x rays

narrowing of disc space is indicative of old rupture

106

CT scan

reveal other pathology that may simulate a disc protrusion such as facet syndrome, spinal stenosis, tumor.

107

myelography

rule out possibility of nerve root tumor

108

should allow _______ of therapy before surgery

6 weeks

109

conservative management

1-2 weeks bedrest
ice or heat to relax low back muscles
muscle relaxants
exercise
proper posture practiced

110

criteria for surgery

impaired function of bowel or bladder
progressive motor weakness
severe sciatic pain

111

chemonucleolysis

injection of enzyme chymopapain into herniated nucleus pulposus
cause dissolution of mucopolysaccharides of the disk and reduce intradiscal pressure
3-6 months recover

112

percutaneous automated discectomy

posterolateral approach, nucleotome is positioned in nucleus pulposus, activated by a foot pedal and moved gently back and forth within disc while suction aspiration takes place
permits immediate mobilization

113

microdiscectomy

1-2 inch incision, use of operating microscope and microdiscecting technique to remove the disc under general anesthesia.
knee-chest position which decreases intraabdominal pressure and minimizes epidural bleeding.

114

laminectomy

most common
portion of lamina and some of ligamentum flavum is excised.
7-10 days for office workers
8-12 weeks for laborers

115

exaggeration of the normal posterior thoracic curve

kyphosis

116

includes kyphosis, forward head, and forward (rounded) shoulders

kyphosis syndrome

117

etiology of kyphosis

congenital
failure of curves to develop
acquired imitated posture
occupation
ectomorph more prone

118

postural kyphosis

functional, non-fixed curves
result of minor muscle imbalances
curvature can be corrected easily by patient

119

scheuermann's disease

adolescent roundback
more common form of kyphosis seen in young teenagers between ages 13-16
juvenile epiphysitis
fixed, structural
males more than females

120

Adam's Test

patient assumes adam's position
in postural or functional kyphosis spine assumes normal smooth arc
in scheuermann's or structural kyphosis the spine forms sharp angle or hump at the apex of the kyphosis

121

muscles and ligaments involved

stretched/weak: thoracic erector spinae
scapular adductors
shortened: pectoral muscles
serratus anterior

122

pathological changeds

can result in impaired vital capacity
increased lordosis common

123

exercise alone will not prevent the _____

progression of a progressive spinal deformity

124

major component in conservative management of scheuermann's disease is ___

the use of a brace

125

most common brace

milwaukee brace

126

braces not found effective in patients with:

vertebral wedging of >10d
initial kyphosis of >65d
initiation of treatment after iliac epiphyses has closed

127

exercises for kyphosis

strengthen scapular adductors
strengthen thoracic erector spinae
stretch pectoralis major
stretch serratus anterior
stretch anterior thoracic ligaments

128

lateral curvature of vertebral column >10d

scoliosis

129

scoliosis is characterized not only by lateral curvature but by ________

vertebral rotation

130

in structural scoliosis, the curve fails to

straighten out on side bending, this is indicative of vertebral and paravertebral bone and soft tissue deformities.

131

infantile scoliosis

onset between birth and 3 yrs
usually noticed in first year
males dominate
left thoracic curve most common
majority resolve spontaneously
life span limited to 30 yrs

132

juvenile scoliosis

occurs between 3 and 10 yrs
13-21% of all idiopathic scoliosis
right thoracic most common
the older the child the more likely to be girl

133

adolescent

from 10 till skeletal maturity
right thoracic most common
80% of idiopathic scoliosis

134

chest flatness on side of

convexity

135

rotation of vertebral bodies toward _______ and spinous processes toward _______

convexity, concavity

136

intervertebral discs are compressed on the ______ side

concave

137

distortion of vital structures

heart displaced downward

138

right thoracic

most common
highly structural, cosmetic deformity

139

thoracolumbar

t8-l3
not as cosmetically deforming

140

double major

right thoracic and left lumbar

141

double thoracic major

upper curve to the left and lower to the right, both in thoracic region
less deforming than simple curves because of symmetry

142

lumbar

t11-l4
most to the left
lead to arthritic pain

143

screening

takes 1 min per child, every 6-9 months

144

when rotation occurs, the pedicle on the convexity ______ and the pedicle on the concavity _______

rotates toward the midline
away from the midline

145

progression of scoliosis

girls more likely to progress
female to male ratio 8-10:1
younger the child at onset, the more likely curve is to progress

146

most likely to least likely to progress

double major
thoracolumbar
thoracic
lumbar

147

risser sign

measurement of excursion of iliac apophyses from anterolateral to posteromedial. when apophysis reaches SI junction and fuses to ilium, maturation nearly complete.

148

scoliosis curves progress most rapidly during time of ____

peak height growth velocity
girl:11-13
boy:13-15

149

3 major approaches to treatment

bracing and observation
exercise
surgery

150

expectations of orthosis

prevent further curve progression
reduce initial curvature as much as possible
maintain curve reduction
encourage patient compliance through providing a comfortable fit