exsc 460 FINAL Flashcards
(150 cards)
1
Q
Trunk Posture Posterior View: plumb line dropped from ________ should bisect ________
A
occipital protuberance
vertebral spinous processes
2
Q
angle formed by the direction the spinous process and the frontal plane- should be 90d
A
angle of protuberance
3
Q
most prominent spinous process
A
C7 or T1
4
Q
should be symmetrical
A
ribs
arm to body distance
muscular development (no evidence of spasm or atrophy)
5
Q
Trunk Posture Anterior View: should be symmetrical
A
muscular development
ribs
body countour
6
Q
Lateral View: curves
A
cervical-anterior
thoracic-posterior’
lumbar- anterior
sacral- posterior
7
Q
development
A
cephalocaudal
8
Q
primary curves are:
A
thoracic and sacrum
9
Q
secondary curves are:
A
cervical and lumbar
10
Q
at birth:
A
whole spine is concave
11
Q
at 3 months:
A
child begins raising head and cervical curve develops
12
Q
at 6-8 months:
A
child begins to sit up and lumbar curve begins to develop
13
Q
abdominal tonus
A
lack of protrusion
14
Q
functions of abdominal wall
A
protection support of viscera elimination forced expiration trunk flexion and rotation pelvic tilit stabilization of trunk and pelvis (most important stabilization muscles)
15
Q
relationship of abdominal muscles to curves of spine
A
pelvic tilit
lordosis
16
Q
abdominal ptosis
A
a pathological weakness or absence of the abdominal wall
17
Q
beevors sign
A
determines integrity of segmental innervation of rectus abdominus and corresponding paraspinal muscles
18
Q
how beevors sign test is performed
A
patient does 1/4 sit up with arms folded on chest, umbilicus drawn to the stronger or uninvolved side, away from the weakness
19
Q
Deepest layer of the spine
A
multifidus- rotation toward opposite side and extension
rotatores- same as above
interspinalis- extend vertebrae
intertransversarii- lateral flexion
20
Q
intermediate layer
A
erector spinae:
spinalis
longissimus
iliocostalis
21
Q
superficial layer
A
latissimus dorsi
gluteus maximus
22
Q
vertebrae of lumbar spine
A
large and massive w/ short thick and strong pedicles
facet joints absorb shear and rotational forces in the spine
23
Q
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
A
anterior longitudinal ligament
24
Q
thicker in thoracic than in cervical and lumbar regions
posterior lateral corners of intervertebral discs are poorly covered
A
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
