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Flashcards in Final Material Deck (104)
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1

What is a vertebral unit?

2 adjacent vertebrae and the associated intervertebral disc

2

Describe the rule of 3 for T1-T3

spinous process is located at the level of the corresponding transverse process

3

Describe the rule of 3 for T4-T6

spinous process is located 1/2 segment below the corresponding transverse process

4

Describe the rule of 3 for T7-T9

spinous process is located at the level of the transverse process of the vertebrae below

5

Where do T10-T12 fit into the rule of 3

T10 is the same as T7-9
T11 is the same as T4-6
T12 is the same as T1-3

6

Describe cervical superior facet orientation

BUM -> backwards, upwards, and medial

7

Describe thoracic superior facet orientation

BUL -> backwards, upwards, and lateral

8

Describe lumbar superior facet orientation

BM -> backward and medial

9

Describe Fryette Principle: Type One Mechanics

SD is in neutral (not flexion or extension); sidebending and rotation are coupled in opposite directions; tends to be a group of vertebrae

10

TONGO

Type One Neutral Group Opposite

11

Describe Fryette Principle: Type Two Mechanics

SD is non-neutral (it's either in flexion or extension); side bending and rotation are coupled in the same direction; tends to be a single vertebrae

12

TT(NN)SS

Type Two (Non-Neutral) Single Same

13

Describe Fryette: Third Principle

initiating movement of a vertebral segment in any plan of motion will modify the movement of that segment in other planes of motion; if movement is restricted in one direction, it will be restricted in other directions

14

For what parts of the spine does Fryette's first 2 principles work for?

thoracic and lumbar spine only

15

Which part of the spine is located at the spine of the scapula?

T3 spinous process and transverse process

16

Which part of the spine is located at the inferior angle of the scapula?

T7 spinous process
T8 transverse process

17

Which part of the spine is located at the iliac crest?

L4 vertebrae

18

How is scoliosis named?

towards the convexity; levo = left; dextro = right

19

What will you see of PE of someone w/ scoliosis?

asymmetry at the waist and shoulder; possible rib cage prominence; leg length discrepancies; Cobb Angle

20

How do you manage scoliosis?

based on Cobb angle
<25 degrees: conservative: monitor w/ radiographs
25-45 degrees: non-operative: bracing
> 45 degrees: surgical fusion

21

What is seen w/ radiculopathy? How would you work it up?

pain w/ dermatomal distribution, LE weakness/diminished reflexes
Positive straight leg test and perform an MRI

22

What is considered a positive straight leg test? What does it indicate?

raise leg w/ knee extended; pain from 15-30 degrees -> lumbar disc etiology

23

What is seen w/ spinal stenosis? How would you work it up?

bilateral LE pain, LE weakness, diminished reflexes
Positive straight leg raise and perform an MRI

24

What is seen w/ caudal equine syndrome? How would you work it up?

emergency (usually traumatic) -> LE weakness, saddle anesthesia, urinary retention
Perform an MRI

25

Sympathetic influence of head and neck

T1-T4

26

Sympathetic influence of heart

T1-T5

27

Sympathetic influence of lungs

T2-T7

28

Sympathetic influence of esophagus and UEs

T2-T8

29

Sympathetic influence of bladder

T11-L2

30

Sympathetic influence of upper GU (kidney)
Sympathetic influence of lower GU

upper GU (kidney to upper 1/3 of ureter) -> T10-T11
lower GU (lower 2/3 of ureter to urethra -> T12-L2

31

Sympathetic influence of upper GI
Sympathetic influence of middle GI
Sympathetic influence of lower GI

upper GI (mouth to ligament of treitz) ->T5-T9
middle GI (L. of Treitz to ileocecal valve) -> T10-T11
lower GI (ileocecal valve to anus)-> T12-L2

32

Sympathetic influence of uterus/cervix

T10-L2

33

Sympathetic influence of LE, urethra, and erectile tissue

T11-L2

34

Sympathetic influence of Prostate

T12-L2

35

Which parts of the spine have kyphosis?
Which parts have lordosis?

kyphosis = thoracic and sacral
lordosis = cervical and lumbar

36

Flexion/Extension is in which plane? Axis?

Sagittal plane;
horizontal (left to right) axis

37

Sidebending is in which plane? Axis?

Coronal (frontal) plane; anterior-posterior axis

38

Rotation is in which plane? Axis?

Transverse (horizontal) plane; superior-inferior axis

39

On PE you determine a pt's 7-9th thoracic vertebra are rotated right and sideband left; no change in flexion or extension. How would you document SD?

T7-9 N RrSl

40

What actions do the rotatores perform? What type of mechanics are they connected to?

Bilateral: extends T spine
Unilateral: rotates T spine to opposite side
Type 2 mechanics -> single segment

41

What actions do the multifidus M. perform? What type of mechanics are they connected to?

Bilateral: extends spine
Unilateral: flexes spine to same side; rotates to opposite side
Type 1 mechanics -> multiple segments

42

What actions do the semispinalis perform? What type of mechanics are they connected to?

Bilateral: extends T and C spine and head
Unilateral: bends head and rotates to opposite side
Type 1 mechanics -> multiple segments

43

Which organs receive parasympathetic innervation from the pelvic splanchnic nerves?

bladder, lower GI, lower GU, uterus and cervix, LE, urethra, erectile tissue and prostate

44

What are all other levels not innervated by pelvic splanchnic N. innervated by for parasympathetics?

Vagus N.

45

Where do nerves exit cervical vertebrae?

ABOVE the vertebral body

46

What is the OA joint?
What is the AA joint?

OA - atlanto-occipital joint
AA - atlanto-axial joint

47

What is the primary motion of the AA joint? What does the joint not do?

primary motion is rotation; almost no sidebending or flexion/extension

48

How are rotation and sidebending related in C2-C7? Which is most common in C2-C7 -> flexion/extension/neutral?

usually occur in same direction; type II like; flexion/extension most common

49

Contraindications for soft tissue in cervical region

fractures, open wounds, surgical site, infection, DVT, coagulopathy, neoplasm

50

Indications for soft tissue in cervical region

cervical SD w/ significant soft tissue component

51

Indications for HVLA and ART in cervical region

SD with ROM restriction most likely attributed to SD in cervical facet joint, AA joint, or OA joint (hard, firm end-feel)

52

Contraindications for HVLA and ART in cervical region

advanced RA, down's syndrome, carotid artery disease, malignancy, radiculopathy, dwarfism

53

Indications for MET or Still's technique in cervical region

cervical SD

54

Contraindications for MET or Still's technique in cervical region

undiagnosed joint swelling, severe osteoporosis, neoplasm, infection, hematoma, RA, fracture, dislocation

55

From what embryological structure does lymphatic vessels, lymph nodes, and spleen develop?

mesoderm

56

From what embryological structure does the thymus and part of the tonsils develop?

endoderm

57

Which parts of the lymphatic system are pressure sensitive? What does this mean?

Spleen and liver; movement of the diaphragm drives splenic and hepatic fluid movement

58

Which organ creates half the body's lymph?

liver

59

Which lymphatic organs have little/no function in adults?

Thymus, Tonsils, and Appendix

60

35-60% of the drainage through the thoracic duct is associated w/ what?

respiration

61

Describe the histology of lymph channels

blind endothelial tubes composed of a single layer of leaky squamous epithelium

62

Describe lymphangions

chain of muscular units that posses bicuspid valves; contract regularly throughout lymphatic system moving lymph in a peristaltic wave

63

What are 7 factors to consider when evaluating lymph nodes?

size, shape, consistency, tenderness, mobility, color, warmth

64

Describe Virchow's node

left supra-clavicular node -> usually relates to intra-thoracic/ABD cancer

65

What are epitrochlear nodes related to?

secondary syphilis

66

What is the name of the origin of the thoracic duct? Where is it located?

cisterna chyli which is a dilation at L1-2

67

Describe the termination of the thoracic duct

Pierces Sibson's fascia at superior inlet, U turns to empty into L subclavian/internal jugular veins

68

From where in the body does the thoracic duct drain?

left head/neck, left UE, left thorax/ABD, and everything inferior to the umbilicus

69

From where in the body does the right lymphatic duct drain?

right head/neck, right UE, right thorax, heart, lungs (except LUL)

70

Name the 4 functions of lymphatics

maintain fluid balance, tissue cleaning/purification, defense, nutrition

71

Describe normal pressure of interstitial fluid. What happens if it goes wrong?

normal pressure is -6.3 mmHg (negative pressure system); if pressure is greater than/equal to 0, lymph capillaries collapse and flow ceases

72

What role does the diaphragm play in mechanisms of lymphatic flow?

with each breath, contraction increases negative intrathoracic pressure and pulls fluid centrally; also exerts direct pressure on cisterna chyli which pushes fluid up

73

What role does the pelvic diaphragm play in mechanisms of lymphatic flow? What may cause it to be dysfunctional?

helps move fluid from LE and pelvis to thoracic duct; may be dysfunctional in dysmenorrhea, endometriosis, post labor/delivery, BPH, etc.

74

How does the sympathetic nervous system affect lymph valves?

increased sympathetics -> tighter valves -> decreased lymph flow into venous system

75

How does the sympathetic nervous system affect lymphatic smooth muscle?

increased sympathetics -> decreased peristalsis -> lymphatic congestion

76

What is the main consequence of a poorly functioning lymphatic system?

Edema

77

What are some effects of edema?

compression of structures (vascular, neuronal, SOB), decreased tissue waste removal, decreased pathogen clearance and immunity, chronic states of fibrosis/contractures

78

What are the indications of lymphatic OMT?

edema, tissue congestion, infection, inflammation

79

Absolute contraindications for lymphatic OMT?

anuria -> need kidneys functioning to process fluid return
necrotizing fasciitis
pt unable to tolerate treatment
pt refuses treatment

80

What are some relative contraindications for lymphatic OMT?

COPD, asthma exacerbation, unstable cardiac conditions, untreated coagulopathies, cancer, chronic infections, diseased organ, pregnancy, circulatory disorders

81

What are the common and uncommon compensatory (zink) patterns?

common -> L/R/L/R (80%)
uncommon -> R/L/R/L (20%)

82

What are the transition zones of the spine?

OA, C1, C2 -> craniocervical junction
C7, T1 -> cervical thoracic junction
T12, L1 - thoracolumbar junction
L5, Sacrum -> lumbosacral junction

83

What is the sequence of treatment in lymphatics?

open pathways to remove restriction to flow -> maximize diaphragmatic functions -> increase pressure differentials -> mobilize targeted tissue fluids

84

What does BLT stand for? What is another name for it?

Balanced Ligamentous Tension (BLT); LAS (ligamentous articular strain)

85

What type of technique is BLT and what is the position of all treatments?

describes as indirect passive treatment where position of all treatments are done at shifted neutral

86

What are the indications of BLT?

SD involving ligamentous articular strains and areas of lymphatic congestion or local edema

87

What are the relative contraindications of BLT?

fractures, open wounds, ST or bony infections, abscesses, DVT, anticoagulation, post-operative, or aortic aneurysm

88

Describe changes in ligament tensions?

ligaments don't stretch and contract like muscles so their is very little change in tension; relationship between join't ligaments will change as the joint changes position but tension will stay balanced throughout the ligament

89

What happens to collagen during immobilization?

collagen is overall lost b/c the rate of degradation exceeds the rate of synthesis

90

What are the 3 steps in BLT?

- positioning -> place the segment in an indirect position (shifted neutral)
- activating force -> have the pt hold their breath to facilitate release
- reevaluate for motion improvement

91

What does FPR stand for?

Facilitated Positional Release

92

What type of treatment is FPR?

indirect passive treatment

93

What are the advantages of FPR?

easily applied, effective, time efficient, pt satisfaction, thorough (b/c of time efficiency)

94

FPR indications

myofascial or articular SD

95

FPR Absolute Contraindications

unstable fracture, neurological sxs brought on by treatment position, exacerbation of life-threatening sx by treatment position in a monitored pt

96

FPR relative contraindications

tx not tolerated well or significant sx during process, comorbidities that put pt at risk for fx, moderate to severe joint instability, spinal stenosis/root impingement

97

What is the proposed mechanism of FPR?

SD maintained by increased gamma motor neurons of muscle in segment; by putting muscle in neutral position, it eliminates afferent excitatory input which unloads the joint and leads to soft tissue

98

What are the 4 steps in FPR?

- setup -> continuous assessment of SD and place pt in neutral position
- activating force -> compression, torsion, or distraction
- positioning -> hold 3-5 seconds
- return to starting position and re-evaluate

99

What type of treatment is Still's technique?

Indirect and direct -> start at shifted neutral and end at anatomic barrier (push through restrictive barrier)

100

Advantages of Still's technique?

same as FPR -> easy, effective, time efficient, pt satisfaction, thorough

101

Indications of Still's

SD in virtually all tissues of the body

102

Contraindications of Still's

not advisable across recent wounds or fractures less than 6 weeks old

103

What are the 5 steps to Still's technique?

- initial treatment position -> indirect
- add localizing force (less than or equal to 5lbs compression)
- move through RB while maintaining force in a smooth path
- end at the final treatment position -> direct at anatomic barrier
- return pt to neutral and reassess

104

What usually accompanies a compression fracture? What is the work-up?

history of trauma or osteoporosis
Work-up: A-P and lateral fims