Final Part 1 Spinal Biomechanics Flashcards Preview

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Flashcards in Final Part 1 Spinal Biomechanics Deck (60)
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1
Q

Which Thoracic Vertebrae are Atypical?

What makes them different from Typical Thoracic Vertebrae?

A
  • T1 and T9-12
  • T1 resembles C7 and has one facet which articulates with the first rib (whereas usually it’s two vertebra per rib
  • T9-T12 have variations on the location of the facets on the body and transverse process for articulation w the ribs (T11, T12 start to look like lumbar vertebra)
2
Q

Out of the vertebrae, which type has the biggest body?

A
  • Lumbar
3
Q

Which type of vertebrae has transverse foramen?

A
  • Cervical
4
Q

Which part of the Thoracic vertebrae articulate with the rib head? the rib tubercle? joint name?

A
  • costovertebral joint on side of body to rib head
  • costotransverse joint on transverse process to rib tubercle
    (inferior costal facet on the body of top vertebra, superior costal facet [of body] and transverse process facet of bottom vertebra articulate with a rib)
5
Q

What about the anatomy of C1, the atlas, allow it to compliment the Occipital Condyles?

A
  • concave surface of facets which face superiorly and medially allow condyles to rock
6
Q

Which group of vertebrae make up Kyphosis of the spine? Lordosis? degree range? Random facts?
How many of each vertebrae are there?

A
  • Lordosis: Cervical 20-50 degrees (45 deg ave) facet and disc planes determine curve. secondary curve. develops in response to upright posture.
  • Kyphosis: Thoracic 20-50 degrees (45 deg ave) apex at T6-T7. primary curve at birth. flattening causes 1. cervical curve to decrease. 2. cervical curve to shift forward. 3. lumbar curve to increase.
  • Lordosis: Lumbar 20-60 degrees (35 deg ave) extends to sacrum. apex at L3-L4. develops in response to standing. Anterior pelvic tilt increases lordosis while posterior pelvic tilt decreases lordosis.
  • (think breakfast lunch and dinner) 7 cervical, 12 thoracic, 5 lumbar
7
Q

When Flexing the entire spine, which vertebrae account for the most ROM? When Extending?

A
  • Lumbar, then cervical, then thoracic
  • Cervical, then lumbar, then thoracic
  • cervical spine by far has the most ROM when flexing and extending.
8
Q

When laterally flexing the entire spine, which vertebrae have the most ROM?

A

Cervical, then equally thoracic and lumbar

9
Q

In rotation of the entire spine, which vertebrae have the most ROM?

A
  • Cervical, then thoracic, then a little in lumbar
10
Q

Which vertebrae have thick and broad spinous processes and which have long and slender ones?
Which have thick, strong and long transverse processes and which have slender and long ones?

A
  • thick, broad spinous processes with long slender transverse processes are lumbar vertebrae
  • long, slender spinous processes with thick, strong and long transverse processes are thoracic vertebrae. (just remember thoracic vertebrae are more even in shape)
11
Q

In the lumbar region, greatest mobility is in what type of movement?
Facet orientation limits what type of movement? How are the facets oriented?

A
  • greatest mobility in flexion-extension
  • face orientation limits rotational movement. articular facets are primarily in sagittal plane but become more coronal at the lumbosacral junction (facets at 90 degree angle to the body of vertebra vs. thoracic at 60 degree angle and lower cervicals at 45 degrees)
12
Q

Where is the greatest ROM?

A

C0-C1 condyles and atlas

13
Q

Which ways do the condyles face?

A
  • laterally and inferiorly

- form convex rockers that sit in concave surface of superior articular facet of C1

14
Q

In Flexion, the occiput moves how? In Extension? Lateral Flexion? Rotation? (rotation limited by?)

A
  • in Flexion, the occiput Glides posteriorly (10 degrees)
  • In Extension, the occiput Rolls anteriorly (25 degrees)
  • In Lateral Flexion, the occiput Rolls ipsilaterally and Glides contralaterally (5 degrees)
  • In Rotation, the occiput Glides posteriorly ipsilaterally and Glides anteriorly contralaterally (rotation limited by the alar ligament on opposite side - 5 degrees ROM)
15
Q

In Flexion, how does C1 move in relation to C2? Extension? Lateral Flexion? Rotation?

A
  • In Flexion, C1 articular surfaces Glide posteriorly (minimal) < same as occiput
  • In Extension, C1 articular surfaces Glide anteriorly (minimal) < the occiput rolls
  • In Lateral Flexion, C1 articular surfaces Glide ipsilaterally (5 degrees) < occiput rolls (ips.) and glides
  • In Rotation, C1 articular surfaces Glides posterior ipsilaterally and anterior contralaterally and C1 rotates around odontoid in horizontal plane (40 degree ROM, but first 25 deg occur exclusively at C1-C2) < same as occiput
16
Q

How many joints does C1-C2 have with each other? Describe the inferior facet of C1 and superior facet of C2 (this is where they articulate).

A
  • 3: two facet joints plus atlas-odontoid joint
  • inferior facets of C1 are slightly convex and face inferior and medially
  • superior facets of C2 are slightly convex and face superiorly and laterally
17
Q

What kind of joint is the Atlas-Odontoid Joint? Which ligament courses around the posterior aspect of the odontoid? What ligament connects the odontoid to the occiput?

A
  • synovial joint (between odontoid and Anterior arch of atlas)
  • transverse ligament
  • alar ligament (the one that limits rotation)
18
Q

Design of Lower Cervicals C3 to C7 is consistent. The articular facets are parallel to each other (in frontal plane). The Joints of _____ limit what type of movement to only a few degrees and serve as guides to couple ________ with ________ (coupled motion).

A
  • Joints of Luschka limit lateral flexion and serve as guides to couple lateral flexion with rotation.
  • these joints are inter body joints (completed by age 18)
19
Q

What does Degrees of Freedom mean?

A

the number of ways in which a body can move

  • one degree of freedom is translation or rotation about one axis
  • spinal segments exhibit 6 degrees of freedom: 3 translations & 3 rotations
20
Q

Define Axis. X, Y, Z. Movement around the X-axis is in what plane? What about Y and Z?

A

a line around which rotary movement takes place or along which translation occurs
X-axis
- a line passing horizontally from side to side
- referred to as the “frontal” or “coronal” axis
- movement around the X-axis is in the sagittal plane
Y-axis
- perpendicular to the ground
- referred to as the “longitudinal” or “vertical” axis
- movement around the Y-axis is in the transverse or axial plane
Z-axis
- passing horizontally back to front
- referred to as the “sagittal” axis
- movement around the Z-axis is in the frontal or coronal plane

21
Q

Motion occurring in sagittal plane is? Frontal? Transverse?

A
  • In Sagittal Plane, motion is flexion and extension.
  • In Frontal/Coronal Plane, motion is R or L lateral flexion
  • In transverse/axial plane, motion is rotation.
22
Q

What is Out of Plane Motion?

A

motion in which all points of a rigid body do not move in a single plane (3D movement)

23
Q

What does Instantaneous Axis of Rotation mean?

A
  • when a rigid body moves in a plane, at every instant there is a point in the body or some hypothetical extension of it that does not move
    • an axis perpendicular to the plane of motion and passing through that point is the instantaneous axis (center) of rotation for that motion at that instant
    • used to describe any vertebral motion in a 2D plane
    • as diff force vectors are applied to a vertebra, they may cause a shift in the IAR which will dictate the pattern of deformation for that motion segment
    • the IAR is different fro cervical, thoracic, and lumbar
24
Q

The functional unit of the spine is referred to as? What does this mean?

A
  • Motion Segment - smallest spinal segment exhibiting biomechanical characteristics similar to those of the entire spine
  • two adjacent vertebrae and their interconnecting disc, joints, capsule, and ligaments
  • six degrees of freedom
25
Q

Define Coupled Motion.

A

the consistent association of one motion (translation or rotation) about one axis w another motion about a second axis

  • one motion cannot be produced wo the other
  • two motions occurring at the same time along two diff axes
26
Q

Define Loose-packed joint position vs. Closed-packed joint position. give example of each.

A
  • joint capsule and ligaments are most relaxed vs maximally tightened
  • max joint play vs no joint play
  • articulating surfaces maximally separated vs max contact between surfaces
    ex. facet joint loose-packed position when half way between flexion and extension
    ex. facet joint closed-packed position when in extension
27
Q

What are similarities and differences of the disc in each region? location of nucleus pulpous?

A
  • Cervical Discs height-to-body ratio is 2:5 allowing greater ROM in cervicals and contributes 25% of height of cervical curve; whereas Thoracic disc ratio is 1:5, the smallest in the spine contributing to decreased flexibility. Lumbar discs 1:3 allow ROM.
  • Cervical and Lumbar region, nucleus pulpous located posteriorly within annulus (think lordosis). In Thoracic, located centrally.
  • Lumbar discs resist axial compression forces
28
Q

Where are disc lesions most common? What is a bulge? What is a disc herniation and what are the types?

A
  • Lumbar Region
  • Bulge: not diagnostic. can be symmetrical or asymmetrical. asymmetrical bulging found in scoliosis. Annual fibers buckle outward and may compress neural tissues in the IVF (intervertebral foramen) or spinal canal causing pain, joint dysfunction. NOT A HERNIATION.
  • Disc Herniation: disc material ruptures through annular fibers (somatic pain) and may compress nerve in IVF, cause radicular pain, and/or intense inflammatory response. displacement of disc material beyond the limits of the intervertebral disc space.
    • Focal Herniation: involves less than 25% of disc circumference
    • Localized Herniation: involves less than 50% of the disc circumference
    • Broad-based Herniation: involves bet 25-50% of disc circumferences
  • herniated discs may take the form of protrusion or extrusion, based on the shape of the displaced material
    • Protrusion: base is broader than distance it protrudes
    • Extrusion: balloons into canal w narrow base (bud)
29
Q

What is an Annular Tear and where is it seen? Symptoms?

A
  • seen in disc herniation
  • radial, transverse or concentric tears (fissures) in the annulus
    • may weaken the disc
    • may generate pain
    • disc material may migrate into the tears
30
Q

Force Transmission through a disc: Compression force from body weight and muscle contraction raises what kind of pressure in nucleus pulposus? Increased pressure elevates tension where? Increased tension in _____ inhibits ______ expansion in the nucleus. The nuclear pressure is exerted where? The nucleus pressure reinforces the peripheral annulus fibrosis creating _____________.

A
  • compression force, raises hydrostatic pressure in nucleus pulposus.
  • increased pressure elevates tension in annulus fibrosis which then inhibits radial expansion in the nucleus. the pressure of the nucleus is exerted upward and downward against endplates. pressure within the nucleus reinforces the peripheral annulus fibrosis creating a stable weight-bearing structure.
31
Q

What is the average ROM for Flexion and Extension of lower cervical, upper thoracic, and lumbar regions? Planar movements?

A
  • for lower cervical, thoracic, and lumbar, movement is a combo of sagittal rotation and sagittal translation (gliding).
  • Lower Cervical: 15 degrees per segment *flex and ext predominate over other motions
  • Thoracic: ave 6 degrees (altho 4 in upper and 12 in lower)
  • Lumbar: ave 25 degrees
32
Q

What is the average ROM for Lateral Flexion of lower cervical, upper thoracic, and lumbar regions? What is Lateral Flexion’s coupled motion per region?

A
  • Lower Cervical: 7-8 degrees *lateral flexion and the degree of coupled rotation decreases as you moved caudally down cervical spine.
    • coupled with ipsilateral axial rotation
  • Thoracic: 6 degrees
    • upper thoracic coupled with ipsilateral axial rotation (body rotation to the concavity and spinous deviation to the convexity)
    • middle and lower thoracic: coupling may occur in either direction
  • Lumbar: 6 degrees *lumbosacral joint has only 3 deg
    • coupled with contralateral axial rotation (body rotation to the convexity and spinous deviation to the concavity)
33
Q

What is the average ROM for Rotation of the Lower Cervicals, Thoracic, and Lumbar regions? Coupled motion?

A
  • cervical and thoracic coupled with same side Lateral F`lexion; whereas, lumbar coupled contralaterally L1-3, then ipsilaterally L4-L5 (lumbar also has slight sagittal plane rotation)
  • Lower Cervical: 5 degrees (2 degrees at C7-T1) *coupling not as strong as when laterally flexing
  • Thoracic: upper is 8-9 degrees
  • Lumbar: 2 degrees (very limited by sagittal facets)
34
Q

During Rotation, do the articular facets of the Lumbar vertebrae on the same side of rotation glide together or apart? Lateral Flexion? Flexion?

A
  • Rotation: glide apart
  • Lateral Flexion: glide together
  • Flexion: glide together superiorly (disc “stretched” posteriorly)
  • Extension: facets approximate. Lumbar disc, facet capsule, and anterior longitudinal ligament are stretched anteriorly.
35
Q

During Rotation, what do the facets of the lower cervical and thoracic region do?

A
  • Lower Cervical:
    • on the side of rotation the inferior facet glides down and medially < same as lateral flexion
    • on the side opp rotation the inferior facet glides up and laterally
  • Thoracic:
    • on the side of rotation the inferior facet glides down < similar to cervical
    • on the side opp rotation the inferior facet glides up
36
Q

During Lateral Flexion, what do the facets of the lower cervical and thoracic region do?

A
  • Lower Cervical:
    • inferior facet glides down and medially on side of lateral flexion. opposite on opp side.
    • lateral disc wedging and approximation on side of lateral flexion, so distraction on opp side.
  • Thoracic:
    • disc and facet joint approximation on side of lateral flexion. distraction on opposite.
    • upper thoracic inferior articular facets glide medially on side of lateral flexion (same as cervical). on opp side, glide laterally.
37
Q

During Flexion & Extension, what do the facets of the lower cervical and thoracic region do?

A
  • Lower Cervical:
    • In Flexion, facets glide apart (opp in extension)
    • also, anterior disc compression and posterior disc distraction. There is stretching and joint gapping.
  • Thoracic:
    • In Flexion, facets glide apart (opp in extension)
38
Q

The degree of Craniocervical Flexion:

A

45-50 degrees

39
Q

The degree of Craniocervical Extension:

A

85 degrees

40
Q

The degree of Craniocervical Lateral Flexion:

A

40 degrees

41
Q

The degree of Craniocervical Axial Rotation:

A

90 degrees

42
Q

In the cervical region, most flexion-extension occurs in which segment? Least?

A
  • most C0-C1 at 25 degrees
  • C1-C2 at 20 degrees along with C4-C5, C5-C6
  • least ROM in C7-T1 for flexion-extension at 9 degrees
43
Q

In the cervical region, most Lateral Flexion occurs in which segment? Least?

A
  • most C3-C4, C4-C5 at 11 degrees

- least is C0-C1, C1-C2 at 5 degrees

44
Q

In the cervical region, most Rotation occurs in which segment? Least?

A
  • most C1-C2 at 40 degrees (huge relative to others)
  • least C7-T1 at 2, then C2-C3 at 3
  • remember, majority of rotation occurs at C1-C2, whereas flex-ext occurs at both C0-C1 & C1-C2 with a little more at C0-C1
45
Q

In the Thoracic region, most Flexion-Extension occurs in which segment? Least?

A
  • most T12-L1 at 13, then T11-T12 at 12

- least from T1 to T6 at 4 degrees per segment

46
Q

In the Thoracic region, most Lateral Flexion occurs in which segment? Least?

A
  • most T11-T12 at 9, then T12-L1 at 8

- least T1-T2, T3-4 at 5

47
Q

In the Thoracic region, most Rotation occurs in which segment? Least?

A
  • most T1-T2, T8-T9 at 9 degrees, then T2-T6 all 8

- least T10-T11, T11-T12, T12-L1 at 2

48
Q

In the Lumbar region, most Flexion-Extension occurs in which segment? Least?

A
  • most L5-S1 at 17
  • least L1-L2 at 12
  • pretty even throughout
49
Q

In the Lumbar region, most Lateral Flexion occurs in which segment? Least?

A
  • most L3-L4 at 8, then L1-L2 & L2-L3 & L4-5 at 6

- least, lastly L5-S1 at 3 degrees

50
Q

In the Lumbar region, most Rotation occurs in which segment? Least?

A
  • most L1-L5, ea segment at 2 degrees

- least, lastly L5-S1 at 1 degree

51
Q

Degree of Thoracolumbar Flexion:

A

85 degrees

52
Q

Degree of Thoracolumbar Extension:

A

35-40 degrees

53
Q

Degree of Thoracolumbar Lateral Flexion:

A

45 degrees

54
Q

Degree of Thoracolumbar Axial Rotation:

A

90 degrees of craniocervical rotation + 35 degrees of thoracolumbar axial rotation = 125 degrees

55
Q

How many true ribs and how many false? floating?

A
  • 7 true

- 5 false (2 of those floating)

56
Q

What does the transverse costal facet articulate with? What is this facet on?

A
  • it’s on the transverse process of the thoracic vertebrae and articulates with the tubercle of the rib
57
Q

What are the ligaments associated with ribs and thoracic vertebrae?

A
  • lateral costotransverse ligament: near costotransverse facet. connects transverse process to lateral of tubercle of rib.
  • (superior) costotransverse ligament: more medial than the lateral one. transverse process to rib (before costotransverse joint).
  • intra-articular ligament: between the two bodies of vertebrae and at head of rib
  • intertransverse ligament - between transverse processes
58
Q

Describe the Pump Handle Action. What ribs does this happen at?

A
  • T1-T6 during inspiration
  • ribs pulled up and forward
  • pump handle movement increases the A-P diameter of the rib cage
  • rib head rolls downward, elevating the anterior end of the rib like the handle of a pump (head articulates with vertebrae)
59
Q

Describe the Bucket Handle Action. What ribs does this happen at?

A
  • T7-T10 during inspiration
  • ribs elevated and depressed
  • bucket handle movement increases the transverse diameter of rib cage
  • ribs ride up and down on transverse process while rib elevation and depression simulates a bucket handle moving on its hinges
60
Q

Describe the Caliper Action. What ribs does this happen at?

A
  • T8-T12 during inspiration
  • ribs move laterally
  • caliper movement increases the lateral diameter or the rib cage