OS1 F Flashcards
(108 cards)
1
Q
spine curvatures
A
LKLK
2
Q
vertebral unit?
A
2 adjacent vertebrae and associated vertebral disc
3
Q
rule of 3s?
A
t1-t3: spinous and transverse processes same level
t4-t6: spinous 1/2 level below transverse process
t7-t9: spinous at the level of the inferior transverse processes
T10: same as t7-t9
T11: same as t4-t6
t12: same as t1-t3
4
Q
superior facet orientation of vertebrae?
A
Cervical = BUM (backwards, upward, medial) Thoracic = BUL (backwards, upward, lateral) Lumbar = BM (backwards, medial)
Bumblebee
5
Q
anterior longitudinal L?
A
connects anterolateral aspects of vertebral bodies and IV discs
limits extension
6
Q
posterior longitudinal L?
A
runs within vertebral canal and connects posterior vertebral bodies
resists hyperflexion and prevents herniation of nucleus pulposus
7
Q
ligamentum flava?
A
connects laminae of adjacent vertebrae
8
Q
interspinous L?
A
connects spinous processes
9
Q
intertransverse L?
A
connects transverse processes
10
Q
iliolumbar L?
A
connects base of lumbar spine to ilium
11
Q
rotatores muscles?
A
longus - b/w transverse processes skipping 1 vertebrae
brevis - b/w transverse processes of adjacent vertebrae
extends thoracic spine bilaterally, rotates thoracic spine to opposite side unilaterally
12
Q
multifidus muscles?
A
insert spinous processes skipping 2-4 vertebrae
extends spine bilaterlally, side-bends and rotates to opposite side unilaterally
13
Q
semispinalis muscles?
A
transverse to spinous processes
extends thoracic/cervical spines and head bilaterally, side bends and rotates opposite side of head/cervical/thoracic
14
Q
coupled motion?
A
motion about 2 axes, principle motion cannot be produced w/o the associated motion
15
Q
linkage?
A
relationship of joint mechanics, linking joints increases ROM
16
Q
results of spinal SD?
A
reduce efficiency
impair flow of fluids
alter nerve function
create structural imbalance
17
Q
vertebral motion nomenclature?
A
motion is the movement of the anterior/superior surface
excessive motion/restriction is in reference to the top vertebrae in the unit (excess motion of L2 is the motion of L2 on L3)
18
Q
who described physiological motion of the spine?
A
Fryette 1918
19
Q
developers of principles of spinal motion
A
principles 1 and 2 = fryette (1918)
principle 3 = Nelson (1948)
20
Q
type 1 Fryette mechanics?
A
in neutral range, sidebending and rotation are coupled in opposite directions (rotation towards convexity) (tends to be group of vertebrae)
Type One Neutral Group Opposite (TONGO)
21
Q
type 2 Fryette mechanics?
A
in flexion/extension, sidebending and rotation are in the same direction (rotation towards cocavity) (tends to be single vertebrae)
Type Two Ø (non-neutral) Single Same (TTOSS)
22
Q
naming SDs w/ Fryette
A
if neutral; left sidebending restriction = right rotation restriction, etc
if f/e; left sidebending restriction - left rotation restriction, etc
abbreviated: T3-8 N Sr Rl (Vs/state/restrictions)
23
Q
type 3 Fryette mechanics?
A
if motion restricted in one direction, it will also be restricted in other directions
if motion improved in one direction, it will also be improved in other directions
summary: movement in any plane modifies movement in other planes
24
Q
spinal landmarks?
A
spine of scapula - T3 spinous/transverse
inferior angle of scapula - t7 spinous/t8 transverse
iliac crest - l4
25
scoliosis?
lateral curvature of spine (levo-left, dextro-right)
26
cobb angle?
```
angle measurement of degree of scoliosis
<25 = conservative Tx, minor
25-45 = non-operative, bracing Tx
>45 = surgical fusion required
>50 = respiratory compromise
>75 = cardiac compromise
```
27
radiculopathy?
pinched nerve causing lower back pain radiating to below the knee w/ dermatomal distribution; may have weakened neuro function (weakness, reflexes)
Dx: straight leg test - raise leg w/ knee extended and pain b/w 15-30 degrees indicates lumbar disc etiology
28
l4-l5 disc hernia manifestations?
lateral thigh/leg pain/numbness, first 3 toes pain; weakness to dorsiflexion, diminished hamstring reflex
29
l5-s1 disc hernia manifestations?
posterior thigh/leg pain/numbness, lateral heel/foot pain; weakness to plantarflexion w/ gastrocnemius and soleus atrophy, ankle jerk reflex diminished
30
spinal stenosis?
narrowing of spinal canal on nerve roots; bilateral lower limb pain w/ possible neuro impairment, typically chronic
Dx: straight leg test
31
cauda equina syndrome?
herniated disc impinging cauda equina; impaired neuro function (saddle anesthesia, LE weakness, diminished reflexes, urinary retention)
EMERGENT - work up = MRI
32
spina bifida occulta
meningocele
myelomeningocele?
SBO - failure of neural tube closure w/o herniation
M - failure of neural tube to close w/ meninges hernia
MM - failure of neural tube to close w/ meninges and spinal cord hernia
defect in closure of lamina
33
sacrilization/lumbarization?
S - one or both TPs of L5 are long and articulate w/ sacrum
L - failure of S1 to fuse w/ sacrum
34
spondylosis/spondylolesthesis?
SL - fracture b/w body processes
SLL - slipping of one vertebrae on another
35
where do nerves exit in C spine?
| T/L?
above the vertebral body
below vertebral body
36
vertebrae w/ no vertebral body?
atlas (c1)
37
C-spine lateral view X-ray uses?
use for trauma/MVA; is easy to use and you can observe all cervical vertebrae from this angle very easily
38
things to look for in C-spine x ray?
lamina unstable fractures
increased white (bone), spurring, or abnormal growth leading to negative arthritic changes
39
Hangman's fracture?
spondylolisthesis of C2 w/ a vertebral arch fracture as well as tearing of C2/C3 ligaments
caused by hyperextension of neck
40
AP C-spine X-ray uses?
can see alignment of spinous processes, not all fractures visible on lateral view
41
misalignment of C-spine usually due to?
unilateral facet joint dislocation
42
space b/w spinous processes in C-spine?
no space should be more than 50% wider than the one immediately above or below, if it is = anterior cervical dislocation
43
open mouth radiograph uses?
assessment of C1/C2
44
burst fracture?
seen in open mouth radiograph; if lateral masses of C1 overhang C2 it is indicative of burst fracture
45
45 degree oblique C-spine radiograph uses?
visualize IV foramen and present of osteophyte encroachment in spondylosis (OA)
right posterior oblique visualizes left foramina and right anterior oblique visualizes right foramina (posterior visualizes opposite side)
narrowing = MRI and assess soft tissue
46
altanto-occipital (OA) joint motions?
```
major = F/E
minor = SB/R
```
Type 1 like SB and R (opposite directions)
47
atlanto-axial (AA) joint motions?
primary = rotation; via obliquus capitis inferior Ms
almost no SB/F/E
48
C2-C7 joint motions?
R/SB in same direction (type 2)
49
C2-C7 SDs?
sagittal plane dysfunctions (F/E/Neut)
50
OA joint diagnosis?
restriction to SB right or RL = SBR/RL SD
restriction to SB left or RR = SBL/RR SD
repeat in flexion/extension
- if end feel more symmetric in F/E add that to SD
- ex: symmetric in F-> OA F/SBR/RL SD
51
AA joint diagnosis?
rotation only, fully flex C-spine to isolate atlas and rotate
greater rotation right = RR SD
52
C2-C7 joint diagnosis?
type 2
ex = C4 E RLSL
53
sidebending assessment?
translation (pushing) ease towards left = SR SD
fulcrum side = pushing side = SB side you're assessing
54
contraindications to HVLA in C-spine?
RA, down syndrome (L instability), vertebral artery disease, carotid disease, dislocation of dens
55
C6 dermatome affected in Pt; which spinal segment would be effected?
C5-C6 b/c it exits above spinal segment
56
lymph tissue from what embryological layers?
lymph vessels/nodes/spleen - mesoderm
thymus/tonsils - endoderm
57
spleen palplation?
normally not palpable, but it can be found beneath ribs 9-11 on the left side
58
spleen fluid movement driven how?
by diaphragm movement; movement is pressure sensitive
59
liver palpation?
RUQ; palpable at R costal margin
60
liver fluid movement driven how?
movement of diaphragm like spleen; pressure sensitive
61
liver lymphatic function? spleen? thymus?
liver - 1/2 of body's lymph formed here, clears bacteria, drainage site
spleen - rbc recycling, Ig synth, clears bacteria
thymus - maturation of T cells, limited Fx in adults
62
majority of lymph drainage pumped how?
associated w/ respiration and cysterna chyli
63
tissues w/o lymphatic vessels but use direct diffusion?
epidermis
endomysium (inner lining of muscles)
cartilage
bone marrow
64
pathway from lymph to veins?
lymph capillaries -> collecting lymphatics -> afferent lymphatic vessels -> efferent lymphatic vessels -> thoracic duct or R lymphatic duct -> venous system
65
lymphangions?
muscular units in lymphatic collector chains; contract and move lymph in peristaltic waves
66
pathway of lymph through a lymph node?
afferent lymphatics -> subcapsular space -> outer cortex -> deep cortex -> medullary sinus -> efferent lymphatics
67
superificial lymph nodes found where? deep?
superficial - in subcutaneous tissue
deep - beneath fascia, muscles, and organs
68
evaluation of lymph nodes?
swollen, soft, painful -> infectious
swollen, hard, non-painful, fixed -> malignant
69
virchow's node?
L supra-clavicular; intra-thoracic or abdominal cancer
70
epitrochlear nodes?
swell in secondary syphilis
71
jugulodigastric node?
common swelling in upper respiratory infections, below ear
72
L/R lymph drainage in body?
thoracic duct: drains LEFT head, neck, UE, thorax, abdomen, and both side of LE
R lymphatic duct: RIGHT UE, thorax, head, neck, abdomen
73
cisterna chyli?
origination point of thoracic duct, found at L1-2
74
termination point of thoracic duct?
it pierces Sibson's fascia at superior inlet and U-turns into LSCV/IJV
75
R lymphatic duct origin/termination?
origin - RJ/RSC trunks
termination - RSCV/IJV junction
76
functions of lymphatic system?
fluid balance
tissue cleansing/purification
defense
nutrition (fat absorption, protein return to blood)
77
mechanisms of lymph flow?
```
interstitial fluid pressure
diaphagmatic pressure (thoracic and pelvic)
SNS
```
78
SNS effects on lymph?
on lymph valves -> tightens valves, decreases flow
on smooth muscle -> increases tone, decreases peristalsis
79
consequence of poorly functioning lymphatic system?
edema
80
causes of edema?
increased A pressure (HTN, drugs)
increased V pressure (CHF, obstruction)
decreases plasma osmotic pressure (cirrhosis, malnutrition)
increases capillary permeability (infection)
81
effects of edema?
compression of local structures (vascular, neuro, etc)
decreased tissue waste removal (lactic acid, etc)
decreased pathogen clearance
chronic states -> fibroblast recruitment/activation (fibrosis)
82
purpose of lymphatic OMT?
improve functional capacity of lymphatic system including:
- maintenance/purification/cleansing
- tissue nutrition
83
indications for lymphatic OMT?
```
edema, congestion, lymphatic stasis
infection
inflammation
pregnancy
sprains/strains
```
84
absolute contraindications for lymphatic OMT?
- anuria - kidneys have to be functioning to process extra fluid return
- necrotizing fascitis in treatment area
- fracture/dislocation
- some infections
- circulatory disorders (obstructions, embolisms...)
Pt refuses to tolerate or refuses Tx
85
compensatory patterns? uncompensated?
common - LRLR
uncommon - RLRL
uncompensated - anything else
86
compensatory patterns and lymphatics?
uncompensated can contribute to lymphatic congestion
87
fascial patterns of Zink?
describes fascial restriction patterns that could restrict lymphatic flow
4 diaphragms = cranial-cervical, cervicothoracic (thoracic inlet), thoracolumbar/ribs, lumbosacral
compensatory patterns
88
diagnosis in lymphatics approach
- evaulate risk/benefit
- evaluate fascial patterns of Zink
- evaluate diaphragm/fascia for restriction
- evaluate for any SD
- evaluate for tissue congestion
89
steps in evaluating diaphragms/fascia in lymph Tx?
1st - thoracic inlet MFR
2nd - SO release for HEENT, doming diaphragm for problems inferior
3rd - ischiorectal release for LE problems
90
sequence of Tx in lymphatic OMT?
1 - open pathways to remove restriction
2 - maximize diaphragmatic functions
3 - increase pressure differentials or transmit motion
4 - mobilize targeted tissue fluids (localized to SD)
91
BLT/Stills/FPR: direct/combination/indirect?
```
Stills = combo
indirect = BLT/FPR
```
92
BLT involves?
minimizaiton of peri-articular tissue load and placement of affected ligaments in a position of equal tension in all planes
93
BLT indications?
SD involving ligamentous articular strains
| areas of lymphatic congestion/edema
94
BLT contraindications?
```
fractures
open wounds
ST/bony infections
abscesses
DVT
anticoagulation
post-op conditions
aortic aneurysm
```
95
biochemical changes w/ immobilization
- fibrofatty infiltrates found in folds/recesses; correspond directly w/ length of immobilization
- loss of water/glycoaminoglycans in ground substance
- immobilization <12 weeks -> new collagen in haphazard manner
- immobilization >12 weeks -> collagen loss
96
physiological changes w/ immobilization
- force needed to move an immobilized joint = 10x normal
- after repetitions, force required = 3x
- over time, joint regains normal mobility
97
steps in BLT
- position in BLT
- activating force (respirations)
- reevaluate
98
FPR absolute contraindications?
unstable fracture
neuro symptoms
life-threatening symptoms
99
FPR relative contraindications?
tx not tolerated well
pt at risk for fracture (osteoporosis)
joint instability
spinal stenosis/nerve root impingement
100
FPR mechanism?
SD initiated by increased activity in gamma motor system; overall result is increased tension even in neutral
positioning M in neutral resets tension/hypertonicity of M fiber and unloads the joint; all of which soften tissue
101
FPR steps
- position in neutral while monitoring
- activating force (compression/torsion/distraction)
- position in SD, hold 3-5 seconds
- return and re-evaluate
102
Still's contraindications?
wounds/fractures less than 6 weeks old
103
Still's steps
- position in SD
- force (compression/traction)
- move through RB while maintaining force
- final tx position (RB/AB)
- return to neutral and reassess TART
104
neural reflexes w/ spinal root for:
biceps
brachioradialis
triceps
biceps - c5
br - c6
triceps - c7
105
compression test?
pt seated, phys applies axial compression to head
positive = pain down arm -> nerve root compression (cervical radiculopathy)
106
spurling's maneuver?
test in stages each being more provactive, so one positive test stage the testing can end
1- compress head in neutral
2- compress head in extension
3- SB head away from affeected side then toward affected side and add compression
positive = pain down arm -> nerve root compression (cervical radiculopathy)
107
most common compensatory pattern?
LRLR
108
when to use BLT/FPR/Stills
BLT - fragile Pts, ligamentous articular strains, edema
FPR - hypertonic Ms
Stills - hypertonicity, motion restriction
