spinal bio 2 test 1 Flashcards
(250 cards)
1
Q
2 main functions of the functional spine
A
rigidity
flexibility
2
Q
what % of body weight does the spine hold
load bearing?
A
50% body weight
100% load bearing (picked up items)
3
Q
flexibility ensures ________ & _______
A
mobility and plasticity
4
Q
what is involved in proprioception
A
muscle spindal fibers
vestibular apparatus
righting reflex
5
Q
what is the righting reflex
A
keeps eyes perpendicular to horizen
6
Q
cervical spine has what mobility and stability
A
increased
decreased
7
Q
thoracic spine has what mobility and stability
A
low mobility
increased stability
8
Q
lumbar spine has what mobility and stability
A
increased mobility
increased stability
9
Q
where is the center of gravity
A
anterior 1/3 of sella turcica
10
Q
is the cranial curve anatomical
A
no
11
Q
explain the lever system in the cranial curve
A
center mass of skull is the load
the condyles are the fulcrum
the posterior extensor muscles are the effort
12
Q
where does the cervical curve end
A
inferior epiphysis of T1
13
Q
what is the apex of the cervical curve
A
C4-C5 IVD
14
Q
where does the thoracic curve begin and end
A
sup. epiph of T2——>inf epiph of T11
15
Q
where is the apex of thoracic curve
A
T6-T7 IVD
16
Q
Where is the apex of the thoracic curve in relation to the back of the trunk?
A
1/4 anterior
17
Q
Is the cervical curve anatomical and functional?
A
yes
18
Q
how does the cervical curve develop?
A
breastfeeding
curiosity
19
Q
how does the lumbar curve develop?
A
crawling
20
Q
where does the lumbar curve begin and end?
A
sup. epiph of T12—–>inf. epiph of S1
21
Q
what is the apex of the lumbar curve?
A
L3 body
22
Q
SC curve is anatomical not functional. T or F
A
T
23
Q
In the fetus the occiput to L5 is kyphotic. T or F
A
T
24
Q
When does the cervical curve develop?
A
birth —-> 5 months
25
When does the ALL begin to get stretched?
birth----->5 months
26
when does convexity of the lumbar spine start?
5 months---->3 years
27
when should there be an obvious curve?
8 y/o
28
where should the GWL go in a radiograph?
1. ant 1/3 of sella
2. C5-6 IVD
3. Body L3
4. Femur head
5. Lat. maleolus
29
What is the visual A-P GWL?
1. Eop
2. Scaoula
3. Buttocks
4. heels
30
What is the lateral visual GWL?
1. tragus
2. shoulder
3. acetabulum
4. knee
5. lat maleolus
31
Why is there a slight physiological curve in the thoracic spine to the right?
heart
32
A lever gives _________
a mechanical advantage
33
forces are ______ or _______
parallel or perpindicular
34
a curve takes a vertical force and
transfers it to a horizontal
35
stress is _______ distributed among a curve
evenly
36
what is the bending moment?
force on the apex of a curve
37
what is an example of a class 2 lever?
wheelbarrow
| foot
38
what is an example of a class 3 lever
arms
39
what is the goal of a curve?
to have the lowest bending moment with the highest flexibility
40
the force on the apex _____ at first then increases ________
slow at first
| increases very quikly
41
wolfe's law
the body will add bone to areas of stress
42
the mechanical advantage _______ quickly as the curve increases but _______ off
increases
| levels
43
how many curves in the human spine?
4
44
what is the resistance to axial compression
R=(n)2 + 1
45
how much do the curves in the human spine increase resistance to axial compression?
8 1/2 times stronger
46
what does the delmas index measure?
clinical measurement of degree of overall curve in a spine
47
the # of curves in a spine determines what
resistance to axial compression
48
According to the delmas index, what is optimal curve?
95 %
49
According to the delmas index, what is regional hyper-curvature?
less than 94%
50
According to the delmas index, what is regional hypocurvature?
more than 96%
51
The leading theory is that the spinal curves are what?
arcs of circles
52
What is the basic spinal unit?
2 vertebra and all associated muscles and structures
53
Where does the ALL begin and end?
Basion---->skips ant. tubercle of C1---->sacral promentory
54
What does pre-loaded mean?
tension artificially induced in the structural elements in addition to any self-weight or imposed loads they may carry. It is used to ensure that the normally very flexible structural elements remain stiff under all possible loads.
55
The ALL limits what movement?
extension
56
The ALL is a wide ____ band
elastic
57
The ALL naturally wants _______
kyphosis
58
Where does the PLL begin and end?
Foreamen magnum------>skips C1----->posterior C2 body----->post. S1
59
The PLL is ________ attached
loosely
60
The PLL narrows between the
pedicles
61
The ligamentum flava begins and ends where?
C2-3----->L5,S1
62
What is the most elastic ligament in the human body?
yellow ligament
63
The intertransverse ligaments limit what movement?
contralateral lateral flexion
64
The intertrasverse ligament go from where to where?
proximal tp to the tp below
65
What is the anterior column?
vertebral bodies + IVDs
66
what is the posterior column?
Z column + vertebral arch
67
What is the function of the anterior column?
weight bearing
68
The load on the anterior is passed where?
posteriorly
69
The anterior column is purely ______
anatomical
70
The anterior column is _______ adapted
passive
71
The main function of the posterior column is
mobility and motion guidance
72
the posterior column is not passive due to
muscles------mainly interspinalis
73
Internal trabeculation patterns
| vertical fibers resist
resist axial compression
74
Internal trabeculation patterns
| A--P fibers run from
sup. epiph----->spinous
75
Internal trabeculation patterns
| A---P fibers part 2 run from
inf. epiph---->post zyg---->spinous
76
Internal trabeculation patterns
| horizontal fibers resist
inward thrust (reenforce side walls)
77
Internal trabeculation patterns
| oblique fibers run from
inf. epiph----->side wall
78
the least stress is on what part of the vertebral body?
anterior
79
Where is the most dense bone?
pedicle
80
What are the most common clinical causes of compression fracture?
`oteoporosis
Forward head posture
kyphosis
81
what is loose packed position
where the joint is most open and capsule + ligaments are most relaxed
82
what is joint play
assesment of resitance from neutral and/or loose packed joint position
83
what is capsular feel?
some spongy give but increase in pain
84
pain is normally due to an
enlarged capsule
85
what is the end play zone?
end of passive ROM at the elastic barrier
86
What is ligamentous creep?
deformation of ligaments under continous load
87
what is the main functions of synovial fluid?
lubrication
| bring in nutrients and evacuate waste
88
what is the articular cartilage composed of?
hylaronic acid
proteoglycans
type 2 collagen
89
what is an adhesion?
scar tissue
90
when is fluid film lubrication prevalent?
happens during light load
primary lubricant
increases movement
91
what is boundry lubricant?
is used when cartilage is heavily loaded
92
what are the properties of the zyg joints?
1. change with volume of fluid; fluid excursion under pressure into hyaline cartilage w/i 3 min
2. hyaline cartiladge can go under massive pressure and keep shape (plyable)
3. As joint loaded and unloaded, the cartilage and joint exchange nutrients & waste
93
What are the four main biomechanical characteristics of ligaments and tendons?
1. passive structures that are important to stability
2. get stiffer with increased strain
3. ligaments in joint capsules act as static restraints
4. tendons transmit tensile loads from muscle to bone
94
elastic: collagen ration in ligamentum flava
2:1
95
Both tendons and ligaments have
mechano/proprioceptors
96
Damage to ligaments is due to
rate of impact
| amount of load
97
what is hysteresis?
energy lost due to deformation
98
What is the weakest point of a ligament/tendon?
insertion point
99
T or F
| corticosteriods inhibit collagen synthesis?
T
100
What is George's line?
a line down the posterior vertebral bodies on a x-ray
101
Henri gillete's fixation theory
1. muscles
2. ligamentous
3. articular
primary----->secondary
102
Henri gillete's fixation theory
| muscles
secondary; minor fixation, palpated tender, taut muscle fibers, hyperaestetic, little end play
103
Henri gillete's fixation theory
| ligamentous
ligaments shorten slowly & lose stretch ability. abrubt block w/ no give; improvement is partial and takes time to acheive
104
Henri gillete's fixation theory
| articular
total fixation, palpates as a full blockage
pathology-ankylosis (fusion)
(not-always adjustable)
105
Henri gillete's fixation theory
| primary leads to
secondary
106
Henri gillete's fixation theory
| secondary fixations are
compensatory
107
Henri gillete's fixation theory
| adjusting the secondary alone will
never change the primary
108
Lumbar facet syndrome
1. localized pain sometimes radiates to butt and thighs
2. often sudden onset
3. decrease weight bearing
109
What is dynamic coupling?
two or more motions that necessarily occur simultaniously
110
What 2 factors are involved with dynamic coupling?
1. coupling mech. joint surface structure
| 2. ligamentous factors
111
Thoracic lumbar coupling
| 2 mechanisms
1. lateral flexion/ contralateral rotation are strongly coupled
2. rotation/contralateral lat. flexion are not coupled
112
mechanisms of coupling
| anterior mech.
IVD
| Lat. flex---contralateral wedge opening/ipsilateral annulus
113
mechanisms of coupling
| posterior mechanisms
1. lat. flex---> contralateral streched ligaments
effect maximized on intertransverse, capsule, & yellow lig.
2. pull arch ipsilaterally to shorten arc
114
T or F coupling must happen both ways
F
115
Rotation is defined by
the vertebral body
116
Cervical coupling
lateral flexion is coupled with ipsilateral roation
117
IVD structure
| nucleus pulposis
1. yellowish-white, translucent gel
2. hydrophilic muco-polysaccharide matrix w/ CT cells and mature chondrocytes
3. up to 88% H2O from surrounding tissues mostly through cartilage of epiphysis
4. imbibation decreases with aging (fibrosis is common)
5. avascular, no nerve supply
6. derived from the notochord
118
IVD structure
| Annulus fibrosis
1. 95% collagen
2. 12-20 lamina
3. multiple orientations
4. more oblique ---->closer to nucleus
5 attached to VB by Sharpe's fibers
119
IVD structure
| annulus/nucleus boundry
1. no distinct boundry
2. only volume-no shape- amorpous
3. forced into roughly spherical shape
120
active joint movement
requires muscular contraction
121
active joint movement
| factors determining active ROM
1. articular design
| 2. inherent tension or resiliency of the associated muscle
122
passive joint movement
1. when dr. must bring joint through ROM
2. passive joint movement has greater ROM than active joint movement
3. takes muscle resistance out of play
123
passive joint movement
| factors determining ROM
1. articular design
| 2. flexibility of soft tissue
124
restriction
can occur anywhere along the ROM
125
Active ROM restriction
1.myofascial shortening (splinting, aging)
126
passive ROM restriction
1. due to shortening of joint capsule, ligaments
127
close packed position
1. joint surface = compressed
| 2. joint capsule and ligaments are at tightest
128
adjustments
1. correct subluxations
| 2. neurological component
129
manipulative therapy
1. often applied along planes of resistance to increase ROM
2. decrease pain
3. occurs in para-physiological space
130
end play zone
1. must go beyond active ROM
| 2. movement at end of passive ROM right before elastic barrier
131
end play
qualitative assessment of resistance at end of passive joint movement
132
abrupt & extreme pain
bone on bone contact
133
global ROM
between regions
134
segmental ROM
between two vertebra
135
physiological barrier
end of active ROM
136
elastic barrier
1. end of passive ROM
| 2. adjustment set up just prior to elastic barrier
137
anatomical limit
1. joint trauma or pathology
| 2. strains and sprains
138
para-physiological space
1. place where manipulation takes place
2. some adjustments take place here (diversified)
3. where cavitation comes from (nitrogen release
139
IVD function
| hydrophilic nucleus
1. incompressible but flexible
| 2. acts as ball-bearing between two plates=swivel joint
140
6 degrees of freedom
| three rotations
1. F/E (sagittal)
2. L/R Lateral Flexion (Coronal Rot)
3. L/R rotation (Axial rot)
141
6 degrees of freedom
| three translations
1. anterior--->posterior gliding
2. L/R gliding
3. Compression and Traction
142
rotation definition
movement around a point
143
translation definition
movement in a straight line
144
Water Imbibition
| nucleus communicates with ______ bone via _________ in cartilage
1. spongy
| 2. micropores
145
Water Imbibition
| what absorbs water
resting disk
146
Water Imbibition
| what happens to the pressurized disk?
1. water is squeezed out
| quickly at first then levels off
147
Water Imbibition
| how much height can be lost over the course of a day due to pressure?
3/4 of inch
148
When one ages what happens to the nucleus?
1. more fibrotic
| 2. decreases hydrophilic properties
149
How does aging directly cause subluxation?
loss of IVF space=pressure on nerves
150
What is the goal of pre-loading?
gives greater resistance to forces of compression and lateral flexion
151
What are two factors that maximize pre-load?
1. nucleus has a set volume
| 2. water imbibition
152
T or F
| pressure on the nucleus can be zero
F
| due to water imbibition
153
T or F
| the nucleus translates radial load to axial load
F
| axial to radial
154
T or F
| An increased load will make the annulus stiffer
T
155
How much axial load is on the nucleus?
75%
156
How much axial load is on annulus fibrosis?
25%
157
What is the self-stabiliztion mechanism in the IVD?
the IVD returning to its neutral state
158
What is the neutral state of the IVD?
1. maximum thickness
2. minimum stress on annulus
3. level end plates
159
What is the IVD response to axial load?
1. IVD gets stiffer
160
Why does the IVD stiffen under axial load?
1. Nucleus bulges against annulus
| 2. annulus must increase resistance to prevent prolapse
161
Dampening oscillation happens within _ sec
1
162
What is the nucleus' response to asymetrical load?
compresses ipsilaterally/ depressurizes contralaterally
163
What is the annulus' response to asymmetrical load?
compresses ipsilaterally/ tensioned contralaterally
164
The nucleus under asymetrical load wil press against the contralateral side and _______
the annulus?
tension
165
How many disks in the spine are level to the ground?
4
166
What is the annulus response to torqueing load?
50 % becomes stiffened due to concentric alternating pattern
167
What fibers are tightened in torqueing load?
oblique fibers in the direction of motion
168
Why is rotation a compromising position?
The annulus is only 50% stiffened
169
What effect happens during torquing load?
screw down effect
170
Direction of sheer is direction of
inferior tilt
171
sheer increases as you move ______ from the disk
away
172
T or F neutral disks have sheering force?
F
173
What are the four IVDs that are level to the ground?
1. C4/C5
2. T6/T7
3. L2/L3
4. L3/L4
174
What disks are extended?
1. C2/C3
2. C3/C4
3. T7-L1
175
What disks are flexed?
1. C5-T5
| 2. L4/L5
176
What happens to extended disks during flexion?
neutralizes sheering force
177
What happens to flexed disks during flexion?
increase sheering force
178
Which disks have the most problems over lifespan?
flexed
179
What is the most common injured disk in the body?
L5/S1
180
What type of sheer comes from left lateral flexion?
anterior and left sheer
181
Where is herniation of the disk most common?
posterolateral
182
What is the weakest part of the annulus?
lateral
183
Where is the maximum vulnerablity of the annulus?
1. contralateral to rotation in flexed disks
| 2. ipsilateral to rotation in extended disks
184
During right rotation where are flexed disks most commonly injured?
left side
185
During right rotation where are extended disks most commonly injured?
right side
186
traction =
axial tension
187
What does traction do?
seperates end plates (brings fluid into disks)
188
What happens to the nucleus during traction?
consolidated inward & upward
189
What happens during extreme traction?
damage to the annulus
190
What determines the amount of mobility in a region?
Amount of soft tissue associated
191
Where is the cervical apex in relation to back of neck?
1/3 anterior
192
Where is the thoracic apex in relation to the back?
1/4 anterior
193
Where is the Lumbar apex in relation to the back?
1/2 anterior
194
What is the average thickness of an IVD in the cervical region?
3 mm
195
What is the average thickness of an IVD in the thoracic region?
5 mm
196
What is the thickness of an IVD in the lumbar region?
9 mm
197
T or F
| Disk thickness is more important to mobility than overall percentage of soft tissue?
F
198
What is the percentage of soft tissue in the cervical region?
28%
199
What is the percentage of soft tissue in the thoracic region?
16%
200
What is the percentage of soft tissue in the lumbar region?
25%
201
The lumbar region has a high percentage and very thick IVDs which indicates ________ _______ and ________
high mobility and stability
202
In the cervical spine the nucleus is what percentage of disk width?
30%
203
In the cervical spine the nucleus is in what relation to center?
slightly posterior
204
In the cervical region the nucleus is where in relation to the axis of motion?
directly under
205
In the thoracic region the nucleus is what percentage of disk width?
30%
206
In the thoracic region where is the nucleus located in relation to center?
slightly posterior
207
In the thoracic region where is the nucleus located in relation to the axis of motion?
very posterior (low mobility)
208
In the lumbar spine the nucleus is what percentage of disk width?
40%
209
In the lumbar spine the nucleus is located where in relation to center?
posterior (more than cervical and thoracic)
210
In the lumbar region how much of an increase (over the other regions) in surface area does the nucleus have?
80%
211
In the lumbar region where is the nucleus located in relation to the axis of motion?
directly under (good mobility)
212
The interspinous ligaments limit what movement?
flexion
213
What region has the most defined intertransverse ligaments?
lumbar
214
What limits contralateral lateral flexion?
intertransverse ligaments
215
What region is most prone to compression fracture?
thoracic
216
What vertebra are most commonly injured due to compression fracture?
T7/T8
| T12/L1
217
What factors impact biomechanical properties?
1. aging
2. pregnancy (relaxin)
3. corticosteriods
4. NSAIDs
218
Hyperesthetic definition
increased sensitivity to touch
219
ankylosis definition
joint fusion
220
Protrusion/bulging definition
position of nucleus shifted within annulus
| but still contained
221
2 types of protrusion/bulging
concentric
| radial
222
concentric protrusion
| 4 points
1. the protrusion is 360 degrees
2. nucleus is seeping into the outside of the annulus
3. delamination is a precursor to concentric protrusion
4. unlikely to reconsolidate/ rupture
223
the disk is not usually the cause of the problem, but a __________
symptom
224
What is the best way to evaluate a disk?
MRI
225
delamination definition
the annulus fibrosis fibers have slight rips due to microtraumas
226
radial protrusion
| 4 points
1. nucleus cuts across annulus layers
2. usually posterolateral
3. better chance of reconsolidation
4. more likely to rupture
227
a straight posterior radial protrusion is the ______ type of protrusion and the ______ most common
worst
| 2nd
228
An anterior protrusion is _______
rare
229
what is a prolapse/rupture/herniation/extrusion?
nucleus is free of annular containment
230
A subligamentous prolapse may be reconsolidated if it is ___________
non-sequestered
231
What happens during a subligamentous prolapse?
1. nucleus is under the PLL
2. the nucleus may move up or down
3. the nucleus may be sequestered or non-sequestered
232
what does sequestered mean?
fragmented outside of annulus to where part of the nucleus becomes isolated
233
What does frank prolapsed mean?
1. nucleus breaks through PLL
2. nucleus is in the neural canal
3. may be sequestered or non-sequestered
234
Frank prolapses increase ________ ________
nerve entrapment
235
What is cauda equina syndrome?
1. massive directly posterior prolapse
2. entire nucleus is expelled
3. can cause total paralysis of legs and complete loss of bladder control
236
Which has a better possibility of naturally healing, protrusion or prolapse?
prolapse
237
T or F
| During a protrusion disk function remains intact.
T
238
T or F
| during a prolapse ankylosis will occur within 1-3 years.
T
239
T or F
| protrusion rarely has repeated occurences.
F
240
T or F
| protrusion has a low possibility of long term healing
T
241
The spinal cord ends at
T12-L3
242
What are some conservative ways to treat disk issues?
1. traction
2. bed rest
3. muscle relaxors + pain killers
4. bracing
243
What are some preventative measures for disk issues?
1. H20
2. posture
3. proper weight
4. lifting properly
5. chiropractic care for subluxations
244
What are two conditions that lead to disk trauma?
1. delamination of Annulus Fibrosis
| 2. precipitating event
245
Most disk trauma happens after the age of
40
246
T or F
| disk trauma is more common in women
F
247
A precipitating event most likely happens because of two factors.
1. sudden excessive disk loading
| 2. most likely flexion sheer
248
During disk trauma pain results from
| 2 factors
1. ligament trauma (dull, achy)
| 2. nerve root entrapment (sharp, can radiate)
249
What is the Val Salva reaction?
a diagnostic tool for disk trauma consisting of
1. bearing down
2. closes all sphincters in abdominal area and thorax
3. happens during bowel movement naturally
250
What are two surgical options for disk trauma?
1. decompression (laminectomy)
| 2. excise the disk
