spine Flashcards
Kin 1 and 2 (248 cards)
1
Q
Where does the anterior longitudinal ligament attach?
A
attaches to anterior aspect of vertebral bodies and disc
2
Q
The anterior longitudinal ligament primarily resists which direction of movement?
A
extension/hyperextension
3
Q
Describe a pedicle
A
short, stout pillars with thick walls that connect the vertebral body to the posterior elements
4
Q
What is the function of a pedicle?
A
To transmit the bending forces from the posterior elements to the vertebral body
5
Q
Describe the lamina
A
vertical plate that constitutes the central portion of the arch posterior to the pedicles
6
Q
What is the function of the lamina?
A
Transmit the forces from the articular, transverse and spinous processes to the pedicle
7
Q
Describe a transverse process
A
lateral projection of bone that originates from the laminae
8
Q
What is the function of transverse processes?
A
Serves as muscle attachments and provide mechanical lever
9
Q
describe a spinous process
A
a posterior projection of bone that originates from the central portion of the laminae
10
Q
What is the function of a spinous process?
A
serves as much attachment and provides mechanical lever; may also serve as a bony block to motion
11
Q
describe the vertebral foramen
A
opening bordered by the posterior vertebral body and the neural arch
12
Q
What is the function of a vertebral foramen?
A
combined with all segments, forms a passage and protection for the spinal cord
13
Q
What is the anterior longitudinal ligament made of?
A
collagen fibers
14
Q
What does the posterior longitudinal ligament attach to?
A
posterior aspect of vertebral bodies and disc
15
Q
What movement does the posterior longitudinal ligament primarily resist?
A
flexion/hyperflexion
16
Q
The ligamentum flavum connects the __________ of ___________ ___________.
A
laminae of adjacent vertebrae
17
Q
The ligamentum flavum is made of what kind of fibers?
A
elastic
18
Q
what is the significance with the ligamentum falvum being made of elastic fiber?
A
it is far from the AOR so the this ligament needs to be able to stretch more/further. Elastic fibers allow that.
- won’t buckle
- constant disc compression
- basically it will stabilize a segment and compress load to disc
19
Q
The ligamentum flavum primarily resists which direction of movement?
A
flexion (excessive separation of the vertebral laminae)
20
Q
What does the supraspinous ligament connect?
A
posterior aspect of spinous processes (tip to tip)
21
Q
Interspinous ligament located between what?
A
spinous processes
22
Q
intertransverse ligament connects what?
A
transverse processes
23
Q
What is a laminectomy?
A
surgical procedure removing part or all of lamina. relieves pressure on spinal cord or nerves.
24
Q
Questions to think about:
what problems to laminectomies pose? What problems do laminectomies help with?
A
what occurs to the tissues when the lamina is removed? muscles, ligaments?
25
What are the 5 mover muscles of neck/back?
## Footnote
some snakes slither so elegantly
1. splenius
2. semispinalis
3. sternocleidomastoid
4. scalenes
5. erector spinae
26
what 3 muscles make up the erector spinae?
## Footnote
I LOVE STRETCHING
Iliocostalis, longissimus, spinalis
27
What is torticollis?
twisted neck (muscles contract involuntarily -dystonia)
28
what are symptoms of torticollis?
- neck pain
- **contract SCM** (chin to contralateral shoulder)
- inability to turn head (ipsilaterally)
| - can present in many different ways
29
What are the 5 causes of torticollis?
1. congenital
2. sleeping awkwardly
3. slipped facet
4. herniated disc
5. viral/bacterial infectioni
30
What are 8 muscles that aid in stabilization of the back/neck?
## Footnote
Many Interesting Travelers Roam In Scenic Lovely Locations
1. multifidus
2. intertarnsversarii
3. transvers abdominis
4. rotatores
5. interspinales
6. suboccipitals
7. longus colli
8. longus capitus
31
What is a fusion?
permanently joins 2 or more vertebrae in the spine to eliminate movement (also decrease pain)
32
What are 7 reasons one would get a spinal fusion?
1. fractured vertebrae
2. excessive motion (instability)
3. spondylosis
4. spondylolethesis (slip)
5. osteoarthritis
6. spinal deformity
7. bludge/herniated disc
33
Talk about the bodies of each type of vertebrae
34
When it come to the cervical spine there is an anterior shear due to __________. this moves the head _________.
anterior LoG (line of gravity). it will move the head forward
35
What muscle helps resist the LoG which pulls the head back
levator scapulae
36
semispinalis capitis/cervices has an optimal line of pull for ____________ which can increase _________
extension, lordosis
37
During shoulder elevation the upper trapezius acts as the _______, while the longus colli/capitis act as __________
agonists, synergist
38
during shoulder elevation what are examples of an antagonist to the upper trappezius?
latissimus dorsi, pectoralis minor
39
when looking for normal head/neck posture what would you expect to see in the anterior view?
no tilting, no rotation, not seeing too much of the top of head or the neck
40
when looking for normal head/neck posture what would you expect to see in the lateral view?
normal lordosis, tragus and nose aligned horizontally
41
when looking for normal head/neck posture what would you expect to see in the posterior view?
seeing normal lordossi, skin folds, no head translation, no head tilt
42
label
43
label
44
label
45
where do you palpate for cervical flexion?
When do you have the patient stop?
what is the
AOR
SA
MA
AAOS ROM?
palpate C7 and T1 spinous processes
have move into flexion and stop when movement at T1 is felt
AOR: external auditory meatus
SA: perpendicular to the floor
MA: base of the nares
ROM: 45° measure difference between beginning and end positions
46
what is the normal end feel for cervical flexion?
firm
47
where do you palpate for cervical extension?
When do you have the patient stop?
what is the
AOR
SA
MA
AAOS ROM?
palpate spinous processes of C7 and T1
instruct the patient to extend the neck to end ROM - this is when T1 moves superiorly after C7
AOR: external auditory meatus
SA: perpendicular to the floor
MA: base of the nares
ROM: 45° measure beginning and end positions
48
where do you palpate for cervical lateral flexion?
When do you have the patient stop?
what is the
AOR
SA
MA
AAOS ROM?
palpate spinous processes of C7 and T1
end range is when T1 moves
AOR: spinous process of C7
SA: aligned between the scapulae, over spinous processes of thoracic spine, perpendicular to floor or table
MA: bisecting the cranium vertically
ROM: 45° measure difference between beginning and end positions
49
what is normal end feel for cervical extenion?
firm
50
what is normal end feel for cervical lateral flexion?
firm
51
where do you palpate for cervical rotation?
When do you have the patient stop?
what is the
AOR
SA
MA
AAOS ROM?
palpate spinous process of C7 and T1
end rom is when T1 moves
AOR: superior surface and center of the cranium
SA: lateral border of acromion
MA: parallel with nose
ROM: 60° measure difference between beginning and end positions
52
what is normal end feel for cervical rotation?
firm
53
what is the arthrokinematics of lower cervical flexion?
always in a 45° plane at facet
up and forward of bilateral superior segments
54
what is the arthrokinematics of lower cervical extension?
always in 45° planet at facet
down and back of bilateral superior segments
55
what is the arthrokinematics of lower cervical lateral flexion and rotation? (for right side)
right facet moves inferior and posterior (down and back); left facet moves superior and anterior (up and forward)
56
what is the arthrokinematics of lower cervical flexion and rotation? (for left side)
left facet moves inferior and posterior (down and back); right facet moves superior and anterior (up and forward)
57
lateral cervical flexion and rotation are coupled ____________
ipsilaterally
58
arthrokinematics of AA joint (C1-C2)
Flexion:
Extension:
tilts anteriorly
tilts posteriorly
*this is due to the transverse ligament *
59
arthrokinematics of AA joint (c1-C2)
rotation (right)
right C1 facet glides posteriorly; left C1 facet glides anteriorly
60
arthrokinematics of AA joint (C1-C2) rotation (left)
left C1 facet glides posteriorly; right C 1 facet glides anteriorly
61
in the AA joint is there coupling?
NO
62
arthrokinematics of atlanto-occipital joint (C0-C1). which is convex, convave?
C0 = convex
C1 = concave
so it is convex moving on concave (opposites)
63
arthrokinematics OA joint (C0-C1) flexion?
rolls anteriorly and glides posteriorly
64
arthrokinematics OA joint (C0-C1) extension?
rolls posteriorly and glides anteriorly
65
arthrokinematics OA joint (C0-C1) lateral flexion (LF) (right)?
right condyle moves medial, inferior and anterior (MIA); left condyle moves lateral, posterior and superior (LPS)
66
arthrokinematics OA joint (C0-C1) lateral flexion (LF) (Left)?
left condyle moves medial, inferior and anterior (MIA); right condyle moves lateral, posterior and superior (LPS)
67
the orientation of the joints in the OA are positioned in what direction to the sagittal plane?
medial
68
in the OA joint, LF and rotation are coupled ____________?
contralaterally
69
# segmental mobility (accessory motion)
what is hypomobilty?
less than physiological range
70
# segmental mobility (accessory motion)
what is hypermobility in regards to the deformation/strain curve?
increased tendency to move into elastic/plastic zone during daily activites
71
# segmental mobility (accessory motion)
draw and label the segmental mobility deformation curve table.
what are the different zones? when does it become traumatic?
72
# segmental mobility (accessory motion)
with hypomobilty what is different with the osteo and arthrokinematics?
osteokinematics:decreased ROM
arthrokinematics: decreased joint glide
73
# segmental mobility (accessory motion)
hypermobility(instability) has what differences with osteo and arthrokinematics?
decreased or increased ROM (skin fold observed)
increased joint glide
can lead to hypermobilty later in life
74
# segmental mobility (accessory motion)
what is the sequence of events that leads hypermobility to become hypomobility?
hypermobility ---> altered forces ---> bone formation (spurs, bony promineneces) ---> hypomobility
75
# segmental mobility (accessory motion)
how does spondylosis lead to hypomobility?
abnormal wear/tear ---> bone formation ---> hypomobility
76
# segmental mobility (accessory motion)
what is spondylosis?
type of degenerative disease that can affect any part of spine. normally soft disks between vertebrae provide cushioning, with spondylosis they become compressed
77
# segmental mobility (accessory motion)
what are symptoms of spondylosis?
- pain in the neck/thoracic region/lumbar region
- pain traveling down extremeties
- headaches
- grinding feeling when moving neck
- weakness in arm and legs
- numbness
- stiffness
- trouble maintaing balance
- trouble controlling bladder
78
# segmental mobility (accessory motion)
with foraminal compression (stenosis) there can be bone formation like spurs which results in?
nerve compression at intervertebral foramen
79
# segmental mobility (accessory motion)
What is foraminal compression?
condition that occurs when the openings in the spine narrow, putting pressure on the spinal neves
80
# segmental mobility (accessory motion)
what are 6 causes of foraminal stenosis?
1. osteoarthritis
2. paget's disesase (bone overgrowth)
3. herniated discs
4. thickened ligaments (bulge into foramen)
5. tumors
6. spinal injuries
81
maximal open-packed position of cervical spine
neutral (upright head) - basically just midway between full flexion and full extension
82
closed-packed position of cervical spine
full extension
83
what is the capsular pattern of the cervical spine
equally limited ipsilateral lateral flexion and rotation ROM > limited extension ROM
| side flexion and rotations equally limited compared to extension
## Footnote
extension is still limited just less so
84
capsular pattern is uesd clinically to?
see if joint capsule is causing the issue
85
what is capsular pattern?
a pattern of ROM used in the interpretation of joint motion:
a capsular pattern ofrestriction is a limitatioin of pain and movement in a joint specific ratio, which is usually present with arthritis or following prolonged immobilization
86
waht is non capsular pattern?
restriction is a limitation in a joint in any pattern other than a capsular one, and may indicate the presence of either a derangment, a restriction of one part of the joint capsule, or an extra-articular lesion, that obstructs joint motion
87
to assess the OA joint for pain, range, end feel what direction would you move the head?
side bending (lateral flexion)
88
if you wanted to assess pain, range, endfeel of AA joint what test would you use?
flexion-rotation test
89
if you wanted to assess mid-cervical spine pain, range, endfeel what would you use?
side glide
90
# attachments
what is the proximal and distal attachment of splenius capitis?
PA: nuchal ligament
DA: fibers run superolaterally to mastoid process of temporal bone and lateral third of superior muchal line of occiptal bone
91
what is the proximal and distal attachment of splenius cervicis?
PA: nuchal igament and spoinous process of C7-T1 vertebrae
92
what is the proximal and distal attachment of the iliocostalis (erector spinae)?
PA: arises by broad tendon from posterior part of iliac crest, posterior surface of sacrum, sacroiliac ligaments, sacral and inferior lumbar spinous processes and supraspinous ligament
DA: lumborum, thoracis, cervicis; fibers run superiorly to angles of lower ribs and cervical transverse processes
93
# anterior structures and related cervical spinous processes
C3 goes with which anterior structure?
hyoid bone
94
# anterior structures and related cervical spinous processes
how to identify hyoid bone?
gently place fingers in front of patients neck and have them swallow to feel hyoid move
95
# anterior structures and related cervical spinous processes
C4 is equivelent to what anterior structure?
thyroid cartilage (V)
96
# anterior structures and related cervical spinous processes
how to palpate thyroid cartilage?
from the hyoid bone - move down, the next prominenece is the thyroid cartilage. there is a small V shpe on the supeiror aspect of the thyroid cartilage
97
# anterior structures and related cervical spinous processes
C5 is in line with each anterior structure?
thyroid cartilage body
98
# anterior structures and related cervical spinous processes
how to palpate thyroid cartilage body?
the body ofthe thyroid cartilge is a flate surface felt onteh lateral aspect beneath the small V
99
# anterior structures and related cervical spinous processes
C6 is in line with each anterior structure?
first cricoid ring
100
# anterior structures and related cervical spinous processes
how to palpate cricoid ring
inferior to the body ofthe thyroid cartilage is the first cricoid cartilage ring
101
how to palpate for spinous process of T1
- while the patient is sittingwith arms at side, palce fingers dorsally over the spaces betwen where you believe C7, T1 and T2 spinous processes to be
- place the finger tips of your other hand on the manubrium and press dorsally
- the superior most spinous porcess to move dorsal is T1
102
what are the 5 cues to palpate the cervical facet joints
1. locate C2 spinous process
2. move one finger width off of the spinous process on either side
3. this is the transverse process, the articular pillar is just medial to this
4. continue to assess the remaining cervical segments moving inferiorly on one side
5. repeat on other side
103
# palpation
Oblique capitis inferior muscle runs from _________ to __________?
from spinous proocess of C2 to transverse process of C1
104
# innervation
What is the innervation of oblique capitis inferior m?
dorsal rami of lower cervical nerves
105
# palpation
Oblique capitis superior muscle runs from _________ to __________?
trasverse process of C1 to posterior aspect of occipital bone
106
# innervation
what is the innervation of Oblique capitis superior muscle
dorsal rami sub-occipital nerve C1
107
# palpation
rectus capitits posterior major is located where and runs to where?
located deep and runs from the spinous process of C2 to deep in the occiput nearthe foramen magnum
107
# innervation
What is the innervation of the rectus capitis posterior major muscle?
dorsal rami suboccipital nerve C1
108
# palpation
rectus capitis posterior minor (more medial) is located where? attaches where?
posterior arch of atlas (c1) to inferior nuchal line of occipital bone and adjacent area
109
# palpation
what is the set up of patient to palpate sternocleidomastoid?
have pateint perform contralateral rotation with slight neck flexion to see the very prominent muscle belly in the aterolateral aspect.
- follow from its orgion on the manubrium and clavicle to the insertion point on the mastoid process
110
# posterior triangle
what are the borders of the posterior triangle of the neck?
anterior margin of the upper trapezius, the posterior border of the SCM
111
# posterior triangle
what structures are found in the poterior triangle of the neck?
splenius capitis, levator scapulae, posterior scalene and medial scalene (when palpating from posterior to anterior)
112
# referral pattern
trigger points in the SCM can give rise to pain felt in which regions of the head?
occipitial, temporal, auricular, zygomatic, frontal
113
# nerves, veins, arteries
the external jugular veins drains into what?
subclavian vein
114
# nerves, veins, arteries
the carotid artery can be palpated at what spinal level?
C4 (thyroid cartilage V)
115
# nerves, veins, arteries
what other structure can be located at the C4 spinal level along with carotid artery?
internal jugular vein
116
The ligaments flavum is a highly elastic ligament this is advantageous because the ligament will not buckle on itself during movement. If the ligament did buckle on itself, it would __________ the spinal cord in the vertebral canal, especially with any movement into ________.
compress, extension
117
# vertebrae
uncinate proccesses develop around what age range?
6-9
## Footnote
this is why kids have very loose maliable necks
118
# vertebrae
uncinate processes ________ motion
guides (like bumpers)
## Footnote
vertebrae is a terrible driver and runs into unicate process over and over again - this develops extra bone (osteophytes)
119
# vertebrae
what is a common site of osteophyte formation
uncinate processes
## Footnote
the development of these formations are some indicators of arthritis or development of stiff neck
120
# vertebrae
C0- occiput and rests on C1 to form what joint?
atlanto-occipital (OA) joint
120
# vertebrae
C1 and C2 form what joint?
atlantoaxial (AA)
121
# ligaments
nuchal ligament attaches to?
external occipital protuberance
122
# ligaments
alar ligmanets limts _______ and ____________ on contralateral side
rotation and lateral flexion
123
# ligaments
the taransverse ligament of the cervical spine limits __________ translation of _____ and _____
anterior, C1 & C2
124
# vertebrae, ligaments
tectorial memebrane is a continuation of what?
posterior longitidutinal ligament (PLL)
(C2-occiput)
125
# clinical considerations
cervicogenic headaches involves what nerve roots?
C1-3 nerve roots
126
# intervertebral disc
what percent of the nucleus pulposus is water?
70-90%
127
# interveretebral disc
what % of nucleus pulposus is proteoglycans (of dry weight?)
65%
128
# intervertebral disc
what % of the nucleus pulposus is collagen? (of dry weight)
20%
129
# intervertebral disc
what is the end plate?
cartilage covering disc
130
# intervertebral disc
what is the role of the end plate?
passive diffusion of nutrients from vertebral body to disc (movement is critical)
131
# intervertebral disc
what does the annulus fibrosus control?
nucleus movement
132
# intervertebral disc
what % of the annulus fibrosus is water?
60-70%
133
# clinical considerations
what are 7 symptoms/tests to indicate cervical myelopathy is present?
1. paresthesia (tingling/numbness)
2. weakness
3. hyperreflexia
4. (hoffman sign)
5. clonus
6. loss of fine motor
7. gait disturbances
134
# clinical considerations
what are 3 symptoms of cervical radiculopathy?
paresthesia
weakness
hyporeflexia
135
# clincial considerations
what is cervical radiculopathy?
pinched nerve in neck
136
# clincial considerations
what is cervical myelopathy?
condition that occurs when the spinal cord is compressed in the neck
137
# thoracic spine
why is the posterior height of thoracic vertebrae body longer than anterior height of body (wedge-shaped)?
the natural kyphotic posture creates the wedge shaped appearance
138
# thoracic spine
what is the normal kyphotic angle?
## Footnote
think about age
20-40
increases with age
139
# clinical consideration: spine
how does osteoprosis lead to compression fractures?
osteoprosis can weaken spinal vertbrae resulting in brittle bones that can lead to compression fractures. the vertebral body will collapse
## Footnote
*leads to hyperkyphosis or loss of height
140
# clinical considerations
causes of kyphosis?
| 6 of them
1. poor posture
2. muscle weakness
3. ligament laxity
4. scheuermann's disease
5. bony defect
6. age
141
# clinical considerations
effects of kyphosis
- bending forces
- wedge deformities
- facet loading
- lengthened extensors
- pain
142
# clinical considerations
scheurermann's disease
hyperkyphosis
- anterior wedging
- involves disc and vertebrae
- 12-17 years old
143
# clinical considerations
scoliosis
sidebend and rotation generally occur in contralateral directions
144
# clinical consideration: scoliosis
rotation occurs in same direction as?
apex
- named for the side where the apex of the curve is located
## Footnote
apex = point
145
# clinical consideration: scoliosis
rib hump
posterior prominence of rib cage on side of thoracic rotation
146
# clinical consideration:
what test is used to check for rib hump?
adam's test
| also known adam forward bend test
147
# clinical consideration
what is the adam's test used for?
to diagnosis scoliosis
## Footnote
the middle school forward bend test
148
# clinical consideration: scoliosis
what is the cobb angle used for?
The Cobb Angle is used as a standard measurement to determine and track the progression of scoliosis. Dr John Cobb invented this method in 1948
149
# clinical considerations
what are the cobb angle for
spinal curve
mild scoliosis
moderate scholiosis
severe scoliosis
0°-10°
10°-20°
20°-40°
>40°
150
# clinicial consideration: thoracic kyphosis
what are the commonly affected (shortened) muscles with posture
upper trap
levator scapulae
pectoralis
151
# clinicial consideration: thoracic kyphosis
what are the commonly affected (lengthened) muscles with posture?
## Footnote
these muscles may be weak
deep neck flexors
lower trap
serratus anterior
152
# clinical considerations: posture -scoliosis
commonly affected muscles that are shortened take on what shape?
concavity
153
# clinical considerations: posture -scoliosis
commonly affected muscles that are lengthened (may be weak) take on what shape?
convexity
154
# spinous processes - thoracic spine
T 1-3
| the rule of 3's
at level of vertebral body
155
# spinous processes - thoracic spine
T 4-6
## Footnote
rules of 3's
halfway between vertebral body and level below
156
# spinous processes - thoracic spine
T 7-9
## Footnote
rules of 3's
level below vertebral body
157
# spinous processes - thoracic spine
T10
## Footnote
rules of 3's
level below vertebral body
158
# spinous processes - thoracic spine
T11
## Footnote
rules of 3s
halway between vertebral body and level below
159
# spinous processes - thoracic spine
T-12
## Footnote
rules of 3's
at level of vertebral body
160
# joints - thoracic spine
what are the joints in the thoracic spine?
## Footnote
3 of them C,C,S
- costotransverse joint
- superior articular facet
- costocorporeal joint
161
# thoracic spine
what TV level have 2 demifacets?
T2-8 (articulate with 2 ribs)
162
what is occuring with osteoporosis?
osteoclasts are breaking down the bone and the osteoblasts cannot regenrate fast enough - leading to an imbalance that results in breakdown of bone
163
# muscle action
what is the function of the levator scapulae?
scapular elevation and rotation
164
# muscle action
what is the action of serratus posterior superior and inferior
elevate ribs 2-5
depress ribs 9-11
165
# muscle action
what is the action of spinalis, longissimus, iliocostalis (erector spinae)?
## Footnote
bilaterally and unilaterally
bilateral: extend head, cervical and thoracic spines
unilateral: ipislateral lateral flexion of cervical and thoracic spines
166
# muscle actions
function of the multifidus bilateral and unilateral
bilateral: extend vertebral column
unilateral: lateral flexion and contralateral rotation of vertebral column
also acts as an extensible ligament to stabilize the vertebral column -BIG STABILIZER
167
lumbar lordosis normal rom?
40°-60°
168
arthro kin of flexion in lumbar spine
up and forward of bilateral superior segment
169
arthro kin of extension in lumbar spine
down and back of bilateral superior segment
170
Lateral flexion (to the right) of lumbar spine
right facet joint glides down and back, left facet joint glides up and forward
171
What is scheuermanns diease
## Footnote
juvenile kyphosis, or juvenile discogenic disease
hyperkyphosis that involves the vertebral bodies and discs of the spine identified by anterior wedging of greater than or equal to 5 degrees in 3 or more adjacent vertebral bodies.
172
what is a stress fracture of pars interarticularis
spondylolysis
- fracture at the pars interarticularis typically between L5-S1 lumabr vertebra
173
typical lumbar vertebrae have a foramen shaped like a triangle. what is the significance of this?
able to accept more load
174
in typical lumbar vertebra articular pillars are replaced with?
lamina groove
175
What is the pars interarticularis?
- space between superior and inferior articular facet
- part of the lamina. is a space that does not get much blood supply making it more vulnerable to fracture
176
stress fracture of pars interarticularis occurs in what age range?
- younger population (typically age 5-7) when bone is still developing
## Footnote
the bone developing becomes a weak spot - sometimes called the gymnast fracure
177
where does spondylolysis commonly occur?
L5-S1
178
spondylolysis can progression to what?
spndylolisthesis (slippage)
179
What is spondylolisthesis
anterior slippage of lumbar vertebrae, typically a progression from spondylolysis
180
What are the 4 grades of spondylolisthesis?
grade 1: 0-25%
grade 2: 25-50%
grade 3: 50-75%
grade 4: 75-100%
## Footnote
*how far anterior one vertebrae is from the one below it
181
what is spondyloptosis?
grade 4 - 100% of spondylolisthesis
(a full anterior slipped vertebra)
182
what is normal lumbar lordosis?
40°-60°
## Footnote
* think of ice cream tiliting off of cone
183
what ligament can be prime preventor of spondylolethsis?
iliolumbar ligament
184
iliolumbar ligament can limit movement in what directions?
all directions and rotation
185
186
# muscles - lumbar spine
how does erector spinae muscles help resist against falling forward?
think - ice cream come falls forward and ES helkp revent that with posterior shear and compression
## Footnote
*ice cream come metaphor
187
what does the iiacus and psoas (iliopsoas) have the capacity to perform movement wise for lumbar spine
on stable leg - has capacity to compress and stabilize (also anterior tilting of pelvis)
- less capacity to pull into lordosis
188
what vertebrae does psoas originate on?
T12-L4
189
a short iliopsoas has excessive compressive load on a disc, this then prevents the disc from what?
being able to pull water/nutrients the disc needs
## Footnote
*think of a sponge that stays squeezed when running under water
190
lumbar laminectomies are common and result in a loss of what 3 things?
## Footnote
also alters arthrokinematics
- proprioception
- loss of strength
- loss of endurance
## Footnote
Loss of muscle, ligaments, segmental stability and strength
191
superior facet of lumbar vertebra faces what direction from superior view?
- posterior
- medial
## Footnote
almost in sagittal plane
192
inferior facet of lumbar vertebra faces what direction?
- anterior
- lateral
## Footnote
almost in sagittal plane
193
194
what osteokinematic movement involves the lumbar spine the most?
flexion and extension (sagittal plane)
195
# joint arthrokinematics
lumbar flexion arthrokinematics
up and forward of bilateral superior segment
196
# joint arthrokin
extension of lumbar spin arthrokin
down and back of bilateral superior segment
197
# joint arthrokin
LF (Right) lumbar spine arthrokin
right facet joint glades down and back, left facet joint gludes up and forward
198
rotation of lumbar spine arthro kin (to right)
right facet joint separates, left facet joint approximates (orientation of facets)
199
lumbar spine - LF and rotation coupling varies depending on the position of the sipne, but often considered?
contralateral
200
# lumbopelvic rhythm
trunk flexion degree:
hip flexion degree:
arc of motin:
- 20°
- 70°
- 90
## Footnote
-in typical lumbopelvic rhythm hip flexion happens first
201
during early face of flexion returned to extension, where is the line of gravity?
through chest
202
degenerataive disc disease (DDD) can be waht type of condition?
mechanical or metabolic
203
what are the 5 grades of DDD?
grade 1: disc has a uniform high signal in the nucleus on T2
grade 2: central horizontal line of low signal intesnity
grade 3: high intesnity in the central part of the nucleus with lower intensity in the peripheral regions of the nucleus
grade 4: low signal intesnity centrally and blurring of the distinction between nucleus and annulus
grade 5: homogeneous low signal with no distinction between nucleus and annulus
204
DDD mechanical issue aligns with at law?
wolfs lawa - bone will respond to forces imparted on it
205
during a mechanical cause of DDD what will occur?
lay down of osteophytes to distribute force (but doesnt work)
## Footnote
the more one loads the bone --> keep laying down osteophytes (bony tissue)
206
# DDD - metabolic cause
what are the ranges for healthy, aging, degenerative end plates due to DDD?
## Footnote
6 types
type 1 = healthy
Type 2,3 = aging
type 4,5,6 = degenerative
207
what are the 6 type grades of end plate injuries?
type 1 = normal end plate, no interruption
type 2= thinking of endplate, no break
type 3= focal endplate defect w established disc marrow contact but with maintained endplate contour
type 4= endplate defects <25%
type 5= endplate defect ≥50%
type 6 = extensive damaged endplates up to full distruction
208
what is schmorl's nodes?
migration of nucleus ---> endplate fractures
## Footnote
type of herniated disc
209
differences between mechanical DDD and metabolic?
mechanical:
- acute or chronic
- osteophyte lay down (wolffs law)
metabolic:
- endplate injuries/fractures
- schmorals nodes (disc herniation)
210
what muscles are shortened here? what muscles are lengthened here?
short: iliopsoas (hip flexors), paraspinal muscles (extensors)
lengthened (weake): gluteus amximus, abdominal muscles
211
muscles that are shortened and lengthened in the picture?
short: abdominals, hip extensors
long (weak): lumbar extensors, hip flexors
212
What muscles are shortened? lengthened?
short: upper abdominals, lumbar back extensors
long (weak): lower abdominals, hip flexors
213
# clinical consideratiosn - lumbar spine
maximal open packed position
neutral (midway between full flexion and full extension)
214
# clinical consideration - lumbar spine
closed packed position?
full extension
215
# clinical consideration - LUMBAR SPINE
capsular pattern of LS?
equally limited ipsilateral LF and rotation ROM; limited extension ROM
216
# segmental mobility
PA mobility - lumbar spine
217
what are 3 abnomral lumbosacral spine postures?
- hyperlordosis
- sway back
- flat back
218
when measure rotation of thoracic spine what is the best position set up?
modified childs pose of end of table
219
# segmental mobility
what is PPIVM?
passsive physiological intervertebral mobility natural segmental mobility achieved with AROM assesses global passive motion
| physiological
## Footnote
occurs at a segment in nature (natural)
220
# segmental mobility
what is PAIVM?
passive accessory intervertebral mobility component of segmental mobility achieved with AROM focus on arthrokinematics (facet joints)
| accessory
## Footnote
example: PA = not natural
221
what 3 things are you assessing with segmental mobility?
- pain
- range
- endfeel
222
# clinical considerations
what is a true restriction in H and I combined motion?
true restriction = restricted in same pattern between motions
223
# ```
```
what is inconsistent restriction in H and I combined motion?
restricted in one pattern but not the other- they can't maintain their neutral zone
224
peroneal (fibular) nerve is assessed in a SLR with what food positioning?
plantar flexion and inversion
225
sural nerve is assessed in a SLR with what food positioning?
dorsiflexion and inversion
226
tibial nerve is assessed in a SLR with what food positioning?
dorsiflexion and eversion
227
in H and I testing consistent limitation may be indicitive of?
hypomobility
## Footnote
same on both H and I but different from other quadrant
228
in H and I testing inconsistent limitation mya be indicitive of?
hypermobility
## Footnote
- okay in H but may not be in I or vise versa
229
H and I testing is typically performed?
after AROM
230
what degree range is taking up slack during a SLR?
0°-35° - no dural movement
231
what degree range is ension on neve roots over IVD during SLR?
35°-70°
232
when you get above >70° on SLR neural tension testing, what is most likely occuring?
primarily joint strain
233
SLR neural tension testing has a high sensitivity indicating that?
- few false negatives
- neg test = ruled out
234
what is the leg assessed in well leg raise
uninvolved limb is raised
235
well leg raise has a high specificity indicating?
few false positives
positive test = ruled in
236
what are symptoms of cervicogenic headaches? what nerve roots are assciated with it?
- unilateral pain
- ipsilateral shoulder pain
- arm pain
- nerve root C1-C3
- segmental mobility that can help assess for pain
## Footnote
*often pain and aching on one side
* pain is also felt from eye, to ispilateral frontal and temoral bone
237
gasserian ganglion -->
convering sensory input
238
greater occipital nerve -->
primarily sensory input
239
thoracic discogenic pain
## Footnote
* what % of all disc ruptures? plus symptoms? what can this progress too?
0.5%-4.5% (not a lot)
symptoms:
- dermatomal pattern (pressing on nerves)
- chest wall
- upper extremity pain
progress to: radiculopathy or myelopathy
240
in thoracic region what is the disc:body height ratio for upper, middle, lower thoracic? ADH to PDH ratios
upper: 1:4.0 --> 27.12% ADH≥PDH
middle: 1:4.7 --> 29.68% ADH ≤ PDH
lower: 1:3.8 -->14.66 % ADH > PDH
241
the abdominal viscera is supplied by what nerves? what trunk?
- greater splanchinic nerve
- less splanchinic nerve
- least
- splanchnic nerve
- sympathetic trunk (chain)
242
what thoracic levels are involved in mostly flexin/extension (sagittal plane)?
T11-T12
T-12-L1
243
what muscles are commonly shorted in thoracic kyphosis?
upper trap
levator scapulae
pectoralis
244
what muscles are lengthened (weak) in thoracic kyphosis?
- deep neck flexors (longus colli, longus capitis)
- lower trap
- serratus anterior
245
what are cobbs 4 angles?
- 0-10 --> most people normal
- 10-20 mild scholiosis
- 20-40 moderate scholiosis
- >40 severe scoliosis
246
what rib levels have demifacets?
T2-8 (articulate with 2 ribs)
