Spine Flashcards
1
Q
What percent of CSI come from sports?
A
8%
2
Q
What is axial loading?
A
Spearing, which occurs when the head and the neck is flexed between 20-30 degrees and serves as the point of contact
3
Q
What order is the assessment listed?
A
Assess breathing, circulation, pulse, LOC, symptoms, palpate c-spine and perform extremity CMS assessment
4
Q
What indicators warrant activation of CSI management protocol?
A
Unconsciousness, bilateral neurological complaints obvious deformity and significant c-spine pain
5
Q
C1
A
None
6
Q
C2
A
Neck flexion
7
Q
C3
A
neck lateral flexion and extension
8
Q
C4
A
Shoulder shrug
9
Q
C5
A
Shoulder abduction
10
Q
C6
A
Elbow flexion/wrist extension
11
Q
C7
A
Elbow extension/wrist flexion
12
Q
C8
A
Ulnar deviation/thumb extension
13
Q
T1
A
Finger intrinsics (abd, add, opposition)
14
Q
L1
A
None
15
Q
L2
A
Hip flexion
16
Q
L3
A
Knee extension
17
Q
L4
A
Ankle dorsiflexion
18
Q
L5
A
Hallux extension
19
Q
S1
A
Plantar flexion, eversion, knee flexion, hip extension (gastrocs and hammy’s)
20
Q
S2
A
Plantar flexion, knee flexion, hip extension
21
Q
What root level is for the diaphragm and how do you sensory test it?
A
C4 and you test the shoulder tops
22
Q
What is the most common neurological cervical injury?
A
Unilateral neurapraxia of the cervical nerve roots and brachial plexus “burner” or “stinger”
23
Q
List 2 techniques to get an athlete on a spine board
A
Prone log roll or 6 person lift
24
Q
How many vertebrae?
A
33
25
How many vertebrae are movable (true)?
24
26
Which vertebrae are movable?
Cervical, thoracic lumbar
27
How many vertebrae are immovable and what are they?
9 are false and they are the sacrum and coccyx
28
Cervical spine has how many vertebrae?
7
29
C1 has no _____ or ______
Body or spinous processes
30
C2 allows for
Rotation (no duh)
31
Movements of C1
Flexion, extension, lateral
32
How many vertebrae in the thoracic spine?
12 and they articulate with ribs
33
Largest and thickest vertebrae
Lumbar spine
34
How many vertebrae in lumbar spine?
5
35
Fusion of 5 vertebrae in adults
Sacrum
36
Also known as tailbone
Coccyx
37
While sitting weight is transmitted through these joints
Sacrum/SI joint
38
Between each of the cervical, thoracic, and lumbar is an
Intervertebral disk
39
Each intervertebral disk is composed of _______ and the _________
Annulus fibrosis and nucleus pulposus
40
Forms the periphery of the disk Composed of strong, firbrous tissue
Annulus fibrosus
41
In the center of the annulus fibrosus, shock absorption
Nucleus pulposus
42
Wide strong band extends the full length of the anterior surface of vertebrae
Anterior longitudinal ligament
43
Inside the canal and extends the full length of the posterior aspect
Posterior longitudinal ligament
44
Connects spinous processes
Supraspinous
45
Extends the spine
| Superficial
Erector spinae
46
Deep muscles of the spine
Go from vertebrae to vertebrae
Extend and rotate the spine
Multifidus, quadratus
lumborum
47
How many pairs of spinal nerves are there?
31
48
Specific area of sensory in a spinal nerve is called
Dermatomes
49
Nerves form a
Plexus
50
Movements of the vertebral column
Flexion
Extension
Right and left lateral flexion
Rotation to the left and right
51
```
Can be life threatening
Strengthening is critical
Bull the neck
Isometric, isotonic, isokinetic contractions can be used
Watch for spearing
```
Preventing c-spine injuries
52
What back pain is the most common?
Lower back pain with
53
How do you prevent a lumbar injury
Avoid unnecessary strain
Be aware of posture anomalies of the athlete
Abdominal strength is essential
54
Cervical neck MOI
```
Axial Load
Flexion
Hyperextension
Rotation and Flexion
Rotation and Hyperflexion
Lateral Flexion
```
55
Gymnasts, hockey, diving, football, rugby
Relatively uncommon in athletics but must be prepared.
MOI: Axial loading and flexion, rotation, hyperextension
S/S:
common in C4-C6
Point tenderness
Muscle spasms = decrease ROM
Numbness & pain in extremities, loss of bladder/bowel cont
Cervical fracture
56
MOI: Violent flexion, extension or rotation, affects anterior and posterior ligaments
S/S: Persistent, tender over transverse and spinous processes, pain occurs a day later
Cervical sprain (whiplash)
57
MOI: Pain on one side of the neck upon waking up, synovial lining or capsule is pinched
S/S: Palpable pt. tenderness and muscle spasm, limited side flexion, and rotation
Acute torticolis (wry neck)
58
Athlete lies supine. Examiner grasps the patient's head under the occiput and chin and gradually applies traction.
Cervical distraction
59
Cervical distraction positive test
reduction or elimination of symptoms caused by cervical radiculopathy
60
Athlete seated with neck bent to affected side. Carefully compress straight through the head. Repeat on opposite side.
Spurling compression test
61
Spurling compression positive test
pain in the upper extremity on the side the head is flexed = pressure on the nerve root
62
Kyphosis resulting from wedged fx of 3 or more vertebrae, causes nucleous pulposis to enter into vertebrae
S/S: Kyphosis and lumbar lordosis but no pain, point tender over spinous processes and back ache at end of day
Scheuremens disease
63
athlete is seated or standing. The examiner pushes the hands together to compress the ribcage and then releases the pressure.
Rib compression
64
Rib compression positive test
Pain with compression or release of pressure indicates the possibility of a rib fracture, rib contusion, or costochondral separation.
65
MOI: Sudden extension and rotation, faulty posture, excessive lumbar lordosis
S/S: Pain with active extension and passive flexion
Lumbar strain
66
Inflammatory condition of the sciatic nerve
MOI: Nerve compression, irregularities in
vertebrae, tight piriformis muscle
S/S: Acute or chronic, sharp shooting pain that follows the nerve pathway
Sciatica
67
Athlete is supine. Examiner slowly raises the legs until tightness or pain is noted
Straight leg raise
68
Straight leg raise positive test
Pn @ 30 degrees = hip problem or inflamed nerve
Pn. @ 30-60 = sciatic nerve
Pn. @ 70-90 = SI joint
69
MOI: Congenital degeneration of the vertebrae, appears as a stress fx, most common in boys
S/S: Asymptomatic until hyperextension or disk
herniation
Spondylolysis
70
MOI: One vertebrae slipping on one below it, a complication of spondy higher in girls
S/S: hyperlordosis
Spondylolisthesis
71
Procedure:
| subject stands on one foot and extend their back, repeat on opposite side.
Stork test
72
Stork positive test
Lumbar pain= possible fracture of pars of vertebrae
73
Subject is sitting
ask subject to take a deep breath and blow against closed fist (bowel movement)
This increases intrathecal pressure
Valsalva maneuver
74
Valsalva maneuver positive test
Pain or neurologic symptoms in buttox and thigh = Herniated disc
75
Athlete is lying prone. Athlete uses hands to push up upper body and extend spine
Press ups
76
Press ups positive test
pain radiating into the buttocks/thigh = herniated disc
77
MOI: Twisting with both feet on the ground, falling backward, landing heavily on one leg
S/S: Point tender on SI joint, ASIS and PSIS may be asymmetrical, side bending toward the injury side increases pain
Sacroiliac pain
78
Athlete is supine or side lying. Examiner has both hands over the lateral aspect of the pelvis.
Examiner applies downward pressure through the anterior portion of the ilium, spreading the SI joints
SI compression
79
SI compression positive test
SI pain
80
Athlete is supine
| Examiner applies pressure to spread the ASIS
SI distraction
81
SI distraction positive test
SI joint pain
82
Athlete is supine with the foot of the
involved side crossed over the opposite thigh (figure–4 position) & the leg resting in the full external rotation
Examiner has one hand on the opposite ASIS & the other hand on the medial apsect of the flexed knee
Examiner applies overpressure at the knee & ASIS
Fabers (Patrick’s) test
83
Faber’s positive test
SI joint pain
84
History questions to ask
Did you land on top of, or hit someone with your head?
Did you lose consciousness?
Do you have pain in your neck?
Any tingling, numbness, or burning in your shoulders, arms or hands?
Equal muscle strength in both hands?
Able to move your ankles and toes?
85
After you’ve ruled out a spinal injury what history questions should you ask?
Were you standing, twisting, sitting, bending?
Did the pain begin immediately?
How long has it been going on?
What motions/movements hurt your back?
Tingling or pain in your buttocks or down the back of your leg?
86
General observation
```
Head is tilted to one side
Shoulder is lower on one side, or carried forward
Scapular imbalance
One hip is prominent
Hips are tilted
One arm hangs lower
One patella is lower than the other
```
87
Increased thoracic curve
Kyphosis
88
Compensatory change in the position of the head and neck
Forward head posture
89
Decreased lumbar curve
Flatback posture
90
Anterior shifting of entire pelvis
Swayback posture
91
Increased curve in lumbar spine
Lordosis
92
Lateral curvature of the spine
Scoliosis
93
Cervical observations
```
Look at the position of the head and neck
Symmetrical shoulders
Is the patient willing to move head
and neck
Check active ROM
```
94
Lumbar observations
Pelvis and shoulders should be level
Soft tissues symmetrical
Unusual curve in lower back noticed
95
Thoracic observations
Check active ROM
| Flex forward and laterally/extend and rotate the trunk
96
What if there is pain when you flex forward and laterally/extend and rotate the thoracic trunk
nerve root irritation to the lower thoracic region
97
What if there is pain when you check ROM of thoracic
cervical disk or trigger
| point
98
What does most common thoracic pain have to do with?
Facet joints
99
Spine palpation
```
Athlete lying prone
Head and neck should be slightly
flexed
Pillow under the hips
Musculature on both sides of spine
Spinous processes
Sacroiliac joint
```
100
General rule of thumb for spine rehab
Any movement that causes the back pain to radiate or spread over a larger area should not be included during this early phase of treatment
101
Flexibility exercises for rehab
Flexion
Extension
Lateral bending
Rotation
102
When should you do lumbar extension exercises
When back pain is diminished with lying down and
increased with sitting
Forward bending is limited and increase the pain
103
Rehab cervical strengthening exercise for rotation
Put one palm on side of forehead and the other at back of head. Push with each hand, attempting to rotate head
104
Rehab cervical strengthening exercise for lateral flexion
Place palm on side of head and press head into palm
105
Rehab cervical strengthening exercise for extension
Lace fingers behind head, press head against hands
106
Rehab cervical strengthening exercise for flexion
Press forehead against the palm of hand
107
Why use extension exercises?
Reduction in the neural tension
Reduction of the lead on the disk which decreases disk pressure
Increases in the strength of extensor muscles
108
Examples of lumbar extension exercises
Prone extension on elbows
Prone extension on hands
Alternate arm and leg extension (dead bug)
Supine hip extension-butt lift or bridge
-Double leg support
-Single leg support
109
Indications for lumbar flexion exercises
1. Back pain is diminished with sitting and increased with lying down or standing
2. Forward bending eases the pain
3. Abdominal tone and strength are poor
110
Why use flexion exercises?
Reduction in the articular stresses
| Opening of the intervertebral foramen
111
Examples of lumbar flexion exercises
```
Single knee to chest
Double knee to chest
Posterior pelvic tilt
Partial sit up
Rotation partial sit up
Pelvic tilt down (dog)
Pelvic tilt, tail tuck (cat)
Kneeling – dog tail wags
Kneeling Alternate arm and leg (bird dog)
```
112
Core stabilization exercises
Quadriped
Triped
Biped (alternating)
Thera ball
