Test 2 lumbar Flashcards by Rugger Style

What percentage of the population experiences LBP at some point in their lives?

80%

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What inspection element can clue the doctor in on possible underlying neurological or boney pathologies?

Lipomatas, hairy patches, cafe-au-lait, or birth marks; basically any congenital skin marking

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Lipomata

aka lipoma; benign tumor of fatty tissue

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Neurofibromatosis

hereditary disorder that produces pigmented spots and pedunclated soft tissue nodules clustered along nerve sheathes

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Gibbus deformity

sharp kyphosis in the thoracic spine affecting the normal lordosis of the lumbar spine

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Spondylolytic spondylolisthesis

a unilateral or bilateral defect in the pars with anterior or posterior displacement of the vertebra on the vertebra below it

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What scale is used to measure spondylos?

Myerding’s Grading Scale

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What level is the umbilicus and why is this significant?

L3/4 - where the abdominal aorta bifurcates into common iliac arteries

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Ligamentum flavum

connects two consecutive vertebrae

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Interspinous ligament

connects two consecutive spinous processes

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supraspinous ligament

connects the tip of two adjacent SP’s

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Psoas

originates from anterior portions of T12-L5; main hip flexor

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Sciatic nerve divides into

tibial and peroneal divisions

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What could cause the sciatic nerve to be tender upon palpation?

disc pathology such as a space-occupying lesion

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A disc pathology effects the nerve root _____

below (L4 disc pathology affects L5 nerve root)

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Aka for disc herniation

extrusion - nucleus pulposa extrudes into the spinal canal and fibers have been torn

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What innervates Z joints in the lumbar spine?

Dorsal rami

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In what three planes can lumbar motion occur?

frontal, sagittal, transverse

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How many degrees of freedom are available in the lumbar spine?

six

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Where does most of the lumbar flexion and extension occur? side-bending? rotation?

Lower segmental levels
Mid lumbar levels
Minimal, occurs with lat flexion at lumbosacral junction

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Which lumbar motion requires a change in the degree of lordosis?

Flexion - lordosis reverses

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Palpation of the lumbar spine should be accompanied by palpation of what other areas?

Hip and pelvic

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A heredity (autosomal
dominant trait) disorder
that produces pigmented
spots, and pedunculated
soft-tissue nodules
clustered along nerve
sheaths

Neurofibromatosis

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Nodules develop from Neurofibromatosis
during childhood, growing
to more than ___ cm in
size and can reach up to ____ cm in size

0.5, 1.5+

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Cafe-au-lait patches are usually | seen over the (3)

1. trunk 2. pelvis 3. flexor creases of the elbows and knees

Bone changes in Neurofibromatosis may result in skeletal deformities

``` Scoliosis, Vertebral body scalloping, Fibrous dysplasia, Tibial Pseudoarthrosis, Sphenoid bone deformity, Mental impairment, seizures, hearing loss, exopht halmosis, decreased visual acuity, and GI bleeding eventually occur ```

``` When a patient is standing an inclination or listing to one side or the other may be a sign of a possible ____ ____, secondary to a_____ ____ ```

sciatic scoliosis, herniated disc

sharp kyphosis in the lower thoracics, affecting the normal lordosis of the lumbar spine

gibbus deformity

palpable or visible step-off from onenprocess to another maybe indicative of a

spondyloslisthesis

anterior or posterior displacement | of a vertebrae with pars defect indicates

spondylolysis (oblique views)

A unilateral or bilateral defect in the pars interarticularis with anterior or posterior displacement of a vertebrae on the adjacent lower vertebra

Spondylolytic Spondyloslisthesis

_____ lies at the L3-L4 disc | space at the point where the _____ divides into the common iliacs.

umbilicus, aorta

the primary function of the _______ _____ is to protect the motion segment from anterior shear forces, excessive rotation, and flexion

zygapophyseal joint

Connects two consecutive laminae

Ligamentum flavum

Connects two consecutive spinal processes

Interspinous ligament

Connects the tips of two adjacent spinous processes

Supraspinous Ligament

Functions to restrain flexion, extension, axial rotation, and side bending of L-5 on S-1

Iliolumbar Ligament

separates paravertebral compartments, and do not have any mechanical function

intertransverse, transforaminal, and mamillo-accessory (resemble the membranous part of the fascial system)

lumbar spine stabilizer for breathing

Quadratus Lumborum

provide segmental stiffness and control motion

Lumbar multifidus (LM)

Assists the in transmission of extension forces during lifting activities

Thoracolumbar | fascia

``` Stabilizes the spine against anterior shear and flexion moments ```

Thoracolumbar | fascia (TLF)

``` takes origin from the anterior portion of the T12- L5 vertebral bodies and discs- the main hip flexor ```

Psoas

Pain from a ____ abscess increases when the hip is actively flexed

psoas

``` gives off branches to the hamstrings and then divides into 2 terminal branches – the tibial and the peroneal divisions ```

sciatic

``` A disc pathology or a space- occupying lesion can cause the ____ nerve to be tender to palpate ```

sciatic

To palpate the sciatic nerve – locate midpoint between the ____ ____ and the _____ ____

ischial tuberosity, greater trochanter

A disc is named after the vertebrae _____

above

A disc pathology affects the nerve root ____

below

little pieces of the nucleus pulposus protrude into the annular fibers (weaken annular fibers)

Protrusion

nucleus pops out of the annular fibers NOT yet torn fibers , just stretched

Prolapse aka Bulge

fibers torn, nucleus bursts into the PLL – PLL is torn, patient often describes a shredding noise

Extrusion aka Herniation

multiple pieces of the | nucleus (particles) are in the spinal canal

Sequestration –

_______ joints are innervated by the medial branches of the dorsal rami

zygapophyseal

lateral aspect of IVDs are innervated by

sympathetic innervation

posterior-lateral aspect, outer half of the IVD

sinuvertebral nerve and the grey rami communicants

____ degrees of freedom are available at | the lumbar spine

``` Six right and left Sagittal (flexion and extension) • Coronal (side bending) • Transverse (rotation) ```

_____ and ____ of the lumbar | spine occurs in the lower segmental levels

flexion and extension

most of the side bending of the lumbar | spine occurs in the ____ _____ area

mid-lumbar

occurs most at | the lumbosacral junction

rotation

extension involves a _____ roll and glide of the vertebra, and a posterior and inferior motion of the_____ ____, but not necessarily a change in the degree of lordosis

posterior, zygapophyseal joints

Axial rotation of the lumbar spine amounts to approximately ___ to both sides most occures at L5/S1 at __ degrees

13°, 5 degrees

•Although ____ alignment provides some valuable information, a positive correlation has not been made between _____ alignment and pain

spinal, abnormal

It is the _____ of motion and the symptoms provoked, rather than the _____ of motion that is more important

quality, quantity

The key muscle tests examine the integrity of the _____ and the contractile and inert components of the various muscles

NMJ

isometric tests, the contraction should be held for at least ___ seconds to demonstrate any weakness

If the clinician suspects weakness, the test is repeated ______ to assess for fatiguability, which could indicate spinal nerve root compression.

2-3 times

______ vary considerably between | individuals

Dermatomes

Acute phase goals

• Decrease pain, inflammation, and muscle spasm • Promote healing of tissues • Increase pain-free range of segmental motion • Regain soft tissue extensibility • Regain neuromuscular control • Allow progression to the functional stage

functional phase goals

• Correction of imbalances of strength and flexibility • Incorporate neuromuscular re-education • Strengthening of entire kinetic chain • Postural correction and retraining • To initiate and execute functional activities without pain and while dynamically stabilizing the spine in an automatic manner

Test 2 lumbar Flashcards

(70 cards)