Thoracic & Lumbar Spinal Mechanics Flashcards
(86 cards)
1
Q
What are the four junctions from a lateral view?
A
- craniocervical
- cervicothoracic
- thoracolumbar
- lumbosacral
2
Q
What structures are on the gravitational line from a lateral view?
A
- external auditory canal
- head of the humerus
- L3
- anterior 1/3 of sacrum
- lateral malleolus
3
Q
What is the curve of the cervical spine?
A
lordosis
4
Q
What is the curve of the thoracic spine?
A
kyphosis
5
Q
What is the curve of the lumbar spine?
A
lordosis
6
Q
What is the curve of the sacral spine?
A
kyphosis
7
Q
Name three traits of the body of a thoracic vertebra?
A
- medium size
- heart shape
- costal facets
8
Q
Name two traits of the spinous processes of a thoracic vertebra?
A
- long
- slope postero-inferiorly
9
Q
Name two traits of the body of a lumbar vertebra?
A
- large size
- kidney shape
10
Q
Name two traits of the spinous processes of a lumbar vertebra?
A
- short
- broad
11
Q
What constitutes a vertebral unit?
A
-two adjacent vertebrae and their associated intervertebral disc
12
Q
Where are the spinous processes of T1-T3 in relation to the transverse processes?
A
at the same level
13
Q
Where are the spinous processes of T4-T6 in relation to the transverse processes?
A
half a segment below
14
Q
Where are the spinous processes of T7-T10 in relation to the transverse processes?
A
at the same level of the transverse process of the vertebra below
15
Q
Where is the spinous process of T11 in relation to the transverse process?
A
half a segment below
16
Q
Where is the spinous process of T12 in relation to the transverse process?
A
at the same level
17
Q
What is the orientation of the superior facets for each spinal region?
A
Cervical - backwards, upwards, medial
Thoracic - backwards, upwards, lateral
Lumbar - Backwards, medial
BUM BUL BM
18
Q
What is the anterior longitudinal ligament?
A
- strong, broad fibrous band
- covers/connects anterolateral aspects of vertebral bodies and IV discs
- limits extension
19
Q
What is the posterior longitudinal ligament?
A
- narrow, somewhat weak band
- runs within vertebral canal along posterior aspect of vertebral bodies
- resists hyperflexion
- prevents posterior herniation of nucleus pulposus
20
Q
What is the ligamentum flavum?
A
connects the lamina of adjacent vertebrae
21
Q
What are the interspinous ligaments?
A
connect adjoining spinous processes
22
Q
What are the intertransverse ligaments?
A
connect adjoining transverse processes
23
Q
Where are the rotatores (brevis and longus), and what do they connect?
A
- brevis connects transverse process and spinous process of adjacent vertebrae (T2-T12)
- longus connects transverse process to spinous process two above (T3-T12)
24
Q
Where are the multifidus and what do they connect?
A
connect mammillary processes of L1-L5, sacrum and ilium … superomedially to spinous process 3-5 vertebrae above
25
What is the origin/insertion/action of semispinalis capitis?
O: transverse and articular process of C4-T7
I: occipital bone b/w inferior/superior nuchal line
A: extend head and spine, rotate to opposite side; sidebend to same side
26
What is the origin/insertion/action of semispinalis cervicis?
O: transverse processes of T1-T6
I: spinous processes of C2-C5
A: extend spine, rotate to opposite side, sidebend to same side
27
What is the origin/insertion/action of semispinalis thoracis?
O: transverse process of T6-T12
I: spinous processes of C6-T4
A: extend spine, sidebend to same side, rotate opposite
28
Vertebral ranges of motion
Flexion: 40-90 degrees
Extension: 20-45 degrees
Sidebending: 15-30 degrees
Rotation: 3-18 degrees
29
What is coupled motion?
- consistent association of a motion along one axis w/ another motion along a second axis
- principle motion cannot be produced w/o the associated motion occurring as well
30
What is linkage?
-relationship of joint mechanics w/ surrounding structures
- linkage = increased range of motion
- can be normal or a result of compensation
31
What part of the vertebrae is used as the point of reference when describing motion?
the anterior or superior surface
32
In a vertebral unit, excessive movement or restriction of movement is in reference to what?
the upper vertebra
ex: excess motion of L2 is the motion of L2 on L3
33
What is the physiologic barrier?
limit of active motion
34
What is the anatomic barrier?
limit of passive motion
35
What is the elastic barrier?
range between the physiologic barrier and anatomic barrier
36
What is a restrictive barrier?
- limit within the anatomical range of motion
| - abnormally diminishes the normal physiologic range
37
What happens when a restrictive barrier is introduced?
-shifted neutral
38
What are some consequences of spinal restricted motion?
- reduce efficiency
- impair flow of fluids
- alter nerve function
- creates structural imbalance
39
What did Harrison Fryette's "Fryette's Principles" (published in 1918) describe?
- Type I Spinal Mechanics: in neutral, sidebending and rotation are opposite; tends to be a group of vertebrae
- Type II: in flexion/extension, sidebending and rotation are in same direction; tends to be a single vertebra
40
What spinal muscles are mainly responsible for Fryette's Type II Mechanics?
rotatores m.
41
Who developed Fryette's Third Principle in 1948?
C.R. Nelson, DO
42
What is Fryette's Third Principle?
- initiating movement of a vertebral segment in any plane of motion will modify movement of that segment in other planes of motion
ex: if motion is restricted in one direction, motion will also be restricted in other directions (same for improved motion)
43
What transverse process and spinous process is at the level of the spine of the scapula?
T3 transverse process
| T3 spinous process
44
What transverse process and spinous process is at the level of the inferior angle of the scapula?
T8 transverse process
| T7 spinous process
45
What vertebra is at the level of the iliac crest?
L4
46
What is scoliosis?
lateral curvature of the spine
-named toward the convexity:
dextroscoliosis (frames the heart)
levoscoliosis (obscures the heart)
47
What is the important angle of measurement for scoliosis?
-Cobb Angle
48
How do you measure a Cobb Angle?
Draw a line along the top of the first vertebral segment affected and along the bottom of the last vertebral segment affected, draw a perpendicular line off each, where the two intersect, the superior/inferior angles are the Cobb Angle
49
How would you manage scoliosis w/ a Cobb Angle less than 25 degrees?
OMT
| -monitor w/ frequent radiographs
50
How would you manage scoliosis w/ a Cobb Angle between 25-45 degrees?
non-operative bracing
51
How would you manage scoliosis w/ a Cobb Angle greater than 50 degrees?
-surgical fusion (prevents progression)
52
What is a complication of scoliosis w/ a Cobb Angle greater than 50 degrees?
respiratory compromise
53
What is a complication of scoliosis w/ a Cobb Angle greater than 75 degrees?
cardiac compromise
54
What is radiculopathy?
- pain with dermatomal distribution
- possible neurological impairment:
- -lower extremity weakness
- -diminished reflexes
- typically acute, may become chronic
55
What diagnostic imagine would you get to diagnose radiculopathy?
-MRI
56
What clinical test would you do to diagnose radiculopathy?
-straight leg raise test
57
How do you conduct a straight leg raise test?
-pt. supine, raise leg w/ knee extended
58
What indicates a positive straight leg raise test?
-pain b/w 15-30 degrees indicates lumbar disc etiology
59
What are symptoms of herniated nucleus pulposus in the L4-L5 disc?
- pain in SI joint, hip, lateral thigh, leg
- numbness in lateral leg, first three toes
- weakness in dorsiflexion
- difficulty walking on heel
60
What are symptoms of herniated nucleus pulposus in the L5-S1 disc?
- pain in SI joint, hip, posterolateral thigh, leg to heel
- numbness in back of calf, lateral heel, foot to toe
- weakness in plantarflexion
- difficulty walking on toes
- atrophy of gastrocnemius and soleus mm.
61
What is spinal stenosis?
- bilateral lower limb pain
- neurogenic claudication
- possible neurological impairment
- -lower extremity weakness
- -diminished reflexes
- typically chronic
62
What diagnostic imagining would you get to diagnose spinal stenosis?
-MRI
63
What clinical exam would you perform to diagnose spinal stenosis?
-straight leg raise test
64
What is cauda equina syndrome?
- usually traumatic; emergency
- impaired neurological function
- -saddle anesthesia
- -lower extremity weakness
- -diminished reflexes
- -urinary retention
65
What diagnostic imaging would you get to diagnose cauda equina syndrome?
MRI
66
What causes spina bifida occulta?
failure of the neural tube to close
| -w/o herniation
67
What causes a meningocele?
failure of the neural tube to close
| -w/ protrusion of the meninges through the defect
68
What causes a myelomeningocele?
failure of the neural tube to close
| -w/ protrusion of the meninges and spinal cord
69
What is sacralization?
-one or both transverse processes of L5 are long and articulate with the sacrum
70
What is lumbarization?
-failure of S1 to fuse with the rest of the sacrum
| not common
71
What is spina bifida?
defect in the closure of the lamina
72
What are the spinal levels of the viscerosomatic reflexes of the head and neck (includes upper esophagus)?
T1-T5
73
What are the spinal levels of the viscerosomatic reflexes of the heart?
T1-T6
74
What are the spinal levels of the viscerosomatic reflexes of the lungs?
T1-T7
75
What are the spinal levels of the viscerosomatic reflexes of the upper GI system (including lower esophagus)?
T5-T10
76
What are the spinal levels of the viscerosomatic reflexes of the small intestine and ascending colon?
T9-T11
77
What are the spinal levels of the viscerosomatic reflexes of the ascending and transverse colon?
T10-L2
78
What are the spinal levels of the viscerosomatic reflexes of the descending colon, sigmoid colon, and rectum?
T12-L2
79
What are the spinal levels of the viscerosomatic reflexes of the adrenal region?
T5-T10
80
What are the spinal levels of the viscerosomatic reflexes of the genitourinary (including bladder) tract?
T10-L2
81
What are the spinal levels of the viscerosomatic reflexes of the upper ureter?
T10-T11
82
What are the spinal levels of the viscerosomatic reflexes of the lower ureter?
T12-L2
83
What are the spinal levels of the viscerosomatic reflexes of the upper extremities?
T2-T7
84
What are the spinal levels of the viscerosomatic reflexes of the lower extremities?
T11-L2
85
What organs' parasympathetics are controlled by the vagus N.?
Heart, lungs, esophagus, upper GI, small intestine, kidneys, ascending colon, transverse colon, upper ureter
86
What organs' parasympathetics are controlled by S2-S4, pelvic splanchnic nerves?
colon, rectum, reproductive organs, bladder, pelvis, lower ureter
