THORACOLUMBAR Flashcards
(163 cards)
1
Q
True Ribs
A
Ribs 1-7
2
Q
False Ribs
A
Ribs 8-10
3
Q
Floating Ribs
A
Ribs 11-12
4
Q
Caliper Action
A
11-12 (lateral)
5
Q
Bucket Handle Rotation
A
7-10 (forward, backward, and lateral)
6
Q
Pump Handle Action
A
1-6 (anteroposterior)
7
Q
Spondylosis
A
degenerative changes in the intervertebral disc
8
Q
Spondylolysis
A
defect in the pars interarticularis or arch of vertebra
9
Q
Spondylolisthesis
A
anterior displacement
10
Q
Retrolisthesis
A
backward displacement
11
Q
Lumbarization
A
S1 becomes the sixth lumbar vertebrae
12
Q
Sacralization
A
L5 fuses with sacrum and coccyx
13
Q
Lumbar Facet
A
carries 20-25% of axial loading
14
Q
T7
A
greatest spinous process angulation; upper limb rotation alternates with lower limb rotation
15
Q
Annulus Fibrosus
A
outer layer; strength and torsional movements
16
Q
Nucleus Pulposus
A
85-90% of water; decreases to 65% with age; avascular; slightly posterior
17
Q
Schmorl’s Nodules
A
herniations of nucleus pulposus
18
Q
Disc Protrusion
A
disc bulges posteriorly without rupture of annulus fibrosus; affects nerve root below
19
Q
Disc Prolapse
A
annulus fibrosus contains the nucleus
20
Q
Disc Extrusion
A
annulus fibrosus is perforated and disc material flows into the epidural space
21
Q
Sequestrated Disc
A
discal fragments form outside the disc proper
22
Q
Cauda Equina
A
saddle anesthesia; bladder/ bowel dysfunction
23
Q
Lifting a 20kg with back bent and knees forward
A
169% of disc pressure at L3
24
Q
Walking
A
15% of disc pressure at L3
25
Coughing or Straining
5-35% of disc pressure at L3
26
Bending Forward
150% of disc pressure at L3
27
Scheuermann's Disease
13-16 years old
28
Idiopathic Scoliosis
adolescents
29
Lumbar Disc Problems
15-40 y/o
30
Ankylosing Spondylitis
18-45 y/o
male
31
Spondylosis and OA
>45 y/o
32
Malignancy
>50 y/o
33
Scoliosis and LBP gender predisposition
females d/t menstruation
(ask: changes in menstruation, altered pain pattern, irregular menstruation, swelling of abdomen and breast)
34
Pain in thoracic disc lesion
no pain in active movements
35
Pain in nerve root/ spondylosis of thoracic
"through the chest pain"
36
Pain in breathing
pulmonary issues; trauma, structural deformities, thoracic pathologies
37
Pain referred around the chest
costovertebral in origin
38
Pain on true thoracic ribs
Localized
39
Constant ache
mechanical, inflammation
40
Pain on movement
mechanical stimulus
41
Pain accumulates with activity
repetitive mechanical stress, inflammation, and degenerative disc
42
Pain increases with sustained posture
fatigue on supporting muscles, gradual creep of tissues
43
Latent nerve root pain
Movement produces acute and temporary neuropraxia
44
Facet syndromes
local pain but can also be referred; ROM is same (restricted from the beginning)
45
Mechanical LBP/ Lumbago
unilateral with no referral to knee (muscle strain/ sprain);
46
Muscles and Ligaments Affectation
movements will decrease and pain will increase
47
Bilateral pain
disc injury, central protrusion, spondylolisthesis, spinal stenosis, metastasis
48
Thoracic Nerve Pain
severe referred in a sloping band along intercostal space
49
Lumbar Disc Protrusion
pain in back and buttocks
50
Lumbar and Sacroiliac Pain
back and posterior leg (lateral aspect)
51
Hip Pain
groin and anterior thigh (medial side of knee)
52
Pressure on nerve root sheath d/t disc lesion
pain followed by paresthesia
53
Paresthesia without pain
cord compression, diabetes, pernicious anemia, multiple sclerosis
54
Upper lumbar/ lower thoracic disc lesions
septic, metabolic disorders, tumors, rheumatic inflammation
55
Dural Pain
coughing, sneezing, straining on thoracic region
extra segmental and felt at larger areas in the lumbar
56
Radicular Pain
felt on 1 dermatome in lumbar
57
Aggravating Movements in Thoracic
active use of arms
pushing and pulling
58
Costal Pain
overhand arm motions and breathing
59
Intrathecal Pressure
lumbar spine affectation (neurological tissue)
60
Disc Pathology
inc in sitting, light twisting, and bending
61
Relieving Factors in Thoracic
raising or bracing arms facilitates accessory muscles of respiration
62
Acute Back Pain
3-4 weeks
63
Subacute Back Pain
up to 12 weeks
64
Chronic Back Pain
> 3 mos
accompanied by deconditioning syndrome
65
Predictors of Chronicity within 6-8 weeks of Back Pain (Yellow Flags)
nerve root pain/ spinal pathology
severity of pain during acute phase
beliefs about pain being work related
psychosocial aspects of work
psychological distress
compensation
time off work
longer someone is off work= lower probability to return to work
66
Sitting upright into full extension
facet pathology
67
Sitting increases pain
sustained flexion causing mechanical deformation of the spine/ discogenic pain
68
Forward flexed posture
anterior vertebral compression fx
69
Pain on standing relieved by walking & pain on forward flexion s substantial muscle spasm
disc involvement in lumbar spine
70
Pain inc in relaxed standing, walking, and prone
extension as cause of pain
71
Stiffness or pain after rest
Ankylosing Spondylosis or Scheuermann's Disease
72
Unilateral pain in upper sacroiliac region or groin in extension
Iliolumbar Ligament
73
Difficulty in moving into a seated position
lumbar instability or lumbar muscle spasm
74
Progressive pain in supine or no relieving position
neurogenic or space occupying lesion
75
Postural/ Static
spasm or adaptive shortening (iliopsoas)
76
Phasic/ Dynamic
abdominals (atrophy)
77
Referred pain for costovertebral, costotransverse, and ribs
along the ribs
78
Referred pain for lumbar/ SI
buttocks, posterior leg, or lateral aspect of leg
79
Referred pain for cardiac
C4-T2 (posteriorly)
80
Referred pain for stomach
T6-T8 posteriorly
81
Referred pain for ulcers
T4-T6
82
Visceral pain
abdominal structures: stomach, liver, pancreas
vague, dull, discrete
follows dermatome
accompanied by nausea
83
Centralization
centered on lumbar spine
no radiculation
mechanical LBP
84
Peripheralization
moves to the limb
85
Mechanical Low Back Pain
cyclic pain
referred to buttocks and thighs
morning stiffness and pain
start pain
pain in forward flexion and returning to erect position
aggravated by extension, side flexion, rotation, walking, standing, sitting, and exercise
relieved by lying down (fetal position) and change in position
pain worsens throughout the day
86
4 Categories of LBP
Mechanical LBP/ Back Pain
>disc involvement
>facet joint involvement (strain)
Non-Mechanical LBP/ Leg Pain
>nerve root involvement
>neurogenic intermittent claudication
87
Waddell's signs
pts that need more intense psychosocial examination
88
Acute Back Pain
some degree of antalgic painful posture
loss of lumbar lordosis
lateral shift
involuntary d/t muscle spasm
89
Spinal Dysraphism
incomplete fusion of the spinal neural tube; manifests as excessive midline hair
90
Herpes Zoster (Shingles)
unilat pain on thoracic spine that manifests with erythema
91
Cafe Au Lait Spots
neurofibromatosis or collagen disease appearing like a birthmark
92
Spina Bifida Oculta
faun's beard tuff along the spine that can indicate dystrophies
93
Step Deformity in the Lumbar Spine
Spondylitic Spondylolisthesis: vertebra above
Spondylolytic Spondylolisthesis:
affected vertebra
94
Normal Alignment of the Scapula to the Thoracic Spine
medial edge: T3
inferior angle: T7-9
medial border: ~5cm lat to spinous process
95
Breathing
children: abdominally
women: upper thoracic
men: upper and lower thoracic
aged: lower thoracic and abdominally
96
Pigeon Chest/ Pes Carinatum
sternum projects downward and forward
increased anteroposterior diameter
restricting ventilation volume
97
Funnel Chest/ Pes Excavatum
sternum projects posteriorly due to overgrowth of ribs
anteroposterior diameter is decreased
when breathing, sternum is depressed and kyphosis
98
Barrel Chest
common in pts c emphysema
sternum projects forward and upward
increased anteroposterior diameter
99
Depressed Rib in Breathing
in inhalation, ribs stopped moving relative to others
highest restricted rib
100
Elevated Rib in Breathing
in exhalation, ribs stopped moving relative to others
lowest restricted rib
101
Rib Spring
pain when stressing the joint; sign of hypomobility
102
Anteroposterior Movement Palpation
pt supine; PT's hands on upper chest
103
Lateral Movement Position
from axilla to the lateral aspect of rib cage
check for pump handle, bucket handle, and caliper action when breathing
104
Structural Rib Dysfunction
subluxation or dislocation
105
Torsional Rib Dysfunction
hypomobility or hypermobility
106
Respiratory Rib Dysfunction
hypomobility of the intercostal spaces, costovertebral, costotransverse
107
Rib Hypermobility
elevates relative to the transverse process
108
Rib Hypomobility
stops to move before thoracic spine
109
Anterior Subluxation of Rib
less prominent rib angle
110
Posterior Subluxation of Rib
more prominent rib angle
111
Superior First Subluxation of Rib
superior aspect of first rib is elevated
112
Anterior Posterior Rib Compression
less prominent rib angle and prominent axillary line
113
Lateral Compression of Rib
more prominent rib angle and less prominent midaxillary line
114
External Rib Torsion
superior border is prominent
115
Internal Rib Torsion
inferior border is prominent
116
Inhalation Restriction
rib angle cease rising
117
Exhalation Restriction
rib angle stops falling
118
Kyphosis
normal 20-40 deg
inc with age (>40 y/o); specifically in females
check for T4-T12 angle (cobb's method)
119
Hyperkyphosis
>40 deg
limited forward flexion
120
Round Back Posture
dec pelvic inclination of about 20 deg
kyphosis
121
Structural Kyphosis
d/t tightened muscles from prolonged posture or structural deformities
compensate and maintain center of gravity
122
Scheuermann's Disease
adolescents; structural kyphosis
123
Gibbus/ Hump Back Deformity
sharp posterior angulation of one or two thoracic vertebrae
structural kyphosis
pelvic inclination is normal (30 deg)
124
Flat Back Posture
decreased pelvic inclination of 20 deg
mobile thoracic spine
no presence of excessive kyphosis
125
Dowager's Hump
postmenopausal osteoporosis
anterior wedge of upper and middle thoracic spine
decreased height
126
Non Structural or Functional Scoliosis
mechanical or muscle spasm
scoliotic curve disappears on forward flexion
straight shift
127
Structural Scoliosis
genetic, idiopathic, congenital problems (spine affectation)
scoliotic curve maintains on forward flexion
compensating curves that does not disappear
lateral shift
128
Convex
ribs pushed posteriorly (posterior rib hump)
vertebral body
ribs are farther apart
lamina is thicker
intervertebral disc is wider
vertebral canal is wider
129
Concave
ribs pushed anteriorly
spinous process
ribs are closer together
lamina is thinner
intervertebral disc in narrower
vertebral canal is narrower
130
Dextroscoliosis
convexity on right
131
Levoscoliosis
convexity on left
132
Torticollis
apex on C1-C6
133
Cervicothoracic Curve
apex on C7 or T1
134
Thoracic Curve
apex between T2-T11
135
Thoracolumbar Curve
apex at T12 or L1
136
Lumbar Curve
apex bet L2-L4
137
Lumbosacral Curve
apex at L5 or S1
138
Normal Pelvic Tilt
10-13 deg
139
Severe Scoliosis/ Razorback Spine
ribs rotate even in quiet standing
140
Pelvic Crossed Syndrome
excessive lordosis
weak long dynamic muscles (inhibited): abdominals & g max
short strong postural muscles (tight): back extensors (erector spinae) and hip flexors (iliopsoas)
141
Layer Syndrome
upper and lower crossed syndrome
142
C7-T12 (Thoracic Level)
2.7 cm/ 1.1 inch diff in flexion and extension
2.5 cm/ 1 inch diff in extension
143
C7-S1(Thoracolumbar Level)
10 cm/ 4 inch diff
144
T12-S1
most movement occurs
~7.5 cm/ 3 inch diff
145
Modified Schober's Test (Lumbar Flexion)
PSIS level
10 cm above
5 cm below
146
Fingertip to Floor (Lateral Flex)
no standard value; both sides should be equal
147
Forestier's Bowstringing Sign
tight ipsilateral paraspinal muscles during side flexion
presence of ankylosing spondylitis
148
Limited lateral flexion and rotation
internal joint capsular problem
149
Limited lateral flexion
inside the joint
150
Limited extension and rotation
facet syndrome
151
Instability Jog
sudden rippling of the muscle during active movement= instability
152
SLR difference in sitting and lying
10-20 deg difference
153
Capsular Pattern in the Spine
lateral flexion= rotation > extension
154
End feel
tissue stretch on all four movements
155
Active Movements on Thoracic Spine
forward flexion: 20-45 deg
extension: 25-45 deg
lateral flexion: 20-40 deg
rotation: 35-50 deg
costovertebral expansion (breathing) : 3-7.5 cm or 1-3 inch
156
Active Movements of the Lumbar Spine
forward flexion: 40-60
extension: 20-35
side bending: 15-20
rotation: 3-18
157
Myotomes
L2: hip flexion
L3: knee extension
L4: ankle dorsiflexion
L5: great toe extension
S1: ankle plantar flexion, eversion, hip extension
S2: knee flexion
158
Chest Expansion
Method 1: 4th intercostal space
Method 2: at 3 levels
>axilla: apical expansion
>nipple area/ xiphisternal joint: mid thoracic
>T10: lower thoracic
159
L5-S1
most common site problem
bears more weight
CoG passes through
transition between vertebra
160
Dermatomes of Lower Limb
L1: inguinal area and sup aspect of medial thigh
L2: middle or lateral ant thigh
L3: medial condyle of femur running inferomedial across the thigh
L4: medial malleolus and anterolateral aspect of the leg
L5: dorsum of the foot at the 3rd MTP
S1: lateral aspect of calcaneus
S2: midpoint of popliteal fossa
S3: horizontal gluteal piece
S4-5: perianal region
161
Reflex Testing
patella: L4-L5
medial hamstring: L5-S1
lateral hamstring: S1-S2
posterior tibial: L4-L5
achilles tendon: S1-2
162
Thoracic Nerve Root Symptoms
epigastric area: T7-T8, T10-11
umbilical area: T10-T11
nipple area: T5
groin: T12
163
Differences in pain perception
skin: superficial, sharp, precisely localized, burning
chest: intermediate in localization and depth, aching, sharp, dull
thoracic viscera: vague, diffuse, deep, aching, dull
