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36 Cards in this Set

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- In a superior –inferior direction through the dens
demonstrate the axis of rotation for C1/C2 flexion
In a medial lateral direction- through the lower vertebrae
demonstrate the axis of rotation for T1/T2 sidebend
In an anterior posterior direction through T2 body
Describe the orientation of the superior and inferior articulating facets between the occiput and C1
Inferior facet of the occiput, the condyles, are convex and the superior articulating facets on C1 are concave in an anterior/posterior direction
Your patient lacks OA flexion. What arthrokinematic motion is necessary for OA flexion?
Posterior glide of the occiput
How much motion is there in flexion/extension at the OA joint?
25 degrees total
How much motion is there in OA sidebend and rotation?
5 degrees sidebend, should be no rotation
Describe the orientation of the superior articulating facets of C2?
Downward sloping shoulders
How much one sided rotation is available at this joint?
45 degrees
Describe the orientation of the C4-C5 spinal unit? What arthrokinematics motion occurs here during flexion?
inferior facet of C4 faces 45 degree orientation from the frontal plane facing anterior and the superior facet of C5 faces 45 degree orientation from the frontal plane facing posterior.
Arthrokinematic- allows forward and superior gliding
What osteokinematic motion is the greatest in the upper thoracic spine?
Osteokinematic rotation
In the lower cervical Spine- what structure limits Sidebend and translation?
The uncinate process
In the upper cervical spine, which Ligament prevents anterior shear of C1 on C2?
Transverse ligament
Which ligament in the upper cervical spine contributes to coupling of motion?
Alar ligament
In the upper cervical spine, the ligamenutm flavum now becomes the?
Posterior atlantal occipital membrane and posterior atlantal axial membrane
In the mid thoracic spine, what structure limits extension?
The downward pointing SP and ALL
In the lower thoracic spine, what structure limits rotation of the spine?
The vertical direction of the thoracic facets
Upper cervical instability- stretching or trauma to alar or transverse ligament,
odontoid fracture
Are symptomatic Herniated discs very common in the thoracic region?
no
Describe 2 clinical pathologies that are common in the thoracic region
Pathological fractures
Herniated Discs- not necessarily causing pain
Space Occuping Lesions- ie- tumors- not common- but could be significant in this region as the central canal is small
Scoliosis- Common- however, we did not discuss. Refer to Chapter 9
Describe the coupling patterns for the thoracic spine- be specific.
In flexion coupling is to the same side – ipsilateral
In extension or neutral-coupling is to the opposite sides
What structures and or pelvis position contribute to stability of L5 on S1?
anterior longitudinal ligament, iliolumbar ligament, orientation of facets in frontal plane, posterior tilt of pelvis
Disc pressure is large when one holds a weight in front of body, esp. when holding a weight
Sitting in a slouched posture produces greater discal pressure than sitting erect
Sitting with back arched or curled towards knees
Describe the trend of flexion and extension and rotation ROM as you descend cranial to caudal from the thoracic through the lumbar spine?
Flexion and extension increases as you move down the thoracic spine and into the lumbar spine
Rotation starts higher in the thoracic region and decreases as you move into the lumbar spine
What is the % of load bearing in the healthy lumbar spine on the disc/body vs. the facet joints?
Facets carry 20% of the load
Disc/body carries 80% of the load
How much combined motion is there in the lumbar spine in rotation?
motion is in the opposite directions
Explain how an excessive anterior pelvic tilt increases the anterior shear force on the L5-S1joint?
The anterior shear force increases because the sacrum tilts forward and therefore makes the L5 body want to slide forward in the direction of the shear force
List 3 factors that can contribute to disc herniation
 Propensity for fissures or tears in annulus
 Sufficiently hydrated NP
 Inability of posterior annulus to resist radial pressure from nucleus
 Axial loading applied over a flexed and twisted spine
Describe the effect of lumbar extension on the facet joints, intervertebral disc and the intervertebral foramen?
The inferior facets slide inferiorly and posteriorily
Your patient presents with lumbar stenosis. Describe a specific exercise which would be favorable for this patient and why?
Spinal stenosis can be defined as degeneration of one or more spinal segments, producing a narrowing of the spinal canal.
- put them on their back, bringing their knees to their chest
Your patient presents with a posterior herniated disc. You assess that extension movement decreases her symptoms. Describe a specific exercise, which would be favorable for this patient?
Back extension exercises
You have a patient with back pain, who constantly has a slumped posture: how would you explain the consequence this would have on the joint capsule and the disc?
Slumped posture can canse a thinking of the disc due to a decreased water concentration
In sitting, perform an anterior pelvic tilt. What muscles are responsible for the movement?
Hip flexors and back extensors
What are the positive effects of sitting in anterior pelvic tilt?
Reduces pressure on disc
What are the negative effect of sitting in anterior pelvic tilt?
increase force on facet joints
and increase anterior shear of L/S1
In sitting, perform an posterior pelvic tilt. What muscles are responsible for the movement?
Hip extensors and abdominals
What are the positive effect of sitting in posterior pelvic tilt?
Reduces pressure on facets
Decreases anterior shear of L5/S1
What are the negative effect of sitting in posterior pelvic tilt?
Increased force on disc
Specifically describe the motion at the SI joint, include location of axis of rotation and amount of rotation in the sagittal plane? Describe nutation and counternutation