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100 Cards in this Set
- Front
- Back
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physiologic barrier
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pt where pt can actively move
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anatomic barrier
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physician can passively move pt
beyond this pt = ligament, tendon, skeletal injury |
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Restrictive barrier
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side you cannot move
lies before physiologic barrier |
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tissue texture change acute
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edema
erythema boggy moist |
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tissue texture change chronic
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no edema
no erythema cool skin dec muscle tone, flaccid, ropy, fibrotic |
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assymetry acute vs chronic
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acute - present
chronic - present with compensation |
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restriction acute
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painful with movement
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restriction chronic
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no pain
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tenderness acute vs. chronic
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acute - severe, sharp
chronic - dull, achy, burning |
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nomenclature for neutral and non neutral
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neutral - sb before rotation
non neutral - rotation before sb |
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orientation of superior facets:
cervical thoracic lumbar |
BUM
BUL BM |
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F/E axis and plane
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transverse
sagittal |
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Rotation axis and plane
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vertical
transverse |
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sidebending axis and plane
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AP
coronal |
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isotonic contraction
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muscle contraction that results in the approximation of the m origin and insertion without changing tension
operators force < pts force |
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isometric contraction
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m contraction that results in the inc in tenstionw ithout an approximation of origin and insertion
operators force = pts force |
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isolytic contraction
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m contraction against resistance while forcing the m to lengthen
operators force > pts |
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concentric contraction
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m contraction that results in the approximation of the m origin and insertion
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eccentric contraction
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lengthening of m during contraction due to external force
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active treatment
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what pt does
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passive treatment
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what doc does
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for psoas syndrome what do you treat first
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lumbar or thoraco lumbar spine first
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cervica, thorax and ribs what do you treat first
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thorax then ribs then cervical
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extremity prob what do you treat first
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treat spine, sacrum, ribs first
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what is used to tell cervical, throacic or lumbar motion
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cervical = articular pillars
everything else = tp |
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scalenes
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origin: post tubercle of tp
insert: rib 1 (ant/middle) rib 2 (post) unilat = sb neck to same side bilat = flex ant/middle = elevate rib 1 during inhalation post = elevate rib 2 during inhalation |
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scm
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origin: mastoid process + lateral half of superior nuchal line
insert: medial 1/3 of clavicle and sternum unilat = sb toward, rotate away bilatera = flex scm divides neck in ant/post triangles |
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alar ligament
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side of dens to lateral margin of foramen magnum
can be weakend by RA or downs |
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transverse ligament
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lateral mass C1 to hold dens in place
can be weakend by RA or downs |
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joints of luschka
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= articulation of the superior uncinate process and superadjacent vertebrae = uncovertebral joints
impt for sb uncinate processes, superior lateral projections from post lateral rim of vertebral bodies of C3-C7 |
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OA
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motion of occipital condyles on atlas C1
F/E type 1 like |
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AA
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motion of C1 on C2
rotation feel lateral masses of the atlas...flex to 45 to lock out roation |
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C2-C7
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type 2 like
c2-4 mainly rotation c5-c7 mainly sb place fingers on lateral border of articular pillars |
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cervical foraminal stenosis
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intervertebral foraminal narrowing
mcc: degeneration within joints of luschka sx: neck pain radiating into upper extremity, dull ache inc pain with EXTENSION, + spurling |
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ribs 3-5
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pec minor
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ribs 6-9
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serratus ant
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ribs 10-11
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lat dorsi
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ribs 12
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quad lumborum
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Rules of 3
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t1-3: sp at level of tp
t4-6: 1/2 step below t7-9: 1 step below T10: 1 step below T11: 1/2 step below T12: at level |
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spine of scapula
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T3
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inferior angle scapula
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T7
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sternal notch
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T2
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nipple
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T4 dermatome
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sternal angle
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2nd rib and T4
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Ribs 3-5
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pec minor
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rib 6-9
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serratus ant
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rib 10-11
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lat dorsi
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Rib 12
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quad lumborum
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rule of 3
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T1-3 sp at level of Tp
T4-6 1/2 below T7-9 1 below T10- 1 below T11 - 1/2 below T12 - at level |
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spine of scapula
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T3
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inferior angle of scapula
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T7
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sternal notch
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T2
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angle of louis
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2nd rib and T4
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nipple
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T4 derm
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umbilicus
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T10 derm
anterior to L3,L4 ivd |
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thoracic motion limited by
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rib cage so main motion is rotation
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primary muscles of respiration
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diaphragm
intercostals - external, internal, innermost, subcostal |
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secondary muscles of inspiration
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scalenes
pec minor serratus quad lumborum lat dorsie |
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diaphragm
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primary m of respiration
contracts with inspiration attach: xyphoid process, rib 6-12, bodies and intervertebral disc of L1-3 n: phrenic |
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intercostals
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primary m of respiration
action: elevate ribs during inspiration |
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typical ribs
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3-10
tubercle - attaches to corresponding TP head - articulates with vertebrae above shaft, neck, angle |
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atypical ribs
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1,211,12
1- articulates only with T1 and has no angle 2- large tuberosity on shaft for serratus anterior 11,12- no tubercles 10- sometimes atypical bc articulates only with T10 |
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true, false, floating ribs
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true: 1-7...attach to sterum via costal cartilage
false: 8-12...do not attach directly to sternum. connected to superior rib floating: 11-12...unattached anteriorly |
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pump handle
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1-5
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bucket handle
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6-10
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caliper
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11-12
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inhalation dysfunction
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rib stuck up...cant move down on expiration
tx: lowest rib |
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exhalation dysfunction
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rib stuck down...cant move up with inhalation
tx: highest rib |
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how does nerve root come out of lumbar
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below corresponding vertebrae but above the intervertebral disk!
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erector spinae group
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spinalis
longissimus iliocostalis |
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iliopsoas
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origin: T12-L5
insert: lesser troch primary flexor of hip |
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Facet trophism
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asymmetry of facet joint angles - become coronal
normally in lumbar = sagittal BM |
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sacralization
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one or both of TP of L5 are long and articulate with sacrum
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lumbarization
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failure of fusion of S1 with other sacral segments
less common the sacralization |
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spina bifida
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defect in closure of lamina of the vertebral segment
occulta - no herniation. hair patch meningocele - herniation of meninges meningomyelocele - herniation of meninges and nerve root |
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major motion of lumbar spine
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flex extend > sb> no rotation
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L5 motion influences sacrum
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L5 sb = sacral oblique axis on same side
L5 rotation = sacrum to rotate opposite |
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lumbosacral angle (fergusons)
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intersection of a horizontal line and line of inclination of sacrum
25-35 degrees inc angle = shear stress = low back pain |
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herniated nucleus pulposus
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due: narrowing of posterior longitudinal ligament
mc: L4-5 or L5-S1 ex: herniation between L3 and L4 will compress L4 nerve root sx: numb, tingle, lower back and lower leg pain worse with FLEXION |
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Psoas syndrome
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due to: appendicitis, sigmoid colong prob, ureteral calculi, ureter dysfunction, mets from prostate, salpingitis
sx:low back pain radiates to groin + thomas test, tender medial to ASIS often assoc with L1,L2 dysfunctiion |
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spinal stenosis
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narrowing of spinal canal or intervertebral foramina --> p on nerve root
see: hypertrophy of facet joints, ca deposits wtihin ligamentum flavum and posterior long lig worse with EXTENSION dx: oblique view |
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spondylolisthesis
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ant displacement of one vert in relation to the one below. MC at L4,L5 due to- fatigue fracture in par interarticularis
sx: low back, butt, post thigh pain worse with EXTENSION see: tight hamstrings grade 1= 0-25...2= 25-50...3 = 50-75...4 = 75-100 dx: LATERAL view |
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spondylolysis
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defect of pars interarticularis without ant displacement of vertebral body
dx: oblique - scotty dog |
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spondylosis
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degenerative changes within intervertebral disc and ankylosing of adjacent vertebral bodies
ex. ant lipping of vert body |
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cauda equina syndrome
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p on nerve roots of cauda equina due to massive central disc herniation
sx: sharp low back pain, saddle anesthesia, dec deep tendon reflex, loss of bowel and bladder control |
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scoliosis
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lateral deviation of spine from normally straight vertical ling of the spine...automatically causes slight rotation
sb L = dextroscoliosis; sb R = levoscoliosis |
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structural scoliosis curve
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spinal curve that is fixed and inflexible. wont correct with sb in opp direction
assoc with vertebral wedging and short ligaments and m on the concave side |
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function scoliosis curve
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spinal curve that is flexible and can be corrected with sb to opposite side
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dx scoliosis
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cobb method: draw horizontal line from vertebral bodies, then draw perpendicular lines
mild = 5-15 moderate= 20-45 severe >50 = resp function compromised CVS function compromised if > 75 |
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scoliosis tx
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mild - pt, konstancin exercise, omt...improve flexibility and strenth
moderate - add bracing with a spinal orthotic severe- surgery if resp compromise |
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short leg syndrome
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due to: sacral base unleveling, vertebral sb and rotation, innominate rotation, MCC - hip replacement
sx: sacral base is lower on side of short leg, ant inom rotation of side of short leg, post inom rotation on side of long leg, sb away and rotate toward short leg. first iliolumbar ligaments, then SI ligaments may become stressed on side of short leg tx: if femoral head difference is >5mm then consider heel lift |
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heel lift guidelines
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final lift should be 1/2-3/4 of themeasured leg length prob if chronic prob. if acute prob (hip fracture, hip prostehesis) then full amount
fragile pt should get 1/16 heel lift to start...and inc every 2 weeks flex pt - 1/8 to start, then inc every 2 week max of 1/4 add to INSIDE of shoe max heel lift possible = 1/2 inch |
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iliolumbar ligament
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TP L4-L5 to medial side iliac crest
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sacrotuberous ligament
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originates at ILA to ischial tuberosity
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sacrospinous ligament
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sacrum to ischial spine -
divides greater and lesser sciatic foramen |
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Piriformis
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inferior ant sacrum to greater troch
externally rotates, extends thigh and abducts thigh with hip flexed S1-S2 *sciatic N runs through |
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sacral motions
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respiratory - s2, superior transverse
craniosacral - superior transverse postural - middle transverse walking - oblique inominate rotation - inferior transverse |
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if L5 sbL what side is axis
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L oblique axis
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if L5 RL what side does sacrum rotate
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sacrum rotates right
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if seated flexion test is + on R what side is axis
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L
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