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84 Cards in this Set
- Front
- Back
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What should the plumb line drop through (superior to inferior)
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occipital protuberance
ALL spinal processes |
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What is the angle of protuberance and what should it be?
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-the posterior projection of the spinal processes
-should be 90 degrees |
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What spinous processes should be most prominent?
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C7 and T1
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What should be symmetrical in the trunk?
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-both sides of ribs (ribs not protruding any more than other side)
-muscular development -arm to body length |
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What are the primary curves? What is the direction of the curve?
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Thoracic spine and sacrum
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What are the secondary curves?
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Cervical spine and Lumbar Spine
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When do the cervical and lumbar curves form, respectively?
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- 3 months
- 6-8 months (sit up) |
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What determines normal shoulder appearance?
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NO ROTATION - shoulder not more anterior than the other
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What determines proper abdominal tonus?
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lack of protuberance
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What defines normal head posture?
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Level eys and ears
symmetrical looking symmetrical contour of the neck - trapezius muscles equal |
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What are the muscular structures of the abdominal wall?
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Recuts Abdominis
Transvers Abs External Oblique Internal Oblique |
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What are the functions of the abdominal wall?
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-Protection
-Support of Viscera -Excretion -Forced Expiration -trunk rotation and flexion -pelvic tilt -STABILIZATION OF TRUNK AND PELVIS |
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What does Beevors sign test for?
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segmental innervention of the rectus abdominus and paraspinal muscles
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What constitutes a positive Beevors sign?
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-umbilical deviates
-moves away from involved/weak side |
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What constitute the deepest layer of the spinal musculature? What do each do?
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1. Multifidus - rotation toward opposite side and extension
2. Rotatores (deepest part of groove between spinous and transvers process)- same as Multifidus 3. Interspinalis - extension 4. Intertransversarii - lateral flexion (side to side bending of trunk) |
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What constitutes the intermediate musculature of the spine? What is the name of these muscles combined?
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1. Spinalis - thoracis, cervicis, capitis
2. Longissimus - thoracis, cervicis, capitis 3. Iliocostalis - lumborum, thoracis, cervicis - Erector Spinae muscles |
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What constitues the superficial musculature of the spine?
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Latissiumus Dorsi
Gluteus Maximus |
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What type of joint is the articular facets of the vertebrae?
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Diarthrodial
Synovial - capsule and linings |
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Why is it important that articular facets are diarthrodial?
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absorb shear and rotational forces on spine
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Define Lumbar Lordosis
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Abnormal anterior convexity of the spine
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What causes Lumbar Lordosis?
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-Mal posture
-muscle imbalance -physical condition (obesity, pregnant) -congenital -Fashion = high heels |
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How is Lumbar Lordosis diagnosed?
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xray reveals the following:
- increased sacral and peliv angles -decreased lumbosacral angle -anterior distance between vertebral bodies greater -distance between adjacent spinous processes smaller -increased anterior tilt/pelvic inclination |
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What postural changes occur with Lumbar Lordosis?
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goal: keep center of gravity where it should be
-accompanying kyphosis |
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What sporting events usually aggrevate lumbar lordosis?
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-linemen stance
-gymnastics -equestrian activites |
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What are the 3 types of mechanical syndromes of low back pain?
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Postural
Dysfunction Derangement |
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What defines Postural Syndrome?
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Pain comes from prolonged periods of mechanical stress
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What are the characterisitcs of postural syndrome?
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Pain - intermittent
strictly positional time factor removed immediatley with change in position No pathology - no movement loss or deformity |
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How is postural syndrome corrected?
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Re-establishing correct posture, thus relieving stress on chronically stretched tissue
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What defines Dysfunction syndrome?
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Adaptively shortened structures around vertebrae are subject to mechanical stress during normal end range movment
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What are the characteristics of dysfunction syndrome?
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Pain - intermittent
immediate pain no time factor occurs only at the end of ROM Always loss of movement and function Pain goes away immediately with change of motion |
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How is Dysfunction syndrome treated?
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stretch the shortened structures
Not very quickly |
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What defines derangement syndrome?
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Anatomical disruption and displacement of part of the disc complex at the affected spinal level
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What are the characteristics of derangement syndrome?
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Pain - constant
usually a time factor certain movements produce or exacerbate pain Repeated movements improve or worsen the condition Pain appears during movement range Pathology is present |
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How is mechanical low back pain diagnosed?
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-Fluctuation of symptoms depending on activities and postural positions
-careful mechanical eval must be made to determine theraputic movements -centralization of pain means condition is improving -lack of centralization indicates probable need for surgery |
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What is the progression of radiating sciatic pain?
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1 - buttocks
2 - posterior thigh, popliteal area, and calf 3 - may even get to heel, ankle and foot |
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What happens in 70% of cases with herniated disc?
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sensations of paesthesia and numbness
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What direction is most prevelent in herniated disc?
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Posterolateral
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What happens if herniated disc is directly posterior and/or large?
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Scaitic pain is bilateral
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What motion is restricted in herniated disc?
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Flexion - exacerbates pain
acute stage - pain and muscle spasms restrict all motion |
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What constitutes a gaurded posture in herniated disc diagnosis?
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-lumbar spine deviates away from affected side
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What are the signs of herniated disc?
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-Low back pain
-sciatic pain -reduced mobility and muscle spasm -gaurded posture -tenderness -neurological signs |
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What are the neurological signs present in herniated disc patients?
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motor signs - atrophy and weakness of leg muscles
sensory signs |
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What is another name for the straight leg test?
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Lasegue's test
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What is done during the straight leg test?
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patient completely relaxed, examinar flexes hip while slightly internally rotated and knee fully extended
- +70 degrees is usually joint pain - flexes until pain present, then carefully and slowley extends hip till pain relieved. - dorsi flexes foot to see if pain returns - positive if pain returns |
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What is done during the well-leg-raising test?
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-extends unaffected leg
-positive test produces pain in affected leg (leg not lifted) -indicates ruptures are medial to nerve root |
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What is done during the "bowstring" test?
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-perform straight leg test
-slightly flex knee to relieve pain -apply pressure to popliteal area -positive if radiating sciatic pain returns |
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What vertebral joint does herniation happen most commonly? why?
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L5-S1
-bears most weight of any other vertebral joint -transition between fixed and flexible -angle is greater -most flexible |
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What vertebral joints are the second and third most common locations for disc herniation, respectively?
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L5-L4
L4-L3 |
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What are the classifications of disc herniation?
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Protruded disc
Prolapsed disc Extruded disc Sequestrated disc |
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What is Schmori's Nodes?
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herniation of the nucleus pulposus into the vertebral body
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In xrays to determine existence and location of herniated disc, what is looked for?
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narrowing of disc space between vertebrae - indicates old rupture
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What diagnostic tools are used to determine existence and location of herniated disc?
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Xray
CT Scans MRI Myelography |
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What are 3 prominent surgical procedures to manage herniated disc?
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-Percutaneous Automated Discectomy
-Microdiscectomy -Laminectomy |
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When would you use Percutaneous automated discectomy?
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Appropriate when nucleus pulposus is still contatined by annulus - protruded disc
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Define Kyphosis
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abnormal posterior curving of the thoracic spine
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What is included in Kyphosis syndrome?
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kyphosis, forward head, forward (rounded) shoulders
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What are the two types of Kyphosis?
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Postural - funtional, non-fixed
Scheuermann's Disease - structural, fixed |
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What is the test to see kyphosis?
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Adam's test
-patient flexes hip with legs straight and feet close together, and arms hanging down -positive sees hump, or sharp angle at thoracic spine |
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What is the clinical significance of kyphosis?
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-untreated leads to severity and cosmetic deformity
-decrease in vital capacity -no pain usually -increasd lordosis of cervical and lumbar spine |
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What is the major component of treatment for kyphosis?
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-brace
-brace not effective if: 1. vertebral wedging > 10 degrees 2. initial kyphosis > 65 degrees 3. Initiation of treatment after iliac epiphyses has closed |
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Define Scoliosis
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-Lateral curvature of the spine > or = 10 degrees (Cobb method)
-vertebral rotation (impairs organ function if severe) |
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What are the 4 types of idiopathic scoliosis?
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Infantile - 0-3yrs
Juvenile - 3-10yrs Adolescent - 10-skeletal maturity Adult progression |
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What presents in a physical examination for scoliosis?
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-rotation of vertabrae
-asymmetry of back extensors -rib angulation -folds in skin of trunk -contour of sides of neck -level of scapula and shoulders -forwardness of one shoulder -chest flatness on side of convexity |
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What pathological changes occur in scoliosis?
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-vertebral bodies anlge towards convexity
-spinous process rotates towards concavity -rib angulation on convex side -disc compression on concave side -adaptive shortening of structures on concave side |
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What are the 5 curve patterns found in idiopathic scoliosis?
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Right thoracic
Thoracolumbar Double Major Double Thoracic Major Lumbar |
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How is the angle of scoliosis determined by the Cobb method?
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-find upper and lower end plates
-draw parallel lines from each toward concavity -draw perpindicular lines from each parallel line -angle that perpendicular lines intersect is angle of scoliosis |
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How is rotation measured in scoliosis?
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on xray (anteroposterior view), pedicle on convex side moves toward midline and pedicle on convace side moves away from midline
- +++ rotation occurs when pedicle falls on midline |
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What sign measures spinal maturity?
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Risser sign
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What are the two main factors in effective use of orthotics?
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Maturity of patient
Degree of curve |
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What is the normal carrying angle of the elbow?
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5-10 degrees (males)
10-15 degrees (females) |
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What three views are looke at to determine shoulder posture?
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anterior, lateral, and posterior
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What is the normal angle of ulnar deviation?
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30 degrees
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What is the normal angle of radial deviation?
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20 degrees
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What is the normal angle for forearm pronation and supination?
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90 degrees
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What defines Cubitus Varus?
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-deviation of forearm toward the midline
-called gunstock deformity |
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What causes Cubitus varus?
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malunion fracture
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How is Cubitus varus corrected?
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surgery
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Define Cubitus Valgus
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deviation of forearm away from midline of body
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What causes Cubitus Valgus?
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lateral epicondylar fracture
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What corrects Cubitus Valgus (if severe)?
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Surgery
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What is Cubitus Recurvatum?
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Deviation in which elbow is hyperextended
-more common in girls than boys |
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Define Winged Scapula
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flaring of vertebral border of scapula
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What causes winged scapula?
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weakness of serratus anterior
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How is winged scapula treated?
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exercise
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