Orthopedics Conditions Of The Spine

Front 1

What are the parts of the spine?

Back 1

Cervical Spine

♣ 7 vertebraeThoracic Spine

♣ 12 vertebraeLumbar Spine

♣ 5 vertebraeSacral Spine

♣ 5 vertebrae--fusedCoccyx

♣ 4 vertebrae

Front 2

What is the breakdown of the cervical spine?

Back 2

Atlas (C1)

Axis (C2)

♣ Odontoid process

C3-C7

Anterior curve (lordosis)

Front 3

What is the breakdwon of the thoracic spine?

Back 3

T1-T12

Articulate w/ POST ribs

Larger body than cervical vertebrae

POST curves (kyphosis)

Front 4

What is the breakdown of lumbar spine?

Back 4

L1-L5

Largest vertebral body

Front 5

What is the breakdown of sacral and coccyx spine?

Back 5

Sacral spine is fused and posterior curve

Coccyx levels 2-4 are fused

Front 6

What are the parts of the vertebrae?

Back 6

Spinous process

Transverse process

Body

Facet joint

Lamina

Foramen

Pedicle

Front 7

What are the parts of intervertebral disc?

Back 7

Annulus

Nucleus Pulposus

♣ Both avascular and aneural giving limited capacity to heal

Front 8

What is annulus of intervertebral disc?

Back 8

Fibroelastic cartilage

Stability, movement b/w vertebral bodies, limited shock absorption

Front 9

What is nucleus pulposus of intervertebral disc?

Back 9

♣ Transmits forces, equalizes stress, promotes movement

♣ Movement of intervertebral segments affects fluid mechanics

Front 10

What the posture?

Back 10

“A position or attitude of the body, the relative arrangement of body parts for a specific activity, or a characteristic manner of bearing one’s body”

A composite of the positions of the different joints in the body at any one moment

Front 11

Explain Center of Gravity

Back 11

An object could be balanced by placing something directly below the center of gravity.

Front 12

What is the posture of head? (COG)

Back 12

ANT to atlanto-occipital joint, POST cervical muscles contract.

♣ A forward head posture places greater demands on muscles.

♣ Extreme FLEX causes ligamentum nuchae tension

Front 13

What is the posture of trunk? COG

Back 13

Gravity line goes thru bodies of lumbar & cervical vertebrae, curves are balanced

Erector spinae muscles help & shift w/ movement

Front 14

What is the posture of the hip?

Back 14

Gravity line varies w/ body movement-usually thru the hip w/ no external forces required

♣ If POST to joint, the pelvis POST'ly rotates & creates iliopsoas tension

♣ In relaxed standing, iliofemoral ligament provides passive stability & no muscle tension

♣ If ANT to joint, active support of hip extensors

Front 15

What is the posture of the knee?

Back 15

Gravity line is ANT to joint keeping knee in extension

♣ ACL, POST capsule, tension in hamstrings & gastrocnemius provide stability

♣ Soleus provides active stability by pulling POST'ly on tibia

♣ W/ knee FLEX'd, quads contract due to gravity line shifting POST'ly

Front 16

What is the posture of ankle?

Back 16

Gravity line ANT to joint, causes tibia to rotate forward about ankle Plantarflexors (primarily soleus) provide stability

Front 17

How is posture observed?

Back 17

Plumb Line-Observe

♣ Anterior, Posterior

♣ Midline, symmetry

♣ Lateral

♣Ear, Acromion, Lateral elbow, Greater trochanter, just anterior to knee, just anterior to lateral malleolus

Front 18

What are the subdivision of spinal posture stability?

Back 18

Passive Structures – bones, ligaments

Active Structures - muscles

Neural Control – proprioception, feed forward control

Front 19

What is the role of inert structures in the spine?

Back 19

Inert structures provide most control when not in neutral alignment (ligaments stretched to provide stability at end-range)

Front 20

Global vs. Core Muscles

Back 20

Both global (superficial) and core (deep) muscles function to maintain upright posture

Front 21

Lumbosacral angle

Back 21

Angle that the superior border of the first sacral vertebrae makes with the horizontal, normal: 30°

Front 22

Lordotic posture

Back 22

⇧'d lumbosacral angle to approximately 40°

♣ Often seen w/ kyphosis & forward head: kypholordotic posture

Front 23

Relaxed or slouched posture

Back 23

“Swayback” entire pelvic segment shifts ANT'ly, hips extended, thoracic segment shifts POST'ly

♣ Lumbosacral angle approx 40 degrees

Front 24

Flat low back

Back 24

⇩'d lumbosacral angle, ⇩'d lumbar lordosis, hip extension & POST tilt of pelvis

♣ Lumbosacral angle 20°

Front 25

Round back (kyphosis)

Back 25

⇧'d thoracic curve, protracted scapulae, forward head

Front 26

Flat upper back

Back 26

⇩'d thoracic curve, depressed scapulae, depressed clavicle, flat neck

Front 27

Scoliosis

Back 27

“S” curve or “C” curve, some asymmetry at hips, pelvis & lower extremities

♣ Any lateral curvature of spine

♣Can be cervical, thoracic and/or lumbar

♣75-85% idiopathic

♣Other causes: Neurological, degenerative, osteoporosis, trauma, post-surgical factors

Front 28

Humpback or Gibbus

Back 28

Localized, sharp POST angulation of the thoracic spine

Front 29

Dowager’s Hump

Back 29

Thoracic vertebral bodies degenerate and wedge in an ANT direction due to osteoporosis; seen in older patients

Front 30

Forward Head

Back 30

⇧'d flexion of lower cervical and upper thoracic regions, ⇧'d extension of occiput on atlas, ⇧'d extension of upper cervical vertebrae

Front 31

Flat neck

Back 31

⇩'d cervical lordosis, ⇧'d flexion of occiput on atlas

Front 32

MVA with hyperextension cervical injuries.

Back 32

Hyperextension can cause variety of injuries

♣ Tearing of Sternocleidomastoid

♣ Tearing of longissimus coli muscle

♣ Pharyngeal edema

♣ Tearing of ANT longitudinal ligament

♣ Separation of cartilaginous end-plate of intervertebral disc

♣ Results: PAIN, weakness, paralysis, neurological symptoms

Front 33

MVA with hyperflexion cervical injuries.

Back 33

♣ Tears of POST cervical muscles

♣ Tears of ligamentum nuchae

♣ Tears of POST longitudinal ligament

♣ Intervertebral disc injury

♣ Results: PAIN, weakness, paralysis, neurological symptoms

Front 34

What types of surgeries are commonly used to treat cervical disorders?

Back 34

♣ ANT cervicaldiscectomy and fusion (ACDF)

♣ POST foraminotomy

♣ POST laminectomy

Front 35

CERVICAL SPINE

Muscular strains

Back 35

♣ Very common

♣ Mechanism of injury = flexion/extension, lateral flexion, acceleration/deceleration (whiplash), hyperflexion, rotation

♣ Involved Muscles: sternocleidomastoid, trapezius, scalenes, erector spinae, rhomboids and levator scapulae

Front 36

CERVICAL SPINE

Treatmentfor Strains

Back 36

♣Acute Phase : analgesics, NSAIDS, muscle relaxants, relative rest, control pain and swelling

♣After Acute Phase: AROM exercises-but AVOID mechanism of injury!

♣Cervical isometrics, deep neck flexor retraining, education in cervical spine mechanics, postural exercises

Front 37

CERVICAL SPINE

CervicalRadiculopathy

Back 37

♣Mechanical compression or inflammation of a nerve root with causes neurological symptoms into upper extremities

♣Caused by disc herniation, spondylosis, osteophytes

♣Goals: relieve symptoms, reduce pain and swelling, control muscle spasm, centralizesymptoms

Front 38

CERVICAL SPINE

DiscHerniation

Back 38

♣Symptoms: peripheral pain, radicular signs, localcervical pain, scapular pain

♣Treatment: relieve pain and swelling, positional relief

♣Accurately identify positions that relieve or exacerbate symptoms

♣Gradually strengthen directions that relieve pain and avoid those that make pain worse

Front 39

CERVICAL SPINE

CervicalSpondylosis

Back 39

♣Usually chronic disc disease (wear and tear)—degeneration of bones

♣Symptoms: spinal cord compression or nerve root compression with radicular signs

♣Most commonly found in 40s and 50s, more men than women, C5-C6 and C6-C7 levels

Front 40

CERVICAL SPINE

CervicalSpondylosis Treatment

Back 40

♣Pain relief w/ thermal or electrical agents

♣Usually pain with extension and relief with flexion

-Perform FLEX exercises & axial EXT

♣Traction - relieves cord compression & minimizes joint compression

♣AROM & general mobility exercises to maintain functional ROM once pain is controlled

♣Cervical stabilization including isometrics once pain is controlled

♣Chronic condition – need to educate patients onlong-term management including posture exercises, flexibility exercises, &stability exercises

Front 41

CERVICAL SPINE

Cervicogenic Headaches and Tension Headaches

Back 41

♣Occur 2° to posture,tension, soft tissue injury, TMJD

♣Cervicogenic headaches are due to neck movements and begins in neck

Front 42

CERVICAL SPINE

Cervicogenic Headaches and Tension Headaches Treatment

Back 42

♣⇩'d cervical AROM

♣TTP OA –C3-4 joint dysfunctions

♣ Deep flexor strength impairments

♣ Best research is for mob, manips, and self-mobs by patient + ther ex for deep neck flexor mm. and serratus anterior, lower trap

Front 43

CERVICAL SPINE

Thoracic Outlet Syndrome (TOS)

Back 43

♣Compression of vascular and/or neurological tissues as they exit the superior triangle opening of thorax

♣Proximal compression of subclavian artery and vein and brachial plexus

♣Potential Causes: cervical rib, shortened or hypertrophied anterior scalene, malunion of clavicle and first rib

♣Symptoms: radicular signs of pain, numbness, tingling, weakness,skin temperature changes

Front 44

CERVICAL SPINE

Thoracic Outlet Syndrome (TOS) Treatment

Back 44

Postural education

Stretching anterior scalenes and pectoral muscles

Strengthening scapular retraction

Thoracic extension

Rowing

Theraband

Educate on protection

Possible surgery

Front 45

CERVICAL SPINE

Muscule strains

Back 45

Direct contact or indirect overstretching or contraction of the thoracic spine muscles

♣Treatment: control of pain and swelling, ice, NSAIDs, moist heat, US, e-stim, massage, AROM, strengthening, breathing exercises

Front 46

CERVICAL SPINE: Classification Based Treatment Mobility

Back 46

Mobility: recent onset of symptoms; no radicular/referred symptoms; restricted ROM; no signs of nerve root compression

♣ Mobility treatment: Cervical and thoracic mob and manip; AROM

Front 47

CERVICAL SPINE: Classification Based Treatment Centralization

Back 47

Centralization: radicular/referred symptoms; peripheralization or centralization with ROM; signs of nerve root compression; may have cervical radiculopathy

♣ Centralization treatment: traction; repeated movements to centralize

Front 48

CERVICAL SPINE: Classification Based Treatment Conditioning/Exercise

Back 48

Conditioning/Exercise: relatively low pain scores; longer duration of symptoms; no signs of nerve root compression

♣ Conditioning/Exercise treatment: strengthening and endurance exercises for muscle of neck and upper quarter; aerobic conditioning exercise

Front 49

CERVICAL SPINE: Classification Based Treatment Pain control

Back 49

Pain control: high pain and disability scores; very recent onset; symptoms d/t trauma; referred or radiating symptoms; poor tolerance for examination and most interventions

♣ Pain control treatment: gentle AROM; ROM for adjacent regions; physical modalities as needed; activity modifications to control pain

Front 50

CERVICAL SPINE: Classification Based Treatment

Headaches

Back 50

Headaches: unilateral headache with onsetpreceded by neck pain; headache triggered by neck movements; headache pain elicited by pressure on posterior neck

♣ Headache treatment: cervical spine moband manips;postural education; strengthening of neck and upper quarter

Front 51

How scoliosis is named

Back 51

NAMING: by side of convexity and location of primary curve

Front 52

Describe the effect of scoliosis on muscle imbalance.

Back 52

♣ Muscle fatigue and ligamentous strain on side of convexity

♣ Mobility impairment in structures on concave side

Front 53

Structuralvs. Nonstructural

Back 53

Structural:

♣Irreversiblelateral curve of spine.

♣Vertebraeare fixed in rotation (toward convexity)

♣Does not correct with position change or voluntary movement

Nonstructural:

♣Reversiblelateral curve

♣Canbe changed with position changes

♣ Musclecontraction

♣Functional/Postural Scoliosis