403_exam3

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Author:
itzlinds
ID:
289388
Filename:
403_exam3
Updated:
2014-11-16 21:17:00
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Tx spine
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Description:
Tx of the spine
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  1. the generally accepted tx of the spine is:
    activity rather than rest
  2. what 2 things should tx's of the spine be based on:
    • presenting impariments
    • movement disorders
  3. list the 5 joint injuries that are the results of dysfxn:
    • osteoarthritis
    • instability
    • degenerative disc disease
    • sprains
    • strains


    these are Dx, but doesnt tell why you have the injury, something caused these to happen

  4. Dysfxns are manisfested as which 3 things in regards to motions:
    • increased, too much motion: they cant control the motion they have
    • decreased, too little motion:
    • aberrant, the motion is wrong:
  5. the philosophy of the tx of which type of Dysfxn would constitute MFR/STM, stretching, joint mobilization & encouragement of normal motion with active exercise:
    limited motion (hypomobility)
  6. the philosophy of the tx of which type of Dyxfxn is treated with posture correction and stabilization exercise:
    increased motion (hypermobility)
  7. list the..

    passive:
    active:

    structrues that control too much motion at a segment:
    passive: ligaments

    • active: muscles
    • teach muscle to fxn normally
    • normal position & then exercise there
  8. the primary cause of joint degeneration is either which of 2 things:
    • hypermobility
    • hypomobility
  9. list the 6 results of restricted motion:
    • disuse atrophy of supporting musculature
    • degeneration of synovium
    • joint will not have good circulation; lacks lubirication; potential for arthritis
    • contraction & proliferation of collagen
    • nutiriton of disc is decreased
    • loss of segmental mobility
    • predisposed to traumatic injury
  10. list the 4 results of hypermobility:
    • increased incidence of facet degeneration
    • increased incidence spinal instablity leading to nerve irritation
    • pathologic muscle lengthening & weakness
    • inablity to maintain static posture
  11. list the fxn of the of the 2 structures of the anterior pillar of the spine:

    body:
    disc:
    Body: thicker @ lumbar than cervial: bears more weight

    • Disc:
  12. list the fxn of the 4 structures of the posterior pilla:
    • arch:
    • processes:
    • spinous
    • transverse
    • lamina: space b/w transverse & spinous process
    • facets:
    • occurs at each level
    • help to guide motion
    • foramen: where the nerves come out
  13. what is another term for the facet joints:
    zygoapophyseal joints
  14. what is the structure of the spine that ultimaly determines the motion:
    the orientation of the facet joints
  15. Joint capsule synovium & cartilage can be found at which structures of the spine:
    • facet joints
    • they also have a labrum type disc
  16. what is the primary fxn of the facet joints:
    to guide motion

    only a small percentage of fxn is weight bearing, ~ 10-20% in a normal spine
  17. the bony ring that articulates with C2 & the occiput is called:
    C1 (atlas)
  18. the superior projecting dens articulates with C1 forming the atlantoaxial joint with this cervical structure:
    C2 axis

    • turning head side to side: 50% of motion comes from C1 & C2
    • C2 has the dens
    • C1 sits on top of the dens
  19. the curveature that occurs at the cervical spine is:
    lordosis
  20. what is the orientation of the facets in the cervical spine:
    45 degrees from horizontal and frontal plane
  21. the most prominent spinous process of the cervical spine is:
    C7
  22. palpation of which vertebrae can be located even with the medial border fo the scapula:
    T3
  23. palpation of which vertebrae can be located even with the inferior angle of the scapula:
    T7
  24. the L4 & L5 Vertebral bodies are slightly wedged and thicker in which direction:
    anteriorly
  25. the facets of the lumbar vertebrae are primalry found in which plane:

    what type of motion does this allow for:
    • the facets of the lumbar vertebrae are primalry found in: the sagittal plane
    • primarily allows for: flexion & extension
  26. palpation of which vertebrae can be located even with the umbilicus"
    L3
  27. palplation of which vertebrae can be located level with the iliac crest:
    L4
  28. palpation of which vertebrae can be located even with the bilateral dimples (which may vary):
    L5
  29. the lumbar sacral junction lies primarly in which plane:
    frontal
  30. list the 3 fxns of the intervertebral disks:
    • binds intervertebral bodies together: attaches to both the top & bottom of vertebral bodies
    • permits movement within a segment:
    • creates space between the vertebrae
    • allows for space for the nerve to exit at the foramen
    • transmits load across the segment: provides shock absorption
  31. the pathology in which the disk breaksdown & shrinks is called:

    what is the result of this disk breakdown:
    Disk Degeneration

    • results:
    • the space for the nerve to exit becomes smaller
    • may have radicular pain due to the decreased joint space
  32. the pathology in which the disc ruptures & tears is called:

    what is the result of the rupture:
    Disc herination

    result: the nucleus pushes on the nerve
  33. considering that disks do not have a good blood supply, by what means do they receive their nutirion:
    imbibiton: cycle of loading/unloading moves fluid thru the vertebral bodies

    • compressing/distracting the spine
    • Example: a sponge
    • when compressed there is not alot of fluid
    • when distracted: fluid can return, diffused thru the vertebral end plate to the disk
  34. how will hypomobility at a particular segement affcect the disk's nutrition:
    the disk will not get good nutrition b/c it lacks regular movment
  35. the disk is typically weakest posteriorly or postero-laterally..

    which position is the most "dangerous":

    describe how this positon has potential for damage:
    position which is the most "dangerous: more flexed, or less lordosis

    • how there is potential for damage:
    • compresses disk anterioly, distracts the disk posteriorly
    • overtime it weakens the disk even futher posteriorly
    • potential for herniation (maybe 1 heavy lifting event)
    • annulus tears, pulpose moves posterioly
  36. what is the fxn of the annulus fibrosus of the interveertebral disks:
    • provide restrain during spinal motions
    • contains nucelus on the inside
  37. what is the fxn of the nucleus pulposus of the intervertebral disks:
    distrubitue pressure evenly
  38. what is the fxn of the cartilage endplates of the intervertebral discs:
    encapsulates the nucleus
  39. describe why rotation motions are contraindicated with disk injuries:
    • the annulus has rings 2 opposite diagonal orientations
    • when the trunk rotates; there is strain on half of the annulus; there isnt strain onthe other half
    • there is only half of the strength of the disk
  40. list 5 characteristics of the annulus fibrosis of the intervertebral disc:
    • contains the nucleus pulposus
    • concentric rings bind to cartilaginous end plate helping to limit motion
    • thinner posteriorly
    • roration of the spine increases intradiscal pressure secondary to oblique orientation of fibers
    • must preform rotation activities with neutral spine
  41. rotation of the spine increases intradiscal pressure secondary to oblique orientation of fibers due to:0.
    • rotation increases the pressure of the disk & nucleus "squeezing" the disk
    • this is why rotation is so dangerous for a disc injury
  42. why is is so important for pts to perform rotational activities with neurtal spine:
    • rotation increases presure on the disk & nucleus "squeezing" the disk
    • must teach pt. to move from their hips, rotation thru the hips
  43. what is the worst position for a pt. with a disc injury:
    flexed with rotation, b/c disc are thinnest/weakest posteriorly
  44. list the 5 characteristics of the nucleus pulposus of the intervertebral disc:
    • high H2o component, 85-90%
    • under pressure changes shape and volume
    • 1 cm decrease in spinal height at the end of the day
    • with age lose hydrophillic nature of nucleus, 60-75% by age 70 thus shrinking in size
    • get some movement of nucleus with spinal movement
  45. during the ages of 20-30 what type of spinal injuires occur with greater incidence:
    herinations
  46. during the ages of 50-60 what type of spinal injuries occur with greater incidence:
    disk degeneration
  47. what factor can increase the rate of disk degeneration:
    hypomobility (at 1 level): not getting enough nutrition

    key is to maintain spinal mobility
  48. list the 3 ways in which nutrition can affect the intervertebral discs:
    • relatively avascular structure: segmental mobility allows for good nutrition
    • may play a role in develoment of early degeneration disease
    • gental stretching & relaxing of the spin foster phenomenon called "imbition"
  49. the diffusion of lymph & fluid thru the end plate to the annuls to the nucleus is called:
    imbibition
  50. what is essential for imbibition to occur:
    segmental mobility, segment must be compressed & expanded to get nutrition
  51. list 4 contributing factors that may lead to degenreation of the disc:
    • tight musculature
    • tight fascia
    • facets dysfxn
    • postural dysfxn
  52. when is fluid retention within the discs increased:
    thru the night; lying down
  53. a change in the shape of the annulus is called:
    herniation
  54. when the nucleus is contained by the outer annulus only it is called:
    a protrusion

    • the nucleus begins to push out
    • the disc pushes out on the nerve, causing radicular pain
    • changing positions may make it better or worse, by changing the pressure
  55. when the nucleus enters the canal, by extrusion or free sequestration it is called:
    prolapse

    nuclear material leaves the disc
  56. how does too much extension (excessive lordosis) & anterior tilt change the facet joints:
    • the joints are at the end range
    • the joints are bearing more weight instead of the vertebral body
    • bears more weight at the posterior, facet aspect rather than the vertebral body
  57. considering how excessive lordosis (extension) & anterior tilt change the facet joints, what type of pathologies may this lead to:
    spondolytic conditions:  stress rxns, fx, then fx's with displacements
  58. what is the most common type of incident in which pts. report a disc herniation:
    • putting in/taking out of the car trunk
    • they have an external weight and they are in a flexed & rotated position
  59. how do sitting job contribute to disc injuries:
    • if the pt. has poor sitting posture
    • spine is flexed fwd
    • the flexed position strains the posterior aspect of the disc
  60. in which direction do about 99 % of disc herniations occur:
    postero-laterally
  61. which of the following structures bears the most weight:

    facet joints or vertebral bodies
    vertebral bodies

    facet joints only bear about 10% of the weight
  62. considering that the primary fxn of the facet joints is to guide motion..

    in which plane do the facet joints of the lumbar region occur:

    what motion does this allow for:
    facet joints of the lumbar region occur in: the saggital plane

    allow for motions: Flexion & extension

    does not allow for sidebending or rotation because the facet joints will run into each other
  63. considering that the primary fxn of the facet joints is to guide motion..

    in which plane do the facet joints of the thoraic region occur:

    what motions does this allow for:
    facet joints of the thoraic region occur in: the frontal plane

    allow for motions: side bending ( - the ribs)
  64. considering the primary fxn of the facet joints is to guide motion..

    in which plan do the facet joints of the throaic region occur:

    what motions does this allow for:
    facet joints of the throaic region occur in: facets are orientated diagonally (half way b/w transverse & frontal planes)

    • allows for motions:
    • rotations: b/c they slide up & down
    • sidebending: b/c they slide up & down

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