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ROM - cervical
- Flexion - 45
- Extension - 45
- Lateral flexion - 45
- Rotation - 60
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ROM - thoracic
Flexion - 80
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ROM - lumbar
- Extension - 25
- Lateral flexion - 35
- Rotation - 45
-
Atlanto-occipital joint - 3
- Articulation bet Occiput & C1
- "Yes" joint
- Test - jut out & nod
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Atlanto-axial joint - 3
- Dens of C2 & anterior arch of C1
- "No" joint
- Test - flex & rotation
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Atlas vs Axis - corresponds to what level
-
Uncinate joints (joints of von Luschka) - at what levels? limit what motion?
- C3-C7
- Lateral cervical movement
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NN exiting at Cervical vs thoracic/lumbar
- Cervical - At level above its associated vertebra (Ex: C5 exits above C6 & below C4)
- Thoracic/lumbar - At level below its associated vertebra
-
Spinal cord terminates approximately at what level?
Ll-L2 disc
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Thyroid cartilage - location
At level of 4th/5th cervical vertebrae
-
Vocal cords - location
At level w/midpoint of anterior border of thyroid cartilage
-
Hyoid bone - location
Lies superior to thyroid cartilage at 3rd cervical vertebrae level
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Costotransverse jt vs Costochondral jt - bet what?
- Costotransverse jt - TP & rib of same #
- Costochondral jt - Ribs & costal cartilages
-
Cervical ligaments - responsible for what?
- Alar - Centers odontoid
- Transverse - Keeps Dens in place
-
Transverse ligament - w/what dysfunctions is it compromised? - 2
-
Supraspinous & inter-spinous ligaments - location
Between spinous processes
-
Ligamenta flava - connects what?
Laminae of adjacent vertebral arches
-
Posterior longitudinal ligament - location; prevents what? (2)
- Posterior aspect of vertebral bodies within vertebral canal
- Hyperflexion
- Posterior protrusion of nucleus pulposus
-
Anterior longitudinal ligament - location; prevents what? (2)
- Anterior aspects of vertebral bodies & intervertebral discs
- Hyperextension
- Supports intervertebral disc
-
SCM acting U/L does what?
Tilts head to same side & rotates face in opposite direction
-
Deep layer of back mms (transversospinal) - 3
- Semispinalis
- Multifidus
- Rotatores
-
Transversospinal mms, during U/L contraction do what? - 2
- IPSI lateral flexion
- CONTRA rotation
-
Erector spinae - concentrically/eccentrically do what?
- Concentric - Straighten flexed spine
- Eccentric - Allow vertebral column to bend forward
-
To test for lumbar facet OPENING on L - action?
Flexion + R SBjQuery11010360721362227302_1483385495090??
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Spinal Fxs - mechanism of injury - teardrop; wedge; burst
- Teardrop - Compression of anterior aspect
- Wedge - Forced flexion
- Burst - Excessive compression
-
Spinal stenosis - onset; pain INC w?; pain DEC w? movements to avoid; PT; surgery
- Onset - insidious
- B/L pain & paresthesia in back, buttocks, thighs, calves, and feet
- Pain INC w/extension & prolonged walking
- Pain DEC w/flexion & prolonged rest
- Movements to avoid - IPSI SB & rotation; Extension
- PT - FLEXION based exercises
- Surgery - Laminectormy
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Spondylolisthesis - description - 4
- Fx of pars interarticularis
- L/B pain w/limb weakness or numbness
- Spondylolysis - X-ray view - Oblique - SCOTTY DOG
- Spondylolisthesis X-ray view - Lateral
-
Spondylolisthesis - avoid what movements - 3
- IPSI side bending
- CONTRA rotation
- Extension
-
Spondylolysis - PT - focus on what?
- @ subacute phase - strengthening exercises of what?
- What type of movements will aggravate condition?
- What is CONTRA?
- Focus on dynamic stabilization of trunk, emphasis on abdominals
- Subacute - strengthen Multifidi from full flexion to neutral
- Extension beyond neutral & rotation will aggravate in early stages
- CONTRA - Spinal manipulation
-
Ankylosing Spondylitis - define; onset; look; what movement is impaired? special test; mattress
- Progressive inflammatory disorder - initially affects axial skeleton before 40
- Onset - insidious/non-trauma
- INC stiffness/pain - caudal to cranial
- Impaired spinal EXTENSION
- "Bamboo spine" look
- Special test - Wright-Schober test for spinal mobility
- Mattress - FIRM
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Ankylosing Spondylitis - S/S - Late signs - 3
- Lumbar spine flattens
- Spinal kyphosis
- Sacroiliitis
-
Ankylosing Spondylitis - Pulmonary/Why - 2
- Impaired chest mobility
- DEC vital capacity
- Degeneration of costovertebral jts
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Facet jt - DJD (OA) - pain location; pain INC w? (2); what position is comfortable? mechanism of injury
- Pain - LOCAL
- Stiff upon rising, eases within 1 hr
- INC pain - Extension + stationary position
- Flexion is most comfortable
- Quick flexion w/rotation
-
Disc - Internal disc disruption - 4
- Mostly in lumbar region
- Constant deep, achy pain
- INC pain w/movement
- Avoid - Repetitive bending, Twisting, UE overhead, Carrying heavy loads
-
Disc - Herniation - pain location; pain INC w? mechanism of injury; (+)
- Rotation w/compressive force (under load of heavy object)
- U/L or B/L flank pain
- Limb weak/numbness
- Sciatica
- Pain INC w/flexion, extension, Valsalvas
- (+) SLR
-
Disc - posterolateral herniation - PT; position how for L herniation?
- Manual &/or mechanical traction - cervical 15° flexion
- Positional gapping - 10 min to INC space within region of space occupying lesion
- Pt side-lying on R side, w/pillow under R trunk (accentuating trunk SB R)
- Flex both hips & knees
- Rotate trunk to L (or pelvis to R)
-
Scheuermann’s disease - 3
- Vertebral ostiochondritis or juvenile kyphosis
- Onset - idiopathic, 12-16
- Excessive thoracic kyphosis w/wedging 5 deg or more in at least 3 segments
-
How do ribs move w/inspiration?
- Lateral portion of rib moves up
- Head of rib moves down
-
Thoracic - R SB, pain on L vs pain on R - cause - 2 each
- Pain on L - L facet not opening + L ribs not moving superior
- Pain on R - R facet not closing + R ribs not moving inferior
-
After spinal surgery which movements are not allowed? -3
- NO BLT
- Bending
- Lifting
- Rotation
-
Lumbar stability progression - 4
-
Hypermobile spinal segments - PT - 2
- Passive stabilization w/corsets, splints, casts, tape, collars
- INC strength/endurance/coordination - multifidus, abdominals, extensors, gluteals
-
Posterior lumbar disc derangement - best exercise
Lumbar extension in prone
-
Postero-Lateral herniation at L4-L5 - compresses which nn?
- L5 symptoms; L4 NOT INVOLVED
- Weak toe extensors
- DEC sensation in lateral leg + 1st 3 toes
-
Postero-lateral Herniation at L5-S1 – compresses which nn?
- S1 symptoms; L5 NOT INVOLVED
- DEC sensation back of calf, lateral ankle, heel + plantar foot
- Weak PF
- Difficulty walking on toes
- Atrophy of gastroc/soleus
- Ankle jerk diminished or absent
-
What type of x-ray if odontoid fx is suspected?
Open mouth x-ray
-
Discal degeneration w/o nn root compression - exhibits how?
Centralized gnawing pain w/loss of proprioception (ex: loss of postural control during lifting activities)
-
Sitting posture - DEC lumbar spine compression - chair backrest-seat angle how?
INC to 90-110
-
Scoliosis - what motions should pts avoid? Why?
- Trunk flexion or rotation
- Bc it can cause a compression fx of spine
-
Scoliosis - best time for screening - girls vs. boys
-
Scoliosis - structural vs. nonstructural
- Structural - irreversible lateral curvature of spine WITH rotation component
- Nonstructural - reversible curvature w/o rotation + straightens when pt flexes spine
-
Scoliosis - Intervention
- Conservative PT - @ what degrees?
- Spinal orthosis - @ what degrees?
- Surgery - @ what degrees?
- Conservative PT - <25 deg
- Spinal orthosis - 25-45 deg
- Surgery - >45 deg
-
Other conditions affecting spine - 7
- Bone tumors
- Esophageal cancer - pain radiating to back; pain w/swallowing
- Pancreatic cancer - pain radiates from chest to back
- Acute pancreatitis - mid epigastric pain radiating through to back
- Cholecystitis
- Abdominal aortic aneurysm - appears as nonspecific lumbar pain
- Kidney, bladder, ovary, uterus
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