Lesson 17: Skeletal - Flexion & Extension
Why preform a Lumbar flexion/extension?
-Determine if motion present in an area of spinal fusion -Help localize a herniated disk
Why preform Lumbar Spine Lateral Bending views?
-Done to evaluate the lumbar and lower thoracic intervertebral disks -Helps localize herniated disks -Indicates the presence of structural change when bending in scoliosis patients -Demonstrates motion in area of spinal fusion
What is shown on the Flexion / Extension cervical spine views?
-Shows the anterior and posterior movement vs. the absence of movement due to trauma or disease.
Lumbar Spine Lateral Side Bending - Patient Position
-Upright, standing -MSP perpendicular to the IR, no rotation Right bending: bend upper body to right, cross left leg over the right (pelvis is fulcrum) Left bending: bend upper body to left, cross right leg over the left
Lumbar Spine: Flexion/Extension - Patient Position
-Upright, standing -Place the patient in a true lateral position, MSP parallel with IR -No rotation. Weight equally distributed on both feet. ***Motion must occur in the lumbar vertebrae only! (Hold hips) Flexion: Curl forward, arching lower back WITHOUT "bending" at pelvis. Extension: Arch backward, using the lower back, pushing the chest forward - similar to performing a back dive.
Thoracic Spine Flexion/Extension - Patient Position
-Upright, standing or sitting -Patient is in a true lateral, MSP parallel to the IR -No rotation -Check for rotation at the hips and shoulders -Use FILTER over lung field (open through shoulder area and below diaphragm). ***Movement must occur in the thoracic area only! Flexion: Roll shoulders and upper thoracic area forward, arching the back like a cat. Extension: Roll and arch the shoulders back, pushing the chest forward.
Lumbar Spine Flexion/Extension Critique:
Arm superimposing spine
Lumbar Spine Flexion/Extension Critique:
Arm tissue close to superimposing
Lateral Flexion and Extension- Mayo vs Book
Book - 60-72" SID Mayo - 48" SID
Lumbar Spine Flexion/Extension Critique:
CR too superior otheriwise looks good!
Cervical Spine Flexion/Extension Critique:
CR: Too superior/posterior
Cervical Spine: Flexion / Extension
Cassette: 10x12 lengthwise Bucky: yes SID: 48" or 72"-120" where available Marker: Flexion-marker in upper posterior corner (behind head) arrow indicating direction of movement Extension- Left marker in upper anterior corner (front of face) arrow indicating direction of movement CR: thyroid cartilage (C4-C5) Measure: average technique on chart (base of the neck) Respiration: expiration to help depress shoulders and see all 7 vert.
Lumbar Spine: Flexion/ Extension:
Cassette: 14x17 Bucky: yes SID: 48" Marker: lower anterior margin, arrow indicating movement CR: along mid axillary line, 1" above crest Measure: L5 Respiration: suspended expiration
Thoracic Spine Flexion/Extension
Cassette: 14x17 lengthwise Bucky: yes SID: 48" Marker: lower anterior margin with an arrow pointing in the direction of movement CR: through the posterior ½ of the thorax at the T7 level-film ½ inch above C7 Measure: just inferior to the humeral head Respiration: shallow breathing
Lumbar Spine Lateral Side Bending
Cassette: 14x17 lengthwise Bucky: yes SID: 48" Marker: right bending, use left marker on upper left corner with arrow pointing rightleft bending, use right marker on upper right with arrow pointing left Tube Angle: none CR: along midsagital plane at iliac crest Measure: at xyphoid (thickest part) Respiration: suspended on expiration
Lumbar Spine Flexion/Extension Critique:
Clipped L1 CR too inferior
Cervical Spine Flexion/Extension Critique:
GOOD: -C1 throught the too of T1 visible -shoulders stable -CR is at C4-5
Lumbar Spine Flexion/Extension Critique:
Good!
Cervical Spine Flexion/Extension Critique:
Good: -Just barely got the top of T1
Lumbar Spine Flexion/Extension Critique:
Good: -L1 through part of sacrum -Foramen visible -Open intervertebral spaces
Cervical Spine Flexion/Extension Critique:
Good: -all necessary anatomy -no motion -good centering
Cervical Spine Flexion/Extension Critique:
Shoulders are not stabilized or the patient is very kyphotic
T or F: Flexion/Extension views cannot be done on TRAUMA patients.
True MUST be at least 10 days after trauma
T or F: Whatever mAs value was used on the lateral c-spine should be used for the flexion and extension views.
True Manually enter the mAs value
T or F: Use the same mAs value as the lateral lumbar spine for the flexion/extension views.
True manually enter mAs
T or F: Use the same mAs value as the thoracic lateral spine for the flexion/extension views.
True manually enter mAs
Cervical Spine: Flexion / Extension - Patient Position
Upright-standing or patient sitting up straight-no slouching -MSP parallel to the film -Relaxed shoulders (sandbags strapped to wrists). -Be certain that the motion is occurring through the cervical vertebrae ***Hold the shoulders stationary. Flexion: Patient should drop their chin to their chest Extension: Patient should tip their chin toward the ceiling