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How many muscles act directly on the SI joint?

0

name 5 examples of disk problems

1-Degenerated disk 2- Bulging disk 3-Herniated disk 4-Thinning disk 5-Disk degeneration with Ostophyte Formation

Name two functions of the vertebral column

1-Protect the spinal chord 2- Provide postural control

What are the three sections of the Sciatic Nerve?

1-Tibial nerve 2-Connon Peroneal Nerve 3-Tibial Nerve slip

How is the SI joint influenced

1-muscles that originate on the sacrum function to control the hip 2- Muscles that attach to the pelvic bones cause rotation of the pelvis.

____ -___ % of athletic injuries occur to the spine

10 to 15

Spinal injuries during athletic competition account for what percentage of all spinal injuries?

10% to 15%

Amount of stress placed on the lumbar intervertebral disks when a person is standing?

100 kg of pressure

How many Thoracic vertebrae?

12

The facet joints transfer what percentage of the weight-bearing forces in the spine?

20%

how much weight do the facet joints transmit through the spine?

20%

the synovial facet joints transmit what percent of the weight bearing forces through the spine

20%

How many intervertebral disks are found along the spinal column?

23

How many intervertebral disks are there?

23

how may disks are found along the spinal column

23

The stress placed on the lumbar intervertebral disks when a person is sitting and leaning forward increases to what amount?

275 kg of pressure

How many pairs of nerve roots exit the spinal column

31

How many total number of nerve root pairs exist in the spinal column?

31 pairs

How many vertebrae comprise the spinal column?

33

How many vertebral segments make up the spine?

33

how many sections of the vertebral column are there?

4

How many pairs of foramina perforate the sacral bone allowing for the passage of the dorsal and ventral primary divisions of the sacral plexus?

4 pairs

how many pairs of foramen in the sacrum

4 pairs

the disks are full hydrated until which age

40

the disk is fully hydrated at age __ but fully dehydrated by age __.

40, 60

How many Lumbar vertebrae

5

How many pairs of sacral nerves?

6

what percentage of athletic injuries include damage to the spinal chord/nerves?

6-10 %

At what age have we reached maximum dehydration of the disks

60

the nucleus pulposus is a highly elastic semigelatinous substance that is __ to __ percent water

60% - 70%

how many cervical vertebrae?

7

what percentage of adults will experience back pain?

70%

What percentage of adults experience back or neck pain in their lives compared with the percentage of injuries to the spine during athletic competition?

70%: 10% to 15%

Amount of stress placed on the lumbar intervertebral disks when a person is in the supine position?

75 kg of pressure

How many cervical nerves?

8

At what angle of hip flexion differentiates between nerve root impingement and disc pathology during a single leg raise?

> 70 deg of hip flex. indicates nerve root impingement. < 70 deg indicates disc pathology

What is spondylolysis?

A fracture of the pars interarticularis

What is spondylolisthesis?

An anterior displacement of a vertebra with pars interarticularis fracture

What is the name of the tough, dense, outer-layer of the intervertebral disks

Annulus fibrosus

Provide ligamentous support the entire length of the spine

Anterior and Posterior longitudinal ligaments

What forms the Obturator Nerve?

Anterior branches of L2-L4

What is the thinnest ligament in the spine

Anterior longitudinal ligament

During the Long Sit/Leg Length Discrepancy test if the patient's non-involved side is longer which way is the ilium rotated?

Anterior rotation

Where is the most common location of herniated or prolapsed discs?

At L4/L5 and L5/S1

test for throacic nerve innervation dysfunction and the umbilicus pulls to one side

Beevor's sign

What alleviates the pain felt with a positive Kernig/Brudzinski's Test?

Bending the knee.

Where are there not invtervertebral disks?

Between C0/C1/C2, the sacrum and the coccyx

Which two levels in the spinal column do NOT have intervertebral discs between the vertebral levels?

C0-C1, C1-2

What are signs and symptoms of spondylolysis and spondylolisthesis?

Centralized pain over spine, increased pain with hyperextension of spine, muscle spasm, decreased ROM

What is the most mobile section of the spinal column

Cervical

name the 4 sections of the spinal column

Cervical Thoracic Lumbar Sacral

When two nerves combine to form one

Convergent pathway

What does the Quadrant Test test?

Depends where pain is. Radicular pain indicates nerve impingement, pain over spine indicates facet joint dysfunction, pain over PSIS indicates SI joint dysfucntion

What condition is associated with mannequin posture?

Disc herniation

Considered the gold standard for diagnosing an intervertebral disc lesion?

Discography

When one nerve splits to form two

Divergent pathway

Muscle group that is the primary mover for spinal extension and controls the rate of spinal flexion against gravity through eccentric contractions?

Erector spinae group

The primary function of the anterior longitudinal ligament (ALL) is to limit what spinal motion?

Extension

(True or False) An athlete with a suspected nerve root impingement may self-report pain during urination.

FALSE

(True or False) The Tibial Nerve and Femoral Nerve are branches of the sciatic nerve.

FALSE

Lumbarization is a condition that is normally symptomatic and will require one to seek medical attention.

FALSE

The back's intrinsic muscles' primary function is to provide respiration.

FALSE

The primary movement occurring between the L1-L4 vertebrae is rotation.

FALSE

True or false Kernig's Test involves flexion of the cervical spine

False, the Brudzinski's portion of the test involves the cervical spine.

What motion does the posterior longitudinal ligament limit?

Flexion

What spinal motion is limited by the posterior longitudinal ligament (PLL)?

Flexion

what position does a disc have the most pressure placed on it?

Flexion

Whiat two motions will best relieve the pain if an athlete is suffering from spinal stenosis? Select all that apply.

Flexion and Extension

What could cause an traumatic spondylolysis or spondylolisthesis?

Forced hyperextension of the back.

What special test is used to place a rotator stress on the SI joint by forcing one hip into hyperextension?

Gaenslen's test

What is a classic procedure used to determine whether an individual is malingering during the performance of functional and special tests?

Hoover test

What is the difference between the Well (Cross) Straight Leg Raise and the Straight Leg Raise?

In the Well (Cross) Straight Leg Raise the unaffected leg is tested. In the Straight Leg Raise the affected leg is tested.

Which of the following ligament(s) resist flexion and rotation?

Interspinous Ligament, Ligamentum Flavum

An exiting point for spinal nerve roots?

Intervertebral foramen

What is the space where the spinal nerve roots exit the vertebral column?

Intervertebral foramen

test for nerve root entrapment, bulgind disk, and dural sheath stretch

Kernig

What type of curve occurs in the Thoracic spine

Kyphotic

The femoral nerve is formed by the posterior branches of which nerves?

L2, L3, L4

What can cause an traumatic SI joint dysfunction ?

Landing hard on one leg or a blow to the back.

reinforces facet joints, highly elastic, returns spine to neutral from flexion

Ligamentum Flavum

What is the ligament that reinforces the facet joints and has an elastic property that assists the trunk in returning from flexion to the neutral position?

Ligamentum flavum

Which ligament forms the posterior margin of the vertebral canal?

Ligamentum flavum

What type of curve occurs in the cervical spine

Lordodic

what type of curve occurs in the Lumbar spine

Lordodic

When the first sacral vertebra fails to unite with the sacrum

Lumbarization

Which of the following describes the first sacral vertebra failing to unite with the remainder of the sacrum?

Lumbarization

What position is the patient in when performing the Gaenslen's Test?

Lying supine with one leg off the edge of the table

During a functional assessment, the patient is standing with the involved-side leg flexed at the hip and knee with the pelvis tilted to the involved side. What is the name for this posture?

Mannequin

test for lumbar verve root pressure

Milgram

What special tests differentiate between nerve root impingement and herniated disc?

Milgram Test, Well (Cross) Straight Leg Raise, Valsalva Maneuver, and Straight Leg Raise w/ pain below 70 deg hip flex.

Which test does not test for SI joint dysfunction Gaenslen's test, Milgram's test, or Fabere/Patrick's test?

Milgram's test is a test for herniated disc.

what are coupled motions

Motions that occur synergistically (i.e. lateral flexion and rotation)

What are some of the signs and symptoms of a herniated or prolapsed disc?

Muscle weakness, decreased sensation and diminished reflexes along affected dermatomes and myotomes

Beevor's sign evaluates what?

Nerve root pathology

What is a positive Hoover test

No downward pressure in the examiner's hand cupping opposite the leg being raised

What is the name of the flexible inner layer of the intervertebral disks

Nucleus pulposus

What do the posterior branches of nerve roots L2, L3, and L4 converge to form?

Obturator nerve

Where does the Spine attach to the lower extremity?

PSIS

What is the space between the superior and inferior facet called?

Pars interarticularis

what is a common site for stress fractures

Pars interarticularis

Sciatic nerve dysfunction symptoms can result commonly from a muscle spasm of which of the following?

Piriformis

What forms the Femoral Nerve?

Posterior branches of L2-L4

During the Long Sit/Leg Length Discrepancy test if the patient's involved side is longer which way is the ilium rotated?

Posterior rotation

What is the primary flexor of the spine?

Rectus abdominis

Spondylo

Relating to the spinal column or vertebrae

What is conservative management for a herniated disc entail ?

Rest, core stabilization, core strengthening, modalities, etc.

What level does the spinal chord exit the spinal column

Sacral level

What condition is present when the fifth lumbar vertebra fuses to the sacrum?

Sacralization

when the 5th lumbar vertebrae fuses to the sacrum

Sacralization

What is the name of the fracture that is seen on an x-ray of an athlete with spondylolysis

Scotty dog fracture

Spondylolysis

Scotty dog fracture, Defect in Pars interarticularis. Often caused by repetitive hyperextension of the lumbar spine.

Side 1 (Question)

Side 2 (Answer)

SPECT

Single Positron Emission Computed tomography, a form of radiography that allows for best viewing of Spondylolysis. Uses injection of radioactive dyes.

test for sciatic nerve pain, disk disfunction at 30 degrees

Straight leg raise

Which vertebrae only articulate with one rib?

T1, T10-T12

where are the costovertebral joints

T2-T9

Which vertebrae normally align with the medial border of the scapula spine?

T3

(True or False) Gaenslen's test is used to place a rotarty stress on the SI joint.

TRUE

(True or False) Hoover's test would NOT place tension on a nerve or nerve root, or cause dural irritation irritation?

TRUE

A rehabilitation program should include exercises that result in centralization of the pain.

TRUE

Goniometric measurements of the low back are more reliable if taken at the same time every day.

TRUE

The amount of motion between any two vertebrae is small, but motion of the entire column is large.

TRUE

True or false Compensatory posture is named based on the side one leans to?

TRUE

What is the special test for spondylolysis and spondylolisthesis?

The Single Leg Stance/Stork Stand

Which is a better test for a herniated disc, the Straight Leg Raise or Milgram's Test?

The Straight Leg Raise, it's sensitivity is 91%. Milgram's test has an inconclusive sensitivity and specificity.

Define sensitivity

The ability of a test to identify the patients that do have a specific condition, relative to the gold standard (True Positive)

Define specificity

The ability of a test to identify the patients that do not have the condition (True Negative)

What is retrolisthesis

The opposite of spondylolisthesis, a posterior displacement of a vertebrae

Pars interarticularis

The segment of bone between the superior and inferior facet joints, especially in the lumbar spine

Posterior internal fixation

The surgical implantation of screws to hold the spine in place and stabilize facet joints. Used to stabilize spondylolysis and spondylolisthesis

What is the most protective section of the spinal column

Thoracic

What is the function of the intervertebral discs?

To increase the total ROM available to the spinal column, To serve as shock absorbers of longitudinal forces, To serve as shock absorbers of rotational forces

Muscle group that is formed by the semispinalis, multifidus, and rotator muscles?

Transversospinal group

Which test is not a test for a nerve root pathology, Femoral Nerve Stretch, Tension/Bowstring Test, or Well (Cross) Straight Leg Raise?

Well (Cross) Straight Leg Raise tests for a herniated disc

Schuermann's disease

a disease process involving the disks of the thoracic spine

Spinal Stenosis

a narrowing of the spinal canal or intervertebral foramen.

stability of the spinal segment comes form

active restraints Passive restraints neural control

What is a purpose of he coccyx

an attachment site for muscles of the pelvic floor

each disk is formed by a tough dense outer layer called...

annulus fibrosus

What does the lumbar plexus innervate?

anterior and medial muscles of the thigh and medial muscles of the leg and foot

the entire length of the spinal column is reinforced by what 2 ligaments

anterior and posterior longitudinal ligaments

Spondylolisthesis

bilateral fracture of Pars Interarticularis

cauda equine syndrome

bilateral leg pain, absent deep tendon reflexes, or changes in bowel or bladder function.

spondylopathies

bony disorders of the posterior elements of the spinal column

lysis

breaking apart

how are individual disks referenced

by the vertebrae between which they are found; example - the disk located between the fourth and fifth lumbar vertebrae is known as the L4-L5 intervertebral disk

the articulation between each pair of vertebrae is formed by what type of 2 joints

cartilaginous and synovial joints

a relatively immobile joint in which two bones are fused by cartilage

cartilaginous joints

the union between an intervertebral dik and the superior and inferior vertebrae forms what joint

cartilaginous joints

the part of the spine that provides the greatest amount of ROM

cervical

The spinal column plays a role in protection and ROM. The _______ segment has the greatest ROM and the _______ segment offers the greatest protection.

cervical; thoracic

two nerves combining together to form a single nerve

convergent

what type of joint is formed between each rib and the vertebral body

costovertebral joint

lateral flexion occurs concurrently with rotation and vice versa: neither is a pure, single plane movement

coupled motions

the concurrent and necessary association of a motion around one axis with a different motion around another axis

coupled motions

There is a significant association between back pain and ______?

depression

well or cross straight leg raise

discriminates between sciatic neuropathy or disk herniations

one nerve splitting to form two individual nerves

divergent

the anterior and posterior surfaces of the articulation are strengthened by what ligaments

dorsal and ventral sacroiliac ligaments

the anterior longitudinal ligament functions to limit what motion of the spine

extension

what motion does the anterior longitudinal ligament limit?

extension

the type of muscles primary function to provide respiration and movement associated with the upper extemity and scapula and indirectly influencing the spinal column.

extrinsic

quadrant test

facet joint compression

tests to identify intervertebral disk lesions

femoral nerve stretch tension sign

hyporeflexia

flaccidity of the muscles, and denervation atrophy.

the posterior longitudinal ligament serves primarily to limit what movement of the spine

flexion

the spinal column allows for what three degrees of freedom of movement

flexion and extension, rotation, tilting, resulting in lateral bending

What does the interspinous ligament limit?

flexion and rotation in the spine

Discography

gold standard for diagnosing intervertebral disk lesions

Schmorl's nodes

herniation of the nucleus pulposus through the vertebral endplate

test for malingerers

hoover

Hoover Test

identification of malingering patients

Kernig's test

identify disk pathology or inflammation of nerve or its dural sheath

slump test

identify possible compression of the lumbar nerve roots

2 main functions of intervertebral discs

increase ROM and absorb shock

What is the purpose of intervertebral disks

increase ROM and provide shock absorption

Straight let raise test

indicates sciatic nerve irritation or a herniated intervertebral disk

when these muscles contract, the torso bends to that side

internal and external obliques

what ligaments are formed by strong fibers spanning the anterior portion of the ilium and the posterior portion of the sacrum, filling the void behind the articular surfaces of these bones

interosseous sacroiliac

a series of what ligaments serve to bind the sacrum to the pelvis

interosseous sacroiliac, dorsal and ventral sacroiliac, sacrotuberous, and sacrospinous

filling the space formed between the spinous processes, what ligament limits flexion and rotation of the spine

interspinous ligaments

the space where spinal nerve roots exit the vertebral column

intervertebral foramen

muscles that lie close to the spinal columnand directly influence its motion

intrinsic

where is the ligamentum Nuchae

intrinsic to adjoining vertebrae

how is the formation of the annulus fibrosus beneficial to its function

it leaves some portion of the disk taut regardless of the position of the vertebral column and increases the loverall strength of the tissue

what positions place the largest shear loads on the disk

lateral bending, flexion, lateral shear, and compression

the posterior muscles acting on the spinal column

latissimus dorse, levator scapulae, rhomboid major and minor, trapezius

Where does the supraspinous ligament go?

length of the spine attaches to the posterior apes of each spinous process

Intrinsic muscles

lie close to the spinal column and directly influence motion

the posterior margin of the vertebral canal is formed by what ligament

ligamentum flavum

this ligament reinforces the facet joints, and its unusual elastic property assists the trunk in returning from flexion to the neutral position

ligamentum flavum

in the the cervical spine, the supraspinous ligament becomes what ligament

ligamentum nuchae

the part of the spine that provides a balance of protection and ROM

lumbar

where is the ALL the thinnest

lumbar area

this occurs when the first sacral vertebra fails to unite with the remainder of the sacrum, forming a separate vertebra having characteristics similar to those of the lumbar spine, essentiall becoming a sixth lumbar vertebra.

lumbarization

hook lying position

lying supine with hips and knees flex and feet flat on table

how is the annulus fibrosus formed

multilayered fibers that cross in opposite directions forming an X pattern

the protective tunnel through which the spinal cord passes

neural arch

surrounding a flexible inner layer called...

nucleus pulposus

the broader, thicker anterior longitudinal ligament spans the length of the vertebral column from the ____ to the ____, attaching to both the vertebrasl bodies and the intervertebral disks

occuput, sacrum

the posterior longitudinal ligament attaches to what parts of the spine

originates: from the occiput as a thick structure, lines the anterior portion of the vertebral canal

What is diskogenic pain?

pain associated with disk degeneration or herniation

the common site of stress fractures in the lumbar spine

pars interarticularis

Extrinsic muscles

provide respiration/ movement related to upper extremity and scapula. Indirectly influence the spinal column

the primary flexor of the spine that also influences spinalposture by rotating the pelvis posteriroly, flattening the lumbar spine

rectus abdominis

what hormone increases the extensibility of ligament around the birth canal

relaxin

which ribs do not articulate

ribs 11 -12

this occurs when the fifth lumbar vertebra becomes fused to the sacrum; may occur unilaterally or bilaterally resulting in complete fusion of these segments.

sacralization

the weight of the torso and skull is transmitted to the lower extremity through which joints

sacroiliac joints

this ligament indirectly supports the sacrum and originates from the sacrum's ishial spine and attaches to the coccyx

sacrospinous ligament

what ligament arises from the ishial tuberosity to blend with the inferior fibers of the dorsal SI ligaments

sacrotuberous ligament

molded by 5 fused vertebrae, this bone fixates the spinal conumn to the pelvis and is responsible for stabilizing the pelvic girdle

sacrum

What does Adams forward bend test

scoliosis

listhesis

slipping

ground reaction forces from the lower extremities are transmitted through the SI joints up the ______ ______

spinal column

how much pressure is on the intervertebral disks

supine - 75 kg standing- 100 kg leaning forward- 275 kg

this ligament transverses the length of the spinal column and attaches to the posterior apex of each spinous process

supraspinous ligament

the facet joints represent the _______articulations

synovial

the superior facets of the vertebrae articulate with the inferior facets of the vertebrae immediately above form what type of joints

synovial facet joints, aka zygapophyseal joints

Valsalva test Milgram test

tests used to clinically identify intrathecal pressure

Anterior spinal fusion

the surgical implantation of a metal plate on the anterior side of the vertebrae. Used to stabilize spondylolysis and spondylolisthesis

Facet joints

the synovial joints between the interarticular processes of the vertebrae

the part of the spine that provides the greatest amount of protection

thoracic

Where is the weight of the sacrum transmitted

through the SI joints to the lower extremity

muscle that assists in stabilizing the lumbar spine by acting like a corset

transverse abdominis

what is the smallest functional unit of the spine

two adjacent vertebral bodies and the intervening disk

a test that tests for hernia or nerve root pain

valsalva

intrathecal

within the spinal canal

other name for facet joints

zygapophyseal joints


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