Term
| When does the lumbar curve begin to develop? |
|
Definition
lumbar curve = secondary curve
develops when the child begins to stand and walk |
|
|
Term
| normal angle of the lumbar curve (Ferguson's Angle) |
|
Definition
|
|
Term
| which movements are allowed and discouraged in lumbar spine? |
|
Definition
allowed = back bending and moderate forward bending
discouraged = rotation and side bending |
|
|
Term
| orientation of the lumbar facets |
|
Definition
Superior = BM (face posteriomedially)
Inferior = faces anterolaterally |
|
|
Term
|
Definition
| sacralization of the lumbar spine = L5 fuses to the Sacrum |
|
|
Term
|
Definition
| S1 becomes 6th Lumbar vertebrae (separates from the sacrum) |
|
|
Term
|
Definition
bone formation occurs along lines of stress and areas of weakness
anterior triangle becomes weak link for compression fracture |
|
|
Term
| embryologic origin of the anulus and the nucleus pulposus |
|
Definition
mesenchyme
notocord (ectoderm) |
|
|
Term
| embyrologic origin of the notocord |
|
Definition
|
|
Term
|
Definition
made of fibrocartilage
attachment to anterior and posterior logitudinal ligaments |
|
|
Term
|
Definition
surrounded by anulus fibrosus
allows reciprocal motion
has a high water content and is compressible |
|
|
Term
| anterior longitudinal ligament limits which motion? |
|
Definition
|
|
Term
| the posterior longitudinal ligament limits which motion? |
|
Definition
|
|
Term
| which lumbar ligament is commonly strained in traumatic injuries? |
|
Definition
iliolumbar ligaments
tender area = 1 in superior and medial to the PSIS |
|
|
Term
| Three types of fibers that make up the quadratus lumborum |
|
Definition
1. costovertebral fibers
2. iliocostal fibers
3. iliovertebral fibers |
|
|
Term
| what muscle is the strongest flexor of the hig? |
|
Definition
|
|
Term
| Where do the left and right crus of the diaphragm attach to the lumbar spine? |
|
Definition
|
|
Term
|
Definition
"Failed Back Syndrome"
1. non-neutral (type 2) somatic dysfunction
2. Pubic Shear
3. extended sacrum
4. superior innominate shear
5. Anatomic short leg with pelvic tilt
6. psoas syndrome and supporting muscle dyfunction |
|
|
Term
| major causes of osteomyelitis |
|
Definition
potts puffy tumor
staph infection |
|
|
Term
| major causes of uterosacral ligament traction |
|
Definition
|
|
Term
| Common cause of severe low back pain of sudden onset and without history of trauma |
|
Definition
| dissecting aortic aneurysm |
|
|
Term
| common cause of pain that wakes the patient up from sleep |
|
Definition
| malignancy until proven otherwise! |
|
|
Term
| common cause rapidly progressing neurological deficits |
|
Definition
| epidural abscess/infection |
|
|
Term
| Common cause of claudication symptoms with back pain |
|
Definition
|
|
Term
| what is the most common type of herniation and where? |
|
Definition
posteriolateral herniation (narrow posterior longitudinal ligament)
most common levels = L4-5 and L5-S1 |
|
|
Term
|
Definition
1. foot inversion (Tibialis anterior)
2. patellar reflex
3. medial foot sensation |
|
|
Term
|
Definition
1. Great toe extension
2. No reflex
3. dorsum of foot sensation |
|
|
Term
|
Definition
1. Food eversion
2. Achilles tendon
2. lateral foot sensation |
|
|
Term
|
Definition
reproduces back pain
leg lifted straight up until there is pain
normal = 80 degrees
**When there is pain, lower the leg and dorsiflex the foot to stretch the sciatic nerve (Lasegue's) = pain with the sciatic nerve: |
|
|
Term
| results and interpretation of the straight leg raise test |
|
Definition
0-35 degrees = some tension on sciatic nerve
35-70 degrees = maximally involves the sciatic nerve
>70 degrees = most likely joint pain |
|
|
Term
| Pain on both sides doing the straight leg raise test and the contralateral test may indicate what? |
|
Definition
| a space-occupying lesion (disc) |
|
|
Term
|
Definition
test for malingerers (people faking it)
Patient supine and physician holds beneath the patient's calcaneus
when the pt tries to raise one leg, there should be contralateral pressure on the opposite heel if the person is trying |
|
|
Term
|
Definition
stretches the spinal cord
patient is supine and forcibly flexes head onto chest
pain down to the low back or in the leg means meningeal irritation |
|
|
Term
|
Definition
assessment for contralateral restricted or shortened iliopsoas muscle
flex one thigh up to abdomen/chest
considered positive if opposite knee lifts off the table
can be active or passive |
|
|
Term
|
Definition
SX: Hip/buttocks pain with radiation to calf and foot
EX: Decreased IR and Adduction
CS points: mid-ole sacrum, piriformis muscle, posterioromedial trochanteric points |
|
|
Term
| which organs and body parts receive sympathetic innervated from T12-L2 |
|
Definition
left colon
bladder
prostate
lower extremity |
|
|
Term
|
Definition
forward splippage of one vertebral body on the one below it (usually due to fracture in the pars interarticularis)
L4/5 most common
50% is asymtomatic until age 20 or >
pain quality and location: aching pain in low back, buttocks and posterior thigh |
|
|
Term
| signs and symptoms of spondylolisthesis |
|
Definition
1. increased pain with extension based activities
2. B/L tight hamstrings
3. Stiff legged, short stride, waddling type gail
4. Usually no neurological deficits
5. Positive vertebral step-off sign over spinous process |
|
|
Term
| Four types of spondylolisthesis |
|
Definition
1. Dysplastic (congenital)
2. Isthemic = development of stress fracture of pars interarticularis
3. Degenerative
4. Traumatic = acute stress to pars (can cause disc herniation)
5. Iatrogenic = from surgery or unknown causes |
|
|
Term
|
Definition
| a fracture, defect or separation of the pars interarticularis of the vertebral arch |
|
|
Term
| Which vertebral defect is called "spotty dog" and why? |
|
Definition
|
|
Term
| grading of spondylolisthesis |
|
Definition
Grade 1 = 0-25%
Grade 2 = 25-50%
Grade 3 = 50-75%
Grade 4 = >75% |
|
|
Term
| Treatment of Spondylolisthesis |
|
Definition
weight loss
exercises
OMT
over 25% watch, consult if progression or neuological changes |
|
|
Term
|
Definition
| degenerative changes within the intervertebral disc and adjacent structures (facets, foramina) |
|
|
Term
|
Definition
| pressure on the nerve roots of the cauda equina usually due to massive central disc herniation |
|
|
Term
| symptoms of cauda equina syndrome |
|
Definition
sharp low back pain
saddle anesthesia
decreased DTRs
decreased rectal sphincter tone
loss of bowel and bladder function/control |
|
|
Term
| treatment of cauda equina syndrome |
|
Definition
| emergent surgical decompression of cauda equina |
|
|
Term
|
Definition
developmental anomaly
defect in closure of lamina of the vertebral segment
usually in the lumbar spine |
|
|
Term
|
Definition
1. Occulta = no herniation, may see a coarse patch of hair over site on PE, neuological defects rare
2. Meningocele = herniation of the meninges through the defect
3. Meningomyelocele = herniation of both meninges and nerve roots through the defect; associated with neuological defects |
|
|
Term
| pathogenesis of spinal stenosis |
|
Definition
1. hypertrophy of facet joints
2. calcium deposits in ligamentum flavum and posterior longitudinal ligament
3. loss of intervertebral disc height |
|
|
Term
| signs and symptoms of spinal stenosis |
|
Definition
aching, shooting pain and/or paresthesias in the low back to lower leg or legs
pain is worsened by extension |
|
|
Term
| treatment of spinal stenosis |
|
Definition
OMT to decreased restriction and improve ROM
NSAIDS, steroids, epidurals, laminectomy |
|
|
Term
|
Definition
Reflect appendicular problems
involve innominate and pubes
positive standing flexion test (from tight psoas muscles) |
|
|
Term
|
Definition
reflex axial problems
involve sacrum in relation to ilia and lumbars
positive seated flexion (forward bending) test |
|
|
Term
| how does the pubic symphysis location differ in inflare and outflare of the pelvis? |
|
Definition
| it doesn't--remains the same |
|
|
Term
|
Definition
patient stands barefoot
dr monitors PSIS's
pt flexes maximally w/o bending knees
positive = side where the PSIS moves furthest
purpose = identifies side of iliosacral somatic dysfunction
"Gold standard" test for iliosacral SD |
|
|
Term
|
Definition
|
|
Term
| middle transverse axis (motion) |
|
Definition
| forward/backward bending of sacrum |
|
|
Term
|
Definition
| rotation of the innominants relative to the sacrum |
|
|
Term
|
Definition
1. superior shear (upslip)
2. inferior shear (downslip)
3. posterior rotation
4. anterior rotation
5. lateral (outflare)
6. medial (outflare) |
|
|
Term
| superior innominate shear (upslipped) |
|
Definition
shear betwen the innominate and sacrum
symptoms seen on side of dyfunction:
- iliac crest more superior
- ASIS more superior
- PSIS more superior
- pubic ramus more superior (tubercle)
- medial malleolus cephalad (short leg)
often associated with pelvic pain or low back pain
may be caused by fall on one ischial tuberosity (trauma) |
|
|
Term
| Inferior innominate shear (downslipped) |
|
Definition
shear between the innominate and sacrum
rare and walking tends to reduce it
symptoms on side of dysfunction:
- iliac crest more inferior
- ASIS more inferior
- PSIS more inferior
- pubic ramus more inferior
- medial malleolus inferior (long leg)
may be associated with pelvic or low back pain |
|
|
Term
| Posterior Innominate (Ilial) Rotation |
|
Definition
Rotated posteriorly around transverse axis compared to other innominate
Symptoms on side of dysfunction:
- ASIS more superior
- PSIS more inferior
- medial malleolus superior (short leg)
inguinal/groin pain and knee pain may occur
resistant to anterior rotation of the pelvis |
|
|
Term
| muscles involved in dysfunction of a posterior innominate rotation |
|
Definition
rectus femoris (causes the inguinal/groin pain)
sartorius (causes knee pain) |
|
|
Term
| Posterior rotators of the innominate |
|
Definition
gluteus maximus
semitendinosis
biceps femoris
semimembranosis
piriformis (weak)
external abdominal oblique muscle |
|
|
Term
| Anterior Innominate Rotation |
|
Definition
Rotated anteriorly around transverse axis compared to other innominate
symptoms on side of dysfunction:
- ASIS more inferior
- PSIS more superior
- medial malleolus inferior (long leg)
hamstring tightness
posterior thigh pain
resistant to posterior rotation of pelvis |
|
|
Term
|
Definition
tensor facial latae muscle
quadratus lumborum
iliocostal muscles
internal abdominal oblique muscles
latissumus dorsi muscle |
|
|
Term
|
Definition
wider sacral sulus
positive standing flexion test
ASIS closer to midline (medial) |
|
|
Term
|
Definition
smaller sacral sulcus
positive standing flexion test
ASIS further from midline (lateral) |
|
|
Term
| Abducting muscles of the hip |
|
Definition
| gluteus maximus, medius and minimus |
|
|
Term
|
Definition
rotate about transvers axis
may shear superior/inferior with rest of innominate
anterior/posterior shears are rare; result from significant trauma |
|
|
Term
| superior pubic symphysis muscles |
|
Definition
rectus abdominus
pyramidalis muscle |
|
|
Term
|
Definition
pubic bone moves superior on one side
symptoms on side of dysfunction:
- ASIS superior (or equal)
- PSIS inferior (or equal)
- right pubic tubercle/rami would be superior |
|
|
Term
|
Definition
an angle formed parallel to the floor and the sacral baase
typically 35 degrees
used on lateral x-ray to determine hyperlordosis of lumbar spine |
|
|
Term
| Dysfunction of what sacral ligment causes type 2 mechanics? |
|
Definition
|
|
Term
| three "true" ligaments that suspend the sacrum in between the innominates |
|
Definition
anterior sacroiliac
interosseus sacroiliac
posterior sacroiliac |
|
|
Term
| 3 accessory ligaments that suspend the sacrum in between the innominates |
|
Definition
1. sacrotuberous
2. sacrospinous
3. iliolumbar (prone to irritation) |
|
|
Term
|
Definition
L or C shaped
convex ventrally, concave on the sacrum
no direct muscular attachment
final fusion does not occur until mid 20s |
|
|
Term
|
Definition
L or C shaped (has short upper arm and longer lower arm); angle forms at S2
convex ventrally, concave on the sacrum
no direct muscular attachment
final fusion does not occur until mid 20s
allows joint stability in flexion or extension |
|
|
Term
| sympathetic innervation of the pelvic viscera |
|
Definition
|
|
Term
| parasympathetic innervation of the pelvic viscera |
|
Definition
|
|
Term
| which disease can make the psoas contract and cause problems in the innominate and sacrum? |
|
Definition
|
|
Term
| which disease is also referred to as left-handed appendicitis? |
|
Definition
|
|
Term
|
Definition
1. Transverse = superior, middle, inferior
2. Verticle
3. Anterior posterior
4. Oblique = right and left |
|
|
Term
| Motion and location of superior transverse sacral axis |
|
Definition
Above S2
cranial primary respiratory mechanism creates motion around this axis |
|
|
Term
| Motion and location of middle transverse sacral axis |
|
Definition
At S2
forward and backwards bending |
|
|
Term
| Motion and location of inferior transverse sacral axis |
|
Definition
Below S2
rotation of the innominates |
|
|
Term
|
Definition
1. Bilateral flexed sacrum
2. Oblique axis dysfunctions
3. Sacral shears (unilateral flexion) |
|
|
Term
| In neutral mechanics, the sacrum rotates ______ relative to the oblique axis |
|
Definition
|
|
Term
| In non-neutral mechanics, the sacrum rotates ______ relative to the oblique axis |
|
Definition
|
|
Term
| Two phases of walking cycle |
|
Definition
1. Stance phase (60%) = limb contacting ground; 20% is double stance
2. Swing phase (40%) = limb advancing (not on ground) |
|
|
Term
| How is the sacrum affected during walking cycle? |
|
Definition
| right rotation on right oblique axis, then left on left oblique axis (reversible, neutral oblique mechanics) |
|
|
Term
| How is the lumbar spine affected during the walking cycle? |
|
Definition
| induces side bending of the lumbar spine towards the side of weight bearing leg |
|
|
Term
| How is the ilium affected during the walking cycle? |
|
Definition
| anterior rotation of the weight bearing ilium and posterior rotation of the opposite ilium |
|
|
Term
|
Definition
fibrocartilanginous joint that has motion determined by its anatomic shape, ligaments and muscular attachment (which can rotate it accordingly)
motion occurs at a transverse axis during normal gain
abduction dysfunction normal during pregnancy and childbirth |
|
|
Term
|
Definition
lower leg slightly and dorsiflex the foot
if negative: pain from straight leg raise test may be secondary to tight hamstring |
|
|
Term
| which pelvic ligament divides the greater and lesser sciatic foramen? |
|
Definition
|
|
Term
|
Definition
levator ani
coccygeus muscle
(make up the pelvic diaphragm) |
|
|
Term
|
Definition
these have a partial attachment to the true pelvis
iliopsoas
obturator internus
piriformis |
|
|
Term
| piriformis muscle (origin, insertion, action and innervation) |
|
Definition
origin = inferior anterior aspect of the sacrum
insertion = greater trochanter of the femur
action = externally rotates, extends thigh and abducts thigh with hip flexed
innervation = S1 and S2 |
|
|
Term
| 11% of the population will have either the entire or peroneal portion of the sciatic nerve running through which muscle? |
|
Definition
|
|
Term
| four types of sacral motion |
|
Definition
1. respiratory motion = occurs about the superior transverse axis of the sacrum (moves posterior during inhalation, and anterior during exhalation)
2. inherent (craniosacral) motion = occurs about the transverse axis (craniosacral flexion = counternutates, carniosacral extension = nutates)
3. Postural motion = occurs at the middle transverse axis of the sacrum (flexion = sacral base moves anterior, extension = posterior)
4. Dynamic motion = motion that occurs during ambulation (engages two sacral oblique axes) |
|
|
Term
| bilateral sacral flexion is a common dysfunction in which patients? |
|
Definition
| post-partum women due to birth mechanics |
|
|
Term
| how will weight bearing on the left leg affect L5 and the sacrum? |
|
Definition
L5 will sidebend to the Left and rotate opposite the sacrum (right)
sacrum rotates toward the left |
|
|
Term
| sacroiliac dysfunction will result from a problem with which part of the body? |
|
Definition
|
|
Term
| ilisacral dysfunction will result from a problem with which part of the body? |
|
Definition
|
|
Term
| L5 in relation to the sacrum |
|
Definition
sidebends towards the oblique axis
rotates opposite the sacral base |
|
|
