Support Trunk

Protect Spinal Cord

Do the movement of the spine occur in the same proportion in all the segments?

What are the movements of the spine?

No, in different segements different movements will occurs to a greater degree

The movements of the spine are: Flx, Ext, Ration, lateral flx

How much lateral Flx occurs at C1/C2?

What is the primary movement at C1/C2?

0 zip ziltch

Primary movement is Roation around 32 degress of rotation

What motion is limited in the thoracic spine?

Why is this motion limited?

Lateral Flx is limited in the thoracic spine

L Flx is limited bc of the ribs

Cervical Spine

Can the lumbar spine flx or ext more?

Flx

Pretty sure this is bc the facets appose each other quickly once the L spine is placed in extension ( yep Dr. T said so locking out boney apposition)

Spongy Bone

This cancellous bone is also covered with hyaline cartilage

What articular process does the superior articular process articulate with?

What articular process does the inferior articular process articulate with?

The superior articular process' facets articulates with the inferior articular process' faces of the vertabrae above

Inferior A.P: articulates with the facets of the superior AP of the vertabrae below

Supports the Vertebral Column

Limits Extension

Reinforces Disc

Cervical is in the Transverse

Throacic is in the Saggital

Lumbar is in the Front

These are my answers not is lecture

WHat is the location of the Anterior Long Lig on the veterbral Bodies?

What bones does the A.L.L start at and run to?

A.L.L is on the anterior and lateral sides of the V. bodies

Goes from the Occipute to the Sacrum

Is the anterior longitudinal ligament strong or weak?

Skinny or broad?

Are there deep and superficial fibers?

Strong

Broad

Yes, deep fibers blend with the disc

Where does the Posterior Long Lig least support the disc?

In relation to the structure of the P.L.L why is this?

In the lumbar spine

The P.L.L starts out broad in the cervical region and then ends narrow in the lumbar region so supports the disc less in the lumbar region.

What are the fucntions of the P.L.L?

What are the two characteristics of the fibers in the P.L.L.?

Limits Flexion

Reinforces Disc (less in Lumbar spine)

Fibers are both short and long

They are #ed by the vertbrae that they inter-connect.

i.e. a disc between the L2 and L3 vert will be called the L2/L3 disc

Bind vertebrae together

Absorb shock ( transmit load from 1 vertebra to another)

Allow small amount of movement between vertebral bodies

Spearate vertebrae bodies ( allows rm for passage of the nerve roots)

Contribute to spinal curves (thicker anteriorly, help form cervical and lumbar lordosis)

What how is the size fo the IV disc determined?

Depends on the region

2:5 disc: body in cervical region

1:5 in thoracic Region

1:3 in Lumbar region

Make up 20-25% of the length of the vertebral column

Where are the IV vascularized?

How is the rest of the disc nurished?

On the periphery

The rest of the disc is nourished by diffusion

Where is the nerve supply to the IV disc?

What are the pain sensitive structures surrounding the discs?

Only outer 1/3 of annular wall is innervated

Pain sens structures:

Ant/Post Long Ligaments

Vert Body

Nerve Roots

Adds strength to the disc having concentric rings of fibrous tissue and fibrocartilage that run obliquely and criss-cross.

A.F. also attaches to the periphery of the vertebral body

In what region is the IV disc the thinnest?

In what region is the nuclues pulposus least developed?

Thoracic

Thoracic

Nucleus pulposus is well developed in what regions?

Cervical and lumbar

Does the Nucl Pulposus is a semi gelatinous mass with a water composion  of what at birth and in the elderly?

what position does the NP sit in the annular fibers?

At birth: 85-90%    decreases to ~65% in elderly

NP sits posteriorly in the Annular fibers

In the cervical region how are the nerve roots are named?

What is the exception to this rule?

In the thoracic and Lumbar region how are the nerv roots named?

nerve roots in the cervical region are named for the vertabrae below

C8 is the exception, which lies between C7 and T1

in the Thor and Lumbar regions the Vertabrae are named for the Vertabrae above

When a disc buldges the nerve root affected is the one below the level of the disc buldge

This is because the nerve root above has already left the spinal column

Disc L4/L5 buldge L5 will be affected

2 Paired facet joints

               1 Joint between disc and body

Facet joints: plane synovial joints that are surrounded and supported by the joint capsule

Interbody (vertebral): Cartilaginous joint

What are the movements of the joints of the spine?

What determines the directions of the movement?

Gliding

The direction of the gliding is determined by the orientation of the facets which varies throughout the spine

Lumbar Spine:

Movements?

Facet oreintation?

Capsular Pattern?

Movements of teh Lumbar spine are: Flex/Ext

L spine facet oreintation: vertically (saggital plane) this limits the amount of Lat Flx and Rotation allowing only a small amount

Capsular pattern: Lat Flex & Rotation are equally limited--> extension

What is lumbarization?

What is sacralization?

do these characteristics cause issues?

Lumbarization: when S1 is not fused to the rest of the sacrum acts as a 6th lumbar vertabrae

Sacralization: when L5 is fused to the sacrum?

usually do not cause problems

What is the  intrinsic pressure w/in the Lumbar IV disc?

What changes this pressure?

Intrinsic IV disc pressure: 0.7 kg/cm2

This pressure changes with unloading or loading( adding weight (lifting), body positions (bending, sitting, lying)

When is there the least pressure on the L-spine IV discs?

When is there the most pressure on these IV discs?

when lying supine

When sitting in a flexed posture

Protrusion

Prolapse

Extrusion

Sequestration

Degeneration

Protrusion:

What direction is the movement of the NP?

Are the annular fibers ruptured?

If an individual has a protruded disc will there be issues everytime?

Buldge moves posteriorly

The annular fibers are not ruptured

Can have a protruded disc that has no symptoms

Prolapse:

More or less sever than a protrusion?

Held in by the A.F. or not?

is there nerve root impindgement?

Prolapse:

Is more sever than a prolapsed NP

Is only held in by the outer fibers of the NP

There is nerve root impindgement with a prolapsed disc, the buldge is big enough

Extrusion of IV disc:

What is the condition of the A.F. in this case?

what is the location of the N.P.?

Extrusion of IV disc:

The AF is ruptured

the NP moves into the epidural space

probably depends on how much NP moves out to the degree of impindgement

Sequestration of IV disc:

What is the condition of the Annulus fibrous and NP?

Sequestration of IV discs:

AF is ruptured and peices of it are broken off

Fragments of the AF and NP are left outside of the disc

DDD (degenerative disc disease):

Can be associated with what?

What happens to the facet joints in this condition?

may be associated with degenerative changes in the vertebral body

the facet joints come closure together and hinders the way the vertabrae side over each other creating more issues

What are the signs of Degenerative joitn Disease?

Are these signs variable amoung people?

LBP w/ no radiation, radiation into buttocks/posterior thigh, radiation past knee (sciatica)

+/- neurological signs

Yes there S/S will vary amoung individuals concering their type and severity of the DDD pathology

Percutaneous Discectomy is for what condition?

what is this procedure?

Percutaneous discectomy: 

Is done for pathologies of the IV disc

Microdecompression, mircodiscectomy

Needle excision of part of the mucleus--> decrease the pressure on the Annulus fibrous ( most likely only appoperiate in protrusion or or prolapse, mine)

Percutaneous discectomy

Laminectromy: taking off the lamina and therefore spinous process

Excision: taking out part of the disc (have to fuse bones at disc excision locations)

Fusion: When remove the entired disc and of IV bodies have to be fused

What is the frq of disc pathologies in the different regions of the spine?

Cervical: 36%

Thoracic: 2% (bc not a lot of movement occurs here)

62% in the Lumbar spine ( most torque here)

SI joints

Hip

Abdominal Aorta

Pancreas

Columns of the spine

Stability of the fracture

Anterior column (anterior part of the vertebral body)

Middle column: (middle part of the v. body)

Posterior Column: everything else besides the vertebral body from the pedicles on back

Anterior Longitudinal Ligament

Anterior Vertebral Body

Anterior part of the IV disc (anterior annulus)

Posterior V. body

posterior long ligament

Posterior part of the IV disc (posterior annulus and Nucleus)

Neural arch:

Facet joints and capsules

Spinous process

Supraspinous and interspinous ligaments

Stable: Vertebral components won't be displaced by normal movement. Therefore no SC damage

Unstable: Possibility of vertebral displacement. Therefore there is potiential of SC injury

What is the most common fx of the lumbar spine?

What column of the spine fails when this happens?

Compression fx (most commonly seen in people with OP)

Failure of anterior column (middle column is still intact), posterior ligaments usually intact

Stable fx:

most common

no neurological involvement

loss of <50% of vertebral height

What are the characteristics of a unstable anterior wedge fx?

what condition could a wedge fc create?

Less common than stable

Loss of >50% of the vertebral height. The vertebral body is more likely to degenerate further after the point of fx

Wedge angulation of >20 deg

Multiple adjacent wedge fx

Downgers hump

What is the MOI of an Ant wedge fx?

What are the S/S of an anterior wedge fx?

MOI: Flx ( high velocity or excessive) i.e. falling or a MVA. The amount decreases as osteoprosis sets in

S/S: Marked pain, Loss of anterior vertebral ehight on radiograph

Exercise (UE and LE strengthening)

progressive exercise with brace if needed

typically not bed rest although it maybe an option

Plaster or plastic jacket

ORIF with posterior fixation

what is a burst fx of the spine?

what columns fail with a burst fx?

are the vertebral end plates involved?

What happens to the posterior ligaments?

Stability classification?

MOI?

Compressive fx of the vertebral body

The anterior and middle columns fail with a burst fx?

Both or just the superior or inferior vertebral end plates can be involved

Posterior ligaments stay intack despite being in middle column

MOI: Axial loading (either from top down or bottom up)

S/S:

Marked pain

?neurological deficits

Raiographic: spreading out of the vertebral body and loss of vertebral height

If no neurlogical signs and fragments are not moving--> stabilization in brace/jackeet

if neuro signs or posterior movement of fragments--> decompression and ORIF

What is a flexion distraction Fx?

Is it isolated to only one spinal level?

What types of tissues are involved?

A FDF is a fx that involves all three columns of the spine

Can involve multiple spinal levels

Bone ligament or both at the same time

what is the MOI of a Flx distraction fx?

Is neuro damage likely?

What is the MOI?

Unstable in flexion

neuro damage is unlikely in fact rare

Body is thrown forward against resistance, "lumbar spine jackknifes around an anteriorly placed axis i.e. lap belt"

Bone Involvement: Hyperext brace/cast

Ligamentous involvement: Posterior spinal fusion (Torn PLL)

Fx w/ dislocation

neurological damage frq occurs (impingement on the spinal cord)

How many columns does  fx w dislocation disrupt (think about it?

What is the stability? (think)

all three columns ( both bony and ligamentus disruption)

Very unstable

S/S of fx dislocation of the spine?

What does a radiograph look like with this?

paraplegia (paralysis) or paraparesis (weakness)

Fx through body, pedicle, articular process, lamina, subluxation or dislocation fo body or fragments

How is a fx dislocation of the spine managed?

Is there ever a conservative management?

Yes, Conservative management is done if there is no neurodamage. Includes bed traction --> brace--> PT rehab/conditioning

If thre is SC damage or fail conservative treatment --> decompression and stabilization--> brace--> PT

Transverse process fx:

Management?

if occurs with other injuries then will be treated along with them

If occurs in isolation then will not be treated

what are bengin tumors of the spine or long bones called?

What tissue does this form?

ARe these largeor small?

What pop does this occur in mostly?

Osteoid Osteoma

Bony tumor forms bone

Small, Rarely >1.5 cm in diameter

Childern and young adults

S

Osteoid Osteoma:

S/S?

Management?

What is the typical course of this disease?

S/S: night pain

Managed with NSAIDS, ASA?, surgical excision or radiodrq ablation

Can regress spontaneously or persist

Osteoid Osteoma

Hemangioman and meninigioma

Osteochondroma

Hemangioma and meningioma:

what are these?

what is their effect on the spine?

Managment?

Hemangoima and meningioma are bengin vascular tumors that can effect the spine

Effect is usually asymptomatic. Can cause back pain. neuro sym from pressure on SC or PNS nerves

Managed with excision if symptomatic

Osteochondroma:

what? common or not?

what anatomical deformation does it cause? what is this called?

When does it cause pain?

Osteochondroma:

Bengin tumor of the bone. Most common of the bengin bone tumors

Developmental dysplasia--> causes development of exostosis(outgrowth of bingine bone

Causes pain when present in the spine

what is the risk of a osteochondroma turning malaginent?

what is the name of the maliginant version?

Risk of maligninate transformation: 1-10%

Name changes from osteochondroma to chondrosarcoma

if not excised needs to be wathced

Multiple myeloma

chondrosarcoma

 secondary chondroscarcoma

metastatic osteolytic

maetastic osteoblastic

Mutliple Myeloma:

Malignant/Bengin?

Primary/2ndary neither

Common or uncommon?

what tissue does mutliple myeloma affect?

what cells does it affect?

Primary Malinginant tumors

most commmon primary tumor of the spine

Carcinoma of the bone marrow

Effects white blood cells

What is the effect of multiple myloma on the bone?

mroe common in M/F?

Age of onset?

Can cause multiple lesions that will bore through the bone

2:1 F:M

Middle age onset

bone pain (often in the back or the ribs)

Weakness/ fatigue

Anemia

General ill health (cachexia:wt loss)

pathological fx

what does a radiograph look like for a person with Multiple myeloma?

Management of Multiple myloma?

what is the prog?

Decreased bone density with the appearance of moth eaten bone

Management: Chemotherapy, radiation, ORIF for fx

Poor prognosis

Primary chondrosarcoma is what?

where does thsi typically occur?

slow or fast growing?

what is the effect on bone and soft tissues?

Primary chondrosarcome:

Typically occurs in pelvis, shoulder, femur

P.C.: is a slow growing tumor

P.C.: destroys the bone and then invades soft tissues

secondary chondrosarcoma

metastic osteolytic

metastic osteoblastic

Secondary Chondrosarcoma:

what is it secondary to?

what % of chondrosarcoma case is this?

Develops from osteochondroma

25% of cases of chondrosarcoma

What type (prim or 2ndary) is a metastic osteolytic tumor?

what is its effect?

where does is metastisize from and what bone does it usually end up in most commonly?

Metastic osteolytic tumor :

2ndary (metastic!)

Metastisizes from: primarly from breast but also from lung, kindney, bladder, colon, thyroid

ends up in the vertabrae and pelvis most commonly

Metastatic Osteolytic:

S/S?

Radiographic findings?

Managmenet?

Severe back pain (especialy at night (important question to ask patients)), Neuro change in the late stage of metastic osteolytic

Radiographic Findings: Moth eaten apperance of bone, "hot spots) dark spots that represent areas of high metabolism in bone on a Scintigraphy bone scan

Management: Chemmotherapy, radiation, PT (can be used as palative care to make sure they are the most comfortable)

Metastic Osteoblastic:

Prim or Secondary?

Where does it meta size from and to?

S/S?

Management?

Secondary bone forming tumor

Metasizes from the prostate commonly to the spine

S/S: severe back pain, neurological changes

Manage: chemo, radiation, Palative PT

what are some of the conginital disorderd of the spine?

Less serous ones?

More serious ones?

Facet Asymmetry: No association to pain or dysfunction

Transitional vertebra: Lumbarization, Sacralization, Little/no association to pain or dysfunction

Spina bifida Occulta

Spinal Bifida Occulta:

What anatomical stucuture is affected?

Is there compromise to the SC?

How do this condition effect mobilization tec?

The lamina to varying degrees does not close all the way

The SC is not compromised (this is what lec said but I though if it was sever enough that the SC could be compromised

Can still mobilize the person need to be aware and also how sever their condition is?

SPina bifida Occulta:

S/S?

DOes spinal stenosis occur more in M/F?

what predisposed a person to spinal stenosis?

M that are > 50

a narrow vertebral cannal

Spinal Stenosis:

Typically onsets after ___ of walking sitting?

Relieved by what position?

Better to walk up or down hill?

Typically onsets after 5-10 min of wlaking or sitting

Relieved by flexion so it is better to walk up hill

How is spinal stenosis Managed?

Postural education: Flx ok to decrease Sym but encourage an erect posture(do not want then in constant long term flx)

Decompression laminectormy (potientially at several levels)

Failure of fusion or dissolution of vertebral arch

Failure in 1 or both sides of pars interarticularis ( fibrous tissue replaces bone. Between lamina and articular processess. This can be a congeital or traumatic issue

Spondolysis:

S/S?

Management?

Spondylolysis:

S/S: maybe none pain with hyperext, pain with excessive flexion (stretching of fiberous tissue

Management:  brace is painful

beaware that Spondylolysis can led to spodylothesis

What is spondololisthesis?

What are the 5 types of Spondylolisthesis?

Forward shift of one vertabra on antoher, most commonly L4 on L5 or L5 on S1

Congenital, isthmic, degenerative, traumatic, pathologic

what % of spondylolisthesis are cogeninital?

Where is the defect?

20%

Defect in the superior sacral facets allowing a slow progressive forward slippage of L5

Note: the whole vertabrae slides forward not the case in isthmic

What is another name for Isthmic spondylolithesis?

what % of the cases is this?

When the vertabra slide forward what does the anatomy look like then?

Lytic spondylolithesis = gradual destruction

50% of the cases

spondylolysis--> spondylolisthesis

The spinous process and the inferior articular facets stay behind and the superior facets and the body and the anterior part of the arch go forward

what are the different types of spondylolisthesis and a little bit about them?

Degenerative: changes in the facets and discs allow for slippage forward, occurs in sever OA. 25% of cases. This is usually L4 on L5

Traumatic: following fx, usually a facet fx

Pathological: destrcution of neural arch from tumor of inferion

Grades 1-4

Grade 1: Arch defect w/ progressive slippage. 25% width of vertebral body. Midl back ache

Grade II: progressive shift with collapse of disc ( 25-50% width of body). Separation defect in neural arch seen on radiograph. Back pain, muscle spasm (muscules trying to hold the vertabrae in place), decrease ROM

Grade III: 50-75%. extensive slippage wide separation defect in neural arch. Further disc degneration. Significant pain and dysfuntion. Seperation can be seen on the radiograph.

Grade 4: Complete forward slippage. Sever disability.

General S/S:

Back pain can be mild to sever.

Possibly sciatic is there is nerve root impindgment

Palpable step off (spine shifted forward and then at the break there is a jump out)

Neuro changes if sevre

radiographic findings: foward shift of Spinal column above level

Extension

can do joint mobs above or below the lesion

place them in a brace modalities

can co flxibilty and strethening exercise LE musculatrue stretching lumbar stabiliazaion

What grades of spondylolisthesis are surgically managed?

and for what reason?

Grades 3-4

diabling sym, significacnt neruro invovlement

Generalized chronic inflammatory disease of the spine and SI joints.

Onsets in late adolescents and young adulthood

2:1 M:F

are vertebral infections commmon in theUS?

what is the infectious disease that affects the spine?

No

Tuberculosis, most often occurs inthe thoriacic spine

Tissue become dry and crubly like feta cheese can spread to discs and other vertabrae, forms abscesses near spine

leads to deformation of bodies verbral

what type of infection will cause pyogenic spondylitis and discitis?

S/S?

Staphylococcus infection ( e cloi, brucella, samonella) , similar to tuberculosis

Often begins in the urinary tract an spreads through the blood stream

S/S: rapid onset, pain in spine and surroudning soft tissues, Decrease spinal ROM, radiographic findings (early disc involvement with disc space narrowing, late destruction of adjacent bone)

what extrinsic cause of low back pain results from a vessel?

what population does this typically occur in?

S/S

bdominal aortic aneutysm

Males >50 yoa

Deep, boring back pain, pulsatile mass in abdomen, bruits on auscultation (whooshing), palpation of abdominal aortic width of >5cm

A very serous condition needs to be addressed immedialy can rupture

extrinsic cuases of back pain:

abdominal or pelvic mass can be what?

Tumor or infection

Prostate, uterus, ovary, kidney

Oswestry Low Back Pain questionnaire:

diability index: developed in order to quanitfy diability from low back pain, develpod in 80"s modified in 2001

score each question 0-5 higher # more disability

multiply total by 2 express this as a % of disability

what is  a gibbus deformity?

Hump back

structural deformity. Shown by there being a sharp angulation caused by and anterior wedge fx. usually invovled 1-2 vertebra

pathological fx seen in OP, tumber (neoplasma), bone dieases

Gibbus deformity has a structural deformity of a sharp postrerior angulation at 1-2 segments of the T-spine

Note: that the Dowagers hump is also a structural deformity but is a rnding of the Thoracic spine and involves multiple vertabrae most often seen  with OP

What is Pectus carinatum?

what is the projection direction of the sternum?

Cogenitail or not if not what?

What demension of the chest increases?

What phase of breathing is affected and why?

Pigeon chest

sternum projects forward and downward increasing the A-P dimension of the chest which decreases the lateral dimension of the chest

Impairs breathing during inspiration bc the chest does not expands normally

will also inhibit the viserca (see MRI) , bc lateral diminsion is dcreased everything is sqwished together

pectus excavatum:

whyis the sternum pushed posteriorly

what deminsion of the chest is decreased?

what organ maybe displaced?

why is breathing impaired?

can this cause any issues with the T-spine?

sternum is pushed posteriorly by the overgrowth of the ribs

AKA funnel chest

the AP deminsion of the chest is decreased

the heart maybe displaced

breathing is impaired bc as the ribs go up the sternum is depressed decreasing lung volume during inspriation

can increase thoracic kyphosis

what is a cause of barrel chest?

what do the ribs look like compared to a normal individual?

pulmonary disease such as emphysema, enlargement of air spaces in bronchioles

horizontal rather than down caused by hyperinflation of the lungs, increased AP diminsion of the chest.

How much costovertbral expansion should there be?

where is this measured from?

3-7.5 cm

Measrued at the 4th intercostal space or at the axillam nipple line or 10th rib

The movements of Inspiration:

what is the general movement of the ribs?

Describe the Upper 6 ribs movements?

what handle motion is associated with the upper 6 ribs?

General movement: ribs pulled up and forward

Upper 6 ribs: rotate around their long axis, sternum moves up with ribs, increases A-P dimension of chest,

Pumple handle motion

the sternum moves up with the ribs

Describe the motion of the lower six ribs during inspiration?

what diminsion increases with the lower 6 ribs?

what handle motionis assocaited with lower 6 ribs?

Glide upward and dwnward bc fixed at both ends

the lateral dimension of the chest

Bucket handle

Decreased space for lung expansion: Pectus Excavatum, Scoliosis

Decrease muscle tone to hold the trunk in position upright: CVA, SCI, polio. Makes it hard to expand the chest

Decreased Mobility of the ribs and the sternum: OA ankylosing spondylitis, scoliosis

Decrease stability of the sternm and rib cage: post cadiac surgery or MVA same issue

C3-4: Refer to T1 region

C5-C6: refere to midscapular region and area of T2-T7

C7: refers to midthoracic region and area of T7-T8

Viscera refers to the T-spine

Area that the T-spine refers to:

Shoulder, axilla, scapula, abdomen, epigastrium

Thoracic joint dysfunction:

what is the cause?

S/S?

Management?

Cause: abdnormal vertebral position, usually rotation

S/S: sudden onset, marked local tenderness, C/O sharp local pain with movement

Management: anti-inflammatory modalities, jnt mobs highvelocity low amp thrust

DJD of the T-spine is most common as what levels and why?

S/S of DJD?

Most common at the T-spine at the levels of C7/T1 and T4/T5. The facet joints at these (C7/T1 and T4/T5) levels increase with movement of the shouder

Costovertebral joints: Mid-lower ribs ( would impair breathing with gradual degeneration)

S/S: Decreased ROM, stiffness w/ PAIVMs (passive excessive intervertebral movements), complains of aching and stiffnes in the spine, capsular pattern of lat flx & rotation most limit and extensiton less so

managed with anti infl modaltie flxibility exercises and joint mobilizations

What way are the ribs usually displaced in thoracic joint dysfunctions with abnormal rib position

S/S

posteriorly

pronounced local tenderness

sharp pain with deep breathing

management antiinflammatory modalities and joitn mobilixation/HVLA

Tietze's syndrome what is?

what is this caused by?

S?S?

Costochondritis

can happen at the costochondral or sternocostal junction

there is both acute and chronic forms

low grade inflammation is caused by hypomobility that can lead to hypermobility

S/S: gradual onset usually, local tenderness with aching along sternum increases with activity

Management: phonophoresis works well, joint mobilization if hypomoble, modify activites

what is scheuermann's disease?

cause?

 Adolescent kyposis. A growth disorder of the spine when the vertabra become wedge shaped exaggerating the kyphosis.

Unknow cause. Possiblly rapid growth spurts, size increases out of proportion to bone strength vertabra form in a wedge shape mannar

begins at puberty

S/S: gradual onset of kyphotic posture (fixed deformity), in creased compensatory lumbar lordosis

backache and fatigue, radiographic finding include irregular anterior vertebral endplates, most often T6-T10

How is scheuermanns disease managed?

what is the deciding factor in how it is managed?

Curves <40 deg are conservatively with: strengthening and stretching exercises (abdominals, hamstrings, rectus femoris and iliopsoas (these two help to pull spine into lumbar lordosis)), Flexibility excercises, postural instruction, bracing if still growing: in thoracic extension and neutral lumbar lordosis

Curves >40 deg: May require surgical correction and rod placement, indicated if sever pain, skeletlly mature, usually for curves >70

what causes herpes zoster?

what is another name for it?

S/S?

How long can sx persist after the rash has cleared?

herpes zoster is the result of infection of the nerves caused by lataint herpes virus.

It is also called shingles

It is an acute CNS infection cause by the herpes virus that affects the DRG

Severe pain in cutaneous areas, supplied by sensory nerves, rash, usually unilateral, may involve >1 dermatome

Sx can persist years after the rash has cleared up. Managed by anti-viral medication and TENS

Diaphragm: pain with breathing, refers to yoke area across the top of the shoulder

GI system: refers to midscapular region. r anterior xiphoid region and into left upper abdominal quadrant

Where do the liver refer pain to?

where does pleura refer pain to?

Refers to right postrior thoracic wall above kidneys and gallbladder bellow inferior angle of scapula

Pain over area of irritation, referes to scapula, sym brought on by coughtin or deep breathing

refer to upper and or mid thorcic spine, mid sternum, pectorl region, axilla, arm, TMJ

Thrombus or aneurysm can be the issue here.

Pain at the area of irratation

refers along region of decreased blood flow, referred to back

what is the procedure done in a compression fx in the t-spine?

What is the process of this procedure?

Procedure: Vertebroplasty

Biopsy needle inserted into vertebra trhough pedicle with the use of fluoroscopy, plastic cement injected into the bone that provides stabilization of the fracture however it does not correct the deformity, but prevents any further progression of it

What is a kyphoplasty?

when is it done?

Kyphoplasty: balloon inflated within the vertebra: restores height to vertebra then cement is injected to maintain the height.

Is done for a compression fx

How do you grade the risks for progression of Scoliosis?

How is the % chance of progression determined and what are they?

At what angle is a curve of the spine considerd scoliosis?

By using the Risser (skeletal maturatiy) and Cobb angle (severity of scoliosis)

Risser of 2-4 and cobb angle of 20-29= 20% chance of progression

Rissers of 0-1 and a cobb angle of 20-29= 65% chance of progression

A cobb angle of <30 deg at skeletal maturatyis not likely to progress

At >10 deg curve in the spine is considered scoliosis