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Cunningham Tech III

NYCC final Dr. Cunningham WI10

the __________ region of spine is predisposed to hyperkyphosis with aging thoracic
ribs create __________from hyperkyphotic tendencies of thoracic spine protection
rib subluxation in the thoracic spine is _________ common!
mid to upper thoracics are considered __________posture cervical
lower thoracics are considered __________posture lumbar
the thoracic area has _________ issues!!! Somatovisceral (somatoautonomic) reflexes. Autonomic
the thoracic has ___functional regions 3
name the 3 functional regions of the thoracic spine cervicothoracic, midthoracic, thoracolumbar
where is the apex of the mid-thoracic region? T6-T7 apex
the regional anatomy of thoracic: it is a ____-joint complex with costovertebral and costoransverse joints 3-joint complex
2 types of joints found in thoracic costovertebral and costotransverse joints
thoracic body shape wedged
there are up to _____joints in the thoracic 3-joint complex 12
thoracic regional anatomy - "up to 12 joints" means 2 ________, 4 _________, 2 ________, and 4 ___________ 2,4,2,4 is: 2 IVD's, 4 facet joints, 2 costotransverse, 4 costovertebral
2,4,2,4 thoracic 2 IVD's, 4 facet joints, 2 costotransverse joints, 4 costovertebral joints
the long spinous processes of thoracics limit ________ extension
facet angle of thoracic 60 degrees to transverse plane, 20 degrees to coronal plane
the superior thoracic facet is _________ to the inferior thoracic facet. anterior
where do facet angulations change in the thoracic spine? at thoracolumbar junction
kinematically, the combined flexion/extension range of thoracics is _________ as we move down the spine. GREATER the lower you go (more flexion/extension possible)
There is more __________ than lateral flexion as we move down the kinematic chart for thoracic, but this quality also decreases. Rotation
Lateral flexion ________ as descend kinematic chart for thoracics. increases
Rotation __________ as we descend the kinematic chart for thoracics. decreases
2 increases in ROM, 1 decrease in ROM for thoracic spine kinematic chart: Flexion/extension and Lateral flexion increase as descend, Rotation decreases as descend
what decreases posterior joint flexion/extension in the thoracics ribs
________ orientation affects thoracolumbar junction Lateral flexion and Rotation. Facet (almost vertical at thoracolumbar jcn.)
_________ is sagittal rotation with anterior translation. Flexion
Flexion is sagittal ___________ with anterior __________ . rotation, translation
In flexion, the thoracic disc is compressed _________ anteriorly
In flexion, the thoracic annulus fibrosis is susceptible to ____________ tension forces. posterior
Thoracic disc to vertebral body ratio 1:5
1:5 is the thoracic disc to vertebral body ratio
In thoracic rotation, the spinous processes cross to __________ side, one above farther than one below. opposite
The superior spinous process of thoracic rotates ________ than the inferior spinous process. more
small amounts of _____________ are always associated with rotation. lateral flexion
lateral flexion with rotation is known as ________ motion. coupled
In _______________ thoracic (motion), the TVP's approximate on concavity, separate on convexity. lateral flexion of thoracics
Which has larger amounts of coupled motion in thoracic spine: lateral flexion or rotation? lateral flexion
Lateral flexion has a _________ amount of coupled motion, compared to rotation of thoracics. large
In thoracic coupled motion, rotation occurs to side of ___________ and the spinous processes deviate _____. lateral bending, away
The ________________ deviate away and ___________ occurs to the side of lateral bending in thoracic spine. spinous processes, rotation
Spinous processes ___________, while vertebral bodies ___________! deviate, rotate
If the vertebral body is stuck in a right rotation malposition (left rotation restriction), which way is the spinous process deviated? spinous is deviated left
Upper thoracics are like ___________, because lateral flexion and rotation are same direction (RLF + RR, LLF + LR). cervicals
Both cervicals and upper thoracics behave similarly in what two planes of motion? lateral flexion and rotation = similar in cervs and upper thoracics
__________ thoracics are like lumbars, in that lateral flexion and rotation are in opposite direction (LLF + RR, RLF + LR). lower
Lower thoracics and lumbars share similar traits, in that their lateral flexion and rotation are in the _________ direction. opposite
When a figure is moving in a plane from position 1 to position 2 it is subject to a combination of rotation and translation. However, a point may be determined around which the figure has virtually rotated. What is this called? Instantaneous axis of rotation (kinematics)
3 kinematic directions/axes for thoracics flexion/extension, lateral bending, axial rotation
Most important kinetics concept for test Everything is initiated by Concentric contraction (ConCon) and controlled by Eccentric contraction (ECon).
Kinetically, everything is initiated by ____________ contraction and controlled by ___________ contraction. Concentric, Eccentric
does kinematics consider dynamic static and dynamic forces and levers acting on a joint? If not, then what does? no, Kinetics (movement) considers forces and levers
In mechanics, ____________ is the study of the relationship between the forces that act on a body and the changes they produce in the motion of that body. Kinetics
ConCon is an abbreviation for Concentric contraction
ECon is the abbreviation for Eccentric contraction
ConCon's are ____________; ECon's are ______________. initiators, controllers
flexion of thoracic spine is initiated/ConCon by Rectus Abdominis
flexion of thoracic spine is controlled/ECon by Erector spinae muscles
Ligamentum flavum, Interspinous ligaments, Supraspinous ligaments, PLL, Capsule, IVD (post), and Muscles tissue limits are all examples of what _________ flexion in the thoracic spine. limits
Extension of thoracic spine is initiated/ConCon by Erector spinae
Extension of thoracic spine is controlled/ECon by Rectus Abdominis
Spinous processes, facet joints, anterior IVD's, ALL, muscle tissue limits are all limiters of __________ in the thoracic spine. extension
Lateral flexion of thoracic spine is initiated/ConCon by ipsilateral erector spinae muscles and Quadratus Lumborum
The ____________ erector spinae and Q.L. initiate/ConCon lateral flexion in the thoracic spine. ipsilateral
Lateral flexion is controlled/ECon in the thoracic spine by contralateral erector spinae and QL
The ipsilateral __________joints of thoracic spine limit lateral flexion. FACET
What limits lateral flexion in the thoracic spine? ipsilateral facet joints
Which contralateral thoracic structure especially limits lateral flexion? ribs! (the answer is always ribs)
What muscles initiate/ConCon rotation in the thoracic spine? contralateral semispinalis, multifidus, and rotatores
Muscles that control/ECon rotation in the thoracic spine It is controlled by ConCon and ECon of erector spinae and abdominal obliques.
Is rotation initiated/ConCon by ipsilateral or contralateral spinal rotator groups? contralateral
Joint capsules, facet surfaces, interspinous ligaments, supraspinous ligaments, ligamentum flavum, and intrinsic/extrinsic musculature all limit__________ in the thoracic spine. This is especially true of the ______! rotation, ribs!
prime mover of thoracic spine Semispinalis thoracis
Well-developed ____________ and _____________ produce rotational restrictions and malpositions in the thoracic spine. rotatores and multifidus
Semispinalis Thoracis is a prime mover of the thoracic spine. It's fibers go from what to what? lower transverse processes to upper spinous processes
hypertonicity of semispinalis thoracis can cause abnormal _______________ in the thoracic spine (lateral flexion and rotation restrictions) coupled motion
Semispinalis thoracis can produce sectional _________ subluxations
Where is hyperkyphosis most predominant? upper thoracic
cervicothoracic and mid/upper thoracics are prone to a series of ______________ restrictions called Hyperkyphosis. extension restrictions
when there is hypokyphosis in the mid-thoracics, there is a(n)___________ in curvature. DEcrease
What are 2 trade terms for hypOkyphosis? "dishing" or "Anterior thoracics"
If hyperkyphosis are cervicothoracics in flexion malpositions/extension restrictions, what are hypOkhyphotic mid-thoracics? extension malposition/flexion restrictions
When adjusting thoracics, consider the angle of the disc space in __________ extension
When adjusting thoracics, consider the angle of the disc space in ___________ and stay in the plane line of disc. extension (like bearing down too hard on one side of the horizontal upper bar in a "T", you will lose effectiveness by straying off the perpendicular angle of vertical and horizontal - change with the curve of thoracic)
Because of coupled motion in the thoracic spine, a single adjustment goes a long way
What else besides coupled motion produces far-ranging effects from thoracic adjustment? sympathetic chain and cell bodies
Do not adjust the thoracic spine if the pain is not _________________________. Watch for referred pain because there may be a hidden pathology (ie, hernia, appendicitis, cancer) reproducible with NMS exam
You should not adjust the thoracic spine if there has been ____________ trauma until you rule out fractures or any other significant tissue damage (sprain/strain). post-traumatic
Should you adjust the thoracic spine if there is a sudden onset of pain from light activity? What and where could be the danger? No, compression fracture especially in thoracolumbar junction
Beware of the bone density disease _______________ when adjusting thoracics. It is a relative contraindication. osteoporosis
Complications to thoracic adjustments include mild to moderate painful reactions, due to __________ stretching, tearing ___________, or adjusting a stiff, dry joint. tissue, adhesions
Besides moderate pain, thoracic adjustments can cause a sympathetic storm of flushing, sweating, etc. Uncommon.
The final complication of thoracic adjustments, besides pain and sympathetic storm, is the accidental __________________ due to improper hand placement or TOO MUCH FORCE. Rib fracture
Dorsal ligament connecting tubercle of rib to transverse process lateral costotransverse ligament
Ventral ligament connecting head of rib to demi-facets of vertebral bodies. Articular ligament
Costocorporeal articulation rib to vertebrae at demi-facets
Costotransverse articulation rib to transverse process articulating surface
3 basic types of rib motions bucket handle, pump handle, caliper
movement which is greater in the lower thoracic spine and increases the transverse diameter of the rib cage. bucket handle movement
movement of ribs that occurs more in the upper thoracics. Elevates anterior rib cage with upward and forward movement of sternum or A-P diameter of rib cage. Pump handle
Movement associated with ribs 11 and 12. Caliper motion
Why is the movement of ribs 11 and 12 considered to be caliper-like along the horizontal plane? because there are no costotransverse joints to limit motion
What motion tends to increase lateral dimension of rib cage with slight A-P increase? Caliper
lower thoracic, transverse diameter bucket handle
upper thoracic, A-P pump handle
lateral dimension, ribs 11 and 12 caliper motion
Is the SacroIliac (SI) joint a synovial joint? YES
What causes pain in the SI area, the tissue or the joint? tissue
The most misunderstood joint SI
The SI has mobile, _______________ joints. diarthrodal
Controversial syndrome that is growing in recognition SI syndrome
Lumbar posture is connected to ___________posture. pelvic
Gravitational forces increase _____________to the lumbopelvic posture over time. distortion
Common origin of scoliosis SI
____________could be due to SI misalignment, anatomically short leg, or an anomaly. The Logan Technique is often used. Scoliosis
The SI is part of a ___-joint complex of the pelvis. 3
What makes up the 3-joint complex of SI in pelvis? 2 SI's, 1 symphysis pubis
The SI joint allows movement throughout the pelvis during gait and changes in posture. It most importantly absorbs compressive forces
With the lumbopelvic region, the SI joints form a ___-joint complex. 5
What makes the 5 joint complex of lumbopelvic and SI's? 2 SI's, 2 posterior facets, 1 IVD
The 5-joint complex of lumbopelvic and SI's creates a __________link to the lower extremity and spine. kinematic
Forces from above, __________affected first. Forces from below, __________affected first. Sacrum (above), Ilium (below)
Forces from _________affect the sacrum first. Forces from _________affect the ilium first. Above (sacrum), Below (ilium)
pain referred out from SI/femoroacetabular joint sclerotoginous
Sacrum is a "______" in an arch keystone
Sacrum provides additional support during weight-bearing due to __________ phenomenon. locked-in (keystone)
SI's are true ____________joints. synovial
The sacral facet is mostly ___________cartilage. hyaline
Sacral joint surface covers S1-S3. There is an ________ and _________ joint of sacrum. upper and lower
the Ilium facet is mostly _____________cartilage. fibro
The SI joint is ________ (texture) at birth then _________ (texture) at 60+ yrs. and may fuse with adhesions. smooth, roughens
Degree of orientation medial to lateral, A-P of SI joint (pubic symphysis is also at this angle of degree) 30 degrees
The surfaces of the upper and lower joints of SI move reciprocally. The upper moves in response to loads from _________, the lower joint is influenced by loads from ___________. above, below
Anatomically, the lumbosacral joint complex is a ____ joint spinal motion segment. 3
3 joints of 3 joint spinal motion segment of lumbosacral plexus disc and 2 facet joints
Cervical spine is divided into _________and _________cervical spine. upper and lower
the smallest, most mobile spinal region with a 12 pound bowling ball on top cervical
cervical posture is akin to _________posture thoracic
gravitational forces increase __________over time in the cervical spine distortions
where do upper body distortions commonly begin? cervical spine
the cervical spine has significant _________ and vascular issues neurological
2 distinct regions of cervical spine uppers, lowers
upper cervicals are segments __________ Co-C1-C2 (OA and AA motion segments)
lower cervicals are segments __________ C2-C3 to C7-T1
Lordosis sometimes extends to T?-T? T2-T3
Do upper thoracics impact cervical function? yes
The upper cervicals are the __________ from skull to the rest of the spine. transition
What part of the spine is anatomically unique? upper cervicals
Why are upper cervicals anatomically unique? (3) 1-no discs, 2-OA has two lateral joints, 3-AA has two lateral joints and one central joint
type of central joint of AA (atlantoaxial)? trochoid
Occipito-Atlantal Motion Segment: what is the occipital joint surface feature - convex or concave? convex
Superior joint surface of Atlas functions like hypermobile bony "__________" meniscus
The Atlas superior joint allows mostly movement of Flexion/extension
Occiput motion is almost all flexion/extension
there is very little lateral flexion or rotation (5 degrees) in the occiput
When we laterally flex our head, what happens to the occiput and atlas? Occiput slides towards convexity and atlas slips towards concavity.
The inferior joint surface of the ________ vertebrae is roiund and convex, as is the superior surface. Atlas
The motion of the atlas is mostly rotation
The position of Occiput attachment sites create suboccipital muscle tension HA!
Upper cervical deep muscular anatomy at suboccipital often displays MUSCULAR restrictions at what 2 joints? OA,AA
Pay attention to slide on Occipito-Atlanto-Axial F/E - do the OA and AA function together or separately? together
MYODURAL bridge possible cause of CERVICOGENIC HEADACHES (also called vertebrogenic headache)
In OA-AA movement, the occiput glides posterior (___) and the atlas rotates (____) and glides posterior (____) (-Z), (+thetaX), (-Z)
In right lateral flexion, for example, the occiput glides _______. The atlas slides up and glides _______. What does the Axix do? left, right, RLF and RR (spinous left)
Most of OA's rotation is at the end of global ROM
AA has huge __________! (motion) rotation
the ____ is very active during the first 25 degrees of global cervical rotation, then spreads throughout. AA
In Occipito-Atlanto-Axial Rotation, the __________side moves posteriorly, the __________ side moves anteriorly. ipsilateral, contralateral
There are multiple attachments from occiput to (segments) _______. C1 and C2
C1 and C2 segments function with each other especially during F/E
Postural distortions or muscle contractions affect C1, C2 or both? both
Deep ligaments of upper cervical segments __________ motions. stabilize
Ligament which limits lateral flexion in cervicals Alar
Ligaments which limit flexion and translation Transverse
Atlantodental interspace relates to ___________space. spinal cord
Upper cervical kinematics - occiput centers of rotation are called _______________-axex of rotation. instantaneous
Each lower cervical vertebrae MOTION SEGMENT typically has ___ joints 5
Each lower cervical vertebra has ____ joints. 10
Joints of Luschka are also called uncovertebral joints
the uncovertebral joints are from uncinate processes and are __________joints! synovial (have synovial lining and membrane)
is there a capsule in uncovertebral joints? no, but they ARE synovial joints
Uncovertebral joints (UN) guides __________ motion
motion of uncovertebral joints Lateral flexion with rotation
do uncovertebral joints degenerate? yes
Degeneration of Uncovertebral joints can cause (due to "blunting") root impingement!
The nerve lying on top of the uncovertebral joint lies in the lateral recess
Blunting of UN joints "blunt" due to uncinate processes doing what? causing what? hypertrophying and moving into the lateral recess, causing nerve impingement
Regional anatomy of cervical joint complex: there is a __________nucleus. central
there is a _________disc to body ratio in cervical joints large
why do we need a large disc to body ratio in cervical joint complexes? increases mobility
facet angles of cervicals 45 degrees (know this for test)
Lower cervicals have broad thick _____________ for weight bearing articular pillars
Do cervical vertebrae have large or small IVF's? large
What cervical vertebrae is most like thoracics? C7
the large spinous process of C7 is called the vertebra prominens
C& has a small anterior __________ tubercle
Does C7 have an uncinate process? no
the vertebral artery is or is not in the foramen of C7 is not
there is an occasional _______ present at C7 that may cause ischemic attacks or other pathology cervical rib (or elongated TP) with a true, costotransverse joint
4 structures important to the upper cervical complex: Ligamentum nuchae, ligamentum flava, Posterior Atlanto-Occipital membrane, Vertebral ARtery
there is no vertebral artery at ___ C7
The concept of cervical curve is controversial. The idea is that a ____________curve dampens compressive forces and balances the weight of the skull over the disc and facets. Secondary curve
Changes in the cervical curve are common - possible changes? degeneration, congenital (disc and facet shape), postural, traumatic
A reversed cervcial curve with hyperlordosis is not good and usually causes significant __________ dyskinesia
A hypOlordotic curve in cervical spine causes increased disc load, increased muscular effort as head translates forward
Lower cervical spine kinematics involve segments C2-3 to C7-T1)
There is a decrease in lateral bending as you go ________ the cervical spine. down
degrees of Flexion/Extension per lower cervical spine motion segment 15 degrees
Greatest amount of flexion/extension cervical segments C4-5 and C6-7
Ipsilateral flexion causes ipsilateral ________ in cervicals with spinous deviation away from side of flexion. rotation
there is not a lot of lateral flexion at lower cervicals
Created by: Heather Cutler Heather Cutler on 2010-04-05

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