Question | Answer |
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 |