NYCC final Dr. Cunningham WI10
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| the __________ region of spine is predisposed to hyperkyphosis with aging | thoracic
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| ribs create __________from hyperkyphotic tendencies of thoracic spine | protection
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| rib subluxation in the thoracic spine is _________ | common!
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| mid to upper thoracics are considered __________posture | cervical
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| lower thoracics are considered __________posture | lumbar
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| the thoracic area has _________ issues!!! Somatovisceral (somatoautonomic) reflexes. | Autonomic
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| the thoracic has ___functional regions | 3
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| name the 3 functional regions of the thoracic spine | cervicothoracic, midthoracic, thoracolumbar
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| where is the apex of the mid-thoracic region? | T6-T7 apex
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| the regional anatomy of thoracic: it is a ____-joint complex with costovertebral and costoransverse joints | 3-joint complex
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| 2 types of joints found in thoracic | costovertebral and costotransverse joints
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| thoracic body shape | wedged
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| there are up to _____joints in the thoracic 3-joint complex | 12
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| 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
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| 2,4,2,4 thoracic | 2 IVD's, 4 facet joints, 2 costotransverse joints, 4 costovertebral joints
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| the long spinous processes of thoracics limit ________ | extension
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| facet angle of thoracic | 60 degrees to transverse plane, 20 degrees to coronal plane
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| the superior thoracic facet is _________ to the inferior thoracic facet. | anterior
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| where do facet angulations change in the thoracic spine? | at thoracolumbar junction
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| kinematically, the combined flexion/extension range of thoracics is _________ as we move down the spine. | GREATER the lower you go (more flexion/extension possible)
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| There is more __________ than lateral flexion as we move down the kinematic chart for thoracic, but this quality also decreases. | Rotation
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| Lateral flexion ________ as descend kinematic chart for thoracics. | increases
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| Rotation __________ as we descend the kinematic chart for thoracics. | decreases
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| 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
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| what decreases posterior joint flexion/extension in the thoracics | ribs
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| ________ orientation affects thoracolumbar junction Lateral flexion and Rotation. | Facet (almost vertical at thoracolumbar jcn.)
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| _________ is sagittal rotation with anterior translation. | Flexion
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| Flexion is sagittal ___________ with anterior __________ . | rotation, translation
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| In flexion, the thoracic disc is compressed _________ | anteriorly
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| In flexion, the thoracic annulus fibrosis is susceptible to ____________ tension forces. | posterior
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| Thoracic disc to vertebral body ratio | 1:5
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| 1:5 is the | thoracic disc to vertebral body ratio
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| In thoracic rotation, the spinous processes cross to __________ side, one above farther than one below. | opposite
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| The superior spinous process of thoracic rotates ________ than the inferior spinous process. | more
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| small amounts of _____________ are always associated with rotation. | lateral flexion
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| lateral flexion with rotation is known as ________ motion. | coupled
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| In _______________ thoracic (motion), the TVP's approximate on concavity, separate on convexity. | lateral flexion of thoracics
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| Which has larger amounts of coupled motion in thoracic spine: lateral flexion or rotation? | lateral flexion
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| Lateral flexion has a _________ amount of coupled motion, compared to rotation of thoracics. | large
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| In thoracic coupled motion, rotation occurs to side of ___________ and the spinous processes deviate _____. | lateral bending, away
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| The ________________ deviate away and ___________ occurs to the side of lateral bending in thoracic spine. | spinous processes, rotation
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| Spinous processes ___________, while vertebral bodies ___________! | deviate, rotate
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| 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
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| Upper thoracics are like ___________, because lateral flexion and rotation are same direction (RLF + RR, LLF + LR). | cervicals
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| Both cervicals and upper thoracics behave similarly in what two planes of motion? | lateral flexion and rotation = similar in cervs and upper thoracics
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| __________ thoracics are like lumbars, in that lateral flexion and rotation are in opposite direction (LLF + RR, RLF + LR). | lower
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| Lower thoracics and lumbars share similar traits, in that their lateral flexion and rotation are in the _________ direction. | opposite
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| 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)
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| 3 kinematic directions/axes for thoracics | flexion/extension, lateral bending, axial rotation
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| Most important kinetics concept for test | Everything is initiated by Concentric contraction (ConCon) and controlled by Eccentric contraction (ECon).
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| Kinetically, everything is initiated by ____________ contraction and controlled by ___________ contraction. | Concentric, Eccentric
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| 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
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| 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
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| ConCon is an abbreviation for | Concentric contraction
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| ECon is the abbreviation for | Eccentric contraction
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| ConCon's are ____________; ECon's are ______________. | initiators, controllers
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| flexion of thoracic spine is initiated/ConCon by | Rectus Abdominis
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| flexion of thoracic spine is controlled/ECon by | Erector spinae muscles
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| 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
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| Extension of thoracic spine is initiated/ConCon by | Erector spinae
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| Extension of thoracic spine is controlled/ECon by | Rectus Abdominis
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| Spinous processes, facet joints, anterior IVD's, ALL, muscle tissue limits are all limiters of __________ in the thoracic spine. | extension
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| Lateral flexion of thoracic spine is initiated/ConCon by | ipsilateral erector spinae muscles and Quadratus Lumborum
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| The ____________ erector spinae and Q.L. initiate/ConCon lateral flexion in the thoracic spine. | ipsilateral
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| Lateral flexion is controlled/ECon in the thoracic spine by | contralateral erector spinae and QL
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| The ipsilateral __________joints of thoracic spine limit lateral flexion. | FACET
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| What limits lateral flexion in the thoracic spine? | ipsilateral facet joints
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| Which contralateral thoracic structure especially limits lateral flexion? | ribs! (the answer is always ribs)
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| What muscles initiate/ConCon rotation in the thoracic spine? | contralateral semispinalis, multifidus, and rotatores
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| Muscles that control/ECon rotation in the thoracic spine | It is controlled by ConCon and ECon of erector spinae and abdominal obliques.
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| Is rotation initiated/ConCon by ipsilateral or contralateral spinal rotator groups? | contralateral
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| 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!
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| prime mover of thoracic spine | Semispinalis thoracis
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| Well-developed ____________ and _____________ produce rotational restrictions and malpositions in the thoracic spine. | rotatores and multifidus
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| 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
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| hypertonicity of semispinalis thoracis can cause abnormal _______________ in the thoracic spine (lateral flexion and rotation restrictions) | coupled motion
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| Semispinalis thoracis can produce sectional _________ | subluxations
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| Where is hyperkyphosis most predominant? | upper thoracic
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| cervicothoracic and mid/upper thoracics are prone to a series of ______________ restrictions called Hyperkyphosis. | extension restrictions
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| when there is hypokyphosis in the mid-thoracics, there is a(n)___________ in curvature. | DEcrease
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| What are 2 trade terms for hypOkyphosis? | "dishing" or "Anterior thoracics"
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| If hyperkyphosis are cervicothoracics in flexion malpositions/extension restrictions, what are hypOkhyphotic mid-thoracics? | extension malposition/flexion restrictions
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| When adjusting thoracics, consider the angle of the disc space in __________ | extension
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| 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)
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| Because of coupled motion in the thoracic spine, a single adjustment goes | a long way
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| What else besides coupled motion produces far-ranging effects from thoracic adjustment? | sympathetic chain and cell bodies
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| 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
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| 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
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| 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
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| Beware of the bone density disease _______________ when adjusting thoracics. It is a relative contraindication. | osteoporosis
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| Complications to thoracic adjustments include mild to moderate painful reactions, due to __________ stretching, tearing ___________, or adjusting a stiff, dry joint. | tissue, adhesions
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| Besides moderate pain, thoracic adjustments can cause a | sympathetic storm of flushing, sweating, etc. Uncommon.
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| 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
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| Dorsal ligament connecting tubercle of rib to transverse process | lateral costotransverse ligament
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| Ventral ligament connecting head of rib to demi-facets of vertebral bodies. | Articular ligament
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| Costocorporeal articulation | rib to vertebrae at demi-facets
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| Costotransverse articulation | rib to transverse process articulating surface
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| 3 basic types of rib motions | bucket handle, pump handle, caliper
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| movement which is greater in the lower thoracic spine and increases the transverse diameter of the rib cage. | bucket handle movement
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| 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
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| Movement associated with ribs 11 and 12. | Caliper motion
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| 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
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| What motion tends to increase lateral dimension of rib cage with slight A-P increase? | Caliper
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| lower thoracic, transverse diameter | bucket handle
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| upper thoracic, A-P | pump handle
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| lateral dimension, ribs 11 and 12 | caliper motion
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| Is the SacroIliac (SI) joint a synovial joint? | YES
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| What causes pain in the SI area, the tissue or the joint? | tissue
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| The most misunderstood joint | SI
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| The SI has mobile, _______________ joints. | diarthrodal
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| Controversial syndrome that is growing in recognition | SI syndrome
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| Lumbar posture is connected to ___________posture. | pelvic
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| Gravitational forces increase _____________to the lumbopelvic posture over time. | distortion
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| Common origin of scoliosis | SI
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| ____________could be due to SI misalignment, anatomically short leg, or an anomaly. The Logan Technique is often used. | Scoliosis
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| The SI is part of a ___-joint complex of the pelvis. | 3
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| What makes up the 3-joint complex of SI in pelvis? | 2 SI's, 1 symphysis pubis
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| The SI joint allows movement throughout the pelvis during gait and changes in posture. It most importantly absorbs | compressive forces
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| With the lumbopelvic region, the SI joints form a ___-joint complex. | 5
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| What makes the 5 joint complex of lumbopelvic and SI's? | 2 SI's, 2 posterior facets, 1 IVD
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| The 5-joint complex of lumbopelvic and SI's creates a __________link to the lower extremity and spine. | kinematic
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| Forces from above, __________affected first. Forces from below, __________affected first. | Sacrum (above), Ilium (below)
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| Forces from _________affect the sacrum first. Forces from _________affect the ilium first. | Above (sacrum), Below (ilium)
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| pain referred out from SI/femoroacetabular joint | sclerotoginous
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| Sacrum is a "______" in an arch | keystone
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| Sacrum provides additional support during weight-bearing due to __________ phenomenon. | locked-in (keystone)
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| SI's are true ____________joints. | synovial
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| The sacral facet is mostly ___________cartilage. | hyaline
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| Sacral joint surface covers S1-S3. There is an ________ and _________ joint of sacrum. | upper and lower
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| the Ilium facet is mostly _____________cartilage. | fibro
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| The SI joint is ________ (texture) at birth then _________ (texture) at 60+ yrs. and may fuse with adhesions. | smooth, roughens
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| Degree of orientation medial to lateral, A-P of SI joint (pubic symphysis is also at this angle of degree) | 30 degrees
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| 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
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| Anatomically, the lumbosacral joint complex is a ____ joint spinal motion segment. | 3
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| 3 joints of 3 joint spinal motion segment of lumbosacral plexus | disc and 2 facet joints
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| Cervical spine is divided into _________and _________cervical spine. | upper and lower
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| the smallest, most mobile spinal region with a 12 pound bowling ball on top | cervical
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| cervical posture is akin to _________posture | thoracic
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| gravitational forces increase __________over time in the cervical spine | distortions
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| where do upper body distortions commonly begin? | cervical spine
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| the cervical spine has significant _________ and vascular issues | neurological
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| 2 distinct regions of cervical spine | uppers, lowers
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| upper cervicals are segments __________ | Co-C1-C2 (OA and AA motion segments)
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| lower cervicals are segments __________ | C2-C3 to C7-T1
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| Lordosis sometimes extends to T?-T? | T2-T3
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| Do upper thoracics impact cervical function? | yes
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| The upper cervicals are the __________ from skull to the rest of the spine. | transition
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| What part of the spine is anatomically unique? | upper cervicals
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| 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
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| type of central joint of AA (atlantoaxial)? | trochoid
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| Occipito-Atlantal Motion Segment: what is the occipital joint surface feature - convex or concave? | convex
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| Superior joint surface of Atlas functions like hypermobile bony "__________" | meniscus
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| The Atlas superior joint allows mostly movement of | Flexion/extension
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| Occiput motion is almost all | flexion/extension
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| there is very little lateral flexion or rotation (5 degrees) in the | occiput
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| When we laterally flex our head, what happens to the occiput and atlas? | Occiput slides towards convexity and atlas slips towards concavity.
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| The inferior joint surface of the ________ vertebrae is roiund and convex, as is the superior surface. | Atlas
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| The motion of the atlas is mostly | rotation
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| The position of Occiput attachment sites create | suboccipital muscle tension HA!
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| Upper cervical deep muscular anatomy at suboccipital often displays MUSCULAR restrictions at what 2 joints? | OA,AA
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| Pay attention to slide on Occipito-Atlanto-Axial F/E - do the OA and AA function together or separately? | together
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| MYODURAL bridge | possible cause of CERVICOGENIC HEADACHES (also called vertebrogenic headache)
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| In OA-AA movement, the occiput glides posterior (___) and the atlas rotates (____) and glides posterior (____) | (-Z), (+thetaX), (-Z)
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| 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)
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| Most of OA's rotation is at the end of global | ROM
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| AA has huge __________! (motion) | rotation
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| the ____ is very active during the first 25 degrees of global cervical rotation, then spreads throughout. | AA
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| In Occipito-Atlanto-Axial Rotation, the __________side moves posteriorly, the __________ side moves anteriorly. | ipsilateral, contralateral
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| There are multiple attachments from occiput to (segments) _______. | C1 and C2
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| C1 and C2 segments function with each other especially during | F/E
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| Postural distortions or muscle contractions affect C1, C2 or both? | both
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| Deep ligaments of upper cervical segments __________ motions. | stabilize
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| Ligament which limits lateral flexion in cervicals | Alar
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| Ligaments which limit flexion and translation | Transverse
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| Atlantodental interspace relates to ___________space. | spinal cord
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| Upper cervical kinematics - occiput centers of rotation are called _______________-axex of rotation. | instantaneous
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| Each lower cervical vertebrae MOTION SEGMENT typically has ___ joints | 5
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| Each lower cervical vertebra has ____ joints. | 10
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| Joints of Luschka are also called | uncovertebral joints
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| the uncovertebral joints are from uncinate processes and are __________joints! | synovial (have synovial lining and membrane)
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| is there a capsule in uncovertebral joints? | no, but they ARE synovial joints
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| Uncovertebral joints (UN) guides __________ | motion
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| motion of uncovertebral joints | Lateral flexion with rotation
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| do uncovertebral joints degenerate? | yes
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| Degeneration of Uncovertebral joints can cause (due to "blunting") | root impingement!
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| The nerve lying on top of the uncovertebral joint lies in the | lateral recess
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| Blunting of UN joints "blunt" due to uncinate processes doing what? causing what? | hypertrophying and moving into the lateral recess, causing nerve impingement
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| Regional anatomy of cervical joint complex: there is a __________nucleus. | central
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| there is a _________disc to body ratio in cervical joints | large
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| why do we need a large disc to body ratio in cervical joint complexes? | increases mobility
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| facet angles of cervicals | 45 degrees (know this for test)
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| Lower cervicals have broad thick _____________ for weight bearing | articular pillars
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| Do cervical vertebrae have large or small IVF's? | large
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| What cervical vertebrae is most like thoracics? | C7
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| the large spinous process of C7 is called the | vertebra prominens
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| C& has a small anterior __________ | tubercle
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| Does C7 have an uncinate process? | no
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| the vertebral artery is or is not in the foramen of C7 | is not
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| 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
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| 4 structures important to the upper cervical complex: | Ligamentum nuchae, ligamentum flava, Posterior Atlanto-Occipital membrane, Vertebral ARtery
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| there is no vertebral artery at ___ | C7
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| 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
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| Changes in the cervical curve are common - possible changes? | degeneration, congenital (disc and facet shape), postural, traumatic
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| A reversed cervcial curve with hyperlordosis is not good and usually causes significant __________ | dyskinesia
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| A hypOlordotic curve in cervical spine causes | increased disc load, increased muscular effort as head translates forward
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| Lower cervical spine kinematics involve segments | C2-3 to C7-T1)
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| There is a decrease in lateral bending as you go ________ the cervical spine. | down
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| degrees of Flexion/Extension per lower cervical spine motion segment | 15 degrees
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| Greatest amount of flexion/extension cervical segments | C4-5 and C6-7
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| Ipsilateral flexion causes ipsilateral ________ in cervicals with spinous deviation away from side of flexion. | rotation
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| there is not a lot of lateral flexion at | lower cervicals
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