NYCC Holtzman Spring 3rd tri 2010
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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| Cartesian listing for C3,C4 Right rotation restriction | - theta Y
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| what creates counterpressure between 2 lumbar vertebrae? | nucleus pulposis
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| how do you find a mamillary process on lumbar | up to interspace between spinous processes, then over
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| most common area for abnormal congential defects | L5/S1
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| anterior elements of lumbar vertebrae (2) | body, pedicle
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| the articular process of a lumbar vertebrae has 2 processes - describe | inferior process with facet on lateral side and a superior process with facet on medial side
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| Mamillary process is at the posterior edge of the __________articular process, superior and medial to the ___________ process (on post TP). | superior, accessory
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| transitional segmentation examples in L5/S1 | L5 fuses to sacral base or S1 fuses to L5
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| spondyliolisthesis | anterior slippage of vertebra - stretching of annulus fibrosis - due to fractures (of pars inarticularis) that mostly occur by age 12
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| spondylosis | breakage of pars inarticularis
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| which lumbar segment has the largest nerve root inside the smallest foramen? | you guessed it! L5-S1
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| the lumbar vertebra is perfectly designed for | weight bearing
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| The only connection between the vertebral bodies and the posterior elements | pedicles
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| made up of laminae, articular processes, and spinous processes - they are connected to the vertebral bodies by the pedicles | posterior elements
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| an axial load with bending at the middle (collapse) for give and vertical support to take horizontal loads and horizontal support to take __________ loads = the internal structure of the vertebral body | vertical
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| what is the support inside the vertebra called? | vertebra SPONGIOSA (Sponge Bob)
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| functions of vertebra spongiosa (4) | load, permeability, strength, haemopoiesis
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| The vertebral body is ideally designed to sustain _____________applied loads, but is dependent on other structures (muscles, ligaments) for stability in the horizontal plane. | longitudinal
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| posterior elements of lumbar vertebrae (3) | laminae, articular processes, spinous processes
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| what forms the synovial joints which prevent forward sliding and twisting of bodies? | superior and inferior facets
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| Spinous, mamillary, and transverse processes are all attachments for _________. | muscles.
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| Laminae provide __________ distribution from spinous and articular processes. | FORCE distribution (laminae are like buttresses in a cathedral)
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| what operation destroys the force distribution provided by laminae against the spinous and articular processes? | laminectomy
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| describe location of pars interarticularis if you are standing behind the spine, looking at its dorsal/spinous view | at the base of both inward-facing superior facets, and just medial to accessory process, is the thinnest part of the superior arch of IVF
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| description from notes: runs obliquely from the lateral to upper border of the lamina - connects vertically oriented lamina to the horizontally oriented pedicle | pars interarticularis
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| what bony connection between the pedicle and posterior element (superior facet) must withstand bending forces and forces transmitted with directional change from lamina to pedicle | pars interarticularis
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| 2 parts of IVD | Nucleus pulposis, Anulus fibrosis
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| what gives the nucleus puloposis its ability to retain water, thereby giving the disc turgor and strength? | proteoglycans
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| Water, retained in the IVD by proteoglycans, gives the nucleus pulposis its ____________ and ______________. | turgor, strength
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| highly ordered collagen fibers that give the IVD its shape and provides counter pressure to the nucleus | Anulus fibrosis
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| why are most herniations posterio-lateral? | the Anulus fibrosis is only half as thick in the posterior and laterally, there are no ligaments
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| facets in the zygapophysial joints are ________ in shape | ovoid (egg-shaped)
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| what determines the resistance against forward displacement of the vertebrae? | the extent to which superior facets face backwards
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| what determines the resistance against rotary dislocation of the vertebrae? | the extent to which the superior facets face medially
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| What plane of movement/axis do lumbar zygopophysial joints favor? | flexion!
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| Zygapophysial joints allow for much flexion, some extension and lateral rotation, but not much | rotation;-( no twist and shout, only the funky chicken
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| The lumbar spine forms a lordotic curve due to the | SACRUM being tilted forward, because the lumbar spine rests on it
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| degree of lumbar curve when supine | 45 degrees
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| degree of lumbar curve when standing | 60 degrees (sacrum is at 30) - notes say 8 degrees more so actually 58 but later says "lumbar arc is perfect 60 degrees". Go with 60.
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| the shape of lumbar lordosis is achieved by many factors. Name the 3 basic ones | 1- wedge shape lumbosacral IVD, 2- L5 vertebral body is wedge shaped, 3- each lumbar is inclined slightly backwards in relation to the one below
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| describe the wedge-shape of lumbosacral intervertebral discs and explain why this is significant | 6-7 degrees smaller posteriorly, for lumbar lordosis
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| describe the wedge-shaped L5 vertebral body and explain why this is important | posterior body 3mm less in height than anterior body, for lumbar lordosis
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| describe the inclination of the lumbar vertebrae above L5 and explain the importantce | each lumbar above L5 is positioned slightly backwards in relation to the one below it, allows the lumbar lordotic curve
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| the lumbar arc is a perfect _____ degrees | 60
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| The X coordinate in coronal plane | trunk flexion and extension - rotation, lateral/side to side glide (translation)
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| The Y coordinate in transverse plane | rotation, compression/axial distraction (vertebra spongiosis is strongest in Y-axis!)
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| The Z coordinate in sagittal plane | lateral flexion - rotation, A-P and P-A glide/translation
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| plane that separates the body into anterior and posterior parts (front and back) | Coronal
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| plane that separates the body into right and left parts | Midsagittal
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| plane that separates the body into any plane parallel to the median plane | sagittal
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| plane that separates the body into superior and inferior (upper and lower) halves | transverse
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| when you laterally flex the cervicals, the body moves to same side and the spinous processes move to | opposite side
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| when you flex the lumbars, the spinous processes move | to same side as rotation (different from cervicals and thoracics that move to opposite side)
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| during RLF of L2, the spinous process would move? | to the right
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| which lumbar segment has the most degrees of one side lateral rotation? | L3-L4 (8 degrees)
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| which lumbar segment has the most degrees of combined flexion and extension? | L5-S1 (17 degrees)
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| In set-up of cervical spine, do you want close packed or not? | no closed packed (extension). Only adjust in flexion of cervicals
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| Gonstead subluxation-based technique on the ______being the foundation | sacrum
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| In Gonstead, the sacrum is the foundation and the _________ that begin lateral inclinations are subluxations. | vertebrae
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| Gonstead: foundation of subluxation is sacrum, vertebrae which have inclined laterally are subluxations. What are the compensations? | vertebrae that end inclinations
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| In Gonstead, the start is sacrum, then subluxation, then? | compensation
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| Unique to Gonstead, the adjustment is made within the | PLANE OF THE DISC
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| what is "plane of the disc" | the curvature of the spine which is the direction of the adjustment
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| what is the exception to Gonstead's adjust with the plane of the disc and why? | C1, because it has no vertebral body and therefore no plane of the disc
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| With the exception of C1, all vertebrae subluxate _________ (the most important part of the subluxation). Why? | posterior, because before a vertebrae can move it has to drop posteriorly and rotate L or R
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| what is the most important part of the subluxation, according to Gonstead? | the posterior movement of the vertebrae, because in order to move, a vertebrae must drop posteriorly and rotate L or R
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| what does Gonstead us instead of end feel of a motion unit to detect loss of ROM? | IROM - MP (Motion Palpation)
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| what are the parasympathetic divisions of the spinal cord? | C0-C5 and L5 down
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| What muscle attaches to lumbar discs and therefore can cause discogenic back pain? | Psoas!
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| two guilty muscles of lower back pain | QL and psoas!
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| Gonstead is no ____________ (spring-spring), only __________ (intervertebral ROM). | endfeel, POMP
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| Gonstead uses _______________ instead of endfeel. | intervertebral ROM (POMP)
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| if you want to stimulate the sympathetics, adjust the _________ | thoracics
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| if you want to stimulate the parasympathetics, adjust the __________________ | cervical and lumbar
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| Gonstead progression of subluxation: | fixation, misalignment, damage to disc, nerve interference
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| FMDdNi Gonstead | progression of sublux: Fixation - Misalignment - DiscDamage - Nerve interference
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| _____ is NOT used as an indication for adjustment in Gonstead | pain
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| how does Gonstead list the ilium? | on the side of L5 body rotation (ie, L5 is reflective of the ilium's position)
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| L5 body rotation is used to determine | ilium side of misalignment
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| In Gonstead, ___________moves are viewed as dangerous. | rotational
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| is there pre-load in Gonstead? | no - this is the technique that doesn't like endfeel/spring-spring; why would it like pre load?
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| fixation - misalignment - disc damage - nerve interference (Gonstead subluxation progression) is actually leading up to | ultimately improving spinal nerve root function
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| Why is pain more likely to be the hypermobile side? | inflammation!
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| What causes inflammation of hypermobile side? | too much movement
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| Restricted means | old & cold (decreased circulation and innervation)
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| Gonstead: List the ilium on the side of | L5 body rotation
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| Gonstead: If L5 spinous has rotated right (PR), then list the ilium side of | body rotation, ergo Left! because PR means L5 spinous is right but body rotated left, so ilium is AS or PI left.
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| Gonstead: if it is listed as a Right AS ilium, what does that tell us about L5? | L5 PL (spinous gone left)
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| Gonstead listing: what stands for the first letter of C2-L5 | P
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| Gonstead LIsting: "A" stands for | Atlas
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| Gonstead Listing: first letter is P stands for letter of C2-L5, second letter is L or R which stands for? | side of spinous process deviation/pointing
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| Gonstead listing: first letter P for C2-L5, second letter L/R for spinous direction, third letter S or I for | condition of disc on side of spinous rotation
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| S or I (superior or inferior) in Gonstead indicates the | condition of the disc on the side of spinous rotation, so if the side is open, it is "S" and if it's closed, it is "I"
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| Gonstead: "S" means | open wedge on side of spinous process rotation
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| Gonstead: "I" means | closed wedge on side of spinous process rotation
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| Gonstead: coordinate the x-ray line drawings with static and _____________, and postural analysis | motion palpation
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| Medicare listings indicate joint ________ | malposition (in what position is the joint fixed)
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| The ACA adopted the Medicare listings the year you graduated high school... | 1988
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| example of a Medicare listing | RR malposition
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| Medicare is similar to ____________listings, which list via body rotation, ie, RP for body posterior on right. | diversified
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| RP | body posterior on right (diversified)
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| Diversified uses ________ of vertebrae as reference for listing. | body, as in RP is same as PL or left rotation restriction
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| RP is diversified same as _____ Gonstead or __________ motion | PL (Gonstead) or LRR (motion) or RR malposition (Medicare)
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| PRI | Gonstead for spinous process to right and vertebral body has gone inferior. Same as RR restriction, LR malposition, same as LP (body gone left - diversified)
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| side that always points up | open side
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| side that always points up | S side
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| side that always points up | open S side
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| does Gonstead use endfeel? If not, then what? | no, use motion palpation
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| listing based on the 6degrees of motion the segement will NOT move into | Motion listing
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| L2- RRR | L2 Right Rotation Restriction motion listing because L2 will not rotate to right but is stuck in left position
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| RRR needs doc to induce | RR
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| Motion listing uses what system to describe restrictions | Cartesian coordinate sys (-/+ theta x,y,z or no theta but -/+ x,y,z for translation restrictions)
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| Cartesian coordinate system for Motion listings: describe +X, +Y, and +Z: | +X is to the left so vertebrae will not slide left horizontally, +Y is up so vertebrae will not move up vertically, +Z is forward so vertebrae will not slide forward P-A
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| Motion listing uses "restriction" and __________ coordinates | Cartesian
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| L2-3 RRR, -thetaY L2-3...list Gonstead, Medicare, and Diversified: | L2-3 RRR, -thetaY: (G) is PR, (Med) is Left Rotation Malposition, (Div) is LP as in body gone left but spinous gone right
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| how many vertebrae do static listings include? | 1 vertebral body
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| how many vertebrae do motion listings include? | 2 vertebral bodies, because you have to describe the upper in relation to the lower
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| diversified lists how many vertebrae in listing? | 1
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| only listing that includes 2 vertebrae | motion, describes upper in relation to lower movement
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| PRS | Gonstead: spinous gone right and superior so vertebrae stuck in left rotation malposition or RR restriction, or could be right lateral flexion restriction since S means tp is pointing up
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| opposite of PRS | PLS
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| Multidirectional restrictions like (examples): | PRS or PRI
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| PRS as a multidirectional restriction | Right rotation restriction (PR), Right lateral flexion restriction (S) so PRS
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| Give 4 listings for PL | RR malposition (medicare), LRR (motion), RP (diversified), +thetaY restriction (Cartesian) and PL is Gonstead spinous process gone left
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| Give 4 listings for LP | PR (Gonstead), LR malpositon (medicare), RR restriction (motion), -thetaY restriction (Cartesian) and LP is diversified body gone left
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| Medicare uses the word _________ | malposition
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| Gonstead approximates the | spinous process in relation to the transverse process distance to the one below it, as in spinous process gone right and transverse process on that side is up would be PRS
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| PRS | Gonstead for spinous gone right with t.p. up on that side so RLF restriction or LLF malposition with RR restriction or LR malposition or LP or +thetaY restriction, or LR misalignment (ACA/Vertebra placement)
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| LLF restriction is also | RLF malposition or -thetaZ restriction
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| LLF malposition is also | RLF restriction or +thetaZ restriction
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| RP with RLF misalignment | RP is diversified for body gone right so PL (Gonstead), LRR (motion), RR malposition (medicare), and +thetaY restriction (Cartesian) while RLF misalignment (ACA/vertebral body) is RLF malposition (Med) or LLF restriction (motion)
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| PLI | Gonstead for spinous gone left and inferior so RR malposition (med)or RR misalignment (ACA) or LR restriction (motion) or +thetaY restrictio (Cart) or RP (diversified) AND... LLF malposition or misalignment or RLF restriction (motion)
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| PRI | Gonstead is spinous gone right and tp gone down on right: LP (diverse), LR malposition (med), LR misalignment (ACA/vertebra), -thetaY restriction (Cart) and...RLF malposition or RLF misalignment or LLF restriction
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| is there a Gonstead listing for flexion/extension? | no
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| flexion of L1-L2 | flexion malposition (medic) or flexion misalignment (ACA) or extension restriction (motion) or -thetaX restriction (Cart)
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| extension of T4-T5 | +thetaX restriction (Cart) or flexion restriction (motion) or extension malposition (medic) or extension misalignment (ACA/vertebra)
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| Right translation | -X translation (the superior vertebra has moved to the right)
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| forward translation | +Z translation (the superior vertebra has moved anteriorly)
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| inferior translation | -Y translation (the superior vertebra has moved inferiorly)
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| what is the landmark for listing the SI joint? | PSIS
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| flexion restriction of SI | PSIS has moved anterior and superior so AS ilium or SI extension malposition or SI extension misalignment
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| PI ilium | extension restriction of SI, the PSIS has moved posterior and inferiorly so PI ilium or SI extension restriction or SI Flexion Malposition
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| AS means | ilium has gone anterior and superior so stuck in extension (ilium forward and up) or cannot flex SI joint
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| AS means the ilium is stuck in | extension
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| AS means the ilium is stuck in extension or has moved | forward as in Anterior and Superior (AS ilium)
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| internal rotation of PSIS looks like | PSIS has moved towards midline S2, shortening the distance between sacral crest @ S2 and PSIS
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| external rotation of PSIS looks like | PSIS has moved lateral, away from sacral crest midline @ S@and lengthening the distance between PSIS and midline @ S2
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| internal rotation static listing | IN
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| internal rotation motion listing | external rotation restriction
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| IN | external rotation restriction so want to gap the SI joint by loading superior hand on sacral base, inferior hypothenar/calcaneal on PSIS, step back and drop table/thrust M-L, P-A
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| step away from the patient! step away from the patient! step away from the patient! | for IN or internal rotation or external rotation restriction of SI, after setting drop and placing inf hand on PSIS while super hand on s. base, STEP AWAY FROM THE PATIENT and drop M-L, P-A
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| there are 4 ___________ theories of joint dysfunction | mechanical
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| __________ entrapment is a misnomer. It should be called ____________. | Meniscoid, eXtrapment!
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| a flap of fibro-adipose tissue within the synovium | meniscoid
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| the the facet/zygopophyseal joint flexes, the ___________ moves upward, taking meniscoid with it. | IAF (Inferior Articular Facet)
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| who is the culprit in facet meniscoid en(X)trapment? | IAF (Inferior Articular Facet)
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| what movement causes meniscoid extrapment? | flexion of facet joint
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| on attempted extension, the IAF returns toward normal position, but meniscoid impacts on edge of ____________________ and buckles. | articular cartilage {*notes say "IAP" instead of "IAF"}
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| Why does pain occur due to meniscoid entrapment? | upon flexion of facet then return to extension, meniscoid is pressed against edge of articular cartilage and pain occurs due to pressure outward & CAPSULAR TENSION. In theory, extension is then inhibited.
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| Pain occurs in meniscoid entrapment due to | capsular tension
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| What does a patient with meniscoid en(x)trapment exhibit posture-wise? | lateral or forward flexion antalgia
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| antaligia | a posture meant to keep the patient out of pain
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| what movement is inhibited during meniscoid entrapment pain? | extension
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| What encourages the re-entry of the meniscoid from its flexion-induced entrapment? | manipulation of the joint (GAPPING) to reduce the impaction and open the joint, encouraging the meniscoid of the facet to re-enter the joint space
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| Into what position must you never adjust? | close-packed (extension)
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| fragment of the disc has migrated into the nucleus and is compressed | intradiscal lesion/intradiscal block
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| another term for "intradiscal lesion" | intradiscal block
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| Intradiscal lesion presupposes (assumes) there will be degenerative changes in ___________ fibers of the IVD. | annular (http://www.chirogeek.com/000_Anular_Tear_1.htm)
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| Upon movement (e.g., flexion), a fragment of ________ material displaces along an incomplete radial fissure in the annulus | nuclear (describing intradiscal lesion)
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| nuclear material displaced along an incomplete radial fissure acts as an intradiscal ________-occupying lesion | space
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| on attempted extension, the disc fragment cannot re-enter the nucleus and is compressed. What am I? | an intradiscal lesion
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| An intradiscal lesion , when under compression, attempts to expand _______ and stretches the annulus, causing pain. | radially
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| intradiscal lesions are or are not reducible by manipulation? | we don't know
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| what part of the IVD is affected in the case of a Schmorl's node? | superior vertebral endplate
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| when the strong muscle gets shorter & stronger, the weak muscle gets stretched & weaker. This is called? | Muscle imbalance (another mechanical joint dysfunction cause)
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| facilitation of intrinsic spinal muscles, with reciprocal inhibition of their antagonists describes normal muscle balance. Abnormal muscle balance would be | strong muscle getting stronger and shorter while weak muscle gets weaker and longer
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| repetitive use, emotional stress, limited neurological coordination, chronic postural stress, physical trauma, exposure to cold, visceral disease...these are all causes of? (and are caused by attending a DC program up north) | muscle imbalance
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| emotional stress interferes with ____++ absorption and Mg++ overuse, which contributes to muscle spasm | Ca++
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| the micro_______ of lifestyle, occupation, posture (Creep, Hysteresis and Set), disuse atrophy, and inflammatory responses are all considered _________! | trauma, Trauma!
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| a change in LENGTH of a ligament or capsule when a continuous or sustained force is applied to it | creep
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| gradual rearrangement of collagen, proteoglycans, and water due to a change in LENGTH of a ligament or capsule | creep
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| effects vary with age and in response to injury or disease, due to a change in the LENGTH of ligament or capsule | creep
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| a change in the Length of a ligament or capsule that causes changes in the joint | creep
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| creepy length | a change in the length of a ligament or capsule due to continuous pressure that causes a myraid of changes in the nature of the joint
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| ADL | activities of daily living
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| ADL can cause | creep
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| ADL of various occupational groups, postural syndromes, lifestyle habits can all put continuous, sustained pressure on a ligament or capsule and cause _______. | Creep!
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| a change in behaviour after creep has occurred, reflecting loss of Energy due to prolonged stress | Hysteresis
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| causes permanent deformation wherein collagen a proteoglycan bonds are strained, along with water being squeezed out | Hysteresis
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| loss of turgor may be the result of | Hysteresis
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| change in BEHAVIOR after creep | Hysteresis (prolonged pain can make you hysterical)
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| length change = __________ while behavior change = __________ | length change = creep, behavior change = hysteresis
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| the difference between the original shape or length, and the final shape or length of a ligament or capsule | SET
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| collagen bonds are broken and after the change, the joint is more susceptible to injury | SET
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| over time, this stage of joint ligament or capsule change may experience some restoration and water reabsorption | SET
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| DIFFERENCE in original shape/length and final shape/length of a ligament or joint capsule | SET
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| what joints are involved in lumbar pain | T12-S1 and immediate surrounding areas
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| what is considered sacral pain | pain derived from the area around the sacrum
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| Low Back Pain can be either or both of what? | lumbar (T12-S1) or sacral pain
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| LBP can involve what two areas | lumbar (T12-S1) and/or sacral area
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| the pain source which arises due to stimulation of nerve endings in bone, muscle, ligaments, joints | SOMATIC (body)
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| somatic pain is due to stimulation of nerve endings in (4) | bone, muscle, ligaments, joints = SOMATIC pain
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| pain perceived in an area that is innervated by different nerves than the point of original pain | reFerred pain
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| referred pain is pain that is experienced where? | in a location other than the point of origin
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| what system uses referred pain as a map for treatment | Travell trigger point system
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| soleus trigger point causing ipsilateral SI pain caused by convergence in the CNS is an example of | referred pain
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| name the 3 types of pain | visceral referred, radiculopathy, radicular pain
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| neurological LOSS from spinal nerve root compression or ischemia; NUMBNESS or weakness | Loss and numbness = radiculopathy
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| where do you, the author, have radiculopathy? | C5-C6 to suprascapular for supraspinatus due to C5-C6 herniation
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| radiculopathy | Loss, numbness, weakness
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| IRRITATION to nerve roots | RadiculAR pain
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| radiculAR pain means | irritation
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| radiculopathy means | loss, numbness, weakness
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| radicular pain | irritation
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| can radicular pain be associated with radiculopathy | yes
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| normal nerve roots do/do not cause pain when compressed? | do NOT
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| what causes pain, compression or irritation? | irritation causes pain
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| irritation causes | pain (radicular pain)
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| characteristics of radicular pain | sharp, shooting pain following nerve pathway
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| what is the main cause of radicular pain | DISC HERNIATION
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| disc herniation is the main cause of | radicular pain (sharp, shooting pain along nerve pathway due to irritation of nerve root)
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| pain that is deep, poorly localized, diffuse | somatic pain (bone, muscle, ligament, joint)
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| main cause of radicular pain | disc herniation causes sharp, shooting pain along nerve pathway because nerve root is irritated as hell!
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| If condition is acute, it is ______ pain. | radicular (irritated)
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| ____________is loss, numbness, weakness. | radiculopathy
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| If it's old and cold, it's __________. | radiculopathy (loss, numbness, weakness)
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| somato-visceral pain | starts in musculoskeletal then refers to viscera. EX: subluxation of upper thoracics innervating viscera and thereby causing referred pain
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| viscero-somatic pain | organ to body EX: hear pain going down L arm in men or LBP in women
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| somato-somatic pain | body to body pain
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| viscero-visceral | organ to organ pain
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| psycho-visceral | mind to organ EX: stress to gastric ulcer
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| psycho-somatic | mind to body EX: stress to LBP
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| neurological pain connections include | visceral, somatic, psychological
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| Vertebral BODY structures can cause pain via | compression fractures or osteoporosis
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| Vertebral LAMINA structures can cause pain via | repeated extension injuries leading to periosteum irritation
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| where on the vertebra can the periosteum become irritated and why? | laminae because of repeated extension injuries
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| ____________fracture in pars interarticularis can cause scar tissue and free nerve endings to fill the space | Spondylosis
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| where would spondylosis fracture occur? | pars interarticularis
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| what kind of joint is highly innervated and can cause pain in the buttock and thigh? | Zygapophyseal joint
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| pain in a zygapophyseal joint will limit _________ on the opposite side. | opposite
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| opposite side rotation will be limited with what kind of joint pain? | zygapophyseal
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| capsular tears, adhesions, fracture and meniscoid entrapment are all considered lesions of the ______________ joint | zygapophyseal joint
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| what kind of injury to a disc causes pain? | Torsion injury
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| A torsion injury includes (2): | torsion + lateral shear = circumferential shear
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| what are the components of Circumferential shear? | Torsion + lateral shear
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| a torsion injury is worse when rotation is accompanied by ___________________. | lateral flexion
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| long term joint immobilization leads to restriction, cartilage degeneration, and atrophy of ligaments + capsules. What kind of pain is this? | disuse atrophy
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| casting, reactive muscle splinting, and postural imbalances are symptoms of | disuse atrophy
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| time onset of degeneration from disuse atrophy | within 48 hours of immobilization
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| frequent cause of disuse atrophy | casts
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| the biochemical changes which occur after sprains and strains | inflammation
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| can lead to adhesions, scar tissue and collagen-crosslinking | inflammation
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| limits mobility; reduces elasticity and strength | inflammation
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| can be due to acute or repetitive trauma; biochemical changes after sprain or strain that can lead to adhesions, scarring and collagen crosslinking. Limits mobility, reduces elasticity and strength. | inflammation!
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| IDD | Internal Disc Disruption
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| what has been accused of being one of the major causes of LBP? | the Disc (poor bastard)
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| Do IVDs fail when they are compressed? do they prolapse? | no. What kind of system for upright posture would that be? A bad one. So no, they do not fail or prolapse when compressed.
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| A normal nucleus is intrinsically ____________ and resists herniation. | cohesive
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| what is the FUNDAMENTAL CAUSE OF INTERNAL DISC DISRUPTION believed to be? | vertebral endplate fracture due to compression of disc
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| which is the culprit of IDD: intervertebral discs or vertebral endplates? | vertebral endplate fracture due to compression of disc
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| what could cause the vertebral endplate to fracture, although rare? | sudden fall, forceful muscle activity
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| can a vertebral endplate fracture heal? | yes, or it may trigger degredation of plate
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| Vertebral endplate fracture may ellicit an _________ response. | inflammatory
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| One theory for IDD is the development of an autoimmune response. What happens in this event? | the vertebral endplate fracture causes the proteins of the nucleus to be exposed to the circulation of the vertebral spongiosa, thereby causing an autoimmune response
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| Autoimmune or inflammatory responses are two possible outcomes of | vertebral endplate fracture (IDD)
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| regardless of the mechanism (vertebral endplate fracture or otherwise), the result of IDD is | progressive degradation of the nuclear matrix
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| what suffers progressive degradation after IDD? | nuclear matrix
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| degradation is not the same as _____________. | degeneration. (even though the dictionary says it is the same)
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|
||||
| how is degradation different from degeneration regarding IDD | degradation is a consequence of trauma, not aging degeneration
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| ____________changes the biomechanical support provided by the nucleus. | Degradation (due to trauma)
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|
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| Erosion of the _________along radial fissures may be the result of degradation due to trauma. | annulus
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|
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| During IDD, discs exhibit a progressive loss of the ability to absorb | water
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| Durin IDD, discs exhibit not only the inability to absorb water, but deterioration of ___________function. | nuclear
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|
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| During IDD, in time the annulus will buckle under the load and the disc loses ________ | height
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| what affect of IDD results in a compromise of function of all joints of the segment? | loss of height due to annulus buckling under load (dehydration makes brittle then crash)
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|
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| clinical features of IDD | constant, deep aching pain due to chemical nociception
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|
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| what can aggravate chemical nociception of IDD disc? | movement
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|
||||
| Neurological pain patterns are lacking because the lesion does not involve nerve root __________ or ______________ which have known pain patterns. | irritation or compression (radicular pain or radiculopathy)
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|
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