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Holtzman Tech IV

NYCC Holtzman final exam spring 2010 includes DeCicco lecture

Size and concentration of proteoglycans will decrease with age
The Ks/Cs ratio of proteoglycans will _________ with age (kertain sulfate and chondroitin sulfate). decrease
A decrease in Ks/Cs of proteoglycans with age results in decreased ability to bind to water and therefore leads to water attraction/hydration
The nucleus of a disc will ________ in collagen content and thickness with age increase!
The nucleus of a disc will ____________in collagen-proteoglycan binding and _________ in collagen-collagen binding. increase, increase
Because there is more collagen to proteoglycan binding, there is less binding to water. This means that over time, the nucleus pulposis will dehydrate
The annulus will ________ in collagen content, just like the nucleus pulposis, over the lifetime. increase
Unlike the nucleus, the amount of collagen thickness will ___________ over time in the annulus fibrosis. decrease
The annulus will also see a drop in _________ fibers over a lifetime elastic
The entire disc, (nucleus and annulus fibrosis), become more ________, less _________, fibrous, resilient
distinction between the annulus and nucleus pulposis over time becomes less and less
clinical effect of disc changes over time decreased mobility of the spine
Instead of the nucleus cushioning the weight, the greater share goes to the ___________ over time annulus
Increased stresses on the annulus leads to cracks and fissures
Do discs normally increase or decrease in height with age? Increase up to 10%
If the disc is actually increasing in height over time instead of shrinking, where is the height loss coming from? decrease in vertebral body height
What structure around the disc becomes weak over time due to decreasing permeability for nutrients to enter? vertebral end plate
What determines what tissues fail during a compressive load? Age of patient
a child 4-6 compressive load fail annulus but no crack
teen 15-17 compressive load fail vertebral endplate (resulting in Schmorl's nodes as an uncontrained disc lesion)
young adult 20-50 compressive load fail fusion, annular fibers bear weight, cracks develop in annular lamellae, dehydration, ANNULUS FIBROSIS DISC HERNIATION or disc lesion
contained disc herniation not totally extruded nuclear material
sequestered disc herniation piece of nucleus broken off
uncontained disc herniation totally extruded nucleus pulposis
why does bone density increase over time? the traebecular/spongy bone thickens but also loses mass
Why does the load-bearing capacity of vertebral body decrease with age? traebeculae has changed so cortical/lamellar around perimeter has to take on load
how do vertebral body endplates deform? the endplates bow in, giving the bodies a concave shape
when the VBE's bow in, what happens to the discs? become fish-body shape
how do the VBE's continue to change after bowing in? form osteophyte/spicules at the interface with the disc
The sclerosing of subchondral bone and the thickening of articular cartilage happens at the facet joint
When focal areas of erosion and thinning cartilage at the facet occur, what does it use as a filler? fibro-adipose tissue
where do osteophytes form at the facet joint along attachment sites of capsue and LF to the SAP (ligamentum flavum and Superior articular process)
If osteophytes affect the superior articular facets, what happens to the inferior articular facets? form wrap-around bumpers
why do wrap around bumpers occur at the inferior articular facet? irritation
what do wrap around bumpers provide for the inferior articular facet of the joint complex (the superior vertebrae)? protection against torsional loads
Posterior aspect of facet capsules in lumbar spine are actually part of the ligamentum flavum
Posterior facets in lumbar spine are part of the ligamentum flavum and therefore, have more motion. What does this quality allow pathologically? osteophytes only form on side of the SUPERIOR articular facet
facet tropism any level of asymmetry creating a biomechanically unstable spine
Superior articular processes always lie _________ of the inferior articular process outside
imbrucation facet jamming
osteophytes only form around the ___________ articular process and capsule superior
change in length of shape of protenaceous tissue held out of shape for a time creep
the energy change after creep hysteresis
the new shape of the joint after hysteresis set
what may become entrapped/extrapped in the joint capsule? meniscoid
movement wise, there is a progressive decrease in _____ ROM
what is the decrease in ROM of facet joints due to? increased stiffness in the discs (dehydration and fibrosis)
facets show a greater amt of creep and hysteresis but also greater set after deformation. Why? set because of decreased water-binding capabilities
why isn't osteoarthritis/DJD true arthritis? "itis" means inflammation and there is no inflammation assoc with osteoarthritis/ DJD
when DJD occurs to a disc and facet joint, what is it called? spondyloarthrosis
number one cause of disability in the US arthritis (all forms)
most common form of arthritis is osteo. Why is it not considered a true arthritis? "itis" means inflammation. No inflammation with DJD/osteoarthritis
DJD/osteoarthritis is characterized by breakdown of __________ cartilage at synovial joint surfaces, primarily in the weight bearing joints hyaline
in the spine, what joints sufferf from DJD/osteoarthritis loss of hyaline cartilage zygaphophyseal/facet joints
In DJD/osteoarthritis, at the __________ joints (non-synovial), the same sclerotic changes occur at the bony margins. interbody (non-synovial)
DJD leads to further decreases in water and water-binding ____________ proteoglycans
DJD/osteoarthritis leads to dehydration and decreased ability of disc to handle weight-bearing stress
DJD/osteoarthritis can lead to lumbar-canal spinal stenosis
what can lead to lumbar-canal spinal stenosis? DJD/osteoarthritis
what type of DJD/osteoarthritis is fairly common in older adults and slightly more common in males than females? spinal canal stenosis
Spinal canal stenosis can occur centrally or laterally: what happens laterally? Lateral RECESS stenosis - most common casued by arthritic changes to facet joints. Leg pain, flexing forward mitigates pain.
Uncontained disc lesions can _________ the spinal canal narrow
failed surgical back syndrome (post laminectomy) can cause anklosing spondylitis
The cause of DJD is primarily ___________ mechanical but rarely can be metabolic
Is DJD part of the normal aging process? no!
DJD is most commonly found in middle aged, but can be found in the young
Before age 55, what is the incidence of DJD between the sexes? After 55? even, higher in women after 55
How is DJD diagnosed? x-ray studies look for narrowing of joint spaces and sclerosing of joint margins, and osteophyte information
Big 3 seen on x-ray to diagnose DJD? narrowing, sclerosing, osteophytes
other tests done for DJD? blood tests by MD's but not for DJD - just to monitor effects of meds they give for DJD. Not a diagnostic tool.
Treatment of DJD via medical NSAID's, Cox-2, Steroids, Synthetic joint fluids, surgical replacement, Glucosamine and chondroitin sulfate
surgical treatment of DJD leads to dislocation, infection, sciatic nerve palsy, fracture of pelvis
__________- "It's what we do." Adjust
passive chiro mgmt for DJD adjust to preserve joint motion and correct biomechanics, Modalities like Manual resistance tech, ultrasound, heat/cold, Exercise and pilates, yoga, Weight loss, Nutrition (glucosamine and chondroitin -don't forget the water!), MSM
what IS degenerative joint disease? a disease process? NO, it is an ACTIVE process, not a disease process. It is an adaptive response to STRESS. A morphological change that progresses with the aging process, but not due to age itself.
DJD is not a disease process. It is an __________ process! An adaptive response to stress. Active
DJD can be the adaptive response to the stresses of: __________ or _____________ aberrations. trauma or biomechanical aberrations
Single most common source of DJD? soft tissue
Soft tissue is the single most common source of DJD
what kind of muscles tend to become hypotonic and weak? phasic (fast twitch) muscles
phasic muscles are fast twitch
fast twitch/phasic muscles become hypotonic and weak when __________ muscles become hypertonic and tight anti-gravity/postural muscles
What kind of muscles become hypertonic and tight in the face of gravity? postural/anti-gravity muscles
Degree of hypertonicity or hypotonicity varies between patients but rarely in distribution
increased hypertonicity causes further weakness in the antagonist Sherrington's Law of reciprocal inhibition
Sherrington's Law of Reciprocal Inhibitions states that increased _____________ causes further weakness in the ______________. hypertonicity, antagonist
Quadriceps and Hamstrings would be contenders for Sherrington's Law of Reciprocal Inhibition. Why? Quad threshold decreases and activity increases(postural, anti-gravity) so hamstring motion (antagonist) is shut out
which muscles should you treat first: postural or antagonist? short, tightened ones before you strengthen the weakened ones
Muscular imbalance causes joint ______ and dysfunctional ______ instability, motion
As the threshold of the hypertonic muscle decreases (from being "on" all the time), it's activity __________, shutting out the antagonist's motion altogether. increases
How are postural muscles activated? movement!
poor muscle balance in postural muscles increases activation
Muscles affected by _____lesions are the same muscles that display hypertonicity as a result of poor movement patterns and posture CNS
CNS- difference in control between ______ and _______ muscles phasic (short-twitch, hypotonic, weak), postural (slow-twitch, anti-gravity, hypertonic)
UMN lesions of the CNS affect the same muscles that would be affectex by poor __________patterns and __________. movement, posture
muscle that is a prime mover agonist
stabilizer muscle; allows extremity to return to normal position antagonist
help agonist with desired motion synergist
neutralize agonist motion to create smooth motion synergist
maintain body position to allow motion to occur stabilizers
pectorals lats
anterior deltoids posterior deltoids
traps deltoids
abdominals erectors
quadriceps hamstrings
gastrocs tibialis anterior
biceps triceps
forearm flexors extensors
with Isometric contraction, the stabilizers are/are not changing position? not
no movement takes place, load on the muscle exceeds the tension generated by the contracting muscle isometric (no movement/stabilizer/antagonist) contraction
tension generated by the contracting muscle exceeds the load on the muscle isotonic (prime mover/agonist) contraction
muscle shortens against opposing load concentric contraction is isotonic
muscle lengthens as it resists a load eccentric contraction is isotonic
viscolastic change due to prolonged shortening Long-term hypertonicity
Long-term hypertonicity is not _________ spasm
visco-elastic changes due to prolonged shortening long-term hypertonicity
Can a tight muscle be stretched to its orginal length? Why or why not? no, there is long term visco-elastic change called adaptive shortening
adaptive shortening joint with decreased ROM, permanently shortened muscle, DJD may result from lack of nutrition from lack of joint movement
muscle shortening may be painful upon palpation, does not allow the full joint ROM, and does not register any ________________. electrical activity during contraction
initially, this sort of muscle will be ok but after 20 years will lose the ability to contract. The muscle becomes weak as the result of constant shortening. tightness weakness
in a ________ muscle, the strength intensifies early on (mild to moderate tightness) but the muscle becomes weak as a result of constant shortening. tightness weakness
If tightness weakness occurs in the agonist muscle, what occurs in the antagonist muscle? stretch weakness - weakness from remaining in an elongated/stretched position
Stretching the shortened muscle (actively) will eventually lead to more muscle strength and reduced ? inhibition of the antagonist
sedentary lifestyle, chronic postural overload, bio-mechanically incorrect workstations, repetitive trauma are all causative factors in muscle tightness
what improves the length of the muscle and strength of the antagonist muscle? stretch
a hyper-irritable spot found within a taut band of skeletal muscle or its fascia which, when provocatively compressed, will give rise to characteristic referred pain, tenderness, and autonomic phenomena. Trigger point definition from Janet Travell
where can trigger points occur? Hypertonic muscles, Hypotonic muscles
R belly of soleus is an ipsilateral ______ trigger point SI
how can hypertonic muscle trigger points develop? painful joints (from sprain/strain), muscle spasm/guarding
In hyPOtonic muscles, how do trigger points develop? reciprocal inhibition (Sherrington's Law), trauma, limbic system hyperactivity (traps), overuse
Describe lower (distal) crossed syndrome anterior pelvic tilt, increased lumbar lordosis, large gut
Lower (Distal) Crossed syndrome big 3: anterior pelvic tilt, increased lumbar lordosis, large gut (basically sway-backed and fat)
what muscles are hypertonic in lower crossed/sway back and large gut syndrome: Psoas and Rectus Femoris due to anterior pelvic tilt so gluteus maximus inhibition. Lumbar erectors hypertonic due to fat so inhibition of rectus abdominis and increased lumbar lordosis.
Name the 3 hypertonic muscles of lower crossed syndrome: psoas, rectus femoris, erector spinae of lumbar
Name 2 inhibitors of lower crossed syndrome gluteus max, rectus abdominis
What joints bear the load in lower crossed syndrome? L4/5, L5/S1 facets
How to evaluate for lower crossed syndrome: hip extension with patient prone (excessive hip extension stress the lumbosacral jt.)
Describe upper (proximal) crossed syndrome: the computer syndrome: forward head carriage, upper cervical extension, lower cervical flexion, elevation and protraction of shoulders, winging of scaps
hypertonic muscles of upper crossed syndrome SCM, upper trap, levator, pecs, suboccipitals
what muscles are inhibited in upper crossed syndrome? deep cervical flexors, rhomboids, serratus anterior, lower and mid traps
affects stability, motion, fx of all joints of the shoulder girdle, thoracics, and the cervical spine upper crossed syndrome
what is necessary for normal joint fcn? normal muscle function
Hip extension optimal range 10-15 degrees of hip ex. is optimal for gait
what should happen during hip extension lumbar spine should engage for stability before any lower extremity movement
when patient is prone, external rotation of feet indicates: gluteus maximus
when patient is prone, INternal rotation of feet hanging off table indicates inhibition of gluteus max
Hip extension test Patient prone, observe feet, ask patient to lift leg 6" off table without bending knee.
If lumbar extension occurs with hip extension test, indicates: gluteals, abdominals or both are weak
If patient demonstrates lumbar extension of the spine during hip extension test, what joint is under duress? L5/S1
Trunk flexion test patient curls up, flexing head, then chest as if doing abdominal crunch
If hip flexion is observed during trunk flexion test, what is pathology? weak abdominals (ie, in order not engage iliopsoas and do your sit ups with it, you must not raise above the half-crunch level. This ensures rectus abdominis is doing the work)
tests for hip abductor stability Trendelenburg's test
what percentage of gait is on one leg? 85%
What is positive Trendelenburg's sign? if hip shifts anterior (pelvic tilt) and lateral or patient laterally flexes to side of standing leg, test is positive for gluteus medius and minimus weakness
when looking for imbalance, note whether or not the body deviates from the norm upon attempted normal motion
when assessing for aberrant motion, one observes whether or not the motion is carried out in the desired direction
If the movement is smooth and at a constant rate, what muscles are functioning properly? eccentric contraction of the antagonists
what kind of contraction guarantees a motion will be smooth and at a constant rate? eccentric contraction of the antagonists
movement follows the _________ path possible shortest
Direction of movement is determined primarily by ___________- and secondarily by _____________ antagonists, synergists
what muscles determine direction? antagonists, synergists
what muscles determine precision? neutralizers
strongest arc degree in nature 60 degrees (human pelvis, Roman arches, VW bug!)
what ligaments provide pelvic stabilization? posterior SI ligaments, sacrotuberous, sacrospinous
describe the posterior SI ligament sacrum to PSIS, runs laterally with sacrotuberous ligament, medially with thoracolumbar fascia
describe sacrotuberous ligament inferior lateral sacrum to isch tube, MOVES CAUDALLY WITH BICEPS FEMORIS
describe sacrospinous ligament inferior border of sacrum and superior aspect of coccyx to ischial spine
posterior movement of the sacral base is restricted by sacrotuberous and sacrospinous ligaments
Anterior movement of the sacral base is restricted by posterior sacrospinal ligaments
which ligament stabilizes L4,L5,S1 Iliolumbar ligament
do muscles surrounding the SI directly contribute to its motion? no
what may be affected by biomechanical changes or stresses in the muscles and vice versa? mechanical behavior of the muscles
impairment in form and force closure leads to gait problems
no external forces necessary for stability (mortise and tenin friction joint) form closure
added lateral compressive forces to reduce shear load force closure
what is at a 90degree orientation to SI joint and provides compression forces? Gluteus Maximus
what is required for SI stability? ligament and muscle stability
why does nutation cause stress on the ligaments of the SI? because most of them are posterior
loads most sacral ligaments nutation
which ligaments of the SI approximated posterior portions of the ilium and cause compression interosseous
ligament that contains excessive nutation sacrotuberous
ligament that restricts counter nutation long dorsal SACROILIAC
swing phase: muscles and fascia pulled caudally initial step
swing phase: ilium moves posterior and PSIS approximates the 2nd sacral tubercle later step
what happens once the first ilium moves posterior in swing phase and the PSIS approximates the 2nd sacral tubercle? the other ilium moves anterior and the PSIS rotates away from the 2nd sacral tubercle
in the swing phase, the sacrum nutates slightly on the side of the _________ ilium rotation posterior (initial)
why does the sacrum nutate on the posterior ilium side during swing phase? creates pelvic stability for heel strike
Flexion restriction of SI or Extension restriction of sacral base on one side makes __________ abnormal heel strike
what SI movements make heel strike irregular or pathological? flexion restriction of SI or extension restriction of sacral base
swing phase: loads sacrotuberous ligament, multifidus, erectors (sacral) hamstring activation
swing phase: contracts to maintain dorsiflexion tibialis anterior
coupled with peroneus longus (like a stirrup) to create a longitudinal sling and transfer energy between pelvis and lower extremity tibialis anterior
During heel strike, initially the _________ inverts and the tibialis anterior moves from _________ to _________ contraction. calcaneous, concentric, eccentric
during middle heel strike phase, the calcaneous is neutral, the tibia-talus bisect the ___________ at 90 degrees to the floor, and the ________ internally rotates. Achilles, tibia (along with femur) internally rotates
How is tibia internal rotation (along with femur) initiated during mid heel strike? via knee flexion (popliteus)
Tibia has medially rotated due to flexion of knee. What happens to fibula during mid heel strike? drops inferiorly and INCREASES tension on the SACROTUBEROUS ligament and HAMSTRINGS
dysfunction of the _____________ increase in tension on the sacrotuberous ligament and hams affects pelvic/spinal biomechanics fibula
Longitudinal muscle sling around talocrural jt: (3) tibialis anterior, fibularis longus, biceps femoris
what muscle extends the femur and rotates the sacrum towards the ilium of stance leg during mid heel strike? biceps femoris
which muscle contributes to early sacral nutation during mid heel strike? biceps femoris
what muscle, besides biceps femoris, will also pull the sacrum into nutation durin mid heel strike? multifidus
To complete the heel strike, the biceps femoris, multifidus and ___________ are added in. erectors
In the final heel strike, the talus engages into __________ flexion, adduction, and internal rotation. plantar
In the final heel strike, the talus engages into plantar flexion, ____________ , and internal rotation. adduction
In the final heel strike, the talus engages in plantar flexion, adduction, and ____________________________ internal rotation
the final heel strike is concurrent with full rear-foot pronation
which bone is the final heel strike dependent upon, if not the talus engaging in plantar flexion, adduction and internal rotation? the tibia!
why is full rear-foot pronation difficult? conVEX POST facet and concave others on calc
what is the final step of heel strike closed kinetic chain portion of single-support phase
continuous tension on latissimus dorsi will cause upper crossed syndrome
positive translation of the head along the ___-axis will occur as the shoulders move anteriorly z-axis (forward head carriage)
what happens when postural fault of anterior head carriage? shortened stride length, impairment in fx of cardiac and respiratory systems
Created by: hecutler