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KIN 446 EXAM 1
Terms in this set (46)
Define transverse process
laterally projecting processes provides attachment sites for ligaments and muscles
Define spinous processes
prominent posterior process provides attachment sites for ligaments and muscles
Define neural arch
forms the posterior element of the spinal canal serves as a protective tunnel for the spinal cord
Define facet joints
are articulating joints at the back of the spine on each side. The are encapsulated and have cartilage linning, allow gliding movements (flex, ext and rotation).
Define pars interarticularis
between the upper and lower facets, a prime site of fracture.
Name the different ligaments. What are they?
-Anterior and posterior longitudinal
What is the supraspinous ligament?
attaches the tips of the spinous processes from the 7th cervical vertebrae down. Above C& these ligaments are called ligamentum nuchae.
What does the ligamentum flavum do?
connect the lamina (white stuff between pics) of various vertebrae and reinforce the facet joints.
What are the interspinous ligaments?
fill the spaces between the spinous processes and limit flexion and rotation
What are the levels in the lumbar plexus?
T12-L5 and L2-L4
What does T12-L5 do?
Innervates anterior and medial muscles of the thigh, medial leg, and foot
What does L2-L4 do?
-Posterior branches form the femoral nerve
-Anterior branches form the obturator nerve
What does the sacral plexus do?
-Innervates buttocks, posterior femur muscles, and the entire lower leg
-sciatic nerve (L4-S3)
What are the nerve levels of the sciatic nerve?
Define extrinsic muscles
(Rectus abdominis, External Obliques, Latissimus Dorsi, Middle and lower Trapezius, Romboids major and minor)
Trunk movements and movements associated with the scapulohumeral complex
Define intrinsic muscles
(Iliocostalis Lumborum and Thoracis, Longissimuss Thoracis, Spinalis Thoracis, Semispinalis Thoracis, Multifius, Rotators, Transverse abdominis)
Close to the spinal cord and directly influence its motion
Intrinsic muscles help stabilize the spine while the extrinsic muscles are performing activities. Basis for lumbar stabilization exercises.
What are intervertebral disk lesions?
-Loss of water, decreased protein, and altering of chemical structure
-Disk herniation — extrusion of the nucleus pulposus through the annulus fibrosus
-can lead to spinal stensosis (nerve impingement)
What are the signs/symptoms of spinal stenosis?
-Pain during walking prolonged standing
What is spinal stenosis?
-Narrowing of the spinal canal or intervertebral foramen
-Common in ≥50 year olds
-Typical Degenerative Process with aging (Wear & Tear on the body; arthritis, degenerative disc disease)
What do joint play tests assess for? What is it caused by?
-Facet joint pathology (joints get stuck or degenerate)
-Spondylitic defects (Mini fractures or congenital weaknesses)
What is sacroiliac (joint) dysfunction? Signs/symptoms?
-Ilium rotates and subluxates on the sacrum
-Mobility at SI joint is 2 mm or less
-Injury or degeneration of pubic symphysis
-Tight hamstrings (posterior tilt)
-Tight hip flexors (anterior tilt)
-pain over SI joint
-compression or distraction of pelvis duplicated symptoms
What are spondylopathies?
-Defect in the pars interarticularis
"Collared Scotty dog."
-Localized low back pain restricts extension
What is spondylolisthesis?
-Can be a progression of spondylolysis.
-Separation of vertebra
-"Decapitated Scotty dog"
flaccidity of the muscles
What does an upper and lower quarter screen look at?
-deep tendon reflexes
When inspecting a client's thoracic and lumbar spine, what do you look at, in general?
-observation of gait
-general movement and posture
-general inspection- S or C curvature
When inspecting the thoracic spine, what do you look at?
-bilateral comparison of skin folds
-shape of the chest
When inspecting the lumbar spine, what do you look at?
-paraspinal muscle tone
What wall can collapse and cause kyphosis due to severe osteoporosis of the spine?
When palpating the lumbar spine, what do you feel for?
When palpating the sacrum and pelvis, what do you feel for?
-median sacral crests
-Posterior superior iliac spine (PSIS)
-Ischial tuberosity ?
-Sciatic nerve ?
-Pubic symphysis ?
Explain what happens in the Hoover Malingering Test
Ask patient to raise involved leg. If uninvolved leg does not push down in the other hand the test is positive for malingering.
Explain the following spinal landmarks:
T2 - Posterior from the jugular notch of the sternum
T3 - Even with the medial border of the scapular spine
T7 - Even with the inferior angle of the scapula
L3 - In normal body posterior to umbilicus
L4 - Level with iliac crests
L5 - Typically demarcated by dimples
S2 - Level of posterior superior iliac spine
Explain what happens in the Adam's Test for Scoliosis
Therapist observes back for scoliosis while standing. Often there is a raised soft tissue area or hump on one side which is much clearer to see when the person bends forward. When the therapist asks the patient to bend over at waist and the muscular hump remains on one side the test is positive for structural scoliosis. If the hump does not appear or disappears and scoliosis seems to go away the test is positive for functional scoliosis.
Explain what happens in the Test for Thoracic Nerve Problems "Beevor's Sign"
-Place patient is hook-lying position.
-Patient performs partial sit-up.
-If umbilicus moves in any particular direction the test is positive for possible nerve root condition T5-T12 which innervates abdominal muscles. If the umbilicus does not move in any direction the test is negative as all muscles are working.
Explain what happens in the test for Joint mobility- the Spring Test
The therapist gently presses downward on the spinous processes. There should be a slight spring action. If the process nearly disappears this is hypermobility and if there is no movement, this is hypomobility of the spine. Positive test either way. If there is slight spring the test is negative.
List the special tests for general nerve root impingement
-Straight leg raise test
-Well or cross straight leg raise
Explain what happens in the SLR test
The patient is in supine. The therapist gently raises the leg straight into the air. If patient complains of pain before 70 degrees the test is positive for possible sciatic nerve irritation. Pain may be in low back and buttocks radiating down the posterior of the leg. If pain begins before 30 degrees the test is highly positive. NO complaints of symptoms means a negative test.
Explain what happens in the Slump Test
Place the patient sitting at the end of the table. Patient Flexes thoracic spine and shoulders forward, then flex neck, then extend knee, then dorsiflex the ankle. If pain begins, have the patient relieve the last movement (i.e. slightly relieve the knee extension and neck flexion) then have the patient extend the knee again to see if pain returns without the neck flexed. Pain at anytime during this test makes it a positive test for either sciatic nerve or other spinal root irritation or irritation of the dural lining of the spinal cord.
Explain what happens in the Quadrant Test
Place the patient in either a standing or sitting position. If older patient or suspect balance problems sitting would be better. Have the patient extend the spine then side bend and rotate toward the involved side. Therapist applies pressure downward on the shoulders. If patient complains of pain (especially radiating pain) on involved side the test is positive for nerve root compression on that side. Non-radicular pain may indicate facet joint problems. Less likely but could indicate SI problem if pain over the PSIS area.
Explain what happens in the Femoral Nerve Test
Place the patient in a prone position. The therapist passively flexes the knee then passively extends the hip while stabilizing the body just above the hip. Complaints of pain in the anterolateral thigh is a positive test for femoral nerve irritation (L2,3,4).
Explain what happens in the Sacroiliac Compression and Distraction Test
-Place patient on the side with the painful side upward. Place hands over ASIS and press downward. Pain in the SI area is a positive test for SI pathology.
-Place patient supine. Place hands over each ASIS and press downward. Pain in the SI region is a positive sign for SI pathology.
Explain what happens in the Fabere Test
Place the patient in a supine position with the involved leg crossing over the other (flexed, abducted, externally rotated and extended). Place one hand on the knee and the other over the opposite ASIS. Press down on both simultaneously. If complaints of pain result the test is positive for SI joint or hip joint pathology.
What happens when there are pathologies in the thoracic spine?
-Can affect respiration
-Pathologies can refer pain to the thoracic spine
--Cancer, gall bladder, and gastroesophageal conditions
List the % for the following levels of mobility independence testing:
Independent (needs no help or assistive devices)
Modified Independent (assistive device only)
Supervision (cueing, set-up and coaxing)
Stand-by Assist (needs a helper to stand by close)
Minimal Assist (patient does 75% or more)
Moderate Assist (patient does 50% - 74%)
Maximal assist (patient does 25% -49%)
Total Assist (patient does less that 25%)
What happens when there are pathologies in the lumbar spine?
Pathologies that can be
mistaken as low back
pain can be kidney
infection, CA or other
located just above the
pelvis and lateral to the
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