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89 Cards in this Set
- Front
- Back
what is the first landmark that is palpable in the cervical spine
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the spinous process of C2
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what is unique about the spinous processes of the cervical spine
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C3-7 are bifid and C7 is the most prominent
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what direction do the sp of the spinous processes face
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horizontal in upper cervical area and become more angles as you go down into the thoracic spine
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what is the direction of the facets?
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oriented at 45 degree angle "gutter like"
Superior: face up and back inferior: face down and forward |
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what is the function of the uncovertebral joint
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support the disc and guide motion
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describe the path of the spinal nerve as it exits the cord
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motor and sensory roots course close to the uncovertebral joint and the facet joint
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where do the cervical nerve roots exit the spinal cord in relation to the vertebra
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cervical nerve roots exit above the vertebra of the same number
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what is the direction of the cervical nerve root exiting the sc, what does this tell us
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directly horizontal so for example C4 can only be impinged by C3-C4 disc
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what are the two possible effects of the structures bordering the spinal canal
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1) protect the spinal cord
2) may also cause impingement of the spinal cord |
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what are hte anterior structures bordering the spinal canal
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posterior portion of the vertebral body and the disc and PLL
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what ar ehte lateral structures bordering the spinal canal
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pedicls and capsule of facet joints
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what are the posterior structures bordering the spinal canal
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lamina and ligamentum flavum
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what are the anterior structures bordering the foraminal opening
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posterolateral margin of the vertebral body and the disc
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what are the posterior structures bordering the foraminal opening
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inferior and superior articular processes
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what are the superior/inferior structures bordering the foraminal opening
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pedicles
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what is the arthrology of the occiput on the atlas
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Convex occiput on Concave atlas with NO INTERVERTEBRAL DISC
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where does C1 nerve root exit
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between the occiput and the atlas
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the OA joint is also called the "what" joint
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"YES" joint
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in flexion what happens to the occiput
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forward tilt and backward glide increaseing the distance between the occiput and the posterior arch of C1
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in extension what happens to the occiput
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backward tilt and forward glide decreaseing the distance between the occiput and the posterior arch of C1
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there is 2x more ____ than _____ at the OA
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2x more extension than flexion
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what is the normal distance between occiput and spinous process of C1
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3-5 mm
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If there is a fx in the dens, what would be demonstrated in th emotion of the cervical spine
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C2 will show no rotatino, but the dens will move
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explain the role of the alar ligament
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when you sidebend to the right, the occipital condyles move to the left causing tension in the alar ligament (on the left) which will cause ipsilateral rotation of the axis (C2 sp moving in the opposite direction of the sidebending)
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where does the alar ligament lie
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from the posterolateral surface of the odontoid process to the occiput
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the OA has how much motion of
flexion extension sidebending rotation |
Flexion: 5 degrees
Extension: 10 degrees Sidebending: 3-5 degrees each side Rotation: <2 degrees each side |
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the atlant axial joint is the "what joint"
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"NO joint"
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what are the surfaces of the AA joint
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convex atlas on convex axis
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where does more than half of the cervical rotation come from
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AA joint
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in which joint of the cervical spine is there a true synovial joint
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between the atlas and the odontoid process
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explain the motions that occur at C2-T4 during flexion
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Vbody tilts forward, superior facets move forward and up, nucleus, intervertebral foramen increases, increased volume of the spinal canal
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explain the motions tha toccur at C2-T4 during flexion
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Vbody tilts backward, superior facets move down and back, nucleus pushed anteriorly, sc bunches up, intervertebral foraminal space reduced
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where does the transverse ligament lie
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forms a ring around the odontoid process with the anterior arch of the atlas
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where does the alar ligament lie
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occiput to the posterolateral surface of the odontoid process
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where do the cruciate lig. lie
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form cross to protect the spinal canal, posterior wall to the dens,
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where does the apical ligament lie
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from the tip of the odontoid process to the occiput, prevents distraction
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O and I of SCM
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mastoid process of the occiput to sternum and medial 1/3 of the clavicle
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what motion occurs with unilateral contraction of the SCM compared to bilateral contraction
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Unilateral: contralateral rotation, ipsilateral sidebending, extension of upper cervical spine
Bilateral: forward head position, extension of upper cervical spine and flexion of the lower cervical spine |
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O and I of the scalenes
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from the transverse process of cervical vertebra 2-7 to the medial portion of the first and second ribs
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what motion occurs with unilateral contraction of the scalenes compared to bilateral contraction
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unilateral: ipsilateral sidebending, some (minimal) role in rotation
bilateral: forward head position, extension of upper cervical and flexion of lower cervical |
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how would you best stretch the scalenes
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contralateral side bending and rotation (either contra or ipsi) while in slight flexion of upper cervical
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what role do the suboccipital muscles play
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responsible for upper cervical extension, sidebending, and rotation also fine tuning of htre head position
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O and I of the upper trap
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occiput to the lateral 1/3 of clavicle and acromion
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what motion occurs with unlateral contraction of the upper trap compared to bilateral contraction
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unilateral: ilsilateral SB, contralateral rotation, extension of the upper c spine
bilateral: forward head and upper cervical extension |
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o and i of the levator scap
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tprocess of first 4 cervical vertebra to superior angle of the scap
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what motion occurs with unilateral contraction of the upper trap compared to bilateral contraction
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unilateral: ipsilateral sidebending and rotation of the c spine and upper cervical spine
Bilateral: forward head and upper cervical extension |
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what si the combined actino of the post. cervical musculature
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to produce upper cervical extension
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why does a forward head posture occur
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to maintain a horizontal line of vision so the lower cspine flexes
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what nerve innervates the facet joints
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the medial branch of the posterior primary rami on its own level and the level below
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what innervates the intervertebral discs
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the recurrent nerve on its own leveel and trhe level above (c and T spine) or on its own level and the level below (L spine
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what is the alternative approach we take when treating the spine
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a problem-oriented approach vs. a diagnosis oriented approach
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what is the most common cause and source of neck pain
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muscle disorders
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what are the causes for muscle dysfunction
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1) trauma
2) postural/working habits 3) tension/stress 4) tightness/weakness 5) muscle imbalance |
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what are common complaints with muscle dysfunction
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1) headaches
2) radiating (reffered pain) |
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what are the general intervention approaches for muscle dysfunction
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1) stretching/improving ROM
2) strengthening 3) postural reeducation 4) relaxation 5) addressing poor work habits/conditions |
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what is a trigger point
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area of hypersensitivity of a muscle when palpated, provokes local tenderness with referred pain to a distant region
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what are the possible reasons for trigger points
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1) acute, sustained and/or
repetitive tauma 2) chronic shortening 3) irritation of the related nerve root |
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what are tender points
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area of tenderness without referred pain
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what ar the 3 types of muscle disorders
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1) muscle spasm, guarding
2) muscle strain 3) myositis |
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what is muscle spasm
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increased tone in response to trauma, or a secondary response to an acute injury
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S and S of muscle spasm
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tenderness to muslce palpation, increased muscle tone
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what is the process that could cause muscle guarding over time to become chronic
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1) circulatory stasis
2) retention of metabolites 3) pain |
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what is a muscle strain
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muscle injury (tear) usually due to trauma
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what are the S and S of a muscle strain
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hx of trauma or significant muscular effort, pain upon palpaition of injured muscle. Rest decreases pain. Activities/movements increase the pain. Stiffness after resting for a period of time.
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what is important about using a cervical collar
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you should avoid using the cervical collar continuously for several days/weeks wihtout patient doing ROM--- UNLESS fx damage is suspected
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what is the process by which to remove a cervical collar
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progressively starting with 15 min. 2-3x/day
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what is myositis
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inflammation of the muscle due to chronic microtrauma or repetive stress
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what are the S and S of myositis
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tenderness with palpation. rest decreases the pain. activities movmeents increase the pain. stifness after rest. feeling of loosening up with light activities. pain not as localized to a specific muscle compatred with muscle strain
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what is the most important aspect of intervention for myositis
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to identify and corrrect the cause of repetitive trauma
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what are the 3 types of joiunt dysfunction
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1) facet joint sprain
2) joint inflammation 3) facet impingement (joint locking) |
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what is a facet joint sprain
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sprain of capsule of the post. joint and surrounding ligaments from sudden movement/trauma
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what is the only muscle that does both Side bending and rotation to the ipsilateral side
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levator scapulae
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your patient is "stuck" with neck in L sidebending, rotated to the right and extension of upper cervical vertebrae, what muscles are/couldbe involved
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L scm, L scalenes. L sub occip muscles, L upper trap
COULD NOT be any of these to the R nor could it be R or L levator scap! |
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what are the S and S of facet joint sprain
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hx of mod=severe trauma. rest relieves the pain. Pin with movement, espiecally at the end of range. no marked restrictoin of movement. Pain to palpation of joint structrures
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what is joint inflammation
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irritatino of the posterior articulra structures
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what are the causes for joint inflammation
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chronic loading of the joint, secondary to poor posture and/or poor working havit
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what are the S and S of joint inflammation
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movement increases pain (especially loading to the post. joints), likely slight/moderate restriction of motion. tenderness with palpation of joitn structure. pain my astill be present at rest but will be reduced. typically better in the AM
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what is facet impingement
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sudden locking of the posteir joint due to the capsule of the post. joint getting impinged between the articular facets caused by sudden movements, with backward bending, sidebending and/or rotation
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what is the most common discogenic problem
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degeneration (spondy) NOT disc prolapse!
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when do you not do joint mobs for joint dysfunction
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with a facet jopint sprain! they need time to heal
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when are joint mobs effective for joint dysfunction
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joint inflammation and facet impingement
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what is spondylosis
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degeneratoin of the intervertebral disc and related articular structures
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where isthe most common site for a spondy
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C5/C6 and C6/C7
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what are the causes of a spondy
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repetitive trauma and postural stress (shear forces from hypermobile, lack of nutrition from hypomobile)
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what is the process of degeneration
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1) decreased dis height
2) develop osteophyte along uncovertebral process from increased WB and pull on capsule 3) hypermobility 4) outward bulging places stress on ALL and PLL 5) ALL and PLL produce traction spurs on epiphyseal rim 6) traction on longitudinal ligament --> increased mobility of the segment 6) osteophytes on posterior facets and thickening of subchondral bone from increased WB 7) narrowing of intervertebral foramen from the osteophytes--- nerve root irriation |
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what are the key S and S for disc degeneration
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1) hx of joint pain and/or stiffness
2) positive signs on radiographs 3) local and referred pain from nerve root irritation 4) crepitus with movement 5) if irritation present, palpation or stress on the spinal segment will cause pain |
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what movements do you want to avoid with dis degerneration
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cervical spine extension
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degenerative process may cause partial occlusion of the vertebral canal due to
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1) retrolisthesis of the vertebra
2) osteophytes of the vertebral rim posteroirly 3) posterior bulding of PLL 4) anterior bulding of ligamentum flavum |
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why are cervical disc herniations not as common in cervical as in the lumbar
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1) pll covers entire post. aspect of disc
2) less weight to support 3) after 30, uncovertebral joints are weight bearing 4) nucleus is centrally located within the disc 5) uncovertebral joints provide lateral restraint |