ATR 521 Exam 2 PDF

Ch. 14 - Cervical and Thoracic Spine and Thorax Clinical Anatomy - Cervical Spine ○ Weight of head ○ Smaller vertebrae ○ Transverse processes include foramen - passage of vertebral artery and vein ○ Facet joints ○ C1 atla...

Ch. 14 - Cervical and Thoracic Spine and Thorax Clinical Anatomy - Cervical Spine ○ Weight of head ○ Smaller vertebrae ○ Transverse processes include foramen - passage of vertebral artery and vein ○ Facet joints ○ C1 atlas, no body, supports skill, atlantooccipital joint (flexion & extension), long transverse process, no spinous process ○ C2 Axis, small body, dens (superior projection), atlantoaxial joint (rotation) C0-C1 and C1C2 Articulations ○ Synovial ○ Lack of substantial facet joint Create a lack of restraint against subluxations and dislocations Clinical Anatomy - Thoracic Spine ○ Bodies wider/thicker than cervical -weight management ○ Downward projection of spinous processes – muscular and ligament attachment ○ Costotransverese joints - articulation with ribs 1-10 (no attachment with ribs 11-12) ○ Costovertebral joints - rib and vertebral bodies Intervertebral Disks - Cervical and Thoracic ○ No disk at c0-c1 and c1-c2 Ligamentous Anatomy ○ anterior/posterior longitudinal ligaments Anterior - sacrum to c2, strengthens anterior portion Posterior - most dense in C-spine, reinforces post portion of disks, limits flexion ○ Ligamentous Nuchae Supraspinatus ligament becomes LN in C-Spine, limits cervical flexion ○ Interspinous ligaments Between spinous processes, limits, flexion and rotation ○ Ligamentum flavum Between lamina, limits flexion and rotation Neurological Anatomy ○ Brain stem exits through the foramen magnum to become spinal cored ○ 8 pairs of cervical nerve roots Anterior (ventral) root Posterior (dorsal) root ○ Converge and divide into 2 rami Posterior (dorsal) ramus Innervate facet joints, deep muscles of back, overlying skin Anterior (ventral) ramus Innervate remaining trunk and extremities Brachial Plexus ○ Innervates portion of shoulder, arm, hand ○ C5-T1 nerve roots ○ 5 segmental areas Roots Trunks Divisions  Cords Branches Thoracic Nerves ○ T1-T12 ○ Trunk & Thorax Thorax ○ Sternum Manubrium Body Xiphoid Process ○ Ribs True (1-7) - independent costal cartilage False (8-10) - conjoined cartilage Floating (11-12) - no anterior articulation Cervical rib - off C7 - anomaly, may lead to TOS General Functional Assessment - Pathology and MOI ○ Flexion Anterior compression of vertebral body and disk Ligament sprain Facet sprain Posterior muscular strain ○ Extension Ligament sprain Posterior compression of vertebral body and disk Compression of facet joints Fx of spinous process Anterior muscle strain ○ Lateral Bending - same side Nerve root compression Compression of vertebral body.disk Compression of facet joints ○ Lateral Bending - Opposite side Stretch of nerve roots Lateral ligament sprain Facet joint sprain Muscular strain ○ Rotation Disk trauma Ligament sprain Facet sprain/dislocation Vertebral dislocation ○ Axial Load Compression fx Disk compression ○ Whiplash Cervical instability Cervical muscular strain Facet joint dysfunction Ligament sprain Palpations ○ Hyoid bone  ○ Thyroid Cartilage ○ Cricoid Cartilage ○ Carotid Artery ○ Lymph nodes ○ SCM ○ Scalenes ○ Sternum ○ Ribs/Costal Cartilage ○ Occiput ○ Transverse process ○ Spinous process ○ Supraspinous ligament ○ Trapezius ○ Levator scapulae ○ Scapular muscles ○ Costovertebral junctions ○ Paravertebral muscles Joint/Muscle Function ○ AROM ○ Cervical flexion/extension ○ Cervical lateral flexion ○ Cervical rotation ○ MMT ○ Thoracic Motion Assessment Neurological Assessment ○ Myotomes and Dermatomes Special Tests ○ Babinski Test (p. 566) - upper motor neuron lesions Scrape the bottom of the foot from heal to big toe Toe extension = + ○ Oppenheim Test (p. 567) - upper motor neuron lesions Object is scraped along medial side of anterior tibia Great toe extension = + ○ Beevor Sign (p. 568) - thoracic nerve inhibition Have patient do sit up Watch where belly button goes ○ Cervical Compression Test (p. 570) - compression of facet joints Press down for an axial load on patients head ○ Spurling Test (p. 571) - nerve root impingement Patient in extension and lateral flexion Add axial load straight down ○ Cervical Distraction Test (p. 572) - compression of the cervical facet joints Patient lays supine examiner pulls head straight out ○ Vertebral Artery Test (p. 574) - occlusion of vertebral arteries ○ Shoulder Abduction Test (p. 575) - herniated disk or nerve root compression Patient is seated and abducts arm so that hand is resting on head Maintain position for 30s ○ Erb’s Point (p. 577) -  ○ Brachial Plexus Traction (p. 581) - brachial plexus injury ○ Adson’s Test (p. 584) - thoracic outlet syndrome We like adson Arm extends and externally rotates and head turns toward the arm ○ Allen Test (p. 585) - thoracic outlet syndrome ○ Military Brace Test (p. 586) - thoracic outlet syndrome ○ Roos Test (p. 587) - thoracic outlet syndrome ○ Rib Compression Test (p. 589 ) - Pathologies ○ Upper Motor Neuron Lesion damage to the upper motor neurons that transmit signals from the brain to the spinal cord. Causes can include stroke, multiple sclerosis, or spinal cord injury. Symptoms typically include muscle weakness, spasticity, increased reflexes, and loss of voluntary movement. ○ Whiplash/Cervical Sprain This injury usually occurs from a rapid back-and-forth movement of the neck, commonly from car accidents. It causes damage to the ligaments, muscles, and tendons in the cervical spine, leading to pain, stiffness, reduced range of motion, and headaches. ○ Stinger/Burner A stinger or burner is a common injury in contact sports, often caused by a sudden stretch or compression of the brachial plexus nerves. It results in a sharp, burning pain down one arm, along with numbness, tingling, and temporary weakness. ○ Thoracic Outlet Syndrome TOS is a group of disorders involving compression of nerves or blood vessels in the thoracic outlet, the space between the collarbone and first rib. Symptoms can include pain, numbness, and tingling in the neck, shoulder, arm, or hand. It often results from repetitive activity or poor posture. ○ Scheurmans Kyphosis This is a spinal disorder in which the vertebrae grow unevenly, causing an exaggerated forward curvature in the upper back. It is most common in adolescents and can cause back pain, stiffness, and reduced spinal flexibility. ○ Costocondral Separation/Injury This occurs when the cartilage connecting the ribs to the sternum (costochondral junction) separates or becomes damaged, often from trauma or sudden twisting. Symptoms include sharp chest pain, tenderness, and difficulty breathing deeply. ○ Tortocillis Torticollis is a condition where the neck muscles contract, causing the head to tilt to one side. It may result from muscle strain, injury, or congenital issues. Symptoms include limited neck mobility, pain, and visible tilting or twisting of the head. ○ Ruptured Spleen  A ruptured spleen usually results from blunt abdominal trauma, leading to bleeding within the abdominal cavity. Symptoms include sharp left-upper-abdominal pain, shoulder pain, dizziness, and potentially life-threatening blood loss. Immediate medical intervention is critical. ○ Pneumothorax This is a condition where air enters the space between the lung and chest wall, causing lung collapse. It can occur due to trauma, certain medical conditions, or spontaneously. Symptoms include sudden chest pain, shortness of breath, and sometimes a rapid heart rate. ○ Hemothorax Hemothorax is the accumulation of blood in the pleural cavity around the lungs, typically due to chest trauma. Symptoms include chest pain, difficulty breathing, and signs of shock if blood loss is severe. It requires prompt medical treatment to drain the blood. ○ Kidney Contusion This is a bruise to the kidney, usually caused by a direct blow to the back or flank. Symptoms can include flank pain, bruising, hematuria (blood in urine), and potentially nausea or vomiting. Mild cases may heal with rest, while severe cases may need more intensive care. ○ Commotio Cordis Commotio cordis is a rare but serious condition where a blow to the chest disrupts the heart’s rhythm, potentially leading to sudden cardiac arrest. It usually occurs in young athletes during sports with high-speed projectiles, and immediate CPR or defibrillation is essential. ○ Liver Contusion A liver contusion is a bruise on the liver, often resulting from blunt abdominal trauma. Symptoms may include right-upper-abdominal pain, tenderness, and nausea. Severe contusions can lead to internal bleeding, requiring close monitoring and possibly surgical intervention. The Shoulder and Upper Arm Bony Anatomy ○ Scapula Vertebral Border Inferior angle Superior angle Scapular spine Acromion process Coracoid process Glenoid fossa ○ Clavicle Proximal - convex Distal - concave ○ Humerus Humeral head Bicipital groove Greater tuberosity Lesser tuberosity Surgical neck ○ Sternum ○ Rib Cage  Angle of Inclination and Angle of Torsion ○ Angle of Inclination: Relationship between the shaft of the humerus and humeral head in the frontal plane (130-150 degrees) ○ Angle of Torsion: Relationship between the shaft of the humerus and the humeral head in the transverse plane (variable) Shoulder Joints ○ Sternoclavicular Synovial SC ligaments – A/P movement Costoclavicular ligament - axis Interclavicular ligament - resists downward movement ○ Glenohumeral Ball and socket Motions Flexion Extension Hyperextension Abduction Adduction Circumduction Lateral rotation Medial rotation Horizontal abduction Horizontal adduction scaption Unstable Glenoid labrum Coracohumeral ligaments Glenohumeral ligaments Superior, middle, inferior ○ Acromioclavicular Synovial - gliding AC ligament Coracoclavicular ligaments Trapezoid Conoid ○ Scapulothoracic Not a true joint protraction/retraction elevation/depression upward/downward rotation Anatomy of the Subacromial Space ○ Long head of the biceps tendon ○ Supraspinatus tendon ○ Subacromial bursa Motions ○ Extension Posterior deltoid Teres major Triceps brachii Latissimus dorsi ○ Flexion Anterior deltoid Coracobrachialis Biceps brachii ○ Abduction Biceps brachii Middle deltoid Supraspinatus ○ Adduction Latissimus dorsi Coracobrachialis Pectoralis major Teres major Triceps brachii ○ Internal Rotation Anterior deltoid Lattisiums dorsi Pectoralis major Subscapularis Teres major ○ External Rotation Posterior deltoid Infraspinatus Teres minor ○ Horizontal Flexion/Adduction Pectoralis major Anterior deltoid ○ Horizontal Extension Posterior deltoid Infraspintous Teres minor ○ Scaption Supraspinatus Biceps brachii Anterior deltoid ○ Protraction Serratus Anterior ○ Retraction Rhomboid Major/Minor Middle Trapezius ○ Elevation Levator scapulae Rhomboid major/minor Serratus anterior Upper trapezius ○ Depression Lower trapezius Pectoralis major Serratus anterior ○ Upward Rotation Serratus anterior  Upper trapezius ○ Downward Rotation Levator scapulae Rhomboid major Rotator Cuff ○ S - Supraspinatus ○ I - Infraspinatus ○ T - Teres minor ○ S - Subscapularis ○ Stabilizer of the humeral head Special Tests ○ Apely Scratch Test - rotator cuff/ROM limitations ○ Apprehension Test - GH subluxation/dislocation Supine ER rotation of the shoulder ○ Relocation Test - labrum tear, anterior subluxation/dislocation Press down on shoulder during apprehension test and release to let it “bounce” back ○ Sulcus Sign - inferior instability of the GH joint Pull down on the arm ○ Jerk Test - posteroinferior instability ○ Yergason Test - subluxing biceps tendon, biceps tendinopathy Your out ○ Speeds Test - biceps tendinitis Palms up and arm extended Place downward resistance ○ Empty Can Test - supraspinatus injury/weakness ○ Clunk Test - glenoid labrum tear ○ O’Brien Test - SLAP lesion Arm extended and externally rotated with downward pressure ○ Brachial Plexus Stretch Test - brachial plexus injury Lateral flexion with pressure ○ Neer Impingement Test - impingement syndrome Passive forward flexion ○ Crossover Impingement Test - AC joint pathology, rotator cuff pathology ○ Hawkins-Kennedy Test - impingement Internal rotation with the elbow flexed at 90 ○ Drop Arm Test - rotator cuff pathology ○ Adson Test - thoracic outlet syndrome ○ Allen Test - thoracic outlet syndrome ○ Posterior Apprehension Test - posterior subluxation/dislocation of the GH ○ Faegin’s Test - inferior GH instability ○ Piano Key Sign - AC sprain ○ Sternoclavicular Joint Stress - SC joint sprain ○ AC Joint Compression - AC joint sprain ○ Pec Contracture