1. Back Forum 2011 Answers

2. Describe all you can about this Radiograph: X-ray Orientation? Oblique Region? Lumbar vertebrae Level? L5 Pertient anatomy? Dog’s nose: Transverse process Dog’s ear: Superior articular process Front paw: Inferrior articular process Back leg: Spinous process Neck: Pars interarticularis Costal process

3. Diagnosis? Spondylosis (any defect or unilateral fracture of the pars interarticularis) This causes the vertebrae to slip anteriorly upon its inferior counterpart and compress the vertebral canal. Anatomy involved? Lumbar vertebrae Superior and inferior articular facets Zygapophysial joint

4. Diagnosis? Spinal stenosis Confirmatory findings on physical exam? Upper back, neck and bilateral upper extremity pain Items indicated and other pertinent anatomy? Left arrow = Posterior tubercle of atlas Right arrow = Red star = dens Blue star = semispinalis capitis m.

5. Diagnosis? Disc protrusion of the L4-L5 intervertebral disc Findings on physical exam? Lower back pain Lateral proximal leg pain/compromised motion Medial lower leg pain/compromised motion Identify items indicated and Other pertinent anatomy Right arrow: Spinous process of L3 Middle arrow: Posterior longitudinal ligament Left arrow: S1 How do you test m. strength? Test reflex? MUSCLE GRADATIONSDESCRIPTION (ROM=range of motion) 5 = normalComplete ROM against gravity with full resistance 4 = goodComplete ROM against gravity with some resistance 3 = fairComplete ROM against gravity 2 = poorComplete ROM against gravity eliminated 1 = traceEvidence of slight contraction, no joint movement 0 = zeroNo evidence of contraction, no joint movement Grading ScaleDescription 0Absent 1Hypoactive 2Normal 3Hyperactive without clonus 4Hyperactive with clonus

6. Diagnosis? Herniation of L4-L5 inter- Vertebral disc Findings on physical exam? Affects nerve root L5. Medial lower limb pain, dorsal foot pain Identify items indicated and Other pertinent anatomy Left arrow: S1 Very right arrow: L3 spinous process Middle arrow: Ligamenta flava

7. Describe typical location of procedure, L3-L4 or L4-L5 Anatomy traversed from start to correct finish location Epidermis, thoracolumbar fascia, dura mater, Arachnoid mater, end in subarachnoid space Rationale for procedure? CSF sampling, deliver antibiotics, chemotherapeutic agents, or anesthetics

8. A 60 year old female presents with complaints of pain, numbness, and tingling in her lower limbs when she walks for moderate distances -- ????? -possible DX? Sciatica -possible etiologies? Anular disc tear, disc prolapse, spinal stenosis, Piriformis syndrome

9. A 35 year old male suffered a penetrating neck injury during a tornado. The physician believes he severed his spinal accessory nerve on the left. What findings would be present? Inability to move the upper Trapezius m. Inability to elevate scapula (drooping shoulders), inability to raise arm above his head

10. A 36 year old female presents with neck pain. Physical exam reveals (on the left) a band of tight, ropey muscle extending from the transverse processes of T1-6 to about the level of the inferior nuchal line. What muscle is most likely exhibiting somatic dysfunction? Semispinalis capitis m.

11. What muscles rotate the vertebral column? In which direction? Semispinalis cervicis m. to the opposite side Rotatores m. and multifidis m. to opposite side

12. T10 What muscles will be affected? Thoracic N. 10 is severed so Serratus posterior inferior m. Trouble w/ expiration of breath

13. Suboccipital Release is a technique you will learn in week 5 OPP. Constant steady pressure is placed in the suboccipital area to relax the muscles in this region. List the muscles/structures encountered from Superficial to deep. 1.Trapezius m. 2.Splenius capitis 3.Semispinalis capitis 4.Suboccipital m. 1.Rectus capitis post. Maj 2.Rectus capitis post min 3.Obliquus capitis inf 4.Obliquus capitis sup What nerves may be affected by treatment To this region? C1 (suboccipital), C3 and C4

14. What is the only muscle that rotates the skull without attaching to it? Obliquus capitis inferior Splenius cervis??? Draw the suboccipital muscles and the two nerves in the region (1 from within the triangle, One from below the triangle).

15. Draw and label a spinal nerve diagram, include sensory/motor/mixed labels.

16. Predict findings in the following three patient presentations 1. 34yom with avulsion of posterior roots at C5-6 Loss of sensory information from Latissimus dorsi, Levator scapulae, Rhomboid major and minor m. Also loss of proprioreception, But muscle strength would be the same. 2. 56yom with stenosis of intervertebral foramen b/w C4/5 and C5/6 C5 n. and C6 n. are closed off resulting in loss of sensory and motor function in before mentioned muscles. Possible numbness, And potential difficulty breathing (C5 contributes to breathing) 3. 67yom with injury to anterior horn spinal cord at C5/6 loss of motor function for muscles innervated by C6. Decreased reflexes and weakened muscles leading to muscle atrophy.

19. Patient presents following a traumatic cervical spine injury. She is Unable to breathe on her own and it placed on a ventilator. What Spinal cord levels are damaged? What nerve is affected? C1 atlas fx (Jefferson fx), C2 axis fx (Hangman’s fx), C3 fx. Great occipital n., 3 rd occipital n., and Phrenic n.

21. How would prostate cancer get to the spine?