Question Answer Where is injury for incomplete tetra/paraplegia? Above the neck Where is injury for complete tetra/paraplegia? Below brachial plexus Where are most frequent levels of injury? Why? C5 with C4, C6, T12 following in frequency
C5-7, T4-7, T10-L2
*Mostly C5 bc it is apex of lordosis, also involvement at C4 & C6.
T12 bc transitional vertebra– from kyphosis to lordosis Which ASIA patients are most likely to be employed? Those with Asia D (least involved) Employment: Do pts who are employed tend to work F/t? Which jobs do they return to if they return w/in one year? Who has greater likelihood of returning to work? Full time; Return to same job; Younger, male, white, more formal education, higher IQ What influences return to work? Type of injury, Support at work & home, Position/Type of work Philosophy of Rehab restoration thru personal health services of handicapped ppl to the fullest physical, mental social & economic usefulness of which they are capable, including ordinary treatment treatment in special rehab centers. The Team Approach Members: PT, OT, Speech, Vocational Rehab, Nurse, Physiatrist, Psychologist, Social Worker Achievement of Goals 1. Evaluate (at baseline, see what they can do) 2. Develop a program (based on pt's goals) 3. Motivate & Direct (encourage, be a cheerleader) Individual Vertebrae: Structure 2 Lamina + 2 Pedicles form transverse processes; Vertebral arches (?) form spinous processes Where are discs found? Bt C2/C3 –>L5/S1 Where are ligaments found? Bt vertebral bodies What are the ligaments of the spinal column? Anterior Longitudinal Ligament;
Posterior Longitudinal Ligament;
Ligamentum Flavum (bt Lamina);
Ligamentum Nuchae;
Supraspinous Ligament (tip of spinous processes);
Interspinous Ligament (bt spin processes);
Intertransverse Ligament (bt trans proces Where does spinal cord go from & to? Medulla spinalis- caudal continuation of brain. Exits occiput from foramen magnum–>L1L2. No cord at L4L5 so we do spinal tap here Spinal Nerve Roots- talk about them 31 pairs.
Anterior root: ventral-efferent;
posterior root: dorsal- afferent.
Some "paired spinal segment" of nerve roots exit horizontally, some more obliquely (almost vertical) at bottom What are Meninges layers & where is CSF housed? Pia mater;
Arachnoid mater- subarachnoid space houses CSF;
Dura mater. How long is spinal cord? How much does it weigh? 45 cm in males & 42 cm in females; ~30 grams. Inner organization of vertebra Gray vs white matter; Columns anterior, posterior & two lateral & tracts. (know which column each tract is in) What does nerve room come out of? Nerve root comes out from correct segment. Cord segment of spinal cord does not match bone it sits on- difference bt neurological cord segment & its location compared to the bone it sits on. Anatomical Relationships bt the Spinal Cord & the Vertebral Column Cd seg: Vert Bdies: Spin Proc:
C8 LowC6/UprC7 C6
T6 LowT3/UprT4 T3
T12 T9 T8
L5 T11 T10
S T12/L1 T12 Rules for Anatomical Relationships bt the Spinal Cord & the Vertebral Column Cord comes out above same # vertebra, then switches at C7/T1 bc there is a C8 nerve root

Grays: Rough rule of 2- add 2 to spin process for C2-T10. (Tip of T9 process is at T12), then add 3. Close from C1-C4.. difference gets greater as u go down cord. How can cord function without cortical input? What system does not need cortical input? afferent/efferent nerve form loop- independent. Pt can maintain functions w/o cortical input. Bladder is system like this. Form isolated cord below level of lesion (?) Major Motor tracts Lateral corticospinal (Ips): voluntary mvt- precise mvts of distal limbs
Ventral corticospinal (Con): voluntary mvt of axial mm (not very signif).
Rubrospinal (Ips): voluntary mvt of UE, esp precise mvts of extremities.
Vestibulospinal (Bil): Posture/B Last Major Motor tract Lateral & Medial Reticulospinals (Ips): Posture, balance, modulation of spinal reflexes, axial & proximal limb motions; in performance of motor tasks, comlements actions driven by corticospinals Sensory Tracts Anterolateral system: Spinothalamic, spinoreticular & Spinotetal tracts (Contra): Pain, temp & crude touch
Dorsal column (Ips): Proprioception, vibratory sense, deep touch & discriminative touch Last 2 Major Sensory Tracts Dorsal Spinocerebellar (Ips): Unconscious proprioception from trunk & LE
Ventral spinocerebellar (Bil): Unconscious proprioception from trunk & LE How many pairs of spinal nerves from each section? (thor, lumbar, cerv) Cerv: 8, Thoracic: 12, Lumbar: 5. Anterior spinal artery Runs along anterior fissure until it gets to thoracic spine- here, gives rise to sulcal (supply center of cord) & pial (supply lateral cord) arteries. Lateral spinal arteries A set. Comes from b/t lateral artery b/t C2 & T2. Segmental Radicular arteries Continuation of anterior spinal artery below T4. Have connection to intercostal artery from Aorta. Largest component of this is Adam Kiewicz: supplies anterior part b/t C8-T4. Responsible for Thoracic & Lumbar spine. Posterior spinal arteries From posterior nerve roots- supply posterior horn. Start inter-cranially & descend all the way down. Centrifugal system Comes from anterior median fissure. Arises from anterior spinal artery & supplies center of cord: supplies ___ (most) of gray matter & inner 1/2 of white matter. Centripetal system Comes from anterior & posterior spinal arteries & supplies outer part of white matter. Supplies posterior horns: inner & outer part of lateral column. Fracture dislocation – importance Often the etiology of SCI- causes large bleeds. Capillary network is more dense in gray than in white matter. How do u conduct examination of joint? Subjective, Observation & palpation (posture & limb posturing), Active mvt testing (quick tests), Resistive tests, Passive mvt testing, Special tests/other tests (neuro), Palpation: specific How do u conduct active mvt testing at shoulder complex? Clear jts above & below, Quick tests (tests the shoulder complex)- if these reveal no problems, do Quick tests w/overpressure, Scapular motions, GH jt motions, Elbow flexion & extension How do u conduct passive mvt testing at shoulder complex? Clera jts above & below, Passive ROM = physiologic motions (shoulder jt, ST jt, GH jt), Joint Mobility Testing = accessory mvt (ST jt, SC jt, AC jt, GH jt) How do u conduct Resistive testing at shoulder complex? Muscles for scapular motions, muscles for GH jt motions, muscles for elbow motions What is purpose of special tests? What do u test? Orthopaedic & neuro: tests designed to stress certain structures How do u take subjective of shoulder complex? Hx of present illness (why here? what about shoulder bothers u? ever bothered u before?), Dominant arm (R or L), Neck/thorax prob (upper back/neck refers pn), Systems review – search for referred pn, Job/sport- simulate offending mvts, PMH, PSH, Sochx What are major things to ask during subjective? Area- where pn?
Onset- when start?
Nature- what feel like (burn/pinch)?
Meds: helping?
What about job/sport interacts w/this prob?
How long pn last (irritability)- show me w/good arm what creates prob
What can't u do? (****) Referred pn- red flag example & how do u intervene? Pt says they have shoulder pn that comes on w/climbing steps only – send to dr to get cardiogram *CV may have probs Examination: Observation of shoulder complex Posture: attitude of arm, body posture/habits, willing to mv?, atrophy or hypertrophy (imbalanced mm), note edema-jt could get inflamed then mv down to elbow, symmetry (1 blade much higher). If bad attitude no willing to mv- have TLC- massage to decr. pn Examination: Palpation of shoulder complex Palpate: temperature, edema, atrophy, tenderness (capsule, tendon, bursa, etc), analyze alignment & pos'n- is blade dropped? msr w/tape msr- document "at rest pos'n, scap angle at level of T7." use this as baseline to document changes. How to conduct examination of shoulder complex: active mvt testing incl jts above & below affected jt. Neck: tell pt to look up to sky, then L, then R. then overpressure- but no overpressure this semester.
Quick tests: apply overpressure if no limitation- Flexion, Abdn, Hand behind back, Hand behind head, Rotator cuff. What to look for during examination of shoulder complex: active mvt testing Symmetry, painful arcs ("pn started at 45–>120, then went away"), willingness to mv, pain What does painful arc help u determine? Where probs are What motions to test during examination of shoulder complex: active mvt testing C-spine, scapular elev/depression, scapular upward & downward rotation, scapular ad/abduction, GH physiologic motions, elbow flex/extension How to apply overpressure during flexion of shoulder Stabilize scapula, put hand on distal humerus, apply overpressure (stresses ligaments to the max). If no pn, u clear this motion, so this wouldn't fall into ur goals unless goal is to maintain ROM. What motions to do Resisted (Active) Mvt Testing on for pt w/prob in shoulder complex Scapular, glenohumeral, elbow. For hypermobile joints: if looking for end-range cardinal sign (pn at end-range in shoulder) then u can apply overpressure to hypermobile jt (otherwise, don't) What to include in passive mvt testing Test joints above & below affected jt. Passive physiologic motion & goniometry. Joint mobility testing: remember good body mechanics, relax (pt and PT), get pt feedback What end-feel is normal for shoulder complex? Capsular at 120. Before 120 is not normal. Empty is ROM limited by pain. What are the 3 things u are assessing with passive mvt testing? Arc of mvt (goniometer – preset it to estimated range so u aren't fiddling with it), End-feel, Quality (if u feel hitches or muscle spasm) What should do u for a stiffer joint during passive mvt testing? Alternate hand-placement- gravity doesn't help as much- PT has to perform motion. What mvts do u passively test for Scapulothoracic jt? Which direction is pt lying? Elevation/depression, Ab/adduction, Up/downward rotation, "distraction" (sidelying) What mvts do u passively test for Sternoclavicular jt? Which direction is pt lying? What mvts are u testing? Cephalad & caudad glide, A-P glide (pt supine) Accessory mvts What mvts do u passively test for Acromioclavicular jt? Which direction is pt lying? What mvts are u testing? A-P glide, P-A glide (pt supine) Accessory mvts What is the concept of hand-placement when passively testing SC joint, ST joint & AC jt? Stabilize scapula, control distal same arm as pt, After 90 use opp arm as pt. Note whether GH motion stops at 120. What mvts do u passively test for Glenohumeral jt? Which direction is pt lying? What mvts are u testing? Lateral distraction of head of humerus, anterior glide, posterior glide, ER of head of humerus, IR of head of humerus, longitudinal mvt in neutral, inferior glide (pt supine) Accessory mvts Hand Placements- Caution with: Tender areas (pt will tell u where they are), Unstable bony segments (ie recent fractures, ORIF), *Osteoporosis (u can still test but use no force? What mvts do u assess/mobilize(?) for Scapulothoracic jt? Elevation/depression, Protraction/retraction, Ab/adduction, Lifting scapula What is correct hand placement/body mechanics for scapulothoracic mobilization? Pt sidelying. One hand's web-space on inferior angle, other hand on superior border. Stabilize upper arm w/your forearm- lock ur elbows & mv your legs. What mvts do u assess/mobilize for Sternoclavicular jt? Inferior glide to increase elevation, Superior glide to increase depresion, A-P glide to increase retraction, P-A glide to increase protraction,