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Orthopedic II > Anatomy & Physiology - Spine & SI > Flashcards

Anatomy & Physiology - Spine & SI Flashcards

1
Q

Pars interarticularis

A

part of the lamina - area of thick cortical bone bridging the superior and inferior articular processes

IMPORTANT for transmitting load from POST to ANT

Susceptible to stress and compression fx
(spondylolysis–>listhesis)

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2
Q

Anterior Longitudinal Ligament

A

anterior to vertebral bodies from sacrum to C2

  • attaches segmentally to VERTEBRAL BODIES
  • FUNCTION = resist extension

susceptible to hyperextension trauma

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3
Q

Posterior Longitudinal LIgament

A

runs posterior to vertebral bodies and continuous w/ tectorial membrane at C2

  • attaches segmentally to DISC in fan-like pattern
  • innervated by sinuvertebral nerve (same that innervates 1/3 of outer annulus of disc)
  • FUNCTION: prevent posterior disc protrusion and segmental restraint to flexion
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4
Q

Ligamentum Flavum

A

connects two consecutive lamina

-attaches to anterior part of facet joint and becomes the joint capsule

FUNCTION: allow flexion to a certain extent & limit flexion
–> if it loses elasticity over time it may buckle & cause compression on nerve root

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5
Q

Interspinous LIgament

A

segmental attachment of spinous processes

innervated by medial branch of posterior (dorsal) rami

FUNCTION: assist w/ segmental stability, prevent seperation of two s.p’s during flexion

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6
Q

Supraspinous Ligament

A

runs along the length of the spinous processes w/ segmental attachments via transverse fibers

  • greatest risk of injury b/c furthest from axis of motion

most developed in the lumbar region

FUNCTION: resist flexion

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7
Q

Iliolumbar Ligament

A

attaches bodies of L4/L5 to ilium

FUNCTION: limit motion in lumbosacral region

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8
Q

What does a motion segment consist of?

A

a disc, two vertebral bodies, 2 facet joints and surrounding soft tissue

Superior vertebrae defines direction of movement
Rotation is defined by anterior part of vertebral body (not the direction of the spinous process)

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9
Q

Facet Joint Orientation

A

CS = 45deg to horizontal
- allows rotation, flex/ext

TS = coronal
- allow for rotation, prevents forward translation

LS = sagittal
- allow for flex/ext & resist rotation

L5/S1 = coronal

Greatest rotation = horizontal,
then coronal
Least = sagittal

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10
Q

Fryette’s Law - Lumbar Spine

A

Side bending and rotation are coupled in OPPOSITE directions

Neutral spine = SB & ROT - OPP
Flexed spine = SB & ROT - SAME
Extended spine = SB & ROT - SAME

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11
Q

Erector Spinae

A

FUNCTION - back extension (main) + anterior tiliting + minimal stabilization of LS

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12
Q

Interspinalis & Intertransversarii

A

FUNCTION: fine tune segmental motion & provide proprioceptive feedback

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13
Q

Quadratus Lumborum

A

FUNCTION: lumbopelvic motion, especially rotation, side flexion, stabilizer in sustainted posture, stable base for diaphragm during inspiration

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14
Q

Multifidus

A

FUNCTION: segmental stability & LS/SI stability

- controls anterior shear

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15
Q

Transverse Abdominus

A

FUNCTION: anticipate motion, provide segmental stability, prevent anterior shearing

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16
Q

Internal vs. External Oblique

A

Internal -
FUNCTION - anterior pelvic tilt, initiate L rotation
–> originates from ASIS & t-l fascia, which is why it does an anterior pelvic tilt b/c contraction of I.O tenses t-l fascia

External -
FUNCTION - posterior pelvic tilt, initiate R rotation
–> all anterior attachments, so contraction will cause a posterior pelvic tilt

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17
Q

Thoracolumbar Fascia

A

Spinous process of T12 to PSIS and iliac crests
- envelop lumbar muscles

FUNCTION:

  • attachment site
  • stabilize against anterior shear/flexion
  • “corset” action
  • transmission of extension forces
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18
Q

Vertebral End-plate

A

cartilage above & below disc, tightly bound to disc

Highly innervated

Sharpy’s fibers: annulus fibers that insert onto vertebral body

FUNCTION: hold disc in place

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19
Q

Nucleus Pulposus

A

mainly water allowing for deformation under compression
(contains proteoglycans which hold water)

TYPE II collagen

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20
Q

Annulus fibrosus

A

Type I Collagen that hold the nucleus pulposus in place
- Lamella: bundles of sheath around nucleus arranged in alternating diagonal patterns

Posterior fibers are thinner to allow for flexion, also a common site for posterior disc protrusions

HIGHLY innervated (outer 1/3) by sinuvertebral nerve

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21
Q

Disc Mechanics (5)

A
  1. Compression (normal)
    - WB activities and muscle contraction
    - equilibrium between push & pull
  2. Distraction (normal)
    - separation of vertebral bodies
  3. Rocking (normal or pathological)
    - bending the disc anterior & posterior
  4. Rotation (pathological)
    - half of annulus on slack & other half on stretch
  5. Shear (pathological)
    - MOST DETRIMENTAL to disc
    - takes place w/ rotation (lateral shearing)
22
Q

Lumbosacral Joint

A

L4, L5 and S1 - facets oriented in CORONAL plane and coupling of SB & ROT to the same side (diff from LS)

L5/S1 = primary WB joint

Motion restricted by iliolumbar ligament - especially excessive sacral flexion

23
Q

5 joints of lumbopelvic region

A
  1. lumbosacral
  2. sacroiliac (x2)
  3. pubic symphysis
  4. hip joints (x2)
  5. coccyx
24
Q

Sacroiliac Joints

- joint surfaces

A

Sacrum: Inverted L shape

  • Short arm (superior) = depth of sacrum - in vertical plane
  • Long arm (inferior) = length of sacrum w/n S2/S3 in A-P plane

Ilium: corresponding L shape

25
Q

SI Joints

- FUNCTION

A

transfer load from trunk to legs and absorb/dissipate forces from LE before they reach the spine

Major WB joint (as well as L5/S1)

26
Q

SI Joint Stability (4 things)

A
  1. Articulating surfaces
    - sacral surface has thick hyaline cartilage
    - ilial surface has fibrocartilage
  2. Two joint stypes
    - anterior (1/3 of joint) = synovial
    - posterior (2/3 of joint) = syndesmosis - held together by interosseus membrane which allows for very little motion
  3. Joint surfaces un-smooth (friction)
  4. Extensive ligaments
27
Q

Anterior SI ligament

A

WEAKEST and most susceptible to injury

FUNCTION: limit anterior gapping

test w/ anterior distraction

28
Q

Posterior Interosseus Ligament

A

deepest and STRONGEST

FUNCTION: limit posterior gapping

test w/ anterior compression

29
Q

Long dorsal (posterior) SI ligament

A

connects PSIS to lateral segments of S3 and S4

FUNCTION: prevent counternutation (backward tiliting)

blends w/ multifidus, ES, and t-l fascia which is why those structures are important for the stability of the SI joint

30
Q

Sacrotuberous ligament

A

attaches PIIS medially down to S3 and S4 and to ischial tuberosity

FUNCTION: prevent nutation

blends w/ biceps femoris tendon so contraction of this muscle will increase stability of SI joint by increasing tension in ligament

31
Q

Sacrospinous ligament

A

attaches ischial spine to lateral margins of the sacrum & coccyx

FUNCTION: prevent nutation

blends to form capsule of the SIJ

32
Q

Muscles of the Pelvic Girdle

- inner vs outer

A

Inner tube = local muscles
(TrA, multifidus, diaphragm and pelvic floor muscles)

Outer = global muscles
(4 systems - longitudinal, anterior & posterior oblique, and lateral)

Piriformis - only muscle w/ direct attachment to SIJ

  • function = ER
  • can cause SI problems

Biceps femoris attaches to sacrotuberous ligament so can cause counternutation of sacrum or prevent nutation

33
Q

Sacroiliac Biomechanics

A

Sacrum moving on ilium during LUMBAR motions

Flexion = sacral nutation then counternutation
Extension = sacral counternutation
Axial rotation = reciprocal motion of unilateral ipsilateral nutation and counternutation
(picture hypothetical oblique axis)

Nutation = sacrum gliding anterior & inferior
Counternutation = posterior & superior
34
Q

Iliosacral Biomechanics

A

Ilium moving on the sacrum during HIP motions

Flexion = posterior rotation
Extension = anterior rotation
35
Q

Longitudinal System - outer tube muscles of the pelvic girdle

A

Erector spinae
t-l fascia
biceps femoris (sacrotuberus ligament)

36
Q

Anterior oblique system - outer tube muscles of pelvic girdle

A

Internal and external obliques
abdominal fascia
contralateral adductors

37
Q

Posterior oblique system - outer tube muscles of pelvic girdle

A

Latissimus dorsi
Contralateral glute max
t-l fascia

38
Q

Lateral system - outer tube muscles of the pelvic girdle

A

Glute med & min

contralateral adductors

39
Q

Lumbar Spine flexion

  • facet motion
  • limiters
  • mechanics
  • clinical implication
A
  • Facets glide superior
  • opens foramen & facet joints
  • Limited by: PLL, LF, ISL, SSL (all posterior ligaments), tension on post part of disc, bony block
  • Mechanics: initiated by abdominals, then “flexion-relaxation phenomenon” - TLF stretches, deactivating the ES to prevent overactivation
  • Clinical implication: repetitive flexion can cause disc injuries, avoid w/ certain diagnoses (usually during acute stage)
40
Q

Lumbar Spine Extension

  • facet motion
  • limiters
  • Mechanics
  • Clinical implication
A
  • Facets glides inferior
  • closes facets & narrows foramen
  • Limited by: approximation of spinous processes or facet joints
  • Mechanics: initiated & maintained by back extensors while abdominals work eccentrically
  • Clinical Implication: avoid w/ stenosis, OA of facet joints, excessive lordosis
  • -> excessive loading on pars interarticularis common during hyperextension & sporting activities
  • -> repetitive extension can damage facet joints
41
Q

Lumbar Spine Rotation

  • facet motion
  • limiters
  • clinical implication
A
  • Ipsilateral facets move inferior (caudal) and contralateral facets glide superior (cranial)
  • LS = gapping on ipsilateral side
  • CS = gapping on contralateral side
  • Limited by: approximation of contralateral facet, stretch of joint capsule or disc rotation
  • Clinical implication: optimal stimulus IF w/n pain-free, optimal range, rotational manual therapy due to opening of lateral foramen (LS - same side)
42
Q

Lumbar Spine Side Flexion

  • facet motion
  • coupled w/?
A
  • Ipsilateral facet glides inferior (caudal) and contralateral facet glides superior (cranial)
  • Fryette’s Law = SB & ROT of LS are coupled in opposite directions UNLESS…
  • spine is flexed or extended then coupled in SAME direction
43
Q

Upper CS Biomechanics - Flexion & Extension

A

Flexion

  • occipital condyles glide posterior
  • C1 moves inferior
  • C2 translates anterior

Extension

  • occipital condyles glide anterior
  • C1 moves superior
  • C2 translates posterior on C3
44
Q

Upper CS Biomechanics - SB

A
  • occipital condyle glides anterior

- nothing at AA?

45
Q

Upper CS Biomechanics - Rotation

A

50% of cervical rotation comes from C1-C2!
The AA joint is the “no” joint

  • occipital condyles glide posterior
  • C1 translates to opposite side
  • ipsilateral facet glides posterior
  • CL facet glides anterior
46
Q

Upper CS Motion Coupling

A

SB & Rotation occur in OPPOSITE directions

when you have SB to the right you will have a rotation to the left
- can use to differentiate between UCS vs. LCS problems

47
Q

Lower CS Biomechanics - Flexion/Extension

A

Flexion

  • vertebral body translates anterior
  • Facets glide anterior

Extension

  • vertebral body translates posterior
  • Facets glide posterior
48
Q

Lower CS Biomechanics - SB/ROT

- Coupled motion

A

SB

  • ipsilateral facet glides inferior
  • CL facet glides superior

Rotation is same biomechanics because in LCS coupled motion, SB and rotation occur in the SAME direction
- when you SB to the left it gaps the right foramen, when you rotate to the left, it will also gap the right foramen

49
Q

Thoracic Spine Biomechanics - Flex/Ext

A

Flexion
- vertebral body translates anterior

Extension
- vertebral body translates posterior

Motion increases in the LOWER SEGMENTS

50
Q

Rib Biomechanics - Flex/Ext

A

Flexion

  • anterior rib translates inferior
  • posterior rib translates superior
  • plus ANT rotation

Extension

  • anterior rib translates superior
  • posterior rib translates inferior
  • plus POST rotation
51
Q

Thoracic Spine Biomechanics - SB/ROT

A
  • ipsilateral facet extends (inferior-lateral)
  • CL facet flexes (superior-medial)

Coupled motion - SB & rotation of the TS occur in the SAME direction
- CTJ and TLJ will follow respective biomechanics

52
Q

Rib Biomechanics - SB/ROT

A
  • ipsilateral rib translates inferior and rotates posterior

- CL rib translates superior and rotates anterior

Orthopedic II (9 decks)

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