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Biomechanics II - Exam 1 > Axial Skeleton: Thoracolumbar spine/SIJ – Osteology and Arthrology > Flashcards

Axial Skeleton: Thoracolumbar spine/SIJ – Osteology and Arthrology Flashcards

1
Q

What do the vertebra and ribs do?

A
  • Provide vertebral stability
  • protects spinal cord
  • protects ventral and dorsal nerve roots and exiting spinal nerve
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2
Q

What is a vertebral body?

A

Anterior, primary weight-bearing component of the vertebra

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3
Q

What are the posterior elements of a vertebrae?

A
  • transverse/spinous processes, laminae, articular processes
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4
Q

What are the pedicles?

A

bridge that connects body - posterior elements; thick and strong

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5
Q

What do pedicles do?

A

Transfers muscle forces applied to posterior elements for dispersion across body/disc

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6
Q

What are the 3 divisions of a vertebrae?

A
  • vertebral body
  • posterior elements
  • pedicles
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7
Q

How many body segments are there?

A

33
- 7 cervical
- 12 thoracic
- 5 lumbar
- 5 sacral
- 4 coccygeal, last 2 fused as an adult

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8
Q

Where are there reciprocal curves in the sagittal plane?

A
  • Cervical spine and lumber spine lordosis and kyphosis in thoracic spine and sacrum
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9
Q

What do spinal curves provide?

A

Strength and resilience

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10
Q

What do the spinal curves make the spine vulnerable to?

A

Shear forces at transitions

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11
Q

What can impact the LOG?

A

Limb position, fat deposition, muscle strength and endurance, connective tissue extensibility, the loads supported by the body, shape of facets and vertebral bodies and discs

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12
Q

What do spinal ligaments do?

A
  • limit motions
  • help maintain natural curves
  • protect the spinal cord/nerve roots by stabilizing the spine
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13
Q

What is the ligamentum flavum?

A

anterior lamina to posterior lamina, end ROM flexion, 80% elastin, posterior to spinal cord

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14
Q

What are the interspinous ligaments?

A

between adjacent spinous processes; blends with LF, more elastin, more superficial, more collagen and blend with SS lig, fiber direction varies - Lumbar spine

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15
Q

What is the supraspinous ligament?

A

Between tips of spinous processes; resist separation - flexion; less developed in the lumbar spine

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16
Q

What are intertransverse ligaments?

A

Thin, taut in contralateral flexion

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17
Q

What is the anterior longitudinal ligament (ALL)?

A

Long, strong strap, occiput to sacrum, fibers into and reinforce anterior disc

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18
Q

What is the posterior longitudinal ligament (PLL)?

A

posterior surfaces of vertebral bodies C2- sacrum (in canal)
- blends with and reinforces posterior discs

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19
Q

What are the capsular ligaments (facets)?

A

Entire rim of facets, connect and stabilize, reinforced by adjacent muscles (multifidus)

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20
Q

What should we consider when looking at ligaments in a biomechanical perspective?

A
  • collagen/elastin ratio
  • fiber direction
  • it’s location relative to the axis of rotation of a joint
  • usually lose in anatomic position
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21
Q

What happens to at least some fibers near end ROM?

A

Become taut ( largest joint surface motions - largest passive tension)

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22
Q

What are some clinical questions to ask regarding ligaments?

A

1.) what might have been injured
2.) chronically overstretched?
3.) is it capable of stabilizing?
4.) its impact

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23
Q

What is spinal instability?

A

Loss of intervertebral stiffness that can lead to abnormal and increased intervertebral motion

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24
Q

What is the neutral zone?

A

The amount of intervertebral movement that occurs with the least passive resistance from the surrounding tissues

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25
Q

What increases the neutral zone?

A

Injury or weakness of surrounding tissues

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26
Q

What can cause further injury regarding the neutral zone?

A

marked or chronic instability of the ligs/facets/discs/neural

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27
Q

What happens if the neutral zone is larger than normal?

A

the spinal segments become usntable

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28
Q

What decreases the neutral zone?

A

muscle force

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29
Q

What increases the neutral zone?

A

Injury and degeneration

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30
Q

What does injury do to the vertebral motion pattern?

A

Changes and influences the motion of the whole spine potentially causing pain and hypermobility

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31
Q

What does marked or chronic spinal instability cause?

A

Further injury to local ligaments, injury to facets (apophyseal joints), discs, and possibly neural structures, can result in loss of pain-free spinal ROM

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32
Q

What are Panjabi’s 3 subsystems of control?

A
  • Passive system
  • Active system
  • neural subsystem
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33
Q

What is the passive system?

A

consists of the bony structures, ligaments joint capsules, discs, and passive portion of the musculotendinous units. Sends feedback to the neural subsystem about joint positions

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34
Q

What does the passive system challenge?

A

stability at the passive level

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35
Q

What is the active system composed of?

A

muscles and tendons

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36
Q

What is the neural subsystem?

A

Recieves and transmits information from and to the other two systems to manage spinal stability

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37
Q

What kind of patient can have compromised neuromuscular control?

A

Patients with LBP

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38
Q

What are the osteologic features of the thoracic vertebrae 2-9?

A
  • downward pointing spinous process
  • superior/inferior facets oritented vertically - sup facing posterior/inferior anterior; aligned close to the frontal plane
  • pair of costal facets
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39
Q

Why are T1 and T10-12 atypical?

A

T1 full costal attachment and demi; T10-T12 full coastal attachment

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40
Q

What are the features of the lumbar region vertebra for?

A
  • massive wide bodies for support
  • TPs project laterally 1-4 thin, 5 strong and thick
  • SP broad, rectangular off lamina
  • mammillary processes off sup articular surfaces (posterior side)
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41
Q

What is facet orientation of the vertebrae in the superior lumbar region?

A

concave, face medial to medial-posterior

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42
Q

When are the lumbar region vertebrae closest to the sagittal plane?

A

in the upper lumbar spine

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43
Q

what is the orientation of the articular facets in the lumbar region?

A

Vertical

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44
Q

What is the orientation of the inferior articular processes?

A

Convex- lateral to anterior-lateral

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45
Q

What is the inferior articular process of L5 also?

A

The superior articular process of the sacrum

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46
Q

What do the L5-S1 apophyseal joints provide to the lumbosacral junction?

A

A-P stability

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47
Q

What is unique about the L5-S1 apophyseal joints?

A

Much closer to the frontal plane

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48
Q

What is the orientation of the sacrum base and apex?

A

Base faces superiorly, apex inferiorly

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49
Q

What is the anterior edge of the sacrum known as?

A

Sacral promontory

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50
Q

What are the Ala of the sacrum?

A

Wings

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51
Q

What direction do the superior articular surfaces face?

A

Posterior-medially

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52
Q

What do the facets do in the sacrum?

A

Transmits weight off vertebral column to pelvis

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53
Q

What is unique about the sacrum from childhood to adulthood?

A

Each of 5 segments are joined by cartilaginous membrane in childhood, fuses by adulthood

54
Q

What articulates to form the SI joint?

A

Auricular surface of sacrum and the ilium

55
Q

What is the coccyx composed of?

A
  • 4 fused vertebrae
  • sacrococcygeal joint
  • fibrocartilaginous disc
  • small ligaments
56
Q

What comes out of the 4 ventral foramina of the sacrum?

A

Ventral rami of sacral plexus

57
Q

Why is the dorsal surface of the sacrum rough and convex?

A

Attachments of musculature

58
Q

What are the spinal and lateral tubercles remnants of?

A

The SP/TP

59
Q

What do the dorsal sacral foramina transmit?

A

Dorsi rami sacral spinal nerve roots

60
Q

What should we know about the caudal equina at birth?

A

at birth Spinal cord = vertebral column but vertebral column grows faster

61
Q

What grows faster? Spinal cord or vertebral column?

A

Vertebral column

62
Q

Where does the adult spinal cord end?

A

At L1/2

63
Q

Where do the roots travel out of the cauda equina?

A

caudally to reach their corresponding foramina

64
Q

What are the 3 functional components of the typical intervetebral joints?

A
  • transverse/spinous processes
  • apophyseal joints
  • interbody joint
65
Q

What are transverse/spinous processes for?

A

Mechanical levers that increase mechanical leverage of muscles and ligaments

66
Q

What are the apophyseal joints for?

A

Guiding intervertebral motion

67
Q

What are inter body joints for?

A

Absorbing and distributing load, greatest adhesion between vertebrae, houses axis of rotation, is a spacer, provides passage for nerves

68
Q

What is the axis for each intervertebral junction?

A

near/at interbody joint

69
Q

Where is the rotation reference point for the more cranial vertebra?

A

anterior

70
Q

How many pairs of apophyseal joints are there?

A

24 pairs

71
Q

What kind of joint are apophyseal joint?

A

Plane joints

72
Q

What encloses the apophyseal joints?

A

Synovial well-innervated capsule

73
Q

What do apophyseal joints do?

A

Acts as a mechanical barricade

74
Q

What do the horizontal facet surfaces favor?

A

Axial rotation

75
Q

What do vertical facet surfaces do?

A

Block axial rotation in either sagittal or frontal planes

76
Q

Where are intervertebral/interbody joints found?

A

C2-3 through L5-S1
- disc, endplates, adjacent vertebral bodies

77
Q

What makes up the disc?

A
  • Nucleus pulposus -pulplike gel mid to posterior aspect of disc, 70-90% water in youth
  • annulus fibrosis
78
Q

What do the disc and NP do?

A

Shock absorption, dissipates and transfers loads across consecutive vertebra

79
Q

What is the annulus fibrosis?

A

15-25 concentric rings of collagen fibers, 65 degrees from vertical

80
Q

What does the annulus fibrosis do?

A

Prevents distraction/shear/torsion, entraps and encases the liquid based nucleus

81
Q

What are vertebral endplates?

A

Relatively thin cartilaginous caps the cover most of the superior/inferior surface of vertebral bodies

82
Q

What is the difference between the surface of the vertebral endplate facing the disc and the surface facing the bone?

A
  • Surface facing disc is fibrocartilage and binds directly and strongly to collagen in AF
  • Surface facing bone calcified cartilage, weakly affixed to bone
83
Q

Why is there limited healing at the disc?

A

Outer rings of AF with vascular supply diffuse O2 and glucose

84
Q

Why can reduced permeability be so impactful?

A

Reduced permeability inhibits syntheses of proteoglygcans, leading to less water, leading to less ability to absorb and transfer loads

85
Q

Where is 80% of the load carried in standing?

A

Intervertebral joint at lumbar spine, only 20% in posterior elements

86
Q

What are discs designed to handle the force of?

A

BW AND muscle activation

87
Q

Where do compressive loads push the endplates?

A

Inward toward the NP

88
Q

How do the collagen rings resist/balance force?

A

Stretched rings of collagen and elastin create tension to resist/balance force - uniformly transferred to vertebral bodies then return when load is off

89
Q

What does viscoelastic mean?

A

Resists a fast/strongly applied load; less resistance to slow or light compression

-flexible low loads/ rigid at higher loads

90
Q

What can allow water to be reabsorbed into the disc?

A

sustained and full lumbar extension - reduces pressure in discs

91
Q

What happens with diurnal fluctuations?

A
  • supine causes low pressure which attracts water, swells slightly when sleeping
  • WB forces push water out of the disc
  • height change
  • related to age, as proteoglycan reduces, water retaining reduces
  • less hydrostatic pressure
92
Q

What is spine coupling?

A
  • Any movement of the spine in a plane is combined with an automatic and often imperceptible movement in another plane
93
Q

Is there a consensus as to which coupling pattern is normal for a specific region?

A

NO

94
Q

Where is spine coupling consistent?

A

Middle and lower cervical spine: lateral flexion and ipsilateral rotation

95
Q

What does the thoracic region provide?

A

Stable base for musculature, protective for organs, breathing

96
Q

What are the joints in the thoracic region?

A
  • costocorpeal/costovertebral joints
  • costotransverse joints
97
Q

How many apophyseal joints in the thoracic region?

A

24

98
Q

What is the orientation of the facets in the thoracic region?

A
  • in frontal plane and 15-25 degrees from vertical
99
Q

What is the movement in the thoracic region limited by?

A

Costovertebral and costotransverse joints - links all to sternum

100
Q

How many degrees of flexion are there in the thoracic region? what is it limited by?

A

30-40
limited by connective tissues located posterior to vertebral bodies

101
Q

How many degrees of extension are there in the thoracic region? what is it limited by?

A

15-20
Limited by tension in ALL and lamina of adjacent vertebrae

102
Q

Why is there more flx/ext in the lower thoracic spine?

A

Free floating ribs and facets more sagittal

103
Q

How many degrees of rotation in the thoracic region?

A

25-35 horizontal plane

104
Q

How many degrees of lateral flexion to each side in the thoracic region?

A

25-30 degrees (ribs prohibit more)

105
Q

Bucket handle is used to represent?

A

Inspiration - shaft of rib elevates upward and outward

106
Q

What are the ranges for the thoracic spine?

A

Flexion: 30-40
Extension: 15-20
Rotation: 25-35
Lateral Flexion: 25-30

107
Q

What are the ranges for the thoracolumbar spine?

A

Flexion: 35 (T) + 50 (L) = 85
Extension: 20 (T) + 15 (L) = 35
Rotation: 25-35
Lateral Flexion: 25-30

108
Q

What are the ranges for the lumbar spine?

A

Flexion: 45-55 (60)
Extension: 15-25
Rotation: 5-7
Lateral Flexion: 20 (25-30)

109
Q

What is the lumbosacral angle?

A

Angle between the horizontal plane and the superior surface of the sacrum

110
Q

How is the base of the sacrum inclined?

A

Base of sacrum inclined anteriorly and inferiorly at 40 degrees

111
Q

What happens for anterior tilt of the pelvis?

A

Contration of hip flexors/back extensors // or hip flexion contracture

112
Q

What happens for posterior tilt of the pelvis?

A

Contraction of the hip extensors/abs

113
Q

What structures resist shear at L5/S1?

A
  • disc
  • capsule
  • ALL
  • wide and sturdy facets
  • iliolumbar ligaments

create a resistance force of compression at L5/S1 facets

114
Q

Why is flexion dominant in the lumbar spine?

A

Due to sagittal plan orientation of facets

115
Q

What is flexion a reversal of?

A

Lordosis

116
Q

Where do compression forces shift in the lumbar spine?

A

Away from facets, on anterior aspects of discs and bodies

117
Q

What happens during flexion of the lumbar spine regarding the disc?

A

Can change, NP into posterior direction. Normal disc AF can withstand this - but weakened / cracked cannot. Variations of a HNP can occur.

118
Q

What happens during extension of the lumbar spine to the load?

A

Increased contact and load in facets, causes tips of inferior articular facets to slide inferior beyond the joint surface

119
Q

What can hyperextension cause regarding the tips of the inferior articular processes?

A

Hyperextension can cause the tips of the inferior articular process to contact the adjacent lamina, can cause damage and compress posterior ligaments

120
Q

What happens to the size of the intervertebral foramina when the lumbar spine extends?

A

Size of the foramina is reduced and the nucleus presses anterior

121
Q

What has full lumbar extension been shown to reduce?

A

Pressure within the disc and reduced contact pressure between disc materials and neural tissues

122
Q

What is lumbopelvic rhythym?

A

The kinematic relationship between the spine and hips during sagittal plane motions

123
Q

What is the early phase of return from full flexion?

A

Trunk extension occurs to a greater extent through extension of the hips under relatively strong activation of hip extensor muscles (glut max and hamstrings)

124
Q

What happens in the middle phase of return from full flexion?

A

Trunk extension occurs through a shared activation of the hip and lumbar extensors

125
Q

What happens at completion of return from full flexion?

A

muscle activity typically ceases once the line of force from body weight falls posterior to the hips

126
Q

Where is the axis of rotation for trunk extension for all three phases of returning from full flexion?

A

through the body of L3

127
Q

What would happen if there was more than 3 degrees of axial rotation at any lumbar segment?

A

would damage facet surface and tear AF

128
Q

How much axial rotation is there of the lumbar spine?

A

5-7 degrees each side

129
Q

How much lateral flexion is there of the lumbar spine?

A

20 degrees to each side

130
Q

What happens to the disc during lumbar spine lateral flexion?

A

slight deformation in disc

Biomechanics II - Exam 1 (3 decks)

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