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OS II > DSA- Introduction to the Sacrum > Flashcards

DSA- Introduction to the Sacrum Flashcards

1
Q

Sacral Anterior Anatomic Landmarks (9)

A

1) Sacral Ala
2) Sacral Base
3) Superior Articular Process
4) Coccyx
5) Anterior Sacral Foramen
6) Sacral Promontory
7) Pelvic Brim Landmark
8) Transverse Lines
9) Sacral Apex

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2
Q

Sacral Posterior Anatomic Landmarks (15)

A

1) superior articular facet
2) sacral canal
3) auricular surface
4) posterior sacral foramen
5) coccyx
6) sacral hiatus
7) inferior lateral angle
8) lateral surface
9) sacral tuberosity
10) lateral sacral crest
11) spinous tubercle
12) dorsal surface
13) sacral comu
14) intermediate sacral crest
15) median sacral crest

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3
Q

Coccyx

A

lowest part of spinal column, four vertebra
some fused
some not

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4
Q

Sacrum

A

formed by union of five modified vertebrae

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5
Q

Sacral Joints (4)

A

1) Right SI Joint
2) Left SI Joint
3) L5-S1 Intervetebral Disc
4) Sacrococcygeal Joint

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6
Q

Posterior Sacroiliac Ligament

A

thicker than Anterior SI ligament

- blends with STL and the thoracolumbar fascis

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7
Q

Anterior Sacroiliac Ligament

A

connects the third sacral segment to the lateral side of the pre-auricular sulcus
- iliolumbar ligaments blends

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8
Q

Interosseous Sacroiliac LIgament

A

the major bond between the bones, filling the irregular space posterosuperior to the joint
- covered posteriorly by the posterior sacroiliac ligament

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9
Q

What is the sacrum formed from?

A

5 modified vertebrae with 35 ostification centers

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10
Q

What do costal elements, vertebral arch, and centrum develop within?

A

cartilaginous model

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11
Q

When does the bony vertebral arch fuse with its adjacent costal part?
Unite with centrum?

A

between years 2-5

8 years old

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12
Q

What separates adjacent sacral segments?

A

epiphyseal plates

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13
Q

When do epiphyseal plates fuse?

A

sequentially after puberty, beginning with the lowest segments

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14
Q

What level of the sacrum does the dura attach?

A

2nd sacral segment

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15
Q

What are the bony articulations of the sacrum?

A

5th lumbar vertebrae superiorly
coxccyx inferiorly
2 os coxae (inominates) through C shaped SI articulations

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16
Q

SI joint developmental considerations

-after puberty: male vs female

A

after puberty

  • males: SIJ lig are well developed and strong
  • females: SIJ lig are less developed, allowing the mobility required during childbirth
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17
Q

SI joint developmental considerations

-2nd decade

A

crescent shaped ridge develops along the iliac surface that interdigitates with a depression on the sacral side, which adds stability and limits mobility

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18
Q

SI joint developmental considerations

-3rd decade

A
  • crescent shaped ridge becomes more pronounced decreasing ROM more
  • males: degenerative changes may begin to occur on iliac side
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19
Q

SI joint developmental considerations

-4th and 5th decades

A

males: degenerative changes begin on sacral side

- fibrous ankylosis may further limit joint motion

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20
Q

L- or C- shaped SI joint

A
  • contoured with a shorter upper arm and longer lower arm, with the junction occurring approximately at S2
  • subject to variation, even on opposite sides of the same bone
  • apex points anteriorly
  • diarthroidal joint because it contains synovial fluid and matching articular surfaces: different from any other joint in the body due to one side being hyaline cartilage and the other fibrocartilage
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21
Q

Describe the sacral surface of the SI joint

A
  • generally smooth
  • hyaline cartilage
  • decreases in width inferiorly and is consequently wedged between 2 ilia
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22
Q

Describe the iliac surface of the SI joint

A
  • anteriorly smooth
  • posteriorly fibrous, giving rise to interosseous ligaments
  • fibrocartilage
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23
Q

Describe the posterior sacroiliac ligament

A
  • inferior fibers, from the 3rd and 4th sacral segments, ascend to the PSIS and posterior end of the internal lip of the iliac crest
  • blends with STL and thoracolumbar fascia
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24
Q

Which is thicker: posterior or anterior SI ligament?

A

posterior

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25
Q

Describe the anterior sacroiliac ligament

A
  • connects the 3rd sacral ligament to the lateral side of the pre-auricular sulcus
  • iliolumbar ligament blends
26
Q

Describe the interosseous sacroiliac ligament

A
  • major bond btwn bones, filling the irregular space posterosuperior to the joint
  • covered posteriorly by the posterior sacroiliac ligament
27
Q

What does the long dorsal SI ligament connect? have a close anatomical relationship to?

A

-connects PSIS to the lateral aspect of the 3rd and 4th sacral segments

anatomy

  • erector spinae m group
  • posterior layer of thoracolumbar fascia
  • sacrotuberous lig
28
Q

When does the long dorsal SI lig become stretched?

A
  • when the sacrum is rotated in a posterior manner relative to the ileum (counterstrain)
  • early stages of pregnancy
  • aging and degenerative changes
  • backward torsion or unilatera/bilateral sacral extension
29
Q

Describe the sacrospinous lig

A
  • from ischial spine to lateral margins fo the sacrum where it blends with the sacrotuberous lig
  • forms part of the origin from which coccygeus m arises
30
Q

Describe STL

A
  • runs from lower sacral tubercles to ischial tuberosity
  • gluteus maximus attachment
  • tendon of the biceps femoris attachment
  • connects with fascia of the pelvis
31
Q

What are the functions of the sacrospinous and sacrotuberous ligaments?

A

-stabilize to limit posterior-superior rotation of the sacral apex around a transverse axis

32
Q

What is the piriformis? OINA

A

O: anterior surface of 2nd, 3rd, 4th lateral masses of the sacrum and sacrotuberous ligament
I: superior border of the greater trochanter fo the femur
N: branches of ventral rami of 1st and 2nd sacral plexus of Ns
A: EXTERNALLY rotate the thigh when the hip joint is extended and ABDUCTS the thigh when the hip joint is flexed; assists in holding the femoral head in the acetabulum

33
Q

sciatic nerve relationship to piriformis m

A
  • piriformis hypertonicity can cause sciatica
  • due to chemical reaction that irritatees peroneal fibers of the sciatic N
  • referred pain down posterior thigh
34
Q

what nerve plexus are around the sacrum?

A

lumbar (L1-4)
sacral (L5-S4)
coccygeal (S5-coccygeal N)

35
Q

What ganglia are around the sacrum?

A

inferior mesenteric
superior hypogastric
ganglion impar

36
Q

What posterior landmarks are used to identify sacral dysfunction?

A

PSIS, AIIS, ILA

37
Q

What is form closure?

A

the specific properties of the articular sufraces of the SIJ
-requires proper size, shape and attitude of the articulating sufraces

due to how the joints fit together

38
Q

What is force closure?

A

compression produced by body weight, muscle action, and ligament force

due to gravity and loading forces, muscles, fascia, and ligaments

39
Q

What is the self-locking mechanism a result of?

A

form closure and force closure

40
Q

What postural muscles may effect SI joint stability?

  • posteriorly
  • ventrally
A

posteriorly

  • latisimus dorsi
  • thoracolumbar fascia
  • gluteus maximus
  • ITB

ventrally

  • oblique abdominal m
  • internal obliques
41
Q

Therapeutic exercise and osteopathic treatment for the ______ and _____ helps patients with low back pain and SI syndrome to be significant.

A

core lumbar

pelvic musculature

42
Q

What is physiologic sacral motion?

A
  • may occur around one or more axes motion
  • 2 oblique axes named according to the side of the body toward which the superior end of the oblique axis is located
  • motion about an oblique axis may actually result through motions occurring about a vertical, AP, and transverse sacral axis (combo of rotation and sidebending)
43
Q

What are the sacral axes of motion?

A

ST (respiratory) axis
MT (postural) axis
IT (pelvic/ilial) axis

44
Q

What is the ST (respiratory) axis?

A

transverse axis about which the sacrum moves during the respiratory cycle and inherently due to PRM in OCMM. It passes from side to side through the articular processes posterior to the point of attachment of the dura at S2.

45
Q

What is the MT (postural) axis?

A

functional transverse axis of nutation and counternutation in the standing position, passing through the anterior aspect of S2

46
Q

What is the IT (pelvic/ilial) axis?

A

functional transverse axis at the level of S3 through the inferior articular surface, and represents the axis for movement of the ilia on the sacrum

47
Q

When there is lumbar flexion there is sacral ____

A

extension because as the posterior structures of the lumbar spine move anteriorly, the sacral base moves posteriorly

48
Q

When there is lumbar extension, there is sacral ____

A

flexion because as the posterior structures of the lumbar spine move posteriorly, the sacral base moves anteriorly

49
Q

Where are the sacral base and apex during sacral extension?

A

base is posterior

apex is anterior

50
Q

Where are the sacral base and apex during sacral flexion?

A

base is anterior

apex is posterior

51
Q

What are the static landmarks for the 4-point sacral evaluation?

A

sacral sulcus depth

ILAs

52
Q

What is the load and spring sacral evaluation?

A

sacral sulcus

  • direct force towards the ipsilateral greater trochanter –> lateral and inferior
  • restricted motion = ipsilateral backward torsion, ipsilateral unilateral or bilateral sacral extension

ILA

  • direct your force towards the ipsilateral ASIS
  • restricted motion = contralateral forwards torsion, ipsilateral unilateral or bilateral sacral flexion
53
Q

What types of movement is the sacrum on the ileum?

A

gliding movement

  • flexion/extension, rotation, sidebending, and gliding upward and downward
  • downward force transmitted from teh lumbar region glides the sacrum downward and causes nutation
  • traction applied from above the LS junction glides the sacrum upwards and causes counternutation
54
Q

rotation applied through the lumbar spine causes the sacrum to ___ towards the ___ side and sidebend toward the ____ side

A

rotate
ipsilateral
contralateral

55
Q

sidebending applied through the lumbar spine causes the sacrum to ____ toward the ___ side.

A

sidebend
ipsilateral

rotation direction during sidebending may be inconsistent

56
Q

Which has a greater ROM: flexion/extension, upward/downward, rotation, sidebending

A

flexion/extension and upward/downward

57
Q

What way does the ileum move in relation to the sacrum?

A

the same direction, but to lesser degree

58
Q

When may an intraosseous strain originate?

A

during the time the neural arch, costal elements, and body centers are fusing

59
Q

What is a restricted inferior occipital condylar part related to?

A

a lowered sacral base on that side

60
Q

Describe cranial base and sacral movement in “nervous” infants

A

49% had flexion cranial base and 76% had a fixed extension sacrum

61
Q

What is lumbarization?

A

a transitional segment in which the first sacral segment becomes like an additional lumbar vertebra articulating with the second sacral segment

62
Q

What is sacralization?

A
  1. incomplete separation and differentiation of teh 5th lumbar vertebra L5 such that it takes on characteristics of a sacral vertebra
  2. When transverse processes of the L5 are atypically large, causing pseudoarthrosis with the sacrum and/or ilia referred to as batwing deformity if bilateral

OS II (4 decks)

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