Exam 1: Hard Tissue and Cartilage Flashcards
One of the most dynamic and metabolically active tissues
Bone
Bone remains active throughout
Life
Bone is highly ___ which means it has excellent capacity for ____
Vascular; self-repair
Bone can also alter its properties/configuration to respond/adapt to
Changes in mechanical demand
Examples of changes in bone properties
Bone density changes due to disuse
Shape changes during fracture/surgical healing
Cortical bone is ____ whereas trabecular bone is ____
Stiffer/brittle; tougher
Bone is anisotropic which means that it exhibits distinct mechanical properties when
Loaded along various axes
Because its structure differs in transverse and longitudinal directions
Cortical bone can withstand greater stress in ___ > ___ > ___
Compression > tension > shear
Cortical bone can tolerate _____ > ____
Longitudinal loads > transverse loads
Bone fractures can be produced by
Single load — exceeds ultimate strength
Repeated lower-magnitude loads
Wolff’s Law
Bone has ability to remodel to meet mechanical demands placed on it
Bone remodeling is due to _____ NOT ____
Responses to forces; degeneration
Bone is ____ when not needed
Resorbed
Load/demand can be placed on bone by _____ leading to _____
Muscle activity or gravity; bone deposition
Cartilage is essentially _____
Nonvascular
Cartilage is composed of
Collagen, chondrocytes and ground substance
3 types of cartilage
Articular
Hyaline
Fibrocartilage
Articular cartilage is ____ and subject to ______
Viscoelastic; creep and relaxation
During joint articulation, forces at the joint surface vary from
0 to >10x body weight
Cartilage is nearly ____ which is unlike any man-made material
Frictionless
Interfacial wear is caused by either
Adhesion or abrasion
Fatigue wear is caused by
Repetition of high loads over short period
Repetition of low loads over extended period
Articular cartilage has only limited capacity for
Repair and regeneration
The magnitude of stress sustained by articular cartilage is determined by
Total load and how it is distributed over articular surface contact area
Any intense stress concentration will play primary role in
Tissue degeneration
How many IVD in an adult
23 (numeric name for segment above)
Discs constitute ____% of entire height of vertebral column
20-33%
3 parts of the disc
Nucleus pulposus
Annulus fibrosus
Cartilaginous end plates
Disc to VB ratio
Height of IVD compared to height of VB
Greater disc:VB ratio means
Greater spinal segmental mobility
Disc:VB ratio is greatest in ____ spine
Cervical (2:5)
Disc:VB ratio is least in the ____ spine
Thoracic (1:5)
Disc:VB ratio in lumbar spine
1:3
Nucleus pulposus is a _____ with fine fibrous strands
Mucoprotein gel
Nucleus pulposus is ____% water
70-90%
- 90 at birth
- 80 at 20yrs
- 70 old age
Bigger discs have ___ capacity to change size
More, because of creep
Lumbar nuclei fill ___% of total disc area and are located ____
30-50%; located more posterior
Cervical annulus is minimal on _____ and only a ____ in back
Lateral borders (uncinates reinforce)
Thin strip in back
Annulus fibrosus is fibrous tissue in _____
Concentric laminated bands
Concentric laminated bands appear to cross obliquely to each other at an angle of _____ to VB
30 degrees
Annular fibers are firmly attached to _____
Cartilaginous endplates in inner zone
Peripheral zone fibers attach to VB via
Sharpey’s fibers
____ and ___ reinforce annular fibers
ALL and PLL
The PLL ____ from cervicals to lumbars, only covering ___% of central portion of lower lumbar discs
Narrows; 50%
Weakest area of annulus
Posterolateral aspect
Most likely spot for disc herniation in lumbar spine
Posterolateral aspect
Outer portion of cartilaginous end plate is ____
Impermeable
Diffusion of nutrient occurs in ___ portion of cartilaginous end plate
Central
The end plate supplies ____ with most or all of its nutrition
Nucleus pulposus
How many blood vessels go directly to disc
NONE
Annular fibers get blood supply from
Adjacent soft tissues
Nucleus pulposus get blood supply from
VBs
IVD is an ______ and _____ tissue which means it undergoes rapid degeneration and has limited _____
Avascular; aneural; self repair
During degeneration discs become _____ and _____
Vascularized and innervated by sensory fibers
Overnight what happens to disc
Fluid volume inc
Disc expands
Result of disc expansion overnight
Inc resistance to forces
During the daytime fluid exits the disc which lead to ___ tension of ligs and ___ ROM
Dec tension; inc ROM
**lumbar flexion inc up to 50%
_____ of nucleus pulposus results in ____ of annular fibers
Compression; tension
Flexion results in compression of ____ and tension on ____
Anterior disc; posterior disc
With age and biomechanical stress exposure chemical nature of disc changes to
Become more fibrous
As a result of disc becoming more fibrous ______ is diminished
Flexibility
And injured disc ___ more than a healthy
Deforms
Hysteresis is the
Absorption or dissipation of energy by a distorted structure
Hysteresis varies with
Age
Level
Repetitive load
Relation to level and hysteresis
Less in lower T and upper L
Hysteresis ____ when successively loaded
Decreases
Nucleus resists _____ forces and pushes out against _____
Compressive; annular fibers
Annular fibers resist ___ forces
Tensile
3 types of loads imposed on the disc
Compressive
Tensile
Shear
Examples of compressive loads
Gravity Muscle co-contraction Flexion Extension Lateral bend
Examples of tensile stresses
Flexion
Extension
Lateral bend
Traction
Examples of shear stresses
Axial rotation of torso
A — P
L — R
The disc is more susceptible to failure in area of _____ not ____
Tension; compression
Mechanical failure occurs first in ______ and causes _____
Cartilaginous endplate; nuclear herniation
Nuclear herniation AKA
Schmorl’s node
Compressive loads in extension are transmitted through the ____ leading to ___
Facets; capsular injuries
Compressive loads applied with torque can produce
Circumferential tears in annular fibers of IVD
90% of resistance to torque of a motion segment is provided by
IVDs
____ provides majority of torsional resistance
Annulus
Axial rotation can strain the annulus in torsion but ______ protect it
Zygapophyseal joints
Biomechanical behavior is dependent upon
State of degeneration
State of degeneration is dependent upon ____
Age of the disc
Most degenerated segments in spine
L3/L4
L4/L5
L5/S1
4 stages/types of disc herniation
Nuclear herniation
Bulge/prolapse
Extrusion
Sequestration
Nuclear herniation
Nucleus pulposus migrates outward
Stays within confines of IVD
Bulge/prolapse
Migration outside confines of IVD but NO rupture of outer annular fibers
Extrusion
Outer annular fibers tear, nucleus pulposus move into epidural space
Sequestration
Discal fragments break loose from IVD, float freely in CSF
Disc herniation usually occurs w/ full flexion or lateral bending because of
Excessive forces through PLL
________ also associated w/ disc herniation
Repeated loading
Common postural habits that inc lumbar flexion
Crossing legs
Squatting down on heels
Lifting light weights
Rapid lunging
Contraindication to adjust patient w/ herniated disc?
NO
Adjunct treatment option for disc herniation
Axial traction
- 70-85% effective
McKenzie extension