Exam 3- Arthrology of the Vertebral Column Flashcards
What is the Latin term for joint?
arthron
What is the study of joints called?
arthrology
What is the Latin term for a “tightly bonded together condition”?
syndesmosis
What material was responsible for the “tightly bonded together condition” in the joint?
dense fibrous connective tissue, a ligament
What is the study of ligaments called?
syndesmology
What protein fiber is the dense connective primarily composed of?
collagen fibers which give it a whitish color
Besides collagen, what other proteins are ligaments composed of?
elastin fibers which can give a yellowish tinge to the ligament
What are the examples of the typical syndesmosis from the vertebral column?
most of the ligamentous joints of the vertebral column and the ligamentous sacro-iliac joints
What are the characteristics of an (amphiarthrosis) symphysis?
limited motion, medial plane location, support ligaments both anterior and posterior to the joint, more permanent in longevity than synchondrosis and they occur between bones developing by endochondral ossification
What are the four consistent features of synovial (diarthrosis) joints?
articular or fibrous capsule, synovial membrane, articular cartilage and synovial fluid
What are examples of intracapsular and extracapsular ligaments?
Intracapsular ligaments: cruciate ligaments of the knee
Extracapsular ligaments: collateral ligaments of the knee
What is the generic function of ligaments?
stimulate reflex contraction of muscles around the joint
What are the common characteristics of type I articular receptors?
located in the superficial layer of the fibrous capsule, resemble Ruffini endings, most numerous in cervical zygapophyses and they monitor the joint “at rest”
What are the characteristics of type II articular receptors?
located in deeper strate of the fibrous capsule, resemble Pacinian corpuscles, most numerous in the cervical spine and monitor the joint during normal range of motion
What is the location of type III articular receptors?
collateral and intrinsic ligaments of many joints, they were not thought to be present along vertebral column
What is the function of type III articular receptors?
they monitor the joint during extreme motion or beyond normal range of motion
What are the characteristics of type III articular receptors?
present in collateral and intrinsic ligaments, resemble Golgi tendon organs, not initially observed along the vertebral column and monitor extreme joint motion
What is the function of type IV articular receptors?
nociceptive, they monitor pain
Type IVa articular receptors would be present in what locations?
fibrous capsule, articular fat pads or adventitia of blood vessels
Type IVb articular receptors would be present in what locations?
accessory ligaments in general, dense in the posterior longitudinal ligament of the spine
Type IV articular receptors are absent in what part(s) of the synovial (diarthrosis) joint?
synovial membrane, articular cartilage and synovial menisci or intra-articular discs
Articular fat pads are most numerous in what location along the vertebral column?
lumbar zygapophyses
Condensed fibrous connective tissue or fibrocartilage projections of the synovial membrane are called?
synovial menisic or intra-articular discs
Intra-articular discs are a feature of what joints examples?
temporomandibular, sternoclavicular, acromioclavicular and radio-ulnar joints
Synovial, menisci are a feature of what joint examples?
femur-tibia articulation, cervical zygapophyses and lumbar zygapophyses
What are the specific functions of type A synovial cells?
are phagocytic
What is the specific function of type B synovial cells?
secrete proteinaceous substances and hyaluronic acid
What is the primary function of bound glycosaminoglycans in articular cartilage?
form a network for water retention
Cartilage is able to change shape due to compression, a characteristic known as
deformation
What is implied when cartilage is said to have elastic properties?
cartilage can deform and returns to original volume rapidly, a time independent property
What is implied when cartilage is said to have viscoelastic properties?
cartilage can deform but returns to original volume slowly, a time dependent property
What are the properties of synovial fluid?
it is yellow-white, viscous, slightly alkaline and tastes salty
Synovial fluid consist of what specific chemical groups?
fats, salts, albumins, and hyaluronate
Which substance in synovial fluid was first thought to be responsible for its viscosity and lubricating behavior?
hyaluronate
What substance of synovial fluid has been proposed to be responsible for its viscosity and lubricating behavior?
lubricin
What are examples of synovial plane (diarthrosis arthrodial) joints?
most zygapophyses of the vertebral column:
intercarpal, carpometacarpal and intermetacarpal joints of the hand; intercuneiform, tarsometatarsal and intermetatarsal joints of the foot
What are examples of synovial hinge (diarthrosis ginglymus) joints?
humero-ulnar joint of the elbow and interphalangeal joints of the fingers and toes; temporomandibular joint
Diarthrosis ginglymus joints are commonly called ____ joints based on action.
synovial hinge
Diarthrosis trochoid joints are commonly called ____ joints based on action
synovial pivot
What are the examples of synovial pivot (diarthrosis trochoid) jonts?
median atlanto-axial joint and proximal radio-ulnar joint
What is shared morphological characteristic of diarthrosis trochoid joints?
an osseous pivot point and an osteo-ligamentous ring
What is a common name for the diarthrosis sellar joint?
synovial saddle joint
What are examples of synovial saddle (diarthrosis sellar) joints?
carpometacarpal joint of the thumb, talocrural joint of the ankle and the calcaneocuboid joint of the foot
What is an example of a modified synovial saddle/diarthrosis sellar joint?
the joint of Luschka in the cervical spine
What are examples of diarthrosis condylar joints?
temporomandibular joint and femur-tibia joint of the knee
What are examples of diarthrosis ellipsoidal joints?
radiocarpal joint of the wrist metacarpo-phalangeal joints of the hand, metatarsal-phalangeal joints of the foot and the atlanto-occipital joint of the vertebral column
Which synovial joint classifications are now often interchanged in textbooks?
ellipsoidal and condylar synovial joints
What are the common ligaments of the vertebral column?
those ligaments commonly found between vertebral couples from C2/C3 to L4/L5
Identify the common ligaments of teh vertebral column
anterior longitudinal ligament, intervertebral disc, posterior longitudinal ligament, ligamentum flavum, capsular ligament, interspinous ligament, ligamentum nuchae, supraspinous ligament and intertransverse ligament
What is the maximum number of common ligaments identified with a vertebral couple?
eight
What is the number of true intervertebral discs identified in the adult?
twenty-three
In the adult, which vertebral levels will demonstrate a true intervertebral disc?
those between C2 and S1 inclusive
What is the cervical nucleus pulposus composed of?
fibrocartilage
What is the consequence of non-aggregated glycosaminoglycans in the lumbar nucleus pulposus?
the nucleus pulposus will lose water under deformation conditions
What cell is associated with the nucleus pulposus until about age eleven?
notochord cells
Which type of collagen is dominant in the nucleus pulposus?
collagen type II
What is the organizational pattern for collagen fibers in the nucleus pulposus?
they are irregularly oriented and randomly scattered
What is unusual about the cervical annulus fibrosus?
it lacks any lamellar or layered organization
What is the appearance of the cervical annulus fibrosus?
a horse-shoe with the anterior margin thick and the lateral margins tapering to the uncinate processes; the posterior margin is thin
What compensates for the thinness of the posterior part of the cervical annulus fibrosus?
posterior longitudinal ligament
What is the organization of the lumbar annulus fibrosus?
it has 12-14 concentric cylindrical lamellae
Why is the posterior part of the lumbar annulus fibrosis more susceptible to rupture, herniation, prolapse, or protrusion?
the posterior margin of each lamellus is thin and the posterior longitudinal ligament is also less developed
What is the consequence of aggregated glycosaminoglycans in the lumbar annulus fibrosus?
the annulus fibrosus will retain water under deformation conditions
Which type of collagen is dominant in the annulus fibrosus?
collagen type I
What is the organizational pattern for collagen fibers in the annulus fibrosus?
they are parallel with one another in a single lamellus and angled
What is the organization of collagen fibers between lamellae?
collagen fibers will be angled in the opposite direction such that a spiral- counterspiral organization is observed
What is the average angle of collagen fibers within the annulus fibrosis?
they average 50 to 60 degrees
What cell type is associated with the annulus fibrosus?
fibroblast and fibrocyte
What is the thickest part of the cartilage end plate?
around the periphery
What is the thinnest part of the cartilage end plate?
the central part, over the nucleus pulposus
What is the principal type of collagen fiber within the cartilage end plate?
the type II collagen fiber
What is the direction of collagen fibers within the cartilage end plate?
collagen fibers are aligned anterior to posterior
What is the earliest indicator of intervertebral disc pathology or degeneration?
changed in the histology of the cartilage end plate
What part of the intervertebral disc is innervated?
the outer lamellae of the annulus fibrosus
What are the types of receptor endings in the intervertebral disc?
nociceptors and proprioceptors
What is the relationship between size of the intervertebral disc and receptor endings?
the larger the disc, the greater the variety of receptor endings
What is the proposed function of receptor ending density in the anterior part of the intervertebral disc?
they provide feedback during extension
What are the sources of innervation of the intervertebral disc?
the sinu-vertebral nerve (sinus vertebral nerve, recurrent meningeal nerve), fibers from the ventral primary ramus, fibers from the white ramus communicans, fibers from the paradiscal ramus communicans, fibers from the gray ramus communicans
What is innervated by the recurrent meningeal/sinu-vertebral/sinus vertebral nerve?
the outer lamellae of the annulus fibrosus at the posterior part of the intervertebral disc, the posterior longitudinal ligament and dura mater plus vessels and connective tissue of the epidural space
What innervates the annulus fibrosus at the lateral part of the intervertebral disc?
fibers from the ventral primary ramus, fibers from the white ramus communicans, fibers from the paradiscal ramus communicans, fibers from the gray ramus communicans
What is the name given to the white ramus communicans which becomes embedded within the annulus fibrosus of the intervertebral disc?
the paradiscal ramus communicans
How does the intervertebral disc help shape the spine?
the anterior height is greater than the posterior height tin the cervical and lumbar region this creating a lordotic or anterior curve
What is the popular theory of intra-abdominal cavity pressure and intervertebral disc response to weight bearing?
increasing the intra-abdominal cavity pressure will diminish the amount of resistance the intervertebral disc needs to generate by up to 50%
What vertebral levels will the anterior longitudinal ligament attach to?
those between occiput and S3 inclusive and traditionally indicated
What is the lowest extent of the anterior longitudinal ligament based on recent studies?
L3
What is the function of the anterior longitudinal ligament?
it brakes or limits dorsi-flexion or hyperextension of the vertebral column
What was ossification of the anterior longitudinal ligament in the lumbar region identified as?
Forestier’s Disease
Anterior longitudinal ligament ossification in the lumbar region is now identified as _____?
Diffuse Idiopathic Skeletal Hyperstosis or DISH
What vertebral levels will the posterior longitudinal ligament attach to?
those between C2 and S3 inclusive are traditionally indicated
What is the function of the posterior longitudinal ligament?
it brakes or limits flexion of the vertebral column
Where is ossification of the posterior longitudinal ligament most commonly identified?
the cervical spine with an 80% incidence
What is the clinical sign of posterior longitudinal ligament ossification in the cervical spine?
a loss of hand and finger dexterity
What is the incidence of posterior longitudinal ligament ossification in the thoracic and lumbar spine?
about 10% at the thoracic and 10% at the lumbar spine
What is the clinical sign of posterior longitudinal ligament ossification in the lumbar spine?
faltering gait
What is the gender, age, and ethnic bias associated with ossification of the posterior longitudinal ligament?
it is greater in males over 50 and has a higher incidence in the Japanese
What is the acronym for ossification of the posterior longitudinal ligament?
OPLL
At one time ossification of the posterior longitudinal ligament was an example of what condition?
Diffuse Idiopathic Skeletal Hyperostosis or DISH
What vertebral levels will the ligamentum flavum be attached to?
those between C2 and S1 inclusive are traditionally indicated
What is the histology of the ligamentum flavum?
it is formed primarily with elastic fibers, which are yellow in appearance
What is the name given to the ligamentum flavum based on appearance and histology?
it is a yellow elastic ligament
What is the function of the ligamentum flavum?
it brakes or limits flexion of the vertebral column
What is now thought to be a major function of the ligamentum flavum?
it is an early prime factor in extension of the vertebral column
Where is ossification of the ligamentum flavum most commonly identified?
the thoracic spine or thoracolumbar transition zone
What is the acronym for ossification of the ligamentum flavum?
OLF
What is the relationship between the capsular ligament and mobility?
the more lax/loose the capsular ligament is, the greater the motion of the joint
What regions of the vertebral column demonstrate the greatest laxity of capsular ligaments?
the cervical and lumbar regions
The capsular ligament may blend with which other ligament?
the ligamentum flavum
What muscle will blend with the capsular ligament posteriorly?
the multifidus
What is the pattern of innervation for the zygapophysis capsular ligament?
it is typically innervated by 3 spinal nerves
If the zygapophyseal capsular ligament is not significantly involved in restricting motion what is its’ function?
it is probably involved in proprioceptive feedback to the muscles stabilizing the vertebral couple during movement
What vertebral levels will the interspinous ligament be attached to?
those between C2 and S1 inclusive are traditionally indicated
What is the status of the human interspinous ligament compared with other common ligaments?
they are poorly developed as ligaments although collagen fibers are present
What is the status of the cervical interspinous ligament?
it is lacking, poorly developed, or simply considered the deep anterior part of the ligamentum nuchae
What is the status of the thoracic interspinous ligament?
it is narrow and elongated reflecting the shape of the spinous process
What is the status of the lumbar interspinous ligament?
it is broad and thick with three layers identified from anterior to posterior
What is the classic function of the interspinous ligament?
it brakes or limits flexion of the vertebral column
What is now though to be a major function of the interspinous ligament?
it is more likely a proprioceptive transducer for the spinal reflex
What is the name given to the superficial layer of the ligamentum nuchae?
the funicular layer or part
What is the name given to the deep layer of the ligamentum nuchae?
the lamellar layer or part
What are the attachment sites for the superficial layer of the ligamentum nuchae?
the external occipital protuberance, external occipital crest, and spinous tubercle of C7
What are the attachment sites for the deep layer of the ligamentum nuchae?
the posterior tubercle of the posterior arch of C1, and spinous tubercles between C2 and C6 inclusive
What is the histological make-up of the ligamentum nuchae in quadrupeds?
it is a yellow elastic ligament
What is the histological make-up of the human ligamentum nuchae?
it is a yellow elastic ligament, but has more collagen fibers than in quadrupeds
What is the primary yellow elastic or elastic ligament of the spine?
the ligamentum flavum
What is the classic function of the human ligamentum nuchae?
it brakes or limits flexion of the cervical spine
What will the supraspinous ligament be attached to?
the spinous tubercles along the vertebral column from C7 to sacrum
What is the termination level inferiorly for the supraspinous ligament according to current literature?
primarily at L4 (73%); between L4 and L5 (5%)
Where is the supraspinous ligament said to be best developed?
in the lumbar spine
What is the classic function of the human supraspinous ligament?
it brakes or limits flexion of the spine
What is now thought to be a major function of the supraspinous ligament?
it is a proprioceptive transducer for the spinal reflex
What is the status of the cervical intertransverse ligament?
is it said to be paired with an anterior and a posterior intertransverse ligament present
What is the status of the thoracic intertransverse ligament?
it is said to blend with muscles of the deep back; a separate ligament may not exist
Where in the vertebral column is the intertransverse ligament best developed?
in the lumbar spine
What part of the lumbar intertransverse ligament covers the intervertebral foramen?
the ventral slip
What part of the intertransverse ligament in the lumbar spine divides the body wall into an anterior muscular compartment and a posterior muscular compartment?
the dorsal slip
What is the classic function of the anterior atlanto-occipital ligament?
it brakes or limits “extension” of the skull over the cervical spine
What is the classic function of the posterior atlanto-occipital ligament?
it brakes or limits axial rotation, flexion and perhaps lateral bending of the skull on atlas
What amount of flexion - extension is accommodated by the atlanto-occipital joint?
about twenty-five degrees
What amount of axial rotation is accommodated by the atlanto-occipital joint?
about three to eight degrees one side axial rotation
What amount of lateral bending is accommodated by the atlanto-occipital joint?
about five degrees
Which motion is best accommodated by the atlanto-occipital joint?
flexion-extension
What is the function of the transverse atlantal ligament?
it is the primary stabilizer of the atlanto-axial joint restricting the distance of C2 from the anterior arch of C1
What movements are facilitated at the median atlanto-axial joint?
flexion-extension, rotation and telescoping (superior-inferior gliding)
What is the ADI?
the Atlanto-Dental Interspace, a radiographic distance between the surfaces of the anterior bursa of the median atlanto-axial joint
The ADI is observed between which surfaces?
the fovea dentis of C1 and the facet for fovea dentis of C2
What is the ADI of children compared with that of adults?
about 4.5 mm in children; a range of 2-3 mm or about 2.5 mm in adults
What are the characteristics of the capsular ligament of the lateral atlanto-axial joint?
it is lax or loose and demonstrates a meniscoidal fold within the joint cavity
What are the attachment sites for the accessory atlanto-axial ligament?
the base of the odontoid process and vertebral body of axis to teh tubercle for the transverse atlantal ligament on the lateral mass of C1; a superior continuation may attach on the occipital bone just behind that of the alar ligament
What are the degrees of movement facilitated at the atlanto-axial joint?
about 20 degrees flexion - extension, 40 degrees one side axial rotation, and 5 degrees of lateral bending
The occiput-C1-C2 joint complex accounts for what percent of all cervical axial rotation?
about 60%
Embryologically, what forms the apical ligament of the dens or the apical dental ligament?
the notochord
What ligament attaches to the posterolateral part of the odontoid process of C2 and to surfaces on the medial border of the occipital condyle or as far anterior as the anterolateral margin of the foramen magnum?
the alar ligament
What is the function of the alar ligament?
together they function to resist axial rotation
For the cervical spine below C2, what is the range of flexion - extension?
about 90 degrees or about 18 degrees per couple
For the cervical spine below C2, what is the range of one side lateral bending?
about 50 degrees or about 10 degrees per couple
For the cervical spine below C2, what is the range of one side axial rotation?
about 33 degrees or about six degrees per couple
For the cervical spine below C2, what is the range of motion allowed for each type of joint motion identified?
90 degrees flexion-extension, 50 degrees one side lateral bending and 33 degrees one side axial rotation
Based on current literature, what common ligaments are absent at the lumbosacral joint?
ligamentum nuchae, interspinous ligament and supraspinous ligament
Which ligaments replace the intertransverse ligament at the lumbosacral joint?
the iliolumbar ligament and lumbosacral ligament
What are the attachment sites for the lumbosacral ligament?
the sacral ala and ventrolateral surface of sacrum attach to the transverse process of L5
What are the attachment sites for the iliolumbar ligament?
the iliac crest is attached to the transverse process of L5
What muscle is intimately attached to the superior iliolumbar ligament?
quadratus lumborum
Which vertebral couple of the lumbar spine has the greatest range of motion?
L5/S1
Which range of motion is greatest for all lumbar vertebral couples?
flexion-extension
Which range of motion is least for L1-L5 vertebral couples?
one side axial rotation
Which range of motion is least for the L5/S1 vertebral couple?
one side lateral bending
What are the attaching sites for the anterior sacrococcygeal ligament?
the vertebral bodies from about S3 to Co2-Co3
List, in order, from cranial to caudal the ligaments forming the anterior boundary of the spinal column
anterior atlanto-occipital ligament, anterior atlanto-axial ligament, anterior longitudinal ligament, and the anterior sacrococcygeal ligament
What are the attaching sites for the deep posterior sacrococcygeal ligament?
the vertebral bodies from about S3 to Co1
Which gender has greater unevenness of the auricular surface of the sacro-iliac joint?
males
What pathological or age-related modifications of the sacro-iliac joint may occur?
degenerative arthrosis and ankylosis
What does degenerative arthrosis mean?
a condition of degeneration of the joint, sometimes referred to as degenerative joint disease (DJD)
What does ankylosis mean?
a condition of fibrous adhesion occurs within the joint
What is the age and surface bias associated with degenerative arthrosis of the sacro-iliac joint?
age 40, the iliac auricular surface
What is the age and gender bias associated with ankylosis of the sacro-iliac joint?
age 50 and male bias particularly in African American males
What age and gender bias is associated with ossification of the anterior sacro-iliac ligament?
age 40 and male bias
Which is the strongest of the sacro-iliac ligaments?
the interosseous sacro-iliac ligament
What are the attachment sites of the interosseous sacro-iliac ligament?
at the sacral tuberosity and the iliac sulcus
What passes between the layers of the interosseous sacro-iliac ligament?
dorsal rami from the sacral spinal nerves
What ligament blends with the lateral border of the long posterior sacro-iliac ligament?
the sacrotuberous ligament
What is formed by the continuation of the sacrotuberous ligament along the ischial ramus?
the falciform process
What separates the greater sciatic and lesser sciatic foramina?
the sacrospinous ligament
What is the function of the sacrospinous and sacrotuberous ligament?
they oppose the upward tilt of the sacral apex and resist the rotation of sacrum between the innominate bones
