Exam 3: Arthrology Of Vertebral Column Flashcards
“Tightly bonded together condition”
Syndesmosis
Material responsible for “Tightly bonded together condition” in the joint
Dense fibrous connective tissue, a ligament
The study of ligaments
Syndesmology
Protein fiber that makes dense connective tissue
Collagen fibers (give it a whitish color)
Proteins making up ligaments (besides collagen)
Elastin fibers (give a yellowish tinge to the ligament)
Classification of first cartilage joint to appear developmentally
(Amphiarthrosis) synchondrosis
Classification of primary cartilage joints
(Amphiarthrosis) synchondrosis
Characteristics of a (amphiarthrosis symphysis)
Limited motion, median 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
4 features of synovial (diarthorsis) joints
- Articular or fibrous capsule
- Synovial membrane
- Articular cartilage
- Synovial fluid
Accessory ligaments that accompany/ support capsular ligament
Intracapsular and extracapsular ligaments
Type II articular receptor characteristics
Located in deeper strata of the fibrous capsule
Resemble Pacinian corpuscles
Most numerous in the cervical spine
Monitor the joint during normal range of motion
Type III articular receptor characteristics
Present in collateral and intrinsic ligaments
Resemble Golgi tendon organs
Not observed along the vertebral column
Monitor extreme joint motion
Function of type IV articular receptors
Nociceptive, they monitor pain
Locations of Type IVa articular receptors
Fibrous capsule, articular fat pads or adventitia of blood vessels
Locations of type IVb articular receptors
Accessory ligaments in general, dense in the posterior longitudinal ligament of the spine
3 classifications of synovial membrane
Articular, vaginal and bursal synovial membrane
3 modifications of articular synovial membrane
- Synovial villi
- Articular fat pads or Havesian glands
- Synovial menisci and intra-articular discs
Function of modifications of articular synovial membrane
Aid in spreading synovial fluid
Function of synovial villi
Increase the surface of synovial membrane available for secretion- absorption phenomena
Agings effect on synovial villi number
Increase with age
Articular fat pads are mostly numberous
Along the lumbar zygapophyses
Condensed fibrous connective tissue or fibrocartilage projections of the synovial membrane are called ______
Synovial menisci or intra-articular discs
Synovial menisci are features of what joints
Femur-tibia aarticulation, cervical zygapophyses, lumbar zygapophyses
Functions of type A synovial cells
Phagocytic
Function of Type B synovial cells
Secrete proteinanceous substances and hhyaluronic acid
Common functin of type A and B synovial cells
Formation and absorption of synovial fluid
Primary constituents of articular cartilage
Water, cells, collagen type II fibers and a proteoglycan gel
Primary function of bound GAGs in articular caartilage
Forms a network for water retention
Cartilage that has elastic properties
Cartilage can deform and returns to original volume rapidly, a time independent property
Viscoelastic properties
Cartilage can deform but returns to original volume slowly, a time dependent property
Properties of synovial fluid
Yellow-white
Viscous
Slightly alkaline
Tastes salty
Substance in synovial fluid first thought to be responsible for viscosity and lubrication
Hyaluronate
Substance of synovial fluid proposed to be responsible for viscosity and lubrication
Hyaluronate
Classifications of synovial joints (diarthroses)
- based on number of articulation surfaces
Simple and compound synovial joints
Complex synovial joint (diarthrosis)
Within the simple or compound joint, the articulating surfaces are separated by an articular disc (intra-articular disc) or miniscus
Morphological classifications of nonaxial synovial joints
Plane (diarthrosis arthrodial)
Morphological classifications of synovial joints that are uniaxial
Hinge (diarthrosis ginglymus) and pivot (diarthrosis throchoid)
Morphilogical classifications of synovial joints classified as biaxial
Bicondylar
Condylar
Ellipsoidal
Saddle
Common ligaments of vertebral column (9)
ALL, IVD, PLL, ligamentum flavum, capsular lig, interspinous, ligamentum nuchae, supraspinous, intertransverse
Maximum number of common ligs identified with a vertebral couple
8
Why are there 9 common ligs but only 8 attaches at any specific vertebral couple
Ligamentum nuchae takes over for supraspinous
Common ligament that will attach to vertebral arch
Ligamentum flavum
Common ligaments that will attach to spinous apophysis
Interspinous, supraspinous and ligamentum nuchae
Number of true IVDs in the adult
23
In the adult which vertebral levels will demonstrate a true IVD
C2 — S1 inclusive
What percent of vertebral column length is contributed by IVD
20-25%
Length of IVD contribution to vertebral column length
7 inches
Percent of IVD height contribution to length of each region of vertebral column
Cervical — 22-25%
Thoracic — 20%
Lumbar — 33%
What is the IVD histologically composed of
Cells
Collagen fibers
Hydrated proteoglycan gel
What is cervical nucleus pulposus composed of
Fibrocartilage
What is the water concentration in lumbar nucleus pulposus at birth and after 30
Birth — 88%
Thirty — 70%
What is consequence of non-aggregated glycosaminoglycans in the lumbar nucleus pulposus
It will lose water under deformation conditions
What cell is associated with the nucleus pulposus until about age 11
Notochord cells
What cells are associated with the mature nucleus pulposus
Reticulocyte-fibroblast and chondroblast
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 appearance of cervical annulus fibrosus
Horse-shoe w/ anterior margin thick and lateral margins tapering to uncinate processes; posterior margin is thin
What compensates for the thinness of posterior part of cervical annulus fibrosus
PLL
What is organization of lumbar annulus fibrosus
12-14 concentric cylindrical lamellae
Why is posterior part of lumbar annulus fibrosus more susceptible to rupture, herniation, prolapse or protrusion
Posterior margin of lamellus is thin
PLL is less developed
What is water concentration in the lumbar annulus fibrosus at birth and after 30
Birth —78%
30 — 70%
Which type of collagen is dominant in annulus fibrosus
Collagen type I
What is the organizational pattern for collagen fibers in annulus fibrosus
Parallel w/ one another in a single lamellus and angled
What is organization of collagen fibers between lamellae
Collagen fibers will be angled in opposite direction
Spiral — counterspiral organization is observed
What is the average angle of collagen fibers within the annulus fibrosus
They average 50-60 degrees
What cell type is associated with annulus fibrosus
Fibroblast and fibrocyte
What is thickest part of cartilage end plate
Around periphery
What is principal type of collagen fiber within the cartilage end plate
Type II collagen fiber
What is direction of collagen fibers within cartilage end plate
Collagen fivers are aligned anterior to posterior
What is attachment site for collagen fibers of inner lamellae of annulus fibrosus
Cartilaginous end plate
Earliest indicator of intervertebral disc pathology or degeneration
Changes in the histology of the cartilage end plate
Part of intervertebral disc that is innervated
Outer lamellae of the annulus fibrosus
Types of receptor endings in the intervertebral disc
Nociceptors and proprioceptors
Relationship between size of the intervertebral disc and receptor endings
The larger the disc, the greater the variety of receptor endings
Proposed function of receptor ending density in the anterior part of the intervertebral disc
They provide feedback during extension
Sources of innervation of 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 innervates the annulus fibrosus at the posterior part of the intervertebral disc
the recurrent meningeal/ sinu-vertebral/ sinus vertebral nerve
What innervates the annulus fibrosus at the anterior part of the intervertebral disc
fibers from the ventral primary ramus
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
Name given to the white ramus communicans which becomes embedded within the annulus fibrosus of the intervertebral disc
paradiscal ramus communicans
How does the intervertebral disc help shape the spine
anterior height is greater than the posterior height in the cervical and lumbar regions thus 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%
Part of the intervertebral disc that allows distribution of weight over a maximum surface area
the nucleus pulposus
Vertebral levels the ALL attaches to
those between occiput and S3 inclusive are traditionally indicated
Lowest extend of the ALL based on recent studies
L3
Function of ALL
brakes or limits dorsi-flexion or hyperextension of the vertebral column
Ossification of the ALL in the lumbar region is
Forestier’s Disease
ALL ossification in lumbar regions identified as
Diffuse Idiopathic Skeletal Hyperstosis or DISH
Vertebral levels the PLL attaches to
those between C2 and S3 inclusive
Innermost layer of the PLL is called ______
the perivertebral ligament
Function of PLL
brakes or limits flexion of the vertebral column
Ossification of the PLL commonly identified
at the cervical spine with an 80% incidence
Clinicial sign of PLL ossification in the cervical spine
a loss of hand and finger dexterity
Incidence of PLL ossification in thoracic and lumbar spine
10% in thoracic
10% in lumbar
Clinical sing of PLL ossification in the lumbar spine
faltering gait
Gender, age, and ethnic bias associated with ossification of the PLL
males, over 50 and a higher incidence in Japanese
Acronym for ossification of the PLL
OPLL
Ossification of PLL used to be an example of what
Diffuse Idiopathic Skeletal Hyperstosis or DISH
Vertebral levels that the ligamentum flavum attaches to
those between C2 and S1 inclusive
Relationship of the ligamentum flavum to the vertebral foramen
forms the posterior boundary of the spinal canal
Histology of the ligamentum flavum
formed primarily with elastic fibers, yellow in appearance
Name given to the ligamentum flavum based on appearance and histology
yellow elastic ligament
Function of Liagmentum flavum
brakes or limits flexion of the vertebral column
Major function of the ligamentum flavum
an early prime factor in extension of the vertebral column
Most common location of ossification of the ligamentum flavum
thoracic spine or thoracolumbar transition zone
Acronym for ossification of the ligamentum flavum
OLF
Relationship between the capsular ligament and mobility
the more lax/loose the capsular ligament is, the greater the motion of the joint
Regions of the vertebral column that demonstrate the greatest laxity of capsular ligaments
cervical and lumbar regions
Capsular ligament may blend with
the ligamentum flavum
Muscle that blends with the capsular ligament posteriorly
multifidis
If the zygapophysis capsular ligament is not significantly involved in restricting motion what is its function
probably involved in proprioceptive feedback to the muscles stabilizing the vertebral couple during movement
vertebral levels that the interspinous ligaments attach to
those between C2 and S1 inclusive
Status of the cervical interspinous ligament
it is lacking, poorly developed, or simply considered the deep anterior part of the ligamentum nuchae
Status of thoracic interspinous ligament
narrow and elongated reflecting the shape of the spinous process
Status of lumbar interspinous ligament
it is broad and thick with three layers identified from anterior to posterior
Classic function of the interspinous ligament
brakes or limits flexion of the vertebral column
Major function of the interspinous ligament
more likely a proprioceptive transducer for the spinal reflex
The ligamentum nuchae attaches to
the external occipital protuberance, external occipital crest, the posterior tubercle of the posterior arch of C1, and spinous tubercles between C2 and C7 inclusive
Name given to the superficial layer of the ligamentum nuchae
Funicular layer or part
Name given to the deep layer of the ligamentum nuchae
lamellar layer or part
Attachment sites for the superficial layer of the ligamentum nuchae
the external occipital protuberance, external occipital crest, and spinous tubercle of C7
Attachment sites for the deep layer of the ligamentum nuchae
posterior tubercle of the posterior arch of C1, and spinous tubercles between C2 and C6 inclusive
Histological make-up of the ligamentum nuchae in quadrupeds
yellow elastic ligament
Histological make-up of the human ligamentum nuchae
it is a yellow elastic ligament, but has more collagen fibers than in quadrupeds
Primary yellow elastic or elastic ligament of the spine
ligamentum flavum
Classic function of the human ligamentum nuchae
brakes or limits flexion of the cervical spine
Attachments for supraspinous ligament
spinous tubercles along the vertebral column from C7 to sacrum
Termination level inferiorly for the supraspinous ligament
primarily at L4 (73%); between L4 and L5 (5%)
Where is the supraspinous ligament best developed
lumbar spine
Classic function of the human supraspinous ligament
brakes or limits flexion of the spine
Major function of the supraspinous ligament
proprioceptive transducer for the spinal reflex
Intertransverse ligament attachments
transverse tubercles and transverse processes of adjacent vertebrae along the vertebral column from C1 to L5
Status of the cervical inter transverse ligament
said to be paired with an anterior and a posterior inter transverse ligament present
Status of the thoracic inter transverse ligament
said to blend with muscles of the deep back; a separate ligament may not exist
status of the lumbar inter transverse ligament
well developed with two parts identified, a ventral slip and a dorsal slip
What part of the lumbar inter transverse ligament covers the intervertebral foramen
the ventral slip
what part of the inter transverse ligament the lumbar spine divides the body wall into an anterior muscular compartment and a posterior muscular compartment
the dorsal slip
Characteristics of the capsular ligament of the atlanto-occipital joint
said to be loose, thin, and composed of collagen fibers
What other joint space does the atlanto-occipital joint communicate with
the posterior bursa of the median atlanto-axial joint
Attachment sites of the anterior atlanto-occipital ligament
it is attached to the upper margin of the anterior arch of C1 and to the anterior margin of the foramen magnum
Median thickening of the anterior atlanto-occipital ligament
anterior longitudinal ligament
Classic function of the anterior atlanto-occipital ligament
brakes or limits “extension” of the skull over the cervical spine
Classic function of the Posterior atlanto-occipital ligament
brakes or limits axial rotation, flexion, and perhaps lateral bending of the skull on atlas
amount of flexion-extension accommodated by the atlanto-occipital joint
25 degrees
amount of Lateral bending accommodated by the atlanto-occipital joint
5 degrees
Motion best accommodated by the atlanto-occipital joint
flexion-extension
Which atlanto-axial joint is identified as a synovial pivot (diarthrosis arthrodia)
median atlanto-axial joint
Names given to the synovial joint spaces of the median atlanto-axial joint
anterior bursa and posterior bursa
Joint surfaces of the median atlanto-axial joint at the anterior bursa
fovea dentis of C1 and the facet for fovea dentis of C2
Joint surfaces of the median atlanto-axial joint at the posterior bursa
groove for the transverse atlantal ligament of C2 and the transverse atlantal ligament
Perpendicular extensions from the transverse atlantal ligament will form what ligament
the vertical crus ligament
Part of the vertical crus ligament that may be absent
inferior crus ligament
What ligament is formed by the transverse atlantal ligament and its perpendicular extension
the cruciate ligament or cruciform ligament
Histological feature that forms on the anterior surface of the transverse atlantal ligament
fibrocartilage at the surface of the ligament articulating with C2
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
Movements facilitated at the median atlanto-axial joint
flexion-extension, rotation, and telescoping (superior-inferior gliding)
What is the ADI
Atlanto-Dental Interspace, a radiographic distance between the surfaces of the anterior bursa of the median atlanto-axial joint
ADI is observed between which surfaces
fovea dentis of C1 and facet for fovea dentis of C2
ADI of children compared to adults
about 4.5 mm in children; a range of 2-3mm or about 2.5 mm in adults
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
Attachment sites for the accessory atlanto-axial ligament
the base of the odontoid process and vertebral body of axis to the 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
Degree 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
Occiput-C1-C2 joint complex accounts for what percent of all cervical axial rotation
About 60%
Occipital—C2 region of the spine
Craniovertebral junction
What embryological structure forms the apical ligament of the dens or apicodental ligament
The notochord
Ligament that attaches to the posterolateral part of the odontoid process of C2, medically to occipital condyle, anteriorly to the anterolateral margin of the foramen magnum
Alar ligament
Function of alar ligament
Function to resist axial rotation
Attachment sites for superficial layer of the membrana tectoria (tectorial membrane)
Posterior part of the inferior epiphyseal rim and vertebral body of C2 to the capsular ligament of the atlanto-occipital joint and cranial dura of the posterior cranial fossa
Attachment sites for deep layer of the membrana tectoria (tectorial membrane)
Posterior part of the inferior epiphyseal rim and vertebral body of C2 to the periosteum behind the cruciate ligament attachment site on the anterior rim of the foramen magnum
Range of flexion-extension for cervical spine below C2
90 degrees or 18 degrees per couple
Range of one side lateral bending for cervical spine below C2
About 50 degrees or about 10 degrees per couple
Range of one side axial rotation for cervical spine below C2
About 33 degrees or about 6 degrees per couple
Intra-articular ligament is identified on which ribs?
Ribs 2-9
Attaching surfaces of the intra-articular ligament
Intra-articular crest of the head of the rib and the IVD
Vertebrae with a synovial plane (diarthrosis arthrodia) costotransverse joint
Typically T1-T10
Ribs with a synovial plane (diarthrosis arthrodia) costotransverse joint
Typically rib 1- rib 10
Superior costotransverse ligament is absent on what rib
The first rib
Ligaments that attach to the neck of the 12th rib
Superior costotransverse ligament from T1 and the lumbocostal ligament from L1
Inferior costotransverse ligament does not attach on what vertebra?
T12
Ligament that “fills” the costotransverse foramen
Inferior costotransverse ligament
Vertebra that doesn’t attach to the lateral costotransverse ligament
T12
Vertebral couples of the thoracic spine with greatest motion
T11/T12 and T12/L1
Range of motion that is greatest in lower thoracic vertebral couples
Flexion-extension
Range of motion that is least for lower thoracic vertebral couples
One side axial rotation
Ligaments that replace the intertransverse ligament at the lumbosacral joint
Iliolumbar ligament and lumbosacral ligament
Attachment sites for the lumbosacral ligament
Sacral ala and ventrolateral surface of sacrum attach to the transverse process of L5
Attachment sites for iliolumbar ligament
Iliac crest is attached to the transverse process of L5
Muscle intimately attached to the superior iliolumbar ligament
Quadratus lumborum
Current ligament from the iliolumbar ligament complex that represents the iliolumbar ligament of classical descriptions
Superior iliolumbar ligament
Ligament from iliolumbar ligament complex that represents the lumbosacral ligament of classical descriptions
Inferior iliolumbar ligament
Attachment sites for accessory iliolumbar ligament
Transverse process of L4 and the iliac crest
Vertebral couple of lumbar spine that has greatest range of motion
L5/S1
Range of motion that is greatest for all lumbar vertebral couples
Flexion-extension
Ranch of motion that is least for L1-L5 vertebral couples
One side axial rotation
Range of motion that is least for the L5/S1 vertebral couple
One side lateral bending
Ligaments forming the anterior boundary of the spinal column (cranial to caudal)
Anterior atlanto-occipital ligament, anterior atlanto-axial ligament, anterior longitudinal Ligament and the anterior sacrococcygeal ligament
Ligaments forming the posterior boundary of the spinal canal (cranial to caudal)
Posterior atlanto-occipital ligament, posterior atlanto-axial ligament, ligamentum flavum and the superficial posterior sacrococcygeal ligament
Auricular surface of the sacrum is composed of
True articular cartilage, a modification of hyaline cartilage
Auricular surface of the ilium is composed of
Articular cartilage, interspersed with fibrocartilage
Superficial appearance of Auricular surfaces of the sacro-iliac joint by age 15
Sacrum develops a sacral groove while the ilium develops an iliac ridge
Gender that has greater unevenness of the Auricular surface of the sacro-iliac joint
Males
Pathological or age-related modifications of the sacro-iliac joint that may occur
Degenerative arthrodia and ankylosis
Ankylosis
A condition of fibrous adhesion occurs within the joint
Age and surface bias associated with degenerative arthrosis of the sacro-iliac joint
Age 40, iliac Auricular surface
Age and gender bias associated with ankylosis of the sacro-iliac joint
Age 50 and male bias particularly in African American males
Age and gender bias associated with ossification of the anterior sacro-iliac ligament
Age 40 and male
Strongest of the sacro-iliac ligaments
Interosseous sacro-iliac ligament
Attachment sites of interosseous sacroiliac 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
Ligament that blends with the lateral border of the long posterior sacro-iliac ligament
Sacrotuberous ligament
What is formed by the continuation of the sacrotuberous ligament along the ischial ramus
Falciform process
Separates the greater and lesser sciatic foramina
Sacrospinous ligament
Function of the sacrospinous and sacrotuberous ligaments
Oppose the upward tilt of the sacral apex and resist the rotation of sacrum between the innominate bones
