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OS II > Introduction to Sacrum Lecture (Test 1) > Flashcards

Introduction to Sacrum Lecture (Test 1) Flashcards

1
Q

Introduction to sacrum

A

1) NAME means “Sacred”
- Greek and Latin Origin
- Because of its Density, Sacrum last bone to Decay
- Due to its Location, Protects Reproductive System

2) The Sacrum is the BASE of the Spine, end of the Line
3) With the Attached COCCYX- the Sacrum is the Foundation of the Vertebral Column

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2
Q

Bony Anatomy

A

1) Pelvis is 3 Bones: 2 Innominates and 1 sacrum

2) Sacrum is 5 Vertebrae fused into Single Bone
- S1 to S5
- LUMBARIZATION of the Sacrum = When S1 and S2 do NOT FUSE

3) Sacrum shaped like an Inverted Triangle

4) Sacrum lies in OBLIQUE PLANE, running Anterior to Posterior, Superior to Inferably respectively
- Wedged in an Anterior Direction

5) Superior Aspect = BASE
6) Inferior Aspect = APEX
7) Anterior Surface is CONCAVE, Posterior Surface is CONVEX with Spinous Tubercles

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3
Q

Bony Anatomy Cont 1

A

1) Three rows of Spinous Tubercles
- Medial Rows/ Crest = Fusion of Sacral Articular Processes
- Lateral Rows/ Crests = Fusion of Sacral Transverse Processes

2) The Lateral rows Inferiorly end in a CURVE called the INFEROLATERAL ANGLE (ILA)

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4
Q

Bony Anatomy Cont 2

A
  • Scrum contains the Sacral Canal, which contains the CAUDA EQUINA and Four Bilateral SACRAL FORMINA for the Ventral and Dorsal Rami of the Sacral Spinal Nerves S1-S4
  • SACRAL HIATUS = Defect near the Apex, where the Lamina failed to Close
  • ** This is where the Sacral Epidural Nerve BLOCKS are performed
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5
Q

Bony Anatomy Cont 3

A
  • COCCYX is made up of 4 Vertebrae, some fused and some not
  • ** Co1 = Co4
  • Lowest part of the Spinal Column
  • Coccyx attaches to Sacral Apex vis the SACROCOCCYGEAL JOINT
  • GANLGION IMPAR = Where Right and Left Sympathetic Chains join, rests on Anterior Aspect of the Coccyx
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6
Q

Male vs Female Pelvis

A

FEMALE:

  • Sacrum tilted BACK
  • Ilia Spread WIDER

MALE:

  • Sacrum tilted FORWARD
  • Ilia CLOSER Together
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7
Q

Palpatory Bony Landmarks

A

1) SACRAL BASE
2) SACRAL SULCI: Two Bilateral Palpable grooves MEDIAL and Slightly Super to the PSIS
3) INFEROLATERAL ANGLE (ILA): Two Bony curvatures on either Side and just Superior to the Apex of the Sacrum
4) Greater Trochanters
5) Iliac Crest
6) PSIS
7) Ischial Tuberosities

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8
Q

Ligamentous Anatomy

A
  • Sacrum suspended between the Innominates by 3 True Ligaments and 3 Accessory Ligaments

TRUE PELVIC LIGAMENTS:

1) Anterior Sacroiliac Ligaments
2) Interosseous Sacroiliac Ligaments
3) Posterior Sacroiliac Ligaments

ACCESSORY PELVIC LIGAMENTS:

1) Sacrotuberous Ligament
2) Sacrospinous Ligaments
3) Iliolumbar Ligaments

***True Ligament attach Bone to Bone, Accessory Ligaments attaches to another Ligament, Tendon, or Fascia

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9
Q

Anterior Sacroiliac Ligament

A
  • Flat Bands

- Attach from 3RD SACRAL SEGMENT to PREAURICULAR Surface of the Ilium

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10
Q

Interosseous Sacroiliac Ligament

A
  • Massive Bands attaching MEDIAL SACRAL CRESTS to the ILIAC TUBEROSITIES
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11
Q

Posterior Sacroiliac Ligament

A
  • Thicker with MULTIPLE Layers
  • Connects PSIS to 3rd and 4th SACRAL SEGMENTS
  • Close anatomical Relationship with the ERECTOR SPINAE MUSCLES!!!!!!!!
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12
Q

Sacrotuberous Ligament

A
  • Attaches SACRUM to ISCHIAL TUBEROSITY
  • Gluteus Max and (Tendon of) Biceps Femurs attachment
  • Has friend Ligament: SACROSPINOUS LIGAMENT!!!!!
    a) These Ligaments cross over one another, Creating the Greater and Lesser SCIATIC FORAMEN

b) Both STABILIZE ANTERIOR MOTION, Preventing POSTERIOR SUPERIOR ROTATION (Around Transverse Axis)

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13
Q

Sacrospinous Ligament

A
  • Attaches SACRUM to Ischial SPINE
  • Has a friend Ligament: SACROTUBEROUS LIGAMENT
    a) These Ligaments cross over one another over a Space, Creating the Greater and Lesser Sciatic Foramen

b) Both STABILIZE ANTERIOR MOTION, Preventing POSTERIOR SUPERIOR ROTATION (Around Transverse Axis)

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14
Q

Iliolumbar Ligament

A
  • Attaches 4th and 5th LUMBAR Vertebra to ILIAC CREST
  • Stabilizes POSTERIO MOTION, Restricting Anterior Motion of L4/ L5!!!!!!!!!!!!!!!!!
  • The Upper part/ Blends in with the SACROILIAC LIGAMENT
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15
Q

Muscular Anatomy

A
  • Muscles acting on or through the Sacrum and Pelvis

PRIMARY INTRINSIC Muscle of the Pelvic Diaphragm:

1) LEVATOR ANI GROUP
a) Pubococcygeus Muscle

b) Puborectalis Muscle
c) Iliococcygeus Muscle
2) Coccygeus Muscle

SECONDARY- Muscles considered to have PARTIAL ATTACHMENT to the TRUE PELVIS
1) Rectus Abdominis Muscle

2) Transverse Abdominis Muscle
3) Internal and External Oblique
4) Quadrates Lumborum
5) Also muscle of the Posterior, Anterior, and Medial Compartments of the Lower Extremity

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16
Q

Dural Anatomy

A

DURA MATER
- Layers of FIBROUS Connective Tissue

  • Tension in this Connective Tissue has a Direct Effect on the Cranial and Sacral Bone Motion which it attaches to

DURAL Connections between CRANIUM and SACRUM
1) Cranial Dura Attachments: FORAMEN MAGNUM, C1, C2

2) Sacral Dural Attachment: S2

17
Q

Sacral Forces

A
  • End of the Vertebral Column: Allows the TRANSFERENCE of Forces from Above down through the Pelvis, as well as Forces up from the Ground to the Pelvis and Trunk

1) FORCE CLOSURE: Holding an Object by Pressure on the sides
- Created by Muscles, Ligament, and Fascia surrounding the SI Joint

  • Force on each side that equal each other and they hold something up

2) FORM CLOSURE: “Stacking” or the use of a ROMAN ARCH as a Self Supporting Structure
- The Sacrum acts as the Keystone of the Arch, being WEDGED between the Iliums

  • Concept of an Arch and the Sacrum acts as the main piece of the Arch
18
Q

Sacral Forces

A
  • Angle of the SI Joint, Wedges the Sacrum in an Anterior Direction
  • Significant Pelvic Forces pushing POSTERIORLY
  • Significant DORSAL SI Ligaments help Counteract the Major Pelvic Forces pushing POSTERIORLY
19
Q

Sacral Axes

A
  • 3 Transverse Axes
  • 2 Oblique Axes
  • 1 Vertical Axis
  • 1 Anterior-Posterior Axis
20
Q

Sacral Axes (Transverse Axes)

A

TRANSVERSE AXES OF MOTION:

1) SUPERIOR (“SI Axis”)
- “Respiratory” - axis for Respiratory Motions as well as NUTATION and COUNTERNUTATION from SBS Flexion/ Extension

  • At the level of the Articular Processes of S2
  • At the attachment of the Dura

2) MIDDLE (“S2 Axis”)
- “Postural” or “Sacroiliac”: Axis for Flexion/ Extension in Sitting and Standing

  • At the level of the Body of S2

3) INFERIOR (“S3 Axis”)
- “Iliosacral”: Axis for Rotation of the Iliums on the Sacrum

  • At the level of the Inferior Pole of the Lower Sacral Articulation
21
Q

Sacral Axes (Oblique Axes)

A

OBLIQUE AXES of MOTION: Where Dynamic/ Torsional Motion occurs

1) RIGHT OBLIQUE AXIS
- Diagonal Axis

  • Named for CEPHALIC Side
  • Runs from SUPERIORLY Right to INFERIORLY Left

2) LEFT OBLIQUE AXIS
- Diagonal Axis

  • Named for the Cephalic Side
  • Runs SUPERIORLY on the LEFT to INFERIORLY on the RIGHT
22
Q

Sacral Motions

A

1) RESPIRATORY: Superior Transverse Axis
2) POSTURAL: Middle Transverse Axis
3) INHERENT: Superior Transverse Axis
4) DYNAMIC: Oblique Axes

23
Q

Respiratory Motion

A
  • Around Superior Transverse Axis
  • With INHALATION, Sacral BASE moves POSTERIORLY, while Sacral APEX moves ANTERIORLY
    (DECREASED Lumbar LORDOSIS)
  • With EXHALATION, Sacral BASE moves ANTERIORLY, while Sacral APEX moves POSTERIORLY
    (INCREASED Lumbar LORDOSIS)
  • Think of the Sacral BASE moving back to let the AIR IN, then moving FORWARD in order to PUSH the AIR OUT
24
Q

Postural Motion

A
  • In Standing and Seated Positions
  • Around MIDDLE TRANSVERSE AXIS
  • Flexion and Extension corresponding to Anatomical Nomenclature, same terminology used with the Spine

FLEXION: Forward Bending
- Sacral BASE moves ANTERIOR, Sacral APEX moves POSTERIOR

EXTENSION: Backward Bending
- Sacral BASE moves POSTERIOR; APEX moves ANTERIOR

25
Q

Inherent Motion

A
  • Occurs around SUPERIOR TRANSVERSE AXIS
  • What is SBS?
    a) SPENOBASILAR JOINT/ SYNCHODROSIS/ SYMPHYSIS (SBS)

b) Where two CRANIAL BONES Come Together
c) Main Hinge around which Cranial Motion OCCURS

26
Q

Cranial Motion- Inherent

A
  • Remember those Dural Connections between the CRANIUM and the SACRUM….
  • Motion is TRANSFERRED form the SBS to the Sacrum through those DURAL ATTACHMENTS
27
Q

Cranial Motions- Inherent Cont

Weird one!!!!

A
  • Influences by the DURA, the Sacral BASE moves POSTERIORLY and the APEX moves ANTERIORLY during CRANIOSACRAL FLEXION!!!!!!!!
  • The Sacral BASE moves ANTERIORLY and the APEX moves POSTERIORLY during CRANIOSACRAL EXTENSION!!!!!!!!!!!

**Craniosacral Flexion/ Extension is VERY Different than Postural Flexion/ Extension

**Craniosacral Flexion/ Extension is named for the Position of the Sacrum when the SBS is in Flexion and Extension

28
Q

Sacral Motion- Inherent

A

NUTATION:
- Nodding Forward

  • Sacral BASE moves ANTERIOR, Sacral APEX moves POSTERIOR

**Occurs with Craniosacral/ SBS EXTENSION

COUNTERNUTATION:
- Sacral BASE moves POSTERIOR, Sacral APEX moves ANTERIOR

**Occurs with Craniosacral/ SBS FLEXION

29
Q

Dynamic Sacral Motion

A
  • Occurs when Walking
  • Occurs around OBLIQUE AXES
  • Sacral Base moves FORWARD on one Side, the the other side around the Oblique Axes
  • AS this occurs, the INNOMINATE are CONSTANTLY Rotating in the OPPOSITE Directions to One Another
    ( One Rotated ANTERIORLY, the other POSTERIORLY)
30
Q

Palpatory Landmarks

A

ANTERIOR:

  • Iliac Crest
  • Greater Trochanter
  • ASIS
  • Pubic Symphysis

POSTERIOR:

  • PSIS
  • SACRAL BASE
  • SACRAL SULCI
  • INFERIORLATERAL ANGLES (ILAs)
  • Ischial Tuberosity

OS II (8 decks)

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