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MSK 2 > L/S Anatomy > Flashcards

L/S Anatomy Flashcards

1
Q

describe the body of a typical lumbar vertebrae

A
  1. weight-bearing component of structure
  2. “kidney shaped”
  3. shell of cortical bone, inner cancellous bone
  4. ring apophysis: ring on periphery of caudal and cranial surfaces
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2
Q

describe typical lumbar pedicles

A
  1. short (stout) w/very thick walls
  2. transmit force from posterior components to vertebral bodies
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3
Q

describe typical lumbar transverse processes

A
  1. project posteriolaterally
  2. mammillary processes on superior articular process
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4
Q

describe the orientation of typical lumbar spinous process

A

nearly horizontal

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5
Q

what is the function of lamina?

A

protect neural structures

transmit forces from articular and spinous processes

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6
Q

where is the pars interarticularis and what is it’s function?

A
  1. between S/I articular processes
    • oblique from lateral border of lamina to upper border
  2. transmits forces from horizontal pedicle to vertically oriented lamina

*subject to frx

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7
Q

describe foramen in the lumbar spine

A
  1. Spinal
    • triangular
    • larger than T/S but smaller than C/S
    • L1 contains conus medullaris
    • L2-5 contain cauda equina and spinal meninges
  2. Intervertebral
    • superior notches are shallow
    • inferior are deep
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8
Q

list the ligaments at the lumbar spine

A
  1. posterior longitudinal
  2. anterior longitudinal
  3. Interspinous
  4. Supraspinous
  5. Ligamentum flava
  6. Iliolumbar ligament
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9
Q

describe the posterior longitudinal ligament

A

blends w/IV discs

spans from posterior body of C2 to sacrum

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10
Q

describe the anterior longitudinal ligament

A

thick and pearly

mostly attaches to margins of anterior vertebral bodies

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11
Q

describe the interspinous ligament

A

attaches superior to inferior SP

paired-filled w/fat

likely proprioceptive in nature

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12
Q

describe the supraspinous ligament

A

attaches to tips of spinous processes

less common in lower lumbar region

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13
Q

describe the ligamentum flava

A

attach adjacent lamina

thick, yellow, elastic

checks flexion motion

medial edge fuses w/contralateral ligament (closes vertebral canal)

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14
Q

describe the Iliolumbar ligament

A

spans from transverse process of L5 to anteriomedial surface of ilium

prevents anterior slipping of L5 on sacrum

resists motions of rotation, flexion, and lateral flexion

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15
Q

List musculature involved with the lumbar spine

A
  1. Back muscles
    • erector spinae
    • multifidus
    • interspinales
    • intertransversarii
  2. QL
  3. Abdominal muscles
    • TrA
    • Internal oblique
    • External oblique
  4. Psoas major
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16
Q

what is the role of the erector spinae?

what is their innervation?

A
  1. group of muscles important for stabilization of curvature
    • compressive loads
  2. innervation: spinal nerves
    • medial branch of posterior ramus
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17
Q

what is the largest and most medial of the lumbar muscles?

A

Multifidus

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18
Q

describe the multifidi

A
  1. spinotransverse group
  2. several fasicles w/varied origin/insertion
  3. stabilizer against shear during rotation
  4. eccentrically control flexion of vertebrae inter-segmentally when oblique abdominal muscles rotate the spine
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19
Q

how do multifidi impact zygophyseal joints?

A

they insert onto zygophyseal joint capsules

they pull the capsules out of the way during extension or during motions when the joints are closing down

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20
Q

what is the origin and insertion of the external oblique?

A
  1. originates lateral ribs 5-12
  2. attaches to:
    • inguinal ligament
    • linea alba
    • ASIS
    • iliac crest
    • pubic tubercle
21
Q

what is the action/role of the external oblique?

A
  1. Bilateral activation
    • vertebral column flexor
    • posterior rotation of pelvis
  2. Unilateral activation
    • trunk lateral flexors
22
Q

what is the origin and attachments of the internal oblique?

A
  1. attaches to:
    • inguinal ligament
    • thoracolumbar fascia
    • iliac crest
    • pubic crest
    • TrA
    • costal cartilage of ribs 7-9
23
Q

what is the role/actions of the internal oblique?

A
  1. assists w/postural control during static and dynamic activities
  2. bilateral activation
    • vertebral column flexor
    • respiration
  3. unilateral activation
    • trunk rotator
24
Q

what is the origin and attachments of the TrA?

A
  1. Origins:
    • inguinal ligament (lateral third)
    • anterior 2/3 iliac crest (inner lip)
    • thoracolumbar fascia
    • lower (6) costal cartilages (along w/diaphragm)
  2. Upper and middle fibers run transversely around trunk
    • blend w/fascia surrounding rectus abdominis
  3. Lower fibers insert on pubic crest w/internal oblique
25
Q

what is the role/actions of the TrA?

A
  1. lumbar and SIJ stabilizer
  2. anticipatory activation prior to movement/perturbation
26
Q

what is the origin and attachment of the QL?

what is it’s innervation?

A
  1. Origin → iliac crest and TP of spine
  2. Insertion → 12th rib and spine (TP of lumbar vertebrae and lateral body of T12)
  3. Innervated by ventral rami T12-L2
27
Q

what is the origin and insertion of the psoas major?

what is it’s innervation?

A
  1. Origin → TP of lumbar vertebrae, T12-L5 bodies and IV discs
  2. Insertion → tip of lesser trochanter
  3. Innervated by ventral rami L1-L2
28
Q

what is the role of psoas major?

A
  1. lumbar stabilizer
    • compressive loading on lumbar spine
  2. lateral flexion moment on spine w/unilateral activation
  3. important hip flexor
29
Q

what are the components of IV discs?

A
  1. nucleous pulposus
  2. annulus fibrosis
  3. vertebral endplates

*there is no clear boundary between nucleus and annulus

30
Q

describe the nucleus of IV discs

A
  1. semifluid, mucoid material
  2. cartilage cells and irregularly arranged collagen fibers in semifluid ground matrix
  3. deformed, but not compressed (fluid)
    • transmits pressure in all directions if deformed
31
Q

describe the structure of annulus

A
  1. weight is 60-70% water
  2. dry weight
    • 50-60% collagen → type I (resist tensile loading)
    • 20% proteoglycans
    • 10% elastic fibers
  3. 10-20 lamellae arranged in concentric rings
32
Q

how does the thickness compare at different portions of the annulus?

A
  1. thicker toward center of disc, anteriorly, and laterally
  2. posteriorly the lamellae are thinner, finer, and more tightly packed
33
Q

describe the structure of the vertebral endplate

A
  1. layers (0.6-1 mm thick)
    • hyaline cartilage → toward vertebral body
    • fibrocartilage → toward nucleus
  2. covers superior/inferior vertebral body
  3. covers nucleus, but not entire annulus
  4. encircled by ring apophasis
34
Q

what is the function of IV discs?

A
  1. allow movement between vertebral bodies
  2. transmit loads between adjacent vertebral bodies
  3. absorbs and stores energy
35
Q

how does the IV disc respond with compression?

A

annulus deforms and fluid “squeezed” from annulus

annulus braces the disc

nucles may be deformed, but not compressed

36
Q

how does the IV disc absorb and store energy?

A
  1. collagen fibers of annulus stretch and store energy
  2. attenuates speed of force transmission between vertebral bodies
  3. elastic recoiling w/unloading = transmission of force to nucleus
37
Q

T/F: IV discs are poorly vascularized

A

TRUE for the inner discs

there is some at the endplates at the outermost layers of annulus

38
Q

describe the articulations of zygophyseal joints

A

inferior articular process of a vertebra with the superior process of adjacent vertebra

  • superior facets = faces posteriomedially
  • inferior facet = faces anteriolaterally
39
Q

what is the function of facet joints in the lumbar spine?

A

guide and limit movement of spine

40
Q

what type of joints are facet joints?

A

synovial

41
Q

since facet joints are synovial, describe their structure

A
  1. synovial lining that is surrounded by a capsule
  2. 2 layers:
    • outer collagen
    • inner elastic fibers
  3. thick dorsally, reinforced by multifidi
  4. ballons superiorly and inferiorly
  5. tiny foramen in inferior and superior poles
  6. articular cartilage → 2 mm in height
42
Q

T/F: the surface of facet joints are all the same

A

FALSE

they vary in shape and orientation

may be flat, or inferior facet may be concave

43
Q

T/F: facet joints have fibro-adipose meniscoids

A

TRUE

they transmit loads and protect articular cartilage that would otherwise be exposed during motion

(they are also highly innervated)

44
Q

describe the kinematics of lumbar flexion

A
  1. Facet joints
    • forward sliding of Inf articular process on superior process by 5-8 mm
    • “opening” of joints bilaterally, compression at end-range flexion
  2. Disc
    • compression of annulus anteriorly
    • stretching of annulus posteriorly
  3. Lateral foramen
    • “open” (widen) as motion increases
45
Q

describe the kinematics of lumbar extension

A
  1. Facet joints
    • downward movement of inferior articular process
    • compression of joint
    • joints become weight-bearing
  2. Disc
    • stretching of annulus anteriorly
  3. Lateral foramen
    • “close” (narrow) as motion increases
46
Q

describe the general trends for mean ranges for lumbar kinematics

A
  1. Mid to upper L/S get a good amount of lateral flexion
  2. Not much axial rotation throughout
  3. Less extension generally speaking
  4. Combined flexion and extension results in range from 13-16
47
Q

what coupling motions occur at facet joints w/lateral flexion in the lumbar spine?

A

most commonly coupled w/extension

though variable in direction

48
Q

what coupling motions occurs at facet joints with rotation in the lumbar spine?

A

coupling w/flexion and extension motions variable

49
Q

describe lateral flexion and axial rotation coupling trends in the lumbar spine

A
  1. L1/L2-L3/L4 → contralateral rotation and lateral flexion motions
  2. L4/L5 → variable
  3. L5/S1 → ipsilateral lateral flexion and rotation motions

MSK 2 (20 decks)

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