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DPT 702: Biomechanics > Lecture 6: Axial skeleton Test 2 > Flashcards

Lecture 6: Axial skeleton Test 2 Flashcards

1
Q

function of spinal ligaments

A

limit motion
help maintain spinal curves
protect spinal cord and nerve roots

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2
Q

name all the ligaments found in the spine

A

ligamentum flavum
interspinous
supraspinous
inter transverse
ALL
PLL
apophyseal joint capsule

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3
Q

where can you find the ligaments flavum

A

anterior surface on lamina to posterior surface of one below

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4
Q

describe the characteristics of the ligaments flavum

A

yellow ligament
80% elastin, 20% collagen
thickest in lumbar region

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5
Q

describe the resistance and absorption given by ligaments flavum

A

constant modest resistance throughout wide range of flexion with 35% elongation

absorbs some intervertebral compression forces near end flexion

small but constant compression/stabilization in neutral

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6
Q

when is the fail range for the ligamentum flavum

A

ligament fails at 70% beyond its fully slackened length

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7
Q

describe the interspinous ligament

A

fill spaces between adjacent spinous processes

deep with more elastin bend with LF

superficial with more collagen blend with SS

fiber orientation varies by level

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8
Q

what is the function of the interspinous ligament

A

resists separation of adkjacent spinous processes (resists flexion)

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9
Q

describe the supraspinous ligament

A

attaches between tips of spinous process

more collagen in areas that resist flexion more strongly

very well developed in the cervical region: cranially it is the ligamentum nuchae

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10
Q

function of the supraspinous ligament

A

resist separation of the adjacent spinous processes (resist flexion)

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11
Q

what is the ligamentum nuchae (x5)

A

tough bilaminar fibroelastic tissue that attaches to cervical processes and external occipital protuberance

serves as a midline attachment for many muscles (i.e. trap, splenius capitis/cervicis)

gives some passive tension for extension support

can make palpation more difficult

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12
Q

describe inter transverse ligaments

A

poorly defines

thin, membranous

taut in colateral lateral flexion

slightly tight towards flexion

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13
Q

describe anterior longitudinal ligament (ALL); what does it look like, where does it attach, when is it taut/slack

A

long, strong, straplike - narrow at C/S and widens as it gets lower

attaches at the basilar part of the occipital bone and goes to the entire anterior surface of the vertebral bodies and then goes to attach to the sacrum

deeper fibers blend with and reinforce discs

taut in extension and slack in flexion

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14
Q

describe the posterior longitudinal ligament; what does it look like, where does it attach, where does it sit, when is it taut

A

continuous band of connective tissue

goes entire length o posterior surfaces of all vertebral bodies from C2 to sacrum

within vertebral canal, anterior to spinal cord

deep fibers blend and reinforce posterior Side of discs

broad cranially, narrows toward lumbar

taut with flexion

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15
Q

describe capsular ligaments of apophyseal joints; where does it attach, what type of fibers/why, reinforced by what, slack/taut when

A

attach to the entire rim of the facet surfaces

blend of elastin and collagen; tough to keep integrity of joint but flexible to allow arthrokinematics

reinforced by adjacent multifidus, ligamentum flava

slack in neutral, some fibers taut in each end ROM

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16
Q

describe the significance of knowledge of the ligament related to the axis of rotation

A

gives us information about how it moves/stretches

i.e in the sagittal plane any posterior ligament will stretch in flexion and any ligament anterior will stretch in extension

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17
Q

what is Panjabi’s neutral zone

A

there is a region of intervertebral motion around a neutral position that has little restraint from the passive spinal components (i.e. there is wiggle room between the two vertebrae without passive restraint)

used to quantify the amount of segmental instability

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18
Q

how is the neutral zone affected with injury

A

if neutral zone grows with disc degeneration or ligament injury there is more laxity/instability in the spine to control and more demands are thus placed on the stabilizing systems

with injury the vertebral motion pattern changes and influences the motion of the whole spine, potentially causing more pain and hyper mobility

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19
Q

what is spinal instability

A

loss of intervertebral stiffness that can lead to abnormal and increased intervertebral motion

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20
Q

what is the passive system of control (subset of Panjabi’s control system)

A

consists of bony structures, ligaments, joint capsules, discs, and passive portion of the musculotendinous units

thought to send feedback to the neural subsystem about joint positions and challenges to stability at the passive level

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21
Q

describe the active system of control (subset of Panjabi’s systems of control)

A

composed of muscles and tendons

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22
Q

describe the neural subsystem (subsystem of Panjabi’s) and when is it compromised

A

recives/transmits info from and to the other two systems (passive and active) to manage spinal stability

neuromuscular control can be compromised in patients with low back pain and must be considered in core stabilization program

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23
Q

describe core stability in relation to the neutral zone

A

can be viewed from segmental level or whole spinal level

when neutral zone is larger than normal (thus more slide, glide, and rotation between vertebrae) the spinal segment becomes unstable

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24
Q

describe the osteological features if the cervical vertebral column

A

smallest and most mobile

transverse foramina house vertebral arteries

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25
describe the osteology of C3-C6 vertebrae
small/rectangular bodies superior/inferior surfaces = curved/notched superior portion = concave side to side with hooks (unicate processes) inferior portion - concave ant/post; joint forms between recesses forms medial wall of intervertebral foramen
26
how might nerves be "pinched" in the cervical spinal region
compression between 2 segments can impinge the greater spinal nerve i.e. If there is an impingement between C4 and C5 vertebrae this would impinge the C5 spinal nerve root (because the cervical spinal nerves exit above the respective vertebrae) ** this is also why there is a C8 spinal nerve
27
describe the other osteological features of C3-C6 (x7)
pedicles are short and curved posterior-lateral very thin laminae larger vertebral canal consecutive articular processes form a pillar with apophyseal joints facets in joints are smooth/flat superior facets face posterior/superior inferior facets face anterior/inferior
28
describe the spinous and transverse processes of C3-C6
SP = short and some are bifurcated TP= short lateral extensions with ant/post tubercles; unique to cervical spine and serve as attachments for muscles like anterior scalenes, elevator scapulae, and splenius cervicis
29
describe the important characteristics of the atlas (C1) (x6)
supports the head no body/pedicle/lamina/spinous process 2 large lateral masses joint by anterior and posterior arches (superior concave facets to support cranium) large transverse process inferior articular facets are flat/slightly concave anterior tubercle = attachment for ALL
30
describe important characteristics of the axis (C2) (x7)
large/tall body with dens (odontoid process) dens = regid vertical axis o rotation for head/atlas has superior articular processes to attach with C1 pedicles short transverse processes inferior articular processes face ant/inf bifurcated spinous process (broad/palpable)
31
describe the unique characteristics of C7
largest cervical vertebrae can have large transverse process and spinous process can have a cervical rib (brachial plexus issue) off transverse process
32
key characteristics of T2-T7 (x10)
posterior directed pedicles short/thick lamina spinous process slanted down more narrow vertical canal than cervical larger TP (posterior laterally with costal facet) superior articular facets face posterior inferior articular fastes face anterior apophyseal joints aligned in frontal plane have costal demifacets intervertebral foramina = location for spinal nerves
33
what are the atypical thoracic vertebrae
T1 = has a full costal facet (entire rib) and a Demi facet for rib 2; elongated SP T10-12 = single full costal facet
34
how is rib 1 atypical
shorter/wider than others only 1 facet superior surface marked by 2 grooves that make way for subclavian vessels
35
how is rib 2 atypical
thinner/longer than rib 1 2 articular facets on head as normal roughened area on upper surface where serratus anterior originates
36
how is rib 10 atypical
only 1 facet for corresponding vertebra (T10) *T9 does not have T10 rib reach up to it
37
how are ribs 11 and 12 atypical
no neck only contain one facet which is articulation for their corresponding vertebrae
38
what are the 3 functional components of intervertebral joints
TP/SP = mechanical levers that increase leverage of muscles/ligaments apophyseal joints = guide vertebral motion interbody joint = absorb/distribute load, greatest adhesion, axes or rotation, spacers, provide passage for nerves
39
describe the osteokinematics of intervertebral movement
movement at any one intervertebral junction is small combined motion at different joints = larger angular motion move in 3 cardinal planes axis is at/near inter body joint rotation reference point is anterior
40
describe the arthrokinematics of intervertebral joints
most facets are flat approximation (compression), seperation/gapping, gliding
41
describe apophyseal joints
24 pairs total plane joints lined with articular cartilage enclosed by synovial capsule (well innervated) acts as mechanical barricade
42
how do the orientation of facets influence kinematics
horizontally oriented favor axial rotation vertically oriented block axial rotation
43
describe the make up of an intervertebral disc
nucleus pulposus = pulplike gel mid to posterior aspect of disc; 70-90% water in youth annulus fibrosis = outer ring
44
describe the nucleus pulposus
hydraulic shock absorbing system dissipates/trasnfers loads across consecutive vertebrae gel like proteoglycans. and GAGs linked to core protein thin type II collagen, small # chondrocytes and fibroblasts (synthesizes the proteins and proteoglycans)
45
why is a disc negatively charged by nature
results from charged groups on glycominoglycan (GAG) molecules on the PGs found in the extracellular matrix of the disc
46
describe the annulus fibrosis
15-25 concentric rings of collagen fibers prevent distraction/shear/tortion 50-60% collagen (elastin in between rings of collagen that allows circumferential elasticity) entrap/encase pulposus outer layer contains disc only sensory nerves
47
describe vertebral endplates
relatively thin cartilaginous caps that cover most of the sup/inf surface of vertebral bodies surface facing disc = fibrocartilage that binds directly to collagen in AF surface facing bone calcifies cartilage- weakly affixed to bones diffusion of O2 and glucose outer rings of annulus fibrosis with vascular supply = limited healing at disc
48
what are some of the changes that take place along with the degeneration of a disc
reduced permeability = inhibited syntheses of proteoglycans less proteoglycans = less water less ability to absorb/trasnfer loads doesn't just happen with aging; also with excessive/abnormal loads
49
how is an IVD considered a "load sharing system"
biomechanics interaction between nucleus pulposa and annular rings
50
what happens to the endplates with compressible loads
push endplates inward to NP
51
describe how elastin and collahgen work to create a pressure distributer in Intervertebral discs
stretched rings of collagen and elastin create tension to resist and balance forces the forces are then uniformly transferred to the vertebral bodies once the force is gone the stretch is released and all structures return to normal
52
how are intervertebral discs viscoelastic
resist fast and strongly applied loads less resistance is given to slow or lighter compressions thus they are flexible at low loads and more rigid at higher loads
53
how does sustained, full lumbar extension affect discs
this reduces the pressure in discs and can allow water to be reabsorbed in the discs
54
describe the daily fluctuations that take place in the discs
1% height change during the day supine is low pressure and allows water to "swell" disc and "refill" during the day WB forces push water out of the disc age changes can also affect; less ability to retain water as we get older (proteoglycan reduces)
55
what might give a dx of degenerative disc disease
loss of distinction of AF and NP with imaging nuclear bulging loss of disc space **not always symptomatic or loss of function**
56
changes in discs often proceed what condition
osteoarthritis
57
what is spinal coupling
any movement of the spine in a plane is combined with an automatic and often imperceptible movement in another plane
58
what are the reasons/explanations for why spinal coupling occurs
muscle action facet alignment posture ribs stiffness curve of spine itself
59
what can you/can't you expect with spinal coupling patterns
there is varied and little consensus as to which coupling pattern is normal for different specific regions in the middle and lower cervical spine there is a more consistent pattern = lateral flexion and ipsilateral rotation
60
describe the movement of the Atlanta occipital joint
movement of the cranium on the axis convex condyles of the occiput and concave facets of the atlas 2 degrees of freedom: flexion/extension and lateral flexion
61
median joint of Atlanto-axial joint motions/characteristics
dens of C2 into the osseous ligamentous ring horizontal stability is given by anterior arch of atlas and transverse ligament 2 synovial cavities pivot joitn
62
describe the pair of apophyseal joints on the Atlanta axial joint
flat and close to the horizontal plane 2 degrees of freedom: rotation and flexion/extension
63
what is the tectorial membrane
on the AA joint posterior to the transverse ligament basilar (base of skull) and posterior longitudinal ligament attachments
64
what are the alar ligaments
on AA joint tough fibrous cords 1 cm "check" ligaments run side of the dens to lateral foramen magnum
65
describe the intracervical apophyseal joints
facets of C2-C7 like singles on a roof at a 45 degree angle increased freedom of movement in all 3 planes
66
how much combined motion is present in the cervical region in the sagittal plane
120-130 degrees
67
how much extension is present in the cervical spine normally
80 degrees
68
how much flexion is found in the cervical spine normally
45-50 degrees of flexion 20-25% of total is at the OA/AA (upper cervical) the remainder is from C2-C7
69
resting angle of cervical region in flex/ext
resting is 30-35 degree flexion
70
where is the restraint from in the cervical spine throughout flexion
ligamentum nuchae interspinous ligamen
71
where are the compressive forces in flexion of the cervical spine
compressive forces on the anterior margin of AF
72
where are the restraints in the cervical spine during extension
from approximation apophyseal joints
73
where are the compressive forces in the cervical spine during extension
compressive forces on the posterior margin of the AF
74
how much flexion extension is present in the AA joint
15 degrees flex/ext tilt of the axis
75
how much overall motion is present in the facets
90-100 degrees of overall motion 55-60 degrees extension 35-40 degrees flexion average of 15 degrees for each segment
76
where is the greatest arthrokinematic motion in the cervical spine as well as the most common injury sights
greatest movement at C4-C6, also the sight for greatest spondylosis and hyper flexion injuries
77
what kind of motion is present in the horizontal plane at the AA joint
designed for rotation 35-40 degrees each direction
78
what kind of motion is present in the frontal plane of the cervical spine
35-40 degrees each side (most at C2-C7; 5 degrees at AO)
79
how does flexion affect the apophyseal joints and the intervertebral foramen
full flexion causes an "opening" of the apophyseal joint and an increased size of the intervertebral foramen this can provide greater passage of the spinal nerve roots
80
what is the normal curvature of the thoracic spine? How stable is this area?
normal = 40-45 degrees of kyphosis fairly stable (stabilized by ligaments)
81

DPT 702: Biomechanics (13 decks)

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