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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
Q

describe the osteology of C3-C6 vertebrae

A

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

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26
Q

how might nerves be “pinched” in the cervical spinal region

A

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

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27
Q

describe the other osteological features of C3-C6 (x7)

A

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

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28
Q

describe the spinous and transverse processes of C3-C6

A

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

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29
Q

describe the important characteristics of the atlas (C1) (x6)

A

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

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30
Q

describe important characteristics of the axis (C2) (x7)

A

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)

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31
Q

describe the unique characteristics of C7

A

largest cervical vertebrae

can have large transverse process and spinous process

can have a cervical rib (brachial plexus issue) off transverse process

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32
Q

key characteristics of T2-T7 (x10)

A

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

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33
Q

what are the atypical thoracic vertebrae

A

T1 = has a full costal facet (entire rib) and a Demi facet for rib 2; elongated SP

T10-12 = single full costal facet

34
Q

how is rib 1 atypical

A

shorter/wider than others

only 1 facet

superior surface marked by 2 grooves that make way for subclavian vessels

35
Q

how is rib 2 atypical

A

thinner/longer than rib 1

2 articular facets on head as normal

roughened area on upper surface where serratus anterior originates

36
Q

how is rib 10 atypical

A

only 1 facet for corresponding vertebra (T10)

*T9 does not have T10 rib reach up to it

37
Q

how are ribs 11 and 12 atypical

A

no neck

only contain one facet which is articulation for their corresponding vertebrae

38
Q

what are the 3 functional components of intervertebral joints

A

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
Q

describe the osteokinematics of intervertebral movement

A

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
Q

describe the arthrokinematics of intervertebral joints

A

most facets are flat

approximation (compression), seperation/gapping, gliding

41
Q

describe apophyseal joints

A

24 pairs total
plane joints
lined with articular cartilage
enclosed by synovial capsule (well innervated)
acts as mechanical barricade

42
Q

how do the orientation of facets influence kinematics

A

horizontally oriented favor axial rotation

vertically oriented block axial rotation

43
Q

describe the make up of an intervertebral disc

A

nucleus pulposus = pulplike gel mid to posterior aspect of disc; 70-90% water in youth

annulus fibrosis = outer ring

44
Q

describe the nucleus pulposus

A

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
Q

why is a disc negatively charged by nature

A

results from charged groups on glycominoglycan (GAG) molecules on the PGs found in the extracellular matrix of the disc

46
Q

describe the annulus fibrosis

A

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
Q

describe vertebral endplates

A

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
Q

what are some of the changes that take place along with the degeneration of a disc

A

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
Q

how is an IVD considered a “load sharing system”

A

biomechanics interaction between nucleus pulposa and annular rings

50
Q

what happens to the endplates with compressible loads

A

push endplates inward to NP

51
Q

describe how elastin and collahgen work to create a pressure distributer in Intervertebral discs

A

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
Q

how are intervertebral discs viscoelastic

A

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
Q

how does sustained, full lumbar extension affect discs

A

this reduces the pressure in discs and can allow water to be reabsorbed in the discs

54
Q

describe the daily fluctuations that take place in the discs

A

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
Q

what might give a dx of degenerative disc disease

A

loss of distinction of AF and NP with imaging

nuclear bulging

loss of disc space

not always symptomatic or loss of function

56
Q

changes in discs often proceed what condition

A

osteoarthritis

57
Q

what is spinal coupling

A

any movement of the spine in a plane is combined with an automatic and often imperceptible movement in another plane

58
Q

what are the reasons/explanations for why spinal coupling occurs

A

muscle action
facet alignment
posture
ribs
stiffness
curve of spine itself

59
Q

what can you/can’t you expect with spinal coupling patterns

A

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
Q

describe the movement of the Atlanta occipital joint

A

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
Q

median joint of Atlanto-axial joint motions/characteristics

A

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
Q

describe the pair of apophyseal joints on the Atlanta axial joint

A

flat and close to the horizontal plane

2 degrees of freedom: rotation and flexion/extension

63
Q

what is the tectorial membrane

A

on the AA joint

posterior to the transverse ligament

basilar (base of skull) and posterior longitudinal ligament attachments

64
Q

what are the alar ligaments

A

on AA joint

tough fibrous cords 1 cm “check” ligaments

run side of the dens to lateral foramen magnum

65
Q

describe the intracervical apophyseal joints

A

facets of C2-C7 like singles on a roof at a 45 degree angle

increased freedom of movement in all 3 planes

66
Q

how much combined motion is present in the cervical region in the sagittal plane

A

120-130 degrees

67
Q

how much extension is present in the cervical spine normally

A

80 degrees

68
Q

how much flexion is found in the cervical spine normally

A

45-50 degrees of flexion

20-25% of total is at the OA/AA (upper cervical)

the remainder is from C2-C7

69
Q

resting angle of cervical region in flex/ext

A

resting is 30-35 degree flexion

70
Q

where is the restraint from in the cervical spine throughout flexion

A

ligamentum nuchae

interspinous ligamen

71
Q

where are the compressive forces in flexion of the cervical spine

A

compressive forces on the anterior margin of AF

72
Q

where are the restraints in the cervical spine during extension

A

from approximation apophyseal joints

73
Q

where are the compressive forces in the cervical spine during extension

A

compressive forces on the posterior margin of the AF

74
Q

how much flexion extension is present in the AA joint

A

15 degrees flex/ext

tilt of the axis

75
Q

how much overall motion is present in the facets

A

90-100 degrees of overall motion

55-60 degrees extension

35-40 degrees flexion

average of 15 degrees for each segment

76
Q

where is the greatest arthrokinematic motion in the cervical spine as well as the most common injury sights

A

greatest movement at C4-C6, also the sight for greatest spondylosis and hyper flexion injuries

77
Q

what kind of motion is present in the horizontal plane at the AA joint

A

designed for rotation

35-40 degrees each direction

78
Q

what kind of motion is present in the frontal plane of the cervical spine

A

35-40 degrees each side (most at C2-C7; 5 degrees at AO)

79
Q

how does flexion affect the apophyseal joints and the intervertebral foramen

A

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
Q

what is the normal curvature of the thoracic spine? How stable is this area?

A

normal = 40-45 degrees of kyphosis

fairly stable (stabilized by ligaments)

81
Q
A

DPT 702: Biomechanics (13 decks)

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