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Anatomy II Fall 2023 > Lumbopelvic region > Flashcards

Lumbopelvic region Flashcards

1
Q

What are the primary and secondary curvatures of the spine?

A

Primary: Kyphosis (thoracic & sacral)

Secondary: Lordosis (cervical & lumbar)

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2
Q

What is the lumbosacral angle?

A

130-160 degrees

the junction b/w the lumbar and sacral regions of the spine
- changes with increased/decreased lordosis or pelvic tilt

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3
Q

What are vertebral Endplates?

A

discs of hyaline cartilage that are remnants of the cartilaginous model from where the bone develops

touches the intervertebral discs and it is where they attach to

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4
Q

Which parts of the vertebra make up the vertebral arch?

A

2 pedicle
2 lamina
spinous process
vertebral body
superior/inferior facets

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5
Q

Describe the cervical vertebrae compared to the thoracic and lumbar

A

smallest bodies
largest canals
transverse foramen
bifid processes
facets slope upward toward nose

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6
Q

Describe the thoracic vertebrae compared to the cervical and lumbar

A

slightly larger bodies
long sloping spinous processes
costal facets
articular facets face anterior/posterior (frontal plane)

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7
Q

Describe the lumbar vertebrae compared to the cervical and lumbar

A

largest bodies
vertebral canal slightly larger than thoracic
transverse processes are largest
articular facets are located in sagittal plane (for flex/ext)
well innervated capsules around facet joints

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8
Q

What are some of the unique features of the intervertebral discs?

A

Anulus fibrosus:
- outer layer of the disc
- outer 1/3rd is innervated/vascularized
- less numerous layers posteriorly
- diagonal layers that resist rotational forces

Nucleus pulposus:
- gelatinous core
- sits more posteriorly in the disc
- avascular/aneural
- gets nutrition via diffusion

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9
Q

What are some structures that help hold the L5 vertebra on the S1 vertebra?
(prevent from slipping forward)

A
  • Iliolumbar ligament
  • L5/S1 facet joints (oriented b/w sagittal & frontal planes)
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10
Q

Define the Anterior Longitudinal Ligament (ALL)

A
  • runs along anterior portion of the vertebral column
  • only one that resists extension
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11
Q

Define the posterior longitudinal ligament (PLL)

A
  • runs along the posterior side of vertebral column
  • resists flexion & posterior disc bulge
  • narrows as it travels down the vertebral column
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12
Q

Define the ligamentum flavum

A
  • yellow
  • runs from lamina to lamina
  • helps w/ return from flexion motions
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13
Q

Define the supraspinous ligament

A
  • runs over the tips of each spinous process (to C6)
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14
Q

Define the interspinous ligament

A
  • runs b/w spinous processes
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15
Q

Define the intertransverse ligament

A
  • runs t/w transverse processes
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16
Q

What are the layers of the Thoracolumbar Fascia?

A

Anterior TLF: in front of the QL and behind Psoas
Middle TLF: b/w QL & erector spinae
Posterior TLF: covers posterior erector spinae

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17
Q

What muscles does the Thoracolumbar fascia house?

A
  • Quadratus lumborum
  • transversospinalis group
  • erector spinae group
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18
Q

Which muscles contribute to lumbar stabilization?

A

-Psoas major/minor
- Quadratus Lumborum
- internal oblique & transverse abdominis

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19
Q

Name the extrinsic muscles of the back

A

Superficial
- trapezius
- latissimus dorsi
- levator scapula
- Rhomboids

Intermediate
- Serratus posterior superior/inferior

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20
Q

Name the intrinsic muscles of the back

A

Superficial
- splenius cervicis
- splenius capitis

Intermediate
- Erector spinae group

Deep
- Transversospinalis group

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21
Q

Name the muscles in the Erector spinae group

A

Most lateral
- Iliocostalis lumborum
- iliocostalis thoracis
- iliocostalis cervicis

Next medial
- Longissimus thoracis
- longissimus cervicis
- longissimus capitis (inserts @ mastoid process)

Most medial
- spinalis thoracis
- spinalis cervicis
- spinalis capitis

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22
Q

Name the muscles in the transversospinalis group

A

Posterior to multifidus
- semispinalis thoracis
- semispinalis cervicis
- semispinalis capitis

Multifidus

Anterior to multifidus
- Rotatores

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23
Q

What are the erector spinae muscles a part of and where do they attach to?

A
  • common broad tendon at the iliac crest, sacrum, SI ligaments, & lumbar/sacral spinous processes
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24
Q

Which muscles would be active for flexion of the trunk? (returning from an extended position)

A
  • rectus abdominis
  • psoas major
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25
Which muscles would be active for extension of the trunk? (returning from a flexed position)
- erector spinae group - multifidus - semispinalis
26
Which muscles would be active for side bending of the trunk? (returning from a side bent position)
- abdominal obliques - quadratus lumborum
27
What muscles would be active for rotation of the trunk?
- external oblique (contralateral) & transversospinalis muscles - internal oblique (ipsilateral) & erector spinae muscles
28
What do the outside recurrent meningeal nerves innervate?
- anterolateral vertebral bodies & discs - periosteum - ALL
29
What do the inside recurrent meningeal nerves innervate?
- periosteum (mainly posterior vertebral bodies, pedicles, laminae) - ligamentum flavum - posterior anulus - PLL - dura mater - blood vessels
30
Where does the spinal cord end?
L1 or L2 - depends on individual
31
What is a spinal cord segment?
- a portion of the cord that gives rise to a bilateral pair of spinal nerves - named from where they arise from
32
How do nerve roots get out of the vertebral canal after the spinal cord ends?
- exit b/w the vertebrae much lower than the actual spinal cord segment - spinal cord ends at the conus medullaris then splits into its own segments known as the cauda equina
33
Explain the relationship between a lumbar disc bulge and which spinal nerve root is affected
- compression of the nerve root affects the root below the level of the disc bulge - EX: L4 bulging disc but compresses the L5 nerve root
34
Name the nerves in the lumbar plexus
- Subcostal (T12) - Iliohypogastric (L1) - Ilioinguinal (L1) - Genitofemoral (G: L1; F: L2) - Lateral Femoral Cutaneous (L2-L3) - Femoral (L2-L4) - Obturator (L2-L4)
35
Name the nerves in the sacral plexus
- Sciatic (L4-S3) - Superior gluteal (L4-S1) - Inferior gluteal (L5-S2) - Nerve to piriformis (S1-S2) - Nerve to obturator internus (L5-S2) - Nerve to quadratus femoris (L4-L5) - Nerve to levator ani (S4) - Posterior femoral cutaneous (S1-S3) - Pudendal (S2-S4)
36
What does the subcostal nerve innervate?
- anterolateral wall
37
What does the iliohypogastric nerve innervate?
- abdominal muscles - sensory to skin of iliac crest, upper inguinal, and hypogastric region
38
What does the ilioinguinal nerve innervate?
- skin of lower inguinal region - skin to adjacent medial thigh
39
What does the genitofemoral nerve innervate?
- groin region - anterior thigh
40
What does the lateral femoral cutaneous nerve innervate?
- sensation to lateral thigh
41
What does the femoral nerve innervate?
- motor to quads in anterior thigh
42
What does the obturator nerve innervate?
- hip adductor muscles - pectineus
43
What two nerves make up the sciatic nerve?
- tibial nerve - common fibular nerve
44
What does the superior gluteal nerve innervate?
- motor to gluteus medius, gluteus minimus, and tensor fasciae latae
45
What does the inferior gluteal nerve innervate?
- motor to gluteus maximus
46
What does the nerve to piriformis innervate?
- piriformis
47
What does the nerve to obturator internus innervate?
- obturator internus - superior gemellus
48
What does the nerve to quadratus femoris innervate?
- quadratus femoris - inferior gemellus
49
What does the nerve to levator ani innervate?
- muscles of the levator ani
50
What does the posterior femoral cutaneous nerve innervate?
- sensory to uppermost medial and posterior surface of thigh
51
What does the pudendal nerve innervate?
- sensory to perineal & external genitalia
52
What is Meralgia Paresthetica
- impingement of the lateral femoral cutaneous nerve that causes loss of sensation/paresthesia to lateral thigh
53
Describe the arterial blood supply to the lumbar vertebrae
Lumbar arteries -> anterior, posterior, spinal branches anterior branches -> to vertebral arteries posterior branches -> vertebral arches spinal branches-> 1) radicular arteries to posterior spinal nerves 2) segmental medullary arteries to anterior roots of spinal nerves
54
Describe the arterial blood supply to the spinal cord
Superior vertebral arteries -> anterior & posterior spinal arteries 1) anterior spinal arteries -> sulcal arteries run off this into spinal cord (supplies 2/3rd of the spinal cord) 2) posterior spinal arteries Lumbosacral lumbar arteries -> spinal branches -> radicular & segmental medullary arteries
55
What is spondylolisthesis & how does it happen?
- a fracture of the "Pars interarticularis" b/w superior & inferior facets results in the sliding forward of a vertebra onto another one - usually because of lordosis - these facets allow flexion and extension so it is hard for them to stop this movement from happening - can compress spinal cord or cauda equina
56
What are some of the effects of aging on lumbar vertebrae and discs?
- growth stops b/w 18-25yrs old - decreased bone density & strength - vertebral end plates bow inward - osteophytes around vertebral body & zygaphophyseal joints - "spondylosis" = disease process of degeneration (normal)
57
Describe the different types of stenosis in the vertebral column
Spinal: narrowing of the vertebral column - "central stenosis" - spinal cord compression from bony overgrowth, bulging discs, buckling longitudinal ligament Foraminal: narrowing of intervertebral foramen - nerve root compression from bony overgrowth, osteophytes, posterolateral disc bulges
58
What is a disc bulge and how does it occur?
- habitual actions cause the disc to protrude outward (usually posteriorly) - due to reduced lumbar lordosis & forces nucleus of disc further posterior - usually posterior laterally b/c PLL narrows as it descends the spinal cord allowing for posterior disc bulging to occur - tearing of anulus cause herniation of nucleus (L4/5 & L5/S1)
59
Describe a laminectomy
- removal of vertebral arches at laminae - can be unilateral or bilateral Reason: to alleviate pressure on neural tissue from tumors, HNP, bony hypertrophy - PT is important after surgery to prevent scar tissue from adhering to neural tissue
60
Describe a lumbar fusion
- two or more vertebrae are fused together - arthrodesis: bone graft from pelvis or bone bank creates bridge b/w adjacent vertebrae - medal rods are used to fixate vertebrae until bone grows - no movement at site of fusion (so movement has to come from somewhere else)
61
What is a strain?
- stretching/microscopic tearing of muscle fibers Cause: overly contracting or forceful stretching (erector spinae group vulnerable)
62
What is a sprain?
- injury to ligament or ligament attachment - no dislocation Cause: excessive contractions or movements
63
What is a spasm?
- sudden involuntary contraction of muscle/group of muscles - protective mechanism after an injury/inflammation EX: cramps, pain, involuntary movement
64
What are the fibroskeletal structures of the spine that would contribute to low back pain if injured?
- periosteum (fracture) - ligaments (dislocation) - anulus/PLL (Herniated nucleus pulposus [HNP]) - localized pain
65
What are the categories of innervated structures of the spine that can contribute to low back pain?
- fibroskeletal - meninges - synovial joints - muscles - nervous tissue
66
What causes synovial joint pain in the spine that could contribute to low back pain?
- localized pain - aging - disease - degeneration
67
What causes of muscle pain in the spine that could contribute to low back pain?
- localized pain - spasms (from ischemia)
68
What causes nervous tissue pain in the spine that could contribute to low back pain?
- radicular pain ( in a dermatomal distribution)
69
What is spinal bifida?
- neural arches fail to develop normally & fuse posteriorly
70
What is spinal bifida occulta?
- hidden - minor form - dimple w/ tuft of hair - concealed by skin
71
What is spinal bifida cystica?
- severe: one or more vertebral aches fail to develop - meningocele = herniation of meninges - meningomyelocele = herniation of meninges & spinal cord - symptoms: LE paralysis, bowel dysfunction
72
What deficits would you see with a spinal cord injury at the L2-3 level?
- some quad function - NO lower leg function
73
What deficits would you see with a spinal cord injury at the T10-L1 level?
- some hip function - NO quads or lower leg function
74
What deficits would you see with a spinal cord injury at the T1-9 level?
- paraplegia - NO leg function - some trunk function lost depending upon thoracic level
75
What deficits would you see with a spinal cord injury at the C6-8 level?
- NO hand function - some arm function - still have shoulder function
76
What deficits would you see with a spinal cord injury at the C4-5 level?
- quadriplegia - still have partial diaphragm from C3 root
77
What deficits would you see with a spinal cord injury at the C1-3 level?
- no function below head level - no diaphragm - need ventilator
78
What is an Innominate?
- half of the pelvis - the group of bones that make up the pelvic girdle (illium, pubis, ishium)
79
Why is the SI joint so stable?
- there is an auricular surface that has roughed edges that fit together like puzzle pieces - along with ligaments that are attached to hold the SI joint together
80
Describe the arterial supply to the pelvis
abdominal aorta -> common iliac arteries -> Internal & external iliac arteries 1) internal iliac -> anterior & posterior division A) anterior division -> obturator, visceral, inferior gluteal arteries B) posterior division -> iliolumbar, superior gluteal arteries 2) external iliac -> circumflex iliac, inferior epigastric, pubic branch *exits under inguinal ligament then turns into femoral artery
81
What happens to the SI joint & ligaments during late pregnancy?
- "relaxin" hormone is released & allows ligaments to relax/lengthen At the SI joint: -causes lack of interlocking mechanism -rotation of pelvis -increased lumbar lordosis - all can lead to pain and dysfunction
82
What is sciatica and why does it occur?
- usually pain along posterior thigh and leg (tension of nerve worsens symptoms Causes: - impingement of sciatic nerve roots at spinal level (bulging discs, foraminal stenosis, spondylosis - impingement of sciatic nerves elsewhere (piriformis, entrapment along its course through the pelvis/thigh)
83
What are weak areas in the pelvis?
- pubic rami - acetabula - SI joint region - alae of Ilium

Anatomy II Fall 2023 (11 decks)

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