Practical Exam - Ligaments Flashcards
Anterior Longitudinal Ligament
Bony Reference:
Description:
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A2:
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Anterior Longitudinal Ligament
Bony Reference: N/A
Description: 3 layers: Superficial (3 to 4 vertebrae - weakest), intermediate (2 or 3 vertebrae), deep (one body to next - strongest)
Belt like
Broader caudually, thinner cranially
A1: Front of Sacrum - Anterior surface of vertebral bodies, IVD, hyaline cartilage
A2: C2 (replaced by atlantooccipital membrane) - Anterior surface of vertebral bodies, IVD, hyaline cartilage
Fibres blend with subadjacent periosteum, perichondrium and peripher of the annulus fibrosis
Fibre Direction: Vertical (superior / inferior)
Stress: Taught in extension but can’t in reality stress it
Function: Resists extension, prevents anterior translation, force attenuation by transmitting force through the entire spine.
Relationships:
Continuous with anteromedial aspect of SIJ at the sacrum
Lateral borders of the ALL merge with attachment sites for Psoas - implication is a tight psoas can put stress on the anterior longitudinal ligament and thus the vertebrae. Vice versa if there is no movement or disfunction is present in the lumbar spine it can impact the psoas
Crura shares attachemnt - R. side L1-L3 L. side L1-L2. Every time you breath the crura is pulling on L1-L3
Posterior Longitudinal Ligament
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Posterior Longitudinal Ligament
Bony Reference: N/A
Description: Belt like
3 layers: superficial (3 to 4 vertebrae), intermediate (2 to 3 vertebrae), deep (extends to adjacent vertebrae)
Strongest attachments to outer layer of annulus fibrosis weakest attachments to vertebral bodies
A1: C1/C2 (replaced by membrane tectorium) - posterior surface of vertebral bodies, IVD, hyaline cartilage
A2: Sacrum - posterior surface of vertebral bodies, IVD, hyaline cartilage
Fibre Direction: vertical (superior / inferior)
Stress: Taut in flexion
Function: resist posterior translation, flexion
Relationships:
Affected by anything in the vertebral canal such as meningitis or disc herniation
Attachment for the dura
Ligamentum Flavum:
Bony Reference:
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A2:
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Ligamentum Flavum
Bony Reference: N/A
Description: Made up of 80% elastin (yellow - unique to this ligament)
Short
A1: Inferior aspect of one lamina (inside vertebral canal posterior to spinal cord)
A2: Superior aspect of another (inside vertebral canal posterior to spinal cord)
Fibre Direction: Vertical (perpendicular fibres)
Stress: Flexion
Function: restrics flexion and lends rebound tension to go back into extension
Force attenuation - transmitted between supraspinous, interspinous as well as up and down the spine
Helps to protect the contents of the vertebral foramen by helping to form the roof over top
Relationships:
Lateral fibres attach to facet joint capsule
Medial fibres fuse with interspinous ligament
If buckes as it comes into neutral or extension it could push into the vertebral foramen and you could be in trouble - it merges with the interspinous ligament which pulls it back out disallowing it to buckle
Forms roof of the vertebral canal
With age calcification occurs, decreasing elasticity and leading to spinal stenosis
Supraspinous Ligament
Bony reference:
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Supraspinous Ligament
Bony Reference: SP
Description: Superficial fibres (3 to 4 segments), intemediate (2 to 3), deep (segment to segment)
A1: C7 (replaced by ligamentum nuchae) - Spinous process
A2: Sacrum (may cease at L5) - Spinous process
Fibre Direction: Vertical (superior / inferior)
Stress: Flexion
Function: Resist flexion
Relationships:
Most superficial ligament in the spine
Thicker in L-spine
Binds to the interspinous ligament
Blends with neighbouring fascia - thus act as force transducer - transmitting force develpoed in the extremities and torso into the lumbar vertebral column
Area for muscle, fascia and aponerutoic attachment
Interspinous Ligament
Bony Reference:
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Interspinous Ligament
Bony Reference: SP
Description: Thin almost membranous
A1: Root of one spine
A2: Apex of another spine
Fibre Direction: Vertical - fan shaped allowing the ligament to expand without rupture
Stress: Flexion
Function: Resist flexion, force dispersal
Relationships:
Meet ligamentum flavum anteriorly
Meet supraspinous ligament posteriorly
- Thus dispersed force between the two
- The fibres run mostly anterior posterior to act as an anchor, transmitting the AP pull of the TLF, into which is attached the supraspinous ligament and ligamentum flavum, not allowing the later to buckle
Intertransverse Ligament
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Intertransverse Ligament
Bony Reference: TP
Description: C-Spine = few irregular fibres
T-Spine = Blended with surrounding muscles
L-Spine = thin and membranous
A1: Superior part of one TP
A2: Inferior part of another TP
Fibre Direction: Vertical
Stress: Side bending
Function: Prevents side bending a rotation (a little)
Relationships:
Replaced with intertransverse muscle in the c-spine
Superior Pubic Ligament
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Superior Pubic Ligament
Bony reference: Pubic Disc to Pubic tubercles
Description: Thin flat band
A1: Pubic Tubercle, Crest
A2: Pubic Tubercle, Crest, Superior aspect of disc
Fibre Direction: Transverse
Stress: Gap anterior pelvis
Function: Stabilize pubic symphasis
Relationships: Blends with disc
Arcuate Pubic Ligament
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Arcuate Pubic Ligament
Bony Reference: N/A
Description:
A1: Inferior Pubic Rami, Interpubic Disc
A2: Inferior Pubic Rami
Fibre Direction: Lateral
Stress: Gap pubic symphasis
Function: Stabilize inferior aspect of pubic symphasis
Relationships: Blends with disc
Interosseus SI Ligament
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Interosseus SI Ligament
Bony Reference: Iliac Crest to L4 to S2 to PSIS fall medial into sacral sulcus
Description: Short, strong fibres
A1: Posterior to Sacral Auricular Surface
A2: Iliac Tuberosity
Fibre Direction: Transverse
Stress: Gap posterior in either side lying or supine position *Pain provocation only
Function: Forms cheif bond of SI joint
Relationships:
Covered superficially by Dorsal SI Ligament
Dorsal SI Ligament
Bony reference:
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Dorsal SI Ligament
Bony Reference: Iliac crest to L4 to S1-S4 move to crests
Description: Long and short fibres
A1: Short Dorsal: Intermediate, Lateral Sacral Crests at S1 & S2
Long Dorsal: Intermediate, Lateral Sacral Crests at S3 & S4
A2: PSIS, Internal Lip of Iliac Crest
Fibre Direction: Short = Transverse Long = Oblique
Stress: Push medially on ASIS (Gap posterior SI) *Pain Provocation only
Function: Stability of SI
Relationships:
Lies posterior to interosseus SI ligament
Continuous laterally with the sacrotuberous ligament (Long Dorsal SI fibres)
Anterior SI Ligament
Bony reference:
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Anterior SI Ligament
Bony reference: N/A
Description: Numerous thin bands
A1: Auricular surface of the sacrum
A2: Auricular surface of the ilium
Fibre Direction: Transverse
Stress: Push out on ASIS’s (splay anteriorly)
*Pain provocation test only
Function: Strengthens anterior portion of the capsule
Relationships: Anterior to interosseus SI
Iliolumbar Ligament
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Iliolumbar Ligament
Bony reference: Iliac crest to L4/L5 SP and then move lateral to TP
Description: 5 bands, Strong
A1: Iliac Crest
A2: TP of L5 (L4 too depending on author)
5 Bands
Anterior:
Anterior inferior border TP of L5 & Medial body of L5
Iliac Crest
Posterior:
Tip of posterior border TP of L5
Ilium behind QL
Superior:
Anterior Superior border TP of L5
Anterior/Posterior QL fascia
Inferior:
Inferior border TP of L5
Anterior aspect of Anterior SI Ligament
Vertical:
Anterior/Inferior border TP of L5
Iliopectineal Line
Fibre Direction: 5 directions as above
Stress: Side Bending
patients lies on side, therapist landmarks L5, slide in to the base of the SP and push vertebrae down toward table while stabilizing the innominate with the free hand
Function:
Prevents forward slippage of L5
Limits twisting, forward, back and lateral bending of L5
Stabilizes the vertebrae (L4-L5) on the innominate bone
Relationships:
blend superiorly with the intertransverse ligaments of the lumbar vertebrae and inferiorly with the anterior and posterior aspects of the SIJ capsule
The taut bands of the iliolumbar ligament form hoods over the L4 and L5 nerve roots. These hoods are capable of compressing the associated nerve roots
fibres of the iliolumbar ligament merge with fibres of the QL
Sacrospinous Ligament
Bony Reference:
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Sacrospinous Ligament
Bony reference: Lower lateral aspect of sacrum and coccyx (not palpable but can get close)
PSIS & Ichial tuberosity, break into thirds and lower hand is ischial spine
Description: Thin traingular ligament with a broad base
A1: Lateral margin lower sacrum and coccyx
A2: Ischial Spine
Fibre Direction: Lateral
Stress: Hand on sacrum and push lower end anteriorly (*Not in notes)
Function: Converts GSN and LSN into foramen
Limit anterior rotation of the sacrum
Relationships:
Blends with sacrotuberous ligament (lies anterior to it) and SIJ capsule
Sacrotuberous Ligament
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Sacrotuberous Ligament
Bony Reference: PSIS, Ischial Tuberosity, landmark PIIS using thirds and palpate sacrum
Description: Flat, Y-shaped (Fans out from its base)
A1: PSIS, PIIS, lower 1/2 of the dorsal surface of sacrum, lower ½ of lateral sacral crest, lateral margin of coccyx
A2: Medial margin of Ischial Tuberosity
Fibre Direction: Inferior and Lateral
Stress: Hand on sacrum and push lower end anteriorly
Function: Resists rotation of the sacrum
Relationships:
Blends superiorly with the Dorsal SI ligament and posterior lamina of the thoracolumbar fascia
Blends inferiorly with Bicep Femoris via same attachment site (Ischial Tuberosity)
Posterior surface merges with lowest fibres of Glute Max
Pierced by inferior gluteal artery and perforating cutaneous nerve
Costovertebral Radiate Ligament
Bony reference:
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Costovertebral Radiate Ligament
Bony reference: N/A
Description: Superior, inferior and intermediate fibres
A1: Anterior parts of each costal head
A2: Bodies of 2 vertebrae and the IVD between them
Superior fibres to body above
Inferior fibres to body below
Intermediate fibres to disc
Fibre Direction: Radiate
Stress: Push down on costal *Not in notes
Function: Stabilize costal head on to the vertebrae *Not in notes
Relationships: Blends with IVD and bodies
Surrounds the Intra-Articular Ligament (Superficial to it)
